Member of the Month: Jorge Duchicela, M.D.
Physician serves rural Texas and Ecuador through practice, institute
Jorge Duchicela, M.D., is a rural private practice physician in Weimar, a small community between Houston and San Antonio. He is a partner at the Youens and Duchicela Clinic along with TAFP Past President Robert Youens, M.D., and his sister Olga Duchicela, M.D. Together they serve a community of patients that is diverse in ethnicity, age, gender, geographical location, and social stratum.
Dr. Duchicela founded Cachamsi, a nonprofit medical immersion institute, to help health professionals learn Spanish to better communicate with their Spanish-speaking patients and learn global and cross-cultural medicine. The program places health professionals in the community of Cacha, Ecuador, and requires a combination of a language acquisition methodology and a strong clinical component that makes the medical education venture very effective and efficient for medical students, residents, and practicing physicians.
He was born in Guayaquil, Ecuador, and moved to Wisconsin at age 13. The Cacha community is very special to him and his family; his grandfather migrated from there 100 years ago. “The people there have held onto ancient and traditional ways for centuries since the Incan and Spanish conquest,” he says. “There is a vast reservoir of history, anthropology, spirituality; and in general the entire ecosystem is unique and in many ways relatively untouched by western influences. I felt this was the perfect place to combine my professional and personal missions.”
Tell us a little about yourself and your career. I was born in the coastal city of Guayaquil, Ecuador. As a 13-year-old I went to school in Wisconsin. Through a soccer scholarship I got my degree in biochemistry at the University of Wisconsin in Milwaukee. There I met Juanita, my wife for the last 34 years.
I went to medical school in Madison, Wisconsin, and loved every minute of it. I was so happy to be in school; not many Latinos were in college, much less in medical school. It was because the admission committee saw beyond my GPA and MCAT scores that I was accepted as an early admission to medical school. From then on I felt indebted to make sure all Americans would have a fighting chance in our society.
Why did you choose family medicine, and what’s your favorite aspect of it? Were you inspired by anyone? I was exposed to family medicine in my fourth year in medical school by my preceptor, Dr. Dick Haight, who showed me the best of family medicine. But in the 1980s Wisconsin did not have a compulsory third-year family medicine rotation and I matched in Galveston in general surgery. There is where I truly became acquainted with family medicine.
My family and my dying father were cared for by the UTMB family doctors, Drs. Alice Ann O’Donell and Angela Shepherd. I saw how they were able to have a healthy and comprehensive relationship with their patients, which was not episodic, within the context of the family and the community of the patient. I found in the specialty of family medicine and its academic discipline everything I needed to fulfill my professional vision as a physician.
I have also been inspired by many colleagues. I admire those general practitioners who founded our specialty in the late 1960s. Such tenacity, visionary leadership, sobering pragmatism, dedication to our profession, and respect for the patient’s wellbeing should only be emulated and practiced by all physicians regardless of their specialty.
How does the Cachamsi program benefit the Cacha community and the doctors, nurses, and residents involved with the program? I see great benefits on both sides of the equatorial line. In Ecuador our program supports the rural doctors of an indigenous community. We have helped take care of thousands of patients over the last eight years. We assist them with transportation, medicine, equipment, and professional education in Ecuador and the U.S., and through our administrative team we also support the education and health of this indigenous community in central Ecuador.
This program helps our U.S. students, residents, doctors, and nurses by giving them a tangible tool to improve their communication with their Latino patients in the U.S. They also gain a much enhanced knowledge of the cultural nuances of their Latino patients. These are key ingredients to improve the physician-patient relationship. These acquired knowledge and skills will improve the health of our Latino patient in the U.S. and will broaden the patient population our physicians may serve effectively.
What has been your most memorable experience with a patient? While traveling in the mountains in Ecuador we were stopped by a man in his 30s. He spoke in Kichwa to our driver and appeared desperate and very alarmed. We drove the truck for one more mile and then hiked on foot for an hour to a hut in the middle of the Andes. Entering, the hut was dark and I could barely see where I was stepping having just come in from the bright equatorial sun. I could see the reflection of a dozen tiny eyes huddled in one corner of the hut; they were cuyes or guinea pigs.
As my pupils accommodated I could define the silhouette of a dark bulk sitting at the edge of the bed, a woman. I lifted her bayeta (shawl) to look at her back. Covering one-third of her back, she had developed a large eschar, thick and black, from untreated herpes zoster or shingles. The woman was weak, dehydrated, and febrile. She appeared septic. With a little more light I could see her face was wrinkled from the wind and the sun and she appeared to be well into her 80s if not more. She could not walk. We took her to the truck and admitted her to the nearby hospital, one hour away. It was particularly poignant because in this area the young adults have migrated to the cities or to other countries and have left their elderly parents to fend for themselves.
Tell me about the Youens and Duchicela Clinic. What is the mission of the clinic? Our clinic is a continuation of Bobby’s father’s clinic started in the 1940s. I came 22 years ago, a couple of years after my residency at UTMB. Bobby is like my older brother because of his wisdom and experience, and sometimes like my younger brother because of his catchy humor. We have created a group of three with my sister, Olga, and all are board certified with faculty clinical assistant/associate professorships from UTMB.
Our group culture is clear. Our patients are the epicenter of our focus and attention. Everything revolves around the four A’s: Access, Ability, Affability, and Affordability. Thanks to the excellent leadership from the Texas Academy of Family Physicians, the word Advocacy has made it into our core values. Our mission is to improve the health of our patients through family medicine. We are a busy clinic and serve a community of patients that is diverse in ethnicity, age, gender, geographical location, and social stratum. We strive to use the latest technology and operational systems to see our patients in the most efficient and effective manner.
Do the two communities of Weimar and Cacha share any similarities? Weimar and Cacha are both rural areas. They also have in common the beauty of their landscapes. Their people are independent and are not afraid to work hard. They share a strong sense of community and take their political structures seriously. The majority of their people are not wealthy.
Where they differ is in their access to health services and education. In Cacha their schools are not aligned with their culture or their parental groups. Their teachers are mestizos who do not understand or respect the indigenous language, beliefs, and culture. This creates a great divide between the docent body and the parents. In Cacha there is no such thing as an ambulance or EMS team. Physicians have to be brought in from the nearby city, one hour away from the rural clinics. For the first time ever the Ecuadorean government has realized that family medicine as a specialty is the answer to their medical access problems. I think our national specialty organization should be more aggressive in supporting the courageous initiatives of the Ecuadorean government in training thousands of family medicine doctors in a span of three years. Currently they only produce two, yes TWO, family medicine doctors per year in a country of 14 million.
On a different note, I love the opportunity in both Cacha and Weimar to find solace and space to reflect. No traffic jams, no stoplights, no urban noise, just the rolling hills or the majestic Andes.
What one-sentence advice would you give a young family physician thinking about rural practice? Just go and enjoy the entire experience, have no preconceived ideas or expectations, and create your own ecosystem.
If you could change one thing in your field or in health care as a whole what would it be? I would change how insurance companies and third-party payers recognize and reimburse for the case management work and the cost-effective nature of our specialty of family medicine without taking away from the value of procedures and activities other specialists perform.
How do you spend your free time? I owe much to soccer. Through this sport I was able to obtain my college degree so that I could apply to medical school. In the off season I would work as a coach or soccer camp director to make ends meet. When I am not coaching my wife’s soccer team, I enjoy participating in community activities. I look forward visiting my children and grandchildren who live in other states. My wife Juanita and I like to travel and explore either urban or rural jungles.
TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting Samantha White by e-mail at firstname.lastname@example.org or by phone at (512) 329-8666 ext. 16. View past Members of the Month here.