About vivimbmd

Family Physician. Mother. Wife. Immigrant. Many worlds, many cultures, many interests.

“ideologically certified”

I am an immigrant. I bought the ticket to the “American dream” of respect and value of intelligence, hard work and diversity, and freedom of expression. I moved to this country in 1990 because I felt respected as a woman and as a professional and I did not have to explain myself to machistas who devalued my abilities because of my gender. I moved here because Family Medicine was alive and vibrant and I wanted to be part of its movement. Family Medicine’s movers and shakers were the magnet to an specialty that has become part of my core values.

I felt happy to have my mom and sister join me in the US in 1994, specially when my sister came “out of the closet”, and I thought then, that she would have to fight less for her rights here than in South America. I became a citizen when my son was born. Interestingly, I am married to the son of Italian-Americans and Polish-Americans who warned me I should be careful and give our child an “American middle name”, just in case things turned bad for those with “foreign sounding names”, (as it had happened to Italians in the 60s and 70s).

Working in this country, I encountered an amazingly hard working community of Latinos who often co-exists and lives in the shadows and the woodwork of everyone’s existence, from cooking to cleaning, from service to customer care, from street to hospitals, I have been surrounded by amazing people who originated in Mexico, and Central and South America, proud and hard working, often without permits to be here legally, yet always proudly contributing to society. Perhaps because of the ability to understand an immigrant’s life, I have had patients coming from every corner of the world, speaking many languages, who have enriched my life with their stories.  muslim fer

I will never regret my move, or my choice of country. Yet today I have a heavy heart. Even when I value and respect freedom of expression, I find Mr Trumps’ rhetoric sickening, divisive, violent, racist and in-congruent with what I thought were some  of America’s most cherished values: Equality and tolerance.

I sometimes wonder… If I had tried to immigrate to the US under Trump’s proposed policies… Would I have been considered to be un-American, unworthy of permission to enter the country?   I admire the hard work of immigrants -regardless of legal status… Would that have been considered subversive?  I am respectful of every religion, and as a doctor I care for Muslim families who are both US born and immigrants… Will that be considered ideologically dangerous?  I participated in a hunger strike when I was 19 years old, asking for the right to an open and popular university education during the Argentine dictatorship. The rector, and soon after, the Minister of Education resigned as a result of students’ actions…. Would that have labeled me “capable of destabilizing a government”?

I am “ideologically certified” to care, to work hard, to respect, to build understanding, to cure and to promote health, to educate, to call inequities when I see them, but I am loosing myself in despair…  His rhetoric is so pervasive…. Trump’s horrible circus continues to be well attended every night. Many are excited and exalted by what they consider very powerful speeches. Will there be a point of safe return?


One of my favorite poems by Uruguayan Mario Benedetti

No te salves/Don’t Save Yourself
Mario Benedetti

Don’t remain immobile
At the edge of the road
Don’t freeze the joy
Don’t love with reluctance
Don’t save yourself now
or ever
Don’t save yourself
Don’t fill with calmness
Don’t reserve in the world
Only a secure place
Don’t let your eyelids fall
Heavily as judgments
Don’t speak without lips
Don’t sleep without sleepiness
Don’t imagine yourself without blood
Don’t judge yourself without time.
But if
in spite of everything
You can’t help it,
And you freeze the joy,
And you love with reluctance,
And you save yourself now,
And you fill with calmness
And you reserve in the world
Only a calm place,
And you let fall your eyelids
Heavily as judgments,
And you speak without lips,
And you sleep without sleepiness,
And you imagine yourself without blood,
And you judge yourself without time,
And you remain immobile
At the edge of the road,
And you save yourself,
Don’t stay with me.

No te salves

No te quedes inmóvil
al borde del camino
no congeles el júbilo
no quieras con desgana
no te salves ahora
ni nunca
no te salves
no te llenes de calma
no reserves del mundo
sólo un rincón tranquilo
no dejes caer los párpados
pesados como juicios
no te quedes sin labios
no te duermas sin sueño
no te pienses sin sangre
no te juzgues sin tiempo

pero si
pese a todo
no puedes evitarlo
y congelas el júbilo
y quieres con desgana
y te salvas ahora
y te llenas de calma
y reservas del mundo
sólo un rincón tranquilo
y dejas caer los párpados
pesados como juicios
y te secas sin labios
y te duermes sin sueño
y te piensas sin sangre
y te juzgas sin tiempo
y te quedas inmóvil
al borde del camino
y te salvas
no te quedes conmigo.

 A different translation

Do not save yourself

Do not stand still
by the roadside
Do not freeze the joy
Do not want reluctantly
Do not save yourself now
Or ever
Do not save yourself
Do not fill yourself with calm
Do not book in the world
just a quiet corner
Do not lower the eyelids
Heavy as judgments
Do not stand without lips
Do not sleep without sleep
Do not think without Blood
Do not judge yourself out of time

But if
you can not help it
and you freeze the joy
and want reluctantly
and you save yourself now
and book in the world
just a quiet corner
and lower the eyelids
heavy as judgments
And you dry without lips
and you sleep without sleep
and you think without blood
And you judge yourself out of time
and you stand still
By the roadside
And you save yourself
Do not stay with me


Cancion para Carito, y el rol del médico de familia

Sentado solo
en un banco en la ciudad
Con tu mirada
recordando el litoral
tu suerte quiso estar partida
mitad verdad, mitad mentira
como esperanza
de los pobres prometida.

En este hermoso chamamé,  León Gieco y Antonio Tarragó Ros ilustran la melancolía del personaje inmigrante que parte de un pueblo, de un lugar que se siente propio hacia uno más impersonal, una ciudad más grande y gris desde donde extraña a su litoral y en donde a la vez finge ser del lugar.

Andando solo
bajo la llovizna gris
fingiendo duro
que tu vida fue de aqui
por que cambiaste un mar de gente
por donde gobierna la flor
mirá que el río
nunca regaló el color.

En esta canción se leen la noción de nostalgia, el impacto del desarraigo, la añoranza de la niñez ya dejada atrás. Metáforas que ilustran  la dificultad de esa inmigración y la resiliencia necesaria para triunfar.

Carito suelta tu pena
se hará diamante tu lágrima
entre mis cuerdas
Carito suelta tu piedra
Para volar como el zorzal 
en primavera.

Pienso en cuántas veces como médicos de familia atendemos a inmigrantes que vienen a la consulta presentándose con una miríada de síntomas somáticos originados por el estrés del desarraigo y de los sueños no logrados, o por esa necesidad constante de demostrar una adaptación no siempre sentida en el alma.

Carito yo soy tu amigo
me ofrezco árbol
para tu nido
Carito suelta tu canto
que el abanico en mi acordeón
lo está esperando.

Así como el músico de esta canción, ayudemos a nuestros pacientes a soltar sus penas… que se hagan diamante sus lágrimas ante nuestra habilidad de escuchar y acompañar, para que cada Carito “suelte su piedra y pueda volar como el zorzal en primavera”.

Proclamation for the Health of the People and the Planet.

The Proclamation for the Health of the People and the Planet  (Proclama por la Salud de los Pueblos y del Planeta), was the document signed by participants at the 4° Congreso Iberoamericano de Medicina Familiar y Comunitaria, or 4th WONCA Iberoamericana region CIMF in Uruguay in March 2015.

I am always impressed by the dedication and commitment of family doctors around the world to improving the lives of the communities they serve. As a participant of the WONCA CIMF region congress,  and someone whose heart lives in both the Northern and Southern hemispheres of the Americas, I am always inspired to see that in the Iberoamerican region this commitment expands to caring for all, both inside and outside of hospitals and clinics, it pays attention to communities, to social and political movements, and to the planet earth.

I was inspired and touched as this document was read in Montevideo, and dedicate the translation to all who attended the congress and all who work in Family and Community Medicine in Iberoamerica. So that their ideas are read by others, and all, North and South, East and West go marchando juntos por una mejor salud.

Participants of the 4th Ibero American Congress of Family and Community Medicine, meeting in Montevideo, from  March 18 to 21, 2015 under the theme “Quality and Equity in Health Care”, proclaim our unwavering willingness to contribute to the health of the people in Ibero America and the world with our work, knowledge, strength and enthusiasm, so that all people, whatever their creed, ethnicity, gender, socioeconomic status, place of living, or sexual orientation, will access to the right to adequate  and high quality care.

Iberoamerica has lived a diversity of political and social processes marked by destruction, alienation and looting; from the times of colonization, to the pain-generating dictatorships and to what has been continued by the neoliberal paradigm.

The health of the people has been affected in a process where health becomes the property of the privileged few and a market good. We continue to pursue to advance health as a human right. We know that we are still far from being able to guarantee this right to society.

We recognize in the young people, who are the present, a constructive force, and their view a motor for necessary changes. We need to train mainly in primary care, with the view of family and community health that involves inter-sectorial social participation.

We call for an exchange of knowledge between academia and community, including the teaching-learning processes embedded in the life and the history of peoples.

We care for the health problems affecting our populations and those problems affecting health workers. If we take care of our patients, why not take care of ourselves?

We promote research in the primary care level and in the community as a strategy to improve the quality of health care and to advance proposals adapted to the reality and needs of the region.

We must redouble our efforts to ensure universal health coverage in our countries, coverage that goes beyond the technical aspects of health financing and incorporates the principles of equity, quality and solidarity.  We must redouble our efforts to ensure the responsibility of governments to establish the right.

We are deeply committed to a paradigm shift in health care toward person-centered care, recognizing health as a means for the full development of human beings, protecting it from unnecessary medical interventions that can respond to market interests, avoiding over-medicalization, opting to make only ethically acceptable and scientifically proven interventions.

We call for strengthening citizen participation in health as a right that promotes the action of social actors in decision-making and public health management to influence the social determinants of health, with equality and equity. Family and Community Medicine and Primary Health Care are a key tool for the development and maintenance of the health of the people.

We believe, and the evidence shows it, that only through systems and models of care based on primary health care that incorporate family and community medicine as a fundamental part, you can fast forward to this goal.

For this, we promote a ratio of at least 50% of specialists in Family and Community Medicine in health systems in Latin America, and see this value as an indicator for achieving universal coverage.

One cannot think about advances in the care of the person if we do not include caring for the environment at the same time, understanding the human in its complex interactions with his surroundings and the whole planet. That’s why we want to incorporate and make our concept of planetary health.  Planetary health is an attitude towards life and a philosophy for living. It puts emphasis on people, not on disease, in equity, not in the creation of unjust societies. It is therefore necessary to have an urgent transformation that requires that our values and practices should be based on the recognition of our interdependence and interconnection.

We need a new vision of democratic and cooperative action at all levels of society and a new planetary welfare principle for every person on this earth-a principle that affirms what we should conserve, maintain and do to generate resilience for the human planetary system. Our health depends on giving priority to the welfare of the whole.

Why is the earth sick? The earth is sickened by the overexploitation of our productivist and consumerist culture that yields disease. Let’s become conscious, intelligent and caring to Mother Earth and as we care for her, we will create health in the community and in ourselves.

Let’s create a healthier land, for us and the rest of the planet. This is something that all family physicians and the Ibero American community can contribute to, knowing that a better world is possible for everyone. Because if it is only good for some, it is not good for anyone.

Montevideo, March 21, 2015. 4th WONCA Iberoamerican Congress of Family and Community Medicine.

Confederate flag

It is a beautiful summer evening in Raleigh, North Carolina. Families are out at North Hills -an outdoor mall- with their children… Laughs, smiles, music. Little ones playing under their parents watch. Teens congregating and chatting. Some sip iced coffee, others eat ice cream. Different ethnic groups and colors of skin. A beautiful, peaceful summer evening. It feels almost perfect.

And there she goes: big blue truck driving around slowly several turns along the outdoor mall, once, twice, three times. She is not looking for parking, she is there for “the show”.

It is- it would be- a beautiful summer evening if she wasn’t there with that huge confederate flag waving from the back of the truck. Passing slowly by. Just to remind us all about the injustices of the world. Just in case we were getting too comfortable with our beautiful summer night.

El Papanicolau de Emergencia

Ella nunca se ha hecho ver en nuestra clínica, pero ha llamado esta mañana queriendo una cita “de emergencia” para su prueba de Papanicolaou y físico. María tiene 32 años y trabaja haciendo limpieza en un hotel – dice su formulario de admisión. Mientras la escucho aprendo que es inmigrante de Guatemala, que sus tres hijas aún viven en su pueblo de origen, y que se mudó a Estados Unidos hace 4 años para unirse a su esposo, a quien no había visto en 8 años. Ella no tuvo diabetes gestacional; sus padres están vivos y bien… Las menstruaciones son regulares, su método de control de la natalidad es “mi marido se cuida”. Le pregunto si hay algo más que yo debería saber acerca de su historia clínica, o si tiene alguna preocupación que la trae a la consulta. María dice que “no”, pero yo veo el “eso”. El “eso” es como una pequeña nube que pasa rápida velando sus ojos, una expresión fugaz. Una expresión de dolor y tristeza que viene y va tan rápido que podría haberla pasado por alto si no hubiese estado mirándola a los ojos.

pesar“¿Qué más?” le pregunto en voz baja. “María, ¿hay algo más?”… Y sus ojos se llenan con lágrimas y la expresión de su semblante revela una angustia tan profunda, me doy cuenta de que no hay fondo para este dolor… Y así, me siento ahora más cerca de ella, y mientras llora, María comparte su historia…

“Hacía mucho tiempo, doctora… Yo quería ver a mi marido… Las niñas eran ya mayorcitas, mi madre podía cuidar de ellas, y yo pensaba que si me unía a él y trabajaba, ambos podríamos poner a las niñas en una mejor escuela, construir una casa en nuestro pueblo, mandarlas a la Universidad”dice esbozando una sonrisa.  “Ya era hora de que me uniera a él en los Estados Unidos… Lo echaba de menos… Mi marido pagó por  mi viaje…  Pero los hombres, doctora… Ellos nos cruzaron desde Guatemala por México hasta los Estados Unidos… Éramos diecisiete hombres y mujeres inmigrantes y los cinco hombres que nos cruzaron. Dos de nosotras éramos mujeres que viajaban solas. Una noche, ellos trataron de tener sexo con nosotras. Nos negamos. Nos llevaron a un lugar alejado del resto y nos ataron, nos pusieron en el suelo y nos dijeron que si no teníamos relaciones sexuales con ellos, iban a matar a todo el grupo… La otra muchacha se negó primero. Ellos nos golpearon a las dos e insistieron en que nos iban a matar a todos… Yo pensé en las otras personas y en sus familias a la espera de ellos… Y me tuve que dejar, doctora. Y esos cochinos nos hicieron el sexo todas las noches…  Los cinco hombres me lo hicieron a mí y a la otra muchacha… Los cinco… cada noche, mientras los demás dormían… Yo no podía dejar de llorar, y me golpeaban diciéndome que no llore y me calle… Doctora, fue tan doloroso que tenía moretones por todas partes… Creo que los demás nos oyeron, pero todos estaban tan asustados que nadie hizo nada… No le he contado esta historia a nadie. No puedo dormir. No puedo dejar de pensar en ellos. Yo estaba tan feliz de ver a mi marido, no veía la hora, pero lo que me pasa es que cuando él se acerca a mí, y le huelo su sudor de hombre y le toco su piel no puedo dejar de pensar en todos aquellos hombres. Y desde que cruce la frontera cada vez que mi esposo se acerca a mí yo lloro, y siento náuseas, y a veces vomito… Doctora, por favor, ayúdeme… Lo amo, pero no puedo acercarme a él. Doctora necesito su ayuda… “

Mi personal de recepción se pregunta por qué estas mujeres y jóvenes “de repente” quieren un examen físico… Conozco a esta historia demasiado bien… Yo llamo a esta cita “el Papanicolaou de emergencia”, y les pido a mis recepcionistas que me avisen, es un código que me ayuda a estar preparada. Algo que sucedió anoche o esta mañana en la vida de esta mujer, una fuerza repentina que antes no estaba allí la ha impulsado hoy a venir a la oficina para un “examen físico” que había sido pospuesto por muchos años. Es como una señal interna que le permitirá compartir y hablar con un médico acerca de “eso” si existe un ambiente de seguridad durante su visita clínica. Y esa pregunta adicional: “¿Hay algo más que quieras decirme?” dicha junto a una mirada de aceptación y comprensión se convierten en el momento seguro que estas mujeres necesitaban para poder compartir una experiencia horrible que ha marcado sus vidas.

Estoy aquí para escuchar. Mi papel es el de testigo, ayudante, consejera, persona de apoyo, cuidadora de la salud, médica de familia. Esponja de las historias de dolor, y en casos como el de María: los horrores de la inmigración…

Fantasmas Fer

De la vida de inmigrantes….

Tengo muchos pacientes multilingües que buscan mi ayuda porque mi lengua materna es el español. No es porque ellos no hablan Inglés, sino porque están buscando un entendimiento común. Como me dijo una profesora peruana hace muchos años: “Doctora, no es que yo no hable el inglés, de hecho soy profesora de la Universidad NW, la busqué como doctora porque creo que al lenguaje del dolor y el amor necesito compartirlo en mi idioma natal y sé que usted va a ser capaz de entenderme mejor a través de nuestras experiencias en común”.

I have many multilingual patients who seek my assistance because my first language is Spanish. It is not because they do not speak English, but because they are searching for a common understanding. As a Peruvian professor told me many years ago: “Doctor, it is not that I do not speak English, in fact I am a professor at NW University, I asked you to be my doctor because I think that the language of pain and love needs to be shared in one’s native tongue,  and I know that you will be able to understand me better through our common experiences “.