Joxel García
Deputy Director of PAHO
©Armando Waak/PAHO
Joxel García became deputy director of the Pan American Health Organization (PAHO) in August. Born in Puerto Rico, he was trained as a gynecological surgeon at the island's Ponce School of Medicine and earned an MBA from the University of Hartford in Connecticut.
"I thought I was only going to be an academic and in private practice," he says, "but then I realized that academics and private practice by themselves cannot change the world." He served as Connecticut's commissioner of public health from 1999 to 2003 (see article). He is married, with two children.
What was it like growing up in Puerto Rico?
Well, I'm a farm boy. I was the oldest boy of five children, and we have a very close-knit family. We would go to my grandpa's house on Sundays and have lunch with the entire extended family—20 to 30 people. My grandmother would start early in the morning and have lunch for us at noon. On Saturdays I would go to my other grandmother's house. My parents were extremely busy, but they always had time to talk to us, their friends and family. Today, life is more impersonal than it used to be. But one of the things I try to do is make sure that with my children, my family and my friends, we keep to our principles and try to make time for each other. For me, a priority is that my children feel they can trust me and that I'm there for them when they need me.
How did you get into medicine and eventually public health?
I wanted to be a doctor since I was a kid. First a doctor-soldier, then a doctor-astronaut, then just a plain doctor. I don't know why—maybe because of TV; all my favorite characters were doctors. In medical school, I wanted to be a surgeon to be in the action and do things that could change people's lives. I picked GYN because the career was much more dynamic. There was the advent of laser therapy, pelvic reconstruction, minimally invasive surgery. All those things attracted me more than just opening an incision. Then once I was in the specialty, I thought there was more we could do for women's health than just deliveries and hysterectomies. I realized that I wanted to be involved in administration, to be able to change some of the processes of my institution. Then everything just moved very fast. I also started to do more research and became an inventor. And the next thing I know I became commissioner of health.
What are you proudest of achieving as health commissioner?
What got me on the TV news and shows was bioterrorism, but what satisfied me most were the accomplishments in health status in my state. In national rankings, we started in the top 20. Three years after I took office, we were in the top 10, and within four years, the top five. Now things we did are replicated around the nation, such as door-todoor campaigns in urban health and "house calls for seniors," going directly to communities to ask what they need. Traditionally, when health departments want to have a community meeting, they do some marketing analysis and advertising. We paid out thousands that way to do our first activity. When we showed up for the event, there were fewer people than in this room right now. I thought, "How did this happen?" There was an elderly lady there, and she said, "Well, if you don't know how we talk to each other, you're never going to penetrate this community." I asked her, "Where should I go for that information?" She said to go to the churches and synagogues and mosques, to public schools and the Lions and Rotary clubs—wherever people meet. And it was so successful that we did multiple meetings seven days a week for more than three years.
So that process of taking health to the community caught on?
Yes, the most beautiful thing was when the local directors came and said, "You know, now we have house call meetings." The state paid very little for this. It essentially came from within the community and volunteers and the private sector. We would have events to find out who was not insured, who needs to be screened for diseases. We visited over 10,000 homes, saw 30,000 people in one day. We would have 35 stations with someone checking your spine all the way to someone giving eye exams. We signed up over 300 people who didn't have insurance. We would send a dozen people to the ER every time we had one of these events. We would find a couple of ladies with glucose levels of over 450, and we'd send one to the ER, and she was almost ready to have a heart attack. It was so successful that we did these mega events every three to six months. Bands would play for free. And the budget to take care of 20–30,000 people was less than $2,000.
What else did you learn by connecting with the community?
We found out that transportation was a big issue. For example, in Connecticut I was one of only two Latino OB/GYNs in my health care system. Meanwhile, less than 6 percent of my patients were Latinos. Most were suburban upper-middle and middle class people. We tried some marketing, but we failed to attract inner-city Latinas to our office. The reason was very simple: The closest bus stop to me was over five miles away. Can someone walk there? No! Certainly an elderly or pregnant woman cannot do it. So I learned that if we're going to help change the health of a community we have to change transportation, education and economics. We have to be transcendental. And that's why I got involved in working for the development of communities. You have to understand the dynamics so you can create change. Furthermore, the best way to create leadership is from within; you have to have a sustainable process that allows leaders to flourish. And that process cannot be run by one person; it has to be run by the entire community.
How do you view PAHO's importance to the United States?
PAHO has over a century of incredible successes in the entire hemisphere, and now it's in a unique position. The United States is the fourth-largest Latin American country—as of the last census, we're only behind Argentina by a few thousand. Latinos are not just in the four states that border Mexico; we have millions of people in the Northeast, in Florida, in the Midwestern states. With PAHO's leadership and human resources—its wealth of knowledge—it can help not only with technical expertise but also as a policymaker, communicating with policymakers about ways they can successfully connect with communities in this country. Latinos know the OPS [Spanish initials for PAHO]. They remember how the OPS helped during immunization campaigns and how it is helping families back home. I think PAHO will be a significant presence within the United States, not only with Latino communities but with people from the Caribbean—communities that need people to understand these issues. PAHO can serve that function very well.
What do you learn about communities from their native countries?
We have to benchmark what has been successful, based on the needs and the priorities of the communities within this country, but also understanding and respecting where they come from. There are cultural and historical issues in terms of how you access health care systems. So you have to benchmark what has been successful in the home countries, extrapolate that and bring it to their communities in the USA. Even though they left their country, they haven't left their systems behind. And I think it's going to be extremely cost-effective, instead of trying to reinvent the wheel for a community. Why not bring a process that has been successful for them back to life? It's more efficient and more successful—it's just simple logic.
Your family is still in Connecticut. That must be tough for you.
I would say it's tougher than it seems, especially when you have young children. It's really tough when you cannot kiss them good night, although I talk to them several times each day. But it's amazing. I have not played so much PlayStation or basketball or done so many sports with my son as I have lately on weekends. And same thing with my daughter—things that I haven't done in years, like Chinese checkers.
There's no chance you'd move your family here?
My wife's an internal medicine doctor, a very busy, compassionate and excellent one. She has thousands of patients. She's the favorite doctor of Avon, that's our community. It's a very nice community in Connecticut. My kids love it, we love it, and it's not a bad commute to Puerto Rico. We can fly anytime to see family and friends, and also there are a lot of Puerto Ricans and Latinos in Connecticut, so the kids can grow up with Puerto Rico and the Latin culture as part of their history. It would be very unfair of me to ask them to move here now. I think it's always a possibility. This opportunity to work in PAHO is worth the sacrifice we're making—because it's not only my sacrifice, it's theirs, my family's and others I've left behind in Connecticut. I look forward to Saturdays and Sundays, but I am extremely excited from Monday through Friday here. We have an exciting team—everybody, and I mean everybody here has been exciting to work with. It's worth the sacrifice when you know you're with an organization as accomplished as PAHO and that you're here to help it accomplish many more things. It doesn't make it less painful or less lonely, but it's much more fulfilling when you know you're doing something for the greater good. I think public health by itself is a great profession. And now being in a position to help not only Latinos within this country but also people in the entire hemisphere is great. It's a daunting challenge, and I'm looking forward to meeting it.
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