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From farmworker to doctor: A bold dream is reuniting her with her Indigenous community

Gianna Nino-Tapias knows the challenges of migrant farmworkers better than most. Her mother continues to pick blueberries daily. She plans to use her medical degree to help integrate and advocate for better health care.

The hard work that lies ahead for Gianna Nino-Tapias, her not-so-humble goal of transforming the country's health care system, isn't all that different from the hard work her mother still performs daily, body hunched, joints aching, in the fields of Kennewick, Washington.

They are the same blueberry fields where Nino-Tapias began her own working life at age 14, snatching fruit off the bushes sprouting from the volcanic-ash-rich soil of the Columbia basin.

Gianna Nino-Tapias working the blueberry fields as a high schooler. (Courtesy Gianna Nino-Tapias)

It reminds her of the bold dream she had as she dug her hands into that dirt as a young teen, envisioning a way to not just make things better for herself but also for the people like her mother who were toiling all around her.

She wanted to help create the type of change that would provide a more equitable, humane existence for the migrant farmworker community often seen off the highway's edge by the rest of the world whooshing by. Those stooped-over bodies deserve better care, she thought.

"I was always reading books and looking ahead to the future," Nino-Tapias said. "Eventually I began dreaming of a better future for people like those in my community."

I was always reading books and looking ahead to the future. Eventually I began dreaming of a better future for people like those in my community.

Gianna Nino-Tapias

When Dr. Gianna Nino-Tapias walks to the stage to collect her medical school diploma on June 15, returning from her just-begun primary care residency in San Diego, she will proudly wear Mixtec colors and patterns, representative of her Indigenous roots, beneath her commencement gown.

Heritage, rooted in hard work, passed down from her grandmother to her mother in the southern Mexico state of Oaxaca, has been a major driver of the dream. 

"There were moments I didn't think I could do it -- it felt like there were so many roadblocks," she said. "Now I'm super confident I can do anything I set my mind to."

Forging a new path in America

The eldest of four siblings and a graduate of Stanford University before enrolling at the Stanford School of Medicine, Nino-Tapias will be the last of Susana Tapias' children to complete their path through higher education. The others are engineers who followed their older sister's path to college and are forging their own careers as first-generation Americans.

Her mother was one of nine kids growing up in a small village near Oaxaca. At age 12, she decided to lighten her own mother's burden by leaving home and heading to Mexico City, where she became a live-in nanny for a household of teachers and worked toward her own high school education at night. While she never completed it, eventually traveling north to the U.S to work in agriculture at age 20, the seeds of education's importance had been firmly planted.

Gianna Nino-Tapias (in pink) with her mom and three siblings. (Courtesy Gianna Nino-Tapias)

"My mother is very smart and always dreamed of going to school," Nino-Tapias said. "Her children are living out her dream."

Susana Tapias' new dream: returning to that quiet life in Oaxaca to help her aging mother cultivate beans, squash, corn and potatoes, and to weave palms into sombreros to sell in the small village center of San Pedro y San Pablo Tequixtepec.

Now 48, decades of working the fields have taken a toll on Tapias' joints, and several years ago the pain became too much. But at least she was fortunate to have a daughter in medical school, learning things such as the difference between osteoarthritis and rheumatoid arthritis. With that knowledge, Nino-Tapias was able to help her mom navigate health care hurdles.

Her children are living out her dream.

Gianna Nino-Tapias

"Her doctor had made the assumption that it was osteoarthritis because she was a farmworker, but from what she was describing to me it sounded more like rheumatoid arthritis," she said. "I called the doctor and asked her to run an antibody panel. It ended up being rheumatoid, she got better after a short dose of steroids and is now on some preventive joint pain medicine."

It was the type of firsthand experience that infuses extra passion and resolve into Nino-Tapias' dream. While she has learned that practicing medicine can be as much art as science -- "Not everyone practices it the same," she said -- she believes every patient deserves creative thinking from their physician.

"In the Latino culture we're taught to respect what a doctor says. But how do we empower patients to ask more questions and encourage doctors to think proactively?" she said. "There's always more questions to be asked, more tests to be run, more physical exams to try to find out exactly what's going on with our patients."

In the Latino culture we're taught to respect what a doctor says. But how do we empower patients to ask more questions and encourage doctors to think proactively?

Gianna Nino-Tapias

Nino-Tapias said she has a handle on helping her mother advocate for good care, but she can't turn her head from the struggles of others. Especially now that she holds the degree and the confidence to make the bigger type of difference she's long dreamt about.

"I feel like I finally have the tools I need," she said. "That's a big part of my goal as I begin my medical career: figuring out how I can help people navigate the system and advocate for themselves."

Helping patients navigate care

Nino-Tapias says she has often felt like an army of one trying to figure out that system herself while in med school -- especially when it has involved trying to help the growing number of Indigenous patients who hail from the same Oaxacan region where her grandmother lives, many speaking only a dialect of the ancient language of Mixtec, rather than Spanish.

"I still keep in touch with this one woman from my pediatric rotation whose son was very sick in the hospital, who speaks and writes very little Spanish," said Nino-Tapias, who worked to understand and translate her Mixtec dialect called Triqui.  "I was able to advocate for her, trying to educate my team about her limitations. I really hope to be able to make patients like her feel more comfortable in the clinic because she had a really tough time. She considers me like a little sister now."

It can be an isolating road trying to change protocols and perceptions in medicine. That's why much of Nino-Tapias' time at Stanford Medicine has been devoted to rallying other up-and-coming doctors with a shared experience -- and purpose. Her viral moment -- when she returned to pick blueberries during the pandemic -- brought attention to farmworker pay equity. She has also been vocal about the importance of cultural sensitivity in medical care after watching doctors mock her mother's traditional treatment remedies.

Just as her mother planted the seed of education in Nino-Tapias' as they picked berries in the summer heat of eastern Washington, Nino-Tapias is trying to ignite the same type of changemaker spirit in people mentors, including Angela Williams, through the Stanford American Indigenous Medical Students program.

"To have someone who comes from a low-income Indigenous background, who can relate to me and help guide me and encourage me, has been incredible," said Williams, a Stanford University freshman and pre-med student from a blue-collar agricultural family in Bakersfield, California.

The two recently realized they shared another common, and humbling, experience: Both ran out of money as Stanford freshmen and had to pick up hours at the Panda Express on campus. "We were laughing about it," Williams said. "She even remembers one of the cooks who's still there."

Gianna Nino-Tapias and Angela Williams share their Panda Express experience. (Emily Moskal)

Williams recalls Nino-Tapias taking her to lunch and talking about what it was like to be a newcomer at an institution like Stanford, never realizing such a place existed until they arrived. And then there was the feeling of enormity brought on by that realization -- and the challenges that lay ahead.

"My whole family worked the fields of Bakersfield, and in the summer I would help," Williams said. "I knew nothing about Stanford before I applied. It was a surreal moment for everyone when I got in. My mom calls me the jewel of the family."

Having an impact locally

Like Nino-Tapias, Williams plans to go into primary care where she can "make a connection with people who are underserved and underrepresented in the health system."

She and other mentees will know the places close to Palo Alto where they can make a difference while in school because Nino-Tapias will point the way. One place sits in the coastal fields of Pescadero, where the Puente de la Costa Sur program connects migrant farmworkers to social services, including health care.

During the COVID-19 pandemic, Nino-Tapias helped communicate the dangers and complexities of the infection to workers -- then she volunteered to help make the Indigenous people feel more at home.

Gianna Nino-Tapias and mentor Gabriel Garcia. (Courtesy Gianna Nino-Tapias)

"She would come over for these dinners and always ask them where they were from, then go out of her way to relate to them," said Gabriel Garcia, MD, a professor of medicine emeritus and mentor to Nino-Tapias. "She comes in with a unique perspective on the world. Not many people who start out as agricultural field workers make it into higher education and medicine."

Thinking of that journey brings Nino-Tapias back to the original dream and the sometimes daunting path it took her down. She wants to inspire that next generation to join her, but she also wants to be straight with them about the difficulties they will face.

"It was hard," she said. "There were barriers with exams I didn't think I could pass. I wondered,  'How am I going to take and pass my boards?' ... and, 'What's it going to be like rounding with patients on a daily basis?'"

She doesn't sugarcoat the challenges of taking on the status quo for them: "It can be a lonely road."

Her residency with Scripps Health-Chula Vista will put her within a few miles of the Mexico border and will include monthly visits to Tijuana to help at medical clinics for asylum seekers. She believes her mother is close to achieving her own dream of giving her joints a well-earned rest from field labor and returning to her village in Oaxaca to be with her mother.

While Nino-Tapias joyously awaits that family reunion, for now new challenges are in front of her. So, too, is the culmination of her own long-held dream.

"It's all coming full circle," she said. "I'm finally getting to do the work I've been looking forward to since I envisioned a career in medicine."

Gianna Nino-Tapias, with her mom and three siblings, at Match Day.
(Courtesy Gianna Nino-Tapias)

Photo illustration: Emily Moskal (Gianna Nino-Tapias today, at right, and shown in the fields of eastern Washington as a child with her mom and sister, at left.)

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