Santa Rosa doctor utilizes culture in patient treatment

Enrique Gonzalez-Mendez developed a strong desire to help people while growing up in Mexico City. Now, as a family physician in Santa Rosa and a clinical professor at UCSF, he funnels that inclination into treating his patients and teaching other doctors how to honor the cultural needs of the underserved.

His specialty is known in the industry as “cultural competency,” or delivering health care that honors a patient’s social, cultural, linguistic and spiritual needs, a national concern these days because of the challenges it poses.

Every culture has a system of beliefs to explain what causes illness and how it’s treated; the trust and rapport patients have with their doctor goes a long way toward helping them recover.

For more than 30 years, Gonzalez-Mendez has been crossing that divide in Santa Rosa, seeing low-income patients at the Vista Family Health Center and modeling cultural competency for medical students affiliated with the Santa Rosa Family Medicine Residency, sponsored by Sutter Santa Rosa Regional Hospital and affiliated with UCSF.

“In Latin America, we think with magic realism,” he said. “That is part of how we conduct our lives, and the cure for some (ailments) is to talk with a healer and establish a relationship to determine what is going on.”

In America, disease is mostly viewed as a result of scientific phenomenon, and treatment usually involves a prescription or a procedure. But if you’ve been told that colds are caused by “catching a chill” when you go outdoors with wet hair or without a coat, you can understand the power of culture-based beliefs.

Among those passed down among generations of Latinos are the beliefs that going outside without shoes can cause a respiratory infection and that eating ice chips following surgery can cause pneumonia.

And in some Latino cultures, young children who are quiet, sad and complain of a stomachache are commonly thought to suffer from empacho. The ailment is mostly attributed to food stuck in the stomach, especially if the child has eaten foods such as uncooked tortilla dough.

Gonzalez-Mendez adapts himself to his patients’ cultural needs by doing a routine physical exam to rule out more serious conditions such as appendicitis, for example. Then turns to the mother to ask, “Do you think it’s empacho?”

If he is greeted by a vigorous nod and a smile, he has won her trust and can give the child a stomach massage, maybe prescribe a laxative or encourage the child to eat more greens with his cooked tortilla.

Susto is another ailment that means “fright” in Spanish and is believed to cause headaches or other health problems, which Gonzalez-Mendez treats accordingly. A patient may tell him, “I’m having headaches because I have a susto since my daughter was in an accident,” he said.

The symptoms may relate to anxiety or depression, but the belief is that a susto will not resolve itself without a healer’s help.

Gonzalez-Mendez is able to connect with his Latino patients at that level while also prescribing a medical treatment.

“That to me is beautiful,” he said. “It gives them hope and honors their beliefs.

“Strong emotions and stress change the body, and defenses drop. Studies have shown that this can negatively affect the immune system. Also, patients’ beliefs influence their interpretation of what is causing illness, and therefore what can cure it or make it better.

“If we don’t address cultural beliefs, a patient may be less willing to accept the medical provider’s explanation of a disease or condition and follow a prescribed treatment.”

Born in Mexico City, Gonzalez-Mendez was raised by his parents, Matilde and Francisco.

“My father was a good Samaritan and always stopped to help people. He’d say, ‘All you take when you die is what you gave in life,’?” a philosophy that influenced young Enrique’s desire to help people. “He also loved the U.S. and wanted me to marry an American woman,” Gonzalez-Mendez said, pausing to smile.

When Enrique was 19 and attending a neighborhood picnic, he met a young woman who was visiting from Santa Rosa to do volunteer work. Though Enrique had not been invited to the party at a lake, he and a friend went anyway and Enrique was hit in the face while playing around in the water.

He remembers Mary Maddux, an Ursuline High School student and fourth-generation Sonoma County resident, approaching him to ask, “Are you all right?”

“She had amazing blue eyes and sweetness,” Gonzalez-Mendez recalled. “And I fell in love with her.”

The pair kept in touch and in 1974 were married in Kenwood.

They now live in Santa Rosa and have two grown daughters, Catherine and Christina.

Gonzalez-Mendez attended medical school in Mexico and completed residencies in London and in Florence, Italy.

He went on to run a rural public hospital in Mexico before completing a three-year family medicine residency in Santa Rosa.

“Patients love him,” said Naomi Fuchs, ceo of Santa Rosa Community Health Centers, Vista’s parent group.

Fuchs describes him as kind, compassionate and respectful of each person, adding that he is a strong advocate for cultural awareness that “has improved access and quality of services for all who walk through our doors.”

Ritch Addison, who directs the behavioral medicine program at Santa Rosa Family Medicine Residency, said “over the years, he has trained our residents to become better physicians for patients from all cultures.”

To spread that cultural sensitivity among others in his field, Gonzalez-Mendez also founded the annual Latino Health Forum in Santa Rosa. And for the past?25 years, he has organized and nurtured a daylong Latino Health Conference that helps others learn how to take better care of Sonoma County’s Latino population.

As for Gonzalez-Mendez, he continues to believe in his original goal - to help people and teach others to do the same.

“My passion is working to reach the underserved,” he said, “especially Latin Americans and Mexicans, and make them feel better.

“My hope is to bring healing, and if there is no cure, to bring hope.”