LHS+ Medical Student History and Heritage of the U.S. Northeast Region

Abstract

The Northeast region has the third-largest LHS+ population in the country. Harvard Medical School, with its formation of the Boricua Health Organization (BHO), in 1972, stakes claim to the oldest LHS+ regional medical student organization of the Latino Medical Student Association. The foundation and evolution of BHO to the Boricua Latino Health Organization (BLHO) and then National BLHO in the 1990s, was a reflection of LHS+ youth gathering into a critical mass to succeed in their dream of becoming health professionals and addressing health inequities in their underserved communities. As they entered an unfamiliar homogenous, hierarchical culture, often with limited resources for academic success and defying stereotypes to maintain a positive LHS+ identity, the constant inner whisper of ‘Pa’lante, Siempre Pa’lante’ (Iris Morales. ¡Palante Siempre Palante! http://archive.pov.org/palantesiemprepalante/) has led to generations of LHS+ Northeast physician leaders.

1960s to 2020s: LHS+ Migration, Identity, and Socioeconomic Trends

Migration

The Northeast (NE) currently represents the third largest regional population of Hispanics in the U.S., with 7.7 of 56.6 million U.S. Hispanics in 2015 [1]. Between 1970 and 2015 the populace of Hispanics in the Northeast increased from 1.9 million to 7.7 million, with 71% of the region’s Hispanics living in two Northeastern states—New York and New Jersey. Initially, NE Hispanics resided in metropolitan cities, however after 2000, there has been greater parity with Hispanics residing in suburbs and cities [1].

The national origin of Hispanics in the Northeast is quite distinct from other regions of the United States. The Northeast houses a significant portion of Hispanics from the Caribbean, from islands such as Puerto Rico, the Dominican Republic, and Cuba. In the 1970s, Puerto Ricans represented 2/3 of all Hispanics in the NE, followed by Cubans (roughly 11% of the population), and all other Hispanic groups individually represented single digits in proportion [1]. The large Puerto Rican influx to the mainland was attributed to seeking economic opportunities among a cohort that uniquely held citizenship status. By 2015, Puerto Ricans became 1/3 of the Hispanic NE population, and other groups represented double-digit proportions (Mexicans—12.1% and Dominicans—17.4%) [1].

Identity

Hispanic identity is often influenced and rooted in Spanish, Indigenous, and/or African cultures. Northeast Hispanics, because of the large proportion from Spanish-speaking countries in the Caribbean, have a greater influence of African culture. This contribution is largely due to Caribbean countries importing slave labor from Africa to support the large plantation economy in the Caribbean. Massey and colleagues, point out that race among Caribbean Hispanics “is not perceived as a black-white dichotomy, but more of a continuum.” [1] For NE Caribbean Hispanics, indication of racial categorization on surveys is more likely as “mixed origin” rather than a fixed category of White, Black, Asian, or American Indian.

Socioeconomic Trends

Numerous socioeconomic factors have influenced Hispanic attainment of medical degrees—including completion of high school and college degrees, resources to serve as competitive applicants and a network of role models, mentors and champions. First and foremost, graduation from college is a pre-requisite to attending medical school. In the 1970s, nearly 70% of NE Hispanics had less than a H.S. diploma; in 2015, that proportion dropped to roughly 30% [1]. Over the same time period, the proportion of individuals having some college education rose from 6% to 23% and college graduation rates increased from 6% to 19% [1]. In terms of college graduates, there was also variability within Hispanic country of origin, with Cubans and South Americans achieving college graduation at a higher proportion (respectively 37% and 27%) than Mexicans, Dominicans, Puerto Ricans, and Central Americans (ranging from 15% to 17%) [1].

In terms of financial resources, in 2015, Dominicans, Mexicans, and Puerto Ricans displayed the highest rates of poverty (approximately 25%), whereas Central Americans were approximately 18% and South Americans and Cubans were approximately 12% [1]. Lack of financial resources makes it difficult for pre-medical applicants to access test preparation materials to have an equitable chance of scoring competitively on standardized exams and the opportunity to apply to multiple medical schools.

Beyond high levels of poverty and low rates of college graduation, isolation and segregation placed Hispanics in the NE “at a distinct disadvantage in American society” in achieving graduate education, in particular medical education [1].

In reflecting on her own journey to medical school Sylvia M. Ramos, M.D., M.S., F.A.C.S., Clinical Professor of Surgery, University of New Mexico School of Medicine (Albert Einstein College of Medicine (AECOM), 1969–1974) shares:

I was born in Puerto Rico and arrived in the South Bronx at age 12 in 1959. I lived there during the decades beginning with the great white flight and ending with the burning of the Bronx. An aptitude test in high school, where I did well in Math and Science, led me to the library to explore careers in those fields. I was drawn to Medicine though I didn’t know any doctors or what such a career entailed. Nor did anyone at school suggest that path for me. At Hunter College in the Bronx, where I was a Thomas Hunter Honors Scholar, I remember being told by my pre-med advisor that he didn’t think I could become a physician. I took my own road and sought support from a professor who knew my abilities and believed in me. While a student at the Albert Einstein College of Medicine (AECOM), I adopted my niece when my sister died and took a year-long leave of absence to care for her. I graduated in 1974 and undertook a surgery residency in AECOM and affiliated NYC hospitals program. My struggles and triumphs guided me as I became the inaugural Educational Programs Coordinator of the Office for Under-Represented Students at Einstein from 1978–1982. We served as a primary location for students to express concerns about academic challenges, minority student retention, and family related issues. The office provided academic enrichment programs to enrolled students and successfully engaged in recruitment activities to increase the number of non-traditional students at Einstein. I retired from a fulfilling career in general and breast surgery in 2015.

Norma Villanueva MD, Associate Professor and the Regional Director of Medical Education A.T. Still University’s School of Osteopathic Medicine (Albert Einstein College of Medicine, 1981–1986) shares:

Growing up in the South Bronx in the 70s was tough. We were on welfare and like many youth in the neighborhood we suffered from malnourishment. We never had a primary care physician and would go to the emergency department for care. I would see white teachers and principals and ask myself why weren’t we running institutions. I would see doctors on TV and would think about being that doctor who made house calls…that’s what I wanted to be for families in the South Bronx.

Sociopolitical Activism

The increased migration by Hispanics to the NE occurred during a time of increased sociopolitical consciousness and growing unrest by youth and young adults over unemployment, lack of housing and lack of access to policy-making structure. Numerous groups emerged during the 60s and 70s to support Hispanic youth during these counter-culture times. Since 1961, ASPIRA has been a well-known organization “dedicated to serving NYC youth and their families, providing opportunities that would otherwise not be available to them, serving as an effective advocate, and fighting to improve education in the Puerto Rican and Latino communities.” [2] The Young Lords Party, was another group that emerged to address social and health inequities in the late 60 s. The Young Lords gained recognition for organizing sectors of the community around health care issues, with demands that included access to quality health care and education and subsequent recruitment of Latinos into health care fields [3].

Elizabeth Lee-Rey MD, MPH, private practice physician (University of Pittsburgh School of Medicine, 1984–1990) notes,

My political activism and my love for my Latina Puerto Rican heritage was rooted by involvement with ASPIRA of New York back during the 1970–1980s. True to the vision of Dr. Antonia Pantoja at that time there existed the early Pre Health program that involved leadership development, activities for building self esteem and confidence, medical school tours led by medical students of color, writing workshops for our personal statements, MCAT prep and most importantly, not knowing at that time that I would have lifelong friendships and colleagues in medicine. This early exposure to the opportunities, resources and witnessing those like me who succeeded and were making a difference—kept my aspirations alive.

Health Issues and Disparities

For Hispanics in the Northeast, reproductive health and family planning, access to culturally competent health care and environmental health were dominant topics [3, 4]. In the 1950s–1970s, salient to the large proportion of Puerto Ricans in the Northeast, was reproductive health and family planning. During that time the U.S. strategized to achieve population control on the island, through encouraging migration off the island and promoting sterilization services among Puerto Rican women residing on the island; this period is well narrated in the documentary “La Operación” [5]. Additionally, U.S. companies and governmental officials, in their efforts to develop and test birth control pills, had implemented numerous early clinical trials among Puerto Rican women, without proper informed consent. Nearly one-fifth of these women eventually reported regretting their decision [5,6,7].

The passage of the 1964 Civil Rights Act and the 1965 Social Security Act opened access to hospital employment and medical care for everyone [8]. Health care systems were now confronted with the responsibility of providing quality, comprehensive care for a Hispanic community, diverse by Spanish and English language preference, degree of acculturation, and social determinants of health. Unfortunately, the medical workforce at the time lacked a critical mass of Hispanic physicians and there was little if any medical education content or instruction dedicated to caring for Hispanic patients.

Concurrently, Hispanic leaders like Dr. Helen Rodríguez-Trías and community groups like the Young Lords Party were calling for greater attention to environmental and institutional factors contributing to the poorer health of Hispanic, especially in urban areas [9]. The Young Lords Party launched various programs to combat public health and medical inequalities including—street clean-ups, food kitchens, and health screenings. One of their most notable efforts was the ‘Lincoln Offensive’ of 1970, where members took over Lincoln Hospital in the South Bronx and demanded infrastructural upkeep (e.g. to manage the high levels of lead content in the walls), preventive health services, drug addiction care, and maternal and child care services [9].

Medical Student Activism Emerges and Coalesces

The emergence of social activism in the throes of the 1969 demonstrations and calls for national reform of civil rights and inequities served as the backdrop for Latino/Hispanic medical students to stand, speak, and assume a new role in medical education and the health care systems. LMSA-Northeast arose from the Boricua Health Organization (BHO), which was founded in 1972 by Harvard medical students Jaime Rivera and Emilio Carrillo [10, 11]. At the time, the medical students were motivated to mobilize in response to the rampant discrimination both inside and outside educational institutions. Moreover, they had been deeply involved in social activism and were experienced and skilled in organizing and communication. These pioneers understood firsthand that the health status of the Latino/Hispanic communities was poor and that it suffered from substandard health care. The quest for health equity inspired the resolve of these student organizers, who at times imperiled their studies, to serve a higher purpose.

Emilio Carrillo, Clinical Associate Professor of Medicine, Weill Cornell Medical College, (Harvard Medical School, 1972–1976) shares,

Doing tenant organizing and participating in student government during college prepared me for the big job ahead. One of the first things I did, even before buying my medical books, was to start organizing and talking to people about a student organization. Our class was the first to have even a handful of Latinos. Jaime Rivera and I were the only two Latinos from the East Coast. There were a few Latinos from the West Coast. This small number was in fact huge. Earlier classes had at most one and rarely two Latinos who were mostly children of Latin American families that could pay tuition and other expenses in full.

The name Boricua Health Organization was reflective of the mission of the organization to improve the health status of ‘Boricuas’ or Puerto Ricans. Prior to Spanish colonization, the native Taíno Indians referred to the island of Puerto Rico as Boriken and the inhabitants were named Boricua. The term Boricua in the name Boricua Health Organization recognized the predominant make-up of Hispanics in the Northeast, at the time, to be of Puerto Rican ancestry, and the great sense of pride Puerto Ricans had of their identity. The three areas BHO focused on were: (1) to recruit more Hispanics into medical school, (2) to retain Hispanics in medical school by understanding their cultural issues and their academic foundation, and (3) to maintain Hispanic students’ focus on the health needs of their community—“recruitment, retention, and education”.

The initial mission of the Harvard group stated:

Every person has certain inalienable rights. Foremost among these is the right of every person to live as free from illness and harm as the current status of knowledge and technology will permit. But health statistics show a strong association between the highest morbidity and mortality rates with the poorest members of our society.

We are students, providers and consumers of healthcare services, who direct our attention to the inadequacies engendered with our community in combating the ills of today’s society, we have come together as an organization in search of knowledge and common strength. We seek progressive and equitable institutionalized changes, and advocate for human rights as they apply to health care for our community [11, 12].

Early on, the Harvard students turned to several strong supporters and mentors, Dr. Alvin Poussaint, Dr. Leon Einsenberg, Dr. Furshpan, and Dr. Kravitz, as they shaped their argument that minority students had a place in medicine and a place at Harvard. The medical students shared their own experiences with the administration and highlighted examples of when the school had failed Latino/Hispanic students. One notable example was the loss of a peer and friend Luis Garden Acosta [13].^. Emilio Carrillo recounts:

A joint MIT-Harvard accelerated B.A.-M.D. 6-year program had been started to recruit promising minority students—African American, Native American, immigrant, Latinos, Puerto Ricans, and Chicanos. They recruited one Latino student, Luís Garden Acosta who was an activist in New York, and he had done a lot of work with the Young Lords (former Minister of Health, New York Chapter, Young Lord’s Party). He did very poorly in this program. The program was very well-intentioned, but in taking students who may not have all the required background, the necessary foundation in the medical sciences and biochemistry, and putting them through a 6-year accelerated program, that’s a lot for a student. Luis, because of his poor academic performance, was about to be removed from the program. I remember organizing the students to protest and call for him to be given another chance. The protest was on the local news channels and a group of community activists ended up protesting at the admissions committee. Eventually a decision was made to allow Luís to be re-accepted into the class, but he would basically have to perform at the same level as any other student. Unfortunately, despite a lot of support he got from the students, and tutoring, and the school, he fell off after the first semester.

During the 1970s, BHO built a significant infrastructure. In 1972, Jaime and Emilio reached out to Latino/Hispanic leaders in New York City, including Dr. Helen Rodríguez-Trías, to form a steering committee composed of representatives from several medical schools, as well as, practicing physicians and allied health care professionals. This led to the 1st Boricua Health Organization Conference, in 1973, at Lincoln Hospital, in New York City. Between 1973 and 1980, an active chapter continued at Harvard Medical School (led by Juan Albino, Mike Muñoz, Robert Taylor) and new chapters emerged in Boston (led by Sandra Palleja and Concha Mendoza at Boston University School of Medicine), New York City (led by Mariano Rey and Ernie Ferran at the New York University College of Medicine and led by George Friedman Jiménez and Luis Estevez at the Albert Einstein College of Medicine), Newark (led by Ambrosio Romero and Tom Ortiz at University of Medicine and Dentistry of New Jersey (UMDNJ)), and others in New Haven and Philadelphia. The organization was not just a Boston phenomenon, but an East Coast phenomenon. The member chapters became a way to sustain and grow their base of Latino/Hispanic trainees. Carrillo states “It wasn’t just being altruistic, but basically, by working with others and helping others, we were helping ourselves. It was a very lonely time. I mean, very few of us had role models in our own family.” In 1978, BHO drafted and adopted its first constitution. In the Fall of 1982, BHO with partners, launched a new journal entitled Journal of Latin Community Health. The journal was an innovative scholarly format but due to limited financial means lasted for only two issues.

Many Latino/Hispanic medical students didn’t have a BHO chapter at their school, but were fortunate to tap other networks. Others had to weather the storm and survive on their own till a critical mass arose.

Susana Morales MD, Associate Professor, Clinical Medicine, Vice Chair, Diversity, Department of Medicine, Director, Diversity Center of Excellence of the Cornell Center for Health Equity, Weill Cornell Medicine (Columbia College of Physicians and Surgeons, 1982–1986) shared that her career was directly impacted by her community experiences:

During my undergraduate years at Harvard, I worked at Brookside, a community health center in Jamaica Plain MA, as a family health worker, which strengthened my commitment to medicine. My mentors at Brookside included a Puerto Rican primary care physician, Dr. Juan Albino, a Harvard Medical School graduate and an early member of the Boricua Health Organization. I also encountered BHO at Harvard Medical School at that time, and got to know minority medical students who mentored me, including Lydia Rios, who was incredibly supportive.

My medical school experience at Columbia was complex. We had a very strong student organization named BALSO (the Black and Latin Student Organization) and tremendous support from Dr. Margaret Haynes, our Dean for Minority Affairs, and other faculty like Dr. Jean Smith, Dr. John Lindenbaum and Dr. Gerald Thomson. The fact that our school was in Washington Heights and that one of our teaching hospitals was Harlem Hospital led to our involvement in community activities. We also advocated for linguistically and culturally competent care. Unbelievably at that time, there was no interpreter service in our hospital though it served a huge Latino community. I was frequently the only Spanish speaking provider available, and patients would sigh with relief at being able to communicate, given the absence for many years of any interpreter system. The inequities and system related structural discrimination were so stark.

Another significant urban challenge during medical school and residency years was the confluence of HIV, crack, tuberculosis, gun violence and homelessness epidemics in New York City. All of these problems disproportionately impacted communities of color. AIDS was first described to us in our first years of medical school, and we cared for HIV patients at a time when there was initially no HIV test, no treatment, and intense fear. We saw many people, including many young people, die of HIV in tragic ways. The federal government’s early inaction in the face of the AIDS crisis is legendary and the entire catastrophe is in part an example of a failure of the public health system which had been systematically starved of resources and leadership for years, a punitive criminal justice system, and a drug treatment apparatus that was woefully inadequate for the needs of the community. My experiences during this tumultuous time influenced my decision to enter primary care and work on issues of health equity, access to care, advocacy around HIV, and diversity in medicine.

For Kenneth Domínguez MD, MPH, Captain U.S. Public Health Service, (Columbia College of Physicians and Surgeons and Columbia Mailman School of Public Health, 1983–1988), an awareness of Latino/Hispanic Health in the classroom and through family, pipeline programs, and mentors:

I first learned about the detailed educational pathway towards becoming a physician during a 7th grade class assignment where I interviewed my pediatrician about his career choice. I admired his vast knowledge base and ability to reassure my mom about ailments I experienced as a child. I gained a greater appreciation of Hispanic social determinants of health through stories shared by my dad at the dinner table about equity issues facing Hispanic federal workers and the importance of having union representation to address those issues particularly as they related to equal opportunity for jobs and promotions. I also learned about health issues facing migrant farm workers and the need for occupational health protections by reading leaflets on César Chávez and the grape boycotts during college at Harvard. During winter college breaks, I attended Health Careers Opportunities Program (HCOP) seminars focused on career development and health equity sponsored by the State of California and met several Hispanic physicians with joint MD/MPH degrees. This helped lay the groundwork for my goal of obtaining a joint MD/MPH… During my undergraduate years, I eagerly sought out Hispanic physician role models and enrolled in a special elective with Dr. Emilio Carrillo, an internist at Cambridge City Hospital and associate professor of medicine, who has always been passionate about serving the health needs of the local Hispanic community with a focus on culture and public health. Among the assignments was going to the community and writing down what we saw and thought was putting the health of Hispanic communities at risk; it included mapping out burned-out abandoned buildings and other potential health hazards. This work helped to support a tool to study social and cultural determinants of health which was called the Social and Environmental Relations Profile (SERP) [which eventually led to Health Care Access Barriers Model (HCAB) [14].

As a medical student at Columbia College of Physicians and Surgeons, I found myself in a greater role as a cultural informant/teacher for peers and faculty about Hispanic health. Despite being in Washington Heights, part of Manhattan’s ‘little D.R.’, there were no Spanish interpreters at the hospital. It gave me the impression that the health of Latinos and their special needs weren’t being properly addressed. Two weeks after I co-organized an educational workshop about the value of medical interpreters for students, hospital staff, and senior administrators, with the help of Dagmaris Cabezas, the Director of Community Affairs at P&S, the hospital administration hired 5 new interpreters.

Elizabeth Lee-Rey MD, MPH describes,

I grew up in a multilingual, multiracial family on the Lower East Side of NYC—known then as Alphabet City—now as Loisada. My father was born in Shanghai, China and my mother was from Arecibo, Puerto Rico. I chose the University of Pittsburgh School of Medicine because of the frequent calls from African-American and Chinese faculty who sought out my attendance at the school. However throughout my years at Pittsburgh I did not have any Latina/o medical student peers, no Hispanic advisors, and there was no Hispanic medical organization; but there was the Student National Medical Association. I knew I was different and others viewed me differently because of the way I looked and spoke; more so, others knew each other and I didn’t know anyone. The experience of being the only one and being told I only got in because of affirmative action drove me to prove myself and take action. I worked in the admissions office for four years and served as a medical student peer interviewer, casting votes like the other committee members.

Despite the physical distance I didn’t feel alone because I spoke often to ‘sisters’ from ASPIRA and other pipeline programs who did have BHO, like Daisy Otero—Harvard Medical School, Bianca Gamboa—Boston Medical College, Alina Valdez—New York Medical College and Susana Morales—Cornell Medical College.

Norma Villanueva recounts,

After starting a family and taking pre-med night classes at Hostos Community College I entered medical school (Einstein) in 1981. In the summer biochemistry review class, I met Nellie Correa, Diana Burgos, Diana Torres, Marcus Maldonado, and Jerry Maldonado. Seeing other Hispanic medical students gave me a sense of belonging. The black students were well organized through SNMA but when I started there was no BHO. Hispanics were struggling as a group to ensure that we ALL succeeded academically and worked to prevent any of us from being dismissed. Beyond Dr. Sylvia Ramos, who was extremely busy, we didn’t have mentors. The administrators in the diversity office were not able to help us with academic or personal challenges, they simply weren’t trained or prepared. There were a few Hispanic faculty, but they had completed their training in Spain or Colombia and didn’t seem to appreciate the Hispanic American experience. SNMA had great black role models and leaders. I didn’t feel like we had that and it was tough for me as a Latina coming from the community.

Ana E. Núñez, MD, Ana Núñez, MD, FACP is a Professor of General Internal Medicine and Vice Dean for Diversity, Equity and Inclusion at the University of Minnesota (Hahnemann Medical College, 1982–1986) explains,

I grew up in Altoona, a small city in central Pennsylvania. We were the only Latino family in Altoona and the way to survive was acculturation. In one medical school interview—I was told I was “Hispanic enough” because my fluency was subpar. Walking in the streets of Philly for medical school was quite different than growing up in Altoona. Actually, for me, entering into medical school was entering into three worlds—what it meant to be Latina in Philly, a Latina in medical school, and also as part of the LGBT community. As a medical student, in 1982–1986, it was weird being inaccurately stereotyped as ‘a Latina from the Philly barrios’ or as an oppressed minority.

In medical school, the expectation that came with scholarship support was engagement in support sessions. In our class, there were far more black students than Latino students. The ‘default’ approach for advising minority students was harsh tough love. “They don’t want you here” “They want to get you to fail out”. For me as a Puerto Rican from Altoona this approach was foreign, made me paranoid, and was oppressive at times. Attending those mandatory meetings, viewing myself from a deficit approach, reinforced an imposter syndrome. It was a very ‘fifty shades of gray’-like culture, tough, and perpetuated a sense of isolation. That being said, being able to speak Spanish to patients, and having others ask me for help in caring for Spanish speaking patients, did grant me a counter-balance of self-worth. I had a unique skill that helped me connect, decode and understand and then broker issues to the medical team in ways they could understand.

I didn’t have a Hispanic medical student organization at Hahnemann Medical College. When I was chief resident and as an attending, our students, who consisted largely of West Coast Chicano students and East Coast Puerto Rican students started to galvanize to develop a medical student group. BHO or BLHO didn’t work for us at the time, because of the diversity of our students so our first group named themselves the Latino Medical Student Association (circa 1990–1991). Jessy Sandaval Barrett, MD, now a child psychiatrist in Philadelphia was the founding president and I had the privilege of serving as faculty advisor. This group grew, held events and talking circles, engaged community and became an integral group within the medical school.

As more Latinos/Hispanics from different states and backgrounds joined and strengthened the organization, BHO evolved into the Boricua Latino Health Organization (BLHO); the board and membership voted in this name change in 1992. In 1993, BLHO changed its name to the National Boricua Latino Health Organization (NBLHO). “National” in the name was adopted in reference to the founders’ idea of eventually forming a national student organization.

Arturo P. Saavedra, MD/PhD, MBA, Dean and VP for Medical Affairs, Virginia Commonwealth University (University of Pennsylvania School of Medicine, 1993–2000) shared what he gained from being involved with NBLHO:

I was part of BLHO, first as a chapter member, then as a member of the executive team, becoming treasurer in 1994, at the University of Pennsylvania School of Medicine. The strong sense of community and support allowed me to confidently run for, and become, National Parliamentarian in 1998. Throughout my time with BLHO/NBLHO, I had the opportunity to learn more about my interest in medicine by serving in volunteer activities in various settings including Migrant Health work. This continues today as I participate in many events for the LHS+ community and served as the LMSA advisor for UVA School of Medicine.

I have benefited greatly from the wisdom and talent of my mentors and hope to do the same for others. Formal mentorship programs and national conferences expanded my network and allowed me to learn about future opportunities. This organization, along with other faculty members such as Dr. Ernesto Gonzalez at Massachusetts General Hospital, increased visibility around other successful Latino/a leaders that inspired me to get to the position I have today at VCU.

Luz M. Ortiz PhD, MA (Former Assistant Dean, Office of Diversity and Minority Affairs at Jefferson Medical College; Formerly Program Administrator; Minority Recruiter Counselor for Minority Disadvantaged Students at UMDNJ-Robert Wood Johnson Medical School) recounts her initial encounter with NBLHO Board members:

In April 1991, I joined the UMDNJ—RWJMS family as Recruiter Counselor for Minority and Educationally/Economically Disadvantaged Students. On my second week at the medical school, I was asked by Maxine Lisboa, MS from (UMDNJ—NJMS) to get involved with NBLHO and attend a Board meeting at Temple School of Medicine. Maxine was Director, Recruiter Counselor at UMDNJ-NJMS. I knew Maxine for well over 15 years prior to coming to UMDNJ-RWJMS. She was a champion for Latino students, faculty and administrators. She was instrumental in identifying Latinos for administrative positions at the medical schools in the Northeast. At the time, Maxine was in the process of leaving NJMS to continue her doctoral studies and asked me to attend the meeting so that I could meet the Board members and get involved with the organization. Little did Hilda Luiggi and I know when we attended that meeting that her plan from the inception was to leave National BLHO in our hands.

At the meeting, I met Hilda Luiggi, MS from Temple School of Medicine. Both of us were Faculty Advisors of our local BLHO chapters at our respective medical schools. At that Board meeting, the outgoing President and Vice President of NBLHO, asked us to serve as their official Faculty Advisors. Both Hilda and I agreed to do so. We were handed a box with information on BLHO. To our surprise, some chapters had disbanded, others were basically hanging on with little membership and, yet others, were not participating fully. At that meeting, elections were held and Bobby Ortiz from Temple School of Medicine became President; Belkis Pimentel of UMDNJ-RWJMS became Vice President.

As for the infamous box that Hilda and I were handed at the Board meeting, after the meeting ended, Hilda and I went through the contents of the box. We sat in disbelief that this was the only information available on the organization and that these students carried this box yearly, from one school to another, as the presidency changed. We laughed at the idea of the contents of this box being the only records that represented an entire organization. Que Bochorno!!!! We were in disbelief and total shock!

A few weeks later, due to personal reasons, Bobby resigned from his position as NBLHO President and Belkis ascended to the Presidency. Since we now had the presidency held by Belkis, one of my medical students from UMDNJ-RWJMS, I decided to request office space and funding for the organization. The thought of NBLHO not having a physical office in any medical school was quite alarming. At the time, our Dean was Norman Edelman, MD and the Associate Dean for the Office of Special Academic Programs was Florence Kimball, PhD. They were both in agreement that NBLHO should be headquartered at our respective medical school and provided NBLHO with a fully furnished office, computers, phone and financial support. To my knowledge, it was the first and only physical office that existed for NBLHO. When I left UMDNJ-RWJMS to join Jefferson Medical College to become the Assistant Dean for the Office of Diversity and Minority Affairs, Jefferson agreed to provide office space for the NBLHO Board.

Once Maxine left UMDNJ-NJMS to pursue her doctorate, Nancy Vega, MS was hired to fill that position. Nancy worked for many years at ASPIRA in Newark. After her first year at UMDNJ-NJMS, Nancy joined us in advising NBLHO as did Nilda Soto, MSEd, AECOM. While Hilda and I remained the official Faculty Advisors to NBLHO on paper, Nancy and Nilda helped us immensely throughout the years.

The journey for establishing NBLHO at a medical school was not a given and at times precarious. Beyond the administrative work associated with establishing a chapter, sometimes existing minority diversity leaders were uncertain of the value of having a new Hispanic student group at the medical school or the need to separate them from the Student National Medical Association, which was primarily for African-American/Black students. As Hispanic students increased in numbers, so did the resolve and confidence of a critical mass to be heard.

Luz Ortiz remembers,

It was difficult for some to understand the unique experience and needs of Hispanic students. Most Minority/Diversity Affairs Offices were pushing to grow SNMA and there wasn’t often an interest to emphasize or open NBLHO chapters on their respective campuses. Often students were told, ‘What are you complaining about? We have an SNMA chapter here to represent you’. Many times, the students requesting to open a chapter on their campus were given an emphatic “No” and told that there was no funding available for another student organization. However, as the number of Hispanic students grew, their unified voices called for fairness in allowing them to have an organization that could address their unique needs; an organization that could represent them as students who come from diverse Hispanic backgrounds and subgroups. They also pressured the administration further by telling them what other medical schools had done for their Hispanic students. Some students went directly to the Dean of Student Affairs or found themselves going to the Dean of the Medical School, circumventing the Minority/Diversity Affairs Office, in an effort to request permission to open a chapter of NBLHO at their respective medical school. Most were asked to explain the need for an NBLHO chapter in their request. The students persisted until they were allowed to open a chapter at their respective medical school.

With the evolution of the chapters there was constant networking to champion the recruitment, retention, and education of LHS+ students. A major remaining challenge was developing student leaders and transitioning leadership.

Growth of Latino/Hispanic Identified Minority/Diversity Affairs Administrators

Along with the growth of Latino/Hispanic medical students was a concurrent growth of Latino/Hispanic identified—Minority /Diversity Affairs Administrators. Latino/Hispanic administrators were slowly emerging at medical schools and coalescing in a similar way as the medical students to support themselves and build “una familia” for their students. Not uncommonly these staff were strong Latina/Hispanic women and over time several became advisors to and fixtures at NBLHO events, so much so they were dubbed by some NBLHO members and other Minority/Diversity Affairs Administrators as “Las Comadres”.

Luz Ortiz, one of Las Comadres, states.

Hilda Luiggi, MS (Temple School of Medicine; UPenn School of Medicine), Maxine Lisboa, MS, Doctoral Candidate (UMDNJ-NJMS), Nancy Vega, MS (UMDNJ-NJMS hired after Maxine left NJMS), Nilda Soto, MSed (AECOM) and I were some of the very few Hispanics in these Minority/Diversity Affairs Offices at medical schools across the nation at that time. We realized early on that we needed to form a “united front” and find a way to work together in a concerted effort to create a pipeline of qualified Hispanic students for our respective medical schools. Our decision to work closely together to advise, nurture and educate students on demystifying the admissions process and preparing them adequately for entrance into medical school became our mission. We became known by students and colleagues as, “The Comadres (The Godmothers).” From 1990–2000, we were the only four Hispanics involved in medical school recruitment. It was a priority for us to show our strength and union in recruiting Hispanics to our respective medical schools. It was not a competition for us, rather it was about guiding and getting students into the system. Students followed suit and applied to all four of our schools. Our colleagues knew that nothing was going to come between our relationship and people marveled at our strength. We were in four different schools but we planned our recruitment trips together, presented workshops for underrepresented students nationally, recruited together, and shared our resources. We would sometimes interact with 250–500 students at an event. Eventually students were being advised by their pre-health advisors or faculty from their respective colleges/universities to seek our help and advice. Looking back, we can all safely say that we needed each other because we rarely had anyone else to turn to. The lack of Hispanic representation at our level, within the administration at medical schools nationally and within our own administration, clearly helped us to see that it was imperative for us to formulate this cohesive group of like-minded Hispanic women. It empowered us in meeting the many obstacles and challenges we dealt with on a professional level and in carrying out the mission and goals for our respective medical schools. To this day, Hilda, Nilda, Maxine, Nancy and I remain best friends.

Nilda Soto shared,

Las Comadres shared the same mission which was to assist Latino premedical students to become competitive applicants to medical school. Even though we may have wanted a particular premedical student to attend our individual institution, we shared with them the contact information of the other Comadres so the student would know who they could reach out to at that medical school.

The impact of Las Comadres was felt by hundreds of students. Romeo Morales MD (Clinical Educator Associate Professor, Department of Dermatology, School of Medicine, University of New Mexico, Boston University School of Medicine, 1992–1996) noted,

In 1991, I met Ms. Hilda Luiggi while interviewing at Temple University School of Medicine for a spot in that school. My first impression of Ms. Luiggi was offering nothing less than frank, supportive, calm, and unyielding commitment to advance the agenda of not only Latino/Hispanic groups, but underrepresented minority individuals.

In 1992, I entered Boston University School of Medicine, where there was no representation of medical students of Hispanic/Latino origins. By 1994, the Association of Latin Medical Students at Boston University was a chapter of the National Boricua/Latino Health Organization, which I presided following the capable leadership of Belkis Pimentel.

At the time, one of the accomplishments derived from the National Boricua/Latino Health Organization was the 1994 Annual Convention, “Preparing for the 21st Century” which brought over 150 participants from the Northeast to Boston University. One of the main goals was simply to highlight the contributions and impact Hispanic/Latinos had in medicine. At the time the guest speakers were, Drs. Ernesto Gonzalez-Martinez and Miguel Ondetti.

The common denominator in the success and advancement of the Hispanic/Latino agenda in the Northeast were the four pistons—Hilda, Luz, Nancy, and Nilda. To those 4 pistons, I will always humbly tip my hat—por esa convicción y mentalidad siempre vanguardista!

Forming a National Identity Beyond the Northeast

In the 1990s, amidst rumors that the nascent National Hispanic Medical Association was contemplating starting its own parallel student organization and with increasing recognition among leaders of Latino/Hispanic medical student organizations throughout the U.S. of a need to collaborate more regularly, in 1999, NBLHO agreed in principle to join the National Network of Latin American Medical Students (NNLAMS). NNLAMS would have a two-tiered board, with one tier made up of the leaders of the regional organizations and a second tier of selected (as opposed to elected) officers—specifically not a president. In March 2000, NNLAMS drafted a constitution and in April 2000, NBLHO updated their constitution to indicate membership in NNLAMS. As Edgar Figueroa, M.D., M.P.H., FAAFP, Director of Student Health, Associate Professor of Family Medicine in Clinical Medicine, Weill Cornell Medicine.

Student Health Services and NBLHO President in 1999–2000 wrote in a manual to incoming officers in May 2000:

NNLAMS is a consortium formed by five regional Latino student groups throughout the United States. It was founded as an organization to represent Latino medical students with one voice, as a national Latino organization. It was formed with the hopes that the five regions would ultimately come under one name, one logo, in essence one organization.

This decision was met with some resistance—some of the student members from the NE chapters as well as some of the advisors were concerned about what this unification would mean—there were concerns about loss of history, loss of autonomy and financial implications. These themes would recur frequently over the subsequent decade.

From NNLAMS to Union Under LMSA

The decision for NBLHO to join LMSA as LMSA Northeast was an even more contentious decision. It meant moving NBLHO members and alumni from participation in a network based in the Northeast to become a part of a national organization, with governance by a national board and responsibility to four other regions. For many prior generations of NBLHO leaders and members, there was a concern of a loss of history of Puerto Rican activism, a reduction of focus on Northeast health, and a diffusion of investment in on-going Hispanic student recruitment, retention and promotion challenges in the Northeast.

Gezzer Ortega MD, MPH, Lead Faculty for Research and Innovation for Equitable Surgical Care at the Center for Surgery and Public Health, Instructor in Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School (Howard University College of Medicine, NBLHO Co-Chair, 2008–2009) shares,

In 2008, I remembered working with the other Co-Chair, Raj Sawh, to consider whether we would remain the National Boricua Latino Health Organization (NBLHO) or join a new national group named Latino Medical Student Association (LMSA). The Boricua Health Organization was founded at Harvard Medical School in 1972, and then became the Boricua Latino Health Organization and eventually the National BLHO. We eventually decided to move forward with LMSA. We were seeking something more. The name LMSA, with the word ‘Latino’ seemed more inclusive, and it was simpler; four letters like AMSA and SNMA. But for a short period, LMSA wasn’t a given. The West leaders were concerned that sharing their name with other regions on a national level might negatively impact their brand and reputation. At that time, the West had the largest membership and active alumni base. After several conversations, West extended the use of their name, and NBLHO joined as LMSA-NE.

Luz Ortiz PhD, MA (co-faculty advisor NBLHO, 1994–2013) recalls,

While we, as Chapter Advisors, understood the rationale and importance of having all regional Hispanic organizations under one name, we were not in favor of the name being changed to LMSA for several reasons.

• 1. Continuity in Leadership was imperative. It took us about 10 years to build our chapters back up and maintain continuity in leadership. The regional board members changed yearly. The students could only commit a small portion of their time to the activities of the organization. Experience had taught us that we could not depend on the students to keep the organization thriving. As advisors, we had to step up to the plate and invest many hours to it, to ensure that the organization would not fall apart, like in the late 1980s and early 1990s. By the late 1990s, we had over 40 chapters and needed to keep them functioning well.

• 2. For faculty advisors, it was difficult to maintain our chapters at a regional level, let alone a national level. Who would be responsible for each region and serve as their advisor? Would there be a National Advisor who could take on all of the regions and ensure continuity and keep chapters from disbanding?

• 3. Legacy of the Organization: We were worried that future students would lose the legacy of Puerto Rican leadership that built BHO/BLHO/NBLHO organization from the ground up.

• 4. History, Mission and Goals of the Organization: We were also worried that there would be a loss of the history, mission and goals of the organization. The change would not represent the Northeast perspective any longer.

  It was not an easy decision to make. It took years to come to an agreement. However, as we began to see the climate change for our respective Minority/Diversity Affairs offices, nationally, it soon became apparent to us that all regional organizations needed to merge and unify in order to have a stronger voice. As a national organization under one name, they would be able to do this. While we still worried about whether or not they would be able to maintain all regions fully functional under one umbrella without a National Faculty Advisor, we hoped for the best.

In 2009, NBLHO finally joined the Latino Medical Student Association, known as LMSA-Northeast representing the Northeast region of the national organization. As such, it officially changed its name from NBLHO to LMSA-Northeast to reflect the cohesion of this new national network. This was a tremendous stepping stone for the northeast region and nationally given the existence of a significant populace of individuals committed to the advancement of Latinos in healthcare with a pointed emphasis on recruitment, retention, and education, to ensure accessible, culturally competent, and reflective medical care.

LMSA-NE 2009–2020

Since 2009, LMSA-Northeast has continued its mission and has expanded its membership to include nearly every osteopathic and allopathic medical school within the northeast corridor. Despite its growth and engagement, joining a national organization was not without its challenges. Each region within LMSA-National brought its own character and value with independent leadership structures and strategies to engage in its shared mission. Bridging that distinction and embracing change came with a simultaneous restructuring of how communication was executed, especially as it pertained to a national agenda and to joint rotating national conferences, which per region, transpired every 5 years.

Today, LMSA-NEs mission is to recruit Latinos into higher education, educate the public and one another about Latino health issues, advocate for increased Latino representation in health-related areas, and promote awareness about social, political and economic issues as they relate to Latino health. It also serves to create a support network for Latino students.

In 2022, immediate objectives of LMSA-NE were: [15]

• To recruit and admit Latin-American scholars who exhibit the potential to benefit their community through the health professions.

• Retaining our members in health professions programs by supporting academic and social support activities and by fostering close ties among members.

• Educating ourselves in areas of concern to our communities which may not be part of the health profession or allied health school curricula, ie: preventive and community medicine, politics of health care systems, mechanics of urban city primary care, family practice, etc.

• Orientation of our members towards actively accepting our principles of unity and aims of our organization.

• Community involvement for the purpose of strengthening working relationships with community groups and the overall aim of benefiting the community. A means of mutual education.

• Support and encourage prospective health professions school applicants throughout the admissions process.

• Writing and circulating our ideas and fostering the refinement and development of research skills among our members.

• Encourage the development of courses which better prepare our members to become high quality health care providers serving our community.

• To educate and sensitize the entire Medical Community to the specific needs and differences of the Latino regarding health and human well being.

Long term objectives have been: [15]

• Improve the health care delivery to Latino communities.

• Be advocates of the rights of Latino patients.

• Participate in the planning and implementation of research activities designed to identify the health care needs of our community.

• Networking with other organizations at the local and national levels to achieve common objectives.

Since the first chapter in 1972, BHO/BLHO/NBLHO/LMSA NE has grown to have a chapter in 98% of accredited allopathic and osteopathic medical schools in the Northeast (Table 2.1) with student and faculty chapters and regional leaders (Table 2.2). The organization continues to sponsor yearly conventions (Table 2.3) which highlight regional issues and allow for dialogue between chapters. Between 2000 and 2023, conference titles reflected the desire for communication in English and Spanish and members to be unified, empowered, and overcome barriers for healthier communities (Table 2.3). The titles often called members to serve as leaders and facilitate change in the spheres of education, research and service. The same spheres that are listed in the mission of medical schools.

Table 2.1 List of States and School Chapters (stand alone or connected) in the LMSA Northeast Region (as of December 2022)

Table 2.2 Northeast Regional Leaders, 1994–2023

Table 2.3 List of NE Regional Conference Titles and Host Institutions

Jeans Miguel Santana, MD, Resident Physician Anesthetist, PGY-3, SUNY Downstate Medical Center (SUNY Downstate Medical School, 2012–2017) shares,

I was born in Santiago, Dominican Republic and grew up in the Bronx. As an undergrad I met a LMSA member at a regional conference and I became hooked. When you look for what you need it’s at LMSA—community, involvement, and leadership are intertwined—peers helped me appreciate this and it compelled me to become involved. I served as Northeast Co-Chair from 2015–2017 and helped to create a medical Spanish elective at Downstate to raised a greater consciousness of Hispanic culture and health

Julia Su (MD/PhD Student at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 2017-present)

I joined my local LMSA chapter in medical school to learn Medical Spanish. Reminded by my grandparents’ struggles, I wanted to become a physician that practices cultural humility. I wanted to understand other cultures and learn the language so I could provide that comfort when I encounter my patients on their worst days. My medical school also happened to be hosting the National LMSA conference that year so after being selected as the Co-Chair of my LMSA chapter, I got involved with conference planning. Helping plan a conference that empowered medical students and working with incredibly passionate people drew me into LMSA. The organization’s mission and values aligned with the kind of physician I wanted to become. There is no better way to learn about the problems and challenges affecting a specific population than from the population itself. By being present, attending LMSA events, befriending LMSA members, I heard about the issues that affect their community. From the atrocities of separation of families at the southern border to the DACA medical students facing uncertainty if they can stay in the country to finish their education, I learned a lot by being surrounded by the people these issues affected. At the 2017 LMSA National Conference, I was elected as the LMSA-NE Co-Director Elect and led the Northeast region for two years.

The strong foundation of BHO, BLHO, and NBLHO has been attributed to building LMSA members as leaders, on-going mentorship, and maintaining their focus on community issues. For the organization’s success it was necessary to engage first year medical students right away so they would be well-prepared to serve as chapter leaders by second year. The typical medical school schedule, with third years entering the clinical wards made the leadership hinge on first and second year students. Mentors who are senior administrators and know the culture and climate of the institution are invaluable and therefore every chapter is required to have a faculty advisor. Lastly, promoting trainees’ interests and maintaining their tie to the community has been the heart and soul of LMSA and often has helped trainees overcome the toughest academic times.

And we had a saying that we passed on from year to year, which is that we don’t want to become Harvardized. And that terminology kind of meant that we don’t want you to just become a stereotypical Harvard academic—we want to maintain our community roots, our community involvement….every year since we started over the 50 years—we’ve always had speakers at the conferences who are from the community, who are community activists, who are doing things for improving health in those that are more vulnerable [12]. Emilio Carrillo MD, MPH

Photos

Above: NBLHO members attending the 4th Annual NHMA Conference (2000) in Washington, DC (©LMSA)

Photo above Three of the Comadres (Right to Left—Nilda Soto, Hilda Luiggi, Luz Torres) (©LMSA)

Photos above (Left): Jose Alberto Betances and Vashun Rodriguez 2002 NBLHO Conference, University of Medicine and Dentistry of New Jersey—Robert Wood JohnsonPhoto (Right): Vashun Rodriguez and Edison Machado, 2003 NBLHO Conference, Albert Einstein College of Medicine. (©LMSA)

Photos above (Left): UMDNJ-RWJ NBLHO Board 2002Photo (Right): Albert Einstein College of Medicine. NBLHO Board 2003. (©LMSA)

Photo above NBLHO Board, 2004 NYCOM. (©LMSA)

Personal Narratives

Thomas R. Ortiz, MD, FAAFP, Founder and Medical Director

Forest Hill Family Health Associates, PA in Newark, NJ, BHO Chapter President, NJ Medical School—Newark, NJ

When I went up to Harvard Medical School to be interviewed as a premed student for a spot in the class of 1981, I was fortunate in that, on that same day a meeting of the Boricua Health Organization, BHO, a new organization representing the needs of the Puerto Rican community, was happening that evening and I was invited to attend. There was Emilio Carrillo, Juan Albino and Jaime Rivera walking the stage in a very classic Harvard Hall with all the trappings, talking about Latino lack of access to health care, working jobs, being abused, and not even offering insurance. I felt the enthusiasm in the room with the many Latino medical students from several Boston area medical schools. I felt a good understanding of the group’s mission and high ideas. I was extremely impressed and vowed to bring this same movement, this same mission to the students and community in NJ. Just so happened that I got accepted into UMDNJ NJMS along with 4 other Boricuas in the class of 1981. Add that to the 2 in the class of 80 we amounted to 7 Latinos at NJMS that year. We all got together, and I introduced the idea of starting a BHO chapter here at NJMS after getting the go ahead from Emilio and BHO Boston.

I was very encouraged by the response to my fellow Latino students and I was tasked as the first NJMS BHO Chapter president. We knew we had to do several things, after adapting the BHO Constitution, then the first and foremost was getting more Boricuas into medical school, the second was to get the current medical staff, teachers, professors and hospital staff to join us in our mission and thirdly, we had to get more medical services, education and promotion out to our Latino community as well as sensitize the mainstream health care system to understand the culture and needs of the surrounding Latino community. Our task was to increase our representation in recruitment, retention and admission of medical students at NJMS while providing classes in medical Spanish, create a brown bag lunch series of sessions on the plight of the Latino patient in our health care system presented to the school populations of all students and faculty, and to outreach with resources to the community from whom we gained good support.

The newsletter” Curandero” was born, the brainchild of Ambrosio Romero, NJMS class of 82, a monthly newsletter that published articles and announcements on our movement and programs to achieve our mission. While doing all these as medical students, we realized that we could not do it by ourselves and we expected the institution to support us as well.

Since Aspira Inc. of NJ, led by Griesel Ubarry and later Maria Vizcarrondo, was always an integral part of developing student candidate in premed to be groomed for medical school in NJ, we therefore naturally closely aligned our missions and decided to call a meeting with UMDNJ President Stanley Bergen and all of his Deans in what became known as the “The Aspira Demands of 1977”. In a coalition of medical students (BHO), Aspira officials and community leaders, 10 demands were laid out on the table.

Among the demands was for the schools, both NJMS and RWJMS, would each hire a full-time recruiter/ counselor to support our recruitment and admission of Latinos and support the local activities planned out by BHO. This was accepted and the schools hired professions for these positions and they allowed BHO participation in the selection committee. This is how Mariano Vega, Jr., Luz Ortiz, Maxime Lisboa, Mercedes Rivera and others, all came to these institutions over the ensuing years as we gained strength and numbers, translating into institutional recognition and acceptance and increasing numbers of Latinos getting admitted into NJ medical schools.

Another demand was an assigned seat on the admissions committees, which was also adopted by the schools and over the next 4 years admissions began to climb.

By 1981, NJMS had over 10 Latinos admitted to the first-year class, a national 1-year record. The NJMS BHO Chapter that year also hosted the very first National BHO convention, a 2-day event that included students representing the east coast, 10 medical schools from Philadelphia, NYC and Boston, and a national mission statement and constitution was written.

BHO and its members were very instrumental in the inception and establishment of the Student Family Health Care Clinic at NJMS University Hospital, which was created by medical students to provide free medical care to those who would otherwise be left behind. Students had an opportunity to help the community with volunteer faculty and private practice physicians. This program has grown into an institutionalized NJMS student service program to this day, generously funded by charitable organizations to give students an early experience in patient care and the poor community an opportunity to get themselves checked out.

Since 1981, I have continued to help in mentoring students and supporting their efforts to maintain the momentum of the BHO movement. Now inclusive of all Latino or Spanish speaking students from all Latin American countries, thus the evolution of the name from BHO, to BLHO to its current name NJMS Latino Medical Student Association, LMSA.

The work that we did had an impact, unfortunately, for many reasons, medical school and achieving an MD remains a challenge for Latinos. Our original BHO mission is, sadly, still relevant even today.

Fidencio Saldaña, MD, MPH, Dean for Students

Harvard Medical School, LMSA Member, Harvard Medical School 1996–2001, Chapter President 1997–1998

As a prospective Harvard Medical student in 1996, I never could have imagined being where I am today. I applied to Harvard due to encouragement from faculty as well as peers from the Stanford chapter of Chicanos in Health Education, an organization that continues to provide pre-health support to Latinx undergraduates. I recall visiting Harvard Medical School (HMS) during the underrepresented minority revisit weekend. I was in awe that I would finally have the opportunity to become a physician. I came from a humble background. My parents were both immigrants from Mexico who only had the opportunity of an elementary school education. At the time, HMS appeared to be a daunting place—one where I did not necessarily belong. However, during that weekend, I was fortunate to meet a cadre of faculty and students from similar backgrounds to my own, who helped me put aside those feelings. They insisted that not only did I belong in medical school, there was a large population of patients who desperately needed me to be their physician.

My passion at the time was to become a physician that would help take care of underserved patients—specifically those of Spanish-speaking heritage. I wanted to be their linguistic and cultural interpreter to the world of medicine. I soon became the beneficiary of wonderful mentors who were crucial in allowing me to fulfill this dream. I vividly remember one of my first conversations with Dr. Alvin Poussaint, Director of the Office of Recruitment and Multicultural Affairs at HMS. He is unaware that he was the first person who made me believe that I could pursue a career in academic medicine. Dr. Poussaint insisted that I could serve these patients on an individual as well as a collective level. He believed in both my capacity as a leader as well as my ability to have a broad impact on this population of patients.

At HMS, we had three LHS+ identified student organizations when I matriculated: the National Chicano Health Organization, Boricua Health Organization, and Latin American Health Organization. At the time, my colleagues and I formed the precursor to the HMS LMSA chapter—Medical Students de Las Americas or MeSLA. We recognized that as Latinx students we shared a common heritage and we would be stronger collectively speaking as one voice and being a source of support for one another.

There were two early formative experiences that had an incredible impact on me. The first was when one of my mentors, Ernesto Gonzalez, sponsored my trip to Washington D.C. to attend one of the first NHMA conferences, The second was taking a trip to Philadelphia to attend a Boricua Health Organization Conferences which led me to become more involved in the regional and national organization. These experiences allowed me to see that I did belong in the world of medicine. At these conferences, I was surrounded by students and physicians that looked like me and shared similar backgrounds and challenges. Every conference became a booster shot of energy and motivation that I would take back to Boston. Encouraged by one of my colleagues Fausto Mesa, past chair of the National Network of Latin American Medical Students (NNLAMS), I ran for and was elected to the national NNLAMS board and had the pleasure of attending the Garcia Leadership conference in Galveston, Tx.

Today I am part of the Harvard Medical School faculty. I am proud to say that the passion I felt as a prospective student has only grown with time. I am a clinical cardiologist and cardiac imager who serves Spanish-speaking Latino/a patients at the Brigham and Women’s Hospital (BWH) as well as BWH affiliated community health centers. As I continue to build my practice, I am working to develop programs to improve the health of Latino/a patients beyond the clinic. I am humbled on a daily basis by the gratitude in patient’s voices when I am able to communicate with them in their own language and culture while providing them with the highest quality in cardiovascular care. I enjoy being able to share this experience with the medical students and residents that join me in the clinic.

In addition to being a clinician, I have the privilege of serving as an educator both at the Brigham and Women’s Hospital as well as Harvard Medical School. One of my most memorable moments in teaching happened the first day of one of my courses, when I looked out into the crowd and saw a Latino and an African American student. I felt a great sense of pride that I was able to serve as a role model, a fellow minority in an educational leadership position. I will continue to foster these educational roles and build on them into the future.

My third role was not initially part of a formal job description, but it is a role I take very seriously. It is that of mentor—to all fellows, residents, and students, not just underrepresented minorities. I am a strong believer that we all have something to offer those who are coming up behind us. Mentorship was incredibly important and I continued to work with the LMSA students throughout my training. I would not be where I am today were it not for the paths paved by those that came before me. It came as a surprise when I was awarded the excellence in mentoring award by the HMS underrepresented minority medical students in 2008. It is an incredible honor to know that you have affected the lives of a group of individuals in such a positive manner. I had the privilege of serving as Assistant Dean of Student Affairs and Assistant Director of the Office of Recruitment and Multicultural Affairs at HMS where I served as an advocate for recruitment and retention of underrepresented minority medical students. Four years ago I became Dean for Students at HMS. I have passed on my role as LMSA advisor but continue to serve as a regional advisor to LMSA.

As a successful minority physician, I believe it is my calling to use my talents as clinician, educator, and mentor to support the careers of the minority physicians of the future.

John Paul Sánchez MD, MPH, Full Professor with Tenure, Emergency Medicine, Inaugural Executive Diversity Officer (2000–2022), University of New Mexico School of Medicine; Executive Associate Vice Chancellor, Office for Diversity, Equity and Inclusion, Health Sciences Center, University of New Mexico, LMSA Executive Director (2017-present years), Albert Einstein College of Medicine (2001–2006)

My parents were born in Puerto Rico, my mother in Moca and my father in Santa Isabel. Their parents brought them to New York City in the 1950s in pursuit of social support and economic opportunities. My parents met at a Salsa club and eventually married and gave birth to two sons, both born in the 1970s. Both parents worked for the NYC Board of Education as teachers of the English and Spanish languages. Myself and my brother Nelson Sanchez M.D. not only serve as physicians but have followed in their footsteps as educators. Growing up in the Bronx and witnessing the socioeconomic (e.g. Burning of the Bronx, decrepit buildings) and health disparities (e.g. asthma and HIV/AIDS) impacting Hispanic communities ignited a concurrent interest in medicine and public health. I was fortunate to have parents who supported educational attainment and nurtured career interests. This was critical in succeeding at schools (from elementary to medical school) where I was one of the few Hispanic identified students and often endured discrimination.

Like for many others my pursuit of medicine started in college as a pre-medical student. Unfortunately, being pre-med and associated coursework rarely addressed what it meant to be Hispanic. As such my academic performance during college suffered as I sought groups and experiences that aligned with my Hispanic upbringing and developed my knowledge and skills in understanding and addressing Hispanic community issues. NYU’s Academic Achievement Program, led by Dr. Marcia Cantarella, was one of the few spaces, to be oneself and develop as a Hispanic professional. A second formative experience was participating in the Morehouse School of Medicine/Emory Rollins School of Public/CDC Public Health Summer Fellowship Program, where I learned how to conduct health disparities research and met one of my most influential mentors, Dr. Kenneth Dominguez (medical epidemiologist extraordinaire).

Rebelling against the notion that “treatment” was the best approach to managing health, I opted to obtain an MPH in infectious disease epidemiology at the Yale School of Medicine to better understand prevention. I continued health disparity related service and research work through community based entities such as Alianza Domincana and the Hispanic AIDS Forum, culminating with a graduation thesis on “Culturally Sensitive HIV Programming for Latino Men Who Have Sex with Men?”, and serving as a founding Board Member of the Bronx Lesbian and Gay health Resource Consortium (the first LGBT Center in the Bronx).

After several years working as an epidemiologist, and having attained practical experience in researching Hispanic health issues, I re-directed and commenced medical school in the Bronx at the Albert Einstein College of Medicine in 2006. During the Office of Minority Affairs Retreat, I first learned of NBLHO—and found a new family. NBLHO meetings served as an inviting space to have critical, open, safe, Hispanic centric discussions related to admissions (Why were there so few Hispanic medical students considering >40% of the Bronx was Hispanic identified?), student affairs and promotions (What else could be done to prevent the dismissal of friends RA and BS and so many Hispanic students?), medical education (Where are the Hispanic faculty and curricula content?), and diversity and inclusion (Are we offering a minority orientation retreat?). During medical school, I served as a member of LMSA, supporting social and educational events and as treasurer in year 2, but then took a step back to focus on academic challenges. My relationship with LMSA continued after medical school, as I assumed roles as Chair of the NHMA Council of Residents and as Founding Chair of NHMA Council of Young Physicians, making sure that LMSA members remained connected to a support system through NHMA. The knowledge and skills acquired in supporting LMSA and NHMA members and constituents helped me to develop a leadership foundation to serve as an Inaugural Assistant and subsequent Associate Dean for Diversity and Inclusion at a state based medical school. In 2017, I was elected to serve as the Co-Executive Director of LMSA National Inc. and work towards giving back to a family that supported my completion of an MD and maintained my trajectory to addressing the health issues of LHS+ (Latina/o/x/e, Hispanic, or of Spanish Identified+) individuals.

Amanda Hernandez-Jones, MD, PhD, Assistant Professor, Department of Neurology

University of Connecticut School of Medicine, LMSA NE Co-Chair (2010–2014),

LMSA National President (2015–2016) Yale University School of Medicine 2009–2016

I am the proud child of two Puerto Ricans, both of whom spent the majority of their upbringing in the Bronx, NY. Growing up, I was taught not only to be proud of my heritage but to embrace the complexity, tradition, and diversity that came along with it. My parents met in the 1980s, my mother a bank teller and my father a contractor. At the time, neither of them had attended college or university but remained steadfast in their belief in the importance of education. I was born in the mid 1980s, my sister in the early 1990s, and we both spent our childhood being engrossed not only in rigorous academic practice but also in creative and open-minded spaces. Prior to my engagement in the life sciences, I was primarily focused on music as a singer and flautist. As such, the performing arts functioned as a brave and safe haven for me, especially as I navigated my frameshift into medicine and basic science research, an interest that was born out of what I witnessed in my community. Throughout my childhood and experience in New York City, I was overcome by the lack of cultural competency and bilingual providers. Apart from my intrigue for life sciences, I found myself committed to transforming these barriers and increasing accessibility to comprehensive care for my community.

At Columbia University, I set out on a pre-medical course that quickly shifted to include the neurosciences given my passion for cognition and neuronal circuitry. This interest led me to the laboratory, where for the first time I encountered the creativity of basic science research and instantly fell in love. Science afforded the capacity to be creative, think on your feet, and be bold in the approach to open ended questions and pursuit of knowledge. Initially I was torn between pursuing a medical degree and a degree in basic sciences, however, upon learning of dual-degree programs, I made the bold decision to pursue an MD/PhD. This path led me to ultimately spending 5 years at the bench during and following my undergraduate degree completing work pertaining to the neuroanatomical circuitry underlying the suprachiasmatic nucleus.

I matriculated at Yale University in 2009 to attend their medical scientist training program in pursuit of an MD/PhD. On arrival, my initial intent was to continue neuroanatomical investigations, however I found myself intrigued by autoimmunity and its intersection with neurosciences. This led me to study how dietary shifts in salt intake can alter regulatory mechanisms in multiple sclerosis and other autoimmune conditions. Much of these discoveries and curiosities dovetailed into my medical specialization as a neuromuscular neurologist wherein I am currently engrossed in research analyzing autoantibody and humoral responses in neurological inflammatory conditions.

Throughout my tenure in medical school, I was heavily engaged in communities of color starting with my local LMSA chapter which gave birth to engagement regionally and nationally with LMSA and also with the undergraduate community at Yale. In LMSA, I served as the northeast regional co-chair for 4 years from 2010 to 2014 prior to serving as LMSA National President from 2014 to 2015. At Yale University, this work was translated into the greater Yale College community and throughout this time I participated heavily in the Latinx Cultural Center, La Casa Cultural, initially as a graduate assistant and subsequently as a director. All in all, participating in academic spaces with a conscious focus on recruitment, retention, and mentorship for historically underrepresented communities added substantial latitude to my medical training and provided invaluable leadership experiences.

Jeffrey Uribe, MD, LMSA NE Co-Chair (2014–2015), Temple University School of Medicine (2011–2015)

I was born and raised in New York City by parents who immigrated from Colombia. My father came to New York City in 1969 and my mother in 1984 and met each other through mutual friends. My mother began working when I was in high school after taking night classes to complete an associate degree, despite having a bachelor’s degree in Colombia. My father worked as a taxi driver and then as a garment cutter. Early on, they understood the importance of education and they encouraged me to continue to study and not focus on working to help pay the bills which happens to many first-generation students.

My dream was to become a professional soccer player, but when I was asked by my middle school counselor what I envisioned as my future career, I could only answer “to become a doctor,”, only because my mother came to my head with what she would frequently tell the family, “He is going to be a future doctor, my doctor!” This highlighted something very important to me from a very young age and that was the clear disparity in access to medical care in my community and the cultural barriers in medical care. This was evident in my frequent doctor visits. Soon enough, I took on that vision and with my parent’s support, I entered a path that transformed my life and set my path into medicine. My middle school counselor enrolled me in a science pipeline program, a yearlong program during my freshman year at Columbia University (separate from my high school), where I had the opportunity to take college graduate classes. This introduced me to a different world, where I met other like-minded students and became immersed in the world of science. This experience was followed by another opportunity in another educational pipeline program during my junior year in high school, which involved learning medicine, SAT preparation and the opportunity of shadowing medical doctors. Sadly, but fortunately, it was here where for the first time in my life, I met Hispanic and Black medical doctors and role models. The mentors and volunteers from the medical school were members of the Black and Latinx Students Association (BALSA).

These experiences and encouragement from my mentors kept me on track as I applied to college and medical school. During medical school, I learned about the visible disparities that the Black and Hispanic communities faced. This encouraged me to become President of LMSA chapter at Temple University School of Medicine. I worked alongside Dr. Dela Cadena, who was the Assistant Dean for the Recruitment, Admission and Retention Office at Temple University School of Medicine. A very important lesson I learned is that we need more Latinos, not only in healthcare, but as administrators/Deans in very important positions including the admission committee. Dr. Dela Cadena strived to increase the number of underrepresented students at Temple, and it was here, where I felt most comfortable completing my medical degree. Working with other Latinx students as part of LMSA is where I learned that we as medical students can begin to make a difference in our communities. I was humbled to volunteer my time alongside Dr. Larson at Puentes de Salud, a non-profit healthcare clinic dedicated to serving the immigrant population in South Philadelphia. I continued leadership roles as Co-Chair of NE LMSA during medical school and as Chair of the NHMA Council of Residents during residency. I completed a fellowship in Emergency Medical Services (EMS) and as a medical director for an EMS system, so I can have a role in the intersection of healthcare, public health, and public safety and help educate and work on eliminating disparities. I will continue my role as LMSA chapter advisor, continue the fight to advance Hispanic health, and give back to the village that brought me to who and where I am today.

Julia Su (MD/PhD Student at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell)

I am the daughter of two immigrants. My mother immigrated from China while my father immigrated from Taiwan. While my parents finished their graduate degrees, I was sent to China to live with my grandparents. After living in China for 4 years, I was reunited with my parents in California. Two years later, my grandparents immigrated to California and lived with me and my parents to help with childcare. Much of my passion for working with LMSA came from my formative experiences growing up and seeing the struggles my family had in navigating the health care system.

My grandfather is a two-time cancer survivor. He does not speak any English or drive so he was dependent on my parents to be translators and to provide transportation to all his appointments. To help, I would translate medical reports to my anxious grandpa, help with scheduling appointments, and drive them to their appointments. My family is lucky in that we had the social know-how and the resources to get my grandparents the care they needed, but what about the others who did not have family members that knew English, the education to understand and navigate the healthcare system, or had the means of transportation?

I joined my local LMSA chapter in medical school to learn Medical Spanish. Reminded by my grandparents’ struggles, I wanted to become a physician that practices cultural humility. I wanted to understand other cultures and learn the language so I could provide that comfort when I encounter my patients on their worst days. My medical school also happened to be hosting the National LMSA conference that year so after being selected as the Co-Chair of my LMSA chapter, I got involved with conference planning. Helping plan a conference that empowered medical students and working with incredibly passionate people drew me into LMSA. The organization’s mission and values aligned with the kind of physician I wanted to become. There is no better way to learn about the problems and challenges affecting a specific population than from the population itself. By being present, attending LMSA events, befriending LMSA members, I heard about the issues that affect their community. From the atrocities of separation of families at the southern border to the DACA medical students facing uncertainty if they can stay in the country to finish their education, I learned a lot by being surrounded by the people these issues affected.

At the 2017 LMSA National Conference, I was elected as the LMSA-NE Co-Director Elect and led the Northeast region for 2 years. My first year as Co-Director Elect was mainly focused on developing regional programming and learning what it takes to run LMSA-NE. It was not until I fully stepped into the Co-Director role that I learned about how LMSA-NE’s fits in LMSA National and where it stands compared to other regions. Not all LMSA regions were created equal. We all face similar yet different challenges in terms of finances, history, and the support of faculty and student members. A more established region, with better infrastructure, was able to create a voter drive, and help Latinos register to vote on top of their regular four required quarterly meetings and annual conference where attendance from all chapters were required. While another region, due to lack of student leaders, was struggling to plan their own House of Delegates meeting and annual conference. Being able to sit at the National leadership table, I was able to learn the best practices from regions that were more advanced than ours and also assist regions that were newer than us by sharing our learned best practices. I also noticed that all Regional Directors including myself, always looked out for our region’s interests first. At our monthly meetings, we took pride in the projects we led and our role as a board member on a national organization was secondary to our primary role as regional director.

When I asked Freddy Vazquez, the Co-Director before me, if he had any advice to give Iara and I as we took full reign of LMSA-NE, he said, “Buy into National.” At that time, I did not understand what he meant, but as I took on the role as a voting Board of Directors member for LMSA National, I realized that my vote and my voice steered the direction of the organization. I would attend monthly National meetings and finally understood why the American government took so long to accomplish anything. If LMSA National wanted to release a statement or receive funding to do a project, all the Regional Directors would have to vote, and a simple majority would allow it to happen. However, if Regional Directors did not “buy in”, there would be discussions and no action would come about it. This can cause stagnation in the organization and frustrate student leaders so the most passionate and promising leaders would rather innovate and lead at the regional level than at the national level.

When LMSA-NE wanted to have a conference app, I did the market research and got funding approval within a month. Since it was a successful feature at our conference, I wanted to have all the LMSA regions to also have a conference app so we can all benefit from it. However, when I pitched this idea at the National meeting, I encountered resistance and the time it took from the initial pitch to final voting and adoption was five months. Once the regional leaders used the conference app themselves and saw how well-received by users. When reflecting on this experience, I realized that as Regional Directors, we have strong loyalties to the success of our region, and because there is a lack of in-person meetings at the National level, we may not always trust or cooperate as readily with people we have not met before or gotten to know well. When pitching an idea to LMSA National, one must always think about the people who vote i.e. the Regional Directors and recognize that each Regional Director will always be thinking, What’s in it for me and my region? While this process may seem slow and tedious, it is also remarkably important because anything that is done by LMSA National is reflective of our organization and our values. There are real world consequences if we publish a statement that is harmful to our cause. While we always want positive attention to what our organization does in terms of our programming and our ability to empower Latinos to pursue medicine, we must always be cautious and on the alert for any negative attention that may harm our members and damage our organization.

After serving as the Co-Director for LMSA-NE, I became the first non-Latino identified President of LMSA National and it was controversial. Some people believed I deserved the position because they had personally worked with me before, and they knew that I would continue carrying out LMSA’s mission and goals. Some believed that since the President is the face of the organization and I am not Latino, therefore, I should not be allowed to be in that position. After all, by not being Latino, how can I truly understand the struggles or culture if I did not experience it myself? Other arguments against my candidacy include: one of LMSA’s objectives is “to provide leadership opportunities to Latinos”and by becoming President I am taking away one of those opportunities. The leaders in LMSA are role models for Latino pre-health students and many studies have shown the importance of seeing someone who looks like you, who had similar shared experiences, and who understands your culture to validate that you belong and can achieve the level of success. What does it mean and what is our organization stating by voting someone who is not Latino to represent their organization and their interests?

To me, being voted as President is an honor and privilege that others have entrusted me to carry out the mission of LMSA National. It is acknowledgement by the community that they recognize me for my allyship to their cause. If I failed my duty, I could be impeached. I was voted into power by the people and could also be removed from power by the people.

What is allyship? According to PeerNetBC [16], allyship “begins when a person of privilege seeks to support a marginalized individual or group. It is a practice of unlearning and relearning, and is a life-long process of building relationships based on trust, consistency, and accountability with marginalized individuals or groups. Allyship is not an identity, nor is it self-defined. Our work and our efforts must be recognized by the people we seek to ally ourselves with. Because of this, it is important to be considerate in how we frame and present the work that we do.”

For me, my allyship began when I first joined LMSA to learn Medical Spanish. By getting involved in LMSA activities, I was able to practice critical allyship. LMSA allowed me to transform my motivation from the vague desire to help the less fortunate to concrete commitments like: “I learn from the expertise of, and work in solidarity with, historically marginalized groups to help me understand and take action on systems of inequality.” [17] As the United States becomes more and more diverse, it is imperative for physicians to understand and help fix the health disparities. In order to achieve that, everyone should practice critical allyship because there is always some part of your identity that has more privilege than someone else, whether it be race, wealth, religion, sexual orientation, etc.