BREWSTER Second-year University of Washington School of Medicine student Antonio Guadamuz spent part of his summer serving the largely Latinx population of Brewster.

Born in Nicaragua and raised in Miami, Guadamuz knows exactly what racism looks and feels like.

It's the open stares in grocery stores. It's the awareness of being followed by store employees while doing your shopping. And unfortunately, it can lead to difficulty in getting a correct diagnosis when you're sick. That's what drew the 33-year-old to medical school.

"Five years ago, I was diagnosed with Type 1 diabetes, but it was a circuitous, complicated process because as a person of color, they assumed I had Type 2 diabetes," said Guadamuz, who explained current medical algorithms indicate Hispanics are at greater risk of developing the Type 2 form of the disease.

The frustration he experienced as a patient propelled him toward a career as a physician.

"I see the potential to address the inadequacies in society," he said. "Medicine meshes with my worldview and ideals about what I want to do with my life."

At the end of his first year at UWSOM in Seattle, Guadamuz had the opportunity to participate in a summer training program known by the acronym RUOP: Rural Underserved Opportunities Program; its open to all medical students between years one and two of medical school.

During the four-week summer program, students live in rural underserved communities, working alongside local physicians in hospitals, clinics and private practices.

"Our students develop a profound appreciation of what life is like for physicians practicing rural medicine," said John McCarthy, MD, assistant dean for Rural Programs at UWSOM.

Guadamuz served in Brewster, population 2,300, working with Dr. James Wallace at Family Health Centers.

"We serve all of Okanogan County and part of North Douglas County," said Dr. Wallace. "Brewster's population doubles in size during harvest season. We have a huge influx of migrant workers from Mexico, Central America and even Jamaica. It adds a unique flavor to the cultural melting pot of the town."

Wallace, a North Carolina native, was drawn to underserved communities while in medical school at the University of North Carolina School of Medicine.

"My medical school class voted me, 'Most Likely to Practice Rural Medicine in North Carolina,'" he laughed.

Okanogan County is a long way from North Carolina, but it meshed with Wallace's goals.

"I was drawn to the needs of rural areas," he said. "And serving in a community health center fits my vision of how I want to practice."

He was delighted to work with Guadamuz.

"Antonio is one of the best students I've had," said Wallace. "He was thirsty for experience and very intentional in the clinical skills he wanted to learn."

While Wallace learned Spanish during his residency, he said watching Guadamuz converse easily with patients was eye-opening.

"Seventy-five percent of my patients speak Spanish. They really appreciate someone who speaks their language," he said. "Because Spanish is his first language, Antonio could convey empathy, humor and a depth of cultural understanding that I can't. Seeing him work with our Spanish-speaking patients was an experience that drove that home for me."

McCarthy understands how vital that kind of doctor/patient interaction is.

"It's incredibly important to have providers with whom patients can identify. Much of what we do is based on trust and relationships," he said. "This is easier when we have shared experiences."

Guadamuz was glad to be of service while he was learning about rural medicine.

"I really enjoyed my time and training in Brewster. It's a beautiful area." he said. "I received a great clinical education, and I was able to use Spanish frequently to help patients feel more comfortable."

But because of earlier small-town experiences, Guadamuz had some reservations.

"I was apprehensive about being in a rural, conservative area," he said. "I'd already experienced stares and being followed in stores in my travels to smaller communities throughout the state. Rural areas often feel like unsafe, unwelcoming places for people of color."

It's a conundrum McCarthy is well aware of.

"Our goal is to develop students into physicians who appreciate and respect diversity," said McCarthy. "At the same time, it's important to cultivate a workforce which mirrors the populace of the communities we serve. I've seen patients light up when they see a provider who mirrors their culture and experiences."

However, attracting minority physicians to places they may feel unwelcome can be difficult. Wallace says conversations with medical students like Guadamuz are an important place to start.

"Antonio helped me to recognize my own deficiencies and to explore ways to make up for them," Wallace said. "Traditionally, the best health care wasn't available to people of color which led to worsening health outcomes. We're trying to hire health workers who are part of these communities to provide feedback about how to better serve our patient population."

To be clear, Guadamuz didn't feel unwelcome everywhere he went. Patients felt at ease with him, and the medical staff was very open to important dialog.

"Racism is an uncomfortable topic," he said. "But it's an uncomfortable experience too, and it's important to keep talking about it."

He valued observing how Family Health Centers is actively meeting the needs of the communities it serves.

"When you are among only a handful of doctors in a small town, its important to build long-term relationships with patients," Guadamuz said. "That was a key takeaway from my RUOP experience."

His hope is that conversations about discrimination will become part of a larger dialog that centers on the voices of the people most marginalized.

Wallace agreed, citing the dire need for physicians that fit their cultural population.

"Antonio gives me hope that there are students out there who are endeavoring to explore rural areas despite the expectation that they might experience racism," he said. I appreciate that through RUOP and other rural programs, UWSOM is addressing two of the most vexing problems facing our societyracism and improving the physician workforce in underserved areas of our state.

Guadamuz feels it's way to early in his medical education to know what kind of medicine he will one day practice, or where he and his family will settle, but he does know this: "Wherever I practice I hope to have real conversations about how to address inequities in health care, and how physicians can better meet the needs of the entire community."

Cindy Hval is a freelance writer who writes for the University of Washington School of Medicine.

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He speaks their language: UW medical student trained in Brewster this summer - wenatcheeworld.com