The Global Health Center and Center for Community Health Partnership & Research recently hosted a screening of the HBO documentary “Clínica de Migrantes: Life, Liberty, and the Pursuit of Happiness.” Four Summer Research Program students had the opportunity to interview Steven Larson, MD, co-founder and executive director of Puentes de Salud; and Maxim Pozdorovkin, the film’s director.
Interview with Maxim Pozdorovkin, film director
By Carmen Lyon and Kyle Smith, Summer Research Program 2017
You have a pretty diverse filmmaking history. What was the path that led you to Dr. Larson and Puentes de Salud for this film?
I had seen an article written about Puentes, and I was looking for another project. When I got there, I was so humbled by the work the staff and Dr. Larson were doing. The clinic was this nexus of all the ideas that people talk about related to immigration, related to health care, related to labor. In a way, it was this perfect storm that came together in the clinic.
How do you draw the line between using someone’s story to communicate an important message versus using their tribulations for an emotional effect?
Creating a documentary is always about this idea of making something I would want to watch, something that’s good, in addition to dealing with every ethical dilemma that comes up. I feel it’s better to not have any rules you can appeal to, but rather you’re just with your own conscious. Ultimately, you deal with everything on a case by case basis and trust your moral compass to lead you to the solution.
In this film, the most fascinating ethical dilemma is the shifting sands of consent. When people consent to something, and then the political reality changes, as it did after the presidential election, then what do you do? I don’t think there’s really a good answer.
What was it like filming in such an intimate environment where the language that is being spoken is not your own? What did you find yourself learning about the role language and culture play in healthcare?
Most of the documentary scenes were very intimate because of how small the rooms are. I couldn’t even be in the rooms when they were filming; it would be my cinematographer who would be in there with the patients and doctors, and he knows some Spanish. For me, I think about what the great American documentarian Fred Weisman, who makes observational films, says: “filming is research, and the editing is the writing.”
Do you view yourself as an advocate for the people in the clinic, or someone who is serving as a mouthpiece?
Even though I’m a very political person and have all these ideas about social justice, I cannot honestly say I’m an advocate through the film. Whenever I’m making anything I become almost a mad scientist; I’m incredibly myopic, and I only focus on the way these tiny bricks work together. I don’t have the big idea in my head. I’m just trying to find the maximum impact, and find things that work. Things that hit a chord with me and resonate. I feel like that’s my job.
You’ve had a very interesting, and somewhat unexpected, educational background based on what you do now. How has that formal training influenced what you do now?
I never understood why people say there is a divide between creative work and academic work. For me, it feels exactly the same, whether I’m writing my PhD dissertation or writing songs for the band I play in. I become obsessed with sentences, I become obsessed with sentence structure, I enjoy thinking through it. Songs, documentaries, academic writing, it all feels like the same process, because once I’m in, I go down to the micro level and look at the project as problems that I need to solve.
Were there any unique challenges or difficulties in making this documentary?
One challenge was this balance about wanting it to be about the doctors, and the experiences and challenges they face when dealing with this community, but not going outside the clinic with them. I think that would have made the film something else, if I had really focused on the staff being do-gooders. Additionally, I didn’t want to go too much into labor issues, which I felt like would have shifted attention away from what I thought was the central focus of the film.
What are you currently reading, or is there anything that you have read recently that you would recommend? Are there any films, documentary or otherwise, that you would recommend?
I’d recommend The Idiot by Elif Batuman, and I think Michel Houellebecq’s Submission is really good. I’ve brought Lipstick Traces: A Secret History of the Twentieth Century by Greil Marcus, What I Talk about When I Talk about Running by Haruki Marakami, and Essays by Wallace Shawn to read while I’m traveling. In terms of film, I think I am Not Your Negro is a great documentary. My friend just made a show about the Reagan era called The Reagan Show. I also really liked Fire at Sea, which is an observational documentary about the migrant crisis in Italy, and I would recommend watching that.
Pozdorovkin is currently working on a documentary made entirely of found footage ‘Our New President,’ which explores the cult of President Donald Trump. View a 12-minute excerpt here.
Interview with Steve Larson, MD, co-founder and executive director of Puentes de Salud
By Amber Lee and Vineet Raman, Summer Research Program 2017
Looking over the Mekong River while traveling through rural countryside in northern Thailand, Dr. Steve Larson witnessed a scene that would crystallize his motivation to become a physician. Traveling through Southeast Asia on a gap year from medical school, Dr. Larson was at a crossroads. He was conflicted by the notions of medicine he had learned about in class that didn’t line up with what he always believed to be true about the profession of medicine. So, he took a year off to travel.
What he saw was this: a grandmother combing her grandson’s hair, a mother cooking dinner, and a father coming back from work in the fields–three regular activities in societies and cultures across the world that exemplified the common threads of humanity. Dr. Larson contends that as human beings, we all worry about shelter, food and safety. Humans share a collective concern for their families, the future of their children, and the legacy they hope to leave behind.
After his cathartic experience, Dr. Larson returned to finish his medical training. After fourteen years and several trips to Central America, he founded Puentes de Salud, an organization that aims to provide low-cost, high-quality healthcare to the growing Latinx community in South Philadelphia. Since Puentes doesn’t receive state or federal funding, it is free to serve the undocumented population of Philly. As a result of the legal status of many of its patients, the population that Puentes serves is otherwise ineligible for any social or healthcare services. Usually, patients at Puentes come in their moment of need, with specific complaints. “Most patients avoid coming in willy-nilly and come in their moment of need, so we know to respect their complaints,” explains Dr. Larson. If a patient shows up with stomach pain, there is a high chance it is a condition with a surgical remedy, such as appendicitis or cholecystitis. In these emergency situations, patients are eligible for care at local hospitals.
Puentes was modeled after Common Hope, a Minnesota non-profit with a comprehensive approach to improving the lives of families in Guatemala. Common Hope provides education, healthcare, housing, and social work support for 11,000 students and their families outside Antigua and Guatemala City. The premise of their work is that when given the tools to do so, impoverished families will strive to improve their lives. Puentes aims to provide vulnerable immigrants with a sense of dignity and help them navigate barriers in their communities.
Puentes similarly attempts to arm its patients so they can take better care of themselves. Through its award-winning Promotora program, Puentes has achieved great success in managing chronic conditions such as diabetes and cardiovascular disease among its patients. Puentes reputation as a sanctuary has also helped it become well-known in the community for its mental health services–especially among Latino men, for whom seeking mental health assistance is taboo, Dr. Larson notes.
In the context of the free-market oriented healthcare system of the U.S., Dr. Larson argues that medicine today does not have a uniform humanistic or altruistic side. He uses the metaphor of a car accident on the side of the road to illustrate two common attitudes of physicians toward the plight of uninsured, undocumented migrants. There are those who will stop to help, and those who will keep driving. Whether or not physicians feel they are the natural attorneys of the poor varies by the individual–not every physician feels the call to assist those marginalized in society.
As an educator, Dr. Larson encourages students to go outside their comfort zone and glean meaningful experiences through community engagement. Dr. Larson explains, “If you’re told the world is flat, you’ll grow up thinking the world is flat”, acknowledging that many students are reluctant to face challenges in settings that differ from or antagonize their own upbringing or understanding Dr. Larson knows that talking openly about the plight of these communities may be daunting and discouraging, but he reminds students and colleagues that healthcare providers are in a unique position to promote equal access to care.
Dr. Larson completed his undergraduate education in Art. In his spare time, he stops by his studio to add a few splashes of color to his ongoing projects. For him, it’s a way to get ideas out of his head and work with his hands. His hobby is congruent with the manner in which he has lived his life. He doesn’t use words to clear his mind, but rather, his hands. Extremely humble, he finds himself invigorated by realizing how large the world is, and how insignificant he is in the whole process. This cognizance motivates him to keep “fighting the good fight.”
Puentes in Spanish means “bridges.” Over the last eleven years, Dr. Larson has built a link for the Latinx community of Philadelphia to the affordable, quality healthcare they deserve. With his hands and his soft-spoken manner, Dr. Larson provides a lifeline for thousands of fellow human beings, without regard for their legal or financial status, race, or age. Many of Dr. Larson’s patients traversed thousands of miles to find a new home. Dr. Larson helps them finish their journey by providing a puente–a bridge–into the community, allowing them to access services all humans deserve.