Stephen Schilling, CEO of Clinica Sierra Vista, introduces Dr. Jasmeet Bain, who grew up in Delano and Kern County, to speak at a rally to inform people of the potential impact of cuts to local health care from the proposed GOP Graham-Cassidy bill that would replace the Affordable Care Act.

Peeking through the gates of a chain link fence in a Delano schoolyard, Jazmeet Bains witnessed health injustice during recess when she was just a girl.

She saw farmworkers struggle through flu, valley fever, pregnancy and a menagerie of other ailments without access to a doctor.

Farmworkers didn’t have quality access to healthcare then, and they still don’t, said Bains, who decided then to devote her life to a simple concept: healthcare for all.

She wouldn’t have been able to do it locally, however, if not for the Rio Bravo Family Medicine Residency Program, operated by Clinica Sierra Vista, which gave Bains the opportunity to become a resident physician in a community of need. Her community.

“This is home. It’s always been home. And this is where the need is,” said Bains.

But Teaching Health Centers, like the one where Bains is training, are under threat of losing federal funding, which sunsets Saturday, unless Congress acts to renew legislation. It’s one of about four key provisions set to expire this week in what health advocates are calling the “health center funding cliff.”

Without renewals, health centers would bear an immediate 70 percent reduction in funds.

But without legislation to renew Teaching Health Center funding and the National Health Center Corps, which provides loan repayment to rural doctors, long-term impacts could be felt in the Central Valley, which already struggles to attract enough doctors to the region.

Considered a medically underserved region by the federal government, the San Joaquin Valley averages about 39 primary care physicians per 100,000 residents, and 65 specialists per 100,000. The California Health Care Foundation recommends between 60 and 80 primary care physicians and 80 to 100 specialists per 100,000 residents.

And as baby boomers retire, the workforce gets thinner.

“It’s precisely why Clinica three years ago took over the family medicine program Kern Medical Center was planning to close,” Clinica Sierra Vista CEO Steve Schilling said this year.

Clinica Sierra Vista, which took over the Teaching Health Center program from KMCl in 2013 after it faced a multi-million dollar funding shortfall, operates the Rio Bravo Family Medicine Residency Program – one of just six Teaching Health Centers in California and the only one in Kern County.

It provides a pipeline of doctors into the Central Valley, and delivers vital health access to underserved communities. Resident physicians served 12,000 patients last year, said Dr. Carol Stewart, head of the Clinica Sierra Vista Rio Bravo Family Medicine Residency Program.

“Every day, our residents see the neediest of Kern County,” Stewart said.

The program also heightens the probability that graduating doctors will stay working in the San Joaquin Valley, said Clinica Sierra Vista Director of Community Relations and Public Affairs Jennifer Self.

“You grow your own doctors. That’s how you keep them in Kern County,” Self said. “There’s a chronic shortage of residency programs in this country. It’s dire.”

That program graduated its first class in June, sending six new doctors to work in the region, including two at Clinica locations. The center received re-accreditation in spring for 10 years, Schilling said.

And several doctors currently enrolled in the program far exceed the requirements. At least seven are Cubans who defected from their home country after serving as doctors there for decades.

Ernesto Matos Perez, a second-year resident who practiced as a physician for 15 years before internationally, joked that he and six other Cuban residents “came in a cigar box.”

The influx of Cuban residents came about in a snowball, Schilling said. Clinica enrolled one or two who were connected to a network of trained doctors from Cuba — home to a sophisticated healthcare system — wanting to come to America, he said.

Even though Perez and scores of other international doctors just like him are already trained physicians, they must participate in a residency program to become licensed in the United States.

“If you want to make it, you have to get through the process,” Perez said, explaining the Cuban philosophy for healthcare in underserved communities. “We go to the world to help.”

And they’ll stay in Kern County to work, Schilling said.

That’s the advantage of having a residency program in a rural environment paired with the National Health Service Corps, Schilling said.

“That’s the program that brings providers to this community — not Beverly Hills and San Diego. It brings them to Kern County and Fresno County, and if that program dies, it’s going to be a lot harder to bring the absolutely essential providers we need right now,” Schilling said.

And it would be difficult to attract doctors like Bains, who went to medical school out of the country, then came back, but only because there was a residency program available for her.

“She is a local kid,” Schilling said of the Delano native. “This is what we’re really trying to find.”

Harold Pierce covers education and health for The Californian. He can be reached at 661-395-7404. Follow him on Twitter @RoldyPierce

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