Longhorns Are Pledging to Return Home to Help Their Communities in Need
Janelle Chavez stood inside a home with dirt floors and no electricity in a small village in the Dominican Republic. She was abroad for the 2018 summer through UT Austin’s Global Medical Training, a student-led program that sends students to medically underserved communities and partners with physicians from the area. Chavez and the program’s doctors had come to visit a terminally ill older woman who was suffering from numerous chronic illnesses—diabetes, osteoporosis, malnutrition—and couldn’t leave her house to walk to the clinic they had set up less than 5 minutes away. Surrounded by family, the woman lay in bed as the doctors tended to her. Though Chavez, BSA ’19, was nearly 2,000 miles away from her life back in Texas, the scene felt close to home.
“It reminded me so much of my grandma,” she says. “I was in a totally different place, but there was this elderly woman who was dying—and she had no access to health care and there wasn’t enough knowledge about prevention.” Growing up, most of Chavez’s life revolved around her grandparents’ ailments. One grandfather had congestive heart failure and the other needed quadruple bypass surgery and was diagnosed with oral and skin cancer. Her grandmother on her father’s side struggles with hypertension and her maternal grandmother died of pancreatic cancer.
In her hometown of Port Isabel, a 5,000-person city along the Gulf Coast in the Rio Grande Valley, there are no hospitals and few physicians. In high school, Chavez remembers working at the Port Isabel Health Clinic nearby where a doctor from one of the bigger nearby cities would come in to treat residents every couple of weeks. The closest emergency rooms are in Harlingen or Brownsville—both of which are roughly 40 minutes away. “It’s really disheartening,” she says. “And in an emergency, it was really tough.”
When she recounts this to me in early July, we’re sitting at the only Starbucks for 20 miles in Port Isabel. It’s a sleepy town that many Texans probably recognize as the place they stop for gas and groceries before driving over the bridge to South Padre Island. Chavez is taking some down time with her family before heading off to the Stanford School of Medicine in the fall. She’s had a busy four years, earning a degree in biology, volunteering abroad through the help of her Forty Acres Scholar Program enrichment stipend, and conducting cancer prevention research at The University of Texas MD Anderson Cancer Center in Houston. Through it all, she has had one goal in mind: earn her medical degree and return home to improve health care through cancer research. “This has been a long time coming,” the 22-year-old tells me. “I want to flip things for the next generation.”
She’s part of an increasing trend of UT students planning to go back to their hometowns after graduation to better their communities—a challenge to the commonly held narrative of small-town kids heading off to the big city, never to return. Like Chavez, I’m from the Valley. Many of us grew up thinking that one day we will cross the border patrol checkpoints that mark the exits from the region into the rest of Texas and make a life elsewhere. But as the RGV’s disparities become more apparent, the pull to return home to help grows stronger.
The Rio Grande Valley is made up of four counties—Hidalgo, Cameron, Willacy, and Starr—all of which are designated medically underserved, according to the Texas Department of State Health Services. It’s a nearly 5,000-square-mile strip along the southern border of Texas that is a unique combination of rural and urban cities.Numerous towns spread throughout the flat stretch of land that have a combined population of nearly 1.4 million people, 92 percent of whom are Hispanic. The area, which not only lacks sufficient health care, also experiences poverty at a rate that’s double the state figure. But even with all its problems, and newfound attention in the political sphere, the region is steadily developing.
I was born and raised just 75 miles west of Chavez, in the border city of McAllen. Like her, I spent most of my childhood visiting my grandmother in hospitals and a nursing home. She fell ill the year I was born. It began with years of depression that gave way to crippling dementia. By the time I was 10, she had lost all ability to walk and talk and she couldn’t eat or breathe without the help of machines.
At first, she lived with my aunt and her family, where my mom, my aunt, and their eight other siblings took care of her with the help of home providers. But as the years wore on, and she began to need 24-hour care, my family decided to put her in the nursing home where she spent her final days. Throughout the 16 years she was sick, she experienced numerous complications—like coming down with pneumonia that led to her tracheostomy and developing skin infections at the nursing home—that sent us to hospitals all around the city.
Unlike Chavez, I never felt that we were lacking access to health care. It was all around me. In my city of 142,000 people, there were hospitals I’d grown all too familiar with: the Doctor’s Hospital at Renaissance which has more than 500 beds; the McAllen Heart Hospital which is the first freestanding heart hospital in the nation; South Texas’ flagship hospital McAllen Medical Center; and the Rio Grande Regional Center where I was born. It also felt like every other kid I grew up with had a parent who was a doctor, from radiologists to anesthesiologists to obstetricians.
Pick a random city on the U.S. map, and you’ll likely find similar disparities between there and its rural neighbors. Living in McAllen, Brownsville, or Harlingen—the three major cities in the RGV—was a different reality than living elsewhere in the region. But even these main cities, with all their health care access, aren’t always enough.
Back home, it’s common to hear about people leaving the RGV to seek treatment in San Antonio or Houston. The resources just aren’t there, especially when serious diagnoses like cancer are involved. For part of her cancer research at MD Anderson, Chavez did a study on women’s cancer prevention, specifically cervical cancer in low-resource areas. They found that in the Valley, women are twice as likely to die from cervical cancer compared to other places in the nation. “We’re still not really sure why it’s so elevated here,” she says, “but then there really aren’t providers. There was maybe one gynecologic oncologist in the whole Valley, when at MD Anderson there were at least 10 in one building.”
It’s a similar situation about 165 miles northwest of McAllen, in the border town of Laredo, the largest inland port in the U.S., made up of more than 260,000 people. Though it’s not technically considered part of the RGV, it’s still made up of the same demographics and is embattled by many of the same issues—poverty, a predominantly Hispanic population that’s growing faster than the city is developing, limited access to health care—and is also considered a medically underserved region by the DSHS. Rene Rangel’s family has been there for generations. “Since my great-grandparents first came over from Mexico,” he tells me when we meet in July.
Rangel, BS ’19, is at the beginning of his gap year, which he plans to spend back home, shadowing physicians in Laredo while applying to medical school. He dreams of attending UT’s Dell Medical School in Austin. The med school, established in 2013, is a one-of-a-kind development. Its creation—which was voted on by Austinites in the 2012 election—was a solution to a growing need in Travis County for more physicians and better facilities.
Rangel admires the way Dell Med and Austin jointly serve the community while simultaneously educating future doctors. He hopes to bring that system to Laredo one day. “This idea can be taken back to the border,” he says. “Why does it have to stay in Austin?”
Some of that work has already begun in the Valley. In 2013, the Texas legislature approved funding for UTRGV Medical School, which will graduate its first class in May 2020. It’s the first medical university in the region and was built to produce physicians that could serve the area’s critical needs. In January 2019, UTRGV opened the UT Health Rio Grande Valley Surgery and Women’s Specialty Center, which offers access to the Valley’s first board-certified women’s health subspecialist physicians in gynecologic oncology.
For years, Rangel has been set on becoming a pediatrician, specifically to help the kids who he sees as the future of Laredo. He’s sure of his decision to move back home where his family lives, where the food is familiar, and where he feels most comfortable. But his plan is driven by something deeper.
“I won’t feel that same sense of satisfaction if I became a doctor in Austin,” he says. “I want to know that I helped someone who had the same upbringing as me.”
Like Chavez and Rangel, UT Austin realizes the value of students returning to their communities. The IC2 Institute—which brands itself as a think-and-do tank research center—has been conducting research on economic disparities across Texas for years. There are 191 counties classified by the U.S. Census Bureau as majority-rural in Texas. Their per capita income is about $3,000 lower than that of nonrural counties. The institute has made it its mission to serve the state of Texas by fostering economic growth in these communities.
“It’s easy, from our perch here in Austin, to lose sight of a lot of what’s happening in the rest of the state,” says Art Markman, the research center’s director. “We have to realize that the economies in rural regions matter just as much as the economies of the urban corridor.”
That’s why in the spring semester of 2019, IC2 announced its new program Home to Texas, which aims to provide undergraduates with paid internships at companies in rural and remote regions. The inaugural cohort of nine students—seven from McAllen, one from Brenham, and one from Amarillo—returned to their hometowns at the beginning of this past summer. For eight weeks, they were placed with a company or nonprofit while simultaneously conducting interviews with key community leaders.
“They learn to view their hometown with the eyes of the adults that they’re becoming at UT rather than the teenagers they were when they left home,” Markman says.
That’s a lesson gastroenterologist and Port Isabel-native Nolan Perez, BA ’93, Life Member, does his best to impart on students he advises. A high school friend of her dad’s, Perez met Chavez her senior year of high school and quickly became her mentor. She began shadowing him in Harlingen, where he has one of his two offices. “He’s like the O.G. of returning to the Valley,” Chavez says.
Perez believes that as the RGV continues to develop, the number of opportunities for the younger generations will grow too. Perez, who was appointed by Gov. Abbott, BBA ’81, Life Member, Distinguished Alumnus, to serve on the University of Texas System Board of Regents, is part of the cohort that decided in 2019 to expand tuition funding for students from families that make less than $65,000 a year. He’s eager to see how the change will affect students from the RGV. He has an arsenal of selling points he tells them about why they need to return: the booming healthcare industry; the collaboration between Elon Musk’s SpaceX base in Boca Chica and the University of Texas-Rio Grande Valley’s STARGATE (Spacecraft Tracking and Astronomical Research into Gigahertz Astrophysical Transient Emission) program; and the trade relationship the Valley has with Mexico.
“We’ve got amazing, amazing opportunities down here,” Perez says, “and then I bring it back to: we’re still at the very beginning stages of all this.”
It will be years before Chavez or Rangel make their way down home. Rangel won’t start medical school until at least 2020. And though Chavez knows where she’s going to be the next four years, she will still have her residency left. “It’s going to be a long road,” she says.
I ask if she thinks it’ll be easy going back to life in the Valley after spending such formative years in cities like Austin and Palo Alto. “There’s lots of life in the big city, but I do ultimately picture myself coming back here, living here, and practicing here,” she says.
Her ultimate goal is to open up a practice specializing in cancer prevention in the RGV. She also wants to mentor students from her community, just like Perez and numerous others did with her. Aside from that, she wants to focus on implementing or changing health care policies that help underserved communities and educating the Valley about preventative measures, whether it’s through television, radio, or social media.
Though she thinks it’s always going to be difficult for rural areas to have proper health care in their towns, she says one thing is for certain: “I want to do it all.”
When I call my mom to check a few facts about my grandma, she’s surprised to hear McAllen is considered part of a medically underserved region. But then she starts thinking about it. She remembers how my cousin, as a little boy, developed cancer in his eye and he had to be helicoptered to Houston for treatment. And she thinks about how often a family member would be taken to one emergency room nearby, only to be told there was no room. “They’d say, ‘we’re just too packed,’” she says. “They’d relocate us to a hospital on the other side of town, or even the town one over—that must be part of all this.”
Home is funny that way. Sometimes it takes leaving it to learn something new. The more years I live in Austin, the closer I feel to the Valley. I’m drawn to telling stories about the RGV, and the people who come from there. And every so often, I get an itch to move back. That feeling is something Chavez, Rangel, Perez and anyone else who plans to do what they have fully embrace. It’s a chance to change the trajectory of a place—and help lift up a community that did the same for you.
Illustration by Daniel Stolle
An earlier version of this article incorrectly stated that UTRGV Medical School graduated its first class in May 2019. It will graduate its first class in May 2020.
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