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Migration and Immigration of Latinos to the Midwest

Since the mid-nineteenth century, several push and pull factors have contributed to the migration of Latinos to the Midwest region of the United States (U.S.). All Midwestern states—including Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin—saw increases in the Latino population during this time period. Many forces driving immigrants to the Midwest were related to these individuals’ desire to achieve the ever-elusive “American Dream,” with economic opportunities prompting Latino laborers to establish initially transitory residence in the region.

For migrant laborers in the 1880s, the Midwest region served as a source of seasonal work, not a place for permanent settlement [1]. Jobs in the agriculture, railroad, meatpacking, stockyard, and manufacturing industries attracted primarily unaccompanied males of Mexican descent; these individuals would move to and within the U.S. Midwest according to seasonal harvests or project availability and would return to Texas, California, or Mexico after their work was complete. With these expectations, Midwest-based employers directly sought out these males, often offering wages too low to support workers’ families in order to depress expenses. Moreover, established residents of Midwestern communities often welcomed this strategy, as many feared that, if migrants were offered equitable salaries, they might settle permanently into their communities and affect access to employment [1]. These employment practices contributed to a generally transitory community of Latino workers in the Midwest through the turn of the twentieth century.

War in the 1910s saw a disruption of this pattern of temporary residence. Mexican immigration to the United States increased as individuals sought greater salaries, stability, and safety in the wake of the Mexican Revolution. Alongside this, World War I depressed European migration to the Midwest, creating an immense workforce void. Under pressure from the agricultural sector to address labor shortages, the U.S. Congress implemented the Immigration Act of 1917, allowing Mexican immigrants to enter the United States under a temporary guest-worker contract program. Agricultural employers in the Midwest began to replace their European immigrant workers with ethnic Mexican laborers. This trend accelerated after quota laws in the 1920s reduced the number of legal immigrants allowed from Southern and Eastern Europe [1]. Employers thus started to entice married men with families and, for the first time, hire entire families. This strategy proved successful, and migrants established a more permanent presence in the region. While ninety percent of the Mexican-origin population during the 1930s in the United States resided in five southwestern states, 7% made their home in the Midwest [2]. As cities like Chicago, Detroit, and Minneapolis attracted migrants to the industrial industry, laborers moved from rural to urban areas during times when work slowed in the fields.

World War II created more opportunities for Latinos, as many Americans left to join the military. This led to further expansion of rural laborers into urban settings as they found higher-paying and more stable employment. The war also reduced European agricultural production, leading to an increased demand for U.S. harvests. To address this demand, the U.S. and Mexico established a formal guest-worker agreement, the Mexican Farm Labor Program (Bracero Program), that supplied contract male guest workers to fill the voids in the agriculture and railroad industries [3]. The economic success brought on by the Bracero Program led to a continued agreement even after the war. Another agreement was made with Mexico in 1951 to address labor shortages caused by the Korean War.

The evolving sociopolitical climate of the mid-twentieth century, coupled with corresponding changes in U.S. immigration policy, led to a diverse expansion of the Latino diaspora within the U.S. Midwest. As part of Operation Bootstrap (Manos a la Obra), Puerto Rican contract laborers joined Mexicans in the Midwest. To both control the island’s “overpopulation” and facilitate Puerto Rico’s industrialization, the Puerto Rican government sent male agricultural laborers and female domestic servants to the mainland United States [4]. Prior to the 1940s, mainland Puerto Rican communities were concentrated primarily in the U.S. Northeast region. Migration of Puerto Rican workers following World War II led many such individuals to establish themselves in various Midwestern cities, including Chicago, Illinois; Milwaukee, Wisconsin; and Gary, Indiana. Notably, Operation Bootstrap failed at increasing employment in Puerto Rico and ultimately led to more poverty on the island, displacement, and migration to the mainland United States [1]. Due to the Jones-Shafroth Act, which granted Puerto Ricans statutory U.S. citizenship in 1917, Puerto Rican laborers could not be deported once their work contracts expired, or even if they abandoned their contract before completion—unlike laborers recruited from Mexico [4]. This permanent status contributed to the establishment of stable Puerto Rican communities throughout the U.S. Midwest. Moreover, immigration laws implemented in the latter half of the twentieth century “significantly transformed the Latina/o population in the Midwest” by facilitating migration from several other Latin American countries. By the 1970s, half of all immigrants to the United States were from Latin America [1]. The number of political and economic refugees from Central and South America, as well as Cuba, the Dominican Republic, and other Caribbean nations, surged in the late 1960s through the 1980s.

The growth of this diverse Latino population considerably changed the demographics and culture of the U.S. Midwest. In 2003, data released by the U.S. Census Bureau showed Latinos had become the nation’s largest racial or ethnic minority group [2]. 2021 Census data demonstrate that Hispanics/Latinos comprised 18.9% of the nation’s population. and Illinois is ranked tenth among states with the highest proportion of Latinos [5].

Education of Latinos in the Midwest

As more Latinos began to call the Midwest home, their children entered the education system. As many immigrant parents did not speak proficient English and the majority of teachers and administrators were not proficient in Spanish, immigrant parents were less able than their Anglo counterparts to advocate for their children. Ineffective communication between parents and teachers/administrators was one major factor limiting the number of students that experienced academic success [1, 6]. Parents who were monolingual Spanish were labeled as “uninterested” and “uncaring” because they were not as engaged with teachers in conferences or at extracurricular activities. However, Colvin and co-authors dispelled this idea and discovered that parents were frustrated with the typical communication models between parents and schools [1]. Adding to the challenges facing Latino families and their children’s education, Spanish-speaking children were often separated from English-speaking peers and placed into mobiles outside of the main educational structure [7]. Districts engaging in this practice delivered disparate education to non-English speakers in comparison to English speakers. As educators have more recently identified the benefits of bilingual education on children’s brain development, the physical division of the learning environment on the basis of language deprived all groups of children from potential educational and social benefits [8]. Moreover, such educational practices forced Latino children to forgo Spanish, learn English, and fall behind in their learning until mastery of the English language was attained.

Notably, while children across the Latino diaspora faced the challenges described above, individual subgroups encountered unique obstacles to their educational and social advancement. Unlike Mexican and Mexican American groups who were dispersed throughout the Chicagoland area, Puerto Ricans established themselves in distinct barrios (neighborhoods) in Chicago’s Northwest side [4]. In the 1950s and 1960s, these barrios experienced a “lack of service workers who spoke Spanish and respected sociocultural differences; high infant mortality rates and incidence of preventable diseases; increasing unemployment due to industrial restructuring; police brutality; inadequate educational opportunities; and high incidence of fires induced by white supremacists to drive residents in the area out of the area.” [9]

In response to the verbal and physical abuse Puerto Ricans endured, several community organizations arose to promote and safeguard the education of Latino youth. Among these was the Young Lords Organization, which emerged in the Lincoln Park neighborhood of Chicago and expanded nationally through the late twentieth century [4, 10]. Initially labeled a street gang, the Young Lords became a youth organization: they helped denounce police brutality, advocate for living wages, and demand community control of institutions and land. They developed daycare programs, demanded low-cost housing, and challenged urban renewal efforts that displaced Puerto Ricans in efforts to gentrify the area. Continued unrest prompted the emergence of the ASPIRA Network in Chicago; first founded in New York, ASPIRA established a presence in Chicago in 1968 after the “Division Street Riots” catalyzed efforts to address the growing social and educational needs of youth in the city’s Puerto Rican community [11]. ASPIRA’s mission was to promote the self-determination of Latinos and other underserved youth, through education, leadership development, and cultural awareness. To accomplish this, ASPIRA began operating student clubs and a youth development center geared at providing academic enrichment and career counseling for Latino students. These and other initiatives of the post-Civil Rights era reduced high school dropout rates and promoted the retention of Latino students throughout the U.S. Midwest. In 2020, Latino children—99% of whom are US-born or naturalized citizens—represented nearly one in four public school students in Illinois. While many of the issues fought by the Young Lords, ASPIRA, and others persisted through the turn of the twenty-first century, Latinos have gone on to comprise the largest proportion (46%) of students in Chicago Public Schools as of this chapter’s writing [12].

As the share of Latino students in primary and secondary education grew, a concomitant increase in the number of Midwestern Latino college students followed. For example, the number of Latino students between the ages of eighteen to twenty-four attending college in Illinois increased to over 2.1 million students in 2011 [13]. At the time of writing, Latinos represent the largest non-white racial or ethnic group enrolled at U.S. college campuses [14]. As such, university administrators have a unique opportunity to add curricular elements reflective of their students’ ethnic backgrounds and to create programs geared at improving graduation rates for all students [1]. The Illinois State Legislature established a blueprint for such a program upon creating the Urban Health Program at the University of Illinois in 1978 [15]. Introduced in response to health inequities disproportionately affecting African-American, Native American, and Latino communities in Illinois, this program began to assist not only in the acceptance and retention of Latino students in the University of Illinois College of Medicine (UICOM), but also in the creation of a space in which students could support and mentor each other. The establishment of the Hispanic Center of Excellence at the University of Illinois Chicago (UIC HCOE) built upon the successes of the Urban Health Program. To address the severe shortage of Latinos in medicine, UIC HCOE developed an educational pipeline program to support students as they progress from high school to the level of medical school faculty. In the period from 1991 to 2006, UIC HCOE and its counterparts across the U.S. received federal funding to support their shared mission. When federal financial support for all COEs was cut in 2006, UIC maintained its commitment to its HCOE, allowing the latter to continue combating the underrepresentation of Latinos in the medical profession.

Origin of the Latino Midwest Medical Student Association (LMMSA)

The point is not to pay back kindness but to pass it on.

—Julia Alvarez, Dominican American author and poet

The support provided by UIC HCOE and similar programs proved critical for Latino students to not only enter medical school, but also to network with their counterparts throughout Chicagoland and beyond. In the early 1980s, a small number of universities in the U.S. Midwest began to focus on supporting the development and/or enhancement of student organizations that brought together Latinos/as interested in medicine and other health professions. From such efforts, two organizations in Chicago emerged and became very important for the aspirations of Latino premedical students: the Latin American Student Association – Pre-Health Committee at Loyola University; and the Health-Oriented Latino Association (HOLA) at UIC. Some of the students that entered the UIC College of Medicine in the fall of 1982 had been involved in these premedical organizations. Jorge Girotti, PhD, former Director of the UIC HCOE, reflects that the students “felt that Latinos in medicine did not have a voice that addressed the issues of Latino communities. They looked at other areas of the country to see if any organizations were already doing that work, and found them on the East and West Coasts.”

These ambitious students established La Raza Medical Student Association at UIC in 1983. Often referred to as “La RaMA,” the UIC chapter chose this name based on a medical student organization in California, which had a mission that spoke most directly to their interests. The Spanish phrase “la raza” was thought to “instill a sense of ethnic and cultural pride extending to all Latin American people.” [11] In the late 1980s, the UIC La RaMA students met with their counterparts at other schools in Chicago and surrounding Midwestern states. This included students from the University of Michigan, who had founded their institution’s Latin American & Native American Medical Association in 1985. Students during this time period met during medical conferences and remained in contact through telephone meetings. They would share with one another what meetings they were likely to attend and seek funding from their institutions for travel costs. Over time, these in-person and virtual encounters fomented a desire to connect disparate institution-based medical student groups together under a larger regional umbrella.

This Midwest regional organization came to fruition with the formal establishment of the Latino Midwest Medical Student Association (LMMSA) in Chicago in 1990. That same year, LMMSA held its first regional conference, uniting approximately twenty students primarily from UIC College of Medicine and the University of Michigan Medical School (Table 4.1). Juan J. Guerra, MD, who attended the UIC College of Medicine in 1990, reflects that the “individuals he trusted the most were the medical students in the Midwest that were like” him. “This trust,” Dr. Guerra recounts, “was critical in helping me get through the challenging times of exams and the stress that comes with graduate school.” He recalls the time when an administrator at the College of Medicine addressed his class and stated that a large number of the class would fail their medical exams. Discussions like these were a driving force to rely on peers for support rather than faculty members. Many medical students had similar stories from their institutions and could relate to one another. The shared experiences of Latino medical trainees fostered a growing sense of interconnectedness across universities in the U.S. Midwest and, eventually, across the nation.

Transition to NNLAMS Midwest

In 1999, at its tenth regional conference, LMMSA members and leaders (Table 4.2) welcomed medical student representatives from the National Boricua Latino Health Organization (NBLHO), LMMSA’s counterpart in the U.S. Northeast. Founded as the Boricua Health Organization (BHO) in 1972, NBLHO had established numerous chapters of Latino medical students at Northeastern medical schools. In traveling to the Medical College of Wisconsin in Milwaukee, NBLHO leaders Philip DeChavez, MD, MPH; Edgar Figueroa, MD; and others sought to persuade LMMSA members to join a burgeoning national consortium called the National Network of Latin American Medical Students (NNLAMS). As a medical student at the University of Pennsylvania, Dr. DeChavez served as NBLHO President and strongly advocated for the unification of Latino medical students into one national organization. LMMSA co-presidents Marcelo Venegas, MD, from UIC, and Sandra Torrente, MD, from the University of Missouri-Kansas City, appeared open to the idea of joining NNLAMS and agreed to discuss the prospect further. Dr. Figueroa recalls the Midwest and Northeast groups celebrated this moment of progress by going salsa dancing shortly after the conference ended. The two groups bonded and kept in touch until attending the 2000 National Conference of the recently established National Hispanic Medical Association (NHMA). There, LMMSA formalized an agreement to join the nascent NNLAMS consortium later that year.

As LMMSA developed national connections, its regional identity, infrastructure, and programming continued to expand. Midwest leaders developed a logo showcasing the caduceus staff in front of a globe highlighting the map of North and South America, with flames from the sun in the background. The organization formally assumed the name NNLAMS Midwest, as the national consortium obtained federal recognition as an established non-profit organization under Internal Revenue Code Section 501(c)(3). NNLAMS Midwest established two annual meetings for the academic year: the House of Delegates meeting and the Annual Regional Conference. The House of Delegates meeting allowed for the regional board to have direct contact with chapter leaders and review strategies for regional development. The Annual Regional Conference (Table 4.3) continued to facilitate networking between medical students across the U.S. Midwest, while providing career development opportunities and education on health disparities facing Midwestern Latino communities. Moreover, regional conference workshops included panels of physician leaders and medical admissions faculty providing advice on building a successful path into medicine. By connecting medical students to faculty and professionals committed to supporting the next generation of Latino physicians, NNLAMS Midwest began to address the gap identified earlier by Dr. Guerra and others. This provision of potential mentors, advisors, and role models represented a core element of NNLAMS programming, both regionally and nationally, and remains apparent in modern-day efforts of NNLAMS’s successor, the Latino Medical Student Association (LMSA).

At the local level, NNLAMS Midwest supported its institutional chapters as the latter focused on hosting health fairs, volunteering at various medical centers, and providing mentorship to undergraduate students. Trina Helderman, MD, was a medical student at Indiana University (IU) School of Medicine and NNLAMS Midwest regional president from 2003 to 2004. She founded a chapter at her institution known as the Society of Latinos (SOL) in response to the large Spanish-speaking community they served. Locally, students advocated for these patients and provided Medical Spanish courses for classmates. She remembers, “At the time, there were a lot of Spanish-speaking patients and very insufficient interpreters or bilingual providers and a lack of translated materials.” The SOL Chapter hosted lunch talks on topics specific to Latino health and formed a peer support group much like that offered by the regional conferences. Many SOL members participated in various outreach clinics and helped develop the IU Student Outreach Clinic which functions to this day.

The spring of 2006 was also a historical time for medical student activism in the Midwest and the nation. In cities both large and small, hundreds to thousands of people took to the streets to protest H.R.4437, a congressional bill that would have classified undocumented immigrants as felons. Across the nation, these mega-marches drew an estimated total of 3.5 to 5 million participants [16]. The March 10th demonstrations in Chicago saw more than 100,000 people march for immigrant rights. On May 1, over 400,000 Chicagoans marched from Union Park to Grant Park, the largest such demonstration in the city’s history. Among these participants were Latino medical students from LaRaMA and surrounding chapters in Chicago, including former NNLAMS Midwest regional president, Jared Terronez, MD. Dr. Terronez shared that the students in attendance “all felt the calling to bring some form of awareness for immigrant rights at that time. We wanted it made clear that we, as Latino/a medical students, were the future of medicine and that we were going to advocate for our underserved patient population. Our white coats [worn at the event] were a visual representation of our place in society that could not be ignored, both metaphorically and visually.”

The heightened socio-political awareness of immigrant communities and their struggles drove Latino student leaders to propose a “national day of action.” This effort was championed by Daniel Turner-Lloveras, MD, then a medical student at the University of Chicago with roots in California. He nostalgically recollects learning from his father about César Estrada Chavez, the prominent Latino American civil rights activist, and traveling seven hours as a young boy to attend Chavez’ funeral procession. Dr. Turner-Lloveras still remembers waking up with 50,000 people camped out across the fields around him. “I will never forget that. It made a great impression on me. A year later, I entered an essay competition in Sacramento, California, and tried to continue to spread the word about [Mr. Chavez] in college and medical school.” Dr. Turner-Lloveras attended Chicago’s May 2006 rally, where then-UIC medical student Christina Chavez-Johnson, MD, delivered a powerful speech in support of immigrant rights. Coincidentally, the two had met many years prior to medical school at the funeral of Mr. Chavez, Dr. Chavez-Johsnon’s tio (uncle). Shortly after the march, Dr. Turner-Lloveras approached Dr. Chavez-Johnson to pitch and flesh out the day of service idea. Dr. Chavez-Johnson recollects she was excited about the idea, and both leaders presented the proposal together to the NNLAMS national executive board with “a PowerPoint and a smile.” In March 2007, NNLAMS passed a resolution to establish the “National Latino Healthcare Day” and became a part of “honoring and supporting Chavez’ legacy to educate, inspire, and empower the community.” The Friday closest to Mr. Chavez’s birthday, March 31, was designated as the day on which all NNLAMS chapters nationally would act in solidarity by performing a community service activity, thereby honoring the legacy of Cesar Chavez. The Midwest region chose to honor this day of action with a service event following each regional conference thereafter.

Rebranding as LMSA Midwest

As regional and national programming expanded and became more intertwined, a growing push for unification led to the adoption of a new organizational name in 2010: the Latino Medical Student Association (LMSA). As national leaders discussed changing the organization’s name from NNLAMS to LMSA (the name used by the NNLAMS region representing the West), the Midwest favored this change as it reflected the latter’s previous regional title and allowed for easy branding of one unified, national student body. As the new LMSA Midwest, the region temporarily shared the LMSA West logo until artwork for the entire organization was finalized. Moreover, at the UIC Forum in 2010, LMSA Midwest co-hosted the national organization’s first standalone national conference, independent from external organizations. The event also marked the adoption of the name LMSA National, bringing the community together to celebrate a shared title and identity. Notably, this milestone was commemorated through an event separate from the LMSA Midwest regional conference held only weeks prior at the University of Chicago Pritzker School of Medicine. Elizabeth Homan Sandoval, MD, MPH, LMSA Midwest co-president at the time, recalls how exciting it was to host two conferences in the Midwest: one for the region and another for the national organization. “However, the workload for two conferences was intense. Ever since then, the National Conference has been held in conjunction with the regional conference instead of separate [events].” This practice has only recently ended, with LMSA National slated to host a separate National Conference in the fall of 2023. Dr. Homan Sandoval recollects how well attended the conference was and how profusely advisors and alumni expressed their admiration. With signature events, such as a welcome reception at the renowned National Museum of Mexican Art, LMSA “set the bar high that year for all future national conferences.”

Between 2010 and 2020, LMSA Midwest began to increasingly stress Latino physician involvement in academia. Through mentorship and fellowship, students worked together on research publications. Starting in 2011, Midwest regional conferences incorporated Research Poster Presentations. Students from across the region traveled to present their scholarly work and a panel of Latino academic physicians assisted in judging. This allowed for alumni to strengthen their commitment to the regional organization and its student body.

As part of this growing emphasis on Latino scholarship, in early 2011, LMSA Midwest leaders raised the issue of the importance of language concordant care to the quality of health care being delivered to Spanish-speaking populations. Students were quick to point out that a dearth of Spanish-speaking physicians may be contributing to health and health care disparities among Latino/a patient populations. As LMSA Midwest co-president and a medical student at UICOM – Urbana, Raymond Morales, MD, PhD, MS, suggested that LMSA conduct a regional survey of medical Spanish components within medical school curricula. This project was pursued with the goal of establishing a call to action and an LMSA policy statement regarding this issue. “Our study was part of a movement to improve the care of Spanish-speaking populations starting with provider representation and linguistic and cultural competency in medical school,” states Lauren Rodriguez, MD. “This study occurred at a time of significant student advocacy at my institution [University of Michigan] for the first longitudinal, institutionalized medical Spanish curricula, which was advanced in tandem with a new Global Health & Inequities Path of Excellence. By leveraging our administration’s interest in global health and inequities, we were able to gain participation in the study and support for our goal of a more sustainable medical Spanish program.” Monica Vela, MD, faculty mentor for the Midwest region, urged the leadership to consider a national survey and pursue a publication that would allow educators to raise the level of urgency regarding the issue of medical Spanish. LMSA convened a committee to study the issue of medical Spanish curricula and over the next month conducted a series of focus groups among medical students to better inform the survey development. The committee found few studies on medical Spanish courses in the extant literature. LMSA leaders from the Midwest, including Dr. Morales, Dr. Rodriguez, and Lydia Mendoza, MD, published the “National Survey of Medical Spanish Curriculum in U.S. Medical Schools” under the mentorship of Dr. Vela. The article was initially rejected due to a poor response rate on the survey—less than 45 percent of schools completed the survey. To address this, Dr. Vela used her contacts in the AAMC’s Group on Diversity and Inclusion, and LMSA leadership encouraged each of their chapters to contact their school leadership to complete the study. Marshaling the social capital of LMSA furthered the survey completion rate. The study was ultimately published in the Journal of Internal Medicine in 2015 with a national survey completion rate of over 80%. This was the first study to describe the expanding state of medical Spanish curricula in schools of medicine across the U.S. and the need for standardized testing to ensure the cultural and language proficiency of students and faculty working with non-English language preference patients. This article is repeatedly cited as the landmark article regarding medical Spanish curricula and has served as an impetus for more scholarship in this area [17]. Dr. Vela believes “the process demonstrated the importance of alumni commitment to LMSA, the sociopolitical power of the LMSA student leadership, and the importance of representation of minority-led scholarship regarding Latino/a issues.”

These goals of mentoring and developing future physician faculty members permeated the 22nd Midwest Regional Conference, titled “Academic Medicine: Educating Tomorrow’s Doctors” and held in 2012 at the Instituto Health Sciences Career Academy (IHSCA), a public charter high school in Chicago. IHSCA provides an education focused on “preparing urban youth to succeed in competitive colleges and universities, obtain job-readiness certification for entry-level positions with higher wages in health care, and gain new awareness of and seek out a healthier lifestyle [18]. Then co-presidents Emma B. Olivera, MD, and Stacey Pereira, MD, sought to strengthen pipeline efforts with high school students. “It was important for us to show these young minority students that the possibilities were endless and, more importantly, they were attainable,” remarks Dr. Olivera. During this conference, high school students attended workshops geared specifically towards them, including overviews of anatomy/physiology, career development sessions, and even an exercise and fitness workshop. The high school students also acted as volunteers in organizing the day’s events. While the 2012 event represents the only instance in which a regional conference was held at a high school institution, LMSA Midwest has included programming for local high school and undergraduate premedical students at each major event since then.

Also in 2012, LMSA Midwest mentorship efforts more greatly intersected with policy and advocacy in the wake of inaction by the U.S. Congress regarding immigration reform. President Barack Obama spoke on the failure of Congress to pass the “DREAM Act,” which would have provided a path to citizenship for certain immigrants brought to the country undocumented as children. President Obama stated that, in the absence of congressional action, the Department of Homeland Security would institute a temporary program to defer deportation for “eligible individuals who do not present a risk to national security or public safety.” [19] Referred to as the Deferred Action for Childhood Arrivals program (DACA), this program allowed eligible individuals to obtain work authorization and attend school. In the spring of 2012, Loyola Stritch School of Medicine became the first medical school in the nation to amend its admissions policy to welcome applications from “DREAMers” who had DACA status. Mark G. Kuczewski, PhD, HEC-C, Director of the Neiswanger Institute of Bioethics & Health Policy at Loyola University, had attended LMSA Midwest Conferences since the early 2000s. He recalled receiving an email from a colleague in California regarding a student who was labeled as “the best student his colleague ever had,” but also happened to be undocumented. This propelled him on a journey to research the possibility of accepting such a student. When DACA was announced, Dr. Kuczewski “knew exactly what this meant.” It meant that these students had the possibility to attend Loyola Stritch. The medical school, encouraged by the Dean, used social media and networking to get the word out. Alongside LMSA, another organization called Pre-Health Dreamers served as a primary channel for Loyola to use to inform undergraduate students that it was now possible to enter medical school. Dr. Kuczewski claims the DACA students at the School of Medicine “changed the face of the medical school.” He believes the increased diversity of the student body drove students to learn about and become more involved in social justice causes, such as those surrounding immigration. They accepted their first DACA student in the Fall of 2013 and, as of 2020, nearly half of all undocumented U.S. medical students were enrolled at Stritch School of Medicine.

Among these students was former LMSA Midwest leader Ivonne Beltran Lara, MD. Her path to medicine was not easy, but was one of dedication and perseverance. Born in Colombia, Dr. Beltran Lara immigrated to New York at the age of six with her family, and later settled in Georgia. She “always wanted to be a doctor” since she was a young girl. Her grandmother was a nurse and instilled a love for medicine in her at an early age. Dr. Beltran Lara signed up for college as a pre-medical student; however, she could not attend for very long as the costs of tuition were too great a burden for her and her family. When the DACA program was announced, she was given the opportunity to resume her studies, all the while working full time. While she was not accepted her first time applying to medical school, this led her to seek out organizations like Pre-Health Dreamers and LMSA for guidance and mentorship. With the aid of organizations like this, she found “the light at the end of a dark tunnel” and successfully entered medical school the following year. This experience led her to realize the important role mentorship plays in one’s successful path in medicine. She has taken this lesson into both her past role as chapter president, forming a mentorship program at her school with a grant offered by LMSA Midwest, and her role as 2020–2021 LMSA Midwest Mentorship Chair, working to promote the advancement of her peers across the region.

As LMSA students continued to support each other through growing initiatives, national and regional infrastructure evolved to match. In 2012, the LMSA Midwest regional organization obtained recognition as a 501(c)(3) non-profit. Thalia Torres, MD, was the Regional Treasurer at the time and worked diligently with a non-profit organization called Odysseus to complete the task. The executive board at this time also established a chapter development grant where monies would be given to a chapter with a project consistent with the organization’s core principles and would be sustainable beyond the funding period. The intent was to allow smaller chapters to thrive and develop community or institutional projects they might not have accomplished without financial support. In 2014, the LMSA National Board of Directors reviewed the positions within the regional and national organizations. The following year the following changes were formalized. At that time it was decided that the Regional Co-Presidents would now be identified as Regional Co-Directors. The Regional Co-Directors form part of the voting body and Board of Directors within the national organization. Within the regional organization, the board members were also re-named. The regional organization restructured the following elected positions: Chief Financial Officer, Chief Development Officer, Chief Information Officer, Public Relations Chair, Policy and Academic Affairs Chair, Mentorship Chair, Community Affairs Chair, Regional Conference Chair, and Webmaster. To this day, LMSA Midwest officers holding these positions collaborate closely with their LMSA National counterparts via the latter’s Internal and External Affairs Committees (recently renamed to Operations, Programming, and Communications branches of LMSA National).

Community service, advocacy, research, and mentorship have been the longstanding principal threads that have propelled the Midwest region forward in helping end disparities in medicine. At least through 2020, the Midwest Region has continued to provide funding at various levels for students in the Midwest medical schools. These include funding for leaders of several chapters to attend regional and national meetings, academic scholarships for premedical and medical students, and seed grants to support community-engaged projects. Beyond financial contributions, the regional organization connects with medical societies, such as the National Hispanic Medical Association (NHMA) and the Medical Organization for Leadership Advancement (MOLA) to gain access to mentors, research support, and collaboration in policy forums. Christian Hernandez, MD, alumnus of the Medical College of Wisconsin and past LMSA Midwest co-president stated, “2020 posed unique challenges for various medical societies, including the LMSA Midwest region amid the COVID-19 pandemic. The region explored strategies to host regional meetings remotely.” Moreover, the leadership believed that the need to connect virtually due to COVID-19 could be optimized strategically to increase overall engagement with LMSA chapters across the Midwest without having distance or travel costs serve as barriers to participating in regional gatherings.

Conclusion

Since its inception as LMMSA, and through its transitions to NNLAMS Midwest and now LMSA Midwest, the region has continued to promote its core values of unity, service, and advocacy on behalf of its students and its communities. Whether through in-person or remote programs, LMSA Midwest has rallied its chapters across twelve states to continue pushing for the eradication of health disparities and the establishment of a diverse, equitable, and inclusive field of medicine. Like the rays of the sun represented in its first logo design (Table 4.4), the future is bright for LMSA Midwest, with more organizational support, growth, and unity ahead.

Personal Narratives:

Evelyn Figueroa, MD

University of Illinois at Chicago (UIC) LaRAMA President (1996–1997)

I am from the north side of Chicago, born to parents born in Puerto Rico (PR). Presently, my father is retired and lives with my stepmother, Mary, in Vega Alta, PR. My mother Lucille and her domestic partner Ray (together x 3.5 decades) live near where I live in Logan Square.

I have always loved science and human interaction. As a child, I verbalized interest in all sorts of scientific careers. Throughout high school, I was active in the Chicago Public Schools science fair and acquired an amazing science fair sponsor, Mr. Rosenbaum, a biology teacher. Mr. Rosenbaum and other teachers really encouraged me; they advised me to apply to medical school. I never knew a doctor growing up (we only went for fee-for-service urgent issues or physicals). Their support affected me and helped me think of a career completely outside of my world. Because of my science teachers, I focused on medicine and never looked back.

UIC College of Medicine and its structure offered many more opportunities than my undergraduate institution, Northeastern Illinois University (NEIU). At NEIU, I focused on work, volunteering, and studying; I don’t recall hearing about leadership opportunities. Through student-centered organizations like LaRaMA and Chicago Medical Student Council, I was able to develop as a leader. I served in three positions for LaRaMA: treasurer (‘95–‘96), president (‘96–‘97), and M4 representative (‘98–‘99). LaRaMA, like LMSA, worked to connect with the greater UIC community and during my presidential year, I coordinated over 100 medical volunteers for Alivio Medical Center’s Fiesta del Sol event. In addition, the UIC HCOE helped connect us to the regional and national networks of Latino students through NNLAMS and NHMA. The learning and networking at these larger events showed me Underrepresented Minorities (URM) in leadership positions, which was very important for my journey.

My biggest career goal was to be recognized as a leader, not as a Latinx leader. Since tokenism is a huge threat to any minority’s success, I have also joined mainstream organizations in order to promote diversity and inclusion. At the UIC Department of Family Medicine, I feel that I reached that; I recall during my nine-year maternity director role realizing that I was being counted upon as a leader due to my knowledge, not due to my heritage. This addressed my internal imposter phenomenon and, perhaps, the implicit bias of others. My 10 years in residency administration gave me the power to recruit, hire, and support young minorities in Family Medicine. I have been active in the Society of Teachers in Family Medicine (STFM) since 2008. I chaired a collaborative for 3 years, was a co-primary investigator for a minority mentorship grant, served on the Board of Directors for 3 years, and now am on the Foundation’s board. During this time, we (respectfully) challenged the status quo of URM promotions at STFM and the leadership responded fully to our suggestions.

My community work dating back to LaRaMA is currently the focus of my career – I am now a community activist. Our family founded a nonprofit, the Pilsen Social Health Initiative, and I direct the organization. I am able to incorporate my perspectives as a minority woman in medicine into the community work that I do. LaRaMA was the first organization that helped me realize my voice and gave me the structure to create impact. In August 2019, I reached the full professor rank – I am the first URM in the history of our department to achieve this milestone. My journey thus far has had many ups and downs, unexpected twists, and some heartache – but persistence, resilience, organization, and patience are common strategies I use to persevere. I feel really good about my contributions and the opportunities ahead.

Jimena Alvarez Soto, MD

LMSA National Secretary (2009–2010), LMSA National Scholarship Co-Chair (2010–2011)

My Latino buddies in M1 year of medical school talked about LMSA as “the” organization to join, and the encouragement coupled with unfamiliar and intimidating concepts like advocacy, representation, community, minority leadership. Even the thought of conferences, regional or national, proved to be foreign to me. Yet, my let’s-go-for-it spirit made the short drive from Rockford, IL, to Milwaukee, WI, and brought me to my first live introduction to NNLAMS (now known as LMSA) at the 2008 Midwest Regional Conference. The auditorium was full of medical students from all medical school years within the region, along with faculty physicians, discussing topics like creating awareness, finding ways to make healthcare more available to the Latino community, and ways to facilitate the medical school experience for Latino medical students. Before the end of the meeting, I had “mind-scanned” my upbringing in Peru and some of my new life experiences in the U.S., and I had decided that LMSA was an organization I was meant to be part of.

I was born in Lima, Peru, to a pair of supportive parents who, among many lessons, instilled in me the values of service, humility, and dedication. They taught me que si se puede pensar en metas grandes y justas porque mis sueños son alcanzables si trabajo duro para lograrlos. I still wonder if they were the biggest influence in my life to pursue a medical career. What I do know is that ever since I can remember, I wanted to be a doctor and that everyone I knew growing up gave me nothing but encouragement towards this goal.

International college students have narrow chances of entering a U.S. medical school, and I had been warned about that. I moved to the U.S. at 16 years old after high school graduation, holding an F-1 student visa, but my family only continued giving their encouragement from across the continent. I found very similar support from my extended family and friends in the U.S once they learned about my goal. My pre-med counselor at Brigham Young University seemed intimidating to say the least when I first heard him speak. Plus, I was one of the very few Latino pre-med students sitting in the room. Regardless, after I met with the counselor, it turned out that he became one of my biggest advocates to make my way to medical school. Then came what I like to call a miracle: my long-awaited green card was issued a couple of months before the time I was due to apply to medical school. Life seemed good between the support and blessings I had received. Only once did I get negative feedback about my goal to attend medical school, but I listened, humbly gave thanks, and kept moving forward. Looking back, I am thankful for the polarizing feedback because it was that lack of support that would later make the value of LMSA become more evident to me.

The LMSA National Conference in 2009 was my next opportunity to engage. I served as the LMSA National Secretary, communicating with the national board and taking minutes during the board meeting teleconferences. A great way to serve and learn about the different components of the organization! One day, I thought to contribute by creating something that students could directly benefit from. The project took lots—and I mean lots—of hours of brainstorming, phone calls, sending emails, finding donors, and creating awareness, but ultimately, this is how the LMSA National Scholarship for U.S. Medical Students was created. It was directed to Latino medical students or medical students from any background who demonstrated interest in the Latino community. We raised funds for our first scholarship award, and although the amount was not comparable to the medical school tuition total, everything counts and it was a contribution that in the future could potentially grow and continue helping students—it still is.

LMSA influenced my personal life by creating a platform to meet peers who have become leaders in their medical communities and to make incredible and long-lasting friendships. Academically, LMSA provided opportunities to meet in person with a variety of OBGYN programs and their program representatives in the friendly setting of the LMSA conferences. Unlike today, when we have video posts on social media and webinars at our fingertips to learn about the residency application process, LMSA was making the effort to help orient its students in their path, but live! These live interactions with different residency program leaders increased my understanding and expectations of the residency application process and residency programs. Professionally, the networking opportunities were so vast within the organization and during conferences, that I have to admit, it helped me overcome any fears related to networking, which comes in handy in any profession. My experiences in LMSA also became a topic of conversation during residency interviews. In sum, the perfect boot camp!

Participating in LMSA took extracurricular time and commitment that I had to set aside from academic time, but with the logistical organization and support provided by the organization, it was very worth the experience. Not only did the LMSA Regional Conference break the ice between me and so many intimidating concepts I was meant to unavoidably face in the long run, but it also increased my awareness of disparities based on socioeconomic status and cultural background within the U.S. medical student community. This made me look back at my strong village of support but also the instances when I felt like a minority and unsupported by discouraging feedback. It became my goal to be a part of a boat that rowed toward creating opportunities and facilitating the path for minorities in medicine, and what a better way than working with an organization that was directly involved in this purpose y poder alentar a estudiantes y mostrar que al final, si se puede!

Emma B. Olivera, MD, Assistant Clinical Professor of Pediatrics

UICOM Rockford, LMSA Midwest Regional President (2011–2012), National Coordinator (2012–2013)

I was born in a Northwest neighborhood of Chicago, Illinois. My mother immigrated as a political refugee from Matanzas, Cuba, to Chicago, Illinois, at the age of eight. My father immigrated to Chicago from Tarija, Bolivia, during a time of political unrest in his homeland in his mid-twenties. I am a prime example of the Inter-Latinidad which permeates throughout the Chicagoland area. I identify myself as Latina, but foremost as an American-Bolivian-Cuban woman, as all these cultures form who I am today.

My pediatrician, Enrique Lujan, MD, was from Bolivia and became a strong role model in my formative years. Dr. Lujan would call me colega, or colleague, when I was only 4 years old. My family instilled a strong value of an education and the importance of learning both English and Spanish. As my interest in medicine grew, much of my high school and early college years were spent volunteering at a local medical center. I saw a great need for Spanish-speaking physicians right away and knew I could make a difference in the care of my community.

During my undergraduate education at the University of Illinois at Chicago (UIC), I found a flyer for the Health Oriented Latino Association (HOLA) and immediately knew that I had to join. HOLA provided me with the additional support of peers to reach my goals as a pre-medical student and introduced me to the Hispanic Center of Excellence. It is during this time period I learned of both the National Hispanic Medical Association (NHMA) and the National Network of Latin American Medical Students (NNLAMS) and attended the first NNLAMS Midwest regional conference in 2005. I was offered a travel grant by NHMA in 2006 and coincidentally attended the first NNLAMS conference as an undergraduate student. As I did not have a family in the healthcare field, these organizations provided me with much-needed mentorship in achieving success in applying to medical school. The medical students at the time were very inviting and encouraged me to participate in regional and national activities. The individuals I met helped me stay laser-focused on my chosen path, as I had received advice from my undergraduate counselor against applying to medical school.

In 2008, Ruben Font, MD, offered me the role of Webmaster for the NNLAMS national organization. I had always been artistically inclined growing up and learned graphic and web design as a hobby during my early years in college. While working together, I remember he referred to me as “the chosen one.” It is through his encouragement that I became Webmaster of the Midwest region shortly thereafter and helped organize conferences as a pre-med. During this time, I was also a part of the NNLAMS National “Name Change Committee,” which worked to unify the organization under the name of the Latino Medical Student Association (LMSA). I graduated with a Bachelor’s degree in Biological Sciences and Latin American and Latino Studies and I was accepted to the UIC College of Medicine - Rockford after completing a post-baccalaureate program with the UIC Urban Health Program. I attribute a large part of my confidence in applying to medical school to this much-needed mentorship and to the support of my family. In medical school, I held leadership positions at my local chapter, including LMSA chapter President for my first 2 years. I organized local educational events, and community service events, and established a mentorship pipeline program with pre-medical students. I continued to hold LMSA national and regional positions, including National and Midwest regional Webmaster and National Secretary, all the while helping with the organization of annual conferences. As I had worked on the unification process of LMSA, I was also a part of the organization’s Branding Committee for the new logo design. I later was elected as the Midwest Regional Co-President in 2011, during which time I also was elected as National Coordinator-Elect. As a regional co-president, I was dedicated to increasing the strength of smaller chapters and fortifying a pipeline for high school students. Our leadership team was able to establish 501(c)(3) non-profit status for the region, chapter development grants, and scholarships. In 2012, I had the honor of acting as National Coordinator, now known as the National President. My vision as National Coordinator was to create stronger partnerships with other health organizations, such as the NHMA, Student National Medical Association (SNMA), and National Association of Hispanic-Serving Health Professions Schools (HSHPS), and facilitate the growth of regional development. My participation in these projects afforded me the opportunity to network with medical and academic professionals around the nation, which was useful when applying to pediatric residency.

In residency at the Children’s Hospital of Michigan (Detroit, Michigan) I continued to work closely with the underserved community. I was nominated as Class Representative and was also my class representative on the Liaison Committee for Graduate Medical Education (LCGME). My program director recommended me for the position of chapter representative to the American Academy of Pediatrics (AAP) Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT). It seemed natural when I attended the AAP National Conference and Exhibition I was elected AAP SOMSRFT Region V Communications Director. It also seemed inherent that I would translate my passion in medical school and LMSA to advocacy as a physician. Along with AAP membership, I met with congress members in Lansing, MI to discuss harmful laws affecting our youth with regard to e-cigarettes. I later gave a workshop on advocacy to premedical and medical students at the 2015 LMSA National Conference held in conjunction with LMSA Midwest.

LMSA has undeniably shaped who I am as a Latina physician. It has instilled in me a passion for service, advocacy, and mentorship. I use these lessons every day in my role as a board-certified pediatrician, all while continuing to serve the underserved community and provide mentorship through my participation with NHMA and local medical school programs.

Table 4.1 List of States and School Chapters (stand alone or connected) in the LMSA Midwest Region (as of December 2022)
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Table 4.2 Previous LMMSA, NNLAMS Midwest, and LMSA Midwest Co-Presidents and Co-Directors
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Table 4.3 Regional Conference History
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Table 4.4 Conference Program Artwork (All artwork property of LMSA) (©LMSA)
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