Diego Chaves-Gnecco, MD, MPH, is a developmental-behavioral pediatrician with UPMC Children’s Hospital of Pittsburgh. He is the director and founder of Salud Para Niños (Health for the Children), western Pennsylvania’s first pediatric bilingual and bicultural community clinic. Today, it provides primary care for Latino and other underserved community members. The clinic also offers activities focused on prevention and health care empowerment. Dr. Chaves-Gnecco has a special interest in children with learning disabilities such as ADHD and autism. He is an associate professor at the University of Pittsburgh School of Medicine and also serves on the faculty of the University’s Center for Latin American Studies.
What was your personal path to a medical career?
Perhaps it was destiny. My grandfather, an internist, was the first endocrinologist in my homeland of Colombia in Latin America. He studied under Gregorio Marañón, MD, a Spanish doctor considered by many to be the father of modern endocrinology. His daughter — my mother — also was a doctor.
In high school, I wondered if medicine was my calling. In my senior year, I developed an ear infection. My doctor cured me and I thought, “My God, this is amazing!” I realized as a doctor, I could make a real difference.
You earned your medical degree from Pontificia Universidad Javeriana — considered Colombia’s most prestigious medical school — before coming to the United States for continued medical study. Were the experiences very different?
Students in the U.S. earn their bachelor’s degree and then apply to medical school. In most Latin American countries, the approach is more similar to the European system. I attended college and medical school simultaneously. It takes 6 years of study and a year of social service to be a licensed doctor.
Health Disparities Q&A
The bigger difference lies in the health care systems. In the 1990s, Colombia adopted universal health care for everyone. In theory, even the homeless and unemployed had some level of health coverage. Today, access to health services in Colombia has improved even more.
Here in the U.S., there are about 40 million Americans who do not have health insurance. For those who do, the level of coverage can differ greatly. It’s a challenge to know what will be covered by insurance, and there are many disparities when it comes to access to care for some populations.
In this country, though, we have transformational opportunities for care, such as transplants, that simply aren’t available anywhere else in the world. It’s humbling to practice medicine here.
Why did you become a pediatrician?
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I knew early on that I didn’t want to be a surgeon. I considered becoming an internist like my grandfather. But during my final year in medical school, I cared for a toddler who was severely dehydrated with only hours to live. All night long, I cared for him and the next morning, he was awake and running about. I was amazed by that resilience in children. I also realized that as a pediatrician I could help children stay well by being an advocate, helping to educate and encourage them and their families.
In Colombia, I became interested in clinical pharmacology, because many of the medicines that we used for children are only tested on adults. I decided to broaden my knowledge by studying in another country. I came to the University of Pittsburgh in 1998 as a clinical pharmacology fellow.
At the same time, I was able to earn a master’s in public health (MPH), where I learned about the influence of culture on health care. That expanded my interest in minority populations. I was offered the opportunity to stay at Pitt’s School of Medicine for a residency in pediatrics. I elected to become part of the CORE track — community-oriented residency education — for residents with a specific interest in underserved minority patients. That experience became the foundation for my work today.
I realized during my first two years in Pittsburgh that Latinos were essentially an invisible population. I proposed the creation of a pilot program called Salud Para Niños. We pioneered the use of translation services to families, knowing that people are more likely to seek care from someone who shares their language.
People worried that we wouldn’t have enough Latino patients to make such a clinic viable. But I knew how quickly the local Latino population was growing. Today, there are 48,000 Latinos in western Pennsylvania, including 15,000 children.
Today, we see underserved patients of all backgrounds — and serving Latino families has never been a problem! Our clinic isn’t limited only to primary care for children: We are a community resource connecting women, children, and families to the care and services they need.
What are your services for children with learning differences?
Twice a week I offer specialty services in developmental pediatrics. Families come from throughout western Pennsylvania, and from as far away as Ohio, New York, and West Virginia. Pennsylvania provides insurance based on diagnosis, so fortunately, once state residents are diagnosed with ADHD, autism, or another learning disability, they can qualify to get medical assistance for intensive behavioral services.
While the concept of autism is well known in the mainstream population, that’s not true among Latinos. This gap is so significant that the Centers for Disease Control and Prevention (CDC) has created a program to promote autism awareness in the Latino community. There also are some long-held misconceptions in the medical community, too, that contribute to children getting delayed care — from the belief that growing up in a bilingual household results in language delay or that speech therapy must be in Spanish.
What are some of the health challenges facing area Latinos?
What we have learned over the years at the clinic is that there are barriers to care that we don’t even know about. Every day, we learn from our families and we try to address those needs. For example, we began offering a mobile van to bring our care to families who lack access to transportation.
I especially want to dispel that myth that only undocumented immigrants lack access to health care. A Latino family can be fully documented and not have health insurance. Among the Latino children we serve, 7 out of 10 would qualify for private or state health insurance. They don’t have it because they either don’t know about it or are overwhelmed by the paperwork and application process. This is true, by the way, for all minority families we serve.
Some Latinos do not speak English. They may be living with relatives without a permanent address — and they may not have access to a smartphone or internet service. Collectively, these factors make getting health insurance impossible.
The COVID pandemic has taught us the importance of access to health care. There are currently about 24,000 children of all ethnicities in Pennsylvania who lack health insurance. That simply should not happen when other states like New York, Illinois, California, and Massachusetts offer truly universal health care for all children.
How has Salud Para Niños helped address the challenges of COVID?
My job is to go beyond the clinic’s exam room. That involves more than just taking our mobile van into the community. It means offering events and activities. It means engaging and interacting with people and forging trusted partnerships.
Before COVID, we were doing things like offering CPR classes in churches. We created with the Allegheny County Department of Human Services the Latino Family Center to emphasize our focus on family-based care and support. When the pandemic arrived, we doubled down on our community efforts. I spoke so often in churches about the importance of mask wearing, handwashing, and social distancing that some people actually thought I was a priest!
In 2020, Salud Para Niños saw more uninsured patients than ever before in our history. In 2021, we’ve treated the most patients in our 20 years. We also began expanding our use of telemedicine.
While there was some vaccination hesitancy among those we serve, the greatest challenge we saw was access. We began to vaccinate people in their community — and spoke to them in their language, with the help of interpreters from UPMC. We helped people get their shots without filling out long forms or registering online for an appointment.
The pandemic provided us with the opportunity to expand the telemedicine services we already offered. We began seeing more patients via telemedicine, particularly children with upper respiratory symptoms due to COVID-19. We could quickly determine whether the child needed a referral for testing and advanced care. Telemedicine also makes it easier for families to get care for children with easily managed conditions. For example, once a child has been diagnosed with ADHD and is stable on medicine, we can provide follow-up care using telemedicine.
Are you optimistic?
I have always felt very welcomed by Pittsburgh since arriving here 22 years ago. I don’t like to focus on the negative. When you think about a particular group or ethnicity, it’s too easy to fall back on stereotypes. It’s much easier to understand and appreciate a culture and its values when you focus on a person, not a faceless group. So, when you talk about someone, I hope you can see that person, not that ethnicity.
The truth is we’re all the same in many ways: We want our families, our kids, and our community and country to do well — regardless of our race or ethnicity.
I’m so proud to be an American citizen because what we have in this country is not available anywhere else in the world. You can literally travel around the world without leaving your neighborhood. Many of the great strengths of this country are rooted in that diversity.