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M1 Starina D’Souza champions cultural care

Posted by on Tuesday, October 26, 2021 in First Year, Shade Tree Clinic .

Vanderbilt University School of Medicine offers a path to fulfilling dreams in her own backyard

by Lexie Little

Starina D'SouzaWalking between the columns of University School of Nashville as a high school senior, Starina D’Souza looked back at the building established in 1925. Peabody College students had ventured over to what was then the Peabody Demonstration School for their training as future teachers. Ironic, D’Souza thought, that she should now do the opposite: walk just up the street to Vanderbilt University for training as a future undergraduate student.

She walked toward the biology lecture hall where she took a course on human biology. Feeling young and unworldly, she looked around at all the university freshmen and sophomores.

“Am I supposed to be here?” she asked herself.

With a love for science, she overcame her imposter syndrome on familiar terrain by matriculating at Vanderbilt the next year. Though the geography remained familiar, she allowed herself to explore uncharted academic avenues during her first years.

“I didn’t come into undergraduate studies knowing I was pre-med with a four-year plan. I came in freshman year and thought, ‘Okay, this is what it means to be pre-med and what the career path looks like,’” she said. “It was not what I expected, so it was a lot of reframing and maturing about what exactly it means to go into medicine and what you’re committing to. So, my first two years were full exploration. I was really everywhere. I was on the mock trial team for a whole year for fun to explore law and some political science.

“Ultimately, I think it gave me a lot of experience to then say, ‘Okay, I don’t necessarily resonate with these other professions, so this is why medicine is looking even more and more like something I could really commit my life to.’”

By the second semester of her junior year, she had decided to pursue medicine. She registered for organic chemistry and general physics, taking a heavy course load to inform her career path. Reflecting now, she knows the time spent in other fields only helped her to solidify her passion rather than detract from studies to prepare.

The more she vetted medicine, the more she realized how she could care for patients, particularly those in the Spanish-speaking population through her second major. Though it might have felt like a late start on a pre-med path, she already had insight into medicine and medical practice through her linguistic studies.

Found in translation

In her Spanish program, she learned of an opportunity to translate at Shade Tree Clinic, a clinic system run by medical students to serve the underinsured, uninsured, and housing insecure populations in Davidson County.

“I think the first exposure to the clinic was through my Medical Spanish professor in my Spanish major who wanted us to have immersion experiences in that course,” D’Souza said. “She had a relationship with Siloam and Shade Tree. I worked with both places midway through college. Shade Tree gave me an extra benefit of talking to all of these med students. That was a big reason why I thought, ‘Maybe medicine actually is for me.’”

Intrigued by the possibility of helping the underserved populations of Nashville, she signed up for some shifts. As she sat waiting for a clinician to ask for her services, she chatted with other volunteers who had come to speak with and for around 50% of the clinic’s patient panel who are non-English speaking.

A medical student walked in and asked her to assist. Entering the room, D’Souza composed any nerves, remembering that she needed simply to serve her patient and practitioner to the best of her ability, humbling herself to correct mistakes promptly.

“The patient drinks…Jamaican flower tea? I’ve never heard of it,” the clinician said, looking puzzled.

Despite her coursework and meticulous attention to medical translations, D’Souza could not possibly know the translation for every word that might come up in primary care – where additional histories inform the wholistic picture of patient health.

She pulled out her iPhone and pulled up Google Translate.

“Oh, hibiscus tea, of course,” she said, learning a new term.

She can reflect now and laugh, but those moments proved stressful at the time.

“There’s nothing like being in the moment and then seeing the face of the provider or the patient when you know what you just said is not registering,” D’Souza said. “You think, ‘This is completely on me. I have screwed up. What should I do?’ There’s a gut instinct that says, ‘I need to rectify this. How do I rectify this?’ I think I quickly shed any sense of pride because it’s not worth it. It’s not worth trying to cover it up or act like you knew what you were doing because at the end of the day, someone’s health is in your hands.

“When patients and providers see that you’re invested in them, and that you are going to fix your mistakes and improve on them, it just strengthens that triadic relationship that you build. I learned a lot and continue to learn a lot from that role. You can’t replicate that on-demand skillset that you have to demonstrate at the same time you’re holding somebody’s health in your hands.”

As she worked with patients and the future doctors running the clinic, she developed relationships with students she considers like older siblings. MD students acted as examples of who she could be as a future physician, confirming that she remained on the right path for her by majoring in Medicine, Health & Society and Spanish. Older students reassured her as she applied and solidified her passion for helping others.

Building relationships

She felt welcomed by the Vanderbilt University School of Medicine community well before she studied for her MCAT or started as a first-year student this summer. She laughed when she realized her Robinson College “great-great grand big” in her student mentoring family had also looked after her at Shade Tree.

“Coincidentally, my great-great grand big, Peety Kaur, matched into OB-GYN residency last cycle,” D’Souza said. “She was one of the students I would interpret for at Shade Tree. She was really warm, super embracing, and willing to answer questions and ask questions like, ‘Why do you want to do this?’ Full circle: she wrote me the note in my white coat that the upper levels leave for you when you enter med school. It was so surreal that this person that made such an impact on me as an undergrad is giving me advice formally as an M1. That was so heartwarming. It just worked out that she was in my family.”

Now, D’Souza serves as one of those medical students she would have admired. The opportunity stands as a “full circle moment” as she works to implement changes in patient care. She sees undergraduate students come in to translate from time to time, eager to reassure them and help them remain involved in Shade Tree care, which continues to expand and improve.

She and M4 Nicole Kloosterman discussed the impact of COVID-19 on translation services. With many patients communicating via telehealth opportunities, D’Souza saw a need for virtual translation.

“During my gap year, I was more on the quality improvement side of things for interpreter services, which was so cool because I had reached out to Nicole Kloosterman, who is the current director of services there,” she said. “Obviously the language barrier is already something really difficult to surmount in an in-person setting, so over Zoom was another whole set of obstacles. We filmed some instructional videos in Spanish to teach patients how to navigate Zoom, which is not easy for someone whose first language is English, let alone another.

Kloosterman immediately agreed, giving D’Souza the agency to make the videos and send back for approval and distribution.

Through that process, D’Souza realized she could continue her work at Shade Tree on an even greater scale.

“I realized it was something I could explore once I had decided to come to Vandy for medical school for the next four years,” she said. “I can help grow the program and interpretation services at Shade Tree. And follow in Nicole’s footsteps because she has been a role model for me as an upper-level student.”

Kloosterman had always been impressed by D’Souza’s initiative and willingness to work. She said D’Souza will soon enough be a leader in her own right.

As a “total standout” undergraduate interpreter, D’Souza launched a path Kloosterman believes will benefit Shade Tree patients for years to come.

“It was so exciting [to see D’Souza back at Vanderbilt] because she was a total standout as an interpreter as an undergraduate student,” Kloosterman said. “She was the first to pick up shifts, the first to cover, truly was so involved…I think you could tell she was passionate about this patient population, so being able to recruit her and have her be a part of our medical school – you can see how she’s going to be able to grow and develop as a leader in the next couple of years. You can tell that she’s someone who is genuinely passionate about working with our Shade Tree patients.

“She’s going to do absolutely amazing things.”

Coming full circle

D’Souza said she’s thankful to have kept such a supportive community by staying at home for medical school. When the COVID-19 pandemic forced classes to move online her senior year, she relied on family in Nashville to support her while others remained isolated from family across the country. She knew she made the right choice in medical schools as she received help from and observed the older cohorts. She realized that she wanted to return support and service to the community, and VUSM offered her the opportunity to do just that.

“I think because I had the Shade Tree experience as an undergraduate interpreter and interacted a lot with med students, I really saw them as role models from the beginning. The qualities that they displayed – the altruism and the service – that’s the main arm of VUSM that I saw,” she said. “And that was what I wanted in any medical school that I was fortunate enough to be admitted to. It was important to me that there was a genuine investment in the community – in the marginalized community, specifically – and that the medical students are being taught to think about the macro perspective of health and not just, ‘Here’s one patient we’re going to treat and move on.’ They think about what barriers they’re facing outside of the clinic.”

As a pre-clinical student, D’Souza now enacts change as one of the students helping to keep Shade Tree up and running. She remains grateful for the agency, support, and resources allowed the medical students by administration and the School of Medicine. She feels empowered to help the underserved and underrepresented community, always acknowledging she can never fully have the same relationship to their culture or replicate it, but she can bring respect and a genuine desire to understand to give competent care.

She personally retains first-hand context for recognizing marginalized communities. Her family immigrated to the United States from a part of India once colonized by the Portuguese. The multicultural dimension led to a distinct dialect and heritage often ignored in India. With this context in mind, she strives to remain open to learning about and respecting her patients’ cultures and values.

“The opportunity to surmount that language barrier in general is really impactful for a provider-patient relationship, giving them the space to share whatever cultural thoughts or practices they want to share,” she said. “If I cannot empathize based on my experience, I have resources to learn more about them. I don’t want to act like I understand everything. I don’t. But I want to be able to provide whatever services I can provide so that they can get equitable health care. I want them to feel comfortable in navigating a complex health care system in America.

“It’s very easy to blur language with culture when they’re actually very distinct, and I want to approach other cultures sincerely, the way I would want them to approach mine.”

But she also feels empowered to help younger students in her former position, wanting to be what Kaur was to her. She now grins as she overhears undergraduates assisting, remembering her own days of doubt and panic.

“You feel like things are unachievable until you achieve them,” she said. “But it is possible. Why was I convincing myself it wasn’t? I could not be more grateful I think because I had such a genuine dream of having the support and the resources to build my knowledge, build my foundations, so I can be that reliable and culturally humble provider for patients. Because I’ve seen those physicians, and they really are committed to this. It’s a vocation for them more than a career. That’s what I aspire to more than anything.

“Now that I have this platform and am in this class with all of these other exceptional people, I think, ‘Wow. I think I can do this.’ I see this dream, little by little, coming together.”

Right back where she started.