December 2008 Edition

QUOTED AT LENGTH

Dr. Socorro Gross
Assistant Director
Pan American Health Organization

Photo by Eduardo Ortiz/PAHO

Socorro Gross-Galiano became assistant director of PAHO in May 2008 and currently oversees the organization's core
programs for technical cooperation in its member countries. A Costa Rican national, Gross holds a medical degree from the University of Costa Rica and a master's in epidemiology from the University of Texas. She has practiced medicine, has taught at the University of Costa Rica, and served as chief of the Health Services Research Section and the Adult Health Section at the Costa Rican Social Security Institute. She joined PAHO's staff in 1994 as an advisor on health promotion in the country office in Bogotá, and in 1997 became PAHO/WHO representative in the Dominican Republic. Most recently she was PAHO/WHO representative in Nicaragua.

Tell us about your early life.
I was born on my grandmother's farm on the border between Costa Rica and Nicaragua. My grandmother attended my birth. I spent my earliest years in San Carlos, Río San Juan. Later we moved to Escazú in Costa Rica, where I spent my adolescence and got my medical training. I consider myself binational and I love both countries. I come from a very strong and close family, and my mother is the person who has had the greatest influence on my life. She has always been a super hard-working, forward-looking person who never gives up, and she taught me to face any challenge that life presents.When I was 16, I traveled to New Zealand as an AFS [American Field Service] exchange student. I lived in a small town called Palmerston, on the South Island. The father of my host family was a doctor, and it was really there that I decided to study medicine. I also spent time with a Maori family and had a wonderful experience in their sheep-shearing operation.

What were your first experiences in medicine?
After high school, I went to medical school at the University of Costa Rica. I originally wanted to be a pediatrician, and I did a rotation in a pediatric hospital. The hardest part was dealing with parents. In the emergency room, you see a lot of negligence and abuse. And in infectious diseases, when a child died under my care it was very difficult emotionally. Dealing with the pain of a mother who loses her child to meningitis, for example, is really hard. But it didn't change my mind about pediatrics. I went on to do my social service at the hospital in Limón, which was a beautiful experience, working with outpatients and again in the emergency room. I also worked twice a week on a banana plantation, where I set up a clinic.At first, only women and children came in, but then there was a hepatitis outbreak and cases of pesticide intoxication, snake bites, and work injuries. Those were mostly men. They opened up to me even though I was a woman doctor.And eventually I became the link between the banana plantation and the hospital, which got me very involved in the community. I had to find ways of communicating about things like sex education, about how they themselves could improve their living conditions. That experience with social service had a major impact on me. I became convinced that I wanted to be a family doctor and not a specialist.

How did your career develop?
My first permanent job was in a suburban clinic. At first I worked in family planning, but then they assigned me to do house visits to homebound and terminal patients. That had a strong impact on me. I learned that a person's health—and especially a woman's health—is affected by and affects all the people around her. It was difficult work because you lose people, but you also learn to dialog with them. They're anxious about the illness or about how to care for a patient. Many of them had had to leave their jobs to care for someone bedridden at home. You become essential to that family. You also end up handling logistics, making sure, for example, that patients get their medication or a home visit when they need it. You end up being not just a doctor but a psychologist and a social worker, one who deals with norms, regulations, references—what can and cannot be done. You learn to fight for what the family needs. But there are also many rewards. People receive you with a cup of coffee. You're someone they look forward to seeing.

Was that how you got interested in public health?
Not exactly; I still wanted to be a family doctor. But then I got involved in a couple of research projects, one of them on hypertension with Hermán Vargas [then director of preventive medicine at the Costa Rican Social Security System]. He had been my professor, and he was determined to persuade me to go into public health. When he took a year-long leave, I assumed his post, in the area of health services and at the university. I liked it, and I got more and more involved, so I ended up staying. Then I got a scholarship from USAID to study epidemiology at the University of Texas in Houston. That's how I started in public health.

What was your first experience with PAHO?
I worked for a year—on sabbatical from the Costa Rican Social Security System—at INCAP as coordinator of the basic technical group and an expert on chronic diseases. Then later I applied for and got a post as advisor in health promotion in the PAHO Country Office in Colombia. I don't think people in Costa Rica expected me to stay away so long.

In what directions would you like to take PAHO's technical cooperation?
One of the important things I bring to this post is my in-country experience. I've worked in a large country, a small country, and a priority country, and I keep all those experiences in mind. Something else that is fundamental for me is the commitments we have made as an organization to health for all, to equity, to the Millennium Development Goals, and to the idea that we really cannot wait any longer to deal with the great disparities you find in our countries. One great challenge we have as a region is to make primary health care a reality, in the sense of social protection, universal access. And for me a very important challenge is to address the needs of vulnerable groups—Afro-descendants, indigenous communities—groups with great inequities.We need to make sure that the current economic crisis doesn't affect health in these groups even more. For me, the three big challenges are the unfinished agenda, vulnerable populations, and the renovation of primary health care in the region.We also need to exercise leadership to make sure that health is part of policymaking in other sectors, to affect the determinants of health.

What's it like to head one of PAHO's most important areas?
You can't do it all yourself; we work as a team and involve everyone. You have to build alliances, with WHO, NGOs, banks, bilateral alliances, institutions of excellence at the country level—a whole range of alliances that spans all aspects of PAHO's work. This produces a dialog and advances such as the PAHO Strategic Plan and the Health Agenda of the Americas, which is something other regions don't have. It gives clear direction to channel country capacities. These become goals we have to fulfill.

Tell us about your family and your new life in Washington.
My three sons—Ronald, Franz, and Joshua—are among the most important things in my life. They have helped make me stronger. Learning to be a mother is a difficult process, and combining that with work and my own dreams has always been difficult. My sons have supported me many times; they've left their friends to follow me. As for settling in Washington, it's been a little complicated. It was easier to build a support structure, especially for my children, in Latin America. But I've gotten support here from very good and close friends; building a support network is always important, and I'm doing that here in Washington. My youngest son goes to school, to the community center, and we're involved in community work. I'm still learning to live here, but it's been a good start. They even brought us a welcome package when we first moved in.