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.
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.
On February 5, 2018, community health center advocates united across the country in a “Day of Demonstration” aimed at fixing the funding cliff impacting health centers and their patients. Advocates nationwide wore red and voiced concerns to their members of Congress urging them to include health center funding in the budget package that was passed by both houses and signed by the President in the early hours of February 9th. CPCA members throughout California joined with their counterparts in all 50 states and took to social media, traditional media, held events, and put calls into Capitol Hill – showing the strength and solidarity in our movement.
I myself joined colleagues at the Capitol to meet with Congressional members and discuss with them personally what was at stake for community health centers and the communities they serve. I personally met with Congresswoman Judy Chu, Congresswoman Lucille Roybal-Allard, Congressman Tony Cardenas and Congresswoman Doris Matsui – as well as staff for Speaker Nancy Pelosi, Senator Kamala Harris, and Congressman Kevin McCarthy. Throughout our visits, the overwhelming consensus was clear – community health centers have bipartisan support and are greatly valued by all. Unfortunately, we were caught up in the political dysfunction of Washington D.C. This made it even more critical that we rise above the politics of D.C. and make our voice heard in the halls of Congress.
By all accounts we were hugely successful in our efforts, and thanks to our advocacy both chambers of Congress took appropriate action to fix the funding cliff with a two-year extension to health center funding! This is an amazing accomplishment and I want to thank all of the health center leadership, staff, advocates, board members and patients that showed up – both at the Capitol and in their communities – to help us achieve this monumental win. I would especially like to thank the health center leaders that joined me in Congressional District meetings including: Community Health Partnership, Gardner Family Health, North East Medical Services, AltaMed Health Services, and the San Francisco Community Clinic Consortium, among others.
This tremendous effort was led by the National Association of Community Health Centers (NACHC), our national organization, with the help of CPCA staff and one of our federal lobbyists Angie Melton, all of whom played a pivotal role in the overall success of the day. The greatness of the day and the importance of this fly-ins was not lost on me. We are all busy. We all have a million things to do day-to-day. But we cannot lose sight of the critical role these “Days of Action” play in pushing our agendas and promoting our issues, or the fact that our voice is louder when we all come together and advocate as one. We need to continue our efforts on issues that are important to us and the communities we serve – including immigration. While I am very pleased that Congress averted the health center funding cliff, I am deeply concerned about the future for DACA recipients. The Senate will begin their floor debate on immigration legislation next week, and I hope that the House of Representatives shows the same commitment to an open process. DREAMers are an integral part of the fabric of our communities in California – they are patients and, in some cases, employees at our health centers, and they are also our neighbors and friends.
I call on Congress to find a fair solution that allows DREAMers to continue to thrive in their lives as Americans and I hope that you will join me in doing so. We have the opportunity here and now to join together and have our voices heard on DACA. We can build on this momentum and this victory for health centers. I hope to see an even stronger delegation of advocates at NACHC’s Policy and Issues Forum in March and at our own Day at the Capitol in Sacramento in April, because we still have much to fight for!
With all that is going on at the federal level, including the potential loss of 70 percent of federal funding for health centers, it can be easy to lose sight of what is going on here in our own backyard. Our legislative leadership and our Governor have stood up for and continue to protect our immigrant community by making California a sanctuary state and enforcing protections to this population. We are indeed fortunate, especially compared to other parts of the country, considering that California’s proposed budget by Governor Brown had many positives, specifically for our patient population. The Governor remains committed to the ongoing support of vital health programs including the Child Health Insurance Program (CHIP), Medi-Cal and the Affordable Care Act (ACA) – all of which impact our patients. While we don’t take for granted how progressive our state is on many issues, we can’t stand idly by when proposals that undermine our ability to do our work and serve our patients are being considered.
Unfortunately, undermining the safety net is exactly what Governor Brown’s proposal to eliminate the 340B drug discount program from the state’s Medi-Cal program will do. 340B is a federal drug discount program intended to ensure low-income patients receive their prescription drugs at a much-reduced cost. The program also allows the health centers and other safety net providers the ability to utilize the savings (between the discount and the market price of the drug) to reinvest in patient care. The 340B program in Medi-Cal enables health centers to stretch their resources to ensure that underserved and low-income patients receive the necessary comprehensive services they need, services that are beyond the reach of the Medi-Cal program. Without this essential and critical lifeline for the safety-net, there will assuredly be some devastating impacts – ranging from a reduction in clinic hours of operation to the elimination of wrap around culturally competent medication assistance for patients, to staff layoffs.
I remain flabbergasted that this proposal is in the budget. Why would California want to undermine the safety net at this point in time? The Administration is well aware that health centers are facing a dramatic and unprecedented reduction in federal funding unless Congress reauthorizes the health center program. If the funding is not reauthorized, it will be a hit of some $240 million this year and then over $400 million in the years to come. To layer on top, another multi-million dollar hit by eliminating the 340B program from Medi-Cal simply makes no sense. Not to mention Congress’ continued focus on undermining the ACA and the Medicaid program. The safety net does not have sufficient margins or reserves to withstand such dramatic revenue losses without some dire consequences. And these consequences impact the lives of over 6 million patients that consider a community health center their medical home.
In light of this, we must remain steadfast in the protection of programs currently safeguarded as part of the budget. The continued congressional interest in dismantling the ACA was seen in the passage and signing of a Tax Reform bill that included the elimination of the individual mandate. This proposed state budget reminds us that, while the state continues to safeguard ACA coverage options, significant federal funding changes or an ACA repeal could disrupt benefits and coverage.
We must continue to fight for our patients and the programs that impact them. We are asking the Governor to reconsider his misguided elimination of the 340B program and work with health centers and other safety net providers to make the 340B program work for our state and our patients. Join me in advocating for health centers and their patients! Become a health center advocate today – click here to learn more.
National Conference of State Legislators Capitol Forum attendees at San Ysidro Health Centers
I had the great honor of attending the National Conference of State Legislatures Capitol Forum in Coronado, California on December 12th. This event is where legislators and staff from states across the country come to learn the latest on pressing issues and develop the agenda that guides NCSL’s advocacy work on Capitol Hill. This year’s event included an educational component that involved a tour of the San Ysidro Health Maternal and Child Health Center, San Diego PACE, Senior Health Center and San Ysidro Health Center sites. It was a great event and such an amazing opportunity to highlight the great work our community health centers are doing to legislators and their staff from other states.
I was personally moved by the presentation Assemblymember Lorena Gonzalez Fletcher gave at the event. A long-time champion of the community health center movement, she made a point to feature the great work that San Ysidro Health was doing in the community and the vital role they play in the lives of their patients. It was important for this audience to hear the true impact our health centers have, but it was equally important for these legislators to hear about the great relationship San Ysidro Health and Assmeblymember Gonzalez Fletcher have. We are truly lucky to have such amazing legislative leaders here in California – leaders who continue to be our staunch supporters. Assemblymember Gonzalez Fletcher is a true friend to the health center movement.
Carmela and Assemblymember Lorena Gonzalez Fletcher at the NCSL Capitol Forum Event December 12th
Senator Ben Hueso gave a moving presentation at the San Ysidro Maternal & Child Health Center. Senator Hueso spoke so eloquently about the health center movement being born of a time when communities were being left behind – the poorest neighborhoods with the most need were left without access to much-needed health care services. Like the border town where San Ysidro Health was originally established back in 1969, and how the organization had grown to provide high-quality care to thousands of patients through a vast and integrated network of sites throughout San Diego and El Cajon. His words were inspiring and rang so true for us in the room who are so dedicated to the health center movement.
Carmela with San Ysidro Health CEO Kevin Mattson (l) and Sentor Ben Hueso (m) at the San Ysidro Maternal & Child Health Center
Culminating the day with the San Ysidro Health site visit was probably the most exciting part of the event. I had personally never visited the Maternal & Child Health Center before and was blown away by the programs and services they offered – especially the child development services. It was a beautiful site and was a shining example of the all that our health centers offer. We were also fortunate to be able to see the San Diego PACE, Senior Health Center which provides senior support services along with health care services to those in the community.
It was such an incredible day, made even better by all of the wonderful comments I heard from the other attendees on our way back from the site visit. I’m excited and energized to get to work on our own legislative priorities in 2018 and feel so fortunate to be working with Senator Hueso and Assmeblymember Gonzalez Fletcher on important health center issues next year.
Last Thursday, I had the honor of attending the Hispanas Organized for Political Equality’s (HOPE) 28th Anniversary Awards Dinner in Los Angeles. I have always been a strong supporter of HOPE and the important work it does in advancing Latinas. I have always admired the mission of HOPE and think that they are doing wonderful work in ensuring political and economic parity for Latinas through leadership, advocacy, and education to benefit all communities and the status of women. This event had a special significance for me personally, because one of my dear friends was receiving an award. It was made even more memorable as I was joined by some Los Angeles-based CPCA members: Richard Veloz, CEO of South Central Family Health Center; Margie Martínez, Chief Executive Officer of ChapCare; and Dr. Anitha Mullangi, CMO of Saint John’s Well Child & Family Center.
Helen Torres, Executive Director of HOPE, is a powerhouse Latina doing wonderful work to develop future leaders for the state. Serving in this position for more than 17 years, Helen has dedicated her professional life to bettering the lives of Latinas through the advancement of important issues and personal empowerment.
Olga accepting the “Spirit of Hope” Award
I also had the pleasure of seeing my friend of many years Olga Talamante, Executive Director of the California-based Chicana/Latina Foundation, who received the “Spirit of Hope” Award that night. I was overjoyed to see Olga receive this award from HOPE – it is so well deserved. She has been such a trailblazer and a leader within the Latina community for many years now, spending nearly 15 years running the Chicana/Latina Foundation. Prior to that, she spent a number of years relentlessly working to improve and uplift the lives of Latinas. I have always been so inspired by Olga’s boundless energy and her tremendous leadership and dedication. She was entirely dedicated to the Chicana/Latina Foundation as a volunteer Board member long before she accepted a leadership role at the organization.
Olga and I
The Chicana/Latina Foundation has been a grantee of the Castellano Family Foundation (CFF) since its inception over 15 years ago. As a result, I’ve been able to witness Olga’s hard work from multiple perspectives. My mother is a former Board member of the Chicano/Latino Foundation, and she has always been extremely supportive of the organization. When my siblings and I transitioned onto the CFF Board five years ago, we continued that commitment to Olga and her organization and have enjoyed being able to work with her.
Margie Martinez, Myself, and Anitha Mullangi
HOPE and the Chicana/Latina Foundation are two organizations that are making a tremendous contribution to advancing and empowering Latina women. Through this event, I was able to celebrate Olga and HOPE, and all of the amazing work they do. But on a daily basis, I celebrate all the women who are involved and dedicated to advancing and bringing up the next generation of women leaders in our state.