UCSF Fresno Graduates to Care for Patients and Teach Future Physicians
2021 Emergency Medicine Graduates
By Brandy Ramos Nikaido
One hundred medical residents and fellows along with four oral and maxillofacial surgery dental residents and five physician assistants completed training at UCSF Fresno this year for a total of 109 graduates. Due to the COVID-19 pandemic, UCSF Fresno celebrated the occasion for the second year in a row with a virtual commencement on June 10. Many of the graduates are staying in the Central Valley to care for patients, teach future physicians or continue their medical education.
A regional campus of the UCSF School of Medicine, UCSF Fresno is the largest academic physician-training program between San Francisco and Sacramento in the north and Los Angeles to the south. Faculty at UCSF Fresno along with residents and fellows provide care to thousands of patients each year. UCSF Fresno was established in 1975 to address the severe shortage of physicians in California’s San Joaquin Valley.
“Under the leadership of our faculty, trainees pivoted and persevered during the height of the COVID-19 pandemic and subsequent surge,” said Michael W. Peterson, MD, associate dean at UCSF Fresno. “They continued their critical work in learning environments, at bedsides and in the community, while addressing the renewed movement for social justice that calls on each of us to recognize, reject and break down systemic barriers and racism. We are pleased to have helped them fine tune their skills. We are incredibly proud of the health professionals they are today and particularly delighted that so many are staying in the Central Valley.”
Graduates from Community Medical Centers’ General Dentistry Residency program also were recognized during the 2021 commencement program.
UCSF Fresno 2021 Graduation Highlights:
- 60% of residents and fellows completing training in the Department of Emergency Medicine are staying in the Central Valley to provide care.
- 47% of residents and fellows completing training in the Department of Family and Community Medicine are staying in the region to provide much needed primary care
- 50% of Internal Medicine residents are staying in the Valley
- Both fellows in the Infectious Diseases Program are staying in Fresno as faculty at UCSF Fresno to train physicians and provide desperately needed expertise in the community to address COVID-19 and other infectious diseases
- 46% of residents completing training in the Department of Pediatrics are staying in the region
- 25% of residents completing Psychiatry training are staying in the Valley and 75% are staying in California or 1 out of 4 graduating Psychiatry residents is staying in the Valley and 3 are staying in California
- 40% of all UCSF Fresno 2021 graduates are staying in the Central Valley
- 75% of all graduates are staying in California to provide care, teach or continue their education.
The 2021 graduating class includes:
Hebah Ghanem, MD, completed a two-year fellowship in Infectious Diseases (ID) at UCSF Fresno. Fellowships are advanced training in a sub-specialty after residency. After graduation, Dr. Ghanem is staying in Fresno as faculty at UCSF Fresno to provide care and teach residents and fellows. Her co-fellow in the Infectious Diseases program also is staying in Fresno, where the medical expertise is desperately needed.
Dr. Ghanem, who is Jordanian, was born in Kuwait and lived in various countries. After the Gulf War, she moved to Jordan where she went to medical school, completed residency training and became board certified in Dermatology. She and her husband moved to the United States in 2013 for her husband to finish his nurse practitioner degree. They moved to Orange County in California to be near family. At that time, she decided to shift her focus from Dermatology to Internal Medicine.
Even though she had scored the highest rank, earning her a spot in Dermatology, which was considered the most prestigious specialty in her country, coming to the U.S. as a foreign graduate was challenging. “My four years of experience was not considered. It was hard for me to stay in medicine.”
As the wife of a student, her visa did not allow her to work. She stayed home for two years and wondered during that time whether she should stay in medicine. “I think I wanted to be a role model for my daughters,” she said. “I watched Gray’s Anatomy and would cry. Friends wrote in my yearbook that I was going to be at WHO (World Health Organization) one day. That was my lowest point, and I didn’t want my daughters to feel like it’s OK to quit.”
When her husband finished his nursing program, it was time to decide whether to go back to Jordan or stay in the U.S. They decided to stay and applied for Permanent Resident Cards. Meanwhile, Dr. Ghanem applied to Internal Medicine residency training programs and matched with Trinitas in New Jersey. Following residency, her plan was to go back to Orange County, but an interview at UCSF Fresno would change her course.
“I like the people at UCSF Fresno the best. The staff are very friendly and make me feel at home,” she said. “My co-fellow, Dr. Michele Maison-Fomotar, it felt like we knew each other for a long time. Dr. Naiel Nassar, our program director, we can go to him with any concerns. And Lorna Tahan (program coordinator), emailing her was one reason I chose this program. She was so friendly, so great. When I came here for the interview, I felt like ‘yes, I want to be here’ from day one when I did my interview.”
Dr. Ghanem looks forward to joining the faculty at UCSF Fresno, teaching and being an Infectious Diseases attending physician and expanding the program. Infectious Diseases is an important sub-specialty in Fresno, especially with valley fever, sexually transmitted illness rates that are high, and with COVID-19, she said. “It’s been very important to have the ID expertise here.”
When not working, Dr. Ghanem spends time with family, taking her three kids to gymnastics, swimming and horse riding. After graduation, she is going back to Jordan to see her parents. It’s been three years.
Her advice for new interns coming to UCSF Fresno in late June is to like what you do, love what you do, and you will feel connected. “Even at moments when you feel down, you have this inside you and that will make you feel right again. I think anyone who loves what they do, they can do it, too. I’m proud of myself.”
Fresno native Walid Hamud-Ahmed, MD, completed a four-year emergency medicine residency program at UCSF Fresno, fulfilling a childhood dream.
“As a kid, my dad was a big influence in my life and he would always joke, ‘My son, when I get old and sick, I need you to be my doctor and take care of me,’” said Dr. Hamud-Ahmed. “It really stuck with me.”
Sadly, his father died tragically in a car accident when Hamud-Ahmed was 11. His mom Nor was left to raise six boys alone, including Dr. Hamud-Ahmed, who was third oldest. “No one gets anywhere in life alone,” Dr. Hamud-Ahmed said. “There were definitely moments where things were brought into question, ‘like is school the most important thing?’”
His family ran a small grocery store in Fresno County that served many migrant farmworkers. They sold food and cashed checks. Ghasan, Dr. Hamud-Ahmed’s brother, the oldest of the six boys, stepped up to run the family business. Ghasan was just 19 years old at the time. “At certain points in my teenage years, I saw my brother struggling and it made me feel guilty because I was able to go to school and he wasn’t. I know he could see a brighter future ahead of me and his support was what changed the world for me. Certainly, without him, I would not be where I am today.” A graduate of Central East High School, Dr. Hamud-Ahmed graduated from Fresno State as part of the Smittcamp Family Honors Program.
Attracted by its Program in Medical Education for the Urban Underserved (PRIME-US), Dr. Hamud-Ahmed was admitted to the UCSF School of Medicine. PRIME-US is designed to nurture, support and equip medical students to effectively promote health equity and provide health care to urban underserved communities.
While at UCSF, Hamud-Ahmed was involved in a violence prevention program that studied people who were injured from gun violence and ways to prevent further injury. With the American Association of Yemeni Students and Professionals, he also worked with students from Yemen, first-generation Yemeni boys and girls who didn’t get the encouragement to go to college due to cultural pressures. He hopes to continue these efforts in the Central Valley following residency. “Residency is so busy; it will be nice to have some free time to give back again.”
“A lot of us went into medicine to give back to those most in need. Medicine alone will not fix societies. We need to address issues in education, financial health and literacy, safe neighborhoods, pipeline programs– all very much are tied to your health and wellbeing. I saw firsthand how your ZIP code can affect your health and safety. These are things that will take grassroots efforts to change. I always had that kind of outlook in life.”
At UCSF Fresno, he loves the faculty, residents, and patients. “Our patients are some of the most generous and grateful patients that you can take care of. The need is so great. They really do appreciate our care and our service. The gratitude they share is unlike anything I’ve experienced at other hospitals, and I’ve worked in many.”
Dr. Hamud-Ahmed is grateful to the people who encouraged him to become a physician, including Kenny Banh, MD, emergency medicine physician and assistant dean for Undergraduate Medical Education at UCSF Fresno. He met Dr. Banh when Hamud-Ahmed was a premedical student. Part of the UCSF Fresno Academic Research Associates Program while at Fresno State, Dr. Hamud-Ahmed calls himself a product of UCSF Fresno pathway programs.
He is most proud of being a husband to wife Haleema and father to Ismael and Noora. “They changed my life for the better and gave me perspective on what really is important. I’m proud of them and lucky to have them in my life.”
After graduation, Dr. Hamud-Ahmed will work in the Emergency Department at Clovis Community Medical Center and will stay at UCSF Fresno as part-time faculty.
“I don’t want to stop being a resident in a way. I want to continue learning. I want to stay on the cutting-edge,” he said. “I’m very grateful for UCSF Fresno, for the support and encouragement, and my family, especially my mom Nor and my brother Ghasan.”
Leslie Littlefield, MD, completed a three-year fellowship in Pulmonary and Critical Care (PCC), a division within the UCSF Fresno Department of Internal Medicine. Fellowships are advanced training in a sub-specialty following residency. PCC fellows receive extensive training in pulmonary medicine with dedicated faculty in all subspecialties in pulmonary medicine such as cystic fibrosis, pulmonary hypertension, interstitial lung disease, asthma/COPD, lung infection, lung cancer, interventional pulmonary and general pulmonary medicine.
Dr. Littlefield, a self-described first-generation Mexican American, grew up all over California, moving with her mother about 20 times before she was 16 to escape an abusive background. They settled in Orangevale near Sacramento, where she graduated from Casa Roble High School at age 16 and became a certified nurse’s aide. With the goal of becoming a doctor, she became a licensed vocational nurse and took courses at nearby community colleges – wherever she could find classes that fit her schedule. When a chance came up to go to medical school in Mexico, she seized the opportunity.
“It was another world,” she said. “Speaking Spanish at home was different than being fluent and speaking with (medical school) peers.” Six years later, she graduated at the top of her class and completed the customary internship year as well as a year of community service in Mexico.
There were times when she thought about giving up. Pit bulls attacked her beloved Chihuahua. Her husband could not find a job. Her car was stolen, and family belongings were stolen back in the United States.
A tale she heard in Mexico kept her going. It was a story of two frogs stuck in a bucket of cream. Unable to get out, one frog gives up. The other, determined to survive, keeps going, keeps churning away. The cream begins to solidify and eventually turns to butter, and the frog climbs out of the bucket.
Dr. Littlefield returned to the U.S. and completed residency training in Internal Medicine at Alameda Health System in Oakland. There, she developed an interest and passion for Pulmonary and Critical Care. She did an elective at UCSF Fresno and fell in love.
“I love the people, the culture, the patients, everyone is humble here,” she said. “There is high acuity seen here that you don’t see anywhere else and my program prides itself on teaching autonomy and critical decision making.
The Pulmonary and Critical Care Division was on the front lines during the height of the COVID-19 pandemic and the subsequent surge in 2020.
“COVID gave a whole new meaning to intensive care,” she said. “We worked around the clock, 24 hours a day in shifts. There were so many unknowns brought on by COVID. You don’t know if you’re going to get infected, but you have a moral responsibility to do right by the patients.”
Looking back as training ends, Dr. Littlefield said, “I am proud that I got here. I could have stopped many, many times but didn’t. I think about the underprivileged part, coming from a background like that could have led me down a very different path.
“I would like to tell every impoverished person from every ethnicity, if I can do it, if one person can do it. They can all do it. Never give up. Whatever your dreams are – go for it.”
Oh, and thank you, mommy, she added, grinning widely.
After graduation, she looks forward to spending time with her family in Sacramento, paying off some student loans and finding work-life balance that may include belly dancing, which she enjoyed so much in her life before residency and fellowship training.
Michele Meime Maison-Fomotar, MD, completed a two-year fellowship in Infectious Diseases (ID) at UCSF Fresno and will stay as Internal Medicine faculty.
Dr. Maison-Fomotar completed a three-year residency in Internal Medicine at UCSF Fresno before continuing as an Infectious Diseases Fellow. “I am happy to have been a part of the UCSF Fresno family since 2016, and I look forward to staying on as ID faculty,” she said. “I hope I can inspire people to love ID as I do.”
Dr. Maison-Fomotar grew up in Cameroon, Africa, where she went straight to medical school from high school for a seven-year program at the Faculte de Medecine et des Sciences Biomedicales Universite de Yaoundé. Her biggest challenge, as an immigrant, was getting into residency and “learning how to adapt in a new educational system here in the United States, especially since I learned medicine mostly in French,” she said. But at UCSF Fresno, she felt a sense of belonging to a large family, and the best part of her training experience has been the collegiality of her co-residents, fellows and faculty, she said.
She drew inspiration to become a physician from the strong women in her life. Her godmother was a midwife. One of her close family friends is a physician and her older sister is a physician. Watching her mother struggle with diabetes inspired her to become an internist, she said. She also found Internal Medicine fascinating. “The complexity of dealing with the adult patient has always called to me. As a physician in Cameroon, I worked mostly with adult patients, especially patients with HIV, tuberculosis, and malaria.
Dr, Maison-Fomotar and her co-fellow in the Infectious Diseases program are staying in Fresno, where medical expertise is desperately needed for valley fever, increasing rates of sexually transmitted diseases and for COVID-19.
“I have always wanted to do Infectious Diseases, especially after my experiences in Cameroon.” The pathology she has seen in Fresno is unparalleled as well, she said.
“And I have a healthy respect for microorganisms and the havoc they can wreak. The world of ID continues to enlighten, challenge and fascinate me daily.”
COVID-19 was a new experience, she said. “I don’t think many of us were prepared for the magnitude this pandemic would take and it was daunting to be in the middle of it. However, it highlighted the resilience and solidarity we can have in the face of adversity, opened us to new ways of working, exciting new research and vaccines, and has forever changed the way we learn, work, and relate with others.”
Her advice for incoming interns arriving at the end of June? “Enjoy the ride! It will be challenging but these years are the ones where you will learn the most.”
In her spare time, Dr. Maison-Fomotar enjoys cooking, traveling, dancing, playing the piano, event planning and décor – and just spending time with family. Her plans after graduation include taking a vacation before she joins the Infectious Diseases team at UCSF Fresno. “I am so excited!”
Eric Rabey, DDS, grew up in Fresno. He graduated from Clovis West High School, UC Irvine and the USC School of Dentistry. He also completed a two-year General Dental Practice Residency Program (GPR) at Community Regional Medical Center and recently completed a four-year residency in Oral and Maxillofacial Surgery (OMFS) at UCSF Fresno.
In dental school, he planned on practicing Orthodontics but as time went by, Dr. Rabey changed his focus to General Dentistry. A one-month rotation in UCSF Fresno’s OMFS program during General Practice Residency and he set his sights elsewhere.
“I like the scope of practice (in OMFS). It’s exciting. There’s a lot more surgery,” he said. “There’s trauma, benign and malignant pathology, infections, a lot of variety and a lot more application of diverse knowledge.”
Following his GPR, he applied and was accepted to the OMFS residency program at UCSF Fresno. Residents train and operate mostly downtown at Community Regional Medical Center and the UCSF Fresno OMFS Clinic Care Center. Residents also rotate and operate at the VA Medical Center in Fresno, Clovis Community Medical Center, Saint Agnes Medical Center and Kaiser Permanente’s Fresno Medical Center.
Dr. Rabey is one of four chief residents and currently, serves as the clinic chief.
“The attendings are the best part of training at UCSF Fresno,” said Dr. Rabey, referring to OMFS faculty Robert Julian, DDS, MD; Brian M. Woo, DDS, MD; and George Zakhary, DDS, MD. “You’re not going to find them anywhere else. They have a ton of experience and are more than willing to share. They foster a positive environment, and they all inspire you to be a better resident and person. They’re just good people.”
If you were to walk in the residents’ room right now, it’s like 17 people who despite working hard are in great spirits and I attribute that a lot to our attendings, he added.
The past year hasn’t been without hurdles though. Finishing his final year of residency during the COVID-19 pandemic was mentally taxing for the husband and father. Out of concern for his family’s safety, he stayed away from his wife Celeste and their three kids Capri, Coco and Chip for three months. But the family had a good support system, and the state of the pandemic has improved significantly.
Dr. Rabey looks forward to staying in Fresno after graduation and joining a local practice Premier Valley Oral Surgery & Dental Implants.
“I was excited to be able to get a job here,” he said. “That was the whole goal. My parents are here, my wife’s family is here. I just happened to get a job at the same place I got my wisdom teeth out when I was 15.”
His advice to incoming residents: Enjoy learning and stay positive. It’s well worth it. Residency has been fantastic. I will miss it. I will miss all the people I work with.
Monika Thomas-Uribe, MD, MPH, completed a three-year residency training program in Pediatrics at UCSF Fresno. After graduation, Dr. Thomas-Uribe will stay in Fresno to care for patients at Kaiser Permanente’s Fresno Medical Center.
The patients she serves in Fresno remind her of the patient population in Valle de Bravo, the small town in Mexico where she grew up. “My father is a surgeon. He did surgeries, but also delivered babies, cared for patients of all ages, and was often paid with chickens and pigs. That’s what I thought it meant to be a doctor, she said. I always wanted to be a doctor.”
Her family moved to Toluca, the capital of Mexico’s central State of Mexico so she could attend high school. She attended medical school at the Universidad Anáhuac in Huixquilucan, State of Mexico, Mexico.
“In Mexico, students go to medical school for six years. The fifth year is an internship. The sixth year is a social service year,” said Dr. Thomas-Uribe. “You spend time providing medical care in remote areas of the country.”
During medical school, she volunteered to go to Haiti after the 2010 earthquake. After medical school, she did visiting rotations at Oxford in England and in Germany. Her passion for public health led her to Emory University where she earned a master’s in public health. It was then she decided to stay in the United States, moving to California for a job as a research assistant at Stanford University. There, she met her husband.
While applying to residency programs, mentors at Stanford and a colleague both recommended UCSF Fresno. She applied and matched. The colleague who recommended UCSF Fresno – Mackenzie Yore, MD – is completing residency training in the UCSF Fresno Department of Emergency Medicine.
“Being here and about to finish residency training is a dream come true, said Dr. Thomas-Uribe. The patient population is what I like best. I was nervous at first that I wasn’t going to help people I am passionate about. But I speak Spanish every day and I understand the culture and that’s something I love about being here.”
The end of training comes with bittersweet moments, too. She had her final medical visit recently with the very first pediatric patient she saw in residency. He’s almost three years old now. And looking back, she is reminded that the path wasn’t always easy. It was hard to get into medical school. It was expensive and it was emotionally draining, she said.
“It’s difficult in the United States for international medical graduates, trying to understand everything again in English and trying to prove that you are good enough,” she said. “I don’t know if it was my own insecurities or if it was real, probably a combination of both.”
She acknowledges the help of family, her husband, mentors and friends and is grateful for everyone who supported her along the way.
She is proud of a pesticide project she has been working on. Latinos make up many people working in the fields. They deserve help with education about exposure to pesticides, she said. “We need to make sure they understand with information in Spanish, Mixteco or the language they speak. They need personal protective equipment and vaccines. This is something I’m going to continue to work on.”
In her spare time, she enjoys running, participating in triathlons, working out, being outdoors, practicing capoeira (a Brazilian martial art) with her husband, relaxing and reading. She is looking forward to more spare time after residency and caring for patients at Kaiser. “I love working with children. It is the best,” said Dr. Thomas-Uribe. “Children teach you so much.”
Some of her patients even bring her whatever fruit is in season, a fond reminder of the special bonds she recalls her father having with patients when she was growing up.
UCSF Fresno Oral and Maxillofacial Surgery is First in Nation to Use Robotic, Three-Dimensional Digital Microscope for Reconstructive Surgery
Brian Woo, DDS, MD
By Barbara Anderson
Patients with oral cancer have been coming to the UCSF Fresno Oral and Maxillofacial Surgery (OMFS) Residency Program for two decades for state-of-the-art surgery and reconstruction. Now, the program is the first nationwide to use a robotic three-dimensional digital microscope for surgery to rebuild head and neck defects after tumor surgery.
Before we got here, there was no one in the Valley doing this (microvascular free flap reconstructive surgery), on a regular basis for larger resections, said Brian Woo, DDS, MD, UCSF Fresno OMFS program director. The complex reconstructive surgery entails transplanting soft tissue, muscle or bone taken from elsewhere in the body to rebuild tongues, cheeks or jaws; and UCSF Fresno surgeons do several of these free flap surgeries a week. The procedure results in a better return of function for patients.
UCSF Fresno OMFS is committed to patient care. It takes cancer patients from start to finish (cancer resection to reconstruction) to get them back to their original form and function, Dr. Woo said.
For the past eight months, UCSF Fresno OMFS surgeons have been using the 3D Modus V digital microscope in free flap surgeries. Free flap surgery can take 10 to 14 hours. Transplanted tissues and bone need a blood supply – and the surgeon must sew blood vessels together that can be less than three millimeters in diameter or slightly larger than a pencil point. The 3D Modus V microscope gives surgeons increased visualization and an enlarged view of tissue during surgery, which can reduce surgery time and surgeon fatigue. “It’s better ergonomics for surgeons,” Dr. Woo said.
“Indeed, UCSF Fresno’s OMFS team is definitely the first in California and the nation to use our system for free flap reconstructive microsurgery,” Synaptive Clinical Applications Specialist Vatche Baboyan said in an email.
UCSF Fresno OMFS full-time faculty are fellowship trained (two in head and neck surgery and one in craniofacial surgery) and UCSF Fresno was the only OMFS service on the West Coast doing microvascular reconstruction from 2010 through 2020, said Robert Julian, DDS, MD, OMFS program chief. “We are the only surgical service in central California that offers microvascular reconstruction after severe head and neck trauma or after cancer surgery,” he said.
OMFS faculty and residents provide a wide range of oral and maxillofacial care in the Valley. They respond to head and facial trauma at Community Regional Medical Center, one of the busiest Level 1 trauma centers in California. They also treat and operate on patients at Valley Children’s Healthcare, the VA Central California Health Care System, Saint Agnes Medical Center, Kaiser Permanente Fresno, and Clovis Community Medical Center. In addition, about 15,000 patients are year are treated as outpatients.
We offer services that are rarely handled by any other OMFS or ear, nose and throat surgeons in central California, Dr. Julian said. The services include: Vagal Nerve Stimulator placement for seizure, Hypoglossal Nerve stimulator for sleep apnea, skull base surgical access for neurosurgery, head and neck cancer, microvascular reconstruction of head and neck, major reconstructive procedures of the head and neck in general, and application of embryonic tissue grafting in head and neck reconstruction.
Oral and pharyngeal cancer is the 12th most common cancer in California. The American Cancer Society estimates there will be 5,320 new cases in 2021. According to a 2020 oral health assessment of Fresno County by the Central Valley Health Policy Institute, there were 93 newly diagnosed oral and pharyngeal cancers in 2016 in the county.
UCSF Fresno OMFS faculty and residents work with UCSF Fresno oncologists at the Community Cancer Institute in Clovis in providing care before and after surgery for oral and pharynx cancer. “We formulate a plan for the patient all together,” Dr. Woo said.
UCSF Fresno OMFS provides services to a broad patient population and turns no patient away for care, Dr. Julian said. “We are well trained, very experienced and always up-to-date and innovative,” he said, emphasizing, ‘always.’ This is what is required to ensure the best possible outcomes for our patients.”
UCSF Fresno, Community Medical Centers Participating in CDC Multisite Study Examining COVID-19 Vaccine Effectiveness
By Brian Chinnock, MD, UCSF Clinical Professor, UCSF Fresno Department of Emergency Medicine
UCSF Fresno has been working with Community Medical Centers as one site in a Centers for Disease Control and Prevention multisite study examining COVID-19 vaccine effectiveness in health care workers (HCWs). The study, entitled “Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel–33 US Sites, January–March 2021”, released the interim findings on May 14, 2021, in the Morbidity and Mortality Weekly Report. The study demonstrated that the mRNA COVID-19 vaccines were 82% effective 14 days after a single dose, and 94% effective 7 days after a second dose. Of the 1800 HCWs enrolled, approximately 100 were HCWs who provide services in a CMC facility.
The vaccine effectiveness of the complete two-dose regimen was consistent with findings from two previous clinical trials that did not involve HCWs and showed higher single-dose effectiveness.
The site primary investigator for the study is Brian Chinnock, MD, in the UCSF Fresno Department of Emergency Medicine, and research coordinators are Peter Poerzgen PhD, and Jannet Castaneda.
Enrollment in the study is continuing. if you are a Community Medical Center HCW who is getting a COVID-19 test, you may receive a message through MyChart asking for your interest in participation or scan the QR code for more details or email Fresno-Prevent-Project@ucsf.edu
COVID-19 Equity Project Partnerships Prove Need for Ongoing Solutions to Health Inequities and Disparities
Corina Jefferson, medical assistant, UCSF Fresno CEP draws a vaccine
By Barbara Anderson
Driven by the coronavirus pandemic, the City of Fresno approached UCSF Fresno and community-based organizations in spring 2020 with an urgent request: provide free COVID-19 tests, outreach, contact tracing, social support – and ultimately vaccines — for the most vulnerable and underserved populations in the city – specifically people of color who are disproportionately sickened and hospitalized by the coronavirus.
By Labor Day weekend, with contracts signed and $5 million in federal CARES Act funding secured from the city, the UCSF Fresno Mobile HeaL COVID-19 Equity Project (CEP) launched as a drive-thru, first-come, first-served testing service. The no-appointment model helps eliminate barriers to health access experienced most often by people of color, such as transportation constraints, limited English proficiency, and limited technological literacy or no computer access. “We really did not want to do an appointment system because it really didn’t fit the mission to serve the underserved and vulnerable population,” said Kenny Banh, MD, assistant dean of undergraduate medical education and CEP medical director.
This spring, CEP signed a contract with Fresno County for administering vaccine through the fall.
CEP administered 36,451 vaccines from Feb. 10, 2021 to June 15, 2021, and 72% identified as a person of color. Between Aug. 31, 2020 and Jun 15, 2021, CEP gave 29,435 COVID-19 tests and 82% of those tested identified as a person or color.
UCSF Fresno, a regional campus of UCSF, was uniquely positioned to quickly begin COVID-19 testing and vaccine injections. In 2018, Dr. Banh started a mobile health service for the central San Joaquin Valley. UCSF Fresno’s Mobile Health and Learning (HeaL) provides flu shots and health screenings for patients while providing learning opportunities for medical students and pre-health students under the guidance of medical residents and faculty physicians. In addition to training physicians and teaching medical students and providing clinical and volunteer experiences for pre-health students, UCSF Fresno is committed to improving the health of the San Joaquin Valley, and Mobile HeaL and now CEP, are means of providing needed care outside of hospital and clinic walls, said UCSF Fresno Associate Dean Michael W. Peterson, MD, FCCP, MACP.
More than a dozen community-based organizations (CBOs) spread the word about UCSF Fresno CEP, helping to build trust in communities with systemic inequities and longstanding mistrust of government and health care. The partnership with CBOs has been immeasurable to the success of the project. And the collaboration has attracted the attention of state and national organizations that are interested in the project as a model of best practices.
Organizations involved in UCSF Fresno CEP include: African American Clergy Taskforce, Black Wellness & Prosperity Center, Central Valley Health Policy Institute, Centro Binacional para el Desarrollo Indígena Oaxoqueño, Centro La Familia, Cultiva La Salud, Cultural Brokers Inc., Fresno Building Healthy Communities, The Fresno Center, Fresno Economic Opportunities Commission, Fresno Interdenominational Refugee Ministries, Fresno Black Metro Chamber of Commerce, Go Public Schools Fresno, Jakara Movement, Reading and Beyond, Take a Stand Committee and West Fresno Family Resource Center. Some of these organizations make up the Immigrant Refugee Coalition, the African American Coalition, and the Disability Equity Project, which implement COVID-19 Equity Projects in tandem and focus on specific underserved populations in Fresno County.
UCSF Fresno CEP is a good example of what it really means to invest in equity,” said Christine Barker, executive director of FIRM, a faith-based non-profit serving primarily refugees of Hmong, Laotian, Slavic, African and Syrian communities.
CEP has greatly strengthened UCSF Fresno’s alliances in the community, Dr. Peterson said. “In order to really try to achieve our goal of improving the health of the community, we cannot do that alone,” he said. “We have to do that by engaging with community-based organizations and the community as a whole about how to provide preventative services and how we help support the work they are doing in the community so that we’re really impacting the health of people before they get sick and need to see a doctor.”
Fresno City Councilmember Esmeralda Soria has been a supporter of CEP and advocated for the allocation of $5 million from the CARES Act for the project. “I have always highlighted the need that exists for health services in our underserved areas, Councilmember Soria said. “We have sadly witnessed the detrimental effects this pandemic has had in these communities. In an effort to facilitate access to health services, I had the pleasure of working with the UCSF Fresno team to provide our residents with COVID -19 testing and flu vaccines. The COVID Equity Project has proven to be successful in providing COVID testing, contact tracing, community outreach, and now much needed COVID-19 vaccines.”
Likewise, Fresno City Councilmember Miguel Arias, who was Council President when the CARES Act allocation was approved, said, “the City of Fresno is privileged to partner with a trusted community provider like UCSF Fresno, to ensure we are meeting the needs of our most vulnerable communities during this pandemic.”
CEP Clinical Manager Jolene Woods, RN, said the CBOs have built trust with patients, as well as providing help. “If you don’t have trust, they’re not going to access the care anyway,” she said. Many of the UCSF Fresno staff are fluent in languages other than English, but the CBOs have provided invaluable help with translators, said Juanita Sprowell, CEP operations specialist.
Tania Pacheco-Werner, PhD, co-director of the Central Valley Health Policy Institute at Fresno State, said CEP has shown “vaccine hesitation is not an issue with our most vulnerable in this community – it’s just access.”
Outreach and education are essential, particularly in the African American community where people have not necessarily had good relationships with the health care system, said Heather M. Brown, chief administrative officer at Fresno Economic Opportunities Commission. “The real value is having both people in the community talking about the vaccine, answering questions about the vaccine and really honoring vaccine hesitancy, acknowledging historical problems that the African American community has had.”
“For the Southeast Asian community, it was really important to offer testing in familiar and accessible locations,” Barker said. “We saw that once UCSF Fresno started testing at FIRM, the number of Asian positive tests started to grow. That tells me that before UCSF Fresno was testing at FIRM, Southeast Asians were not going to be tested anywhere. We were able to find positive cases that others were not able to catch in our community.”
The Jakara Movement, which serves the Punjabi Sikh community in Fresno, has worked to dispel misinformation and rumors about COVID-19, said Preet Singh Grewal, the CEP project manager at Jakara Movement. “We have used our own platform to not only share what the city and county were sharing and the CDC guidelines translating into Punjabi, but we have provided them in a very easily understandable way,” he said. “Dr. Banh is a very helpful resource. He has made himself available to help our coalition.”
UCSF Fresno’s mission is to provide high-quality health care but also to train the next generation of physicians for the San Joaquin Valley. Working at CEP has influenced several staff to consider the pursuit of careers in health or to return to school for higher degrees in health care fields.
Alex Chavez, 25, a CEP medical clerk, is the son of farm workers and is the first in his family to receive a college degree. He started volunteering on UCSF Fresno’s Mobile HeaL in 2018. He attended classes at Fresno City College, graduated with an associate degree from Clovis Community College and graduated from Fresno State in 2019 with a bachelor’s degree in biology. He is studying for Medical College Admission Test (MCAT) and expanding his clinical and medical and leadership experiences. His career goal is to become a physician and eventually come back to the Valley to serve his community. CEP has helped him understand underserved populations. “I have learned that many of the patients don’t have the ability to get health care” he said. “It’s opened my eyes to return to my home and advocate for those patients who don’t have the ability to advocate for themselves and provide the health care that they deserve.”
For Mackenzie Saephanh, 21, who is Mobile HeaL co-director of outreach, volunteer coordinator and medical clerk, her experiences at CEP have given her a new appreciation for the Valley. “I’ve grown a deeper love for the area I was born and raised in and how diverse and how closely knit everyone is here too – in the community and in CEP.” Saephanh is a pre-med major at Fresno State and is a first-generation college student.
UCSF Fresno consciously looks to hire people from the Valley who are representative of the patients being served, Dr. Banh said. “We want to get people who come from disadvantaged backgrounds, people who are underrepresented. And, as we are serving communities of color, we want to make sure we have language access and the staff to represent the communities that we were treating.” Hiring from the community also is how you address health inequities, he said. “If you’re not doing some active part to address inequity, you’re part of the problem. This is not just about being trusted, this is actually about serving the community.”
CEP Medical Assistant Vanessa Lopez-Jimenez can identify with the people she is helping. “I grew up with a struggle,” she said. “My mother didn’t have resources; she was always needing help as a single mother of five kids.” Lopez-Jimenez, who is fluent in Spanish, said patients are grateful when she talks with them in Spanish, the language they are most comfortable speaking. “It makes me feel good, especially when they say that they love us,” she said. “One day there was a patient I was observing, and he said, ‘you guys are angels. We love you. And you remind me so much of my granddaughter.’ Lopez-Jimenez said she replied, “if it wasn’t for COVID, I would give you a hug.”
Through CEP, relationships have been built with CBOs and local and regional government, Dr. Peterson said. “Hopefully, we can be recognized by them in the future as a partner in working to address some of the things that they are constantly trying to deal with at the county and city level in terms of access to care,” he said. “This is one of the silver linings of COVID-19 – we developed new partnerships to help our community respond to the pandemic. Together, we showed determination, collaboration and resiliency. And we are better for it as a community and my hope is that this spirit of partnership around diversity, equity and inclusiveness continues in the future.”
Ana Carolina Coll, MD, FAAP
UCSF Fresno’s success and growth are a direct result of the dedication and inspiration of our faculty, staff, residents, fellows, students, alumni, partners, donors and friends. In each issue of Focus, we introduce you to the people who contribute to the greatness of UCSF Fresno through informal interviews.
This month, please meet Ana Carolina Coll, MD, FAAP, Division Chief, Pediatric Cardiology, UCSF Fresno Department of Pediatrics.
What is your name? Nickname?
My name is Ana Carolina Coll, everybody calls me Dr. Coll. My staff and Dr. John Moua, Interim Chief, UCSF Fresno Department of Pediatrics, call me “the Queen of Hearts.”
What is your title or titles?
I am the Division Chief of Pediatric Cardiology at UCSF Fresno.
Where did you grow up and where did you go to school (high school, college, medical school, residency, any other degrees, or certifications)?
I was born and raised in Caracas, Venezuela. I earned my medical degree at Universidad Central de Venezuela. I did my internship at Maimonides Medical Center in Brooklyn, NY, and my residency in Pediatrics at Miami Children’s Hospital in Miami, Florida. I completed a fellowship in Pediatric Cardiology at Stanford University in Palo Alto, California. I am Board Certified in Pediatrics and Pediatric Cardiology.
What inspired you to become a physician and more specifically, a pediatric cardiologist?
I knew I wanted to be a doctor since I was a little girl, 4 years old, maybe. I don’t remember a time in my life wanting to be something else. Pediatric cardiology came in my second year of residency at Miami Children’s Hospital. We had a very large Pediatric Cardiothoracic program for children and the Cardiac Intensive Care Unit rotation was extremely challenging. The director of that unit was Dr. Anthony Chang. He was very well known in the field. It was one of the very few pediatric cardiovascular intensive care units in the country at the time. I wanted him to write a recommendation letter for me. I thought I wanted to do Emergency Medicine. I liked the acuity and movement of the ER. When I went to talk to him, he said I should consider pediatric cardiology. I was in shock, a bit confused and disappointed, but he made a deal with me. If I did another rotation in the CVICU, he would convince me that cardiology was a better fit for me, and then after the rotation he would be glad to write me a letter. The rest is history. I fell in love with the field and all “my little hearts.”
Did you encounter any barriers along the way to becoming a cardiologist? If so, what were they and what advice do you have for others who may want to pursue a similar career?
Fortunately, I had many hurdles all throughout my career. When I started pursuing the specialty and got accepted at Stanford, I encountered a male dominated field. I was not just a woman, but from Latin America with an accent. I felt like it was a survival race. At Stanford, the program was extremely busy and with very challenging patients. In addition, instead of the expected three fellows, one quit before I arrived, and the immensity of the work fell on the remaining two fellows. This meant very frequent calls (up to three weeks back-to-back) and every other weekend.
I lost 10 pounds in my first three months. I used to cry at least every two days and I kept asking myself why, I was going through this? But the answer was always the same, I didn’t see myself doing anything different, this kept me going.
The experience taught me resilience, perseverance, and was able to prove to the people around me (many who doubted me) who I was my tiny frame with my Latin accent and my broken English.
My advice is everything is possible if you are determined and committed to achieve your goals in life, and never allow anybody to tell you what you can’t do.
I was the first woman in the history of that fellowship to graduate. After me, many others followed, and now there are more women than men in the fellowship.
Why did you pick Pediatrics and Cardiology?
I found Cardiology very logical. If you master the physiology and the anatomy, you can answer almost any question. If it doesn’t make sense, you are missing something.
Also, it’s very rewarding to follow my “tiny patients” that I diagnosed in utero, receive their corrective surgery, return to clinic after recovery, thriving and making their parents happy. This is a very satisfying feeling.
I always tell the parents of my patients that the heart is “the house of the soul.” What can be better than taking care of it.
What is the best part of your job? What is the hardest?
My patients are the best part of my job. They are warriors, troopers, and resilient. They teach me something daily. Looking at their smiles is the best feeling in the world.
The hardest part is when they lose their battle. As a mother, my heart breaks. It’s very painful.
Are you bilingual, and if so, how has this helped you with providing care?
Yes, I am bilingual. My native language is Spanish. I also speak some Italian. English is my second language.
My Spanish has been a blessing in my practice. It is so much easier to connect and communicate with patients when you speak their language. It’s completely different and makes a world of difference.
As division director of UCSF Fresno Pediatric Cardiology Division, what are you most proud of?
When I started at UCSF Fresno in 2003, there was only a twice a month, half-day of Pediatric Cardiology Clinic. There was no echocardiogram, no fetal echocardiogram, no Holter, or anything else. It was a micro service.
Today, we can provide most services from fetus to adults with congenital heart disease, except for surgery, catheterization and electrophysiology studies. However, we provide these services through UCSF, ranked top 20 in the United States for Pediatric Cardiology and Pediatric Cardiothoracic surgery. Our patients from downtown and all the nearby areas are locally served in a new facility, the North Medical Plaza building. Our ECHOLAB is AIC accredited by the Intersocietal Accreditation Commission in fetal/pediatric and adult congenital echocardiogram.
I am very proud of the growth over the years and all the services we now provide locally.
What is at the top of your personal or professional to-do list?
My professional goal is to keep growing and expanding this Division. I am not done yet. I still want to bring even more services to our community. This is just the beginning. The sky is the limit.
What do you like to do in your off time?
Off Time? I don’t have much of that, but I am happy about it.
I love to cook. I love to run and I love to spend time with my husband and my two boys. The conversations with my family keep me grounded and serene. I have known my husband for more than 30 years and he understands my passion for what I do, and he supports me emotionally.
The zombie apocalypse is coming. Which three people from UCSF Fresno would you pick to be on your team and why?
From UCSF Fresno, I would pick my Chief Dr. Moua. He has the leadership and the love for what he does that I appreciate. I also would pick Dr. Cynthia Curry. She is the most energetic, smart and funny person I know. Considering the situation (zombie apocalypse), I will definitely need her wisdom. The third person will be Dr. Anan Rajani. He will probably be able to get us transportation (he loves cars) and take care of the very little ones in the post-apocalypse baby boom.
But I could not survive a day, much less a zombie apocalypse without my team at Community Regional Medical Center, including my medical assistant Michell Camarena, a dynamite, knowledgeable, fast and super smart person who is always working hard and there when I need her. My scheduler/assistant Veronica Camarena. I have worked with her since 2003. We will need her calm character and organizational skills. Karen Stevenson, the nurse for the Division. She is the backbone and glue keeping things together, and the front-line person for the patients.
I could not survive without my Echolab and Joy Guthrie, PhD, the lead sonographer, who we are blessed to work with. What she doesn’t see we may not see either. I need her knowledge and her eyes. I cannot leave out my new faculty Dr. Manish Malkar, a kind, polite, hardworking partner, who is helping to grow this Division. And finally, my favorite Vice President Kudzi Muchaka, a kind, hardworking individual with the business experience to start a Department from the ground up. He will provide the necessary support post-apocalypse.
What is the most important thing you would like people to know about you? Or what else would you like to add about you, your background, family or career?
I would like people to know that the most important thing for me is the health and outcome of my patients. I work for them. I am their advocate and I will always do what is best for them, despite contracts, politics, different institutions, business, insurances, etc. My loyalty is to my patients. I will do what it takes for their well-being. When I am taking care of a patient, they are my first, second and all priorities. I am a fighter, and I will fight for them.
Supporting UCSF Fresno
Long-time Valley Resident Planned to Make a Difference
By Kathleen Smith, Development and Alumni Relations, UCSF Fresno
Long-time Central Valley resident Charles “Pete” Gorini was a down-to-earth man with a big heart for animals and an earnest desire to leave a legacy that would help provide high-quality medical care to residents of the Valley and beyond.
Born in 1934 in Los Angeles, CA, Gorini grew up in Pasadena, where his family grew flowers. They later moved to Visalia where he attended high school. After serving in the Navy, he spent the rest of his career working for Southern California Edison until he retired in 1989 to take care of his mother.
When Gorini died in 2018 at the age of 84, he left a portion of his estate totaling over $1.6 million to establish two funds benefiting the UCSF School of Medicine and its regional campus UCSF Fresno.
Gorini’s bequest established the UCSF Fresno General Research Endowment fund, which will provide lasting annual support for the many research studies being conducted by faculty and trainees at UCSF Fresno. Some of the research provides residents of the Valley the opportunity to participate in innovative clinical trials on a variety of diseases, including pneumonia, stroke, diabetes, liver disease, pulmonary hypertension, lung cancer, heart failure, valley fever and most recently COVID-19.
His bequest also established the San Joaquin Valley Program in Medical Education (SJV PRIME) Scholarship fund to provide scholarship support to students in the UCSF SJV PRIME. SJV PRIME is a tailored track of the UCSF School of Medicine designed for future physicians who are committed to providing high-quality medical care that addresses the Valley’s unique health needs. Students enrolled in the program spend 18 months at UCSF in San Francisco and then move to Fresno for the remainder of their medical school training including research and community engagement in collaboration with UC Merced. Gifts like these allow students the freedom to pursue their passions, commit to serving the public good, and start their careers without crushing debt at a time when the cost of paying for an education can fast outpace salaries for new professionals.
Gorini’s legacy helps UCSF Fresno realize our mission to improve the health of communities and individuals in the San Joaquin Valley through excellence in teaching and patient care, innovative clinical research, and community partnerships.
“UCSF Fresno is so very honored by Mr. Gorini’s generosity,” said Michael Peterson, MD, associate dean at UCSF Fresno. “I only wish I could thank him personally and tell him how his gift is helping improve health care in the San Joaquin Valley for generations to come.”
If you have already included UCSF Fresno in your estate plan, please let us know. We would be honored to welcome you as the newest member of Heritage Circle, our recognition society for those who have remembered UCSF and UCSF Fresno in their philanthropic plans.
Explore the wide range of planned giving possibilities to find the gift plan that best meets your philanthropic and personal goals or contact us directly at email@example.com to learn more about the benefits of making a planned gift to support UCSF Fresno.
Left to right: Kenny Banh, MD, and Andrew Field
In acknowledgement of and appreciation for their volunteerism, extra effort, and contributions towards UCSF’s response to the COVID-19 pandemic, UCSF Fresno’s Kenny Banh, MD, and Andrew Field were recognized with a UCSF School of Medicine Dean’s Commendation for Exceptional Volunteerism and Community Service. Dr. Banh and Field received the commendation for their work on the UCSF Fresno Mobile HeaL COVID-19 Equity Project.
Launched in 2020 as a partnership with the City of Fresno and community-based organizations to provide free COVID-19 tests, outreach, contact tracing, social support – and ultimately vaccines — for the most vulnerable and underserved populations in the city – specifically people of color who are disproportionately sickened and hospitalized by the coronavirus. This spring, CEP signed a contract with Fresno County to administer vaccines through the fall.
Kudos to Dr. Banh, Andrew and to the entire UCSF Fresno COVID-19 Equity Project team.
Dr. Banh is assistant dean for undergraduate medical education at UCSF Fresno, faculty in the UCSF Fresno Department of Emergency Medicine and medical director of the UCSF Fresno CEP. Field oversees Campus Life Services – Wellness at UCSF Fresno and is the project manager for the UCSF Fresno COVID-19 Equity Project.