What My Patients are Facing is Beyond Medical Need

Heart health was personal—many in her family faced chronic illnesses like lupus and diabetes. For some, this meant dealing with amputations. For her mother, it meant dialysis and a new kidney.

She understood the risks. But almost immediately after saving her mother’s life as a donor, she was faced with saving her again. Three days after surgery, her mother had a pulmonary embolism and collapsed. Ochoa gave her mom CPR, and she and her father rushed her to the ER.

Upon arrival, she told the ER doctor he needed to intubate and run a central line. Ochoa says he told her he had no idea how to do either of those things. She was without hospital privileges at that particular hospital, making it unethical to run the line herself. Even after finding a surgeon who could give her mother the care she needed, her mother died.

In more ways than one, Ochoa never envisioned herself being in such a position. In high school in the Rio Grande Valley, Ochoa was a jock, splitting her time between cheerleading, track, volleyball, and basketball. The daughter of migrant farm workers, she had an aptitude for STEM subjects, but medicine, and certainly surgery, were not on her radar.

Then the Medical Honors College Scholarship came along. It was designed to find people like her, and it provided eight years of full tuition at the University of Texas Pan-American (now University of Texas Rio Grande Valley) and Baylor College of Medicine in Houston.

“I remember telling my dad that I didn’t know if I even could be a doctor,” Ochoa shared. “‘Mijita,’ he said to me, ‘you are applying for this scholarship.’ So, I did.”

The rigor of the program along with the dedication and comradery of her fellow residents fed Ochoa’s determined spirit. She was intimidated—some of those colleagues hailed from Ivy League schools—but she flourished. After her residency in Houston, she took a job as a vascular surgeon in a private practice in downtown San Antonio. After six years, she was made partner.

Over time, Ochoa began to notice a trend. Certain patients were traveling farther than others to get the same care. And many of the patients who came the greatest distance resembled her.

“I felt connected to them because they looked like me,” she said. “They looked like my family.”

In talking to patients from the Southside, she realized some of her patients were traveling many miles for post-op checkups or routine care—if they were choosing to make the trek at all.

Her curiosity turned to determination. In 2018, she opened her own private practice.

A 20-Year Gap in Life Expectancy

Adjacent to Harlandale Creek on San Antonio’s Southside is one of Ochoa’s six Southside clinics—the San Antonio Vascular and Endovascular Clinic, also known as The SAVE Clinic. SAVE clinics address one of the city’s most tragic realities: Southside residents and Northside residents have a 20-year gap in life expectancy.

That figure comes from a study done in 2019 by University of Texas Southwestern showing that the ZIP code children in San Antonio are born into can shape not only the quality of their lives, but also the length of their lives.

For San Antonio’s Southside, discrepancies in access to healthcare provisions are glaring. According to the University Health System 2023 South Bexar County Community Health Needs Assessment Report, the Northside has four beds for every 1,000 residents. The Southside has less than one bed per 5,000 residents.

Many of the urban core and South Bexar County ZIP codes experience diabetes-related amputations at 25 times the rate of Northside ZIP codes. That is upwards of 50 amputees annually for every 10,000 residents on the Southside compared to 1 or 2 for every 10,000 on the Northside.

Southside hospitals are closing due to unsustainable financial pressures, like 25% of patients being unable to pay their medical bills. The SAVE Clinic is trying to bridge all these gaps. But Ochoa says she is applying a Band Aid to a much larger and growing problem: medical care is only one element among many needed investments in the daily wellbeing of Southsiders.

“What my patients are facing is beyond just medical need,” said Ochoa. “Some don’t have reliable transportation. Many are in unstable housing situations. And some struggle to keep jobs because of both of those things.”

The Unseen Factors Affecting Wellness

Ochoa has worked hard to grow her network beyond the medical sector. In 2016, before leaving the previous clinic, she was accepted into a local leadership development program called Leadership San Antonio (LSA) that identifies and develops community leaders. In broader networked spaces like this, her understanding of the breadth and depth of San Antonio’s disparities came into focus.

In one LSA meeting, she heard a presentation about San Antonio’s early years of development by Dr. Christine Drennon, associate professor of sociology and anthropology at Trinity University. Ochoa was dumbstruck by what she saw on Drennon’s PowerPoint: color-coded maps of San Antonio from the 1930s showing the city divided into sections indicating where mortgages could be allowed or denied.

In the 1930s, the federal government created these maps—now known as redlining maps—as part of the New Deal. The Homeowners’ Loan Corporation graded neighborhoods on a scale from A to D, with A being the safest and least risky investment and D being the most hazardous and risky. The people who lived in “hazardous” neighborhoods were denied access to mortgages and other lending programs. Often a neighborhood was deemed hazardous because it did not have a racial covenant. In other words, the redlining maps listed white only neighborhoods as the “best” investment for lenders, while Black and Brown neighborhoods were considered “hazardous” investments.

These maps were shocking to Ochoa because they mirrored contemporary maps of diabetes-related amputee rates, heart disease rates, and locations of medical providers. In the exact same neighborhoods where mortgages were denied a century ago, heart disease is prevalent and health providers are few.

“Christine Drennon inspired my work connected to other health-related realities,” Ochoa said. “And her research gave me the support I needed.”

The idea that the environmental conditions of someone’s day-to-day could have something to do with their larger wellbeing is not new. The U. S. Office of Disease Prevention and Health Promotion calls this our “social determinates of health.” Meaning, where someone is born, lives, works, learns, plays, worships, and ages has many implications for their overall health and quality of life.

Other healthcare workers notice this, too. Maryn Swierc is a licensed master social worker at Baptist Medical Center in downtown San Antonio. Because of the location of the hospital, the majority of patients Swierc sees are from the near west, south, and east sides of town.

“The effects of redlining continue to haunt our city,” says Swierc. Redlining created the conditions for poverty, and the resulting health disparities still exist. “It’s expensive to be poor. And it costs a lot. By that, I mean it is costing people their lives.”

More Than a Doctor

Shadow Ochoa for a couple hours, and you’ll find that Ochoa’s patients see her as so much more than a doctor. For many, she’s their advocate, confidant, tía, and mentor.

Like any good doctor, she takes the time to make sure each patient understands the complications they’re facing and why. She gently dresses and undresses surgical wounds. She delicately gauges pulses on wrists and ankles. She thoroughly fills out charts before leaving the room. But she also goes a step or two further.

She checks incisions done by different surgeons. She consoles patients as they learn about a drastic diagnosis. She comforts those who are in debilitating pain. She flows from Spanish to English. She asks about kids and grandkids, remembering their names and major life events. She coaches and counsels. When one patient had questions about their new managerial role at Dollar General, Ochoa took the time to share how she leads the staff at her own clinic.

“This is what makes her a great doctor,” says SAVE Clinic nurse practitioner Monica Kincade. “This is normal for her. This is how she treats all her patients.”

Between each of her patients, Ochoa is often on the phone with other specialists or hospital intake professionals advocating for patients she had seen that day or days prior. She checks in to make sure they are seen in a timely manner and that their conditions are taken seriously.

She’s fierce. All day, every day, Ochoa makes sure Southsiders’ voices are heard.

“I care about these people,” said Ochoa. “And because I care, I’m the person to be doing this work.”

Editor’s Note: An earlier version of this story included allegations about a former medical practice in San Antonio that we did not substantiate. We regret the error.