Serving the Community

Profile of Salvador Sandoval

“With the homeless population, there are African-Americans, white, Asians — there’s a little of everything. They’re all people, and they’re all needing some help, and to be treated with dignity.”

For Salvador Sandoval, MD, a lifetime of service to his patients in California’s Merced County comes down to one important thing: community. Or maybe chicken soup.

Dr. Sandoval had just returned from a home visit, during which the patient, an elderly woman living in farmworker housing in Planada, CA, a few miles of east of Merced, had served him chicken soup from a chicken she had raised herself. “We’ve built a friendship over time,” Dr. Sandoval said. Many years prior, he had cared for her now-deceased husband, who had a long list of health issues, requiring frequent home visits for blood draws.

He recalled an early visit to the couple’s home, where he was accompanied by Pedro, a medical student who would eventually become a Physician’s Assistant. Dr. Sandoval noted that the visit should be short, as he had several other home visits to make that day. “I started smelling mole, with chicharrones, and nopales, and fresh-cooked beans. I told Pedro, ‘I think I’m going to be here for a while!’” he joked. Dr. Sandoval continues to make home visits to the wife, who now has health and mobility issues of her own.

Dr. Sandoval jokes that he never intended on being a geriatrician, but his patients keep aging. “Some of them I’ve been seeing since I first came to the community,” he explained. Dr. Sandoval has been with Golden Valley Health Centers in one form or another for his entire 34-year career, including a two-year stint as the medical director.

But Dr. Sandoval enjoys his work the most when he is immersed in the community. Now, “I’ve reduced my hours in the office,” to spend time among the people of the farmworker community of Planada. In addition to home visits for the elderly in the area, “I have a homeless clinic on Tuesdays in the morning. I work with students from [University of California,] Merced, primarily, that shadow me and help there.”

Homeless Clinic

About fifteen years ago, Dr. Sandoval learned about a spate of deaths in California as a result of hypothermia. Three of the deaths were in Merced County. “One of them was a farmworker, who stayed in a shed and just froze to death,” Dr. Sandoval recalled. The event sparked the National Guard Armory building to open its doors to the homeless, and Dr. Sandoval offered to do a free clinic there as a volunteer. “Golden Valley Health Centers opened up their first homeless clinic in Modesto, and we started asking if we could do it here,” Dr. Sandoval explained. Eventually, “we got a mobile van, and started doing outreach for farmworker homeless. There were three of us, two physician assistants and myself… When they opened up the shelter, we started to do our clinics there,” as well.

About six years ago, “with budget cuts, the clinic’s funds got cut off,” Dr. Sandoval said. He continued doing the clinic, once again as a volunteer. “I was running it out of the trunk of my car,” Dr. Sandoval said, utilizing samples he had received from drug companies in place of pricey prescription drugs. A University of California, Merced student who worked with Dr. Sandoval assisted him in mounting a campaign to regain funding, calling on local politicians and pastors to pressure Golden Valley into once again providing funding. The campaign worked, and Dr. Sandoval’s weekly homeless clinic continues.

The homeless clinic has encountered plenty of issues beyond its financial woes, and Dr. Sandoval has always worked to find a solution. For some time, his work with the clinic was in jeopardy as Golden Valley did not want to cover his malpractice insurance, despite the coverage already in place for his home visits He eventually assured Golden Valley of the importance of the clinic and the need for malpractice, by calling it home visits for the homeless — but ongoing issues with his patient population aren’t so simple to address.

Continuity of Care with a Homeless Population

Dr. Sandoval says that his homeless patient population is quite diverse, populated with transients, newly homeless, farmworkers, drug addicts, and others. But continuity of care seems to be a theme for his wide ranging population. Assisting homeless patients in signing up for services can be difficult without a permanent address — so the clinic often uses the shelter’s address. But shelter users can only stay for five months a year, and many in the homeless community wait until the winter months to use their allotted five months, which can disrupt care for the other seven.

Other homeless services, like food banks and soup kitchens, are spread out around town, and so patients may miss the homeless clinic because they need to walk or bike across town for other services.

Personal belongings are often stolen — Dr. Sandoval notes that the lockers at the shelter are all opened with the same key — so patients lose their birth certificates or identity cards, or their bike is stolen and they’re unable to get across town.

Those with cell phones don’t always have them on, as it’s difficult to find a place to charge the battery, or often won’t answer, because of the cost associated with the call, Dr. Sandoval explained.

Illegal homeless encampments — it’s illegal to camp in Merced, as in many cities across California — are also spread out across the county, and when one is torn down, as was the case at the beginning of 2015, the residents, again, are hard to track down.

Continuity of care is always difficult, as with any mobile population. But with a homeless population, the mobility can be just a few miles around the clinic site, and can still critically affect continuity of care.

What’s Needed

When asked what needs to change in health care, Dr. Sandoval points to a specific patient: an undocumented woman whose kidneys were failing. “She almost died with kidney infections and poorly controlled diabetes. We could see it coming,” he said. “If she had health insurance, we might’ve been able to prevent her kidneys from failing.”

Another undocumented patient began taco and tamales sales to pay for her own kidney transplant. “Now, she’s a legal resident, and she’s had [the transplanted kidney] for nine years,” Dr. Sandoval said.

For health care, he believes we need to examine “where our priorities are as a country,” Dr. Sandoval explained. “Not having a house affects your health, not having a job affects your health.” Although he commends the Affordable Care Act for covering many people, referrals have been slow due to low Medicaid reimbursement rates. A homeless patient needing eye care has been “tripping into things” on the street, waiting the many weeks before her appointment, he said. And many people are still without health care coverage: “Just like K-12 [schooling] is a benefit of being a resident, and fire and police protection — I think health care should be that way, too.”

From Farmworkers to Homeless Patients

Dr. Sandoval was born in Sacramento, two hours north of Merced, and also in the Central Valley. “My mother worked in the Campbell’s soup cannery in Sacramento, and later at Patterson Frozen Foods, and my father was a barber. In the summers, we’d work in the Dixon/Davis area,” an agricultural area close to Sacramento.

During his medical schooling, “I did a preceptorship in Yuba City,” an agricultural town on the north end of the Central Valley. “I worked with Spanish-speaking patients, mostly.” He loved the small town feel and the agricultural community, which he found again when he moved to Merced in the 1980s, for residency training and to raise a family. “I was the only Latino doctor in Merced,” which is a surprise, considering the current demographics of Merced, where Latinos are more than 50 percent of the population.

Following a tumultuous first few years trying to establish a private practice, Dr. Sandoval became Golden Valley’s first medical director at a time when most of its doctors had recently quit. “A lot of the community health centers were going through… turmoil,” he explained, as shifts in funding and oversight tossed Golden Valley and other health centers into uncharted waters, and disputes arose between administration and practitioners on how to operate under the new structure.

Eventually, as things settled down, Dr. Sandoval managed to create an atmosphere of cooperation between clinicians and administration. Since that time, Golden Valley has grown dramatically, expanding its service area into large swaths of the Central Valley with 30 clinics, including school-based clinics.

At the same time, Dr. Sandoval’s family — of which he is very proud — grew, too. His youngest daughter is now a physician practicing in Sacramento. One of his twins is a newborn intensive care nurse, and the other a teacher in Davis, California. His wife, a transplant from East Los Angeles, is a highly regarded high school counselor. All together, they have eight grandchildren.

Meanwhile, Dr. Sandoval continues his work in improving health care access for all members of his community. “The main reason I came to Merced was to work with farmworkers. Now I see there’s been a growing homeless population, too — and they’re also in need,” he explained. “I still see a lot of Spanish-speaking patients, and I think being bilingual and bicultural helps with that. With the homeless population, there are African-Americans, white, Asians — there’s a little of everything. They’re all people, and they’re all needing some help, and to be treated with dignity.”

— — -

Profile originally published on MCN’s website as part of 30 Clinicians Making a Difference, a project celebrating Migrant Clinicians Network’s 30th anniversary through the life stories of 30 clinicians making a difference in migrant health.