UCSF Fresno’s mission to improve health in the San Joaquin Valley and its charge to train the next generation of physicians to provide the highest-quality of care have been guiding principles of the UCSF Fresno Mobile HeaL COVID-19 Equity Project (CEP). The project, which started in spring 2020 as a response to the pandemic and with $5 million federal CARES Act funding through the City of Fresno and continues in partnership with the County of Fresno, provides free COVID-19 testing, vaccines, monoclonal antibody therapies and Paxlovid anti-viral treatment for the most underserved populations in the city.
CEP has intentionally hired diverse people representing the Valley to give COVID-19 tests, administer vaccines and therapies with the intent that they represent the people they are serving. Vaccine support specialists have given more than 91,000 tests, administered more than 76,000 vaccines; and since September 2021, they have provided treatment and prevention treatment to more than 600 patients.
“Our vaccine specialists are from the community,” said Kenny Banh, MD, medical director of CEP and Assistant Dean for Undergraduate Medical Education at UCSF Fresno. “We recruit people who are underrepresented in medicine who understand the people they are serving and communicate to and provide care in a culturally appropriate manner.”
CEP has become fertile ground for pre-med, registered nursing and other health professional students looking for hands-on patient care experience. And their encounters with vulnerable populations have influenced medical school and nursing school choices. About 80% of the people receiving COVID-19 tests, vaccines and treatments identify as people of color.
Six CEP staffers will be attending medical schools this fall and one will be attending nurse practitioner school. Two of the staff – Lili Garcia Pacheco and Darien Galvez – have passed the exam for Emergency Medical Technician (EMT) certification.
Three of the six medical school students – Myrka Macedo, of Sanger; Seshaan Ratnam and Lillian Vang of Fresno – will spend most of their education time in the Valley as students in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). They are among 12 students accepted into SJV PRIME this year. Other students admitted to SJV PRIME in 2022 are: Hector Acosta Parra, of Kerman; Jagjot Dosanjh, of Fresno; Kennth “Ken” Fox, of Fresno; Neytali Kanwar, of Fresno: Viangkaeo Lee, of Merced; Austin O’Callaghan Langhoff, of Redding; Alan Pham, of Fresno; Mina Sarofim, of Tracey; and Maria “Denalene” Tiu, of Fresno.
SJV PRIME is a tailored track at the UCSF School of Medicine for medical students who are committed to ensuring high quality, diverse and well distributed medical care to improve the health of populations, communities and individuals in the San Joaquin Valley. The program incorporates the expertise of UCSF, UC Merced and UCSF faculty at UCSF Fresno. It provides medical students with the unique opportunity to work in the Valley with underserved populations. The students accepted into SJV PRIME spend their first 18 months at the main campus in San Francisco and the remaining two and a half years at the UCSF Fresno regional campus.
“The dedication that these students have shown in the care of the Valley’s underserved is the foundation of the SJV PRIME program. Our mission is to train physician leaders to provide care to our underserved communities. I look forward to the effect that all these students, both physicians and nurses, will have in our community in the future,” said Loren I. Alving, MD, director of SJV PRIME; the Mr. and Mrs. David George Rowe and Stephen W. Rowe Endowed Chair for Teaching in Neurology; and director of the UCSF Fresno Alzheimer & Memory Center.
UCSF Fresno, a regional campus of UCSF, has provided patient-care opportunities for pre-med students prior to CEP. In 2018, Dr. Banh started UCSF Fresno’s Mobile Health and Learning (HeaL) to provide flu shots and health screenings to patients while providing learning opportunities for medical students and pre-health students under the guidance of medical residents and faculty physicians. CEP expands Mobile HeaL by bringing equal access, barrier- free COVID-19 and other health care services to targeted communities in partnership with community-based organizations.
The decision to hire CEP staff from the community is just the right thing to do, Dr. Banh said. “We have a duty to do our part to address health care inequities and providing a pre-med training ground for underrepresented medical school students is one way of doing that.”
The six CEP staffers pursuing medical school and nurse practitioner school this fall:
- Noel Cruz, 30, will be attending AT Still University of Osteopathic Medicine in Arizona.
- Mankamal Dosanjh, 23, will be attending Yale University Graduate Entry Pre-Specialty in Nursing Program in Connecticut.
- Monica Le, 25, will be attending California Health Sciences University College of Osteopathic Medicine in Fresno.
- Nicholas Linville, 26, will be attending Michigan State University College of Human Medicine in Michigan.
- Myrka Macedo, 26, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
- Seshaan Ratnam, 23, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
- Lillian Vang, 24, will be attending UCSF School of Medicine as part of the San Joaquin Valley Program in Medical Education (SJV PRIME) in San Francisco.
As a vaccine support specialist at CEP for the past year, Lillian Vang, the daughter of refugees from Laos, got a hands-on experience providing patient care to underserved populations. The experience solidified her desire to become a physician to improve accessibility to health care in low-income communities and address disparities and inequities in health care.
“I’ve just been so exposed to the disparities of how difficult it is for patients to make an appointment with a primary care physician or get any of their medications prescribed, or even the disparities of not understanding what their physician wants from them, whether it be language barriers or culturally,” Vang said.
This fall, Vang, 24, will be attending medical school in the UCSF San Joaquin Valley Program in Medical Education. “SJV PRIME was my top choice because of the mission that they hold and how sincere and genuine they are about helping resolve a lot of the health care issues here,” she said.
Vang hopes to return to the Valley to “make a difference for the Central Valley in helping to resolve some of the disparities. Conversationally fluent in Hmong, she wants to serve her community. “Many of the Hmong population and the Southeast Asian cultures are hesitant to seek health care here in the U.S. Many of the cultures’ traditional medicinal remedies are quite different from Western medicine. Furthermore, I have seen how difficult it is for these cultures to trust something they do not know about. Therefore, it has been my goal to help break down these barriers and help bridge this gap.”
A native of Fresno, Vang knew in college – she was a Smittcamp Scholar at Fresno State – that she was interested in medicine. She participated in a volunteer summer pre-med program where she shadowed a physician in Italy. “Seeing how knowledgeable and compassionate the physician was to her patients inspired me to one day be the same,” she said. Her sophomore year at Fresno State, she worked as a medical scribe at Saint Agnes Medical Center. She graduated from Fresno State in 2020 with a bachelor’s degree in Biology with a minor in Child and Family Science and Physical Science.
But her year at CEP provided the first hands-on experience with patients she craved. “The position here at CEP is something so unique and special,” she said. “Especially with CEP going out into the communities, that was something that has inspired me for my future profession. I want to bring more health care accessibility to low-income areas and address disparities and inequities.”
Seshaan Ratnam’s year as a volunteer at CEP cemented his plan to go to medical school – and his desire to come back to the San Joaquin Valley as a physician one day.
Both of Ratnam’s goals are possible by his acceptance to medical school in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). “I can be a part of a program that is tailor fit for the Valley, and is exactly what I was looking for,” he said. “I feel like this program was made for me.”
Ratnam, 23, of Fresno, says his interest in medicine developed over time. While attending Clovis Community College and then UCLA, he leaned toward education and did community outreach to help connect underserved students with resources. At the same time, he worked on the clinical side as a medical scribe and researcher. He has always had a strong interest in mental health, and during the pandemic incorporated his experience as a yoga instructor and training in mindfulness-based stress reduction therapy to work with various community-based organizations. When he came back to Fresno in 2021, he inquired if his background in mental health would be an asset for CEP, and he was brought on board as a volunteer.
Ratnam created CEP fliers that included information about meditation, breathing exercises and mental health resources. He led individuals in minute meditations as they waited in cars to receive COVID-19 vaccine at the drive-thru CEP clinic and advocated on the importance of taking care of their mental health. “That’s the role I played with the COVID-19 Equity Project so it was a little bit different, more on the mental health side, but I would say pretty important.”
He also became fascinated by the collaboration between CEP and community-based organizations, such as the Jakara Movement, Fresno Interdenominational Ministries (FIRM) and others. “You saw all these groups coming together and it was so amazing. I had no idea you could even make a project of this grand of a level to come together for something that is so important.”
CEP showed Ratnam education and medicine can be fused in his future. “I want to do medicine, but specifically in the community. I am very interested in community health and in using our community resources to connect people to resources that our community offers.”
Myrka Macedo, a health policy research assistant who served as Director of Outreach at CEP, has been accepted into the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME). A native of Sanger, Macedo, 26, is excited to begin medical school “and to be able to continue to be around my family for emotional support.”
Family is very important to Macedo. Growing up, she helped care for her maternal grandmother and grandfather. Her grandfather had congestive heart failure and later developed cancer and dementia. A native Spanish speaker, Macedo would go with her grandparents to doctors’ appointments and provide translation as needed. She also witnessed Katherine Flores, MD, a Latina primary care physician and director of the UCSF Fresno Latino Center for Medical Education and Research (LaCMER), provide holistic care to her grandparents in their native language, making her grandparents feel confident and in control of her grandfather’s afflictions. Those experiences helped convince her she wanted to be a physician. While preparing to apply to medical school after graduation from Fresno State with a double major in Chemistry and Biology in 2018, she volunteered at free clinics and then became an emergency support technician at Valley Children’s Hospital.
She joined the Central Valley Health Policy Institute in 2021 as a research assistant, working closely with community-based organizations that provide community health workers to CEP and she served for a while as Outreach Director at CEP. During this time, she and other research assistants would talk with Dr. Banh. “There is a lot of misinformation surrounding COVID-19 and Dr. Banh is the one to address a lot of those questions that we have,” she said. Macedo provided public health education training in Spanish for community health workers and helped create a public health infographic in Spanish that could be distributed to patients coming to CEP for COVID-19 vaccines.
The pandemic exposed the need for collaboration to solve health needs in the Valley, she said. And she can envision a future in medicine that includes a public health component. “I learned the importance of working with CBOs and I can see myself working with them in the future as a physician.”
Noel Cruz was a vaccine support specialist at CEP and will be attending AT Still University of Osteopathic Medicine in Arizona beginning this summer.
He will spend his first year at AT Still in Arizona and will complete the final three years of medical school in the San Joaquin Valley at a health center in Visalia. “I get to return and continue to work with the population here that I am already familiar with, but I would like to further that experience and learn more,” Cruz said.
Cruz, 30, was raised in the Bay Area and graduated from Berkeley City College before transferring to Fresno State, where he graduated with a major in Biology and a minor in Chemistry. He began volunteering for UCSF Fresno Mobile HeaL prior to the pandemic and remained as a CEP employee.
“It’s been a great experience working with the population here and trying to increase the COVID-19 vaccine numbers. And as a pre-med student, it is great. “You learn how to vaccinate, and you get your medical assistant certification. And you get to educate the public, which is preventive care,” he said.
“There are so many underserved communities here, the LGBTQ, the migrant farmworkers, the Latino community, the Hmong community, the homeless population. And for each community, there is a different approach to providing services and through Mobile HeaL and CEP, you learn that. Especially for me, being Latino and bilingual, I have been able to help the Latino community by providing comfort and trust.”
Cruz’s interest in medicine was sparked early. As a child, he saw his mother, a Nicaraguan immigrant struggling to communicate with physicians who were not fluent in Spanish, her first language. “She would always shy away from asking questions. I didn’t realize that until I got older and understood why, that there was the language and culture barrier. I just wished I could have helped my mom – I just wished I could be the physician.”
From his experience at CEP, plus an earlier job registering patients in the Emergency Department at Valley Children’s Hospital, Cruz said he saw the need for more physicians in the Valley to address unmet medical and health needs. He sees a return to the Valley for himself as a physician – perhaps in Pediatric Emergency Medicine. “I just really fell in love with the population here,” he said. “And I just want to make a difference.”
A year working as a vaccine support specialist at CEP gave Mankamal Dosanjh added confidence and resolve to enroll this fall in the Yale University Graduate Entry Pre-Specialty Nursing Program to become a family nurse practitioner.
Dosanjh, 23, will earn a registered nursing degree in the first year of the three-year Yale program and will focus the remaining two years on advanced nursing classes for the family nurse practitioner specialty she has chosen.
Growing up in Selma, Dosanjh said she knew she wanted to have a health career and joined the Doctors Academy, a health care pathways program for high school and middle school students in Fresno County that is operated out of the UCSF Fresno Latino Center for Medical Education and Research (LaCMER). An interest in nursing grew from a Doctors Academy summer internship experience shadowing a nurse practitioner. After graduating from Selma High School, she attended UC Irvine, where she received her undergraduate degree in Biology. During her last year of college, she participated in a community outreach program where she helped nurses on the medical-surgical and cardiology floors at a hospital in Irvine.
Moving back home to Selma during the pandemic, she applied for the vaccine support specialist job at CEP. “It was really an amazing opportunity to get more clinical experience and also to help out the community during the pandemic,” Dosanjh said. “You don’t get a chance like this every day to get such a large amount of clinical experience and also interaction with patients daily in all aspects of registration, vaccination, observation. Especially in the beginning, when our volume was so high, we got to talk to a lot of patients during observation periods and hear about their hesitancies to be vaccinated and hear about how grateful they were that we existed. And they were always so intrigued about us being there and what we were pursuing. They loved hearing that we were planning on pursuing something in health care in the future.”
“I’ve gotten close to the nurse practitioners at CEP,” she added. “It’s great to work with them and I’ve been able to ask them questions about working at CEP versus a traditional clinic. They enjoy CEP, and I’m excited to pursue my career even more because of that.” And she wants to return to the Valley and continue helping the community, she said. “I would like to come back and work with Mobile HeaL.”
Growing up in Sanger, the daughter of a low-income single parent, Monica Le saw her mother struggle with English as she navigated the health care system for Le’s grandmother.
A fluency in Vietnamese influenced her decision to pursue a medical care with a focus on providing culturally competent care in underserved regions. “I experienced firsthand the social determinants of health that adversely affected my family and friends and wanted to become a part of the solution,” Le said.
Le is a first-generation student to both graduate college and attend medical school in her family. A graduate of the UCSF Fresno’s Sunnyside High School Doctors Academy program, Le received a bachelor’s degree in Human Biology from UC San Diego. She thanks her mother, who came to the United States from Vietnam, for giving her and her three sisters opportunities. “I am so thankful to have her support as I explore my passions in higher education.”
Le first volunteered at the UCSF Fresno Mobile HeaL clinic after college graduation and was a part of its transition to CEP. “I definitely wanted to be a part of the solution to this novel virus and to gain clinical experience working with our underserved and minority populations.” While working at CEP as a Vaccine Support Specialist, she also was a medical scribe in the Emergency Department at Clovis Community Medical Center. Before leaving CEP to attend California Health Sciences University College of Osteopathic Medicine, she was promoted at CEP to Monoclonal Antibody and Antiviral Therapy Lead and Events Lead. In her full-time positions, she created workflows for training staff for administration of treatment, drawing up medications and screening patients for eligibility for antibody treatment.
Le sees a medical practice in the Valley in her future. “I also want to eventually become involved in educational pathways that encourage disadvantaged students, like myself, to pursue careers in medicine. I would not be here without the encouragement and support of my mentors who are also working physicians here in the Valley.”
Nicholas Linville learned the importance of giving patients respect over several years of volunteering at UCSF Fresno Mobile HeaL and more recently as a vaccine support specialist at CEP.
Empathy for patients was taught alongside how to take blood pressure, blood glucose, pulse and ultimately how to vaccinate for COVID-19, he said. “Through Mobile HeaL and CEP a compassion for the patients develops,” he said. “I really saw Mobile HeaL populations – the homeless, rural communities and communities with no access to health care – in a different light,” he said.
A native Fresnan, Linville, 26, had an interest in medicine as a child when his grandmother was diagnosed with lung cancer. “I was old enough to understand the sickness but still too young to understand why she was not getting better,” he said. But he had not given thought to medical school until experiences at Mobile HeaL and CEP. “Getting clinical experience, I realized the joy of helping others,” he said. It also influenced Linville’s decision to major in Biology and minor in Psychology at Fresno State, where he graduated. He had been focused on Psychology while attending the University of California, Santa Barbara, and while attending Clovis Community College.
This summer, he will be going to medical school at Michigan State University College of Human Medicine in East Lansing, Michigan.
Linville is working to become fluent in Spanish and while at CEP he gained confidence in speaking Spanish with patients. “Patients understand that we are learning, and they are happy to know people who are going into a medical field are learning another language.”
He is interested in Emergency Medicine, Internal Medicine and Psychiatry. Either at CEP or with Doctors Without Borders, he hopes to continue serving rural and other under resourced communities. “I would love to come back to the Central Valley for residency or even post- residency,” he said.
