Interview with Maureen Strohm, MD

This year, CAFP is proud to honor Condessa Curley, MD, MPH, Los Angeles as its 2008 Family Physician of the Year. Each year, CAFP presents this prestigious award to an individual who exhibits the finest qualities of family physicians and who goes above and beyond in service to patients and community. Nominated and interviewed by Maureen Strohm, MD, residency director at the USC California Hospital Family Medicine Residency Program, Dr. Curley explains why she feels driven to care for the underserved and involve her community in the process.

MS: You were an oncology nurse for 10 years before going to medical school. You are also a commissioned officer in the US Army. Your career path is certainly not straightforward. How and why have you made the career choices you have made?

CC: Oncology/Bone Marrow Transplant Nursing, although not my initial career goal, gave me the opportunity to develop a bedside manner conducive to the needs of patients. Working with patients at various stages of death and dying gave me significant insight to the need for a more holistic approach when delivering patient care. It also enhanced my problem-solving skills and allowed me to develop better rapport with my patients and colleagues. After 10 years, I realized in order for me to be more effective as a health care provider I needed to return to my childhood goal of becoming a physician. As a commissioned officer in the United States Army Reserves, I was able explore the army's core values of loyalty, duty, respect, honor, integrity and selfless service. This experience was the most challenging yet satisfying undertaking of my life. As time passed, the primary goal of serving my country became secondary. Seeing myself in the lives of those who are less fortunate has become front and center.

MS: You were raised by a strong woman who ingrained many of her compassionate, selfless traits in you. Can you share a story or two with us?

CC: I currently work in an underserved population, much like the one in which I was raised. I did not become familiar with the word "underserved" until I attended medical school.

Mary Tolbert, a complete stranger, made the commitment to care for four foster children - my siblings and me - in her home. From very early on, she instilled in me the importance of finding strength within in order that I could give to others. She taught me that I had to be a leader as well as a follower and that success is never accomplished by standing alone. She would often say, "If you think you are a leader, turn around and look back. If there is no one following you, you have taken a long walk." She instilled the need to educate myself, not only academically, but as it relates to changes and challenges in my world. She always taught me to look for the good in others, and to always remember from where I had come.

I vividly remember a disheveled, elderly Caucasian man who would ring our doorbell each winter. Although we would always run to the door, we were afraid to open it, so we would call to her, "He's here." She would come to the door with food she'd prepared for him, spare change and warm clothing. And we didn't see him again until the next winter. I can't remember a year that went by when this didn't happen.

Each spring, Mom would have us put on our Sunday dresses to solicit donations for Easter Seals, the March of Dimes and the Red Cross. Another memorable quote from her was "an idle mind is the devil's playground." I don't remember what I know today as free time because our work was play as we bounced from Lutheran, Presbyterian, Baptist, and Catholic churches volunteering as well as attending vacation bible school.

Thinking back on the 10 years that I lived in her home, she instilled in me a responsibility to give back to the community, tolerance of difference, and the mission to care for the sick and homeless.

MS: How did you come to establish Project Africa Global?

CC: The formation of Project Africa Global (PAG), by a core group of six volunteers, was stimulated by the rising number of people infected with HIV/AIDS, the increasing number of people displaced from their country and living in refugee camps, and the increasing number of children left parentless. Establishing a non-profit organization that focused on sustainability was the goal. PAG has grown and now has more than several hundred volunteers who have been part of our humanitarian missions.

MS: How do you involve your community here in the Project?

CC: We have volunteers ages 16 to 75 years old who are affiliated with high schools, civic organizations, churches, colleges and universities. It is absolutely amazing the number of people who wish to volunteer, but many feel they can't because of "time." PAG understands this and has structured its programs so that people can volunteer one day a week or once a year, as a group or as an individual. In conjunction with the International Visitors Center of Los Angeles, PAG has developed a program to encourage high school students to learn about different cultures and contribute as global citizens to programs for orphans and vulnerable children in developing countries. Through creative fundraisers, these students have raised money to purchase items for orphanages, which instills pride, self-worth and sustainability. We are especially proud of the partnerships that we have established with local colleges and universities. Students are given the opportunity to participate in what in many instances are life- and career-altering experiences.

Undergraduates, medical students and residents from the University of Southern California Keck School of Medicine, University of Pittsburgh, Loma Linda University and most recently the University of Redlands return from our missions with an introduction to global health in developing countries and a strong sense that they can, and do, make a difference. Most recently an ethics professor from the University of Redlands contacted PAG seeking assistance in developing a two-week program in Swaziland for his students. His students chose Swaziland because they had read that 42.6 percent of the country's population was infected with HIV, and the number of AIDS orphans was sky rocketing. We developed and implemented "The Gardens" collaborative to grow gardens around the soup kitchens in Swaziland where orphans and those with AIDS are fed. The students worked side-by-side with Swazi women and children, planting seeds, vegetables and fruit trees appropriate for the season and soil content.

Local HIV positive and negative inner-city youth are chosen to participate in a 16-hour peer education network training on HIV/AIDS education and prevention. These students then travel with us to lead our AfricAmerica Youth Summit on C.H.A.N.G.E. (Changing Habits and Attitudes while Negotiating Goals Effectively) which is provided free of charge to Swazi youth.

Forming collaborations with community partners and individual volunteers sustains our mission to serve vulnerable populations.

MS: How do you balance it all?

CC: I have never been one to step back and look at how I do what I do. If I did, I don't know if I would get much done. Recently my husband and I were attending a function and he was asked what his relation was to me. He said, "I am Dr. Curley's wife." We all laughed as he corrected himself, but his slip of the tongue was not far from the truth. Most male professionals have wives who help them balance it all. I have a husband who puts the brakes on when he feels I am working a little too hard.

There are nights when I am editing a project and the phone rings. My husband rushes to answer it and tells them that I will have to call them back in the morning because I am getting ready for bed. I am so fortunate to be married to such a wonderful man.

MS: What about being a family physician is most satisfying?

CC: Direct patient care. There is nothing more rewarding than helping another person maintain the most precious gift we have - one's health. I must confess that my patients give me a lot as well. They let me into their lives, educate me on what does and doesn't work in the regimens I prescribe. It is really a partnership. I must also say there is nothing like receiving a dozen fresh brown eggs from patients who have chickens in south Los Angeles. That's when you know your patients really appreciate your efforts to educate, treat and keep them healthy.

MS: What do you make of all the discussion about reforming our health care system?

CC: The numbers of uninsured absolutely astounds me when I participate in the Cover the Uninsured Week Campaigns in Los Angeles. Recently it was recently that 47 million individuals lacked health insurance of any kind during 2006. This means that 15.8 percent of the total US population was uninsured in 2006. And, one in five uninsured workers is employed in firms with 500 or more employees. And the most devastating statistic of all is that 18,000 to 22,000 Americans die each year because they didn't have health coverage. Insurance is about people with good health subsidizing those who are less healthy to varying degrees. We can't look into a crystal ball to know who will get sick tomorrow, who will be diagnosed with some catastrophic disease, or who will get into an accident that alters one's earning potential or ability to care for his or her family. Health care is such an expensive proposition. The questions are how can we get to a system in which everyone can get a basic level of care, and who will pay for it? I believe we have to pull together now to cover those at risk with basic coverage that will work for society. I think we need a focused discussion on how we can all participate. The healthy and the sick must come together to form a system that works for everyone.

MS: How would you restructure family medicine residency training to better model the patient-centered medical home?

CC: With the growing interdependence of people around the world in regard to societal influence, economies and cultural exchanges, we are experiencing health problems, issues and concerns that transcend national boundaries. Emerging infectious diseases such as Ebola, drug-resistant tuberculosis, and HIV/AIDS present one of the most significant health and security challenges facing the global community. Contributing factors, such as climate change, ecosystem disturbance, increased movement of people and goods, and the deterioration of public health infrastructures, show no sign of abatement. Most US cities are within a 36-hour commercial flight to any area of the world; this takes less time than the incubation period of many infectious diseases. The US is vulnerable to a release of biological agents which could result in the spread of infectious diseases. Addressing these challenges requires that we must train and educate our residents in a manner that will be relevant to the health needs of the populations they serve.

A "medical home" is defined as comprehensive primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective. Expanding and implementing this model to embody a more global view and meaning of home and community, to reflect the health challenges we will be facing as our global community expands, is one of the key components to the future of family medicine residency training.

MS: You are a shining example of how one family physician can make a real difference. What advice would you give to aspiring medical students and residents who want to do the same?

CC: I vividly remember medical school orientation, when one family physician said, "Do what you love and everything else will follow." This piece of advice has always worked for me.