The Universal Language of Health

Learning to paint and sculpt inside a Haverford studio, Steve Larson came away with values and ideals that he has drawn on throughout his life.

After graduating from the college as an art major in 1983, he earned a medical degree at the University of Pennsylvania, and studied health-care delivery systems in Southeast Asia and Central America.

But even while he traveled the world, Larson's emotional center of gravity remained in Ardmore, near his alma mater. When he bought a house in 1991, he deliberately chose a cozy Colonial an easy trot to the campus.

Now, when the pony-tailed, 47-year-old doctor needs to unwind after a long shift in the emergency room, or as medical director of Puentes de Salud, the Spanish-friendly, free clinic he co-founded four years ago to treat Philadelphia's fast-growing Mexican-immigrant community, he makes time to stroll Haverford's winding paths to decompress and meditate.

Before a towering oak, he chuckled recently as he recalled the times he and prankster classmates used to launch water balloons hundreds of yards across campus using a large slingshot they fashioned from a funnel and surgical tubing. Near the Fine Arts building, he reminisced about two particularly cherished professors—Charles Stegeman and Chris Cairns, both since retired—who taught him to paint, sculpt and view the world through the tough-love lens he has incorporated into his own teaching now as an instructor of Penn medical students.

“I still remember (department chairman Stegeman) saying, ‘Look, everything you paint is (crap). And within that (crap) is good (crap).

Your job is to see what's good. You're not going to go to the canvas and get it right the first time. But you have to be willing to go to the canvas every day,'” Larson recalled. For a kid from South Jersey, whose dad, a West Point grad, used electric shears to administer weekly buzz cuts to his three sons (but spared the daughter), the“somewhat cloistered” environment of the Quaker-inspired college, its“genuine tolerance for other people's perspectives” and its“willingness to engage in dialog” was“intoxicating,” and“laid a foundation for future growth,” Larson said. That foundation proved especially valuable as he trained to become a doctor.

“Medical education is very regimental. ‘Take this book and cram it in your head. Take this stethoscope. Take this lab coat.' It's not tunnel vision. It's funnel vision. It gets narrower as you go along, which is even more insidious.

“You can lose your perspective,” said Larson, who credits his extensive foreign travel and the liberal arts grounding he got at Haverford for helping him achieve“a point of view that is outside the mainframe” of traditional medicine.

Clearly outside the box is Larson's Puentes de Salud, the clinic held Thursday nights in donated space inside the basement of St. Agnes Medical Center in South Philadelphia. The clinic, whose name means“bridges of health,” was established in 2004 as a charitable partnership between medical and nursing students from area teaching institutions and nonprofit organizations, including the Hispanic advocacy group Juntos, to focus on the needs of Philadelphia's burgeoning Latino population, which was 6,200 in 2000 and estimated at 15,000 to 18,000 last year.

Typical of the clinic's clientele is Mexican immigrant Leticia Loyola, 41, who studies English at home using CDs and videotapes, and like many language learners comprehends more than she speaks. With a pain in her belly, and concerned that it could be a liver ailment, the married mother of four went to Puentes recently for a checkup.

“The fact that I can speak in Spanish here makes me feel more comfortable,” Loyola said through an interpreter in an examining room where volunteer medical and pre-med students took her health history and a volunteer doctor examined her.“Buenos dias. Me llamo Dr. Mallya,” Larson's colleague, Dr. Giridhar Mallya, said as he entered the room. A few minutes later he prescribed an oral medicine available to Loyola through a discountprogram at a local pharmacy.

In addition to the peace of mind she gets from speaking about her health problems in her native language, Loyola is grateful for the free services.“I have no health insurance and no money,” she said, adding that her family came to the United States from Mexico City in 2006, lived in Denver for a year and a half, and last September moved to Philadelphia, where her husband works as a shipping-and-receiving clerk.

The Puentes staff never asks about patients' immigration status; most patients, like Loyola and others interviewed, don't volunteer it.

Though most patients receive basic primary care, there are occasions when someone presents with a serious problem, like the woman who needed a CT scan to rule out brain damage after she slipped and fell on her head, or the woman who had persistent blood in her urine with no obvious cause.

In serious cases, which present the potential for loss of life, limb, or permanent damage to internal organs, Puentes helps patients apply for emergency medical assistance, which is federal money dispensed by the state.

In an examining room next to Loyola's, 42-year-old Silvano Tlapechco had a manageable problem. He was there for a follow-up appointment to monitor treatment for an inflamed prostate.

Tlapechco (pronounced“klah-peshko”) said he barely supported his family of four as a farmhand in Puebla, Mexico, before they came to the United States in 2003. Now he works for a produce company in the Italian Market district, which he described as a“10 times better” job than he had in Mexico, but he still asked that it not be named, fearing possible fallout if it were publicized.

Against the backdrop of the nation's fierce immigration-policy debate, Larson is unwavering.“Legal? Illegal? My job is to take care of people,” he said.“A life is a life.” Raised in Woodbury Heights, N.J., Larson had his eyes opened to the problems of providing low-cost health care for marginalized people when he worked at a public hospital in Guatemala during that country's 1988 civil war.

In subsequent years he explored health-care delivery systems in Honduras, Nicaragua, El Salvador, Mexico and Costa Rica. Then, for 13 years beginning in 1993, he worked at Project Salud, a well-known migrant health center in Kennett Square, Chester County, Pa.

“The majority of my patients made less than $13,000 a year; housing opportunities were limited; public transportation was nonexistent in the rural countryside; lack of immigration papers and language barriers were the norm,” Larson said.

“Today I realize that these variables which impacted so heavily on the health and well-being of my patients have a name: social determinants of health.” Grounded in that holistic ethos, Puentes, which serves 15 to 20 patients a night, strives to be more than a take-thesepills-and-call-again operation.

On any given night its sofa-lined waiting room might be the setting for a short presentation by law students about landlordtenant relations or immigration and customs enforcement policies.“Promotoras,” lay people trained to promote Puentes in the Latino community, might give a presentation on public health. Nursing students might speak about nutrition.

Through an active word-of-mouth network, student-volunteers— including those from Haverford—find their way to Larson and to Puentes' door.

“They show up. They are kids, looking for something,” said Larson.“Pretty much the way I was”—30 years ago at Haverford—“when I showed up at that art department door.”

—Michael Matza