Central Valley Health Fall 2017 by McClatchy Custom Publications

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Central Valley Magazine | NOVEMBER 2017 1

Working Together N

FOR A HEALTHIER VALLEY

early one out of every 50 people in Fresno County wears a Community Medical Centers’ badge – as an employee,

“Caring for our workforce is as vital as caring for the health of our region.” Making the Valley a medical destination

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• 420,000 Visits by Valley Kids Last Year • 200+ Pediatric Specialists • Experts in Treating the Most Complex Congenital Conditions • National Leader In Neonatal Survival Rates • Partnered with Saint Agnes Medical Center for High-Risk Deliveries valleychildrens.org/newbornservices

MORE THAN A HOME… As a local third generation family homebuilder, we appreciate that “home” means a new beginning for you and your family. We understand how important location is which is why we build in communities that provide easy access to important daily services such as grade-A schools and shopping to major employment centers. Discover your new “home” today….your new life awaits.

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McCaffreyHomes.com All square footages stated are approximate. Actual square footage will vary. Pictured homes are models with some features, furnishings and landscaping not included in the purchase price. Included features vary throughout the models and are subject to change without notice. Information about community association facilities and assessments is available in the Sales Office. Homes, prices, financing, incentives and included features are effective date of publication deadline and subject to prior sale, change or cancellation without notice. The McCaffrey Group, Inc. dba McCaffrey Homes. Offered by McCaffrey Home Realty, Inc., CA Real Estate Broker #01222049.

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Fall 2017

24 Denial is necessary

12 14 18 24

Don Farris says sometimes denial is necessary for your quality of life, but there are times you need to face facts.

Home-grown healthcare Doctor Academy envisions a future where students from disadvantaged backgrounds become healthcare providers.

Female surgeons Not much sets these surgeons apart from their male counterparts — except, perhaps, their determination.

Making history

14 8 Your Health

Two residents with local ties are part of Valley Children’s Healthcare’s inaugural Pediatric Residency Program.

12 Voices 14 Heal 18 Heal 24 Heal 28 Eat

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29 Last Look

Just 35 percent of physicians nationwide are women and the percentages of women practicing surgery are even lower. Medical schools and professional physicians’ organizations assert that it’s crucial to have a diversity of cultures and races — and gender — among healthcare providers because it helps improve the delivery of care to a diverse patient population. PHOTOGRAPHY: Nicole Bulter

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At Home

The future of healthcare in the Valley t’s something many of us take for granted, until it turns bad. But your health is something you should take seriously. And while denial may be a necessity, according to Don Farris (see page 12), not going to the doctor because you’re afraid of what he or she might tell you is never a good idea. So as the weather changes, maybe it’s time to take note of your health and get in for your annual physical exam. In the meantime, Farin Montañez writes about local medical educators having a dream: One day, the diversity of health professionals in the Valley will mirror the diversity of the community itself. The UCSF Fresno Latino Center for Medical Education and Research established a Doctors Academy program to create a pipeline for middle and high school students who come from disadvantaged families to become healthcare professionals. The goal: for our future healthcare leaders to provide care in a patient’s primary language. Read about students shadowing doctors in their chosen field starting page 14.

What does a surgeon look like? Starting on page 18, Erin M. Kennedy explores that question in detail. In the Valley, a surgeon may “wear smoky eye shadow and cameo earrings in the operating suite or cover their hair with girly flowered surgical caps.” But these female surgeons are no different from their male counterparts, except maybe for their determination. And 13 young doctors form the inaugural class of Pediatric Residency Program at Valley Children’s Healthcare. We spotlight two, Dr. Daniel Ebbs and Dr. Devon Goosen, who are local to the Valley, starting on page 24. Our Last Look highlights a very special place for children with disabilities and veterans — Heart of the Horse Therapy Ranch. Equine-based therapy has many benefits, and its annual Cowboy Dinner and Dance is on Nov. 4. Get your tickets now because this event is sure to sell out. Cheers to your good health!

Monica Stevens, Central Valley Health Editor

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Fall 2017/ Vol. 2, Issue 2 ......................... Central Valley Health is produced by the Custom Publications staff of The Fresno Bee and published by The Fresno Bee. Cover price $3.95 President & Publisher Tom Cullinan Vice President, Sales & Strategic Marketing John Coakley Custom Publications Editor Carey Norton | 559-441-6755 Advertising Sales Director Stan Diebert | 559-441-6127 Production Coordinator Anna Ramseier | 559-441-6751 Central Valley Health Editor Monica Stevens | 559-441-6149 Custom Publications Staff Janessa Tyler Dani Villalobos Gary Kazanjian Contributing Writers Don Farris, Katie Fries, Douglas Hoagland, Erin M. Kennedy, Farin Montañez Contributing Photographers Nicole Butler, Farin Montañez , Tomas Ovalle Design Carey Norton, Monica Stevens Cover Design Juan Vega Reader inquiries Central Valley magazine 1626 E St., Fresno, CA 93786 www.centralvalley.com 559-441-6755 All content © The Fresno Bee To contribute, please contact Carey Norton at 559-441-6755 or cnorton@fresnobee.com

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8 FALL 2017 | Central Valley Health

Shirt helps children fighting cancer The Emilio Nares Foundation, a nonprofit that helps families navigate their child’s journey through cancer, is celebrating the 10-year anniversary of the patentpending ENF Loving Tabs Healing Shirts. The innovative shirts are designed with an open-close shoulder panel to allow medical professionals to easily administer chemotherapy into a child’s permanent chest catheter port, without requiring children to lift or remove their clothes. “Already frightened, young cancer patients are often reluctant to lift or remove their clothing due to feelings of fear and modesty, which can interfere with lifesaving treatment,” says Richard Nares, co-founder and lead visionary of the Emilio Nares Foundation. “Our goal is to make sure every child battling cancer in every children’s hospital has a Loving Tabs Healing Shirt. Children fighting for their lives should not also have to fight for their dignity.” The prototypes of Loving Tabs were created while Richard’s son Emilio and ENF Patient Services Director, Luz Quiroga’s son, Martin, were both battling cancer. Both children refused to lift or remove their shirts for treatment, until finally the parents resorted to cutting the shirts to facilitate easier access. This personal experience grew into the patent-pending Loving Tabs Healing Shirts, which can now be found in children’s hospitals across the country. “After modifying more than 20 shirts for my son when he was in chemotherapy, we knew this idea would stick and be very important for children battling cancer,” says Luz Quiroga, patient services director of the Emilio Nares Foundation. “It means so much for

Saint Agnes Medical Center receives accolades for women’s services Saint Agnes Medical Center has earned accolades from Healthgrades and Blue Shield and Blue Cross companies for successful outcomes of common gynecologic procedures and for the quality of care provided to women during and after childbirth. Healthgrades, a national organization that evaluates thousands of hospitals nationwide, named Saint Agnes among the Top 10% of Hospitals Evaluated for Labor and Delivery, Obstetrics and Gynecology, and Gynecologic Surgery. The medical center also received Healthgrades 5-Star awards for Vaginal Delivery, C-

my son Martin to be one of the first to use the Loving Tabs Healing Shirts, and now children across the country enjoy the same ease of treatment.” Loving Tabs Healing Shirts have been proven to support a faster and easier treatment process for patients and their medical providers. The shirts are the first of their kind to be developed and subsequently tested and evaluated through a major grant from the Robert Wood Johnson Foundation. A two-year study from three Southern California hospitals produced the following results: t 92 percent of partners in care (parents, social workers) observed less stress and increased patient cooperation t 88 percent of patients indicated that the shirt improved their overall treatment experience t 92 percent of doctors and nurses indicated they prefer the Loving Tabs Healing Shirt and reported a faster treatment process More than 1,300 Loving Tabs Healing Shirts have been distributed in children’s hospitals across the country, including Valley Children’s Healthcare in Madera. To find out more about the Loving Tabs Healing Shirts or the Emilio Nares Foundation, visit www.enfhope.org. Section Delivery, Gynecologic Surgery, Hysterectomy and GYN Surgery. In addition, Saint Agnes has been named a Blue Distinction Center+ for Maternity Care. Hospitals with this designation by Blue Cross and Blue Shield companies are shown to deliver improved safety and better health outcomes. Blue Distinction Centers+ for Maternity Care demonstrate expertise and quality care for vaginal and cesarean section deliveries, with better overall patient satisfaction and a lower percentage of early elective deliveries. “We’re honored to be the recipient of these elite designations that bring to light the compassionate, quality care we deliver,” says Saint Agnes Medical Center President and CEO Nancy Hollingsworth, RN. For more information, visit www.samc.com/womens-services.

Did you know that November is designated as National Alzheimer’s Disease Awareness Month? Alzheimer’s disease is devastating. It can’t be prevented, cured or slowed down, but it’s growing at a rapid rate. According to the Alzheimer’s Association, Alzheimer’s disease is an epidemic that affects more than 5 million men and women in the United States. The number is estimated to triple in 2050. To raise awareness and promote education about Alzheimer’s disease, the Alzheimer’s Association hosts a nationwide fundraiser in September. In 1989, the Walk to End Alzheimer’s was launched as the Memory Walk — raising $149,000 by 1,249 participants. It grew to raise $4.5 million within four years. Today, more than $75 million has been raised by thousands of teams. In the Central Valley, Fresno is among a handful of cities that host the Walk to End Alzheimer’s. The 2017 Fresno Walk to End Alzheimer’s was held on Saturday, Sept. 16 at Fresno State.

Good night, sleep tight More than 223 million U.S. adults have experienced a traumatic event once in their lives and many are returning troops. Our fellow American veterans face some of the most troubling aspects of PTSD, such as sleep problems, especially chronic insomnia and nightmares. Studies have shown that 52 percent of combat veterans with PTSD report having nightmares and 92 percent of active-duty personnel with PTSD report clinically significant levels of insomnia. While sleep problems are symptoms of PTSD, evidence suggests they become independent problems over time. To support our American heroes in getting a better night’s sleep, the tech-based Dreampad is helping people to sleep easier, one restful night at a time. The Dreampad is a comfortable pillow that uses patented sound technology to ease you

Fresno State joins partnership for healthier choices for students

A total of 149 teams — 1,225 participants — raised more than $165,000 to cover the costs of care, support and research conducted by the Alzheimer’s Association. Alzheimer’s disease is the sixth leading cause of death in the United States. Symptoms — loss of memory, confusion, inability to solve problems and complete tasks, withdrawal from work or social activities and mood swings — usually develop slowly, but worsen over time. Symptoms can also be as minor as misplacing keys and forgetting appointments. If possible, keep track of symptoms with a journal to determine if there are recurrences. Details: www.alz.org

into a peaceful sleep. Through relaxing music and gentle vibrations that only you can hear — a bed partner won’t hear or feel it — Dreampad prompts the body and mind to relax. The Dreampad has proven to help PTSD veterans in three ways: t Initially fall asleep faster t Fall back asleep after nightmares or change patterns of recurring dreams t Reduce PTSD symptoms of nightmare such as sweating and heart pounding The Dreampad features that fight against sleep problems include: t Free music app with music, timer and personalized settings t Eight different soundscape options or you can program your own music t 30-day money-back guarantee; if you don’t like it, just send it back t Choice of pillows that offer memory, firm, medium or slim support Prices for Dreampad range from $149 to $179. Visit dreampadsleep.com.

Fresno State has joined the Partnership for a Healthier America and made a three-year commitment to implement guidelines around food and nutrition, physical activity and wellness programming for students, faculty and staff. The Partnership for a Healthier America, supported by honorary chair and former First Lady Michelle Obama, includes more than 50 colleges and universities and touches more than 1.2 million students, faculty and staff across the United States. Fresno State is the first campus in the California State University system to make this commitment and one of four universities to do so in California. “Increasing access to healthy foods and opportunities to exercise can only help to make Fresno State a healthier environment for our students, staff and faculty,” says Kathy Yarmo, coordinator of health promotion and wellness services at the Student Health and Counseling Center on campus. Fresno State agreed to 23 guidelines, including: t Convening a three-year planning coalition to advise the healthy campus initiative t Including a healthy icon to identify healthier food options on campus t Marking walking routes on campus to identify the Bulldogs Trails t Installing outdoor fitness systems t Providing additional support to lactating students, staff and faculty “Colleges and universities are in a unique position to help shape tomorrow’s leaders, no matter where their education takes them,” says Partnership for a Healthier America CEO Lawrence A. Soler. “We know that going to college is a time of change for many students — we also know that means it’s a time when new habits are formed. “By creating healthier food and physical activity environments today, campuses and universities are encouraging healthier habits that will carry over into tomorrow.” For more information, visit www.ahealthieramerica.org/campuses.

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The Fresno Bee fresnobee.com

8 FALL 2017 | Central Valley Health

Fresno State joins partnership for healthier choices for students

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Sonography careers stretch beyond tracking pregnancies It’s not exactly X-ray vision, but one look into the future seems especially promising. That look involves medical technology and sonography careers. As a whole, the health care economy is expected to add 2.3 million jobs by 2024, reports the the Bureau of Labor Statistics. This in turn exceeds all other occupational groupings studied by BLS. Demand for medical technologists and technicians (including sonographers) is expected to increase 16 percent in the near future. And while most people initially associate diagnostic medical sonography — also called ultrasound technology — with onscreen, moving images of babies inside mothers’ wombs, the field now sprawls beyond obstetrics to pediatric, vascular and cardiac sonography, new areas of specialization crop up all the time. In brief, sonographers (or ultrasound techs) work hand-in-hand with doctors and radiologists in capturing and interpreting diagnostic images. The Society of Diagnostic Medical Sonography explains that: Using highfrequency sound waves to image or illustrate internal organs and blood flow patterns allows practitioners to get deep insights as to whether a person’s body is functioning in a healthy manner. In on-the-job terms, sonographers ensure patient safety with proper methods and equipment; take diagnostic scans, maintain patient records (i.e. anatomical or pathological abnormalities); and educate patients on the use and relevance of sonographic data. While there are a number of national organizations that offer credentials for sonographers and technologists, there is currently no single licensing requirement recognized by the federal government and related medical authorities.

Valley Children’s Residency Program: National Award for Advocacy, $1m gift Valley Children’s Pediatric Residency Program, affiliated with Stanford University School of Medicine, is the recipient of one of only four national Advocacy Training Grant Awards from the American Academy of Pediatrics. The grant recognizes residency programs seeking to strengthen advocacy training within their institutions, and Valley Children’s program — in its first year — was awarded the grant based on its innovation, interprofessional collaboration and desire to create a culture of advocacy for the Central Valley’s underserved children. “With our new residency program and the state of the health of our local children, there is tremendous opportunity for teaching advocacy to our residents and creating awareness around

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Still, as various forms of certification and licensure may be voluntary, hospitals, radiology groups and other employers typically prefer registered sonographers. More than ever, schools nationwide now offer extensive diagnostic medical sonography programs. Besides coursework, students typically complete a supervised clinical practicum to garner real experience working in a professional environment. More important perhaps than experience gained in internships in other fields, this hands-on, practical training must be completed before certification. Probably the most-cited and sought after certification in this field is that offered via the American Registry of Radiologic Technologists. As for the bottom line: Diagnostic medical sonographers make an average annual salary of $70,880. According to the Bureau of Labor Statistics (BLS May 2015), the highest salary recently surveyed hit $97,390 (in a populated urban area). Experts also project that openings in this field will grow 26 percent between 2014 and 2024, an almost-stunning rate of growth. — Career News Service

our faculty,” says Dr. Jolie Limon, Chief of Pediatrics and Executive Director of Medical Education. “We are looking towards a sustainable model that will be part of our training program and infiltrate our organizational culture.” Valley Children’s faculty-resident team will start implementing an educational project in collaboration with Valley Children’s AAP chapter. “Valley Children’s is committed to improving the health and well-being of all children throughout our service area,” says Tim Curley, Valley Children’s director of community and government relations. “The Residency Program will play an important role in that commitment as we work to measurably move the needle on some of the most important issues adversely impacting children’s health.” Valley Children’s Pediatric Residency Program is also honored to be the recipient of a $1 million gift from the Richard Berberian family of Fresno. This gift established the Richard and John Berberian Chief of Pediatrics Endowed Chair and the Richard and John Berberian Pediatric Resi-

dency Program Endowment. The Endowed Chair is a position structured to lead Valley Children’s entire Medical Education program. Chief of Pediatrics and Executive Director of Medical Education Dr. Jolie Limon is currently serving in that role. The Residency Program Endowment will specifically fund the needs of Valley Children’s Residency Program. The first class of 13 residents arrived in June. “As a family, we welcome Valley Children’s first group of residents to our Central Valley,” says Barbara Berberian, spokesperson for the Berberian family. “We are excited by their willingness to be a productive part of our community through service and education, both of which we recognize as being vital to the fabric of our lives. As Valley families, we have been the recipient of their high standard of care that is provided in a loving, joyful and caring atmosphere. “We are thankful to have the opportunity and are honored to become a contributing member of this very special place called Valley Children’s Hospital.”

Fresno State launches ‘Clear the Air’ campaign for smoke-free campus Fresno State recently announced its plan to provide a clean, safe and healthy environment for the campus under a new California State University system-wide policy requiring all 23 campuses to become tobacco, smoke and vapor free as of Sept. 1. The university’s “Clear the Air” campaign will educate students, employees and campus visitors about the new policy adopted in the spring 2017 semester by the CSU Chancellor’s Office with Executive Order 1108. State law already bans smoking from workplaces and all buildings accessible to the general public throughout the state as well as within 20 feet of buildings. Title 5 of the California Code of Regulations authorizes universities to set and enforce smoking and tobacco policies. The new CSU policy, which will be in effect at all times, applies to all university property, including buildings, athletic venues, residence halls, parking lots, vehicles and grounds. This includes no smoking, vaping or tobacco use

inside any personal vehicles located on Fresno State property. This restriction applies to tailgate gatherings and other outdoor, on-campus events. The new plan also removes 22 designated smoking areas that had been established under Fresno State’s previous smoking policy. Fresno State offers cessation resources for students, faculty and staff at: www.fresnostate.edu/adminserv/smokefree/cessationprgs.html. To help support the implementation and communication of this new policy, University President Joseph I. Castro assembled a committee of 20-plus members including students, faculty and staff. The committee is led by Deborah Adishian-Astone, Fresno State vice president for administration. Adishian-Astone says the primary goal of the committee is to educate the campus community and public about the smoke-free policy. “We are sensitive to what this change will mean for our campus community, so we want to do as much as we can through educational programs, communication and resources,” Adishian-Astone says. “To support this goal, the ‘Clear the Air’ educational campaign will create awareness of the change and invite cooperation as we move toward creating a healthier campus

Make time One of the most common lines that people love to use: “I wish I had more time.” Maybe it’s more time to spend with family or friends; more time to exercise and eat healthy; or more time to go back to school. Whatever it is, how do you make more time for those truly important things in your life? Dr. Alok Trivedi, author of “Chasing Success,” says the reality is we all have the same 24 hours. The difference is some people know how to better manage it than others. When it comes to making time for the important things, Dr. Trivedi recommends: 1. Minimize, minimize and minimize some more. There was a reason Marie Kondo’s novel about tidying up your space to become happy was so successful. There is truth in her message of eliminating the unnecessary and finding what you love in the process. Get rid of what does not bring you joy. This can be old items or even toxic relationships that no longer serve you. 2. Being busy does not bring you value. It’s wise to assess what in your life is bringing you value and maximize that rather than trying to do things that just don’t feel right and make you feel unworthy on the inside. 3. Differentiate between efficiency and effectiveness. When you are doing any task, approach it within a concept of both maximum efficiency and total effectiveness to reap the best results. In your personal life, this is

environment.” She says Fresno State campus and community members are asked to help create a smoke-, tobacco- and vapor-free environment using community reinforcement. “Community reinforcement relies on individuals to educate one another about the smoke-free policy and the value of breathing smoke-free air,” Adishian-Astone says. “Studies show that tobacco-, smoke- and vapor-free campus policies can reduce tobacco use and exposure to secondhand smoke, which provides health benefits to the entire campus community.”

Resources t For help with smoking and tobacco abuse, online resources and information are available at www.fresnostate.edu/smokefree. t Students needing help can contact the Student Health and Counseling Center at (559) 278-2734. t Faculty and staff may contact the Employee Assistance Program Life Matters 24/7 Referrals at (800) 367-7474 as well as the online resources. t For more information about Fresno State’s smoke-free programs, visit the websites for smoking cessation and counseling programs and the Fresno State Alcohol, Tobacco and Other Drug Safety Council.

achieved through being present and genuine in your interactions. 4. Single task and hold your focus. Many people find themselves casually checking a single email, and before long they snap into full-fledged work mode. Develop a schedule and follow it religiously. 5. Know what you hold important. It is a challenge to know how to dedicate your free time if you haven’t discovered what you love. Find the activities where your creativity flows and your heart sings. 6. Address problems at the root. Confront your problems head on to solve them with best results. Shying away will only allow the problem to become worse in the shadows. 7. Getting and staying organized. When it is time to be with friends and family the last thing you want to do is housework. Dedicate an initial cleaning and mass organization of your space. After this initial step, take a little time each day to clear your space and organize everything into its given area. 8. Block out time just for you. You must become your top priority. Declare certain times of the day and week that are just for you. This time can be for you to indulge in your favorite pastimes, meditate or even to do nothing. This time is yours to center yourself and think about what you are presently encountering in life. Live in every moment, and focus on the present. Details: www.chasingsuccessbook.com, alignedperformanceinstitute.com

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Voices

Denial is a necessity Don Farris, LCSW, BCD, is a licensed clinical social worker in Fresno, providing counseling and psychotherapy to individuals, couples and families. He can be reached at donfarris 1871@gmail.com.

ILLUSTRATION: Thinkstock

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hat you want to hear least may be what you need to hear most. Things that are mildly annoying, frustrating or irritating can be the first inklings of approaching danger. The tip-toes of uneasiness can become thunderclaps of terror and the first warnings of looming pain or loss. A physician talked of his frustration when a patient is told they have the symptoms of cancer, but won’t get the necessary testing because they’re afraid of what they might find out. When their symptoms can no longer be denied, they return to his office. Their condition may then be untreatable, although it could have been successfully managed earlier. No problem was ever solved by being avoided, no question was ever answered by being ignored and no threat was ever eliminated by being denied.

An ounce of prevention is worth much more than a pound of cure: it can be worth immeasurable tons of cure. During the war of 1812, Thomas Jefferson reportedly said, “The price of liberty is eternal vigilance.” Liberating yourself from your own shortcomings — in this case, inappropriate use of denial — demands the same price. In high school, I had a Jewish friend whose family left Germany in the 1930s before it was too late. They tried to convince family and friends to leave with them. A few did, more did not. Those who chose to stay didn’t want to hear that they were not only no longer welcome in their homeland, they were actually no longer safe in it. So they denied it. Although sustained denial is necessary for the quality of your life, it is an ineffective solution for quandary

and a worse one for problem solving. It can keep you from making the necessary adjustments to the inevitable changes in your life. The Jewish experience in Germany is a good example of why it is so necessary to address your fears. Addressing a fear enables you to know what the danger signal of fear is about and to develop a way to deal with it. Denial is a necessary psychological defense mechanism. Just as you must be able to defend yourself physically, you must also be able to do so psychologically. Defending yourself psychologically is not the same as being “defensive.” It is realistic to protect your worth, reputation, position on an issue and any threat to your emotional well-being. “Defensive” people feel threats to their well-being when they do not exist or overreact to those that do. This can be the result of frequent criticism, blame or accusations in childhood. Such unfortunate people have often been in emotional danger, so they often find it necessary to defend themselves. They have developed unhealthy defenses, as well as the necessary healthy ones. Every behavioral trait and characteristic that you see in others, whether likable or not, developed out of necessity. There is always a rational and understandable reason for why anyone conducts themselves the way they do — even though their behavior may be irrational and not understandable. People’s behaviors are the result of the good fortune or misfortune of their genetic endowment, the mental health of their families, how they were parented and other life experiences. Recognizing this will help you understand people better, define them more accurately and regard them more fairly. People don’t arbitrarily choose to be “jerks” or earn the scorn, contempt or disfavor of others. All human behavior is purposeful and goal-oriented. It is designed

to get our needs met or protect ourselves from threat and harm. From the point of view of the person, their behavior makes sense. Whenever you cannot see a sensible reason for anyone’s behavior — including your own — it simply means you don’t know what caused it. When you know the cause, it makes sense and often seems it could be no other way. In speaking to groups of hundreds of people, I have asked, “Who in this room has never been the victim of undeserved physical or emotional pain, or loss or injustice?” In more than 25 years, not a hand has ever gone up. I would then ask, “How many of you think you will get through the rest of your lives without any of these things happening again?” Again, no hand has gone up. We all know that pain, loss and injustice are part of our existence, and will be for as long as we live. We also know that this applies to those we love. We are also aware that we, and those we love, will die. We additionally know that those deaths may be very unpleasant. We cannot live happily with these realities constantly on our minds. Denial enables us to live our lives by protecting us from these disturbing truths. Denial comes easy to us because we use it constantly. Without vigilant self-monitoring, denial can almost be a psychological kneejerk reaction to any emotional discomfort. Misusing it is an easy thing to slip into. We do it frequently. Your well-being requires alert and consistent honesty in dealing with yourself. Being alert to and taking responsibility for your shortcomings and misdeeds protects you from worse consequences. Although being honest with yourself about yourself may be the most difficult thing you will ever be faced with, it is one of the most effective, satisfying and emancipating qualities you can develop. This truth really does set you free. CV

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Heal

uals who are from the Valley, understand the nuances of the Valley and can come back and provide services.”

Pipeline to success

ACaruthers High School student Lisa Romero, left, listens to the heartbeat of 12-year-old patient Thomas Chang. Romero shadowed Kaiser Permanente Clovis pediatrician Dr. Lorraine Lopez, right, for five weeks as part of the UCSF Fresno Doctors Academy program.

Middle school to med school UCSF Fresno Latino Center envisions a future of home-grown health care providers BY: Farin Montañez | PHOTOGRAPHY: Farin Montañez

eceiving medical care from someone who doesn’t come from your socio-economic background or speak your native language — a common situation in the diverse Central Valley — can be daunting. But local medical educators have a dream: One day, the diversity of health professionals in the Valley will mirror the diversity of the community itself. In this vision, people of color and those who come from poor families will be our future healthcare leaders, providing care in patients’ primary languages. To realize this dream, the UCSF Fresno Latino Cen-

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ter for Medical Education and Research established a Doctors Academy program that creates a pipeline for middle and high school students who come from disadvantaged families to become healthcare professionals. Doctors Academy students come from a plethora of ethnic backgrounds, including Latino, Southeast Asian and Indian, and many are bilingual, says UCSF Fresno Latino Center director Dr. Katherine Flores. “We’d like students to come back to the Central Valley to provide health care services in languages patients are comfortable with,” she says. “The bottom line of the program is to improve the health of our local community by growing a cadre of young individ-

If a student will be the first in their family to earn a college degree, or if they come from an economically disadvantaged family, they can apply to Doctors Academy and be taken under the wings of local healthcare professionals and teachers who want to see them succeed. “The whole other part of this is to give young people the opportunity they’ve never had before — to learn to navigate the educational system, to take the right courses so they can get accepted into the college of their choice, and to become a successful graduate of that college,” Flores says. “Then we continue to work with those students to mentor them as to how to apply to a health professional school.” The Doctors Academy program started in 1999 at Sunnyside High School, with its first class graduating in Students choose the top three specialities they’re 2003. The program expanded in 2007 to include Selma interested in, along with a thorough explanation of why and Caruthers high schools. they’re fascinated by them. Then they’re paired with The challenging school-within-a-school program medical professionals. helps students in rural and urban areas explore career The most common requests are for dentists, family paths in various medical specialities ranging from practice doctors, pharmacists and pediatricians, Cantu dentists to surgeons to pharmacists, says, because those are the prosays Diana Cantu, clinical coordinator fessions the students are typically for UCSF Latino Center for Medical most familiar with. To learn more about Doctors Academy eligibility and applicaEducation and Research. But they have shadowed everytion requirements, visit Students work hard throughout one from oncologists to physical www.fresno.ucsf.edu/latinohigh school to maintain a 2.8 GPA and therapists to obstetricians and center-for-medical-educationcomplete accelerated math, science orthopaedic surgeons. and-research and writing classes. What the students learn and Then comes the fun part: an insee is up to the health care protense, six-week clinical job shadowing opportunity in vider they follow. the summer between their junior and senior years. For Selma High School student Brianna Colado, that can include watching the births of several babies, and Hands-on health care the draining and extraction of a 17-centimeter ovarian Over the summer, around 70 Doctors Academy cyst. students shadowed healthcare professionals at Kaiser Dr. Lissa Yu practices obstetrics and gynecology at Permanente, Community Regional Medical Center, Kaiser Permanente’s Clovis Medical Office and was Adventist Health Centers, Valley Children’s Healthcare thrilled to sign up as a provider to be shadowed, espeand other local private healthcare offices. cially when she was told that what the student got to Some got to listen to a patient’s heartbeat using a see was up to her discretion. stethoscope. Some handed gel and paper towels to an “So I said, ‘Very good; she’s going to go where I go,’ ” obstetrician/gynecologist during a routine ultrasound Yu says. “So Brianna has been on the labor floor, she’s on a pregnant belly. seen C-sections, vaginal deliveries, hysterectomies, a But most importantly, the students were able to cystectomy — the whole nine yards.” watch and observe the day-to-day practices of local Colado, 16, says she enjoyed shadowing Dr. Yu and health care providers, noticing everything from the thinks being an OB/GYN would be an interesting and diversity of patients they see to the nitty gritty of the satisfying profession. operating room to the behind-the-scenes tasks of “In the OB patients, it’s really nice being able to see maintaining charts and paperwork. when they come for their first ultrasound in their “This is a way to immerse themselves and find out, pregnancy, how excited she is to see that there’s a little ‘Is this what I really want to be?’ You may find that you heartbeat beating inside of her,” Colado says. “Especialdon’t. You may find, ‘Wow, I didn’t realize how differly the dads, that’s a cool thing to see because they just ent it was once I’m behind the scenes,’ ” Cantu exstare at the ultrasound like, ‘That? That’s a baby?’ It’s plains. cool. That’s been memorable.” CV

ASelma High School student Brianna Colado, left, works with Dr. Lissa Yu to help listen to the fetal heartbeat of patient Sonya Holder’s son using a handheld Doppler. Colado has shadowed Dr. Yu, an OB/GYN, for five weeks as part of the UCSF Fresno Doctors Academy program.

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uals who are from the Valley, understand the nuances of the Valley and can come back and provide services.”

Pipeline to success

Middle school to med school UCSF Fresno Latino Center envisions a future of home-grown health care providers BY: Farin Montañez | PHOTOGRAPHY: Farin Montañez

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exciting. I like finding a problem and fixing it,” she says. Prentice was the only female in her medical school class in 1994 that went into general surgery, but she ended up in a residency with all women at UCSF Fresno. Prentice encountered mostly encouragement in her training and later vascular fellowship. But after more than two decades performing surgery, she’s still sometimes treated like the clinical helper rather than the one in charge. “It happens a lot in the hospital when I explain a procedure and tell them what I’m going to do, then they look at me and say ‘OK, so who is going to do the surgery?’ ” Prentice says. “I think they are surprised I’m the surgeon.”

Outnumbered 4 to 1 in surgery

This is what a surgeon looks like BY: Erin M. Kennedy | PHOTOGRAPHY: Nicole Butler

hese surgeons are gracious when patients mistake them for a nurse, when hospitals don’t provide doctor scrubs in their size or peers make wisecracks about their physiology and medical leaders actively discourage them. These surgeons are women. They may wear smoky eye shadow and cameo earrings in the operating suite or cover their hair with girly flowered surgical caps. But just like their male counterparts, they cut out cancers and bullets, reroute digestive systems and repair hernias, shoulders and hearts. Most would say besides appearances, there’s little difference between them and their male peers in the OR. But probe further and you’ll find a steely determination that has prompted some to switch residency programs because of rampant sexism or take

A“You have to love it. I honestly do ... It would be terrible to look back and have regrets. It’s exciting. I like finding a problem and fixing it,” says Anne Prentice, MD, FACS, of Valley Vascular Surgery and a UCSF assistant clinical professor.

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extra call just to prove themselves as the only woman in their program. They’ve all spent most of their prime reproductive years in medical school, residencies and fellowships, working crazy long hours perfecting their skills and knowledge. Because of it, many have opted not to have children or husbands in order to follow their passion — a choice their male counterparts rarely have had to make. Anne Prentice, MD, FACS, of Valley Vascular Surgery and a UCSF assistant clinical professor, tells the medical students who ask about her life and if she would recommend a surgical career that the profession is all-consuming and days are unpredictably long. But she also tells them to go for it, especially if they feel the same thrill she does. “You have to love it. I honestly do ... It would be terrible to look back and have regrets. It’s

It’s no wonder. She’s still an anomaly. Just 35 percent of physicians nationwide are women and the percentages of women practicing surgery are even lower. The American Medical Association polls from December 2015 showed only 19 percent of general surgeons were female. The percentages of women surgeons shrink even further for specialties like neurosurgery or thoracic surgery. In Fresno and Madera counties there’s only one woman bariatric surgeon, Pearl Ma, and one woman cardiac surgeon, Sarah Minasyan. Google “Fresno Madera orthopedic surgeons” and you’ll see nearly 60 names but only three women show up on that Google screen — a ratio far less than the 9 percent of board-certified orthopedic women surgeons nationally. One of those three is Michele Schulz of Sierra Pacific Orthopedic Center, who does much of her surgery at Saint Agnes Medical Center and Fresno Surgery Center. “The American Academy of Orthopaedic Surgeons thinks it’s the lack of women mentors. But I think it’s because the muscular skeletal system is under taught in medical school. Orthopedics is an elective rotation so not everyone gets the exposure,” Schulz says on why there weren’t more orthopedic specialists like her. But she also acknowledgs, “Of all the specialties, this really felt like it was the good old boys club. They do fit the stereotype of a big strong guy who used to be a college football player or jock. There’s really only a certain type of women who can put up with it.”

The ‘boys club’ requires thick skin Schulz was not fussed by the raunchy jokes or boys club’ ribbing, she says. Mostly she took it in stride as “fun,” but she also put up with a lot of inappropriate probing on her way to becoming a surgeon. “Even though it was not legal, at every single residency interview I had, I was asked if I was married or had children or if I was planning to have children,” says Schulz, who waited until after her training to have two children with her PhD cancer researcher husband. “I was the only woman from top to bottom in all of my training.

“It was good, because you are forced to know what you’re doing. All the attendings and chief residents knew my name and I got called on at every conference. It was always ‘all the guys and Schulz’ and I would’ve got eaten alive as a woman in ortho if I wasn’t 100 percent sure of myself and what I was doing.” That was in the mid to late 1990s at University of Southern California and University of California, Irvine. Being on call is a huge part of residency and when you’re in a small program that might mean you’re rotating call with just one other person. So Schulz wasn’t offended when the only other orthopedic resident she was sharing call days with, a man, told her, “You better not get pregnant!” She wasn’t discouraged either when in her first hospital experiences there were only pink nurses’ scrubs available to her. Her male counterparts had distinct surgeons’ scrubs and separate locker rooms from the male nurses. “If it’s going to bother you then you probably aren’t cut out for orthopedic surgery,” she says. As soon as she finished her training at UC Irvine, Schulz became a faculty member to help mentor those who wanted to blaze the same trail she did. “Ortho is a very physical surgery and there’s lots of power tools involved,” she says. “I’d tell residents ‘You can either muscle it in or manipulate it.’ I can’t muscle it in, so I had to lean on technique.”

Just 35 percent of physicians nationwide are women and the percentages of women practicing surgery are even lower.

Does gender make a difference? Does the gender of a surgeon really make a difference? Some argue women surgeons have smaller hands, more finesse and are naturally more collaborative. Medical schools and professional physicians’ organizations assert that it’s crucial to have a diversity of cultures and races — and gender — among healthcare providers because it helps improve the delivery of care to a diverse patient population. Nicole Hill, MD, who specializes in breast surgery at Kaiser Permanente Fresno, notes that in her practice being a woman helps her patients be comfortable asking uncomfortable questions. “Breast surgery and breast cancer is very emotional,” Hill says. “Lots of patients experience a loss of intimacy and sexual dysfunction after this kind of surgery. And it’s a difficult subject to bring up with a male surgeon for many patients.” She’s glad she didn’t heed the advice of those in medical school. “People kept telling me ‘Whatever you do, don’t go into surgery!’ ” she says. Even during her surgical residency at UC Irvine others tried to discourage her from her goal. “Another (male) resident told me, ‘You know what they say about women surgeons? They’re either not very good women or very good surgeons.’ I shrugged it off at the time.” It’s clear national leaders in surgical medicine disPlease see next page

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Outnumbered 4 to 1 in surgery

This is what a surgeon looks like BY: Erin M. Kennedy | PHOTOGRAPHY: Nicole Butler

18 FALL 2017 | Central Valley Health

Just 35 percent of physicians nationwide are women and the percentages of women practicing surgery are even lower.

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ASurgeon mothers, like most women with high-powered jobs, get creative and become masters of multi-tasking.

continued ... agree. In the American Association for the Surgery of Trauma’s inaugural newsletter in 2007, Donald D. Trunkey, M.D. wrote “51 percent of all medical students are now female, but only 7 percent apply to general surgery” and he lamented that a talented pool of possible candidates were never even getting into the trauma surgery pipeline. In the past decade that number has more than quadrupled with 30 percent of all residents and fellows now women, but his insights remain valid. Trunkey asked, “The bottom line question is: How can we make this specialty more attractive to women? At the University of Melbourne in Australia, women are allowed more time to finish their surgical training and even fellowship training. Daycare, such as offered at the Medical College of Virginia, is also a very attractive perk that might be useful. Obviously, I think this needs more dialogue.”

Fresno’s the anomaly for women surgical faculty Somehow, even without more time to finish their surgical training or onsite daycare options, UCSF Fresno has created a place that’s attracting twice as many women as other places. Six out of 10 trauma surgeons currently practicing at Community Regional Medical Center with UCSF Fresno medical education

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program are women. “We have a lot of role models here,” says Trauma Surgeon Amy M. Kwok, MD, FACS, MPH, who is one of those role models now as associate program director of the UCSF Fresno General Surgery Residency Program. “The real anomaly is having a program director who is a woman … A lot of what we have here is because of Dr. (Jim) Davis (chief of trauma at Community Regional and program director of the critical care surgery fellowship at UCSF Fresno). He does not care about gender or political views, just about dedication and talent.” A 2014 report from the Association of American Medical Colleges shows how much of an anomaly it is. While nearly half of medical students and are female, women only make up 38 percent of full-time academic faculty, 21 percent of full-time professors, 15 percent of department chairs, and only 16 percent of medical school deans. In the field of surgery, women comprise only 22 percent of full-time faculty and only 1 percent of all department chairs. “We have a long history of female faculty here,” says Mary Margaret “Meg” Wolfe, MD, FACS. She became the director for the General Surgery Residency Program at UCSF Fresno in 2012. “Two years ago, we had an entire class of female residents in surgery. That’s noteworthy even nationally.” When Wolfe finished her trauma/critical care fellowship at UCSF Fresno, she stayed because of the culture, the commitment to diversity and the opportunities. During her residency at Loyola University Medical Center in Chicago she was asked if she “identified as a surgeon or as a female surgeon.” Wolfe thought it was a funny question because she never felt treated differently due to her gender. She wants to create that same egalitarian atmosphere here at UCSF Fresno. “I want them to be surgeons first and not female surgeons. But that said, we’re family-friendly for everyone. That’s the legacy of Steve Parks making this a very family-oriented residency.”

Leading by example to create a family-friendly program Steven N. Parks was the Chairman of Surgery and the Program Director for UCSF Fresno’s Surgical Residency before his death in 2010. He was a brilliant surgeon and a dynamic educator, but many remember him for his devotion to his two children and the way he managed to be at every school performance. Daughter Nancy Parks, MD, FACS, followed in his footsteps becoming a trauma surgeon at Community Regional and Associate Program Director for UCSF Fresno Surgical Critical Care and Acute Care Surgery Fellowship Program. She says her father never pushed her into medicine, but being able to shadow him at work and listening to him tell stories about his trauma patients at the dinner table solidified her doctor dreams early in life. “It always sounded so exotic and

exciting,” she says. During medical school in Nebraska a woman surgeon warned Dr. Nancy Parks it wasn’t all exotic and exciting. That woman mentor encouraged her to be “very purposeful” before choosing surgery, implying it would take toll on having a family. She got a different message during her residency at UCSF Fresno: “It’s always been an equal opportunity place.” Andrea Long, MD, the newest member of the UCSF Fresno trauma team, agrees that egalitarian tone is set from the top and by a man: “Dr. Davis said to me the first time I met him, ‘If you can’t work for a woman, you can’t work here.’ ” “It’s certainly different than my training” she says of the majority female team. “During my training in Georgia, I was the first female surgery resident in 15 years. But I never felt I was treated differently. During my fifth year, one of the residents had maternity leave and she had to go out pre-term so there was grumbling about covering for her. But another resident hurt his knee and people did the same amount of grumbling about covering for him.” While she didn’t experience the subtle sexism that other woman surgery residents, Dr. Long noticed it. “I think I had more of an easy time as a woman surgeon because I’m a stronger personality,” says the selfassured and very out lesbian. “I’m not the cute, dainty one. I had a friend who is and she’s always got called by her first name as a resident instead of Dr. So-and-so. And people would burst into her OR and treat her like she was the assistant. I really had no problems. The gay man had way more problems than me in training. ”

Mixing motherhood and surgery Kwok says her discouragement was very direct. During her third year as a medical student when she declared her interest in surgery, she says, “The chief resident told me, ‘Women aren’t supposed to be surgeons.’ This was 2003! He said, ‘You will always have one foot out the door. You will never be dedicated enough. If you want to have children, you’ll never have the time to come a great surgeon.’ ” That’s the kind of statement that surgeon mothers scoff at. Like most women with high-powered jobs they get creative and they become masters of multi-tasking. Shana Ballow, DO, a UCSF Fresno clinical professor in surgery, illustrates how it’s done during a recent break in trauma cases at Community Regional. She walks into the UCSF surgery conference room with her oversized scrubs top pulled out of the waist band where she normally tucks it, a breast pump discretely suctioned on to both breasts, the portable pump’s battery slipped in her pocket. She chomps on an apple in one hand, checks her smart phone in the other and continues a conversation interrupted a few minutes before. Ballow has a 3-year-old son and 7-month-old daughter. She doesn’t have the luxury of a regular

schedule, but pumps milk when she can to leave for the au pairs that fill in for her and her husband when they’re working. Because her child care help lives with them she’s easily able to take call in the middle of the night. “I hate to be the weak link on the team,” she says of her arrangement. Like the majority of her peers she waited until she finished her residency in 2012 before trying for a family. Ballow says she didn’t think much about how she was going to manage. She knew there weren’t many how-to manuals for what she was attempting. But in 2017, there’s social media and supportive Facebook communities for surgeon mothers that Ballow turns to for advice. “When I came back from maternity leave, my baby was refusing to take a bottle. The other surgeon moms told me not to worry; she’d eventually get hungry enough. And she did.” Christina Maser, MD, FACS, didn’t think twice about balancing a family with her endocrine surgery career and UCSF Fresno teaching. But she knows her women colleagues do. “I think women carry that burden a lot more heavily than men. Having a family doesn’t physically impact (male surgeons’) ability to do their job in terms of being pregnant and maternity leave,” she says. But the bigger burden, Maser suggests, is the emotional tug of war women impose on themselves: “I saw a patient yesterday and she said to me, ‘Oh, I think you had to cancel our last appointment because your kid was sick.’ And she said it very nonchalantly with no judgment. But the immediate guilt I felt was ‘Oh, I let this patient down, because I was doing something selfish by taking care of my sick 4-year-old.’ ” Maser adds, “But that’s my internal struggle. I don’t think that’s something men think about.” Hill says she often has that internal struggle and there are days she feels like the worst mother ever to her two small children. “One day I got off and I was post-call and excited to be able to take my baby to the pediatrician’s office. Then the pediatrician asked me about the name of the formula we gave our baby and I couldn’t remember,” she says. “I felt so awful in that moment.” She also seeks solace in the Facebook community of physician moms who share tales about missing a son’s championship soccer game because a surgery went late and studies about resiliency in children and how to juggle it all. “It’s so great to have a group of women who understand and have lived through it,” she adds.

“Really male or female, surgery is demanding — physically, emotionally and the difficult cases will keep us up at night.” — Nicole Hill, MD

A child’s eye view of mommy surgeons “Really, male or female, surgery is demanding — physically, emotionally — and the difficult cases will keep us up at night,” Hill says. “There’s really a lot of emotional fatigue in American medicine today so you really need an anchor and a sense of something bigger Please see next page

Central Valley Health | FALL 2017 21

continued ... AThe faces of surgeons in the Valley: Anne Prentice, MD; Christina Maser, MD FACS; Shana Ballow, DO; Andrea Long, MD; Mary Wolfe, MD, FACS; Kristina Kaups, MD, MSC, FACS; Ibironke Adelaja, MD, FACS; Nancy Parks, MD, FACS; Amy Kwok, MD, MPH, FACS

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than yourself. As moms, we see that anchor every day when we come home from work. My daughter makes comments that ‘There are sick people in the world and mommy helps them.’ I hope she continues to witness that.” Sarah Zhanna Minasyan, MD, a board-certified cardiothoracic surgeon with Community Foundation Medical Group in Fresno and Division Chief of Cardiothoracic Surgery at North Bay Medical Center in Fairfield, wondered if her own children were witnessing the sacrifices and realizing the impact of her work. Minasyan has four children — a 12-year-old daughter she delivered during her surgical training, and 4-year-old twin boys and an 18-month-old daughter carried and delivered by the same surrogate.

It’s an exhausting profession with long hours of physically demanding work but Minasyan says there’s great satisfaction in fixing the body, often literally saving lives. She wasn’t sure her kids noticed. But when her seventh-grade daughter was assigned to write an essay on someone who inspired her, Minasyan was shocked by the choice: “I was thinking she’d pick someone like Madame Curie or the first woman astronaut. ‘Nope,’ she said, ‘I wrote about you.’ She read it to me and it was really wonderful. In one sentence she’d write ‘Sarah’ and the next, it’s ‘Dr. Minasyan.’ “After that I got matching T-shirts for me and my daughter that read ‘This is what a surgeon looks like.’ ” CV Reprinted with permission from Fresno Madera Medical Society magazine, Central Valley Physicians

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Yeung says. She calls Ebbs a “renaissance person” because of his experience as a paramedic and his demonstrated commitment to improving global health care.

Her story

VCH residents make history 13 young doctors form inaugural class of Pediatric Residency Program BY: Doug Hoagland | PHOTOGRAPHY: Tomas Ovalle

ADr. Daniel Ebbs and Dr. Devon Goosen are residents at Valley Children’s Hospital.

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wo young doctors. Each with a story. Both helping make history at Valley Children’s Hospital. Dr. Devon Goossen, a Fresno State graduate, and Dr. Daniel Ebbs, a one-time Fresno County paramedic, are the physicians. They joined 11 other young doctors this summer to form the inaugural class of Valley Children’s Pediatric Residency Program. Affiliated with Stanford University School of Medicine, the program represents a historic milestone for Valley Children’s. The hospital has trained residents from other programs for 40 years. This is the first time Valley Children’s has sponsored residents who will spend the bulk of their three years of training at the hospital. Hospital officials see the program as an investment in the future of health care in the Valley. They hope the residents will settle here after their training is finished because the region doesn’t have enough doctors. Both Goossen and Ebbs plan to remain in the Valley to live out their professional passion. “I know medicine is the right fit because I love science and also the thought of watching kids grow up and being their primary care doctor,” Goossen says. Ebbs realized in medical school that he was always happier on his pediatric rotations. “I saw I could have more of an impact as an educator and physician when I was working with children,” he says. Dr. Karla Au Yeung, director of the residency program, describes Goossen and Ebbs as “shining examples” of all the physicians in the program. (Residents are medical school graduates training in a specialty under the supervision of experienced physicians.) Goossen is “exceptionally gifted” and exemplifies empathy, compassion and professionalism, Au

When 26-year-old Goossen was a little girl, she thought she’d follow her mother into teaching. Then 14 years ago — while a seventh-grader at Kastner Intermediate School in northeast Fresno — she had an assignment about careers in a leadership class. Her mother, Jeanie, made what turned out to be a life-changing suggestion. Why not become a pediatrician? The idea stuck. After graduating from Clovis West High School, Goossen went to Fresno State as a biology major. She excelled in her science classes, and she explored pediatrics by volunteering at Valley Children’s before attending the Saint Louis University School of Medicine. Goossen volunteered mostly in the hospital’s playroom, and she recalls that time with a smile. “Fun stuff,” she says. “Art work. Toys. A doctor’s set and pretending to be a doctor with the kids. I feel like I’ve come full circle now that I’m back here.” A medical residency is countless moments of learning from more experienced doctors, and Goossen had such a moment in acute care — her first rotation as a resident. One morning, she was part of family-centered rounds. Team members caring for a patient — attending physician, pharmacist and others — sat with the patient’s parents to explain how things were going and discuss future treatment. Goossen listened closely as Dr. Jennifer Snider, an attending physician, talked about the case in words that family members could understand. “She did a wonderful job,” Goossen says. The next day, Goossen applied what she had learned to discuss the details of another case with a family. “That was such a good moment because it reminded me of how much teaching there is in pediatrics,” she says. “It’s wonderful when you know the family understands what you’re saying and you know you’ve made a connection.” Goossen and the other residents will not only treat patients in the hospital but get involved in projects beyond Valley Children’s campus in Madera. “The inaugural class signifies the start of a new era in which the residents will reach out to the community and be hands-on with the children of the Central Valley,” Au Yeung says. For Goossen,that ourtreach includes working with the Fresno County Suicide Prevention Collaborative. While in medical school, she followed news reports about three students at her alma mater, Clovis West, taking their lives in a three-month period in 2016. “It was absolutely heartbreaking to hear about the loss of those young lives, but I am further inspired to increase suicide prevention efforts in the community,”

she says. Facing such serious issues and treating sick children at the same time raises an important question: How do young doctors learn to handle the stress? “We’re very fortunate to be in a program that makes our emotional wellness a priority,” Goossen says. Residents meet regularly with a social worker and chaplain to talk about stress and their ways of coping. “We’re seeing kids who are so ill, and we have to accept the fact that as much as we can do for them, there are situations where there is nothing more we can do, and it’s out of our hands,” Goossen says. “Accepting that is hard, but we’re learning how to do it and cope together.” One way Goossen copes is scheduling a weekly activity removed from medicine. She recently re-started ballet lessons after a 12-year break. She’s also planning her wedding next spring to Daniel Ward of Fresno. They met in the Premedical Club at Fresno State, and he’s a third-year medical student at the University of California San Francisco. “We’re both pursuing our dreams of becoming physicians and working in the Central Valley,” Goossen says.

His story Ebbs, 34, grew up in San Jose and graduated from Cal Poly, San Luis Obispo with a bachelor’s degree in international relations. He then came to Fresno County to work as a paramedic — work he had wanted to do since high school. He chose to get a job in this area because of the volume of calls and variety of experiences. Answering calls on Fresno County’s west side exposed Ebbs to how people living in medically underserved communities suffer, and it made him consider becoming a doctor. So he took science classes at Fresno State and volunteered at Valley Children’s. “I visited kids with cancer and tried to cheer them up,” he says. “We watched a lot of cartoons together.” But it wasn’t a straight line from there to medical school. First, Ebbs moved to Albuquerque, New Mexico, where he worked as a critical care flight paramedic on a helicopter and also earned a master’s of science degree in community health at the University of New Mexico. As part of his master’s research, Ebbs traveled to the Amazon region of South America, where he stayed for 11⁄2 months. “I found a theme of health workers being appointed to work there, but they didn’t have any

ADr. Devon Goosen meets with Chandler Banta, 17, who has leukemia.

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Yeung says. She calls Ebbs a “renaissance person” because of his experience as a paramedic and his demonstrated commitment to improving global health care.

Her story

VCH residents make history 13 young doctors form inaugural class of Pediatric Residency Program BY: Doug Hoagland | PHOTOGRAPHY: Tomas Ovalle

ADr. Daniel Ebbs and Dr. Devon Goosen are residents at Valley Children’s Hospital.

24 FALL 2017 | Central Valley Health

ADr. Devon Goosen meets with Chandler Banta, 17, who has leukemia.

Please see next page Central Valley Health | FALL 2017 25

continued ...

resources,” he says. So Ebbs established a nonprofit organization to help the health workers start a training program. “I’m not running it but giving them the resources to develop it themselves,” he says. “It’s the ‘train the trainer’ approach that allows the program to continue and grow while not being dependent on us.” The nonprofit also assists health workers in Uganda in east Africa. Ebbs has traveled there and says Uganda has tremendous health needs with up to 20,000 new cases of malaria reported in some weeks. Ebbs jokes that the name of the nonprofit illustrates that he is — in his words — a “nerd.” The nonprofit is called MGY, and it takes a two-step translation to fully understand the meaning of that name. But it’s worth unpacking the elements of the name to see how Ebbs combines the heart of a humanitarian with the mind of a scientist. MGY is the formula in physics for potential energy (mass x gravity x distance). In Ebbs’ vision, mass stands for community, gravity represents the barriers to healthy living in communities and distance is the gap that needs to be closed between disease and healthy living. “What we try to do is transform this potential for healthy living by bringing health resources to underserved regions,” he says. As Ebbs finished at the A.T. School of Osteopathic Medicine, he came to Valley Children’s for a residency in-

terview. “It was different than anywhere else I interviewed across the country,” he says. “Everyone here is so excited about the public health opportunities and being a voice for children. It was empowering, and it changed my life.” Now that he’s back in the Valley, Ebbs wants to continue his advocacy to improve public health. As part of a residency research project, he’s looking at using apps on tablet computers to help train rural health workers on some of the Valley’s biggest health issues, such as asthma, obesity and developmental delays. Ebbs finds the residency training satisfying, but also emotionally challenging. Treating seriously ill children requires a certain emotional distance from patients, and stress is a natural byproduct. “You have to have an outlet,” Ebbs says. His is trail running or mountain biking, which provides the opportunity to reflect “on where I’m at in life,” he adds. His family also provides solace from the pressures of the job. Ebbs and his wife, Erika Gendron, have an 18-monthold son, Jude. Gendron is from Madera, and the couple met at Fresno State. She is finishing a doctorate degree from the University of New Mexico in parasitology, the subsection of biology that studies parasites. She plans to return to Fresno in December. One thing few people know about Ebbs is his fascination with owls. “I like their world view,” he says. “They can see in all directions, and they’re always watching over you. They’re interesting.” CV

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The joy of juice Juice bars are committed to providing healthy options BY: Janessa Tyler | PHOTOGRAPHY: ThinkStock

et ready for a chance to live a healthier life without sacrificing flavor — thanks to the bevy of local juice bars and health food stores. In northeast Fresno, Raw Earth Juicery puts a fresh spin on tried-and-true recipes. Owned by Rick Rosales, the menu features organic, dairy-free, plant-based items made with fresh, in-house ingredients. “We’re proud of our commitment to using 100 percent non-GMO ingredients,” Rosales says. “We don’t use sugar or artificial sweeteners.” Organic, cold-pressed juices are served in ready-togo bottles. Since Raw Earth Juicery uses a state-of-theart hydraulic cold-pressed juicer, Rosales says, “the result is very little oxidation.” “We bottle and refrigerate for a three-day shelf life,” he adds. According to Rosales, consuming organic, coldpressed juices provide a variety of phytonutrients and enyzmes to help boost immunity, reduce stress and anxiety, decrease the risk of diabetes, strengthen bones and organs, enhance intercellular communication and increase energy. There are also more than a dozen smoothies with a tasty mix of flavors to choose from like the Green Tea Mint Pineapple Smoothie and the Mango Pineapple Protein Smoothie. A popular item on the menu: the Vanilla Cinnamon Banana Smoothie. The dairy-free and sugar-free smoothie is blended with house-made almond milk. Nut milks include the Sweet Almond Greens and the Sweet Brazil Nut Milk. In addition to cold-pressed juices and smoothies, the juicery sells smoothie bowls (the Raw Earth Bowl, the Incredi Bowl and the Almond Butter Bowl), parfaits with overnight oats and blueberries like the House Made Parfait, wheat grass shots and cleanse packages. “The No. 1 best-selling item is the Raw Earth Bowl — our signature smoothie bowl,” Rosales says.

28 FALL 2017 | Central Valley Health

HOMEMADE ALMOND MILK

Servings: 4 cups 2 cups almonds 4 to 5 dates, pitted 2 teaspoons vanilla Cinnamon or maple syrup, optional

Soak the almonds in 4 cups of water overnight in the refrigerator. Drain almonds and add to a powerful blender. Add fresh water into the blender — how much you use depends on the desired thickness. Soak the dates for a few minutes to soften, start the blender on low and gradually moving to high. Once almonds turn into a white liquid, stop blender. Place cheesecloth over a bowl. Start pouring the liquid over the cheesecloth in batches. Grab and gather the cheesecloth into a closed top sack. Squeeze the cheesecloth to remove the liquid. The cheesecloth will hold the remaining almond pulp. Set the almond pulp aside. Once almond milk is strained, add the vanilla and cinnamon or maple syrup, if desired. Store in the refrigerator in a closed jar. Provided by Tawnie Kroll, Kroll’s Korner, www.krollskorner.com

The Raw Earth Bowl features a base of cold-pressed apple juice, blended with frozen strawberries, blueberries and bananas, and topped with sliced strawberries, blueberries and banana, gluten-free sprouted granola, shredded coconut and chia seeds. Also in northeast Fresno: Lassens Natural Foods & Vitamins. The health food store sells organic produce, supplements and wholesome products to nurture your mind, body and soul. The juice bar, located next to the delicatessen, serves fresh-squeezed organic juices and fruit smoothies. The top two favorites: the Green Monster and the Wellness Tonic. Like Raw Earth Juicery, Re-Invent Juicery also serves cold-pressed juices and smoothies. It operates a storefront at Milburn Avenue near Herndon Avenue in northwest Fresno. The Skinny Glow is an infusion of juices from strawberries, apples, oranges and pineapple. For a kick of spice, thanks to the addition of ginger and cayenne pepper, try the Detoxifier or the Immunity Enhancer. The juice bar also sells blends like the Dr. Acai and bowls like the Classic Acai, topped with berries, banana slices, granola, coconut and honey. On the horizon: JUGO Salad & Juice Bar is planting roots at Champlain and Perrin avenues. It plans to open by the end of October. If you’d like to build-your-own smoothies, start with a base like homemade almond milk. CV

The healing benefits of equine-assisted therapy BY: Katie Fries | PHOTOGRAPHY: Wayne Hutchison

AAdam Hill rides Bandit at Heart of the Horse Therapy Ranch with help from Jack Hannah, Jacquline Fleming and Alex Bouchard.

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These days, Heart of the Horse Therapy Ranch does about 200 therapeutic riding sessions a month with medically fragile children. It also offers special programs for veterans. Some the therapy’s benefits include improvements in balance, flexibility and muscle strength; increased attention span; and improvement in social interactions. Adams notes that one rider, a child with a limited vocabulary, spoke her first three-word sentence after her first therapy session. Each child who comes to Heart of the Horse for therapy must have a doctor’s release, says Adams. Often — with a parent’s permission — he will discuss the patients’ needs with their doctor or therapist to “figure out what we can do to make this child better.” The sessions are facilitated by Adams and other volunteers, including Fresno State students and veterans. CV

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ccording to the National Center for Equine Facilitated Therapy, adaptive riding, a type of equine-assisted therapy, “emphasizes the acquisition of riding and horsemanship skills, both on and off the horse, in an effort to achieve physical, emotional and cognitive goals.” For the past six years, Clovis’ Heart of the Horse Therapy Ranch has offered its version of therapeutic riding to children with conditions like cerebral palsy, autism and Down syndrome as well as veterans suffering from post traumatic stress disorder or traumatic brain injury. Owner and founder Guy Adams was inspired to open the facility after witnessing the effect horses had on children with disabilities and other challenges, but he may never have had the opportunity had it not been for an earlier, less positive experience. “I had a horse for sale and a guy came up from Morgan Hill and he had a little girl with him in a wheelchair,” Adams recalls. The girl wanted to ride and pet the horse, he says, but he just wasn’t sure how to accommodate her special needs and had to deny her request. Later, he says, he felt bad about the experience so he “searched out a horse I could train just like one of our therapy dogs ... I called up the dad and he brought her back and when we put her up on that horse I saw her sit upright and get this great big ol’ smile. Everything about her was different.” A version of the experience was repeated, he says, when he invited a young autistic man out to the ranch to ride the horse. “It was flawless. It was amazing. I went home and told my wife, ‘I know what we’re doing for the rest of our lives.’ ”

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Last Look

Central Valley Health | FALL 2017 29

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