Teach
Kenny Banh, MD, and UCSF Fresno Mobile HeaL CEP staff
Three from UCSF Fresno CEP Admitted to UCSF SJV PRIME
By Barbara Anderson
UCSF Fresno’s mission to improve health in the San Joaquin Valley and its charge to train the next generation of physicians to provide the highest-quality of care have been guiding principles of the UCSF Fresno Mobile HeaL COVID-19 Equity Project (CEP). The project, which started in spring 2020 as a response to the pandemic and with $5 million federal CARES Act funding through the City of Fresno and continues in partnership with the County of Fresno, provides free COVID-19 testing, vaccines, monoclonal antibody therapies and Paxlovid anti-viral treatment for the most underserved populations in the city.
CEP has intentionally hired diverse people representing the Valley to give COVID-19 tests, administer vaccines and therapies with the intent that they represent the people they are serving. Vaccine support specialists have given more than 91,000 tests, administered more than 76,000 vaccines; and since September 2021, they have provided treatment and prevention treatment to more than 600 patients.
“Our vaccine specialists are from the community,” said Kenny Banh, MD, medical director of CEP and Assistant Dean for Undergraduate Medical Education at UCSF Fresno. “We recruit people who are underrepresented in medicine who understand the people they are serving and communicate to and provide care in a culturally appropriate manner.”
CEP has become fertile ground for pre-med, registered nursing and other health professional students looking for hands-on patient care experience. And their encounters with vulnerable populations have influenced medical school and nursing school choices. About 80% of the people receiving COVID-19 tests, vaccines and treatments identify as people of color.
Six CEP staffers will be attending medical schools this fall and one will be attending nurse practitioner school. Two of the staff – Lili Garcia Pacheco and Darien Galvez – have passed the exam for Emergency Medical Technician (EMT) certification.
Three of the six medical school students – Myrka Macedo, of Sanger; Seshaan Ratnam and Lillian Vang of Fresno – will spend most of their education time in the Valley as students in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). They are among 12 students accepted into SJV PRIME this year. Other students admitted to SJV PRIME in 2022 are: Hector Acosta Parra, of Kerman; Jagjot Dosanjh, of Fresno; Kennth “Ken” Fox, of Fresno; Neytali Kanwar, of Fresno: Viangkaeo Lee, of Merced; Austin O’Callaghan Langhoff, of Redding; Alan Pham, of Fresno; Mina Sarofim, of Tracey; and Maria “Denalene” Tiu, of Fresno.
SJV PRIME is a tailored track at the UCSF School of Medicine for medical students who are committed to ensuring high quality, diverse and well distributed medical care to improve the health of populations, communities and individuals in the San Joaquin Valley. The program incorporates the expertise of UCSF, UC Merced and UCSF faculty at UCSF Fresno. It provides medical students with the unique opportunity to work in the Valley with underserved populations. The students accepted into SJV PRIME spend their first 18 months at the main campus in San Francisco and the remaining two and a half years at the UCSF Fresno regional campus.
“The dedication that these students have shown in the care of the Valley’s underserved is the foundation of the SJV PRIME program. Our mission is to train physician leaders to provide care to our underserved communities. I look forward to the effect that all these students, both physicians and nurses, will have in our community in the future,” said Loren I. Alving, MD, director of SJV PRIME; the Mr. and Mrs. David George Rowe and Stephen W. Rowe Endowed Chair for Teaching in Neurology; and director of the UCSF Fresno Alzheimer & Memory Center.
UCSF Fresno, a regional campus of UCSF, has provided patient-care opportunities for pre-med students prior to CEP. In 2018, Dr. Banh started UCSF Fresno’s Mobile Health and Learning (HeaL) to provide flu shots and health screenings to patients while providing learning opportunities for medical students and pre-health students under the guidance of medical residents and faculty physicians. CEP expands Mobile HeaL by bringing equal access, barrier-free COVID-19 and other health care services to targeted communities in partnership with community-based organizations.
The decision to hire CEP staff from the community is just the right thing to do, Dr. Banh said. “We have a duty to do our part to address health care inequities and providing a pre-med training ground for underrepresented medical school students is one way of doing that.”
The six CEP staffers pursuing medical school and nurse practitioner school this fall:
- Noel Cruz, 30, will be attending AT Still University of Osteopathic Medicine in Arizona.
- Mankamal Dosanjh, 23, will be attending Yale University Graduate Entry Pre-Specialty in Nursing Program in Connecticut.
- Monica Le, 25, will be attending California Health Sciences University College of Osteopathic Medicine in Fresno.
- Nicholas Linville, 26, will be attending Michigan State University College of Human Medicine in Michigan.
- Myrka Macedo, 26, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
- Seshaan Ratnam, 23, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
- Lillian Vang, 24, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
As a vaccine support specialist at CEP for the past year, Lillian Vang, the daughter of refugees from Laos, got a hands-on experience providing patient care to underserved populations. The experience solidified her desire to become a physician to improve accessibility to health care in low-income communities and address disparities and inequities in health care.
“I’ve just been so exposed to the disparities of how difficult it is for patients to make an appointment with a primary care physician or get any of their medications prescribed, or even the disparities of not understanding what their physician wants from them, whether it be language barriers or culturally,” Vang said.
This fall, Vang, 24, will be attending medical school in the UCSF San Joaquin Valley Program in Medical Education. “SJV PRIME was my top choice because of the mission that they hold and how sincere and genuine they are about helping resolve a lot of the health care issues here,” she said.
Vang hopes to return to the Valley to “make a difference for the Central Valley in helping to resolve some of the disparities. Conversationally fluent in Hmong, she wants to serve her community. “Many of the Hmong population and the Southeast Asian cultures are hesitant to seek health care here in the U.S. Many of the cultures’ traditional medicinal remedies are quite different from Western medicine. Furthermore, I have seen how difficult it is for these cultures to trust something they do not know about. Therefore, it has been my goal to help break down these barriers and help bridge this gap.”
A native of Fresno, Vang knew in college – she was a Smittcamp Scholar at Fresno State – that she was interested in medicine. She participated in a volunteer summer pre-med program where she shadowed a physician in Italy. “Seeing how knowledgeable and compassionate the physician was to her patients inspired me to one day be the same,” she said. Her sophomore year at Fresno State, she worked as a medical scribe at Saint Agnes Medical Center. She graduated from Fresno State in 2020 with a bachelor’s degree in Biology with a minor in Child and Family Science and Physical Science.
But her year at CEP provided the first hands-on experience with patients she craved. “The position here at CEP is something so unique and special,” she said. “Especially with CEP going out into the communities, that was something that has inspired me for my future profession. I want to bring more health care accessibility to low-income areas and address disparities and inequities.”
Seshaan Ratnam’s year as a volunteer at CEP cemented his plan to go to medical school – and his desire to come back to the San Joaquin Valley as a physician one day.
Both of Ratnam’s goals are possible by his acceptance to medical school in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). “I can be a part of a program that is tailor fit for the Valley, and is exactly what I was looking for,” he said. “I feel like this program was made for me.”
Ratnam, 23, of Fresno, says his interest in medicine developed over time. While attending Clovis Community College and then UCLA, he leaned toward education and did community outreach to help connect underserved students with resources. At the same time, he worked on the clinical side as a medical scribe and researcher. He has always had a strong interest in mental health, and during the pandemic incorporated his experience as a yoga instructor and training in mindfulness-based stress reduction therapy to work with various community-based organizations. When he came back to Fresno in 2021, he inquired if his background in mental health would be an asset for CEP, and he was brought on board as a volunteer.
Ratnam created CEP fliers that included information about meditation, breathing exercises and mental health resources. He led individuals in minute meditations as they waited in cars to receive COVID-19 vaccine at the drive-thru CEP clinic and advocated on the importance of taking care of their mental health. “That’s the role I played with the COVID-19 Equity Project so it was a little bit different, more on the mental health side, but I would say pretty important.”
He also became fascinated by the collaboration between CEP and community-based organizations, such as the Jakara Movement, Fresno Interdenominational Ministries (FIRM) and others. “You saw all these groups coming together and it was so amazing. I had no idea you could even make a project of this grand of a level to come together for something that is so important.”
CEP showed Ratnam education and medicine can be fused in his future. “I want to do medicine, but specifically in the community. I am very interested in community health and in using our community resources to connect people to resources that our community offers.”
Myrka Macedo, a health policy research assistant who served as Director of Outreach at CEP, has been accepted into the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). A native of Sanger, Macedo, 26, is excited to begin medical school “and to be able to continue to be around my family for emotional support.”
Family is very important to Macedo. Growing up, she helped care for her maternal grandmother and grandfather. Her grandfather had congestive heart failure and later developed cancer and dementia. A native Spanish speaker, Macedo would go with her grandparents to doctors’ appointments and provide translation as needed. She also witnessed Katherine Flores, MD, a Latina primary care physician and director of the UCSF Fresno Latino Center for Medical Education and Research (LaCMER), provide holistic care to her grandparents in their native language, making her grandparents feel confident and in control of her grandfather’s afflictions. Those experiences helped convince her she wanted to be a physician. While preparing to apply to medical school after graduation from Fresno State with a double major in Chemistry and Biology in 2018, she volunteered at free clinics and then became an emergency support technician at Valley Children’s Hospital.
She joined the Central Valley Health Policy Institute in 2021 as a research assistant, working closely with community-based organizations that provide community health workers to CEP and she served for a while as Outreach Director at CEP. During this time, she and other research assistants would talk with Dr. Banh. “There is a lot of misinformation surrounding COVID-19 and Dr. Banh is the one to address a lot of those questions that we have,” she said. Macedo provided public health education training in Spanish for community health workers and helped create a public health infographic in Spanish that could be distributed to patients coming to CEP for COVID-19 vaccines.
The pandemic exposed the need for collaboration to solve health needs in the Valley, she said. And she can envision a future in medicine that includes a public health component. “I learned the importance of working with CBOs and I can see myself working with them in the future as a physician.”
Noel Cruz was a vaccine support specialist at CEP and will be attending AT Still University of Osteopathic Medicine in Arizona beginning this summer.
He will spend his first year at AT Still in Arizona and will complete the final three years of medical school in the San Joaquin Valley at a health center in Visalia. “I get to return and continue to work with the population here that I am already familiar with, but I would like to further that experience and learn more,” Cruz said.
Cruz, 30, was raised in the Bay Area and graduated from Berkeley City College before transferring to Fresno State, where he graduated with a major in Biology and a minor in Chemistry. He began volunteering for UCSF Fresno Mobile HeaL prior to the pandemic and remained as a CEP employee.
“It’s been a great experience working with the population here and trying to increase the COVID-19 vaccine numbers. And as a pre-med student, it is great. “You learn how to vaccinate, and you get your medical assistant certification. And you get to educate the public, which is preventive care,” he said.
“There are so many underserved communities here, the LGBTQ, the migrant farmworkers, the Latino community, the Hmong community, the homeless population. And for each community, there is a different approach to providing services and through Mobile HeaL and CEP, you learn that. Especially for me, being Latino and bilingual, I have been able to help the Latino community by providing comfort and trust.”
Cruz’s interest in medicine was sparked early. As a child, he saw his mother, a Nicaraguan immigrant struggling to communicate with physicians who were not fluent in Spanish, her first language. “She would always shy away from asking questions. I didn’t realize that until I got older and understood why, that there was the language and culture barrier. I just wished I could have helped my mom – I just wished I could be the physician.”
From his experience at CEP, plus an earlier job registering patients in the Emergency Department at Valley Children’s Hospital, Cruz said he saw the need for more physicians in the Valley to address unmet medical and health needs. He sees a return to the Valley for himself as a physician – perhaps in Pediatric Emergency Medicine. “I just really fell in love with the population here,” he said. “And I just want to make a difference.”
A year working as a vaccine support specialist at CEP gave 
Mankamal Dosanjh added confidence and resolve to enroll this fall in the Yale University Graduate Entry Pre-Specialty Nursing Program to become a family nurse practitioner.
Dosanjh, 23, will earn a registered nursing degree in the first year of the three-year Yale program and will focus the remaining two years on advanced nursing classes for the family nurse practitioner specialty she has chosen.
Growing up in Selma, Dosanjh said she knew she wanted to have a health career and joined the Doctors Academy, a health care pathways program for high school and middle school students in Fresno County that is operated out of the UCSF Fresno Latino Center for Medical Education and Research (LaCMER). An interest in nursing grew from a Doctors Academy summer internship experience shadowing a nurse practitioner. After graduating from Selma High School, she attended UC Irvine, where she received her undergraduate degree in Biology. During her last year of college, she participated in a community outreach program where she helped nurses on the medical-surgical and cardiology floors at a hospital in Irvine.
Moving back home to Selma during the pandemic, she applied for the vaccine support specialist job at CEP. “It was really an amazing opportunity to get more clinical experience and also to help out the community during the pandemic,” Dosanjh said. “You don’t get a chance like this every day to get such a large amount of clinical experience and also interaction with patients daily in all aspects of registration, vaccination, observation. Especially in the beginning, when our volume was so high, we got to talk to a lot of patients during observation periods and hear about their hesitancies to be vaccinated and hear about how grateful they were that we existed. And they were always so intrigued about us being there and what we were pursuing. They loved hearing that we were planning on pursuing something in health care in the future.”
“I’ve gotten close to the nurse practitioners at CEP,” she added. “It’s great to work with them and I’ve been able to ask them questions about working at CEP versus a traditional clinic. They enjoy CEP, and I’m excited to pursue my career even more because of that.” And she wants to return to the Valley and continue helping the community, she said. “I would like to come back and work with Mobile HeaL.”
Growing up in Sanger, the daughter of a low-income single parent, Monica Le saw her mother struggle with English as she navigated the health care system for Le’s grandmother.
A fluency in Vietnamese influenced her decision to pursue a medical care with a focus on providing culturally competent care in underserved regions. “I experienced firsthand the social determinants of health that adversely affected my family and friends and wanted to become a part of the solution,” Le said.
Le is a first-generation student to both graduate college and attend medical school in her family. A graduate of the UCSF Fresno’s Sunnyside High School Doctors Academy program, Le received a bachelor’s degree in Human Biology from UC San Diego. She thanks her mother, who came to the United States from Vietnam, for giving her and her three sisters opportunities. “I am so thankful to have her support as I explore my passions in higher education.”
Le first volunteered at the UCSF Fresno Mobile HeaL clinic after college graduation and was a part of its transition to CEP. “I definitely wanted to be a part of the solution to this novel virus and to gain clinical experience working with our underserved and minority populations.” While working at CEP as a Vaccine Support Specialist, she also was a medical scribe in the Emergency Department at Clovis Community Medical Center. Before leaving CEP to attend California Health Sciences University College of Osteopathic Medicine, she was promoted at CEP to Monoclonal Antibody and Antiviral Therapy Lead and Events Lead. In her full-time positions, she created workflows for training staff for administration of treatment, drawing up medications and screening patients for eligibility for antibody treatment.
Le sees a medical practice in the Valley in her future. “I also want to eventually become involved in educational pathways that encourage disadvantaged students, like myself, to pursue careers in medicine. I would not be here without the encouragement and support of my mentors who are also working physicians here in the Valley.”
Nicholas Linville learned the importance of giving patients respect over several years of volunteering at UCSF Fresno Mobile HeaL and more recently as a vaccine support specialist at CEP.
Empathy for patients was taught alongside how to take blood pressure, blood glucose, pulse and ultimately how to vaccinate for COVID-19, he said. “Through Mobile HeaL and CEP a compassion for the patients develops,” he said. “I really saw Mobile HeaL populations – the homeless, rural communities and communities with no access to health care – in a different light,” he said.
A native Fresnan, Linville, 26, had an interest in medicine as a child when his grandmother was diagnosed with lung cancer. “I was old enough to understand the sickness but still too young to understand why she was not getting better,” he said. But he had not given thought to medical school until experiences at Mobile HeaL and CEP. “Getting clinical experience, I realized the joy of helping others,” he said. It also influenced Linville’s decision to major in Biology and minor in Psychology at Fresno State, where he graduated. He had been focused on Psychology while attending the University of California, Santa Barbara, and while attending Clovis Community College.
This summer, he will be going to medical school at Michigan State University College of Human Medicine in East Lansing, Michigan.
Linville is working to become fluent in Spanish and while at CEP he gained confidence in speaking Spanish with patients. “Patients understand that we are learning, and they are happy to know people who are going into a medical field are learning another language.”
He is interested in Emergency Medicine, Internal Medicine and Psychiatry. Either at CEP or with Doctors Without Borders, he hopes to continue serving rural and other under resourced communities. “I would love to come back to the Central Valley for residency or even post-residency,” he said.
Care
Graduates from UCSF Fresno Stay to Care for Valley Community Members
UCSF Fresno Commencement 2022
UCSF Fresno Celebrates Commencement In-Person for First Time Since 2019
By Brandy Ramos Nikaido
In June, 95 medical residents and fellows, four oral and maxillofacial surgery dental residents and one head and neck oncology and microvascular reconstruction fellow, along with eight physician assistants in three different programs completed residency training at UCSF Fresno in 2022. UCSF Fresno celebrated commencement in-person this year for the first time since 2019. Until recently, in-person gatherings were held virtually or postponed preventing further spread of COVID-19.
Many of the graduates stay in Fresno and the Central Valley to care for patients, teach future physicians and continue their medical education.
UCSF Fresno is focused on improving health in the San Joaquin Valley and central California through teaching, patient care, research and community partnerships. Historically, roughly 50% of UCSF Fresno graduates stay in the region to provide care.
Residency is the required hands-on clinical training (postgraduate training) when clinicians fine tune skills under the guidance of attending faculty members prior to practicing independently. Resiliency, dedication, determination and commitment to service are common among UCSF Fresno residents and this year’s class demonstrated those traits throughout their training during the most challenging of times.
“The past few years have been unlike any others we have encountered in our lifetimes, and this has increased the challenges of residency and fellowship training. We are traversing through new terrain – from responding to a pandemic to seeking to right health disparities and inequities and advancing social justice,” said Lori Weichenthal, MD, Associate Dean for Graduate Medical Education and Clinical Affairs and the Designated Institutional Official at UCSF Fresno. “We applaud and are thankful for the resiliency and dedication of our learners. We also applaud the strength and determination of their colleagues and our faculty and staff.”
Associate Dean for Undergraduate Medical Education and Research Michael W. Peterson, MD, joined Dr. Weichenthal in congratulating the graduates and acknowledged their contributions to medical student education and for contributing to the learning environment at UCSF Fresno.
“We are grateful for the knowledge you have shared with those who follow in your footsteps and trust that the opportunities to teach have enhanced and enriched your training, said Dr. Peterson. Just as you have left your mark here, we hope that you remember the knowledge and skills you acquired at UCSF Fresno and the lessons learned from the patients we care for. Congratulations on your achievements UCSF Fresno Class of 2022. Go with confidence and compassion to serve and improve our communities, the health of your patients and of our profession.”
As the winner of the 2021 Henry J. Kaiser Award for Excellence in Teaching, the commencement keynote speaker was Mohammed Sani Bukari, MD. Dr. Bukari is a faculty member in the Department of Internal Medicine, Division of Hematology and Oncology, and director of the Sickle Cell Program at UCSF Fresno.
Numerous awards were presented during the ceremony, including the 2022 Henry J. Kaiser Award. Each year, the UCSF School of Medicine awards the prestigious Henry J. Kaiser Award for Excellence in Teaching to four members of the clinical faculty. These awards recognize outstanding teaching, motivational skills and communications abilities. One of these prestigious awards is reserved for a faculty member at UCSF Fresno.
The winner of the 2022 Kaiser Award for Excellence in Teaching at UCSF Fresno is Brian Chinnock, MD, RDMS. Dr. Chinnock is a health sciences clinical professor and research director in the UCSF Fresno Department of Emergency Medicine.
UCSF Fresno 2022 Commencement Highlights:
- 50% of residents completing training in the Department of Emergency Medicine are staying in the Central Valley to provide care
- Nearly 40% of residents completing training in the Department of Family and Community Medicine are staying in the region to provide much needed primary care
- 60% of Internal Medicine residents are staying in the Valley
- Both fellows in the Gastroenterology and Hepatology Fellowship Program are staying in the Valley
- 40% of residents completing training in the Department of Pediatrics are staying in the region
- 3 out of 5 graduating residents in the Department of Psychiatry are staying in the Valley. According to a California Health Care Foundation Report, there are 6.5 psychiatrists per 100,000 population in the San Joaquin Valley. The state ratio is 11.8 per 100,000 people
Graduates from Community Medical Centers’ General Dentistry Residency program also were recognized during the commencement program.
For a complete list of award winners announced at commencement and to read about some of the UCSF Fresno graduates who are staying to provide care, visit https://www.fresno.ucsf.edu/2022commencement/
Research
UCSF Fresno and UCSF School of Medicine Partner in Large OB/GYN Study Investigating How Chemical Exposures and Health Inequities Increase Cancer Risk
By Barbara Anderson
UCSF Fresno is working in partnership with investigators at the UCSF School of Medicine in San Francisco, Community Regional Medical Center (CRMC) in Fresno, and UC Berkeley on a large OB/GYN observational cohort study to enhance understanding of how multiple exposures to environmental chemicals and pollutants affect pregnant women and their offspring.
Over the next four years, in partnership with CRMC, UCSF Fresno plans to recruit and enroll 7,000 women at the time of childbirth and 700 women in the second trimester of pregnancy as participants in the “Discovering Cancer Risks from Environmental Contaminants and Maternal/Child Health (DREAM Cohort).
Another 3,000 women will be enrolled at UCSF Mission Bay and Zuckerberg San Francisco General.
Study leadership spans the two UCSF campuses, UC Berkeley, and CRMC. Co-Principal investigators of the cohort study are Tracey Woodruff, PhD, MPH, professor of OB/GYN and director of the UCSF Program on Reproductive Health and the Environment and the Environmental Research Translation for Health (EaRTH) Center at UCSF, and Peggy Reynolds, PHD, MPH, professor in the UCSF Department of Epidemiology and Statistics. Rachel Morello-Frosch, PhD, MPH, professor in the Department of Environmental Science, Policy and Management is serving as the site PI for UC Berkeley. Priya Pannerselvam, DO, UCSF assistant clinical professor in the Department of Obstetrics and Gynecology at UCSF Fresno is serving as PI for Fresno site. Subhashini Ladella, MD, director of Maternal Fetal Medicine at Community Medical Centers and volunteer UCSF clinical professor of OB/GYN at UCSF Fresno, brings a long history of collaboration with the UCSF research team and will direct the field activities at CRMC.
“We are very fortunate to have the opportunity to work with a world-class research project, DREAM, at UCSF to study the potential impact of environmental exposures on the cancer risk among women in our community,” said Michael W. Peterson, MD, MACP, UCSF Fresno Associate Dean for Undergraduate Medical Education and Research. “We unfortunately, have some of the highest levels of environmental exposures in some of our neighborhoods in Fresno, and it is important to understand the health impacts of these exposures on women’s health.
The UCSF DREAM study is a state-of-the-art study that will hopefully help answer this important question. This is another concrete example of the commitment that UCSF has made and continues to make to the San Joaquin Valley.”
The DREAM study notes that cancer is the second leading cause of death in women and children in the United States and breast cancer is the most frequently diagnosed cancer site in women – and the second leading cause of cancer death. Over the last decade, the incidence of cancers has markedly increased among women of reproductive age in California, especially among Latinas and Asians, and this is as a modest decline in overall cancer incidence rates has occurred over the same period, the investigators say.
Latina and Asian women of reproductive age, who have a higher incidence of cancer, are large populations seen by OB/GYN faculty at UCSF Fresno. “This study will provide important and new insights into environmental factors that may more negatively and adversely impact the health of diverse populations resulting in higher risks of cancer,” Dr. Ladella said.
Increasingly, evidence points to physical environment factors, particularly endocrine disrupting chemicals, as contributing to cancer risk. And pregnancy, which creates physiological changes, including rapid proliferation of mammary cells, is a time of susceptibility to chemical exposures that can increase cancer risk, especially for breast cancer. The study will focus on pregnancy with the hypothesis that exposures to environmental chemicals that disrupt endocrine and other systems during pregnancy can predispose women and children to cancer, as identified by intermediate cancer risk biomarkers.
The study will focus on environmental exposures to consumer product related chemicals and environmental pollutants in air and water, as well as pesticide use. Investigators will be able to see through time what the impacts are of environmental pollutants and the effects of exposure to different types of chemical agents.
Currently, there is a dearth of knowledge on the exposure and mechanisms of environmental carcinogens associated with common cancers in women, including breast cancer and other hormone-related malignancies, Dr. Woodruff said. “We will target a critical window of cancer susceptibility in women by enrolling and following an economically, geographically, ethnically, and racially diverse participant pool of 10,000 pregnant women and their children in the San Francisco Bay Area and California’s Central Valley.”
Of the overall 10,000 pregnant patients recruited and enrolled over four years at CRMC in Fresno, UCSF Mission Bay and Zuckerberg San Francisco, about 5,300 of the women will be consented for collection of specimens at delivery (surveys, maternal blood, urine and umbilical cord blood). They will have follow-up assessments at years one, two- and a half, and four. The follow-up assessments at the first year and again in years two to three will be done remotely, with participants completing surveys that are collected via email or mail. The participants also will self-collect hair and mail samples from mother and child. The four-year visit will take place at a clinic location and will include collection of maternal blood, child saliva; and hair, nails and urine from mothers and children. A subset of 600 pregnant women will be followed beginning from their second trimester of pregnancy (13-27 weeks).
The other 4,700 participants will consent for sample collections at delivery only; and will give permission for health information for long-term passive surveillance collected from medical records. This group will not be a part of the follow-up assessments at years one, two- and a half, or four.
“The opportunity to collect and bank infant biosamples, concurrent with those of mothers, also positions our cohort to provide important future insights into potential mechanisms for risk of childhood cancer associated with multiple environmental exposures in utero, another period of increased susceptibility,” Dr. Woodruff said. “Focusing on these critical, but understudied windows of exposure, our study will contribute to an enhanced understanding of the relationships between multiple exposures to environmental contaminants and intermediate cancer risk biomarkers leading to more effective prevention of environmentally mediated cancers.”
The Dream Cohort is going to be groundbreaking for the San Joaquin Valley, said Dr. Pannerselvam, who came to UCSF Fresno to serve patients in the medically under resourced region of California and to teach residents. UCSF Fresno’s mission is to improve health in the Valley and this study will help to enhance patient care and resident training, she said. “We need to know what environmental toxins and chemicals our patient population is exposed to so that we can provide more holistic care today and for the next generations to come.”
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South Bay AHEC vaccination
Partner
UCSF Fresno Celebrates 50-Year Program Dedicated to Improving Access to Quality Health Care for Underserved Populations through Academic and Community Partnerships
By Barbara Anderson
AHEC Program Director JD Garza with Sharon McClain, UCSF Fresno medical library professional
The California Statewide Area Health Education Center (AHEC) Program, housed and administered at the UCSF Fresno Department of Family and Community Medicine, is celebrating 50 years of recruitment, training, and retention of health professionals for under resourced communities.
California AHEC was established in 1972 as part of the National AHEC Program developed by Congress. The AHEC mission in California is to improve access to quality health care for underserved populations in urban and rural communities through academic and community partnerships. Health care workforce development is crucial in California, especially in the San Joaquin Valley, which has the second-lowest rate of primary care physicians per 100,000 population in the state.
California AHEC receives federal funding through state initiatives and from the Bureau of Health Workforce under the Health Resources and Services Administration (HRSA). UCSF Fresno administers the funding and subcontracts with a network of 12 AHEC centers, serving 58 counties, located in under resourced areas of the state to provide population-based education and training for students and health professionals. Each center, in collaboration with their regional advisory boards develops programs to respond to specific health care workforce needs of the community. The AHEC centers conduct their programs through many educational, clinical and community partnerships.
“California is a large, diverse state with health care workforce shortages and challenges that are as varied as the state’s geography. Addressing disparate workforce needs requires a collaborative spirit that AHEC has engendered to achieve,” said Ivan Gomez, MD, program director and principal investigator of AHEC, and Chief of the UCSF Fresno Department of Family and Community Medicine. “Statewide, each AHEC center has developed activities that respond to individual community health workforce priorities and opportunities, all the while engaging with each other to share ideas and best practices. We, at the AHEC Program Office at UCSF Fresno, are proud to help facilitate our partners in their efforts to improve access to quality and culturally competent health care to people in under resourced regions of the state.”
In the past three fiscal years (2018-21), California AHEC has provided professional education and support to 16,318 participants; health careers promotion and preparation to 15,893; and 1,922 in rotations, clerkships, internships and community experiences.
The AHEC Program Office coordinates the implementation of our program objectives through our 12 centers. The program office provides technical assistance, webinar development, and promotes collaboration with our state partners. “We collaborate with our AHEC centers to provide the training and education that are needed in our regions,” said JD Garza, AHEC Associate Program Director.
For example, the Central Coast AHEC, housed at the non-profit Health Projects Center (HPC) in Santa Cruz, California, focuses on increasing the number of health professionals trained to care for the state’s rapidly growing geriatric population. “Our nonprofit is dedicated to keeping older adults and people with disabilities safe at home,” said John Beleutz, MPH, Central Coast AHEC Director. Central Coast AHEC trains Family Medicine residents from Natividad Medical Center in Salinas, California, and nursing students from Cabrillo College in Aptos, California, through clinical and community rotations, teaching and simulations. Health professionals from area community health centers also receive continuing education in chronic disease care and geriatrics.
“Our biggest pipeline for new social workers at the Health Projects Center is our internship program that is in part supported by AHEC to allow us to give those folks experience. Many of them are bilingual, bicultural, from diverse backgrounds, and we’re retaining them,” Beleutz said.
The Central Valley AHEC, hosted by the Central Valley Health Network (CVHN), is focused on collaborative workforce development activities to address member health centers’ needs in the areas of recruitment, retention and on-going staff development. CVHN is comprised of 14 Federally Qualified Health Centers (FQHCs), which serve 21 counties in California. FQHCs serve people of all ages, races and ethnicities and people without insurance.
“Workforce development has long been one of our primary strategic initiatives,” said CVHN Chief Operation Officer and Central Valley AHEC Director Mary Renner.
All 12 AHEC centers in California participate in the AHEC Scholars Program in Community Health, which launched in 2018 for high-potential health professions students in the health professions to experience primary care with an emphasis on community health and interdisciplinary practice in medically under resourced communities. “We have grown AHEC Scholars over the last three years. We have been able to enroll over 530 students to date,” Garza said.
UCSF San Joaquin Valley Program in Medical Education (SJV PRIME) participates in the AHEC Scholars Program, serving as mentors and role models for youths in the Central Valley. SJV PRIME is a tailored track at UCSF for medical students who are committed to ensuring high quality, diverse and well distributed medical care to improve the health of communities and individuals in the San Joaquin Valley.
Amitoj Singh, an SJV PRIME student from Fresno, said participating in the AHEC Scholars Program allowed him to gain additional knowledge and experience in underserved settings. “During my involvement, I was able to educate community members in the Central Valley about chronic health issues like diabetes, engage in research on the relationship between COVID-19 and asthma, and create mental health resources that were distributed at Camarena Health (a Madera-based Community Health Center) Fairs. To all health professional students who are interested in working with marginalized communities, I highly recommend participating in this program.”
The AHEC Scholars Program has been successful for the South Bay AHEC said Jesse Tarango, South Bay AHEC Director. The South Bay AHEC is hosted by the Community Health Partnership (CHP), a community clinic consortium of 10 community health centers with 41 sites serving Santa Clara and San Mateo counties. AHEC Scholars are placed in the health centers and three graduates of the AHEC Scholars Program were hired by health centers this past year. “We’re getting great feedback from the CEOs,” Tarango said.
The Central Valley AHEC has expanded its AHEC Scholars Program to include high school students. “Even though initially the idea of AHEC Scholars was for medical students, as the program evolved across the country, people realized it really needed to be broader than that,” Renner said. “We have a couple of high schools that we work with in Madera around certified nursing assistant programs, and a high school in the Sacramento area, we work with on its community health worker program.”
The California AHEC has five partners that provide the latest information about health professional workforce development and share information about available resources with AHEC centers,” Garza said.
The partners are California Primary Care Association; California State Office of Rural Health; California Department of Health Care Access and Information (HCAI); California Community Colleges – Workforce & Economic Development Division; California State University Office of the Chancellor.
“For example, through its partnership with the California State Office of Rural Health, California AHEC has received a five-year grant for workforce resiliency. As a result, AHEC centers across the state will be able to provide services to address burnout among health profession students and health professionals. Burnout is a primary factor in health professionals leaving their field and we want to mitigate that by providing resources with the goal of having them stay on board with the community health center consortia they are working with,” Garza said.
“The California AHEC is grateful for its partners and the network of centers,” Garza said. “Through collaboration we are achieving the goal of recruiting, training and retaining health professionals. And that is the overarching mission of the California AHEC.”
Inspire
UCSF Fresno
People Spotlight
Tia Vang, MD
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 Tia Vang, MD, assistant clinical professor, UCSF Fresno Department of Internal Medicine and faculty practice physician at University Medicine Associates. Dr. Vang is fluent in Hmong.
What is your name? Nickname?
My name is Tia Vang, MD.
What is your hometown? Where did you go to school? High School? Undergrad? Medical School and Residency?
My hometown is Fresno. I graduated from Sunnyside High School, and attended college at the University of California, Berkeley. I received my medical degree from the University of Washington School of Medicine and completed internal medicine residency training with Alameda Health System/Highland Hospital in Oakland, California.
What are your titles?
I am an UCSF assistant clinical professor at UCSF Fresno.
Why did you decide to become a physician?
From a young age, I have always been fascinated with math and science. At the same time, I grew up seeing my family and community members struggle with access to quality health services. I eventually decided to merge my interests in a career in medicine.
How did the UCSF Fresno Doctors Academy influence your decision?
UCSF Fresno Doctors Academy was instrumental in providing me with opportunities to gain exposure to health-related careers while allowing me to learn and understand the health disparities in Fresno County. It also enhanced my experience with a rigorous academic curriculum, which shaped me into a competitive college applicant. The Doctors Academy strongly influenced my perspectives and growth as a high school student and helped to pave the way for my career in medicine.
Do you have any areas of expertise or special interests, if so, what are they?
I practice primary care Internal Medicine with interests in metabolic syndromes, preventative medicine, and social determinants of health.
What, if any, challenges or obstacles did you encounter on your path to becoming a physician?
As the first in my family to go to college and medical school, it was challenging to navigate medical school prerequisites while helping to support my six siblings financially and academically. However, my struggles to balance multiple responsibilities strengthened my resilience, which helped me be successful in medical school and residency.
What advice do you have for students who are pursuing careers in health and medicine?
Find those who share your similar interests and let them guide you to carve your own path.
What is at the top of your professional to-do list?
My priority is to be a mentor to residents and students, and to collaborate with organizations and other professionals who are interested in addressing health disparities to help improve health outcomes in the Valley.
What do you like to do in your off time?
I enjoy doing international backpacking trips.
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 am very happy to be back in Fresno, and to serve and be a voice for the communities that have inspired my journey to medicine.
Alyssa Marie Rivera
Supporting UCSF Fresno
Scholarship Support: Fueling the Next Generation of Physician Leaders for the Valley
By Kathleen Smith, Development and Alumni Relations, UCSF Fresno
The UCSF School of Medicine’s San Joaquin Valley Program in Medical Education (SJV PRIME) seeks to recruit and train future physicians to address the unique health needs of the region’s diverse and underserved populations. Students admitted to the program spend their first 18 months of medical school in San Francisco, then transition to the Fresno regional campus for the remainder of their education. SJV PRIME’s curriculum is tailored to address health issues prevalent in the Valley and encompasses community engagement programs, core seminars, clinical immersion experiences, and robust mentorship and support. SJV PRIME incorporates the unique expertise of UCSF, UC Merced, and UCSF faculty at UCSF Fresno, as researchers, educators and leaders in the field of health care in the Valley.
All SJV PRIME medical students come from or possess close ties to the Valley, so they are particularly motivated to ensure that high-quality, comprehensive, and well-distributed medical care is available to every patient, regardless of geographic location, socioeconomic level, or life circumstance. SJV PRIME helps us “grow our own” by training students from the Valley, in the Valley, and for the Valley.
One of our exceptional students is Alyssa Marie Rivera from Fresno. Alyssa just completed her first year in SJV PRIME and is grateful for scholarship support from generous donors like you. In the following Q&A, she shares more about herself and the impact of scholarship support.
Please tell us a little about yourself and how you first became interested in medicine.
My mother was diagnosed with leukemia when I was young, and she received the best care at Cleveland Clinic Hospital. When we moved to Fresno, a severely medically under resourced community, my mother no longer had access to the specialists she required for her health. We had to travel three hours north for checkups, and I would often miss school. In college, I started learning more about the social determinants of health and challenges to care, which prompted my interest in medicine.
Why did you choose UCSF and what are you looking forward to training here?
I chose UCSF specifically because of SJV PRIME. This program allows me to go back to my home in Fresno for the second half of the program to complete my clinical rotations and help address the unique needs of my community as a physician.
What are your career goals or interests in medicine?
My current interest is in emergency medicine, pediatrics, and pediatric emergency medicine. I also hope to engage in public health work.
How would you describe the impact of your financial aid?
My financial aid has been a tremendous help. It has allowed me to focus on my school work and becoming the best physician I can be. Pursuing this profession has been rewarding, but also costly, especially coming from a family with only one working parent and two of us currently in medical school.
If you could thank donors personally, what would you say?
Thank you for investing in my future and the future of my community! I have dreams of re-shaping health care and improving my hometown community of Fresno. You are not only helping one person become a physician, you are also helping support the future of an entire community! I intend to pass on the same kindness that you have shown me to others – now and in the future.
Establishing a new scholarship or giving to one that already exists lets you make a difference in the life of a talented, purpose-driven student who shares UCSF Fresno’s mission and culture of innovation, service, compassion, and collaboration. Your generous support helps ensure that the highest-quality medical education remains accessible to the most exceptional Valley students that mirror the diversity of the communities they will one day serve.
To learn more about how your gift to UCSF Fresno can help us continue the important work of educating the next generation of physicians for the Valley, contact Kathleen Smith, assistant director of development, UCSF Fresno, at (559) 499-6426 or kathleen.smith@ucsf.edu.
Kudos
UCSF Fresno
Recognition
Loren Alving, MD
Congratulations to Loren I. Alving, MD, on her appointment to the Mr. and Mrs. David George Rowe and Stephen W. Rowe Endowed Chair for Teaching in Neurology. The purpose of the endowed chair is to support teaching in the UCSF Department of Neurology. Dr. Alving is a health sciences clinical professor in Neurology; director of the UCSF Fresno Alzheimer & Memory Center and director of the UCSF SJV PRIME. This is the first endowed education chair appointed at UCSF Fresno.
Kudos to Kathryn Bilello, MD, UCSF clinical professor; director of the UCSF Fresno Pulmonary and Critical Care Medicine Fellowship and Central California Faculty Medical Group physician on being named to the Pulmonary Disease Board by the American Board of Internal Medicine.
Congratulations to the numerous award winners who were announced at UCSF Fresno’s 2022 Resident and Fellow Commencement:
Brian Chinnock, MD, and wife Karin Chinnock
Each year, the UCSF School of Medicine awards the prestigious Henry J. Kaiser Award for Excellence in Teaching to four members of the clinical faculty. These awards recognize outstanding teaching, motivational skills and communications abilities. One of these prestigious awards is reserved for a faculty member at UCSF Fresno. The winner of the 2022 Kaiser Award for Excellence in Teaching at UCSF Fresno is Brian Chinnock, MD, RDMS. Dr. Chinnock is a health sciences clinical professor and research director in the UCSF Fresno Department of Emergency Medicine.
Outstanding First-Year Resident: Jessica Wang, DO, UCSF Fresno Family and Community Medicine Residency Program
Outstanding Resident or Fellow Teacher: Julian Nguyen, DO, UCSF Fresno Family and Community Medicine Residency Program
Outstanding Attending Teacher: Kulraj Dhah, DO, UCSF Fresno Department of Family and Community Medicine
Outstanding Non-Physician Teacher: Julianne Jacober, CNM, Community Regional Medical Center
Borba Faculty Research Award: Marina Roytman, MD, UCSF Fresno Department of Internal Medicine
Borba Fellow Research Award: Andrew Hwang, MD, UCSF Fresno Department of Internal Medicine, Hematology/Oncology Fellowship
Borba Resident Research Award: Omar Mahmood, MD, UCSF Fresno Internal Medicine Residency Program
VA ICARE Award: Omar Mahmood, MD, UCSF Fresno Internal Medicine Residency Program
Leon S. Peters Resident of the Year: Rachna Casteel, DDS, UCSF Fresno Oral and Maxillofacial Surgery Residency Program
Leon S. Peters Fellow of the Year: James Yang, MD, UCSF Fresno Department of Internal Medicine, Pulmonary Critical Care Fellowship
Fresno Madera Medical Society Steven N. Parks, MD, Leadership Award: Heather Chow, DO, UCSF Fresno Pediatrics Residency Program
Kudos to Emy Lopez Phillips, EdD, on being appointed the inaugural director of the newly created UCSF Fresno Office of Health Career Pathways within the Department of Undergraduate Medical Education.
Congrats to Marina Roytman, MD, on being inducted to the Marquis Who’s Who Biographical Registry.