Clinic is where the heart is

Margarita Pereyda’s office at Share Our Selves Free Clinic belies her

medical training. It’s small -- almost cramped.

But Pereyda, 37, who in October became the Costa Mesa clinic’s

medical director, has found a home to practice her specialty: serving

the medical needs of the impoverished.

At the clinic, she supervises a staff that includes four nurse

practitioners, two physicians and 13 volunteers -- including a

dermatologist, a physical therapist, a surgeon, a nephrologist and a

gynecologist.

The days are busy, with Pereyda and her staff seeing about 30 or

40 -- sometimes 50 -- people a day with various medical problems.

Parking is cramped outside the clinic’s modest facility. Lines of

families wait near the clinic’s doors for the three-decade-old

nonprofit’s services, which also include food and financial aid to

the area’s impoverished.

And yet, for Pereyda, who recently moved from the Bay Area to

Laguna Niguel with her husband and two children, the scene on any

given day at the clinic, though it’s no utopia, illustrates why

people help people and why pre-med students become doctors. It’s not

about offices and paperwork. It’s about helping a man or woman who

has no medical insurance and has a family to feed. With help for that

early diabetes, maybe that patient won’t end up in an emergency room

or lose his sight.

This is not an unfamiliar world for Pereyda, a physician who honed

her skills at the University of Michigan and Stanford.

Pereyda was born and raised in Douglas, Ariz., a poor border town

in the southeast part of the state, where paying for medical school,

or even medical insurance, was not in the cards for families. But

Pereyda, the second-youngest of 11 children, made it out of there.

And she never lost an interest in community medicine. That interest

has brought the bilingual physician from helping to start a clinic in

San Mateo to Costa Mesa, where through a partnership with Hoag

Hospital, her employer, she has taken the directorship at Share Our

Selves.

Pereyda spoke with the Pilot’s Ryan Carter.

I’m sure you could have chosen other paths within medicine. Why a

clinic? And why in Costa Mesa?

We just moved here about a year ago. I was in private practice for

a year -- my first stint in private practice. But since I got out of

residency, my whole goal was to work in a community-based clinic, and

did that after graduating from residency at Stanford. I went on to

work with the County of San Mateo and the Palo Alto Veterans Health

System, and then went on to be medical director of a brand new

start-up clinic in East Palo Alto, where we provided care for people

who didn’t have insurance or who were underinsured.

So, my whole career has always been geared toward being a civil

servant, or a public servant. It just so happened that my husband

changed jobs and we moved out here.

How did you get involved with Share Our Selves?

I had a good experience with the employer I was working with

[doing internal medicine for a private group], but I felt that I was

not moving in the direction that I wanted my career to move in, nor

was the passion that I had for helping people who are underserved

being met. I felt like I was missing something. So, I started looking

around. I e-mailed Hoag Hospital’s Human Resources Department, I

pasted my curriculum vitae and boom, within 30 minutes, the Hoag

person called me.

How long have you known you’ve wanted to go into medicine? And how

long have you known you wanted to go into this kind of medicine?

I grew up in a very poor environment. I was lucky. My dad was

always employed and always had health insurance. But many of my

friends didn’t. I remember people making fun of one of my best

friends in elementary school because she smelled. It turned out she

had this horrible ear infection because she didn’t have access to

healthcare. And I just always remember feeling that just wasn’t a

right thing and having this motivation that I wanted to get out of

the circumstance that I grew up in and that it just didn’t seem right

to me that people would not have access to healthcare.

What’s the best part of your job?

Being a doctor is a major privilege. People open themselves up and

you enter into their lives at a level of confidence that is just

really beyond even clergy. It’s a privilege to get to know people in

that way.

To make a difference in somebody’s life, even as hard as your day

can be, that’s really, really, really rewarding.

What’s a typical day like here?

A typical day for a nurse practitioner, for example, is filled

with feeling really great and then heartache, because lots of people

come through here, and there’s a lot of people we have to turn away

for various reasons -- because they qualify for other programs or

they live really far away. That doesn’t make it easy.

Every day you see people who are really on the fringes. People who

should have never gone the extent they’ve gone. We see a lot of

people with urgent-care problems who otherwise would end up in an

emergency room.

What we’re finding is a lot of our patients have very severe

chronic illnesses, so we’re seeing sicker patients who have more

problems that require more interventions, and more medications. And

working under the constraints of a free clinic, it can get a little

frustrating sometimes.

What’s the worst part -- the most challenging part?

You always want to provide VIP care to all your patients, and

that’s very hard to do.

We are lucky, though, in that we have a good relationship with

Hoag, and Hoag physicians who give us a lot of in-kind caregivers.

Is there anything unique about practicing community medicine in

Costa Mesa?

Yes. Palo Alto and Menlo Park, where I worked, although they have

many recently arrived immigrants, there’s a pretty established

community already with a lot of activism, as is typical of the Bay

Area. The communities are educated in the sense that they know what

their rights are, they know what to fight for, they know how to put

up a political fight. In that sense, it’s quite different than here,

where people are very disenfranchised in this community. I think has

that has a little bit to do with the different politics -- the Bay

Area versus Orange County. But it does make it that much more

difficult.

But there are a lot of wonderful people here who help us out. This

clinic is sustained by donors, by people who donate their time,

money, food, products.

What kind of patterns of clinical needs of the people you serve

are you seeing in Costa Mesa?

The bigger percentage of people we see here are Latinos, however,

we are seeing more and more fourth- and fifth-generation Americans --

average Joes -- who have lost their jobs, who lose their insurance or

who can’t make their insurance premiums for their whole family.

Interestingly, we’re not seeing a lot of drug addiction here, which I

was more accustomed to. We really, truly are seeing the working poor,

people who have two or three jobs but who just can’t make ends meet.

These are families -- entire families.

I think what’s really great about this clinic is that it really is

serving the community that lives in Costa Mesa -- mixed as it is. We

are getting representation from all the groups that live here.

In many ways, I hope our clinic serves a greater educational role

in terms of race relations and socio-economic relations. You kind of

sit here and realize that anybody can be uninsured. It doesn’t matter

what you are like, what your background was, where your parents came

from, you can end up being an uninsured person.

Do you think the clinic will become more of a hub, given the state

of healthcare in our country?

Absolutely. Community clinics will play an increasingly bigger

role in being safety-net providers, because healthcare costs are out

of control -- we all know that. They are out of control for people

who work.

What could you do better here?

The trend in this clinic is typical of the trend nationwide, that

people are sicker and they are older.

Where I see room for improvement would be to streamline our

dealing with very ill and chronic patients. I see room here for us to

be able to streamline that process and actually take more patients

in, so that we catch their disease earlier, before they have severe,

very costly problems. For example, we can catch an early diabetic and

intervene and educate so that that person does not go on to require

dialysis -- so they don’t go blind, lose a foot or end up in

emergency rooms at all of our local hospitals. It all adds up.

My goal would be to intervene earlier and provide a wider range of

educational topics to the community.

I have also always felt that community clinics such as us have a

job in educating other healthcare providers and turning them on to

community medicine.

Anything I didn’t ask that I should have?

I’m excited to be here, but I’m still figuring out where things

are and the issues in the community, which always play a role.

It’s a privilege and an honor to be a doctor. We physicians have a

social responsibility to advance healthcare in a positive way -- to

look at social justice issues. I think that is so inherent in what we

are all about.

If you look at everybody who goes to medical school, we all go in

with that attitude of “we want to help people,” and “I want to make

people better.” Then, we get jaded along the process.

You get lost in having to do your day-to-day activities, where you

forget why you really wanted to do this and what your passion was for

medicine. But we have volunteer doctors coming here, and you can just

see that they realize, “this is why I went to medical school.”