INTERVIEW TOPIC LOG

00:00 Introduction 00:26 Overview of Dr. Martinez-Bianchi's Roles and Connections to Duke Health 03:03 Recollection of Childhood Community in Entre RĂ­os, Argentina 03:14 Motivation for Pursuing Medicine and Primary Healthcare Advocacy 11:57 Stories of Early Mentorship and Community Engagement 20:16 Challenges and Strategies in Community Advocacy 24:23 Student Activism During Argentine Dictatorship 38:00 Pursuing Medical Education in the United States 42:26 Kidney Transplant Research at Rush University 45:06 Stories of Community Engagement in Chicago 1:02:54 Moving to North Carolina from Iowa 1:11:17 Transforming the Department of Family Medicine Residency Program 1:18:25 Founding of Latin-19 1:28:44 Advocacy Efforts for the Latinx Community in Durham 1:32:42 Further Challenges and Strategic Approaches in Community Advocacy 1:36:19 Upcoming Role as President-Elect of WONCA 1:39:58 Current Community Initiatives 1:50:27 Balancing Family Life and Nurturing Support Networks

FULL TRANSCRIPT

Fiorella Orozco 00:01 Hello, my name is Fiorella Orozco, a third year undergraduate at Duke University. And I'm here with Dr. Martinez Bianchi in the conference room in Erwin Square Plaza. I want to thank you for joining us today for this oral history interview. Your insights are invaluable and we're excited to capture and preserve your experiences. Dr. Martinez Bianchi, could you provide a brief overview of your position, current roles, and your connection to Duke Health? Viviana Martinez-Bianchi 00:26 Yeah, so I'm a family doctor. I'm the Director for Health Equity in the Department of Family Medicine and Community Health, I have been working at Duke in the same department for 18 years. I see patients at the Family Medicine Center for half of my time and the other half is dedicated to health equity research and a lot of different things related to health equity. I'm, also outside of the Duke, I'm a President- Elect of the World Organization of Family Doctors, which I was just elected in October. FO 00:28 Congratulations. VM 00:32 Thank you. FO 00:33 So, I think we're gonna start our interview off with a few background questions about your childhood growing up. So, can you describe your community growing up? VM 01:23 Yeah, I grew up in the capital of a province called Entre Ríos, "between rivers." It's a province in Argentina, north of the province of Buenos Aires. A lot of people have gone to Argentina, to Buenos Aires, and I'm from the province right north of that. In some ways, my town reminds me of how Raleigh is, where a lot of people who work for [the] government, not too many factories. And, but the difference is that it's on the river. So [it's] a beautiful place to navigate, to sail in a non-polluted river, which was different from other rivers in the U.S. Gosh, I'm trying to, I'm thinking about this because I also lived in Iowa on the Mississippi River, which looked a lot like the river I grew up with, except that you could drink the water directly from the river in the Paraná River. But you cannot do that in the Mississippi River because of the different levels of pollution. I grew up in a town where my father was a well respected surgeon, and my mom and dad both work for the public hospital. And then also my dad had a clinic where he had a vascular surgical clinic and surgical center. And he worked half of his time at the hospital and half his time at the private center. FO 03:03 Perfect, thank you. What motivated your decision to pursue a career in medicine? And how did you envision it as a platform for positive change? VM 03:14 So first of all, I was the daughter of, when I was born, my mom was studying her PhD in biochemistry, and my dad was a first year surgical intern. So it was very, like life was about medicine. And people tell me that I would sit down with my parents. When my parents were studying, I would sit down next to them, grab the big medical books and pretend that I was studying. So, I always thought I was going to be a doctor because that's where my mom and dad did. And then it was common for us to end up. My father became the trauma surgeon in our hospital. So we often, my dad will go, you know, take us on rounds. Or we would wait in the call room while he would be seeing patients in the ER and then come back because my mom will take us in to try to have dinners with him because he was on call every Friday and one Sunday a month. So we would try to spend time there. So I grew up in a hospital environment. You know, this is years ago. I'm 60 years old today, in January. So, this was many years ago where it was more common that doctors would bring their kids to work. But when I was 14 years old, the Declaration of Alma-Ata happened. In Alma-Alta, countries of the world met in Kazakhstan to declare health as a human right, and to really promote primary health care for the world. I will never forget the day that appeared in the newspapers. And my father was really excited and he's showing me the newspapers, like Viviana, this is going to change the world, you know, health as a human right. Imagine, people are gonna have access to health care. He really, really believed that countries that were signing on to this declaration that was ratified by the United Nations, were really going to make a big effort towards primary health care. And I really was excited to see this and I thought for the rest of my life, I wanted to do that work. I wanted to do primary health care, policy advocacy, and bring this to a global setting. I was asking my father, what career, what is the specialty that I need to be? And at that time, he was saying, well, that my career had not been described yet. There was no, no one had, that that wasn't. Because what I wanted to do was not just policy, I wanted to stay a clinician, and be able to also work at the policy and global level. And so he said, well, your specialty hasn't been defined yet, but you will find your own path. So I always thought that I would do global work, policy, and primary health care. And then I discovered family medicine. And this is how I ended up moving from Argentina to the U.S. to become a family doctor, because it wasn't quite developed in Argentina when I finished medical school in 1990. But I saw what was happening in the U.S. with family medicine, and I had been a foreign exchange student as a high school student in the Chicago area. And that's when I learned about family medicine. I said, okay, that's what I want to do. And so I moved here in 1990. FO 06:54 How do you think that family medicine was able to bridge, like bridge your two interests in policymaking and health care? VM 07:04 Yeah. So this is also tied into how I grew up. My dad was a vascular surgeon, but I saw him often working in the community. My dad was the vascular surgeon who taught at the School of Anatomy and School of Nursing. He was the surgeon that everybody knew in town, that everybody would come to him for questions. If there was an accident at the beach, we because we lived at the beach in the summer, we are often there on the weekends, everybody would run to my dad to get the doctor. And when we went sailing in the islands, my father always carried the doctor's bag, and fishermen would row up to our boat. Any sort of fishermen who lived in little shacks on the islands or on the coast, they would row to our sailboat. We always had a cabin sailboat. They would row to our sailboat and my dad would teach. He would talk about diabetes. He would cure wounds. He would always be counseling. He would convince them, try to convince him to not smoke. I mean, there were all these different things. So I grew up with this model of somebody who was very community involved, as a vascular surgeon. In many ways what a lot of family doctors do. The other thing that used to happen, that for the first I guess, 10 years of his career, his consultorio, his office, was at the front of my house. And, then eventually he earned enough money to buy a surgical center. So we lived in the city. And so the office was in the front and then our home was in the back. And so, I would see how many people would come in to see him, right? But also, even when the doors were closed, and there were no longer the office hours, if any kid in the neighborhood were to fall, cut, kind of a laceration, people would run him over to our house and my father would be suturing kids at all times of the day. So I grew up watching him, seeing a lot of different people and talking with [the] community. And so when I moved to the U.S., and I when I learned about family medicine, I was fascinated because I would be able to see people from the moment that they're born to the moment they die, from birth to death and everything in between. I knew I was gonna be able to do prenatal care and deliver babies. I was really, really excited. And at the same time, I always imagined that people who are doing this are also very embedded in their communities. I couldn't imagine being a doctor not involved with a community. First, because it was the framework I grew up with when. My father was so involved in the community through the work he did. And so I said, well, family medicine, you're doing all of it, you're going to be involved, you're going to know. And, at times, I became a bit sad when I saw that a lot of my colleagues weren't so involved, right? Perhaps, they didn't work with the public health department, or they didn't know the community based organizations. But I created a career in which I was always connected with who was living in the community no matter where I worked. I wanted to know who is who in this community, which are the organizations that are taking care of, especially the most marginalized, or people who are having difficulty with access. So I just always, if the opportunity was in there already, I built the opportunity to actually do that. For example, when I was a resident in the University of Iowa, we didn't work with the free medical clinic, and I just basically challenged our faculty. Why aren't we involved with a free medical clinic? I'm one of the very few people in this city that speak Spanish and the free medical clinic sees a lot of Spanish speaking patients with interpreters. Why don't I go as a physician to see patients in the free medical clinic? And they're like, that nobody could argue with these health equity proposals, right? And so that's kind of how I put the two things together. FO 11:57 It sounds like you were always kind of advocating for community involvement wherever you went and that's very inspiring. How did you go about building trust within those organizations or with your community? Was there anything in particular that you did that made people feel more welcomed and receptive to your work? VM 12:22 Yeah, I think when I started doing this, I saw some, you know, great mentors, right? In many ways, I always mentioned my father was a great mentor. I also started my journey in the United States in Chicago with a lead abatement campaign. Back in 1990 [and] 1991, the majority of children that were suffering from severe lead poisoning were either Hispanic or Black. And the lead abatement campaign, that was the moment when I moved to Chicago, they didn't have enough volunteers that spoke Spanish to talk to [the] community so I started going there. And there were some physicians that were also involved in helping to kind of do the material, you know, educational material for the families to identify children that were suffering from lead poisoning. And so, I kind of watched what they were doing. And then there was Dr. Steve Rothschild, at the neighborhood family practice of Pilsen. Pilsen is a very large Mexican enclave in Chicago. And he had opened a clinic and he was a geriatrician, and he opened a clinic. And then, I started volunteering at that clinic. This was before I was a resident, and I was studying to pass my exams. And I realized that even though he wasn't a native Spanish speaker, there because he had had the humility to go, and he was Jewish, yet he I thought he was identified as a community member as a güero, white man. I will never forget when Doña Rosa, who was like the matriarch of Pilsen, said to me, “Do you know Dr. Rothschild es güero? Sabes Dr. Rothschild es güero” Si, si. “Y es judío? Si, pero lo amamos como familia.” But we love him as family. “Porque él nos quiere.” Because he loves us. “Y hace tanto esfuerzo en comprendernos.” He makes so much effort to understand us. To me, he was one of these great mentors where I learned from him to have humility. You can be the doctor, you can be the person who has studied all that, but the community has knowledge and they have their ways in which they care for each other. He had taken the time to watch who and what was happening in Pilsen, who was in charge, just opening a clinic wasn't enough. We know he opened the clinic. He learned Spanish as a second language. He opened a clinic in the middle of where it was most needed. He had mapped it and saw there's a clinic needed here but nobody was coming. And then he went to all the Catholic churches and the Catholic priests and offered his services and sat down with them and sat down at their mass, the Spanish mass. And, it wasn't until the community vetted him in some ways that he was going to be humble, nice, etc, that they started coming to that clinic. He was a very trusted member of that community, as a doctor. So I guess it was that right? Seeing the work of others, of real committed humility. And that can bring down your knowledge to help a community. So I was watching mentors like him, and then others in Iowa as well, where when I started working, I started seeing those possibilities. Now, of course, I finished my residency program at the University of Iowa, and then I went to work as a rural doctor. And when you start seeing the inequities, and when you start seeing the severe disparities, you're activated. I wanted to make a revolution, you know? I wanted to make changes. I was ready to start activating. I wanted to call the American Civil Civil Liberties Union. I wanted and members of the community were like doctora [doctor], calm down. “Se calma, por favor. Usted tiene privilegios.” You have privileges. “Usted es una doctora.” You are a doctor. “Usted tiene papeles.” You have papers. “Usted es blanca.” You are white. So they started pointing out all my privileges. And if you go and make a fuss, half of us are going to be deported. “A usted no la van a deportar.” You are not going to be deported. “Pero la mitad de mi familia, si.” Half of my family can be deported. "Half of my family will lose their jobs. We don't want you to shed light on this. We are living better here than we lived in Mexico. So, I had to calm down all my interests in making a huge difference and work with them to see, okay, how can I do this better? So there were other smaller things that I could do. I could buy food from the church where groups of women will get together to make tamales. And then also show my colleagues how delicious these tamales were, so then everybody would buy tamales in my clinic, right? I could, when kids get sick that didn't have access to my clinic, because perhaps they didn't have insurance. I would go and take care of them in the Motel Eight where they all lived, right. Like there were other ways I could work. And I could also work by educating my health system on why we cannot see people as the others, but we have to see them as how much they're contributing to our community. Start thinking about them as us. Right? And, I help people who don't understand other cultures as a bridge because I am learning to understand both. And I have to say learning to understand because I think we are always continuously learning things are changing. We need to always be checking to know whether we are learning or not right. So some of those things were happening. At one point I was accused by an administrator of hiring illegally. Hiring illegals? I say I don't ask whether, you know, what's the status. I do know that they are huge contributors [to the community]. I mean, the state of Iowa wouldn't be producing half of what it produces in different goods, if it wasn't for an immigrant community that came to the state. The same happens in North Carolina. 95% of migrant workers in the fields are members of the comunidad Latina [Latinx community]. They speak Spanish only. And, they make $11,000 a year for us to eat great stuff, right. So, that's my focus. Who is here? Can we start seeing people as contributors to our economy and not burden because they're not a burden? Right? FO 20:16 Did you receive any other pushback from your people in your community for the work you were doing? Advocating for the Latino community? VM 20:36 So, when you ask me the question [about] the people in my community. I belong to many communities, right? And so I think of, I'm trying to think about my community, mi comunidad Latina. I think of and am thankful that I have the privilege of a voice, and that I can talk about these issues. And I have been very careful ever since I learned that lesson, too, if I am talking about certain things, that I'm not putting people at risk, right. And I tend to know whether my patients, members of the community may have legal status or not, but I wouldn't out them and if they are out themselves, right? My healthcare community is hard, sometimes. I will say that before the COVID-19 pandemic, it was very lonely at times. But the convening of many Latina, Latine, Latinos, and allies during the pandemic, with the creation of Latin-19, brought me sisterhood and brotherhood and my community expanded dramatically, to where I don't feel that part of my health community pushes back. Because often, the data, not often always, My goal is to always bring something up, that there is data to support my claim. That there's no doubt that these things are happening, right? Yeah, I think there's a different type of pushback that sometimes happens, it's hard to find funding for some work, right? I would like for us to, to hire more representatives of the community to inform our decisions, and to inform the work that we're doing to make it better and more congruent with community needs. And, sometimes, the pushback may be hidden under structural ways that these things cannot be done, right? People are not going to tell me, oh, Viviana you cannot do that. But, they're gonna give me all the rules of why this cannot be done. Right? They get it, but then it takes so much time to change the way things are done. So I think sometimes you could call that pushback. Right? FO 23:35 It is, definitely. VM 23:36 There's a definite way, of like, how do we navigate those difficult spaces sometimes? And, how do we inform decision makers at all institutional levels, that these issues are important and are happening and we need to make a difference? Does that make sense? FO 24:00 Yes, that makes sense. Reflecting back on your early days in Argentina. What were some, what were some instances of early activism that you took? VM 24:23 So, as a student I went on a hunger strike. I wanted to enter medical school, and I grew up during the Argentinian dictatorship. So the dictatorship started when I was 11 years old, and it ended when I was 20. And in Argentina, people go to medical school right after high school. During the time, it had become a very small group of people [who] were able to [go to medical school]. And, there [in Argentina] you don't go to college right? You start right after high school. You go to Escuela de Medicina [medical school], or you go to law school, or you go to psychology school, or you just don't have four years of college, right? And so, there was a moment when you could see that it was very difficult to enter the university, and there were a lot of "who is who" getting in. And there were people who had passed the entrance exam, even at a high level, but have not been able to get in. And so, I had started going to medical school anyway, as an auditing student, so I would be in all the classrooms. I was participating in a classroom. I was doing the anatomy lab and everything else in the first year of med school, which in Argentina is a six year program. And then we started, students started organizing to make changes to propose changes into how you enter medical school. And one morning in the middle of the winter, July of 1983, I believe it was. We marched to the Chancellor's Office demanding a change in the way you enter medical school. And, so there were 100 medical students. No, 100 students who wanted to be medical students, who had been in my situation, auditing classes. And, some medical students who were already students there, but they were also asking for different restrictions or limits to how to enter [medical school]. And, so that's how I started. I had never been involved in politics, because there was no political activism during the [dictatorship]. You could die, if you were politically active during the dictatorship years. And, we marched to the Chancellor's Office and within, you know, 20 minutes of arriving, we were surrounded by police, with their guns drawn at us. And, and so the students, the leaders, who were sixth year med students started talking to the police chief, [explaining] why we were there, that we were there so that the children of workers could actually enter medical schools, that the children of police officers could actually dream of an education in medicine. And, after speaking with the student leaders, they decided that they were not going to [shoot], they were actually going to protect us. And then, soon after the military police came up as well. And then the local police turned their guns at them and said, we're here to protect them. When we're not gonna, you can leave. Well, we didn't know that there was that the police themselves had risen against the dictatorship because they had not been paid for four months. So it was like, we were very lucky [laugher] that they had already because otherwise I don't, I wouldn't be telling you this story. I am certain of that. But what happened was extraordinary and we started with 100 students that marched. Soon after we were surrounded by community members around this place. Famous musicians started coming in and started a concert right on the street. They started, they started putting, because it was so rare for medical students to be activists. So that was the first, like, usually you will see their school of political sciences in the school of law and to be the marching people. Not the school of medicine. And so, soon after, you know, like, in a couple of nights there were 10,000 people, so we are laying there on [the ground]. It was really cold, it was freezing cold, and we were there in black. And then there was a radio [station] that was across the street, which provided a shelter, but we were right there. And, on the ninth day. So what happened on the seventh day, I think other universities also went on strike like us. And suddenly the whole country, all the public universities in the country were on strike, starting with the school of medicine and all the other schools. And then on the ninth day, not only did the chancellor resign, the Minister of Education resigned for the country and I woke up in the emergency room because I had fainted. I passed out because we had been on hunger strike so all we had was broth and mate, which is an Argentinian tea. So it taught me, that experience taught me, the importance of bringing people together on something you believe in. And never in my life expected to be on that march that day, you know, with [the] other 99 students that marched. And, my parents were completely scared of what I was doing. My dad, my mom, and my grandmother came over with my little sister to see what I was doing. They wanted to take me away and I refused to be taken away. Oh, I was there until the end. And then I think what my mother, my mother had traveled that day because they were there was all this talk about what was happening in Rosario, the city of Rosario where all this was happening on the radio they were watching what was happening they were hearing what was happening on the radio and TV, but it taught me that students and marching and public activism can can end up in, you know, gaining what you were trying to do, even during dictatorship. I don't advise that. [Laugher]. FO 31:21 Can you describe your feelings of the day? Were you scared? What was that like? VM 31:25 I was just like, it was everything. You know, you're freaked out. You're, you're- how do I say this? It's the nervousness of and there's this adrenaline rush, right? Then, there's a freaked out when, you know, when the guns are pointing at us. I just like I will never forget having all the guns pointing, you know, like you're thinking oh my god. And at the same time, I just had this belief that this was a real thing and that we needed to do it and and I didn't grew up in a particularly religious environment, but my father was a believer of people, in people's ability to make a difference and I just felt that there was this light that the people had, that we were going to make a difference. And so, now my dad was very scared you know. We told you, you know. You are there to abide by the law right and I said well the law was not chosen by the people, you know, we are living in a dictatorship father, you know? But on the day, because it became really heavy, like we're talking cars and cars and they had these signs, where honk if you are in favor of the students. So it was like a nightmare of constant [noise]. And this is a city of about 2 million people and so there's a lot of noise. Oh, then musicians started doing concerts there and bonfires, right? So it became this incredible moment in a country that had been really subdued during the dictatorship and then a corollary to this was I was able to enter medical school. This happened in I think it was July, it was in the middle of the winter for us there. Then things happened and I entered medical school and then I took anatomy as an auditing student, which is very difficult to test. It's all oral in front of five people and then you have all the anatomy things and you have to go through. You have this thing with a little ball and then it tells you what are you going to be talking about and I had gone to the classes to say that I was going to take the exam and they're like, “Usted qué pretende siendo mujer?” What do you pretend being a woman? Of course, I'm like, what do I pretend to be a woman? It's like another one I'm fighting also. Not just because I want to enter or be part of medical school. He is insulting me because I'm a woman. I mean more reason for me to be activated here right. And, I grew up [with] my father believing I could do anything being a woman. There was no, you know, I grew up in an environment where it was very clear that it was my ability that if I studied, [I will achieve my goals]. My father was like, if you study well, you will go ahead. There's no gender issue here. Right? And so to hear in medical school that I am pretending to match being a woman. That I will [fail]. Nobody has ever passed that exam. It was too difficult. And I actually passed the exam and people took me. All the other students grabbed me and then they took me out in andas [on their shoulders], como se llama [how do you say]? They'll bring you on their shoulders. Yeah, on the shoulders of other students, saying Viviana pasó [passed], you know, she passed the exam. So, that was an incredible time. Also, again, it's this recognition that you can do something, that you can follow your dream and that you can be active and make it happen, right, and then the others can actually follow and do the same. You know, it was my first time believing in myself and my possibility of leadership, right, having been in that situation, you know? Walking, they used to, I used to have a backpack, nobody had backpacks at that time. And so I was like la chica de la mochila, the girl with a backpack. Everybody wanted to meet the girl with a backpack. And so it was an incredible time and yeah. I think it takes a lot of courage to do what you did. Craziness too, I have to say. A little courage, a little bit of like, not craziness, but just belief, yeah. FO 36:14 Lots of support from your parents, as well, to always believe in you. VM 36:18 And, I think that's the issue. I believed in myself and what our community of students could do, and therefore, I thought it could happen. My parents didn't believe I should be there, though. And, not in a hunger strike, obviously. But, they had made me believe, they had allowed me to believe in my abilities. Yes, yes. FO 36:41 So, in terms of your academic or your career timeline, after you graduated medical school, you moved to the United States to pursue your residency in family medicine, right? VM 36:56 Yes FO 36:56 That is, was it in Iowa? VM 36:58 So, I did two years in a suburb of Chicago, at Hinsdale Hospital. And then I met while I was doing research right after medical school. I went to Rush University in Chicago. And I met Greg who was, Greg Bianchi, who was a first year med student. And I was already done with medical school. So I didn't want to date a medical student, but he insisted. And, he kept talking to friends of mine that he wanted to date with me. So we went on a somewhat of a blind date. And, then I always say that he got the date for life. Because we've been together for 33 years. FO 37:38 Yeah, that's so sweet. VM 37:40 So, then he matched at the University of Iowa in urology. And so we moved to the University of Iowa. So I graduated and I was chief resident at the University of Iowa, in family medicine. FO 37:50 Wow, what was the most difficult part about the transition? VM 37:57 The transition from? FO 37:59 Moving from Argentina to the United States? I know you mentioned that you studied here before? VM 38:05 Yeah, I had been a high school student in the U.S. for one year in the Chicago suburbs in Mount Prospect. And so, I knew, I spoke English as a second language and had a very thick accent way thicker than now. Can you imagine it? And what was the most difficult [event]? I think it was more about missing some of my friends and my missing the people. Argentinians tend to sit in restaurants or bars for hours, and talk and, and my friends and I would meet. You know, we go to a movie and then spend four hours at the bar. And we're talking at the bar, drinking coffee and talking, not [at the] bar getting drunk, right? Like we will just be. And, my friends were from other schools from law and psychology, and political sciences and anthropology and we will meet and talk for hours and hours. And, I was really homesick for those friendships for the people with whom I could talk and think about the issues of the world and how to solve them, right? We would create our own revolutions in our minds and work together, think about things right? Or, we would go see a movie. And if, like, for example, we would go see a movie with some of them and I wouldn't understand the movie. We would go back to see the movie again to try to understand. We're talking like dense Almodóvar movies, or French or British movies that had lots of new nuances. And so, they were, I grew up in a very biological family, where there was a lot of nature. We will go to the islands, and stay in the islands and eat fish that we've got. And my friends had lived in skyscrapers in Rosario going to museums and living in a city. And so, I was learning from them and they were learning from me, right? So I was very homesick for that. Family, of course. Then my father died. After I moved here, he died six months later. And I never had the chance to get back with him about what I was doing with my career. And that was a really, really terrible loss. I was cleaning houses in Chicago. I had no money, no money, especially after my father died. So I learned a lot about, you know, being street savvy, and until I pass my exams. The other thing, I was very naive. When I moved to the US, my family sold an apartment for me to move here. Now the apartment, the condominium, they sold was $9,500. Imagine, what do you do in the U.S. for $9,000? Doesn't last too long. So I was like this. And then my dad died. And so I didn't have any source of income from [family] and then I couldn't work here legally, right? So I clean houses for friends of friends and friends of friends. And that was my first initial job in the U.S. And then I started doing research that gave me a room and board. They couldn't pay for me. So they gave me a place to stay. But at least they had an academic home so I could be at the university and use the library and computers there. And I don't know. I've always been very resilient and if bad things happen. I would always move forward. And so that was I think I was armed with that, the resilience. Being the granddaughter of immigrants and an immigrant myself, I just just do it, you know? I don't know. I don't tend to worry or think about the difficulties, I think. I tend to think more about what I can do to make a difference or make a difference in my life or the lives of people around me? FO 42:26 That's an amazing perspective to have. I was wondering if you can talk a little bit more about like the research session that you had when you [were at the university]? VM 42:37 Yeah, I woked in a pathology department doing research on kidney transplant rejection, and [that was] enough to learn that I will never be a pathologist because I couldn't talk to tissue, and the tissue wouldn't talk back to me. But, it was amazing because we're talking the early years of monoclonal antibodies, and the early years of knowing what you can do with this. And so, somebody from the Karolinska Institute in Sweden would fly into O'Hare Airport, and we will go to O'Hare. This guy would bring anti-fibronectin antibodies inside of his pocket. And, then we will re-staining kidney transplants that had been rejected to see what happened because that was like the very beginning we're talking 1991, I think. It's like my first publication was on this and with my maiden name, which is Martinez Lacave. And it was amazing then. It was like the most cited paper because then, I mean, science has evolved so much in 30 years. So, it was a wonderful time because of having a spot, having a place and learning in a lab. I was working with a lab technician that was doing the stainings and was from China. And so it was my first time meeting a person from China and so we would sit there and talk for hours about our different lives and the differences between how we have grown up. She had an arranged marriage and I couldn't understand an arranged marriage for my life. And so, I learned so much from her and it was a beautiful time for me to learn from other people or their lab. And then to go on the microscope and discover what could be happening with fibronectin or the markings and then so it was that it was just six months of doing that. It was enough to give me a place to live and then I passed my exams and I was able to start my residency program which was fantastic. I became a family medicine resident soon after. FO 45:00 Did you ever continue to pursue research later in your career? VM 45:06 More recently, I've been involved in health equity related research in different areas. Here now, we're working with a grant on the access of Latinos to Medicaid and ACA health insurance (Affordable Care Act). I worked with teams, global teams, on doing primary health care, research, or different methods of understanding primary health care in the world. But in focusing more on Latino, the Latino community. I don't tend to have the mind of a researcher. I'm more of a connector and a person that is able to bridge the differences between community and researchers. My expertise is more of bringing people together, aligning myself with people who would do the research, the statistics, the analysis and and getting together. And then I have to bring the questions, I tend to bring the questions and the possibility for answers on who can help us answer the questions. Who has the expertise? Oh, I think, you know, I am convening. I'm great at convening. So to me, it's been getting together great teams to do research on especially health equity related to different marginalized communities. FO 45:15 When did you first get started with or pursuing research in health equity? VM 46:53 So, I've been a member of different teams throughout probably the last 10 years and when you talk about health equity, part of it has to do with access to primary health care. And then more in detail in the last four years with the work of the team, you know, different teams of people working to improve has access and health outcomes for the comunidad Latina [Latinx community]. FO 47:29 When did you first start to interact with the Latino community in the United States? And how do you think it has changed over time? VM 47:41 From the moment I got here. When I was a foreign exchange student at age 17, I was told by people in my school that I shouldn't hang out with a comunidad Latina [Latinx community], the people in the community that were not good people. And they didn't want me hanging out with those people. And in my school, there were very few Latinos anyways, but it stayed in my mind. And I didn't hang out with the comunidad Latina [Latinx community], for other reasons. But then, right when I was 17, it stayed in my mind this otherness already, right? Other people. And then when I came here to live, to do family medicine, and I mentioned earlier, my first volunteer opportunity. I did two very important volunteer opportunities. One was volunteer work with a lead abatement campaign where I learned that the majority of children who were intoxicated by lead were Latino kids or black kids. But because I spoke Spanish, I started working with them. And the other group was a group called Chicago House, which was hospice care for mostly men, but there were men and women dying from AIDS, and whose families had, you know, kicked them out and they are dying in horrible situations because there was no treatment for AIDS at that time. And then, when I started working as a family medicine resident, we're talking thirty years ago, there were not that many Americans who spoke Spanish. I was the only person in my class in residency. We were 13 per year that spoke Spanish. And then there were two other people who are also from Argentina in the program that graduated right when I started. So I was the only Spanish speaking resident at that time and people started driving. I mean, the western suburbs of Chicago and people were driving from 70 miles away because once they recognized they were there was a doctora [doctor] that hablaba Español [spoke spanish] people came from all over. I was very, I'm just an intern. I was feeling so small, right? Like, oh my god, we are coming. But they believed in me because I spoke Spanish. Then I started doing home visits in some of the homes in the Chicago area. And, and really, oh my goodness, if you talk about disparities, you know, I started going into homes where four families would live in a small room and each family would have a bedroom and one kitchen where they all share. The baby would sleep on a hammock above the bed of the parents because there was just such a limited room so I started seeing how people lived. And yet at the same time, how hard they were working. Some of these homes in Berwyn in the Chicago area, were sitting on stilts and the stills were made of car batteries. Talk about toxic waste, right? It's like an old car but I mean, it was just like, in the United States, right? In the backyard of O'Hare Airport. This is where I was doing home visits, and I had several families that I visited there. So families followed me. And then I started creating a clinic study hosting Latino groups and people would come into these parties that we would have with the community. The other thing that happened in this interaction was the beginning of LARCs, long acting birth control, and there was a new one called Nexplanon. There were five rods as opposed to the implant that was one rod. And suddenly, my residency program started calling me the queen of arm implants because I had a waiting list of Latina girls that wanted the arm implant. They were all wanting to know what I did, and I had no idea what I did. People just started lining out to have it done. And it was a community activist, the matriarch, a mother figure for all these young women, who were new immigrants from Mexico, mostly. She was the one that was convincing them but it was the day I met her because she brought all these women to the party I had. It was this amazing recognition of how a community activist, promotora de salud, health promoter or community health worker was doing in connection with the community. So that was very early, like this was my first year, [or] second year of residency. And then when I moved to Iowa. Again, after finishing my residency program, I started working in the free medical clinic, seeing patients in Spanish there in a tiny little town. Again, when people discover that I spoke Spanish they will come from all over. Can you tell you a medical story okay, yeah, of course. There was a man that I adored, I'm gonna call him Mr. Guerrera. And he came in and he had a pathologic [fracture]. So I saw him at a Thursday evening clinic, he had a pathologic fracture of his humerus. So I said, well, we're gonna get some X-rays. And I knew I was gonna have to give him bad news right? I said, I want you next Thursday to come in with your family. So I can tell you what's going on. And I knew it was important for his family members to know. And so next Thursday comes and this is the evening clinic so it's 6 to 8 PM. And I'm seeing my second to last patient and my last patient in the schedule is Mr. Guerrera. And the nurse comes in [knocking noises]. Just knock on the door. I'm like, the nurses don't come and knock on the door so much. I'm like, "what's up?" He goes I don't know what's going on. But you only have one patient left in your list and there are 16 people in the waiting room [laughter]. What happened was Mr. Guerrera had brought his family. He brought all the members who could come and he apologized because seven people couldn't be there. And he and his six children, their wives, and their grandchildren were there. Seven who couldn't be because they were working. I will never forget them. First of all, we had no room in the building to accommodate 16 people sitting so they stood. I sat in the front and together with Mr. Guerrera and a couple of the daughters. Then everybody else kind of stood like you do in front of a picture because they all wanted to hear what I had to say. I had to tell him that he had what looked like metastatic disease and that he was going to need care. And he was going to need to be admitted to the hospital to understand what was going on. And unfortunately, he died soon after that, from an opioid overdose. It was a horrible thing. He died in the hospital, and then I graduated. So this was probably like in March of my senior year, my residency year, my chief year. Then I went on to work in Muscatine, which is thirty miles southeast of the university. I went to work as a rural doctor and the family found out I was going to work there. And they all came. So before I started, there was the whole, like, there were multiple family members and acquaintances of this family because they had recognized that I cared about families, because I had told them to bring their family. And it was just incredible. First of all, this idea of what family means to Latinos [and] Latinas. They understood that I respected what I meant. And then I became like, I started taking care of a lot of Hispanic folks. I was the only Spanish speaking doctor in almost all of Iowa that time. And then I was in Muscatine, Iowa, which is a community health center at that time, on the verge of the Mississippi River. There was a health professional shortage in the area, in a town of 20,000 people, but with a catchment area of 110,000 lives on both sides of the Mississippi River. And I say like half of my patients spoke Spanish only. And the other half were people from different backgrounds in Iowa. And, it was a both a rural and industrial town, there were 10 fortune 500 industries right in that area. So it would be anything from Monsanto to Heinz products. Like, you know, big, big companies. There were days the wind was coming from the south, and if they were making ketchup, the whole town would be stained red. And if they were there making mustard, the whole town would be stained mustardy color. It was really interesting to work there. FO 57:59 Yes, I really appreciate that story. Thank you for sharing. It reminds me a lot of what it means to have the same values as your community and how it really, really matters that you show your community like your values, and building that trust is also very important. VM 58:22 Fobr me, as a doctor, I do share personal information, you know, to a degree, right, but I do share myself with my patients. I feel like if I want to build trust that I need to connect. They're going to be more likely to trust me if they connect with me as a person, not just as their medical provider. And using it right, you can really connect and be able to be more effective in the care, I think. Now it's a little different because I've been on TV a lot, as a Latina. Telemundo calls me all the time and Univision calls and so I'm always on their channels. And so a lot of my patients are like, "Oh, mi doctora esta en la televisión." [My doctor is on TV]. So it's a little bit different because I'm also known on TV and at the same time, I just want to make sure that people know I'm there for them. Right? Like I'm not Viviana, who's in all these places. I'm here with you, talking with you. I'm going to take care of you. Your time with me is going to be not linear because I don't have enough time. But we're going to make a circular in the sense that I will know about you. And I'm taking care of you and I'm paying attention to you and how it is that I can do [what's] best for you. And if I am not able to do [the] best for you right now, I will take the time later to understand the situation a bit more. Especially, sometimes you have a patient that was just added to the day, and you haven't been able to dig in the chart a little bit. It's like, okay, let me let me see what I am able to do right now? And unless there's an emergency, and you know, someone's needing immediate attention, there are ways that I can do to connect later and understand more. But in the moment that you're with me, I'm going to be with you. It's my way of operating and talking with people. Right? FO 1:00:33 I know, the US healthcare system doesn't always allow doctors to have those personal connections with their patients. How do you go about balancing, working in a big healthcare setting, and also, kind of forming those personal connections with your patients? VM 1:00:54 So this is the art of family medicine; long connections over time. It's continuity of care. It's being there for them. It's taking care of mom, dad, child, and grandmother. And so I often know, the patients know their kids. Don't share information with each other, but I understand what's happening in the family unit, which allows me to do better for them. It's getting to know them over time. It's a big portion of that, right? It's like, you know, I have so many patients and the images are going through my mind as I'm speaking with you that I've been taking care of for 18 years. And even, you know, people I delivered babies to in Iowa 21 years ago, or 23 years ago. Now with time their parents are finding me on social media, or they follow me on LinkedIn. And suddenly I get a message from a 22-year-old saying, "My mother tells me you delivered me in Iowa, they had never forgotten you." And I get these like messages and I'm like, "Oh my God!" You know something that happened so long ago, can still have a meaning. It's just it's a beautiful privilege and a beautiful opportunity as a doctor to have had that connection with people, right? Even people who I have not seen for a [while]. You know, 18 years ago, I moved from Iowa to North Carolina, and I still have people who find me after. And of course, and I remember so many of them, right? Like I wish I could go and find out. Did Arielito go to college? All these different family members. I'm talking not just about Latino [or] Latinas. People of all different groups and backgrounds are contacting me after 20 years. It's amazing. FO 1:02:54 Yeah, that's beautiful. I think that is an example of what it means to be a doctor. And like an example that I think many people would love to follow. When did you start working for Duke Health and like, what made you move from Iowa to North Carolina. VM 1:03:15 Partially, it was the weather. It was after 11 winters, I was ready to move south. And so my husband and I both were looking for a job that would provide in an academic center where they will be looking for both a urologist and a family doctor. And so yeah, Duke was one of them. And the main reason for me to come to this department is that the Department of Family Medicine and Community Health, which was at that time a Family and Community Medicine, was going through a lot of changes. And it was redesigned itself. And I took the job the day after they announced that they were going to close the family medicine residency program when I was coming in as Associate Program Director of the residency program. I took the job purposely because I thought, if I go, I can make a difference. I can make something that just restarted itself. I know I can make a difference and that we can restart the program and make it amazing, you know? Bringing all these experiences and getting it together with a new team. And so I joined the faculty as Associate Program Director of the residency [program] in 2006 and resuscitated the program and went on to be one of the top residency programs in the country. And so it was very exciting and then I was associate program director working with Bryan Hofstadter who was great and then moved on to be the program director until 2020. So it was a very exciting time, like bringing these ideas of the things I had done [and] I had learned. Dreams I had or what kind of people we want to train. What kind of community engaged activists and globalists, and that we could train. And so it's been a very exciting time to see the quality of people that are graduating from the residency. FO 1:05:31 Do you think it took a lot of courage to move from Iowa to North Carolina? Knowing that, perhaps that the family medicine department wasn't its best at the moment? VM 1:05:43 No. Well, so two issues, right? I am part of a specialty where there's a job for a family doctor everywhere in this world. Right.? So that's number one. Second, I've seen way worse working conditions in so many other places, including my own country of origin that I just don't fear. You know, situations in the U.S. are a lot easier here in comparison, or it has been easier in comparison. And I always worry about the future of the United States. Because of lots of things I hear in politics and policymaking. But I know it didn't take courage. I was so afraid of the winter. 11 winters, 20 degrees below zero, I was done [laugher]. I didn't miss my colleagues and Iowans were wonderful people. I will never stop, you know, loving all the experiences I had. Right? They were great. Yet, working in Duke Health has been building the career I dreamed I always dreamed. I'm doing 50-50. You know, 50%, clinical, 50% policy research and global work. Duke has allowed me the opportunity to develop as a doctor, I always dream, you know. When Alma Alta came out in 1978. I wanted to do a career that would bring policy and global work, and clinical work [together]. And I'm doing it right now. Right, I was just elected president of the World Organization of family doctors or president-elect. And we have five years of this work. And so, it's all like coming together in ways that I always hoped for and kind of imagined. The world has changed as I move, right, but yeah. You were talking about courage. This is how I maneuver the world. I'm extremely flexible. And people around me will say it's very messy, like my office is a mess. I have all these plans, everything is in my head. And I have plan A, plan B, plan C, plan D, plan E, plan F. Every one of them is amazing. I know all the different things that I'm doing. And at the same time, I'm very organized in my long term approaches. And so, 10 years ago, I started working with one kind of organization, family doctors as a volunteer and a different organization. And this is a volunteer organization, but it has the possibility of significant impact around the world. And so 10 years ago, I told my department chair I wanted to work together with WONCA and perhaps become the president of the World Organization of Family Doctors. And so that has always been in my mind, and this is the way I'm going to be doing this. This is how I will work on this. But in the meantime, there's all these other things that I'm doing that are not exactly what I had planned. You know, I didn't plan to be the residency program director. But it was an amazing opportunity to make a difference vicariously through the lives of all the people who graduated on the program. And that was an amazing opportunity. When I first applied for the job, I wanted to work in undergraduate medical education. I was not interested in residency program education, but they gave me the job of associate program director and I was like, okay, right? And then it was amazing too. So it's been able to make changes. And then when I was elected to the Executive Board of the World Organization of Family Doctors, in 2016, I never expected I would be given the role of liaison to the World Health Organization. And suddenly there I am, you know, three to four times a year in Geneva, at executive board meetings with the World Health Organization. I never expected that I would be speaking to the United Nations or to the World Health Assembly, right? It was like, Okay, let's do it. I'm happy to be doing these things, right. So things evolve, and I think if you commit yourself to doing them and you do well, you you get to do things that you weren't expecting. I never call it courage. I don't know, it's fun. It's wonderful. But maybe others could call me courageous. I don't know. FO 1:11:17 I think I would call you very courageous. Can you describe what the Department of Family Medicine was like when you first started and what changes you made that you thought were necessary to improve the department. VM 1:11:33 So my role was in the residency program. And then, when I first arrived at Duke the department had announced that it was going to close his program. It was having trouble recruiting. The department believed the family medicine training should be more community engaged and community focused, something that I believed in as well. And that it should move to remove itself from the hospital setting. And I didn't quite believe that. But I really, really understand family medicine as a community engaged specialty. So I had a lot of experience with community engagements with the work I had done as a community engaged family doctor in rural Iowa. I mean, I also worked in Davenport, Iowa and other places before and so I believed in that. And then I saw that [Duke] had so many amazing resources, the division of Community Health, has started clinics in affiliation with Lincoln Community Health Centers, or Walltown [Neighborhood] Clinic, Lyon Park and later on Holton Clinics. So I thought, these are places where the residents could receive training, so that we have training at the Duke Family Medicine Center, and all those clinics to see different types of populations, especially the Lincoln Clinic, sees more people who are more marginalized, who don't have access to health insurance, who live in with different socioeconomic indicators. And so, so that was part of what I put into this right. And then really, going around the country recruiting in convening students who wanted to become change agents. I believe that there are two things that are happening. First of all, at Duke, we will have the opportunity to train change agents, people who believe in all of these issues of health as a human right, and create new models of primary health care, and advocacy and policy. And so that, and my promise to them was that they were going to develop to be able to do more of that. And at the same time not to lose their job because talking about these issues, right. And when I talk about this, depending on where you work, it can be very difficult and that does take courage, being able to say these are the issues right. You should take care of people without asking for a picture ID. You should take care of people, only charging them through their medical insurance, but maybe doing pay models that they can afford using a sliding scale. [Duke] was doing a sliding scale for insurance companies. Can we do it for people who do not have insurance? I've been doing this, but there are ways to do this again, if you're back against with the data, right? And so I have learned ways of showing this truth without punching people but more about showing. I had learned in the past back in Iowa that if I took the administrative staff that accused me of harboring illegals, to a humanities workshop, where they would learn more about who are the immigrants in the state of Iowa, and what are their contributions that they could actually see differently. And sure enough, that is the way it happened. They, when you start seeing people as humans, and not as others, it becomes a different thing. So, that was part of this, you know, creating a space where people can train to be excellent clinicians and do procedures, while doing all the elements of vast knowledge of family medicine. And so that was part of my contributions, right? And then bridging differences. We have different divisions. And so can we work together. One of the things that you see in large academic centers is all the styles of how this group works, and how this group works and how this group works. You have to be cutting across and showing horizontally. It makes me so excited to see a medical student to pre-med students often, you know, Bass Connections allows that, right? There's so many times when there is no connectivity between those groups, right? And so, just finding those ways has also been part of that. Another change, perhaps, that I have brought to the department is the work that we did with increasing access for Latinos during the pandemic and running in groups of people together. The Latin-19 convenes on Wednesdays at noon. You'll really talk about both the needs and the assets that the comunidad Latina [Latinx community] brings to the area and the state. And I never expected this. We started this almost four years ago in March of 2020, when the pandemic started, and I never expected that four years later, we will still continue to meet. And you know, this Wednesday, there were 55 people in the call, you know. They talked about, you know, community engagement for health equity, right. And other times there would be someone else talking. We often have different speakers and things like that. But I never expected it would still be happening four years later and create such change and such understanding. To be in more places where now I see material in Spanish and an awareness or an awareness of the need of material in Spanish for people to understand. You know, we've worked almost with every department at the University and also the and I've done this from my role as Director for Health Equity in the department. FO 1:11:33 Can you tell us a little bit more about the foundings of Latin-19 and its impact that is made on supporting the Latino community in Durham. VM 1:18:25 So Latin-19 started by the day the pandemic was announced. The day we started diagnosing the first cases of COVID-19. I think it was March 12th or March 13th. The first cases were diagnosed in my office at the Duke Family Medicine Center. There were 53 people that came through that were positive and the majority of them were students. And soon after, it was like all over the news. There are all these new cases and we started seeing that there was a lot of material in English, nothing in Spanish. And Gabriela Muriel Maradiaga Panayotti sent me an email saying, "Viviana, what are we gonna do?" I have been meeting with different community organizations from before that and our residents were already training at El Futor. They have gone to El Centro Hispano. So there were a lot of different community organizations that cater to the Spanish speaking community, so I was already interconnected with all of these. And if you remember El Paso shooting had happened in September of 2019, before the pandemic and Lenor Corsino, myself, Alex Villeda, who used to be a medical student at Duke, and several others have met with the Dean to talk about the silence from the school. Nobody in the School of Medicine mentioned anything about the El Paso shooting. That shooting had gone through the hearts of the Latino community everywhere in the country, I think because it was about killing Latinos or Hispanics. And so we had convened meetings already, bringing us together between people who were health clinicians at Duke and the school {of medicine]. And so back in September already, we were thinking about what we could do because it was a community that was already suffering. There were also several instances of ICE raids on schools. So there had been an instance where the parents were waiting for the kids at the school. And immigration enforcement came and raided and took parents away from their children. It was horrible. And so all of those things were going on in the community when the pandemic started. So, Gabi sent me a message, " Viviana what are we gonna?" Let's convene people. And I had been using Zoom. I was a member of the executive of the WONCA organization at that time as a member at large. And I had been convening meetings with colleagues from Italy, Spain, and Latin America, about what was going on with COVID. You know, a lot of people were not using Zoom yet, but I was already using my zoom to host meetings with family doctors from around the world about how are they doing to take care of people with COVID. So we started convening the lead in at meetings. And maybe the first time we were 15 [or] 17 people. The the next Wednesday, there were 19 people and the next one was 30. And then we picked out like 120 people. And it was just an open space for democratizing information, making people aware of what's going on. Making sure that the Spanish speaking community is informed there was no materials or a lot of my family medicine residents and medical students got together and started doing pamphlets of information in Spanish to share with the community. We started doing videos. There was an outbreak in a meatpacking plant in Alamance County and the residents did videos in Spanish, Swahili, and Haitian Creole to be used inside the the factory for people that worked in the factory to be informed. So we started doing several different things because nothing was coming from the regular sources. There was no information, we started generating the information and creating pamphlets and sending them around. And so that's kind of that's how it started, you know. It's been this open space every Wednesday at noon that people have learned to expect. And then we started having saying I want to share about this or I want to share with that. Then we started having community members saying we're very worried there is a lot of depression. So people from El Futuro, which is a mental health services organization here, started sharing about, you know, coping mechanisms. And the schools started sharing, you know, best practices on how to teach your kids in school. I mean, like it was, it became this, like, amazing video library for us in many ways, but it's also meetings where everybody came together. And the other thing I think that I'm most proud of is that it became a space where decision makers could hear directly from the community about what the community saw about what's happening. As a Latina, an underrepresented minority in the health system. I have often felt that time is like oh Viviana. Here's Viviana again. You are always talking about Latinos. I'm like, Yeah, because I know this community the most. I want the community to be heard. The community always has a voice. The problem is, are we listening, are we hearing? And so what the Latin-19 meetings did was to bring decision makers to directly hear from the community in ways they don't get to. Both sides don't get to talk with each other, often, right. And so that was I think what was most remarkable in that. First of all, to recognize how caring everybody is, right? Structures are built in the way it's easiest to make them. And what's easy for one culture, may be completely different and difficult for another. And it's not always done on purpose. There's one thing that they have learned right. There are certain things that have historically been done on purpose. And at the same time, there are things that are not purposely done to exclude, I want to believe that. So I don't shoot myself [laughter]. I want to believe that we are all trying to make a difference, that we vowed to make a difference and care for people regardless of their background, ethnicity, ability to pay, right. And then there are structures in place that sometimes limit our ability to do that because of how people access the care. And so yet at the same time, people care. In general, if you're in medicine it is because you care, right? And so it was beautiful at times to recognize that people that I saw, didn't actually care. They would be sitting, listening in meetings, and you can see their eyes getting red, and then they turn their camera. Right. So I think for me, what saved me in some ways, during this difficult time as a pandemic was to recognize the humanity of people both on those who have power and privilege, and those who have need, and bring them together in a place where they could listen to each other. My biggest hope is that Duke has learned the importance of listening to the community and really caring, and to check in with itself as a health system. And think about as a medical center, what happens when we exclude people. How are we excluding? Why are we excluded? And again, sometimes, it was completely not a thought. Because you didn't understand the language. Today, for example, we were working on QR codes for people to become volunteers for the health system. And we have a QR code in English and a QR code in Spanish. But if you go into the QR code in Spanish that's inviting you to become an advisor or a volunteer, then the material is only in English. That's a way of exclusion. I still don't get mad. Let's translate that [laughter]. I don't get angry, I just get energized. I see a barrier, how do we break it? What do we do? How do we do this? And paying attention and I am certain that I have blinders to other things. And then I mean, I am certain all of us have unconscious biases, unconscious blinders. Right? But at least I am making sure that I'm paying attention to what is not there. Yeah, FO 1:28:22 I really, really love the approach of not getting frustrated, not getting mad, taking a step back and really being determined to move forward in a positive way. Because it can be very easy to get mad at situations and it's not gonna make anything better. But instead, I love your approach. You said "I feel energized." VM 1:28:44 I have to say there are days when I'm exhausted. There are days when it's like "Oh no." Right, there are still days when you're thinking, "Oh my God." The system didn't learn. Not again. One example was the day we just finished COVID-19. We've done lots of testing and vaccination. We finally made it. One of the biggest changes that you asked me earlier with Latin-19 was that testing wasn't available for Latinos. We made it available. We went into the neighborhoods. We created more testing sites that were more accessible, not just for Latino but for other marginalized communities. We put testing in low income housing. Then vaccinations, again, first they were all in the only places where the more affluent people will make it to and then we created spaces at the Latino Community Credit Union and both Latino and Black churches so people would be feeling more likely to feel comfortable going there. And we created material in Spanish for testing and for vaccines and information, etc. And then monkey pox comes, and then I get approached, "Viviana, can you help us vaccinate people for monkeypox?" Oh, sure, yes. Let me get the material ready. And then they sent me the material and there's nothing in Spanish. Like didn't we learn? Go on. If you want me to help you vaccinate the communidad Latina [Latinx community], shouldn't we have material in Spanish. Oh, no, Viviana has to create it. No, it shouldn't be that I will create. It has to be that we're readily thinking about this 20% of the community, you know? 80% of those who cannot access. Let's do it. Let's make it in the language that is necessary. And maybe Spanish now maybe, you know, Haitian Creole, another time maybe Pashto another time. It's like, let's think about which community needs the information and how is going to be best received. And it may not be a written language, it may be a spoken language, and then we need to make videos or little things that we can send via WhatsApp because WhatsApp is what a lot of people in marginalized communities use, right? And let's just find ways of getting the communication [going]. So there are times that I get very frustrated, and I just have no energy. I will go to sleep for a couple of days. Or I meet with my peeps, the people who get what I'm doing. Or I meet with the community, and I realize how important this is for the community that this is happening. Another proud moment was when I started realizing that we as a health system went from mistrusted to most trusted. And I was like yes. We made it. Right, the community trusts that we're going to be there for them. And I'm going to say it again, right, the community trusts that we will be there for them. And to me, that's one of the most important things we achieved, that we were going to be there. And they could contact us as the multiple members of this Latin-19 Community Coalition. That is, I don't have a memorandum of understanding. It just came together. People who came together to improve health outcomes for our community. And to me that was really [amazing]. And also for a community that's extremely diverse, you know. There's Latinos, Latinas and Latines. And they're all these different variations of who we are and where we come from, and all the diversity of Latin America, which is huge. Yeah. FO 1:32:42 And going back to like, Latin-19, I was wondering, like, what were some of the biggest challenges you encountered in starting that program? VM 1:32:51 My biggest challenge was funding. We became like, really, like well known. We ended up speaking to Congress. Yet it has been always very difficult to get funding for the work of an administrator. We've had an administrative system for a while that was funded through one structure, but it has never really gotten the funding that it needs for all the work that we've done. So it's millions of others of volunteer work to move forward. And you can't always count on volunteer workers. There's a time when you have to say this program is really making a difference. Let's fund it and make it stick. Right. And so one of the things that we did from advice from people in our health system was create a non-for-profit. So we created it and then it becomes this issue of is it a conflict of interest? What is it that we're doing? Again, Latin-19 has never, none of us, me, Gabriella, any of the leadership in the executive, has ever gotten funded for Latin-19 work. It's more about making sure that we are able to maintain the kind of work that is so necessary, and be able to pay members of the community, community health workers, and others who are doing all this work. We cannot not. It's very difficult to sustain it without funding and that has been one of the most difficult things to get. My dream, my true dream, will be to create a center for Latino health equity, or center of excellence for Latino health or something like that within the Duke Health System, or Duke University. Right. Again, this is the most misunderstood area, you know, I've been asked this question where are you guys? Are you research? Are you advocacy? Are you policy? Are you clinical? Are you a program? We're all of that. We don't belong to one silo, we are all across because health is all across. Health in all policies. Anything that happens impacts health. And so what that Latin-19 has done is to cut across so many departments and locations [such as] the School of Nursing, the School of Medicine, and Wake [Forest] Medical [School], and UNC [University of North Carolina]. I mean, we have people who are joining all the way from very western North Carolina and eastern North Carolina in all these meetings. We're all learning from each other. And that, to me, is the most important thing is how much we can all learn, and we can do better. But I would love to end up with a center for excellence in Latino health within Duke University because it will be one of the first of its kind in the whole country. Especially, you know, aiming and caring for a population that continues to grow really fast, especially in this part of the country. FO 1:36:19 Yes, as president elect of the World Organization of Family Doctors, what are your key priorities for shaping the future of Family Medicine globally? VM 1:36:30 Excellent question. So it has to do with health equity and health for all. So there is health that comes from our policies, and we talk about education and all of the social economic indicators. There is also health in regards to access to appropriate health care, and well trained primary care teams. And for many countries in the world, the best option will be the training of more family doctors. If you train a family doctor, you're training somebody who specializes in taking care of all the areas. And so especially for remote and rural areas, that is your answer. One person as opposed to one pediatrician, one internist, one gynecologist, one obstetrician, one rheumatologist. So at least you have people who are training and teams that are trained in all of the areas necessary. When we're saying trainees, well trained, that you know how to do procedures, that you know how to do at least the most important most ordinary types of things, right? Similarly, to the way I worked, when I was a rural doctor in Iowa. I was delivering babies that I could scrub in all the surgeries of my patients. I wasn't the surgeon, right. But I would be there. We had one single surgeon so I was the first assistant in his surgeries, right? And, I was there at the delivery [of the] babies.We had one the surgeon. So we tried to keep him to be able to sleep at night sometimes, right. He would come in if we needed a C-section. But you know, trained to be able to solve 80% of problems. It's so important. And so my goal will be to continue to [that]. And I'm working right now with the Pan American Health Organization, in particular. Family Medicine is very strong in the United States and it's very strong in Canada, but it's not so strong in the rest of the countries [of the world]. There are strong family medicine training programs in Peru and in Argentina, and Brazil, and Mexico. At the same time, they're not training enough family doctors. In the U.S. there are 550 family medicine residency programs. In Argentina, there may be five, right? Again, there are 40 million people, so you need more training sites. And the other thing is, governments need to recognize what is the speciality? What is it that it does? So that's kind of the work I'm doing. It's really looking at the need for training more people and more teams, not just a doctor. You need to train the nurse that can help in all of these different areas, right. You need to train the members of the team, all of them to work together to improve the community's health. And there are some great models of Family Medicine done really well, including in the U.S., including in Cuba, including in Australia, including in Nepal, but there's not enough of us. Rural areas should be training a lot more family physicians, because narrow focus specialties don't go to rural areas. FO 1:39:48 Yeah, that sounds like an amazing plan. Um, would you consider yourself an activist or would you have another term? VM 1:39:58 I am an activist. I am a community activist. I'm an activated activist. Yeah, I cannot imagine not being an activist in a world with so many inequities and so many disparities. I cannot imagine staying quiet when I see so many things not going well, or it's from being quiet to being activated to initiating the programs that are necessary to make a difference. FO 1:40:37 What motivates you the most to advocate for all these communities globally and locally? VM 1:40:48 People, you know, seeing it, there's no one single thing, right? Like it's, it's seen seeing the bad things that are happening to people, thinking about how things could be improved. And I'm not naive, the world is in so much distress. There's no way we can fix everything, but at least we can fix some of the things, [particularly] those that are in our reach, like the closest to us. And if every one of us were to start reaching across to those who are suffering around us, and not in a I'm coming here to save you way, but let's talk about what we can do to make things happen, right. We would be living in a better world if we were to listen, really listen, without an ego to what certain laws are doing to negatively impact health, to what wars are doing to negatively impact health everywhere in the world. So I'm motivated by seeing those things. I'm also motivated by those colleagues that I see who are making such a huge difference in multiple settings, right. One day in the pandemic, it was 94 degrees outside and we had just set up the first day of testing at Holton [Clinic]. It was the first day of one of the community sites where we started testing for COVID-19. A lot, 70% of people with COVID in the state in Durham County were Latinos that day, and 53% of people with COVID in the state were Latinos, when they're only 10% of the population for the state and 14% of the population of Durham. This just gives you an idea of this disparity, right. And we have finally been able to do the COVID-19 testing sites where people are going to be driving through. We still are marginalizing those who don't have a car, by the way, but at least we were helping. We put it together. When I say we, it's many people working together [such as] the public health department, the division of community health at Duke, myself with Latin-19, Latino community members, and my colleagues in Latin-19. A lot of people came to the public schools, etc. So people will come and test and then they open the trunk, and it will bring PPE and boxes of food that will last if they're positive. You know, remember, people had to be isolated for 10 days to 14 days, depending. And so we would give them everything that they need to be able to isolate. So that was an important, extremely important day, but a community member comes to me and says, "Vivian, I need you to come with me and you need to meet a group of people." I followed him in my car and he's in his car to Clarendon street and we sat out right outside of a Methodist Church. There was a group called La Semilla. They had just distributed boxes of food for community members. And they had also been doing a fundraiser. There was a family. The mom was in the intensive care unit and the father was at home with a 13-year-old daughter. And mom was very, very ill, and they had done a fundraiser to help them with their bills and to take care of the kid because the father is isolated at home he cannot work. His wife is in the ICU. And so I sat down, you know, it's 95 degree weather and people were sweating, and they were all wearing their masks down here. And so we sat down and talked, and I learned so much from them. And they were all like, "Que vienes hacer aquí?" What are you coming to do here? I'm coming to listen. I want to know how you are living through the pandemic. And we sat down on the cardboard boxes or the wooden boxes, they had just used to distribute food right on the street, and we sat down and started talking about what was happening. I ended up there for like an hour and a half answering questions about COVID, and asking them questions. That was like mid July, and then I continued to see them. We didn't have vaccines at that time. We're talking about people dying, right? Then in September, what happened was the Department of Health and Human Services hired me to work with the pandemic response, and asked me to develop testing sites all around the states together with Cory McCray, a person from the department, an amazing guy from the department. And we started looking for testing sites all around the state to locate them in most marginalized communities. But the other thing that we talked about is they were using community health workers to bring food to people in their homes. And nobody had identified they needed PPE. All the PPE was being used in the health system. So one of the things that I learned was that, that I promoted, we can't send community health workers with PEE, to homes of people to bring them food, you know. I would not, at that time approach a patient without wearing an N95 mask and we were completely cover. Why are we sending them [community health workers without PPE]. So it was this recognition. So in September, I met with the same group of people that I had met in July, and brought him together with other representatives from Duke and family medicine residents, to teach them how to wear and don PPE. How to put it on. How to protect themselves. How to protect their community. I will never forget, one of the people have looked at me with her mask, kind of down on the chin and she's like, you know? Every time, I had seen this person multiple other times in their mask was always down on their chin. And just like, I'm not sure if I trust you, you know? You have privilege kind of thing, but in Spanish, right? And so that day, she comes up to me and says, "Doctora, usted hace esto?" You do this why? Why are you here to teach us how to do this? You know and I'm masked. My jaw is kind of dropping because I'm trying to think of the words of what to answer. And then she says, "Ustede hace esto porque nos quiere." You're doing this because you love us. She looked at me and said, "You love us, you love us!" I do. Yo los quiero. I love my community. I love what you're doing all this work and she put on her mask [correctly]. Then [she] went around and instructed everybody to follow what I was doing. But it was an amazing moment, like I am here. I'm part of the community and I really love my community. I want you to be safe not to continue to die. It was like the amount of people that were dying or were getting really ill from the community Latina [Latinx community] was highest in the country at that time and in the state and in Durham. And so it was just like, lo hace porque nos queire. You do this because you love us. She put the words to what I was doing and it was this every single moment. Yes, this is why we're here, you know. And so, perhaps when you asked me about the most important times, sometimes these things come to mind, right? The moment I said I loved my community. I don't want to see it suffer. [These] are the moments that are the most important, I think and the things that drive me the most to continue to do this work. FO 1:49:57 Yeah, that's beautiful. Thank you for sharing that. It's like all your work is really inspiring. I'm glad we got to know a little bit more about you, what drives you, what makes you become such an agent of change. We appreciate all the beautiful stories you've told us today. As we wrap up, is there anything you would like to mention in the interview that you think it's important to you? VM 1:50:27 Yeah, my family. As I was talking to you, my husband called. I couldn't do this if it wasn't because I have great support from my husband, my son, who both of them started volunteering with me in their vaccination events and testing events. My mom and I have this very close family. My husband used to be a surgeon and urologist. He had to retire because he has multiple sclerosis (MS). And so we live through the pandemic in difficult times because he's immunosuppressed because of the medicines. My son and I got COVID during the pandemic and protected him. All these different things, but I have such great support and a great partner that allows Viviana to do all these different things that she wants to be involved with. He is my most fervent admirer and somebody who's right there, you know, supporting the sometimes crazy things that I want to do next. And so I couldn't not mention them and who they are. FO 1:50:55 Yeah, behind every inspiring person. There's always a support network. VM 1:51:48 Absolutely. And the other group is people from Latin-19, and all my colleagues who have been just amazing in stepping up to the challenge of caring for a community and listening to the community. So it's been an amazing time as well. FO 1:52:07 Well, it's been a pleasure interviewing you. Do we want to do the NPR [introduction]? Unknown Speaker 1:52:12 Yes. If you don't mind, would you mind giving us just a short sort of NPR style introduction with your name and any important titles that you want to include? FO 1:52:21 Like, hi my name is... VM 1:52:23 What's an NPR SS 1:52:27 My name is Sarah Spicer and I am a Duke medical student. VM 1:52:29 Oh, okay. All right. You're Sarah Spicer? I've seen your name in a lots of places. Okay, good. All right. I'm Dr. Viviana Martinez-Bianchi. I am a family doctor and Director for Health Equity at Duke, community activist, and thankful for this opportunity. Beautiful, thank you. Unknown Speaker 1:53:02 15 Seconds of silence just to get the sort of room tone.