David Quackenbush (Host): Thank you for joining the Golden Voices podcast, the podcast of Golden Valley Health Centers. I'm the host, David Quackenbush, President and CEO of Golden Valley. And joining me today is Dr. Eduardo Villarama, who is the Chief Medical Officer of Golden Valley. Dr. Villarama, welcome. Thank you for joining us today.

Eduardo Villarama, MD: Thank you, David. And thank you for having me.

Host: So, we've talked several times about how we kind of both ended up where we're at. You have a pretty unique journey. In this podcast, we really try to highlight people's journeys. I've always been fascinated by people's journeys. Primarily, my journey has been somewhat simple in the same area of California, never really having lived many other places. But folks like you, which Golden Valley has hundreds of staff with very robust backgrounds and exciting stories, and they've lived in countries and their career has taken them many, many places. With you being the chief medical officer now, that's kind of where you are now, but you've had a lot of stops on the way. And you are an international medical graduate from the Philippines, which isn't necessarily common in California, having a medical doctor from the Philippines. Philippines is well-known for in importing nurses into the United States. But not so much with medical doctors, and your story is a very unique one.

So, I mean, I have your bio here, but I would love for you to kind of talk about your journey. So, why don't we just start with-- and I know you've told this story hundreds of times, but I'm going to ask you to tell it one more time, because it's very unique. Can you tell us a little bit about your childhood, a little bit about how you decided, or it was somewhat decided for you to become a medical doctor and how you ended up being a doctor in the Philippines prior to your career in the U.S.

Eduardo Villarama, MD: Yes. Actually, I think my profession and my journey had been decided since my early childhood. Unfortunately, I had a life-changing event early in my childhood. I lost my mom at the age of 14. I'm able to comfortably talk about it now, but it wasn't like this before, thinking about it. And I'm the oldest of five siblings. So early, I must be a role model. I must be responsible and care for my younger siblings and my family very early in life. My mother is from a big family. She's THE fifth child of 12 siblings. She has a very kind heart and a natural entrepreneur. She only went to fifth grade, but she was very smart.

So in our community, you know, she saw the potential given that it's in an agricultural environment, that folks are not thriving well in terms of opportunities for employment and opportunities to make a living. So, she started this vegetable plantation in our community where she grew all types of crops and vegetables And then, sold them to the city market for both retail and wholesale, and gradually grew that business, employing almost all of the people in our small town. That kind of inspired others, kind of with the same resources to step up. And that led to our town growing into a thriving community, selling root crops and vegetables.

So, that kind of background really shaped the person and the professional that I am right now. I carry on with me, you know, her legacy of integrity and the passion for helping others and making a difference in their lives, especially of the underprivileged population. She exemplified this together with my parents and grandparents.

To answer your question that I have shared many times back in my childhood is a very interesting one, because my grandma is one of the traditional healers in our small town, because we didn't have easy access to healthcare. She was the midwife and the go-to person when someone is ill. So, she's one of those women that uses oil, tree barks, extracts, and any sort of things that she can to provide relief and care for those sick. And delivering babies is very interesting because it's a remote town, so we don't have those fancy tools or gadgets or equipment. So, she took me under her wing as her sidekick delivering babies.

So as you can imagine at the age of 10, it was very interesting, and at the same time a bit of a traumatic experience for me, but that kind of triggered something in me and got my interest in kind of helping people that are sick. And if we cannot heal them, at least provide comfort and tend to their needs. That's

Host: so, let me ask real quick, because I'm just thinking about a 10-year-old helping to deliver babies. Do you remember what was going through your mind at the time? Like when you were there with your grandmother, helping to deliver babies, do you remember what was going through your mind?

Eduardo Villarama, MD: I actually, yes. Unfortunately, very vividly. And then, I can still hear her voice, right? Just because I'm proud to say that we are a very matriarchal family. She's like the head of the household. My grandma is the head of the household, right? I can hear her voice. So, anything that she asks you or she wants you to do, you need to get it done, right? And she's very good though in terms of giving instructions to people around her so that you will not make a mistake or inadvertently become unhelpful in that chaotic environment when someone's delivering a baby, everyone is shouting, right? But she has this calming voice and calming presence, like, "Don't worry about it. I'm here. I got it. I got my grandson who's going to help us out. He's going to be taking care of the boiling water or the cloth and things like that. You'll be fine. Just listen to me, and we'll get you through it." Yeah, I can remember all those. The first one was the most difficult. But after third, fourth, and fifth deliveries, I was like, "You know what? I'm having such a great time with my grandma. This is good. This is cool," back then.

Host: That's fascinating. I can only imagine, my children who are 10-year-old American children going with their grandparents to deliver babies. So obviously, that had a very direct impact. And then, I want to go back to your comment about your mother's big heart. You've obviously inherited that, because that's what you are known for. People who know you and your patients know that you kind of lead with your heart. So, that's a big piece of you and what we see at Golden Valley.

So, how does your mothers heart, assisting your grandmother in deliveries, how does that evolve into a career in medicine? First, a career in medicine in the Philippines, and then how did you end up in the United States?

Eduardo Villarama, MD: So, I think I can start with where I grew up, right? So, it's a very, very small and remote town in the Philippines. And that we did not have the taste or luxury of electricity until 1995. Yes, I can remember, I was graduating in high school when suddenly we have electricity. So, we now have the ability to prepare for it.

Host: The year you graduated high school was the first year you had electricity.

Eduardo Villarama, MD: Yes. So yes, we depend on the natural light. When the sun comes up and the sun goes down, that's where a lot of activities are happening, right? And at night, the saying you burn the midnight oil, I was literally using an oil lamp to study and make sure that I do well, right? So, the town is really small, underprivileged. So, the town is naturally poor. Opportunities for employment are very limited. Literacy is very low as well. Agricultural, people work in the fields. Education is not a priority. And I think my mom is a trailblazer. Like, she's one of 12. Only two of her siblings of 12 went to school, and she's not one of them, but she probably had sent seven or eight of them to school, because she was the one that had kind of really worked. She was considered the rebel in the family, because she did not want to go to the field. She wanted to study and wanted to do better.

We do not have access to healthcare back home. The clinic that we go to for vaccinations-- but we do vaccinations. That's one good thing-- the clinic that we go to for vaccination is about two hours away, and the hospital is even further. And transportation is a big challenge. If you do not own a vehicle, chances are you're going to travel by foot or by one of those animal-drawn buggies or wagons. That's how we go the city, right? And my mom when she had me, because I'm the first born, I'm the oldest of five, she'll always kind of brag about "My first born is a man, is a son, right? He will be the first doctor in town." So, I don't know. But for her, maintaining health, keeping health and having access to healthcare is a priority next to education. So, she always wanted someone in the community to be first in terms of providing that healthcare access. Yeah, 10 years old, 11 years old, I remember this. My mom will kind of tell all her friends, "My son will be a doctor one day. He will be a doctor." So, yeah, she started that idea.

Host: That's a lot of pressure. Did you feel the pressure? Did you feel that pressure?

Eduardo Villarama, MD: I did not know any better. I was 10 years old. It's like, I love my mom. It's like, "Yes, mom, I will be a doctor." And then, that's when I started with my grandma taking me to these births and attending to the sick. So yeah, it was a well-coordinated plot to get me to med school. And I have no complaints. I can't complain.

Host: So, tell us about med school.

Eduardo Villarama, MD: So, med school, it was one of the universities in the Philippines called Far Eastern University, so it's in Manila. I live in a very remote town, so I have to move to the city, the bigger city of Manila to go to school. Interestingly, I did not find med school to be difficult-- now, I'm bragging a little bit-- I guess because of that motivation and experience in life, because life was hard where I grew up. And we were able to do things within our means and with our resources and kind of enjoy what we can enjoy at that time. We didn't have anything to compare things with. So, we didn't know of any beautiful, new, shiny things and all of those. So, we were very satisfied with what we have. And really, the focus is around family and faith and tradition, because people probably even have less resources than us. We pride ourselves with being able to share the resources that we have for those folks that are lacking them.

Yeah. But the school is in Manila, so went to school, and then had my postgraduate internship in one of the government hospitals. Government hospitals are usually a great training ground because they're very, very busy. And we are always short of healthcare providers.

So in my intern years, this is one year prior to graduating med school, I had my OB rotation and general surgery rotation back to back, because I am this guy who's always volunteering to do things, because I am a bit bold and a bit unafraid in learning and putting myself in a situation where I can be challenged and helpful at the same time. I was doing cesarean sections. I was doing appendectomies. And I was doing all kinds of procedures that usually only a full-fledged physician can do or will be able to do. But I had the confidence of all the physicians around me to help me, because I'm motivated, I'm driven. And again, that time, I already lost my mom. And I told you that I can never break that promise. I will be a physician. So, that has always been my driving force.

Host: You were really motivated at that moment.

Eduardo Villarama, MD: Yes, I am.l I'm always driven. Yeah.

Host: I'm just curious from the change, so growing up in a small agricultural town, and how was the move to Manila, one of the biggest cities in the Philippines. At that time, it probably obviously wasn't as big as it is now, And that must have been a bit of a culture shock in itself, right?

Eduardo Villarama, MD: Yeah. Yeah. It is a culture shock. Because again, you know, first, the electricity and access to everything and other fancy stuff I'm not used to. And I now have to live with one of my mom's sisters because we didn't have a property in the city, in Manila. I have to live with her and kind of learn how to adjust. And even their family, you still have to adjust. There is that feeling of being uncomfortable at times. But again, I have to sort through it, because I know I have to do it. But that gave me an opportunity and an additional perspective in life, right? You know what? There's a big difference. Like, I think this is another world compared to what I remember growing up. Yeah, that was challenging. But also, because I'm with family, it assured me that everything's going to be okay.

Host: So, you did your school and training in Manila. And then, you practiced, you were a doctor in the Philippines for a while.

Eduardo Villarama, MD: Yes.

Host: Where did you do that and how was practicing in the Philippines?

Eduardo Villarama, MD: So soon after graduation, I think this one's a bit too much information I will have to share. I got married after graduation. But I got married. I had my baby and I started practice in an order that is acceptable to our culture. But my grandma will joke about, "But you did that within a year, all of them." It's like, yes, I did.

So, I got married and my wife is from a different town. So, I'm from the north and my wife is from the south. We met in the middle. We met in Manila, because Manila is in the middle, right? So soon after graduation, I'm married and we had our first child, so I have to be responsible, more responsible. So, I ended up practicing in another small town in the province of Albay, Bicol. This is kind of like the Region Number IV of the Philippines, one of the poorest regions in the country, actually. That's where I learned what we call it medicine that serves cradle to the grave. So, I see anything and everything, from pregnancy to caring for the elderly that are very sick and about to pass, right? And that offered me the opportunity of trying to be better in everything that I will be faced or be attending to. Be it just a simple consultation for cough, cold. Be it, you know, suturing lacerations and taking care of someone with a wound or even doing, you know, some procedures like appendectomies and other surgeries, because I was the only physician in that town that people have access to. The bigger hospital is, again, about a couple of hours away. So, I do everything and anything for them. And I did that for four years.

Then, we had our second child there. And my wife-- I call her the architect of my life-- saw an opportunity that "You know what? You're very hardworking. Kids are growing. I think I want a better environment for them." So, that's when she researched about the international medical graduates opportunities for a residency training or a specialty training abroad. And that's how it started. So, I was in practice for four years. But in my third year, I started applying for the residency program here in the U.S. I took all the necessary examinations and, fortunately, I passed them and went on interviewing and landed in one of the programs in Pennsylvania, Penn State University, Hershey Medical Center in Lebanon, Pennsylvania, where I did my community and family medicine residency training for three years.

Host: So, you were a doctor in the Philippines for four years. And so, the requirement to come to the U.S. is you have to take the appropriate examinations, you have to pass the exams. And then, you have to get placed in a residency program.

Eduardo Villarama, MD: Correct.

Host: And you did your residency program in Pennsylvania. How long was that and what kind of experience was that for you?

Eduardo Villarama, MD: So, the residency program is three years. It was really fun for me, because it feels to me like I was just doing my regular stuff or things that I've already been doing in my private practice back home. And of course, the addition of having access now to technology and other materials so I can stay up-to-date and be able to be more effective as a physician.

But honestly, the most challenging for me is the English, the vocabulary. Because although in the Philippines, the teaching instructions are in English. We never speak English on a regular basis. We have our native tongue, Tagalog, right? Yeah, when I was, in my first year, what I do is I go to parks and libraries and talk to older folks so I can practice my English. They're all very nice and accommodating. I can remember this one lady--

Host: Did they know why you were talking to them?

Eduardo Villarama, MD: Yes.

Host: So, they knew you were trying to improve your English when you were talking to them.

Eduardo Villarama, MD: Yes. I was very open about it.

Host: You would just go up to strangers and say, "Can I practice my English?"

Eduardo Villarama, MD: Yes. That's like, "Hey, I'm new to town. Good morning. Can I ask you a favor? Can I have a conversation with you? Because I'm practicing on my conversational English," and they're all very accommodating.

Host: Yeah. That's really adventurous of you. And so, you would just, like, talk about news of the day or just kind of general conversation with these strangers?

Eduardo Villarama, MD: Small talks. Because that's, I think, where I lack the most. I know formal English, right? But I don't know, like, the norm, like how people talk in the community conversationally. So, that was actually very helpful to me. I go up to the cashiers, I go up to the librarians, to the security guards. I talk to all people.

So, they're probably like, "This guy is creepy. There must be something wrong with this guy." But I was nice enough to kind of really make introductions and make them feel comfortable as I approached them.

Host: I'm just curious because, you're now the chief medical officer here and folks who are familiar with the healthcare system, especially health centers similar to ours that serve low-income underserved communities, workforce is so difficult and having enough clinicians is very, very difficult.

As you know, because you've been involved in hiring a lot of folks, Golden Valley, we have 30 some odd international medical graduates on staff. So, you were already a doctor in the Philippines for four years, doing family, literally doing kind of the traditional family practice, as you said, cradle to grave. So, everything in between. And then, you came to the U.S. and still had to do residency. What are your thoughts on that system and kind of those barriers, also recognizing just how difficult it is to find clinicians to serve underserved areas.??

Eduardo Villarama, MD: Probably will respond to that, David, kind of two ways, right? One is, I think it has to do with how driven and motivated the individual is, how driven and motivated the providers are. And then secondly, it has to do with their skills and background in academics. For those folks that already had been doing the work prior to entering a residency program, it's probably not as challenging or not as difficult. For those that are fresh from graduation now going into the residency program, trying to kind of emerge yourself in a different culture, in a different way of practicing medicine, because the western medicine is really different from the third world of medicine where I came from, right? So, I felt like here we have the abundance of technology and resources to make things easier, safer, and more efficient. Back home, you have to settle with what you have available, make it work, and with a clear understanding that it might not be the best approach, but that's what we have and we'll make the most out of it.

I have a soft spot for folks that are coming from a different country and trying to kind of better themselves and have an opportunity here, because I know the drive is there. I'm pretty sure the drive and the motivation is always going to be there. So, hard work is something that you can never question, and the dedication to furthering and improving themselves. It just now comes to the natural skills and talent into developing further into the better version of yourself as an individual and as a professional.

It can be a bit redundant, I would say, going to the residency program again when you're already in practice for so many years back back in your home country. But I would say it is beneficial because really, as I have said, those skills that you have and the resources that you have from where you're from is not the same as you have here. You have to be comfortable in doing things the way people are expecting for you to do it over here. I think that's beneficial. Again, it will be controversial in terms of how long do you have to subject yourself or get yourself in that training program to be as competent, as equally skilled compared to the local grads.

Host: Yeah, as you know, it's a daily challenge for us and we're very creative in our recruitment and the international medical graduates are a important piece of our clinician staff. So, you did your residency in Pennsylvania and then you end up in Merced, California. can you tell us how that happened?

Eduardo Villarama, MD: Yes. Well, I told you my wife is the architect of my life, right? So, Pennsylvania, it's great. Very country, laid back community, feels home. However, it's very cold. And where we're at, we have snow, I would say, seven to eight months out of a year. So, it can be a bit tiring to be digging your car out of your driveway every morning just to go to work or go about your regular events during the weekend. And my wife missed the sun.

It happened that one of my brothers-in-law live in California, Bellflower, California. So, my wife was saying, "Hey, after adressing this program, would you want to consider going into a bit of a sunny state where we don't have this much snow? But we can have access to snow because I know you enjoy it." I was like, "Yes. What are you thinking?" She was like, "California." "Oh, okay. Sure."

So, I was in my second year-- because I came here on a visa, right? So when I joined the residency program, I was on what you called a J-1 visa. So, the J-1 visa is the visa that makes you eligible to convert into an H-1, a working visa. So, I was on a J-1. So, I had to make sure that I would have secured a job or a position before I graduate from the program. Otherwise, my requirement is to go back home and then serve about a year or two and then be eligible again to come back to the U.S. and apply for a job, right?

So, I was fortunate that I have secured it during my early third year into the program. So, I interviewed only in California, because that's where my wife wanted to go, right? So, I interviewed south to north of California And then, I ended up in the middle, because Golden Valley is in the middle. It's in the middle of California. It's a very interesting experience because it's like california is so diverse and it's so huge, right? But I felt, like, the diversity of the state makes it unique and makes it, for me, attractable and conducive to where I wanted to grow my family and my profession at the same time.

And out of all the interviews that I did, I felt so much more comfortable and at home with Golden Valley Health Centers. Because when I walk into the building, everyone was greeting me with a smile. They're also warm. And I can relate to the types of patients that are being served, growing from an underserved community. I've said earlier, I have a soft spot and dedication to the patient population, because I know how struggles and difficulties are. And if I can make a difference in their lives, if I cannot make them feel better every single time, at least I can comfort them and make them smile.

So, that is how I ended up in California. So soon after graduation, I moved to California and joined Golden Valley Health Centers. This has been my only employment since graduating from the residency program to date.

Host: I probably should ask this question, but it's kind of obvious. This is really just a continuation of your life's work.

Eduardo Villarama, MD: Correct. Absolutely.

Host: Yeah. And it's very interesting how your life has played out. My last question-- so I'd like to ask about how your journey determines your career and your personal passions and serving the uninsured, but as we've talked about, I mean, your life was pretty much preordained by the strong women in your life. Really, all three of them, your mother, grandmother, and now wife. So, It was kind of built-in that you were going to serve the community, and your big heart is always very evident. So, the influence of them on your life and on your career is very, very obvious. But I would ask, what advice would you give people to consider in their own journeys?

Eduardo Villarama, MD: I am pleased to be in a position to give advice, especially for folks that are not my patients. I'm very comfortable giving them to patients. It's different when they're not patients, right? I'm humbled by the opportunity.

Host: For a non-clinician, I completely understand that point, but it's also kind of odd to say that, right? Because, literally, you give people advice on a daily basis being a doctor.

Eduardo Villarama, MD: On a regular basis, yeah, but on that professional level. Kidding aside, so first I would say, because we're in healthcare, right? I would encourage everyone to prioritize and invest in their personal health in mind, body and spirit. Because if you are healthy, you are always better navigating your own life's journey. Like anything in life, it will be not as challenging or as difficult for you if you are healthy. So, that's first.

And then, secondly, I wanted to share my motto in life. I think this has been the guiding principle of my life, right? It is a Latin phrase that goes "ad astra per aspera," to the stars through difficulties. Because in life, there are celebratory moments, there are successes, and there are difficulties, and I embrace them both.

So, my advice is to embrace both challenges and successes. Because in successes, you'll appreciate your efforts and it'll enhance your self-belief. And in difficulties, that's actually where you discover more about yourself, your values, your strengths, your weaknesses, which are keys to unlocking those untapped potentials so you can ensure success in whatever you do. As we know, greatness is achieved by overcoming difficulties and adversities. ,So keep moving forward, ad astra per aspera.

Host: That is a great place to. And so, you know, I always enjoy our conversations, especially when I get you talking about your journey, because it's very, very impressive and impactful. But I appreciate your time today and sharing with the audience. So, thank you for joining the Golden Voices podcast, Dr. Villarama. And good luck to you and your continued journey.

Eduardo Villarama, MD: Thank you, David. It's a pleasure. And I'm humbled by the opportunity to share my life's journey. And if this can inspire folks, even better. So, thank you so much. Appreciate it.

Host: I'm sure it will. Thank you for your time.