{"id":7394,"date":"2016-01-06T13:04:36","date_gmt":"2016-01-06T21:04:36","guid":{"rendered":"http:\/\/depts.washington.edu\/medex\/?p=7394"},"modified":"2016-01-06T13:04:36","modified_gmt":"2016-01-06T21:04:36","slug":"simon-mendoza-medex-seattle-class-48","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/test\/simon-mendoza-medex-seattle-class-48\/","title":{"rendered":"The Dream Becomes Real"},"content":{"rendered":"

Simon Mendoza <\/strong>\u2013 MEDEX Seattle Class 48<\/strong><\/span><\/p>\n

When he was a child living in Royal City, WA, Simon Mendoza\u2019s family would travel 25 miles to a medical clinic in Othello for health services. Now a student in his clinical year with MEDEX Northwest, Simon has been placed in that same clinic\u2014the Columbia Basin Health Association Othello Family Clinic\u2014for his 4-month family medicine preceptorship.<\/p>\n

\u201cI feel at home here with the people, the community, and the patients I’ve seen,\u201d he tells us. \u201cSome of the patients here have been my classmates from middle school, some of my teachers, friends. It’s the great rural small community experience that I’ve always wanted.\u201d<\/p>\n

At 24, Simon is the youngest in his class of MEDEX Seattle 48, and across all four sites. The median age for students entering the University of Washington physician assistant training program is 33, representing a second or third career path for most. \u201cI tend to be a little mature for my age,\u201d Simon says. \u201cI really enjoy having older classmates. I felt comfortable with them. I like the maturity that MEDEX brings.\u201d<\/p>\n

But age belies Simon\u2019s experience. At 16 he became a Certified Nurse Assistant through a program offered at his Kent, WA high school. This trained him to perform some basic nursing tasks like taking vital signs, making beds and changing bedpans. But nothing could have prepared him for what was to come, except for his innate abilities as a healer.<\/p>\n

[smartslider3 slider=1]<\/div>\n

A<\/span>s soon as he finished the CNA program<\/strong> <\/span>in his junior year, Simon volunteered with the Red Cross and went to Houma, Louisiana in the aftermath of Hurricane Gustav.<\/p>\n

\u201cI had just turned 17, and I was one of the youngest medical services volunteers they ever had,\u201d he explains. Upon arrival in Houma, he was put solely in charge of an entire shelter with over 230 people. It was two weeks before some registered nurses arrived to relieve him.<\/p>\n

\u201cI learned pretty quickly,\u201d he says. \u201cJust being there for people at their lowest point really made an impact in my life.\u201d<\/p><\/blockquote>\n

Simon explains that the central headquarters for medical services was in Baton Rouge, 85 miles from the shelter. \u201cI could consult with them by phone, but it was a couple of hours drive from headquarters,\u201d he says.<\/p>\n

\"Photo<\/a>
Two elderly women recovering at the FEMA shelter in Houma, LA in the aftermath of Hurricane Gustav. Photo copyright Matt Stamey<\/figcaption><\/figure>\n

At the shelter Simon was called on to treat a few acute injuries, but most medical issues were chronic conditions. \u201cWe had a lot of people who were diabetic, who didn’t have their insulin,\u201d he says.\u201d Conditions at the shelter were challenging, as there was no electricity. \u201cSome people were bedridden, and we had a couple of people who had heart attacks. I couldn’t do much for them besides give aspirin and call 9-1-1.\u201d But under the emergency conditions in the aftermath of Gustav, the 9-1-1 service was backed up. \u201cIt took them close to 30 minutes to arrive.\u201d<\/p>\n

We wondered how the then 17-year-old Simon managed to maintain his composure under these extreme circumstances. \u201cI\u2019ve noticed that if I remain calm people remain calm,\u201d he tells us. \u201cI feel like I matured at a very young age, which is part of the reason I was able to remain calm in that situation.\u201d<\/p>\n

\"Photo
A sheriff’s officer helps a woman at a shelter after Hurricane Gustav. Photo copyright Matt Stamey<\/figcaption><\/figure>\n

To pay for his education, Simon has been working full-time since the age of 16. Even now, while in the MEDEX PA program, he works as a telemedicine triage coordinator on the weekends.<\/p>\n

In high school Simon was in the Running Start program, which allowed him to simultaneously work towards his high school diploma and college bachelors\u2019 degree. Now in a 2-year masters\u2019 program at the University of Washington, his access to higher education is possible under DACA, the Deferred Action for Childhood Arrivals program established by the Federal government on November 20, 2014. This is crucial because Simon is not a US citizen, even though his immigrant parents brought him here at the age of six months.<\/p>\n

F<\/span>acing a tough economy in Michoac\u00e1n, Mexico<\/span><\/strong>, Simon\u2019s parents immigrated to Washington State. \u201cMy uncle was already in the United States and became a resident after President Reagan passed the Immigration and Reform Act in 1986,\u201d Simon says. \u201cHe was in contact with my father back in Mexico, and encouraged him to come north to build a better life for us. That’s exactly what my father did.\u201d<\/p>\n

\"Simon<\/a>
Simon, second from left, is pictured here with his parents and eight brothers and sisters.<\/figcaption><\/figure>\n

Within months, Simon\u2019s mother and the nine children followed. Simon was among the youngest of the siblings. They all settled in Grandview, WA, sharing housing with their uncle\u2019s family. \u201cHe also had nine children,\u201d says Simon. \u201cWe all lived in one place for quite a while.\u201d His father and uncle worked in the fields and orchards of Grandview as farm laborers, picking apples, asparagus, peaches and cherries. In time, Simon\u2019s father was offered a good position an hour from Grandview at Smith Brothers Farms in Royal City, WA. The senior Mendoza worked there for several years until the accident.<\/p>\n

\u201cHis arm was crushed in a manure strainer,\u201d Simon recounts. The machinery broke his father\u2019s arm, and mixed the manure in with his blood. \u201cIt was pretty much septic. They nearly amputated his arm, but the surgeon was able to save it, thankfully.\u201d<\/p>\n

It was his father\u2019s near-death accident that first inspired the 8-year-old Simon think about medicine.<\/p>\n

Simon\u2019s elder siblings had settled just south of Seattle in Kent, WA. With the father unable to work the farms, the entire family relocated to Kent where they remained.<\/p>\n

By middle school, Simon developed a sense that he was undocumented and that there was a danger of deportation. At that time there were immigration raids in Eastern Washington, in the very town where the family had lived. \u201cYou would hear about it on the radio,\u201d he says. \u201cIt was slightly terrifying to me. I began asking questions, and that\u2019s when I learned what I was.\u201d<\/p>\n

The US was the only country that Simon had ever known, so all this added an element of uncertainty to his future. Throughout his early schooling Simon received considerable support from his teachers and counselors. \u201cThey saw my ambition and drive, but they didn\u2019t know the whole story,\u201d he says. \u201cI didn\u2019t tell any of them I was undocumented until high school.\u201d<\/p>\n

T<\/span>he conversation returns <\/strong><\/span>to Simon\u2019s 21 days as a high school age volunteer CNA in the aftermath of Hurricane Gustav. He considers this as another formative event along his path to pursuing a medical career. \u201cAfter that experience I was 110% sure that I wanted more responsibility,\u201d he tells us. \u201cI wanted to further my education because I knew I wanted to help people.\u201d But he wasn’t sure of the best possible path\u2014physician, nurse, or physician assistant. In the Louisiana shelter he met a PA for the first time, and was impressed.<\/p>\n

\"Simon<\/a>
Simon Mendoza at age 17 as a Certified Nurse Assistant.<\/figcaption><\/figure>\n

\u201cThe way he worked to help these people was amazing,\u201d Simon recalls. \u201cHis father was a community pharmacist, so he worked day in and day out to get these people their medications. At that time I don’t think PAs had as much of a prescriptive authority. But his drive to help the people, his capabilities, his knowledge\u2014he was incredibly smart.\u201d<\/p>\n

After the Louisiana experience, Simon returned to Kent. There was another year and a half of high school while concurrently attending college courses towards his bachelors\u2019 degree under Running Start. All along he continued to volunteer locally as a CNA with the Red Cross. He gained further experience during his final year of study at UW by volunteering for a free clinic in Auburn, WA, followed by two years of employment with a Woodinville physician.<\/p>\n

All this pushed Simon to meet his 4,000 hours of patient contact required by MEDEX at that time. In 2013, with a degree in microbiology under his belt, he took steps to apply to the UW physician assistants program. But there was a potential obstacle: Simon was undocumented.<\/p>\n

B<\/span>y that time President Obama<\/span> <\/strong>had put in place the DREAM\u00a0Act,<\/strong> which provided some shelter for the undocumented children of immigrants under the age of 31. Short for Development, Relief, and Education for Alien Minors, the DREAM\u00a0Act is a legislative proposal for undocumented immigrants in the United States that would first grant conditional residency and, upon meeting further qualifications, permanent residency. There are a lot of unknowns and no guarantees.<\/p>\n

Soon after passage of the Act in June of 2012, Simon applied. \u201cIt took me a couple of months to put together my paper work,\u201d he tells us. Acceptance under the Act granted him a two-year renewable work permit as well as a social security number.<\/p>\n

\"Marchers<\/a>Still, there was a problem. \u201cA lot of graduate schools required permanent resident status in order to apply, and I didn’t have that status,\u201d he says. The MEDEX physician assistant program in Seattle is a masters level program. Operating under UW Medicine, MEDEX is subject to the same constraints as the university. And UW had never accepted an undocumented student into any graduate program without permanent residence status. \u201cThe medical school just said that I couldn\u2019t apply with my DACA status.\u201d<\/p>\n

Uncertain of how this would work, Simon sent an email to the MEDEX admissions team. \u201cTheir main concern was my ability to work afterwards\u2014 to obtain national certification and a license from the State of Washington,\u201d he says. That’s when Mariah Kindle, Director of Admissions at MEDEX, stepped in to research the issue.<\/p>\n

\u201cShe was great,\u201d says Simon. \u201cJust very supportive, saying that she would look into everything, contact the MEDEX leadership as well as leadership at the University of Washington and see what the legality of my situation will be and how it will effect applying to the MEDEX program. She made the whole process not easy but easier.\u201d<\/p>\n

Mariah Kindle adds some insight into the process of admitting Simon Mendoza to MEDEX.<\/p>\n

\u201cSimon\u2019s story is interesting,\u201d<\/strong><\/span> Mariah\u00a0says. \u201cHe came to the United States as a young child. Based on conversations around his life, academic, and clinical experiences, he was clearly a mission fit. Before MEDEX admitted Simon to the program we spoke to him for a very long time, about nine months prior to him submitting an application. Turns out he was an excellent applicant. He had an undergraduate degree here at the UW with a very high GPA. He\u2019s really our first Deferred Action Status Student.\u201d<\/p>\n

\"Photo<\/a>
Mariah Kindle, Director of Admissions for MEDEX Northwest.<\/figcaption><\/figure>\n

When Mariah first started talking with Simon about his path, she met with members of the MEDEX leadership group to determine what his process would be. \u201cThat was after a lot of research I had done,\u201d she tells us. Mariah checked with the State of Washington to understand the rules for DACA students. She spoke to the University of Washington concerning policies for financial aid and qualifications for masters\u2019 programs. She reached out to NCCPA\u2014the PANCE national certification body\u2014to make sure that even after Simon finished the program that can he sit for the board exam. She contacted MQAC, the Medical Quality Assurance Commission, which licenses MEDEX.<\/p>\n

\u201cTurns out the rules applied the same for Simon,\u201d she tells us. \u201cStudents with deferred action status must have a Social Security number, pass an accredited training program, sit for the national certifying exam, and they can practice in the State of Washington.\u201d<\/p>\n

With all that the MEDEX leadership group decided that Simon had to follow all the same steps as every other applicant to the program. Mariah clarifies that \u201cthere was no blanket policy actually. It was decided that MEDEX would look at each person with DACA status individually to be sure they not only meet the standard MEDEX qualifications, but also that they are a mission fit. Simon was just kind of the perfect candidate for MEDEX. He\u2019s the whole package.\u201d<\/p>\n

At that time the UW did not accept students with DACA status. \u201cBut because of the MEDEX experience with Simon, the UW School of Medicine looked at our process and took the same approach\u2014looking at people individually, making sure they qualify on the same level as everybody else,\u201d says Mariah. \u201cI think that\u2019s the key.\u201d<\/p>\n

On September 30, 2014, the UW School of Medicine announced a change in policy regarding DACA applicants in a Seattle Times story. It read, in part, \u201cThe University of Washington\u2019s School of Medicine has joined at least 35 others that now admit students who were born outside the U.S. and brought into this country illegally.\u201d<\/p>\n

Deferred Action Status Students cannot receive State or Federal monies. In fact, this is one of the largest hurdles that students with DACA status face.<\/p>\n

With his path to the admission process cleared, Simon began gathering the necessary documents for MEDEX. \u201cI\u2019m still considered undocumented even though I have DACA status because it’s only a temporary deferral,\u201d he says. \u201cIt’s not like I have permanent status at all. I have to reapply every two years. There is a $465 fee and they grant you the two-year work permit every two years.\u201d<\/p>\n

S<\/span><\/strong>till, much remains uncertain for the future.<\/strong><\/span> Given the current volatility of the US body politic\u2014with a strong anti-immigrant rhetoric\u2014there is reason to be concerned. \u201cIf Romney would have become president in 2012, he would have immediately ended the DACA program and deported us all.\u201d<\/p>\n

\u201cMost people have no idea what all this means,\u201d he says. \u201cSome people ask me, \u2018Why don’t you just apply to be a citizen?\u2019 If it were that simple we\u2019d all do that.\u201d<\/p>\n

He\u2019d get in line if he could find an end to the line.<\/p>\n

\"Photo<\/a>
Simon Mendoza at the offices of MEDEX Northwest in Seattle.<\/figcaption><\/figure>\n

What puzzling is that Simon\u2019s parents became permanent residents in 2013. \u201cThey brought me to this country,\u201d he explains. \u201cAll of us were undocumented. They were undocumented, but they applied for a visa with my uncle’s sponsorship because he was a US citizen at the time. We waited in that line for over 20 years. When our visa number became current I had already turned 21. So I was no longer eligible to become a citizen under them. They became residents, and then I was sort of left out. To me it makes no sense.\u201d<\/p>\n

MEDEX students deal with the stress of a greatly compressed learning schedule in their didactic year, and a sequence of ever changing monthly rotations in their clinical year. Add to that the complications of two years of lost income, endless studying, and the impact of all this on their relationships. Simon\u2019s undocumented status adds a whole other layer of stress. How does he manage the uncertainty?<\/p>\n

Again, what strikes those who meet Simon is the calm he brings to challenging situations.<\/p>\n

\u201cI try to take it one day at a time,\u201d he says. \u201cI don’t worry about several years ahead. I just look at it one day at a time. What can I do to better my situation and take the next step forward?\u201d Simon is part of the Latino Medical Students Association and the National Hispanic Medical Association. \u201cWe are advocates for immigrant, undocumented students to get a higher education.\u201d And by incrementally moving the ball forward, Simon opened up possibilities for other undocumented immigrants to higher education.<\/p>\n

W<\/span>hen we caught up with Simon<\/span> <\/strong>during his preceptorship at CBHA Othello Family Clinic, it\u2019s clear that he is in his element. Migrant farm workers are the principle focus of the clinic. In fact, the mission statement of the clinic is \u201cKeeping healthy those who feed the world.\u201d<\/p>\n

\"Simon<\/a>
Simon Mendoza during his family medicine preceptorship at Othello Family Clinic with John Beauchamp, PA-C.<\/figcaption><\/figure>\n

\u201cWe pride ourselves on serving agriculture and migrant farm workers, and we don’t discriminate against people who can’t afford health care,\u201d Simon says. \u201cWe try to serve everybody without regards to ability to pay, no insurance, race, age or anything. That’s the great thing about CBHA.\u201d<\/p>\n

\u201cPatients remind me of my parents,\u201d he tells us. \u201cCultural competence is necessary to provide great care to this community. This includes an understanding of traditional healing practices commonly referred to as curanderismo<\/em>. Herbs for example, are commonly used to treat anything from insomnia to constipation. Understanding this and asking about it is very important because there may be serious interactions with certain prescription drugs.\u201d<\/p>\n

It\u2019s clear that Simon is in his element here in rural Eastern Washington. \u201cI would love to come back and work in a town like Othello. I love the closeness of the interaction with patients,\u201d he says. \u201cMy passion is for prevention and management of chronic diseases and mental health disorders.\u201d<\/p>\n

Simon\u2019s 4-month preceptorship at Othello Family Clinic concludes at the end of January. After that, his clinical year consists of six 1-month rotations, most likely in the urban Seattle area. Emergency medicine is next. \u201cYeah, most of the specialties are over there,\u201d he says. \u201cEven here we have to send patients to Tri-Cities for specialty care. And I don’t mind that. I’ll get a lot of exposure to complex patients over on the west side, especially associated with University of Washington. I’ll get a lot of great exposure, then bring it back here. So I’m looking forward to that.\u201d<\/p>\n

Simon has already inquired with the CBHA leadership about returning to the Othello Family Clinic once he graduates from MEDEX and obtains his national certification as a PA. \u201cI\u2019m certain I want to end up here,\u201d he says. \u201cI love it.\u201d<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Simon Mendoza \u2013 MEDEX Seattle Class 48<\/p>\n

Simon Mendoza became the first DACA student accepted to a UW Medicine graduate program. During his family medicine preceptorship with the MEDEX Northwest physician assistant program, Simon is putting his new skills to use in the migrant farmworkers\u2019 community of Othello, WA. <\/p>\n","protected":false},"author":1,"featured_media":7628,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[7,9,10,11,12,13],"class_list":["post-7394","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-experience","tag-class-48","tag-clinical-year","tag-dreamer","tag-othello","tag-seattle","tag-simon-mendoza"],"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/7394","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/comments?post=7394"}],"version-history":[{"count":0,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/posts\/7394\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/media?parent=7394"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/categories?post=7394"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/test\/wp-json\/wp\/v2\/tags?post=7394"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}