Models and Mentors
In Conversation with Grace Chen Yu, MD
Raised in Jackson, Mississippi, Dr. Grace Chen Yu majored in East Asian Studies at Harvard University. After completing her undergraduate degree, she worked with nonprofit organizations in San Francisco and developed a strong interest in community medicine. She attended Albert Einstein College of Medicine and Stanford School of Medicine, completed her residency at the Stanford-affiliated family medicine program at San Jose-O’Connor Hospital, and currently teaches and practices there as a member of the clinical faculty. Occasionally, she is also known to pull out all stops to throw a “pretty mean dinner party.”
What organizations and initiatives were you involved with during your undergraduate and medical school years?
My first major exposure to public service was a program called CHANCE, which was part of the Phyllis Brooks House Association of public service programs at Harvard. The goal of the program was to help students at a Cambridge high school get into college, because a lot of them were dropping out. This experience really jump-started my interest in public service, and I ultimately applied for the Pforzheimer fellowship to support my work in this field after graduation.
I drafted a proposal for a program called Gateway to America, located in the Chinatown Beacon Center. It focused on helping recent high school-aged immigrants in the San Francisco area get into college, mainly immigrants from East Asian countries between 16 and 18. We offered twice weekly sessions that focused on SAT preparation, ESL tutoring, college preparation, and cultural acclimatization through a big sib-little sib component. I also worked as a part-time grantwriter at the child-care agency Wu Yee Children’s Services, which was located in the same building. I got a feel for the nonprofit world, and found that working in a community setting was really fun for me.
There was also a Chinese hospital located right in Chinatown, and they were asking for volunteers. I lived pretty close by so I would go there all the time. As I lived in the community and saw the types of health care issues faced by residents, I began to consider practicing medicine in an area where not everyone has equal access to care. My experiences during that year really helped solidify my decision to apply to medical school.
I spent my preclinical years at Albert Einstein. During my first year, I got really involved with a brand-new program called ECHO--Einstein Community Health Outreach. It was the first medical school-run free clinic in New York, and the medical director was a really dynamic family physician. The third and fourth year medical students were really great to work with, as well as the attendings who volunteered their time to precept. In my second year, I got involved with fundraising, and we successfully applied for a three-year grant to support the clinic.
I eventually transferred because my fiancé was at Stanford medical school. During my third and fourth years, I volunteered with Arbor Free Clinic. It was also at that time that Tully Free Clinic—now Pacific Free Clinic—was getting started and I talked to Sharon Kwan about how we had gone about finding funding for ECHO.
You've been working with a consortium of clinics in Honduras for a couple years now both as a clinic volunteer and as a Resident volunteer coordinator. What sparked your interest in international health, and what do you hope to accomplish?
Between my first and second years of med school, I had the opportunity to spend a summer in Ecuador through an AMSA-sponsored program called SALUD. While we focused on medical Spanish, we also went to the public hospitals and did a clinical project to get a sense of what the health care situation is like in a different country. We didn’t really have clinical skills, but I hoped to come back and practice internationally someday.
When I was looking for residency programs, I looked for one where I could potentially take a month off for a medical elective. Here at San Jose-O’Connor, we have an opportunity to do a one-month international elective. Through an online search, I found out about a program called Global Healing, which is a pediatric clinic based in the public hospital in Roatan, Honduras. I contacted them and told them I was a family medicine resident interested in doing family medicine with an emphasis on women’s health. They put me in contact with Peggy Stranges, who was operating a clinic from her home. She is a U.S. trained nurse who had moved to Roatan several years prior. Before long, people started seeing her for common issues. For the majority of people who don’t have any money or very little money, the government-sponsored clinics had been the only options available; the resources there are just really terrible—never enough medications, never enough people seeing them. So she just started treating them and word just spread, and volunteers started coming.
When I went it was still in the early years, so I saw her transition from the “clinic” in her house to one operating out of a few donated hotel rooms down the street. Unbelievably, Clinica Esperanza is now in a beautiful large medical building built from the ground up by volunteers sharing the same vision. I worked with her two days out of the week, and then I worked with a local Honduran physician, Dr. Amanda Everett, the rest of the time. She worked in the public clinics, and she and Peggy were friends. They were interested in transforming the health care situation on the island, and in being able to provide excellent health care to anyone who needs it on any of the Bay Islands. During the time that I was there, the Bay Islands Community Clinics consortium got started—now called the Bay Islands Healthcare Association.
I was so excited and wanted to return every year, which was not something I was expecting at all. I was just expecting that, oh, I would spend this month here and maybe throughout my life I’d go to different places… But it was such an amazing place with amazing people who were really dedicated to a vision. So I ended up going back the following year, and by then they had some big donors who were really interested in building a hospital to replace the public hospital.
When I went again this year, Peggy told me they were getting a lot of volunteer requests now--more than she can handle because she doesn’t really have the training to do that and had other things she had to do. She knew that I had recently taken on this faculty position here, and I was really interested in working with residents and med students. She said, “We’re really in need of a resident volunteer coordinator—is that something you’d be interested in?” I said, “Oh yeah! I’d love it!”
So now, potential med student and resident volunteers will contact me, and my job is to help figure out what area they would like to focus on. If they’re not clinical yet, perhaps they could get involved with health education, public health, or eventually some clinical research. It’s all still evolving—that position just started three months ago. But several of our residents have gone now, and we have a faculty member who’s going. So it’s really exciting, because that was what I was hoping when I did my first month there--that someday our program could have more of a link internationally. You can make such a huge impact and potentially focus more people on community health and international medicine if physicians in training get early exposure to that type of community medicine.
You have also been interested in chronic care models, and were awarded a grant for participation in a year-long chronic care collaborative this year. Would you mind describing the purpose behind the formation of the collaborative, and your role in it?
With any junior faculty anywhere, it takes awhile to figure out what within family medicine you might be more interested in, because family medicine is so broad. I looked at our faculty when I was a resident and everyone had a specific focus—women’s health, procedures, etc. I didn’t really know what that was going to be for me. Then fortuitously in October, I was applying for the faculty development program, and there’s a scholarly project that you have to take on over the course of the year. I wanted to increase the quality of care that we were giving our diabetic patients. I had done some projects in my residency years on diabetes—group visits, different ways of looking at diabetes as a chronic illness. I feel that’s an area that residents don’t get a lot of training in since the whole health care system is based on the acute visit model. Patients will see their physician when they feel that something is wrong, when they’re not feeling well. But other things that are lifetime illnesses like diabetes or hypertension, or asthma—they may not go in on a regular basis.
I had heard about the Chronic Care Model in residency and decided that was going to be the focus of my scholarly project. Then Dr. Bob Norman here told me that a graduate of the program now at Stanford—Dr. Nancy Morioka-Douglas—was applying for a grant for this Chronic Care Model. It was going to be the first California-wide collaborative focusing on chronic diseases in an academic setting—either a medical school setting or a residency setting. The goals of the collaborative are twofold. One is to improve care for patients with chronic illnesses using the chronic care model. The other part is to train staff or medical students on the chronic care model. There’s the teaching part of it and there’s the clinical aspect of it.
Nancy was interested in doing it at Stanford and asked if I would be interested in overseeing the arm at O’Connor, because they’re very different patient populations. I thought that would be really great, and so we submitted the application and got it. The actual collaborative year runs January 2007 to 2008, so it’s still ongoing. Because of my involvement with that, I’ve gotten a lot more interested in chronic illnesses and one of my hopes in the next year is to develop a chronic illness curriculum for residents here.
Would you mind giving an example of a personal or professional struggle, barrier, or challenge that you were able to successfully resolve?
Early on, one struggle I had was about going into family medicine, because I felt there were a lot of external forces telling me not to go into it, that I should be choosing something else that might have higher prestige in the general medical community. I had to reflect on why I wanted to go into this field. I went to med school because I wanted to be someone’s doctor. Patients talk about their primary physician—it might be an internist, it might be a family physician—as the person who really knows about them. If I chose a field because other people said I should go into it, or if I chose to go to an academic institution because of the name, rather than what I thought would fit me better and where I thought my training would be better, I would always be just trying to live up to others’ expectations. I thought it would be better in the long run if I went with my gut. That’s how I made most of the big decisions in my life—my marriage, where I was going to live, things like that.
But even at Stanford, even after doing a rotation there and an elective here, I didn’t really get a feel for what family medicine was going to be about until I did my internship here. I felt really lucky because I loved it. Internship is the hardest year, because you’re up all night and you’re on-call all the time and don’t see your family much, but I just really loved internship. I was told, “You’re the happiest intern I’ve ever seen!” I think it was because I was relieved that I had made the right choice and just excited that I was able to do this.
Family medicine is so different because you’re seeing so many things. In any one day in clinic I might have a newborn, an OB patient, a procedure, a patient with diabetes… It makes it so fun to be in clinic. Plus, because of my academic position, I’m not just in clinic. I’m teaching part of the time, practicing inpatient medicine, delivering babies. So it’s a lot of different things that keeps me interested!
I think it’s fun to work with residents and medical students because there’s so much idealism, and I think it’s great. I don’t want our residents to lose that. And I think it’s nice for people out in practice to consistently get that kind of exposure—it reminds you why you went into medicine in the first place. It hasn’t been that long since I applied to med school, but I hope that ten years down the line I feel the same way.
Any final advice for medical students interested in community health or international health?
I hope that med students at Stanford really think about why they went into medicine and remember that. Whatever field they go into, I just hope that they choose something that they’re really passionate about and keep that passion for the rest of their lives.
- Interviewed by Emiley Chang
6/22/07
