Sep 20, 2024, 17:48 PM by Anna Shults

Hispanic Heritage Month: Hear from Carlos Esquivel, MD, PhD

What inspired you to choose a career in healthcare, and how did your Hispanic heritage influence that decision?

I was born and raised in Costa Rica. Thus, my heritage did not influence my choice of career in healthcare. I became convinced that I was going to be a medical doctor when I became very ill with measles early in elementary school, and the family physician made me feel better in such a short period. However, Costa Rica has had a progressive universal healthcare system since 1941, one of the oldest in the Americas.  The country has several reputable medical schools, many accredited internationally. Spanish is the primary language, but several medical school organizations and the majority come back to the country to enhance the overall quality of healthcare.  

Can you share a particular experience where your cultural background positively impacted a patient’s outcome?

As I was seeing consults in the liver transplant clinic, a transplant coordinator asked me if I could help with a Spanish-speaking-only patient who seemed apathetic during the consultation. A Spanish translator was helping the transplant surgeon. The communication problem between the patient and the translator might have been due to some differences in vocabulary -their countries being thousands of miles apart in Latin America- which would be fine for a regular type of conversation, but the information being provided by the consulting surgeon can be overwhelming even for an English speaking patient, the minor differences of their Spanish language became huge. However, there was more to it. In the Hispanic culture, patients often dislike when the given medical information is too direct, without a preamble, and not warm enough. They may feel that such an approach is too aggressive or that the physician does not care about them. Having been in these situations before, I pulled a chair, sat close to him, and began functioning as the translator. The patient's demeanor quickly changed, becoming engaged and asking appropriate questions about the operation and the long-term outlook. This patient eventually underwent a transplant and continues to thrive to this date. Thus, when I attend the patient selection meeting, and I hear that a Hispanic patient (or any other patient whose native language is not English) is aloof or unengaged, I will make an effort to understand better how the evaluation process went to ascertain the exchange between the consulting physician and the patient was. Occasionally, I have offered to call the patient if there is any question about the patient's commitment to undergoing a transplant.

What I did not expect about my involvement with that patient was that I would receive an admonishing email from the patient's affairs office stating that I had crossed my boundaries by functioning as a Spanish translator without having the proper credentials to do so and that I had to stop doing that immediately, unless I could take a credentialing exam which required a written and an oral test. As the old saying goes: "No good deed goes unpunished"! At any rate, I understood the implications of the policy. I considered not getting the credentialing since I was a busy surgeon. Still, the impact of helping someone going through a hardship enhanced by language and cultural barriers to getting the care they deserve was enough for me to get the accreditation. I aced both tests!

How do you balance maintaining your cultural identity while navigating a field that has traditionally lacked diversity?

I come from a multicultural country and spent several years in Sweden pursuing post-graduate studies, so I've had a sense of belonging in whichever culture I am in. However, during my residency at one of the Universities in Northern California, three minorities were among the housestaff: an African American, a woman and me. It became clear to me that there were very few Hispanic surgeons in academic surgery. At the time, I became acquainted with two prominent Hispanic surgeons from UCSF: Luis Vasconez, a plastic surgeon, and Oscar Salvatierra Jr, who was on the path of becoming a pioneer in organ transplantation, as well as President of the ASTS. When I joined the transplant faculty at the University of Pittsburgh, I became one of the four surgical team members, including Thomas Starzl, Shun Iwatsuki, and Robert Gordon. The programs grew at a blinding speed, and my responsibilities grew accordingly. There was no time to worry about fitting in or not.

As a bilingual surgeon, many migrated towards me, particularly those from Latin America and Spain, but from other countries that use romance languages, such as Italy, France, Brazil, etc. It wasn't just the language. There is a cultural bond among all of us, I suppose. When not doing transplants on weekends, we played soccer: Europe vs America. Besides being a much-needed distraction from the clinical work, it became a bonding experience for all of us and paved the way to lessen the cultural differences.

I have not consciously chosen or thought about balancing my life between cultures. I love everything about my Spanish heritage, like the food, the music, the art, the history, and the diversity among us Hispanics. I have brought friends, surgeons, or not, on cycling trips to Argentina, Uruguay, Chile, Spain, Costa Rica, Mexico, and many other European and Asian countries. We can take care of our patients the more we are exposed to foreign cultures since society is becoming more diverse.

It has been an honor and a privilege to be a member and to serve on leadership committees in the ASTS and other American surgical societies. Indeed, surgery lacked diversity when I started my journey many years ago. Still, I felt that I was fortunate to have outstanding mentors who helped me grow as a surgeon and a person, regardless of my Hispanic heritage. My primary goal all along has been to advocate for my patients, and a close second has been the team with whom I worked because, without them, I would not have been able to accomplish the most important goal, which is to give my patients an opportunity for a long and healthy life. In retrospect, this may be the reason why I was able to navigate American surgery despite being of Hispanic heritage.   

What unique challenges have you faced as a Hispanic professional in the transplant field, and how have you overcome them?

I haven't felt overt discrimination, however, when I moved to Stanford, a nice lady (so I thought) said to me: "you’ll never be the chief of transplantation here at Stanford because you do not have blue eyes!” Then, I served as the chief for more than 25 years.

Training in transplantation is intense, and the field is so specialized that we become an asset to our institutions and patients in high need of our services.

In what ways could the transplant field benefit from more Hispanic perspectives and leadership?

Providing opportunities for young kids (many of whom are Hispanic in Northern California) from disadvantaged communities to be exposed to medical disciplines. For example, the Institute for Immunity, Transplantation, and Infection created a summer program for high school students from underserved communities in the Bay Area to spend time in research labs. Many of these students have pursued careers in biosciences. Outreach programs are also effective. The advantage of outreach programs is that students are presented with opportunities without removing them from their environment. Such programs require significant financial resources.

How can healthcare institutions better support Hispanic professionals in advancing their careers in transplant surgery?

Providing grants to pursue their goals, mentorship, opportunities for continuing education in leadership, negotiation skills, and advocacy.