||December 2008 Edition|
QUOTED AT LENGTH
Dr. Socorro Gross
Pan American Health Organization
Photo by Eduardo Ortiz/PAHO
Socorro Gross-Galiano became assistant director of PAHO in May 2008 and currently oversees the organization's core
for technical cooperation in its member countries. A Costa Rican
national, Gross holds a medical degree from the University of Costa
Rica and a master's in epidemiology from the University of Texas. She
has practiced medicine, has taught at the University of Costa Rica, and
served as chief of the Health Services Research Section and the Adult
Health Section at the Costa Rican Social Security Institute. She joined
PAHO's staff in 1994 as an advisor on health promotion in the country
office in Bogotá, and in 1997 became PAHO/WHO representative in the
Dominican Republic. Most recently she was PAHO/WHO representative in
Tell us about your early life.
was born on my grandmother's farm on the border between Costa Rica and
Nicaragua. My grandmother attended my birth. I spent my earliest years
in San Carlos, Río San Juan. Later we moved to Escazú in Costa Rica,
where I spent my adolescence and got my medical training. I consider
myself binational and I love both countries. I come from a very strong
and close family, and my mother is the person who has had the greatest
influence on my life. She has always been a super hard-working,
forward-looking person who never gives up, and she taught me to face
any challenge that life presents.When I was 16, I traveled to New
Zealand as an AFS [American Field Service] exchange student. I lived in
a small town called Palmerston, on the South Island. The father of my
host family was a doctor, and it was really there that I decided to
study medicine. I also spent time with a Maori family and had a
wonderful experience in their sheep-shearing operation.
What were your first experiences in medicine?
high school, I went to medical school at the University of Costa Rica.
I originally wanted to be a pediatrician, and I did a rotation in a
pediatric hospital. The hardest part was dealing with parents. In the
emergency room, you see a lot of negligence and abuse. And in
infectious diseases, when a child died under my care it was very
difficult emotionally. Dealing with the pain of a mother who loses her
child to meningitis, for example, is really hard. But it didn't change
my mind about pediatrics. I went on to do my social service at the
hospital in Limón, which was a beautiful experience, working with
outpatients and again in the emergency room. I also worked twice a week
on a banana plantation, where I set up a clinic.At first, only women
and children came in, but then there was a hepatitis outbreak and cases
of pesticide intoxication, snake bites, and work injuries. Those were
mostly men. They opened up to me even though I was a woman doctor.And
eventually I became the link between the banana plantation and the
hospital, which got me very involved in the community. I had to find
ways of communicating about things like sex education, about how they
themselves could improve their living conditions. That experience with
social service had a major impact on me. I became convinced that I
wanted to be a family doctor and not a specialist.
How did your career develop?
first permanent job was in a suburban clinic. At first I worked in
family planning, but then they assigned me to do house visits to
homebound and terminal patients. That had a strong impact on me. I
learned that a person's health—and especially a woman's health—is
affected by and affects all the people around her. It was difficult
work because you lose people, but you also learn to dialog with them.
They're anxious about the illness or about how to care for a patient.
Many of them had had to leave their jobs to care for someone bedridden
at home. You become essential to that family. You also end up handling
logistics, making sure, for example, that patients get their medication
or a home visit when they need it. You end up being not just a doctor
but a psychologist and a social worker, one who deals with norms,
regulations, references—what can and cannot be done. You learn to fight
for what the family needs. But there are also many rewards. People
receive you with a cup of coffee. You're someone they look forward to
Was that how you got interested in public health?
exactly; I still wanted to be a family doctor. But then I got involved
in a couple of research projects, one of them on hypertension with
Hermán Vargas [then director of preventive medicine at the Costa Rican
Social Security System]. He had been my professor, and he was
determined to persuade me to go into public health. When he took a
year-long leave, I assumed his post, in the area of health services and
at the university. I liked it, and I got more and more involved, so I
ended up staying. Then I got a scholarship from USAID to study
epidemiology at the University of Texas in Houston. That's how I
started in public health.
What was your first experience with PAHO?
worked for a year—on sabbatical from the Costa Rican Social Security
System—at INCAP as coordinator of the basic technical group and an
expert on chronic diseases. Then later I applied for and got a post as
advisor in health promotion in the PAHO Country Office in Colombia. I
don't think people in Costa Rica expected me to stay away so long.
In what directions would you like to take PAHO's technical cooperation?
of the important things I bring to this post is my in-country
experience. I've worked in a large country, a small country, and a
priority country, and I keep all those experiences in mind. Something
else that is fundamental for me is the commitments we have made as an
organization to health for all, to equity, to the Millennium
Development Goals, and to the idea that we really cannot wait any
longer to deal with the great disparities you find in our countries.
One great challenge we have as a region is to make primary health care
a reality, in the sense of social protection, universal access. And for
me a very important challenge is to address the needs of vulnerable
groups—Afro-descendants, indigenous communities—groups with great
inequities.We need to make sure that the current economic crisis
doesn't affect health in these groups even more. For me, the three big
challenges are the unfinished agenda, vulnerable populations, and the
renovation of primary health care in the region.We also need to
exercise leadership to make sure that health is part of policymaking in
other sectors, to affect the determinants of health.
What's it like to head one of PAHO's most important areas?
can't do it all yourself; we work as a team and involve everyone. You
have to build alliances, with WHO, NGOs, banks, bilateral alliances,
institutions of excellence at the country level—a whole range of
alliances that spans all aspects of PAHO's work. This produces a dialog
and advances such as the PAHO Strategic Plan and the Health Agenda of
the Americas, which is something other regions don't have. It gives
clear direction to channel country capacities. These become goals we
have to fulfill.
Tell us about your family and your new life in Washington.
three sons—Ronald, Franz, and Joshua—are among the most important
things in my life. They have helped make me stronger. Learning to be a
mother is a difficult process, and combining that with work and my own
dreams has always been difficult. My sons have supported me many times;
they've left their friends to follow me. As for settling in Washington,
it's been a little complicated. It was easier to build a support
structure, especially for my children, in Latin America. But I've
gotten support here from very good and close friends; building a
support network is always important, and I'm doing that here in
Washington. My youngest son goes to school, to the community center,
and we're involved in community work. I'm still learning to live here,
but it's been a good start. They even brought us a welcome package when
we first moved in.