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Mindy Udell, MD, returned to her birthplace of Yakima, Washington, and now works as a third-year family practice resident at Central Washington Family Medicine. A Lakota Sioux, Udell spent the summers of her childhood working the small family farm in the Yakima Valley town of Satus Creek. "The medical community in Yakima is so friendly and the patient population is equally rewarding,” Udell says. “There are professional development opportunities everywhere, too.”

Mindy Udell, MD, returned to her birthplace of Yakima, Washington, and now works as a third-year family practice resident at Central Washington Family Medicine. A Lakota Sioux, Udell spent the summers of her childhood working the small family farm in the Yakima Valley town of Satus Creek. “The medical community in Yakima is so friendly and the patient population is equally rewarding,” Udell says. “There are professional development opportunities everywhere, too.”

Four different physicians, one common objective: practice medicine at home. These doctors chose to practice medicine in the medically under served areas they have called home since childhood. Challenging? Sure. But, as homegrown family practice physicians, these doctors reap unique professional and personal benefits.

The first white persons to view Washington’s Yakima (YAK-i-maw) Valley were traveling with the Lewis and Clark expedition in 1806. The area takes its name from the Native Americans of the area, the Yakama Nation, one of the largest tribal groups of the Pacific Northwest. Today the city of Yakima has about 82,000 residents, and around 230,000 more populating the many small, rural towns dotting the Yakima Valley, a large area of about 4,300 square miles.

Located in the rain shadow of the Cascade Mountain Range in south-central Washington, Yakima has sun 300 days of the year. The Yakima Valley boasts more than 50 vineyards and wineries and is the primary source of the nation’s hops as well. Ranching and farming are important and honored professions in Yakima Valley, and the lifeblood of its economy.

Doctors Mindy Udell and Saul Valencia, University of Washington School of Medicine-Seattle graduates, are third-year family practice residents at Central Washington Family Medicine, a federally qualified health center (FQHC) located about three miles west of I-82 in Yakima. Both were raised—and intend to continue practicing—in Yakima Valley.

Mindy Udell, MD—Yakima, Washington

“I was born in Yakima and spent summers helping my dad work our small farm on the Satus Creek, located 40 minutes outside of town,” says Udell, 30, a Lakota Sioux. “I had the best childhood, with plenty of land to run on, muddy ditches to swim in, and cows and other livestock to chase.” She and her husband, Nick, want the same for their children, Hailey and Kora.

“Except for my brother and sister, who live in Seattle, pretty much my entire family is here in Yakima Valley. “I love the smaller town,” Udell says. “The medical community in Yakima is so friendly and the patient population so rewarding. I enjoy knowing most of the practitioners in the medical community, which I could never experience in a big city. There are professional development opportunities everywhere, too. It just depends on what you want to do, and how much you want to be involved.”

Besides medical interests, Udell is active in her church and is a volunteer with her community’s Junior League. The Udell family also enjoys travel and camping and, on occasion, does a little wine tasting as well—one of the perks of Yakima Valley living.

“There are things I love about a big city,” she says, “but the secret thing about communities like Yakima is that there is way more to do than we have time for—you just have to find it. A medical practice in Yakima enables me to balance work and family. And the commute—12 minutes—is definitely reasonable.”

From the age of seven, Saul Valencia, MD, worked in the orchards of Gleed, Washington—a small town in the Yakima Valley—picking apples during the summer and fall. He returned to the area to work as a family practitioner at Central Washington Family Medicine. Having worked in the orchards himself, Valencia, understands how orchard workers' injuries happen and what his patients need to recover. They trust and respect him.

From the age of seven, Saul Valencia, MD, worked in the orchards of Gleed, Washington—a small town in the Yakima Valley—picking apples during the summer and fall. He returned to the area to work as a family practitioner at Central Washington Family Medicine. Having worked in the orchards himself, Valencia, understands how orchard workers’ injuries happen and what his patients need to recover. They trust and respect him.

Saul Valencia, MD—Yakima, Washington

Saul Valencia was born on a little ranch in Michoacán, Mexico, a verdant, mountainous region bordered on the west by the Pacific Ocean. As a child, he migrated with his family to Gleed, one of Yakima Valley’s small towns. From the age of seven, he worked in the orchards picking apples over the summer and into fall.

Because Valencia is Latino, he finds his Hispanic-Latino patients more apt to listen when he counsels them on diabetes and exercise. Having worked in the orchards himself, Valencia, 36, understands how those injuries happen and what his patients need to recover. They trust and respect him.

As far as Valencia is concerned, he learns more at this FQHC than he would at larger facilities in Seattle.

“In Seattle, the specialist just comes in [with a resident during a patient’s appointment], stays for a little bit, and leaves. In Yakima, it’s a whole different attitude. They spend time with us, explaining how the disease functions, how to work it up, how to handle it. This teaches residents to think on our own; to be on our own. If I ever want to practice in a small towns with a population of 10,000—and I do—there’s just going to be me.

“Yakima is a big enough town that it has a good hospital and is able to attract specialists. In an emergent situation, we transport the patient to Seattle, which is about two hours away, or to Spokane, three hours away.” Even 10 to 15 years from now, Valencia still sees himself living and working in one of the small towns that dot Yakima Valley.

“One of the things I really like about practicing in a small town is more time for my family,” says the dad of 4-year-old Saul Renaldo, and infant daughter Xiomara Jocelyn. “Time in traffic is time away from them.

“The clinic here is 10 minutes away from my home, and my home is a couple of blocks from the hospital. Often I’ll run home for lunch to spent time with my wife, Norma, and the kids. It’s nice to be home right after clinic is done, to have dinner with the family, and to spend time with my kids before they go to bed. In Yakima, anywhere I am I’m close to home.”

John Molina, MD — Guadalupe, Arizona

Like Udell and Valencia, John Molina practices medicine in a community clinic. But in Molina’s case, he had to build the clinic first, and he chose to build it in the impoverished village of Guadalupe, Arizona, a tiny ethnic enclave within the ever-expanding metropolis of greater Phoenix.

Guadalupe is a small Yaqui Indian and Mexican community of about 5,500 people, located between Phoenix and Tempe. Named after the Virgin of Guadalupe, the patron saint of Mexico, Guadalupe was founded in 1904 when Yaquis fled persecution by Mexican dictator Porfirio Diaz. Soon, Mexican families also settled there. Rich cultural and ethnic identites still characterize the town today. Although culturally wealthy, the community is economically impoverished, and chronically ill residents are unable to afford even the most basic health care.

Molina, a 56-year-old Yaquí-Mexican-American, was raised in Guadalupe and still resides there, as do his parents and several lifelong friends. His connection to the community is deeply rooted, his respect and reverence for cultural traditions innate, and his affection for his neighbors unmistakable.

“I went to medical school for the single purpose of coming back to Guadalupe and opening up a clinic.” Molina says, “I saw a lot of families that were suffering from a lot of disease—diabetes especially. Drug abuse. I saw many people with limbs infected with gangrene.”

After graduating from the University of Arizona-Tucson and completing his family practice residency, Molina set about establishing the Guadalupe clinic. Without available funding for property, supplies and equipment, or staff, he relied on his people skills and his characteristic indomitability. Combined with Molina’s origin and background, those traits make him uniquely qualified to practice medicine in his hometown.

In 1995 the Las Fuentes Health Clinic of Guadalupe opened in a small donated building outfitted with donated supplies and equipment and staffed part-time by Molina, a few medical students, and volunteers. The clinic came to be presciently named since Las Fuentes means The Fountains or The Sources. To the economically depressed Yaquí-Mexican community, the clinic would prove to be the source of desperately needed health services.

In Guadalupe, breaking down barriers to health care demands creativity. The Las Fuentes Health Clinic not only had to overcome patients’ financial barriers to health care, but do so without violating social or cultural norms. Still, even the best homegrown doctor can’t remember everything.

After surmounting the initial obstacles of property, equipment, and staff, the clinic opened for business—only to find itself without patients. Unbelievably, the town of Guadalupe gave Molina the cold shoulder. Why?

The answer: This unique community no longer viewed the university graduate as one of them. Molina had not anticipated this. He says, “I thought the people would welcome me with open arms, but quite the opposite. I was looked upon with skepticism. You see, an educated person in Guadalupe is a foreigner, whether he is from Guadalupe or not. Many in the community feel that education induces a compromise of values, traditions, and culture.” Discouraged but not defeated, Molina persevered by reaching out to his Guadalupe neighbors.

John Molina, MD, 56, was raised in Guadalupe, Arizona, and stayed there to build Las Fuentes Health Clinic in 1995 to serve the Yaqui Indian and Mexican community of about 5,500. The building, medical supplies, and medical equipment were all donated; staffing consisted of Molina, a few medical students, and volunteers. “I went to medical school for the single purpose of coming back to Guadalupe and opening up a clinic.” Molina says, “(Growing up,) I saw a lot of families that were suffering from a lot of disease."

John Molina, MD, 56, was raised in Guadalupe, Arizona, and stayed there to build Las Fuentes Health Clinic in 1995 to serve the Yaqui Indian and Mexican community of about 5,500. The building, medical supplies, and medical equipment were all donated; staffing consisted of Molina, a few medical students, and volunteers. “I went to medical school for the single purpose of coming back to Guadalupe and opening up a clinic.” Molina says, “(Growing up,) I saw a lot of families that were suffering from a lot of disease.”

From his newly heightened sensibility, Molina derived a more comprehensive approach to patients. A healing garden soon adjoined the Las Fuentes Health Clinic, items of spiritual significance adorned waiting room walls, and all medical treatment approaches reflected respect for Yaquí and Mexican customs. In time, these actions put to rest the concerns of Guadalupe residents. Patients came.

By 2005, the building been expanded twice and the staff and range of services available to Guadalupe’s residents had increased as well. One term Molina uses often is “co-ownership.”

“We want a feeling of familiarity and co-ownership between the clinic and residents,” says Molina. “We want those needing health care to feel comfortable coming to Las Fuentes.” Using the clinic is one thing; paying for services quite another.

Many impoverished Guadalupe residents have life-threatening health issues. To facilitate otherwise inaccessible health care, Las Fuentes collaborates with area specialists. These specialists provide diagnostic care and treatment plans to patients at reduced cost. The clinic then provides much of the work-up and treatment under the specialists’ oversight.

Other strategies designed to overcome financial barriers include Las Fuentes’ patient payment options. A flexible protocol virtually guarantees continuity of care. Even a patient who loses his job and insurance can continue to see the same health-care provider. Patients are expected to—and want to—contribute toward their health care by some means. “This preserves their dignity,” Molina says.

Las Fuentes continues to provide quality care to patients without government funding. Sponsors—corporations, charitable organizations, and individuals—loyally support the clinic. “By pursuing non-governmental funding sources,” Molina says, “it allows us more flexibility, more independent decision-making, more creativity in the ways we can obtain support from the community.”

According to Molina, the clinic staff is always looking for opportunities to strengthen community relationships. For example, Las Fuentes sponsors breast and cervical cancer screenings, free dental screenings, and healthy diet education for children. It is also pursuing grant funding for skin cancer screenings.

Not enticed by big city advantages, Molina says he finds satisfaction and contentment helping his neighbors.

“At Las Fuentes,” he says, “one experiences the satisfaction of caring for the poorest of people, which reinforces the reason we choose medicine as a career and gives true value to our profession.”

To augment his interest in humanitarian work, Molina is involved with Rotary Club International. He also writes leadership articles and participates in personal and community leadership forums throughout Arizona. His avocations include playing blues guitar, reading biographies, and indulging in anthropology.

The economic downturn has hurt Las Fuentes and prompted unfortunate changes. “There have been staff cutbacks,” says Molina. “My wife, a family nurse practitioner, holds clinic one day a week. Fortunately, we also have Dr. Shelley Weismann, who is trained in integrative homeopathic medicine. Now we have only one specialist seeing patients now, a Mayo Clinic dermatologist who visits the clinic every three months.” In the past there had been as many as 10 collaborating specialists.

“Due to the depressed economy, the drying up of former revenue streams, and other factors, Las Fuentes is at the lowest point of its 13-year history,” Molina says.

In view of these formidable setbacks and inauspicious times for increasing revenue, is Molina ready to call it quits? Not likely. “We are re-strategizing our operation,” he says.

C. David Smith, MD—Jay, Florida

The panhandle town of Jay, Florida, nearly 50 miles north of Pensacola, straddles State Route 4, and has a population of around 640. A farming community, Jay is surrounded by peanuts, cotton, soybeans, and hay. The hospitable land welcomes local folks and visitors alike to fish and hunt along the Escambia River and in the Blackwater State Forest nearby.

Dr. C. David Smith, a Jay native, attended Florida State University and graduated second in his class from the University of Florida Medical School. It was while completing his family practice residency at the University of South Alabama that he made the pivotal decision to cut his short by two years and return to Jay to begin his medical career.

This unplanned acceleration of his medical career occurred because Jay Hospital was on track to close unless a doctor could be found who would immediately begin to practice in Jay. “I felt that if Jay Hospital closed, it would likely never reopen,” says Smith, 55. Historically, the small town has been short of physicians, and growing up in Jay, Smith saw a great need for accessible health care. If the hospital closed, it would create a real hardship for residents.

The leaders of Baptist Health Care approached Smith, who had always planned to return to his hometown, about returning early. After consulting with his chief resident and his family, he decided it was the right move.

“I feel we’re put on this earth for a purpose, and I felt staying in Jay was the right thing to do. I’ve never wanted to leave.”

Although additional physicians have joined the area’s medical community, it is still considered a medically underserved area.

“At the University of Florida others kept telling me I wouldn’t be challenged enough if I went back home to practice. But, they didn’t really have the experience of practicing primary care medicine in a rural setting,” Smith says. “I am challenged so much more, and my practice is just so rewarding—especially so since my older son became a family physician and joined our practice.”

Practicing rural medicine has benefits urban practitioners can’t even imagine, according to Smith, but it requires a certain mindset that medicine is more than pathology. “Rural medicine means being people-oriented in practice as opposed to disease treatment-oriented. In rural medicine you get to know the people. Rural patients are more independent, more self-sufficient, and are easier to treat because they are more willing to accept a role in their health care, to take responsibility. We have a lot of active elderly here in Jay.”

Although it has its benefits, rural medicine also comes with challenges. “Some patients are not necessarily well-educated, so you need to be able to communicate with a variety of different persons. You also need a sound, basic knowledge of general diseases—not specialized. A primary-care practice is challenging because you need to stay abreast of everything. Therefore, rural physicians need to be comfortable using computers and technology in order to keep up to date,” Smith says.

“You don’t always have the fanciest of tools, or enough manpower, and you could get frustrated, but you do the best you can with the situation and the tools you have,” he says.

Smith, who married his hometown sweetheart, has three children and four grandchildren. Besides his medical practice, Smith is active in church activities, and local sports and recreation, including coaching. He also teaches at Florida State University’s School of Medicine.

“To a physician, time is crucial, but time is not nearly the problem in rural areas as it is in the city. For me, the hospital is only three minutes from my home, and my office and my church are only a minute’s walk away. There’s no fighting traffic”

After nearly 30 years, is he ready to hang up his stethoscope?

“No, I’m not planning on retiring,” says Smith. “I was raised with a great work ethic. I always say, ‘Don’t let anyone outwork you!’ ”

Deb Kincaid is a freelance writer in Vancouver, Washington. This is her first article for UO.

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Deb Kincaid

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