From a Small Town to Internationally Recognized Behavioral Health Expert

Where were you born?”

I was born in Guamúchil, Sinaloa, a small town in northwestern Mexico. This is the same town where Pedro Infante, the Mexican idol singer grew up before he became a celebrity in Mexico and the rest of Latin America. I attended a public elementary and middle school. At age 14, I moved to the “big city” of Guadalajara where I attended a private Jesuit high school called Instituto de Ciencias where I focused on pre-med and then enrolled at the Universidad Autónoma de Guadalajara from which I obtained my medical degree.

I never doubted that I would become a physician. I was thinking about medical school from the time I was about 11 years old. I was partly influenced by my two older brothers who also graduated as physicians from the same medical school.  Being trained by Jesuits in high school in Guadalajara, Mexico early on, I was influenced by their commitment to and compassion of serving the underserved. In high school I started to read some of Sigmund Freud’s works and became interested in the mental health field.

My parents valued education and were very supportive of all of us achieving an advanced degree even though both of them had limited education. My mother had a 6th grade education and my father had even less. My father and mother started a tortilla factory to support our family. The business became successful and they were able to give their nine children an education.  My parents had high integrity, had a strong sense of social justice, and widely respected in our town– they were compassionate especially towards farm workers and the poor. They also instilled in us a strong work ethic. I grew up working in the family tortilla factory, which was also our home, often starting at 4:30 a.m. I remember waking up to the sounds of the farmworkers’ voices from my bedroom that was on the second floor of the factory. My father (and mother) wanted me to see the struggles of the farmworkers so he would take me out in the fields to show me how to recognize the crops from a distance and talk to the farmworkers so I would understand their plight.

“What influenced you to become a physician?”

The high school I went to was quite progressive so I was able to begin my pre-med studies during my last year in high school. When I got to medical school I had a leg up because of this focused training. My mother enrolled me in first grade when I was five and consistently found myself being the youngest from elementary to high school and I officially became a physician at the age of 23. I was quickly employed with the Mexican Ministry of Health and deployed to a community health clinic in a rural town of in the state of Jalisco. A year later, I moved to a Centro de Salud in Guadalajara. Around the same time, I co-founded the first Detox Clinic for alcohol and drug addicts of its kind in Mexico.  This was a 12-bed clinic operated under the Centros de Integración Juvenil, the Ministry of Health’s prevention, treatment and rehabilitation agency in Mexico.

Based on the multiple challenges I faced treating addicts and their families, one of them being so young and inexperienced, I decided I needed more training so I applied to and enrolled in a doctoral program and obtained a Master’s of Science in Psychology and a PhD in Clinical-Community Psychology from Peabody College of Vanderbilt University. I was trained as a scientist/clinician, at the time one of the few American Psychological Association approved programs in the U.S.. The doctoral program I trained at Vanderbilt in Nashville, TN was named Transactional Ecological Psychology Program and was unique in that it, placed an emphasis on transactionalism heavily based on the work of John Dewey and the importance of the ecology or context, an early precursor of the relevance of the social determinants of behavior. From there, I had the pleasure to do an internship and a postdoctoral fellowship at the UC San Francisco’s Langley Porter Psychiatric Institute and the San Francisco General Hospital (SFGH).  At SFGH, I co-founded with my mentor Dr. Ricardo Muñoz and my colleague Dr. Jeanne Miranda the SFGH Depression Clinic, which was located in the heart of San Francisco’s Latino Mission District and primarily served Latinos and other underserved communities including immigrant and refugee populations experiencing significant stress and hardship and major depression and other health/mental health conditions.

“Traditionally in health institutions, physical health has been distinctly separated from mental health, even though both are comprised within each human being. It is apparent you have traveled in both worlds and have made the connection.”

I often reflect back to my experiences with the Mexican farmworkers. During my childhood as well as the 15 years I lived in Fresno, I saw firsthand, the struggles they went through, the constant stress they were under to find and keep work and provide for their families and to pick up and move their families to follow the crops and seasonal jobs. As my colleagues and I reported, experiencing such constant stress eventually impacted their mental and physical health. During the mid nineties, I was blessed to play a key role, along with a research team led by Dr. Bill Vega, in what for many years was the largest National Mental Health Institute funded Mental Health Study of Mexicans in the United States.  In this study we named the Mexican American Prevalence and Services Survey or MAPSS, we reported how people who suffered from mental disorders also suffered from substance use disorders as well as other health conditions.  We documented that comorbidities were the rule rather than the exception. My commitment to understanding the intricacies of mental health and substance abuse and it’s relationship to physical wellbeing never diminished. In 1999, I became involved in the World Health Organization’s World Mental Health Survey Consortium, the largest mental health survey ever conducted worldwide.  Since then, I have been a member of the Executive Committee of the World Health Organization (WHO) World Mental Health Survey Consortium (WMH) and its Coordinator for Latin America and the Caribbean.  We have documented and reported the important comorbidities between health conditions such as diabetes, hypertension, chronic back pain, cancer, etc. and mental health conditions such as depression, anxiety and substance abuse and the impact it has on needs for services.

One common thread in my professional life has been an unwavered commitment to find solutions – make things better for those who are in need of services. One example is the establishment of the SFGH’s Depression Clinic in the heart of the Mission District in San Francisco. We did not want to charge for the service because we felt the fee would restrict access. We used interventions such as individual and group cognitive-behavioral therapy creating manualized interventions that have been adopted by other research groups.

My career has converged with my current body of work. Currently, as a Professor of Clinical Medicine, Founding Director of the Center for Reducing Health Disparities, and the Director of Community Engagement, Clinical Translational Science Center, UC Davis School of Medicine I have sought opportunities to bring together all of aspects of health– integration of behavioral health and in primary care. My research team and I aim to provide better access care and increase service utilization for underserved populations such as Latinos, Filipinos and LGBTQ. A good example is the project we have undertaken in Solano County Behavioral Health Division. Representatives from the target communities, CBOs serving those communities, and county staff and representatives of other sectors – schools, churches, and the criminal justice division are working together to increase access to care and service utilization that is in tune with the culture of the clients.

As part of that project, we have conducted key informant interviews, focus groups, and community forums that allow candid discussions by community members/stakeholders like schools, churches, criminal justice – that further provide insights to how we can improve care. The work is complex and challenging but incredibly rewarding with the prospect of seeing that the underserved communities in Solano County are better served. I’m incredibly grateful for all the opportunities, mentors, and support I have encountered along the way in this long but stimulating journey.

Interview Conducted by Lia Margolis, LPOC CEO