Championing U.S.-Mexico Border Partnerships and Collaboration through Point-of-Care Ultrasound Education:
SOCIAL EM & POPULATION HEALTH COMMITTEE
An Interview with Eva Tovar Hirashima, MD MPH
I
Faith Quenzer, DO MPH
ntroduction
The practice of emergency medicine (EM) is quickly spreading throughout the world. The integration of point-of-care ultrasound (POCUS) has been an important part of in delivering health care in both rural settings and lowand middle-income countries because of portability and cost. Currently, very little information is known about the practice and use of POCUS in Mexico in delivering health care. Information regarding EM trained physicians who utilize both POCUS and education in these global settings is scarcer. Our piece this month highlights the educational and economic needs among the U.S.-Mexico border region and the goals of creating equal partnerships and collaborations in the vast border city of Tijuana. My interview is with the founding member of Ultrasonido en el Punto de Atencion (UPA) del Norte, Eva Tovar Hirashima, MD MPH, who is an Assistant Professor at University of California, Riverside and Ultrasound Fellowship Director at Riverside Community Hospital in Riverside, California. She is currently the Emergency Medical Services (EMS) Director at Cruz Roja in Tijuana. Through her organization, UPA del Norte in conjunction with Cruz Roja Tijuana (CRTJ), Dr. Tovar has successfully created a monthly point-of-care ultrasound (POCUS) interest group comprising of emergency medical services (EMS) personnel, medical students, general practitioners (GPs), midwives, EM and IM residents, and attending physicians. Our interview shares her story and her journey as a foreign-born Latina emergency medicine physician who is not only giving back to the community and country she comes from, but raising awareness to the educational needs and equipping our Mexican colleagues south of the border with high quality POCUS education and mentorship. She has hopes that her efforts could give her colleagues have boundless opportunities to contribute to EM education and our practice. Faith Quenzer (FQ): Tell me about how you decided to become an emergency medicine physician. Eva Tovar (ET): My first “real” encounter with the ED was as an internal medicine (IM) resident in Mexico City. The teaching hospital where I trained did not have an EM residency. As IM residents, we ran the ED. Among my classmates, the ED was known as the “salt mines” and most were relieved once their time in the ED ended. I learned to love it. The unpredictability and the need to make decisions with incomplete information were welcomed challenges. But what I think made me fall for EM was its complex simplicity: “There is someone who has self-selected and presents to the ED asking for your help. Your job is to help them. The challenge is figuring out how to do that despite everything and everyone
>>ANYONE,
ANYTHING, ANYTIME/QUIEN SEA, LO QUE SEA, CUANDO SEA.
else.” It seemed like a just fight, something worth pursuing. What I came to realize was that as an IM resident I was lacking the skill set that allowed me to provide timely and high-quality emergency care. I had found a purpose. The next decision point was simple, I needed to train in EM. FQ: Where did you study medicine in Mexico? What was your path to studying in the United States? ET: In Mexico, you start medical school right after high school. I studied at the School of Medicine (SOM) in the National Autonomous University of Mexico (UNAM by its acronym in Spanish), in Mexico City. It was a six and a half year endeavor. I spent the first two years in the classroom, and the next two and a half years doing clerkships in different public hospitals in Mexico City. I spent the fifth year, which is called an “internship,” in a public hospital in Ensenada, Baja California, where I became part of the treating team and functioned as a PGY1. During my final year I was deployed to a critical access clinic in Baja California Sur, where I served as the community’s general practitioner. As a public university, the tuition at UNAM is affordable. I paid less than a dollar a year. As a middle-class, female medical student in the 90s, studying at UNAM was an eye-opening experience where I was abruptly confronted with the social and health disparities, as well as the institutional barriers that prevent equitable and high-quality care in the public health care system. The contradiction of knowing that health care is a constitutional right compounded with the understanding that you have individually benefitted by having the tuition practically waived stood in stark opposition with a >>
24
COMMON SENSE NOVEMBER/DECEMBER 2022