Last month I was honored to join MEDICC, a nonprofit organization that works to promote US-Cuba health collaboration, on an educational trip to Cuba. My father has always been a big admirer of Fidel Castro and I have always been intrigued by this country, wanting to understand the impact of their revolution. I was honored to be traveling to Cuba with Congresswoman Karen Bass and former State Assemblywoman Mary Hayashi, as well as Maria Carriedo-Ceniceros, Chief Medical Officer of the San Ysidro Health Centers, to learn more about the country’s public health system. I have been to Cuba once before, when my husband played baseball against the Cubans as a member of Team USA, but this trip was so much more enlightening. It opened my eyes to the rich cultural and political history of the country and educated me on Cuba’s contributions to global health equity and universal health.
Here are a few things I learned during my educational adventure in Cuba:
Cuba’s health care system is available to all free of charge and rooted in community
Cuba’s health care system is built on the belief that health happens in the community and care should be free and available to everyone on an equal basis. I was able to visit a local poly clinic where we learned about Cuba’s overall focus on prevention and the community approach to the practice of medicine. We also visited a family doctor’s office where the physician and nurse team were the assigned providers within the community and were ultimately responsible for everyone’s health.
Health innovations are impacted by the embargo
We had a great visit to the Center for Diabetes Care while we were there. We met with specialists and discussed innovative treatments for diabetes – including the use of the drug Heberprot-P to treat diabetic wounds. This drug was developed in Cuba and has greatly reduced the need for amputations. Unfortunately, due to the embargo, it is not available in the United States. Cuba has also been unable to export the drug to other countries.
Cuba is educating American Physicians
At the Latin American School of Medicine, we learned that this medical school was established in Cuba for the purpose of educating doctors from foreign countries for free. These physicians commit to going back to their home country to work in underserved communities. We met students from Ghana, Congo, Angola, Antigua, Ethiopia, South Africa, Tanzania, and Chad, as well as American students from Minnesota, Illinois, and Los Angeles. Most of these students were people of color. It was fascinating to find out about the existence of this educational opportunity and that so many graduates end up working at community health centers and public hospital systems in the United States.
The Revolution is alive and well
I learned about Committees in Defense of the Revolution or CDRs. We met with neighborhood representatives of a local CDR, including women that were its founding members. We learned about the history of these neighborhood entities and how their role has evolved since the revolution. CDRs originally existed to promote social welfare and report on counter-revolutionary activity. They now serve as community support entities, working to put health, educational, and other national campaigns into effect on the ground and they continue to advance the principles of the revolution.
Education system strives to be equal for all
One of my favorite parts of the trip was visiting a local middle school. We observed the classroom instruction and learned about the curriculum. We found out that the curriculum is standard throughout the country and that school attendance is compulsory through the 9th grade. Literacy is widespread throughout the population as a result of this policy. We also got to visit with students and see a wonderful student performance which included singing, dancing, and skits.
African roots flourish
I was fortunate to visit the Biosphere Reserve in the Artemia Province outside of Havana. There we visited land being farmed by a female descendent of the slaves that had once farmed the same property. The property-owner fled during the revolution, leaving the land in the hands of the farmer’s parents and it was passed down to her. She is now growing botanicals that are used in herbal remedies and has a contract to sell these botanicals to the government. She was deeply knowledgeable about natural and herbal healing techniques and used the herbs from her farm to create her own healing products. These techniques and knowledge have been passed down to her from her family, which descended from African slaves.
Cuba’s economy is in transition
We had a fascinating conversation with a University of Havana economist, Dr. Faustino Corruvias, where he discussed the evolution of Cuba’s economy. During the 1990s, Eastern bloc countries and Russia withdrew their financial support virtually overnight. Cubans suffered greatly during this time, but the economic reforms that followed have allowed for greater opportunities for Cubans to be entrepreneurial. As a result of President Obama’s policies, which included lifting the cap on remittances from families abroad, the Cuban government went even further in the loosening of economic policies which allowed for even greater entrepreneurial opportunities, such as operating restaurants or “Paladares” as they’re called, or renting rooms to tourists. However, they also created greater economic inequities within the country, the implications of which Cuba is still struggling with. Most recently, the Trump Administration’s policies have halted much of the progress that was made in opening Cuban and US relations and the government in Cuba has begun to retreat from the policies that were allowing entrepreneurship to thrive. Cuba is struggling to figure out how to hold onto their socialist values while creating opportunity and economic growth.
Music is a common language
One has not fully experienced Cuba unless they experience the music, and I had some pretty amazing exposure in this regard. Early in the trip we were introduced to two local female rappers. We went to their home in a local neighborhood in Havana and had the opportunity to hear about their lives and the challenges they face as female rappers in Cuba. In addition, we received an incredible live performance – a sneak peek into what they will be performing at the Kennedy Center in Washington, D.C. this May. It was such a highlight to go into their home, hear from them personally, and see them perform.
We also went to a small jazz club and saw an amazing quartet that played everything from John Coltrain to Latin jazz. We also took a trip to a local night spot to hear salsa and saw some amazing moves on the dance floor. We then went with a group to experience Reggaeton, giving me insight into how the younger generation likes to experience music. We also went to a place called Fabrica Arte de Cuba – a former factory that had been converted into a giant multimedia complex that included live music, videos, rappers, spoken word, and an incredible display of art work – it was truly unique and amazing. The music I experienced while in Cuba was incredible.
This trip was both educational and inspiring. I learned so much about Cuba’s health care system, educational system, economy, and culture. I am so fortunate to have been able to participate on this tour with Congresswoman Karen Bass. It was an incredible opportunity and I feel so fortunate to have been able to experience Cuba in this manner.
“Carmela Castellano-Garcia was only three years out of Yale Law School when the board of Public Advocates, the law firm where she worked, decided to part ways with the firm’s founding partners. She was left with two other attorneys, also just out of school, and a board who believed in her.”
Read the article here.
Last October, I was honored by the staff and membership of the California Primary Care Association (CPCA) at a reception celebrating my 20 years at the helm of the organization. It was an amazing evening filled with longtime colleagues, mentors from throughout my tenure, and cherished friends. As I watched the slideshow that my staff had put together, showcasing major events from the past two decades, I was filled with gratitude and a sense of accomplishment for what we have been able to achieve these past 20 years. Throughout my tenure I have been so fortunate to have worked with a remarkable team of dedicated staff, an amazingly forward-thinking Board, and a membership that has become a source of inspiration for the rest of the nation. Most days I still find it hard to believe that I’ve been at CPCA for twenty years; but thinking back to why I went to law school in the first place, it is clear to me why I continue to dedicate my career to the community health center movement and to advancing our mission of health care access for all.
Twenty-seven years ago I graduated from Yale Law School. Looking back on it now, the fact that I felt I had a strong purpose in my life is what got me through all of the years of hard work that led me to ultimately graduate from the best law school in the country. My purpose was to arm myself with the most prestigious law degree and arduous training I could secure and use those tools to address the social inequities that were plaguing my community. I felt that my degree would open doors and allow me to use the law to become a social justice advocate for the Latino community.
I am so grateful that I ended up at the law office of Public Advocates, Inc. in San Francisco after graduation. Not only because it brought me back to California, but because it gave me the opportunity to create a Latino voice in health care, at a time when none existed, by founding the Latino Coalition for a Healthy California (LCHC). It also gave me the opportunity to participate in class-action litigation and learn the ropes of non-profit leadership as a Managing Attorney. But the most important thing that happened to me through my work at those two organizations was becoming involved in advocating for community health centers. After all, how do you advocate for health care access in the Latino community if you don’t advocate for health centers? I also learned very early on that advocating for health care access for Latinos was more powerful when joining forces with other ethnic organizations and advocating on behalf of the safety net and California’s diverse communities as a whole.
Carmela in her office at CPCA in the late 1990s
In fact, it was a call from Sherry Hirota, CEO of Asian Health Services, 25 years ago when I was still at LCHC, where she strongly asserted that LCHC would be in a much better position to advocate for cultural and linguistic competence standards in California’s Medicaid program if we joined forces with the Asian community and other ethnic groups that had an interest in the issue. I am thankful to community health center leaders such as Sherry for helping me to see the strength of broader coalitions and unity. My multi-ethnic coalition-building began when I helped to found the California Pan-Ethic Health Network (CPEHN) out of Public Advocates, Inc. I went to law school to help the Latino community, but I realized that, ultimately, my passion was to help ALL vulnerable populations in our state — with a special focus on women’s issues in particular. I realized that there was more that I could be doing for all Californians, while also honoring my original purpose to support the Latino community.
So, after six years at Public Advocates and LCHC, I was fortunate to become the CEO of the California Primary Care Association (CPCA). This was the right move for me at the right time. Term limits had been instituted in the California Legislature and for the first time, Latinos were rising to prominence and turnover was happening at an unprecedented rate. This created an opportunity for more individuals from under-represented areas who were committed to community health centers to move into positions of importance. This further strengthened the existing bi-partisan support from rural and other legislators throughout the state. These opportunities, combined with an aggressive legislative agenda for CPCA, made it an ideal position for me.
(l-r) Dean German, CEO of Shasta Community Health Center; Assemblymember Wes Chesbro; Assemblymember Judy Chu; Cástulo de la Rocha, President and CEO of AltaMed Health Services Corporation; Carmela; Carmen Castellano; and Dr. Sam Shaker, head of HRSA.
Since I started in 1997, CPCA’s staff has grown from just myself to nearly 50 individuals within four (4) departments. I am so proud of the hardworking, innovative, entrepreneurial staff we have at CPCA and of all of the work they do day in and day out for our health centers and their patients. CPCA has worked to develop forward-thinking strategic partnerships and critical service lines. Over the past two decades we’ve developed a robust training and technical assistance program aimed at ensuring community health centers are successful within the larger health care system. Each year, CPCA staff provide thousands of instances of phone, email, and in-person technical assistance. We continue to build partnerships with vendors nationwide to bring the best programs and services to CPCA members, helping them to strengthen their own organizations and improve their bottom lines. Through this work, health centers have only become stronger within the larger delivery system – despite the continually changing environment. In doing so, CPCA has been propelled from one of the youngest state primary care associations into the national spotlight as one of the strongest and most forward-thinking PCAs in the nation.
Carmela meets with health center staff during health center site visits this summer
In the past two decades, CPCA has been instrumental in the financial strength and overall growth of community health centers in the state. In fact, community health centers have had significant income growth, increasing their collective income by more than 600 percent from $795 million in 1997 to over $5 billion in 2016. Patients served has increased more than 275 percent during this same period from 2.4 million to more than 6.6 million, and total annual encounters grew by more than 12 million. During this period, federal funding to CHCs has increased from $105 million annually to $686 million and the number of health center sites has more than doubled to over 1,300 sites in 2016. Community health centers have become the backbone of primary care delivery in the State of California.
We have also enjoyed a progressive advocacy agenda and impressive track record of legislative and regulatory victories throughout the years. By no means have we won every battle, but we’ve always put up a good fight and we have shown the amazing power we have when we are unified – in vision and in purpose. We’ve built wonderful relationships with legislators over the years who have become champions for the movement. We’ve enjoyed legislative victories including the development of the Prospective Payment System model in California, the Cedillo-Alarcon Community Clinic Investment Act of 2000, and the creation of the Steven M. Thompson loan repayment program.
Carmela and California Attorney General Xavier Becerra at the 2017 Day at the Capitol
Carmela and Senator Holly Mitchell at the 2017 Day at the Capitol
And let’s not forget our successful implementation of the ACA in our state. While the uninsured rate dropped across all racial and ethnic groups, the greatest gains were seen among Latinos with 1.5 million additional Latinos gaining coverage under the ACA. The uninsured rate among this population was also cut nearly in half – from 23 percent to 12 percent. Community health centers in California have been a model for the rest of the country and I am immensely proud of what they have achieved – not only in helping the uninsured gain coverage but also in providing access to care for millions of newly insured Californians.
Two years ago we developed a successful 501c(4) organization, CaliforniaHealth+ Advocates, that is dedicated to advancing the mission of community health centers through state and federal advocacy, and continues our legacy of successful advocacy efforts for members – including the recent billable provider legislation and securing $100 million dollars to address our primary care workforce shortage. I am so excited for our future as we continue to ‘up our game’ in Sacramento and strengthen the united voice of community health centers in California.
I am very fortunate to have worked with so many amazing healthcare leaders in the clinic movement here in California. Individuals who, like me, have dedicated their careers to expanding access to health care for California’s vulnerable populations. We share this common purpose and commitment. I am so thankful to the community health center leaders who have taken me under their wing and shown me the ropes. There are a number of amazing leaders who have guided me over the years and been a source of support for me during challenging times, as well as a source of inspiration. I am also excited by the new generation of leaders coming to our movement, bringing renewed energy and a fresh perspective. Leadership development and succession planning will be important for the future of our health center movement as many founding CEOs are more closely approaching retirement. I am reminded of the great work that has already been done and am inspired for the great years of work ahead.
Jane Garcia, CEO of La Clinica de la Raza; David Hayes-Bautista, Director of the Center for the Study of Latino Health and Culture at UCLA; and Carmela at the 2015 Annual Conference
I am also very thankful to my family, especially my parents, Alcario and Carmen Castellano, and my husband, Angel Garcia. They have cheered me on and provided their unconditional support, encouragement, and love. My parents, through their example of generosity, activism and leadership, have set the bar high in these areas and have inspired their children to carry the social justice torch. I am honored to continue their legacy of community involvement, advocacy, and service. It is an honor to represent my family in philanthropy as the President of the Castellano Family Foundation. Through this work, my parents have made it possible for me to give back my hometown of San Jose and have given me the opportunity to support the non-profit sector in a new way. This has greatly enhanced my work at CPCA as well, opening new doors and giving me the ability to take the health center message to new audiences.
Carmela and her mother Carmen Castellano
As I look back on my career, I have to say that I have been truly fortunate and blessed to have the opportunity to thrive in a job I love and work with amazing people day in and day out who share my passion and commitment. I have played a role in bringing health care access to millions of Californians, thereby accomplishing one of my life’s goals – which was to improve conditions for the Latino population of California and thereby positively impacting health care access for ALL Californians. Even more than that, I have been able to advance a broader social justice agenda and for young women coming up behind me, highlight what is possible when you follow your passion and are driven by dedication to do something bigger than yourself.
“CNN commentator and attorney Bakari Sellers received a standing ovation for his riveting keynote address at Charles R. Drew University of Medicine and Science’s (CDU) third annual President’s Breakfast on Thursday, February 22 at the Marina Del Ray Marriott.”
Read the press release here.
“The Silicon Valley Leadership Group Foundation’s Heart & Soles run was started with the goal of raising money to put salad bars in Silicon Valley public schools. And in its three years, the race — sponsored by Lam Research — provided funding to purchase high-end salad bars for 192 schools serving 145,000 students.”
Read the press release here.