Hector P. Garcia Event Photos and Video


Hector P. Garcia Award Ceremony and Luncheon held on Friday, October 6, 2017


"A daughter's perspective: the life of Dr. Hector P. Garcia"


We would like to congratulate the Hector P. Garcia Cultural Competence Essay Contest Winner 2017, Stephanie Tutak, MS4, in the School of Medicine and the Hector P. Garcia Abstract/Poster Winner 2017, Florentino Saenz, MS31.

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UTMB Provost Dr. Jacobs, Mr. & Mrs. Akers, and UTMB President Dr. David Callender, congratulate essay contest winner Stephanie Tutak, MS4.
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UTMB Provost Dr. Jacobs, Mr. & Mrs. Akers, and UTMB President Dr. David Callender, congratulate poster contest winner Florentino Saenz, MS1.

2017 Winning Essay

Ms. B was a patient I met during my third year of medical school on my Internal Medicine Clerkship. Six months before, she received a hysterectomy that was complicated by a deep surgical site infection that resulted in four different hospitalizations in her local community. Since her surgery, she lost 50 pounds, and her recurrent fever, nausea, and abdominal pain never improved despite several courses of antibiotics. When she was diagnosed with disseminated Histoplasmosis from a biopsy of her lymph nodes, her doctors feared that she was immunocompromised and screened for HIV infection. It was during this hospital admission that Ms. B learned she had AIDS. After her nausea resolved, Ms. B was switched to oral antibiotics, started on antiretroviral therapy, and discharged from the hospital to follow-up in clinic.  However, Ms. B never made it to her appointment, and was unable to fill her prescription because she lost her health insurance. She eventually came back to the emergency department with increasing abdominal pain, but was sent home the next day after concerns for possible drug seeking behavior were dismissed.

At the time that I met Ms. B, she was admitted to UTMB yet again after being transferred from the hospital in her hometown for her chronic abdominal pain. As Ms. B received IV antibiotic therapy and drainage of her abdominal abscess, I checked her progress every morning. Due to her frequent admissions into and out of the hospital, Ms. B was distrustful and weary of her medical providers. Her tumultuous stay at UTMB prevented her from witnessing the birth of her grandson, and she could not visit her son in the ICU after he was injured in a car accident. Ms. B knew her medication was important, she told me, but when she returned home, she discovered that the local pharmacy did not carry her Itraconazole, Medicaid would not cover her medication, and the paperwork for patient assistance was confusing and intimidating. She told me about her monogamous relationship with her husband, who had vaguely asked her to get screened for STDs in the past, and the guilt that she felt because she delayed getting tested.

One morning, I visited Ms. B after a scheduled spinal tap. Her medical team ordered the procedure because they were concerned that the infection in her abdomen had spread throughout her body. She was curled up in fetal position in her bed, unable to turn around for fear of inducing more pain. I don't like being a guinea pig, she whispered to me so softly I had to lean well over the edge of the bedrails to hear. I remembered the Tuskegee Syphilis study, which withheld treatment from African American men with syphilis, and Dr. James Marion Sims, the 19th century physician dubbed the modern day father of gynecology who experimented on enslaved women without anesthesia to create the first vaginal speculum and surgical technique for vesicovaginal fistulas. Even though I wasn't present for Ms. B's lumbar puncture, I could understand how the history of medicine and race relations in the United States, and her personal experience receiving care in a teaching hospital, would make her suspicious of her medical providers intentions. I wondered what Ms. B would think if she found out that her case was presented at grand rounds. Her struggle with illness for the last six months was presented to a full auditorium as an educational whodunit for physicians and students. How would she react, I wondered, if I described to her the hushed chatter of colleagues discussing the differential diagnosis for her pain, the excitement in the room of enthusiastic learners trying to solve the puzzle, and the students sitting beside me betting on the final diagnosis? 

I share these intimate details of Ms. B's life because I was frustrated that she needlessly suffered from a preventable disease. In a search for answers, I wondered how her experience as a black woman living in the rural south shaped her values, beliefs, and behaviors about health. To be clear: I am a white, middle-class woman, and I was raised in the suburbs outside Houston. I am privileged to receive undergraduate education and pursue a graduate degree in medicine. I also realize that it is impossible for me to completely grasp the experience of a woman whose life differs so greatly from my own. However, I believe that this patient's clinical course illustrates how a lack of cultural competency leads to patient dissatisfaction, and ultimately, poor health outcomes. If I understand more about the intersectionality of race, gender, socioeconomic status, and geographic location as a physician-in-training, I can provide better care for patients with different cultural backgrounds from my own.

In the United States, the percentage of total cases of HIV and AIDS among female adults has increased from 7% in 1985 to 27% in 2007, and eighty three percent of these cases in 2007, like Ms. B, were attributed to heterosexual contact [1]. According to the CDC, the rate of HIV/AIDS cases per 100,00 population for African American women is 20 times higher than White women [1]. Many factors contribute to the excess risk of HIV acquisition in women of color. These factors have little to do with the biology of race or ethnicity but are the consequence of socioeconomic inequality, lower health literacy, limited access to healthcare, and high-risk environments that result from racial and sex biases in the United States. In fact, many women acquire HIV as a result not of their individual behaviors but of their sexual partner's behaviors and of their membership in a social network where HIV infection is common among potential sexual partners. The high prevalence of HIV among black men results in increased HIV transmission risk for black women whether or not they engage in high-risk behaviors [2]. In other words, simply starting a new monogamous relationship puts black women in substantial risk of encountering HIV. In addition to experiencing disproportionate HIV incidence and prevalence, women of color also suffer from greater HIV-related mortality.

The asymptomatic nature of early HIV infection might explain delays in testing, however, much of the delay in accessing medical care is caused by reluctance of at-risk individuals to get screened (potentially due to denial or misperception of risk). Other barriers include fear of stigma, perceived discrimination in the healthcare setting, poverty, and lack of health insurance coverage [2]. Delays in testing help explain why one third of women with HIV infection in the US present with AIDS at the time of their diagnosis [1]. Mistrust of healthcare providers is another common reason that HIV-infected individuals have decreased use of healthcare services. One study conducted in the southeast United States showed that nearly 25% of minority correspondents thought that the government created AIDS to kill minorities [3]. Another study surveying African Americans only showed that 44% of respondents believed that patients receiving HIV medications are being experimented on by the government, and 59% believed that information and a cure for HIV were being withheld from the poor [4].

Reflecting on Ms. B and her care with this information in mind allowed me to contextualize her clinical course, and I could understand how in an attempt to sympathize with Ms.B, someone might think that, like a child or someone infected by a blood transfusion, she got HIV innocently as a monogamous woman. However, this implies that other individuals deserve to get HIV because of their high-risk behavior (sexual practices or needle sharing during injection drug use). This prejudice is wrong because it suggests blame onto those that are infected. Nobody deserves to get HIV/AIDS, and as healthcare providers, we must respond with humanity and compassion, and without bigotry and prejudice. It is our duty to improve access of HIV care, which includes routine opt-out testing for HIV in all people aged 13-64 years old, with enhanced education from providers, active linkage to care in hospital settings by scheduling follow-up appointments for patients, systematic follow-up for missed visits, and improving trust with culturally competent care [5].

Ultimately, when physicians create treatment environments with culturally competent care (which includes linguistic competency, maintenance of open lines of communication, and understanding another person's history and beliefs), they can create strong patient-provider relationships to allow for retention of care for all patients, including those living with HIV. Ms. B taught me this lesson, and by inspiring me to research these strategies, I hope to improve health care outcomes for my future patients.

References:

  1. Centers for Disease Control and Prevention. New estimates of US HIV prevalence, 2006. CDC HIV/AIDS Facts. 2008.
  2. Hall HI, An Q, Hutchinson AB, Sansom S. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004-2005. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2008 Nov 1;49(3):294-7.
  3. Whetten K, Leserman J, Whetten R, Ostermann J, Thielman N, Swartz M, Stangl D. Exploring lack of trust in care providers and the government as a barrier to health service use. American Journal of Public Health. 2006 Apr;96(4):716-21.
  4. Bogart LM, Thorburn S. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2005 Feb 1;38(2):213-8.
  5. Aziz M, Smith KY. Challenges and successes in linking HIV-infected women to care in the United States. Clinical Infectious Diseases. 2011 Jan 15;52(suppl 2):S231-7.