Looking for Root Causes
Alfonso Molina’s Journey from East Palo Alto to Stanford and Back
Growing up in the inner city environment of East Palo Alto, around an extended family where Spanish was primary and English was a foreign tongue, a young Alfonso Molina was fortunate to be fluent in both languages. As a 9-year-old, he began accompanying relatives to medical appointments so he could interpret what the health professionals were saying. Those visits fanned a flame of curiosity about medicine that was sparked during gatherings with kin.
“Whenever I would go to family parties, I would hear people talking about medicines,” Molina recalls. “If you’re sick, you should try this remedy, or this remedy helps for anti-inflammation. I was always curious to know if that was true or not, if it had a scientific background. I think that’s the first step towards wanting to learn more about medicine.”
While serving as the family interpreter, Molina quickly learned how much knowledge his relatives lacked. He could see how frightening it was for a family member to be in the hospital and not understand much of the medical information. Those experiences inspired Molina to become a medical resource for his family, and for people like his family.
Today, Alfonso Molina, MD, MPH, is in his third year of residency at Stanford. “I grew up around here,” he says. “I know the areas, and it’s a lot of fun being a resident and taking care of people around the community. I’m familiar with all the different neighborhoods that they’re from.”
After high school, Molina moved 40 miles north to attend the University of San Francisco. Four years later, equipped with a bachelor’s degree in biology, empowered by the support of family and friends, and driven by his desire to care for others, Molina relocated 400 miles south to enter a dual degree program at the University of California, Los Angeles. The impetus for applying to UCLA was his participation in the SMDEP program (now known as the Summer Health Professions Education Program [SHPEP]). SMDEP was a free six-week summer academic enrichment program that offered freshman and sophomore undergraduate students the opportunity to focus on medical and dental school preparation.
One of the things that I noticed growing up was that a lot of inequalities existed... Studying about that led me to think that there must be a root cause.
– Alfonso Molina, MD, MPH
Going to Los Angeles
Molina started his classes at the David Geffen School of Medicine at UCLA as a medical student. While working at clinics that were run by UCLA, he questioned why certain procedures or policies were enacted for certain patients. As he began his master of public health (MPH) program, he found that his firsthand experience working in a hospital gave him a different perspective than that of other students in his MPH program. “During the MPH program, I got to learn a lot about health law, how health policy decisions are made, how Congress works, and various logistics related to all that,“ recalls Molina.
Learning about health policy led Molina to think deeply about the underserved patient population. “One of the things that I noticed growing up was that a lot of inequalities existed,” Molina says. “Studying about that led me to think that there must be a root cause. As I learned more, I realized it came down to really understanding policy and how health policy decisions are made in areas like how resources are distributed and how priorities are set.”
As a candidate for MPH and MD degrees, Molina was introduced to the PRIME-LA and Drew programs through SMDEP when he was an undergraduate student. Both PRIME-LA and Drew focus on serving underserved communities and expose medical students to those types of patient populations.
Alfonso Molina, MD, MPH
As a medical student, Molina was also able to participate in the Stanford Clinical Opportunity for Residency Experience (SCORE) program. SCORE brings fourth-year medical students to Stanford for a four-week residential clinical training program at one of Stanford’s hospitals, which can lead trainees to be recruited into academic medicine, provide education and career development, encourage interactions with diverse trainees, and foster collaboration with other institutions where various trainees are based. Through the SCORE program, Molina was able to create connections with program leaders like Wendy Caceres, MD, clinical associate professor of primary care and population health.
Matching at Stanford
A positive experience with the SCORE program was one reason why Molina ranked Stanford high in the National Resident Matching Program, and he was elated to learn on Match Day in 2020 that he would spend the next three years at Stanford, just across the freeway from his hometown.
“I knew it was a great training program, and I kept hearing that there were great mentorship and research opportunities,'' says Molina. “When I got here, it was true. Everyone was very friendly. All the attendings wanted to put me and my education first, and make sure that I understood why we were making decisions that we were making. I got opportunities to ask questions. I’ve been able to work with a lot of good mentors while I’ve been here, and I’ve formed relationships that I know will continue to develop.
“Stanford has exceeded my expectations,” Molina continues. “There’s not only ethnic diversity, but also a lot of diversity in terms of different backgrounds and education. Stanford has not only the resources financially, but the people who will tell you the correct steps to take and guide you along the way.”
During residency, Molina expressed to Caceres an interest in hematology, so she put him in touch with Tamara Dunn, MD, clinical assistant professor of hematology. When speaking with Molina, Dunn suggested that he contact Peter Greenberg, who agreed to be his research mentor.
Stanford has exceeded my expectations... There’s not only ethnic diversity, but also a lot of diversity in terms of different backgrounds and education.
– Alfonso Molina, MD, MPH
Peter Greenberg, MD, emeritus professor of hematology, is a specialist in myelodysplastic syndromes (MDS). Molina’s research with Greenberg involved reviewing data from the U.S. Surveillance, Epidemiology, and End Results (SEER) database, which provides information on cancer statistics among the U.S. population. Using the SEER database to cross-reference MDS patients who came from economic and educational disadvantage and racially/ethnically marginalized populations, Molina formed an observation on the impact that those factors had on a patient’s survival.
Molina’s MPH background leads him to declare that “most of health is actually about social determinants of health. Those factors play an important role when it comes to the overall health of an individual. The things that we do as doctors are only a small part of what leads to good health outcomes for people. It’s more about access to transportation to get to doctor’s appointments, access to good foods, having a green space to do exercise, and feeling safe in the neighborhood. These sorts of things are what really impacts people’s health.”
Molina recently partnered with Lori Muffly, MD, professor of blood and marrow transplantation. They received a grant from the Stanford Cancer Center Clinical Innovation Fund to support a study of differences between referrals for bone marrow transplants and referrals for new CAR T-cell therapies. “I looked at the preliminary database we have, and it was interesting to see that a lot of patients are from East Palo Alto. I’m excited because knowing that there are disparities will prompt us to make changes more quickly and identify the core issues causing these disparities,” says Molina.
Alfonso Molina with his wife, Eva Molina, MD, MBA, and their daughter Natalia. Eva Molina is a third year resident with the Department of Pediatrics.
Familiarity with the areas around Stanford helps create knowledgeable discourse with the diverse patient population that Stanford Health Care serves. Molina recalls talking with one patient to determine how far that person would walk before experiencing shortness of breath. “He was describing how he would go from Fifth Avenue in Redwood City all the way down to the library. Making that connection, I knew exactly how far that is. That’s a good distance, so I could honestly say, ‘You’re doing great,’” Molina explains.
The third year resident also understands the challenges of communicating with patients whose primary language is not English, due to his experience growing up. “Whenever I see a Spanish-speaking patient, it’s nice to be able to help them because it’s my personal first language,” says Molina. “The patient can express themself in the first person without having to go through an interpreter.” Molina can be the doctor that explains things to the family, helping others just as he has done since he was a child.