Sarah Carreira knew from a young age that she loved all living beings dearly and wanted to work towards ensuring that they took care of them. Whether it was the animals she grew up with because they had parents who were veterinarians, or watching the interactions between the pets’ families and their parents, she realized that she wanted a job that was human could accept. At first she thought it was pediatric medicine, but in college she decided to explore her options to find the right fit.
“I did downtown education in Chinatown, social work in rural New Hampshire, middle school in rural Idaho, and bilingual education in Honduras. Throughout all of this, I stayed in medicine as a paramedic until two experiences brought me back to my current primary care role: as medical director for a rural summer overnight program for homeless youth in New York City; and I’m treating one of my little first grader’s scared knees in Honduras, ”she says. “I returned to medicine without hesitation because I knew at the time that the role of a general practitioner (and later the addition of a psychiatrist) would allow me to fully utilize all of my skills – education, social work, and health care. ”
She is now the Program Director of the Combined Family Medicine and Psychiatry Program at UC San Diego and the General Practitioner and Psychiatrist at Father Joes Villages Village Health Center. The UC San Diego residency program is one of six combined family medicine and psychiatry residency programs in the country, and the only one she knows is housed in a homeless shelter.
Carreira, 39, lives in University City with her husband Vinicius and their young daughters Eva and Cora. She took some time to talk about her work providing holistic medical and psychiatric care to underserved and vulnerable populations, and why this particular work is both necessary and rewarding.
Q: Tell us about your work as Program Director of the Combined Family Medicine and Psychiatry Program at UC San Diego.
A: The mission of combined programs is to holistically train residents to address the complex bio-psychosocial problems of all people. Our program has the additional mandate of reaching vulnerable people who are most in need. My role as program director is to ensure that each resident successfully meets their board certification requirements in both specialties while integrating the two disciplines to ensure holistic care for their complex patients. As one of Father Joe’s two general practitioners, I have a dual role as a supervisor and mentor throughout the residents’ journey. What an honor and what a gift, for these are talented, compassionate, and highly intelligent people who strive to make our world better on both a small and a large scale.
Q: I understand you are teaching your students family medicine and psychiatry with an emphasis on underserved medicine? For those of us who may not be familiar, can you help us understand what underserved medicine is?
A: Underserved medicine is caring for groups of people who are disconnected from the health system for various reasons. These include restricted access, a lack of health insurance, transportation problems, financial burdens, unwillingness to participate in the system, a lack of ethnic representation and a history of medicine that, among other things, does not serve its group. The aim of undersupplied medicine is to reach those who are still in need and to offer all people equal health opportunities on a global level.
What I love about University City …
We love the tranquility of our canyon, the nature that makes us feel so far from the city, and how central we are to everything that San Diego has to offer.
Q: Why is it important to address health problems holistically? In general, what difference does this make to caring for a person?
A: Holistic care means looking at each person as a whole, not just the sum of their parts. Western medicine is not only fragmented into subspecialties, but has also historically separated mind and body. This perspective is very detrimental to people because only by looking at a person’s social situations, emotional states and physical complaints together can you create a meaningful picture of their strengths, challenges and needs. Blood pressure treatment fails when someone sleeps on the street and their medication is stolen weekly. Blood pressure will also remain high if you don’t take action against smoking, alcohol consumption, poor diet, depression, and anxiety at the same time. We support and over-medicate when we overlook the roots of health problems and put the individual who needs to be understood at a great disadvantage.
Q: How does this holistic care approach help people in underserved groups?
A: People in vulnerable groups face tremendous social and emotional challenges every day. Many have experienced trauma. These lived experiences affect every aspect of their life and care. We need to address basic needs like safety, food security and shelter so that people can focus their attention on specific medical needs like diabetes. We need to address anxiety, depression, and psychosis to help with placement, control pain, or treat addiction, to name a few examples. And the reality is that if you don’t address all of these levels at the same time, you will run into roadblocks.
Q: Can you give examples of how you or your students have seen this approach in real time? I was told that one of your students shadowed a homeless man for a day in order to better understand him?
A: I could give you countless examples. We have patients who come off the streets frequently with diabetes, high blood pressure, post-traumatic stress disorder, depression, opiate addiction, homelessness and gaping wounds. We find them food, get them clothes, arrange for them to be contacted, treat their wounds, offer suboxone same-day treatment for their addiction, and offer medication to lower their blood pressure and sugar. In order to better understand our patients’ perspective, one of our residents actually decided to spend a weekend on the street and shadow one of his patients. He wanted to break down stereotypes and prejudices and better understand the struggles people face every day. I saw another of our residents walk into the middle of the street on her way to our clinic last week and get out of the way of a gentleman in his wheelchair by personally taking him to Father Joe’s Village cafeteria where he could get the coffee he was trying to find. It is this heart and this larger vision that enable us to successfully change lives.
Q: What’s the best advice you’ve ever received?
A: My daughter Eva actually gave it to me recently when she kept falling while learning to rollerblade. She turned to me after a gigantic fall and said: “Every fall deserves a stand up.” No matter what happens or how far you fall, we all deserve to get back up and move on. It reminded me never to give up as every moment is a new opportunity.
Q: What’s one thing that would surprise people if they found out about you?
A: Despite my bubbly appearance, I have a grounded and determined core. This usually shocks people when they aren’t expecting it!
Q: Please describe your ideal weekend in San Diego.
A: Our favorite places in San Diego are all about animals and nature. We love the San Diego Zoo and Safari Park (San Diego Zoo), the art space in Balboa (park), the Coronado Dog Beach, and the seals in La Jolla Cove. Nature trips by day and garden barbecues with friends in the gorge by night make for a perfect weekend!