Global Health Journeys: From Quito to BYU with Ricardo Noriega

 Summary:

In this episode, Dr. Ricardo Noriega, a physician turned public health professional, shares his journey from medical school in Ecuador to BYU’s Public Health program. He discusses how the realization of the disparities between different regions and people shifted his focus to Public Health. Noriega also reflects on his fieldwork over the summer, where he connected patient information at Paso Del Norte Health Information Exchange (PHIX). 

Ricardo highlights the initiatives led by PHIX that address the broad factors that drive health outcomes. During the summer, he worked on publishing a diabetes data brief to provide insights on the prevalence of diabetes and prediabetes in El Paso. Through this data, Ricardo and his team hope to inform patients about preventable measures that can be taken. Ricardo also discusses his plans and what he aspires to do in the future. 

Encouraging listeners, Ricardo shares how important it is to understand the social determinants of health. For those interested in public health careers, he stresses that the field is full of potential, as healthcare increasingly recognizes prevention as essential to long-term health and well-being. 

Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, and Tanya Gale

Transcript

Cougar: [00:00:00] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University. Whether you are a student, parent, or BYU fan, this podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health. 

Cougar: So whether it's global or local, we will discuss how it plays out. Retains to you, just kick back and relax. As we talk about why health Ricardo Noriega. I welcome you to the why health podcast. 

Ricardo: Thank you so much, Cougar. I'm really happy to be here. 

Cougar: We were supposed to do this earlier, and I didn't tell you where to go, and you've been incredibly patient. 

Cougar: No, thank you so much. Well, our listeners are going to be very thankful that we finally worked out our schedules and we were able to get together and have this [00:01:00] conversation. Will you go ahead and introduce yourself? You're a Masters of Public Health student, second year. Here at BYU, but you have really an amazing background. 

Cougar: So maybe take us all the way back to Ecuador, if you don't mind. 

Ricardo: Yeah, of course. So I am from Ecuador. I was born in Quito. That is the capital of Ecuador. This is the highest capital in the world, actually, so if someone doesn't know about Ecuador, it's a beautiful and small country in South America, and we are located between Colombia and Peru. 

Ricardo: I served my mission in Colombia. Wow, cool. And yeah, I've been married for four years. I have a beautiful wife and have wonderful children. My son is 10 years old and my daughter is 13 years old. And yeah, we are enjoying being here in the U. S. If you want to know, I can tell you my story about how I got here.[00:02:00] 

Cougar: Oh, I have so many questions, and I really do want to know how you wound up at BYU studying public health. I just have to say, I haven't been everywhere in Ecuador, but I've certainly been to Quito, Otavalo, and some different places. Esmeraldas, maybe, on the coast. From the Andes, and to the Amazon, to the tropics, there's everything in Ecuador. 

Ricardo: Yes. Yeah. We have the four regions. We have the coast, we have the jungle, we have the island. So yeah. It's 

Cougar: just, and the people are amazing and beautiful and gracious. Maybe only been there three times, but it's life changing. So I just want you to know that it's not every day that you find someone who has lived abroad and they've been to your home and I consider it a great blessing that I've had the opportunity to travel to Ecuador. 

Cougar: Yes, it's also a beautiful country. Such a beautiful part of the world. Yeah, I'm aware that you have a lot of education. So tell us a little bit about your education. Your education [00:03:00] background, especially in Ecuador. 

Ricardo: Okay. Yes. I am a physician. I graduated from the medical school in 2000. Medical school in Ecuador is our last six years. 

Ricardo: So I spent five years in clinical rotations, taking classes. And the last year is an internship that is mandatory. So I had the opportunity to work for the largest army hospital in Ecuador. So. It was a blessing because it had all the resources there, all the specialties as well, a good and strong system to help people. 

Ricardo: And I'm telling you this because after I graduated, I worked in a rural area. So, I work for the Ministry of Public Health of Ecuador in a rural hospital, and this experience is probably the experience that took me here to the U. S. The difference was huge, because in that part of [00:04:00] Ecuador, it actually was Esmeraldas where you were there, so that place, as you saw, is a really poor region of Ecuador, so the doesn't have or didn't have a lot of resources that we need to work. 

Ricardo: We don't even have an x ray, for example. So, it was a moment where I was able to realize those disparities between regions, between people. So, it was a huge impact for me. I learned a lot in the clinical part. But I was concerned about the other aspect of health. So a lot of poverty. A lot of people that were not healthy just because they don't have money. 

Cougar: Yeah. Oh, it's so humbling, isn't it? Here you had all of this training, but you're in a situation where you don't have the medical equipment, you don't have the supplies, maybe you don't have the medications to treat the folks that come to the [00:05:00] hospital. Correct. You know, in rural areas I've noticed often it's just that, the health post or the clinic is just so far away. 

Cougar: So some people literally don't have access. But then if you do have access, you might wind up in a facility that literally can't care for you as they would like because of the limits when it comes to supplies and equipment. So how did that change your perception of practicing medicine? And providing that type of primary care. 

Ricardo: That's a great question and I probably am going to tell you a story that changed my thinking about medicine. It was because we used to receive a patient, this was a patient that suffered from paraplegia, that is a paralysis of the lower extremities. He used a wheelchair and he didn't have a wheelchair. 

Ricardo: Place where to live. So he used to go to the hospital because he used to get [00:06:00] some ulcers, pressure ulcers, that is, stay too long in one position. So he used to get a lot of ulcers, so he used to go to the hospital, and we cleaned the wounds. But sometimes we hospitalized this patient because the wounds were really bad. 

Ricardo: And he actually enjoyed the hospitalizations. And that was because he received there food, a meal. In the hospital he had a bed where to sleep. So when I was cleaning one of the wounds, he told me that this story or that thinking, and I, wow, it can be possible that people think that being in a hospital is better than being at home. 

Ricardo: So I think that I need to do something. It was not enough to have my medical knowledge because I cannot reach problems. So I start thinking, okay, I have to know more about policies about how to change. People like or reach [00:07:00] the social determinant of health. 

Cougar: Yeah. Oh my heavens, Ricardo. That's such an amazing story. 

Cougar: Yes. When you and I were, that's the last thing we want. Exactly. 

Ricardo: Yeah. 

Cougar: So that's what prompted you to pursue a master's of public health. And what brought you to BYU? 

Ricardo: Well, initially I didn't with the idea of doing a master or I didn't know at what time I want to do my master in public health. I know that I wanted, but I don't know when. 

Ricardo: So when I finished to work with the Ministry of Public Health, I said, okay, I want to specialize in medicine outside my country. So I started looking for places and one of the best option for me was Spain. Because the language and everything or, or Chile or Argentina or Brazil that was close to Ecuador. 

Ricardo: But I was there thinking and praying for an answer to see what is my next step. And it came the revelation and my wife felt that we to come [00:08:00] here to the U. S. and to Utah. And that's why I decided to come here. So, as you can see I decided to come here. the hardest path possible because I had to learn the language. 

Ricardo: And for me, as a physician, I had to validate my medical degree. So it took me three years. So I came here in 2017, and it took me three years to validate my degree. How I did it, I had to take some tests. Actually, it is called the USMLE. The USMLE are the same test that medical students have to take here to get the license. 

Ricardo: So I pass those tests and I receive a certification that is called the ECFMG. And this certification now allow me to work in a hospital or apply for a residency program. So that's the process that I did. But then again when [00:09:00] I finished and I got that certification, I was in an intersection when I had to decide, okay, apply now or I do my master first. 

Ricardo: So I decided to do the master first. As I mentioned, I always pray to know better what to do. And that's why I'm here right now at BYU. 

Cougar: Really the Lord's brought you here in many ways, right? Yes. The Spirit guided you away from Barcelona, which was just the answer I wanted, right? But it brought you here to Provo. 

Cougar: Yes. And congratulations on getting your, your medical license here. That cannot have been easy. So many hoops to jump through, as I like to say, for sure. Yes. Now that you're earning your MPH and you're almost done, tell me what insights have you gained from your studies here? And then as a follow up question, I'm anxious to talk about your field work this past summer. 

Cougar: That's going to be really interesting. 

Ricardo: Okay, yeah, it has been a really wonderful experience to be here. Honestly, I'm [00:10:00] I don't know if you know, the people that live here in Utah know that all the people that are outside of Utah and are members of the church want to be here. That's a fact. So, for example, my father, he wanted to come here to Utah to study, but because he didn't have the resources, he wasn't able to come. 

Ricardo: But now I'm here, so it is a privilege, is the first thing that I can say. I really like BYU because I was able to compare with my university there and here, and there I was a minority. Also here we have a lot of support, a lot of resources that help a student to get all the potential that the student have. 

Ricardo: So, that's something that I would like to say as well. 

Cougar: That's good to hear. 

Ricardo: Yes, so, I'm really happy. And I have learned another thing that is important. For example, in, in, during medical school, I didn't receive any knowledge about social determinant of health. And for [00:11:00] me, I think that each physician should have this knowledge, okay? 

Ricardo: They need to know about that is something more than just medicine or an advice in that moment that is driving the health of the people. So I'm glad that I'm here. I'm learning a lot. All of the skills that I have learned in your classes and other faculty classes help me also in my field trip. 

Cougar: Wonderful. 

Cougar: Yeah. So this has been a very good introduction to the social determinants of health, which if you go on to practice medicine will absolutely inform your practice. And maybe you go on to academia as well. and be a professor, you would be amazing in the classroom. And you're a very strong researcher is my understanding. 

Cougar: So tell us, you went to El Paso this summer. You worked with an organization that a couple of colleagues here set you up with. And by all accounts, you represented us very well and it was really meaningful. So maybe give us an overview of your summer work. 

Ricardo: Yes, I was able [00:12:00] to. find that place or that company because I'm working with Dr. 

Ricardo: Chantelle Sloan Egger. So she put me in contact with the executive director of the company. The company is called FIGS, Paso del Norte Health Information Exchange. So this is a non profit. The aim of this company is to connect clinicians, hospitals, clinics, laboratories, and through a system that is electronical records, so where physicians can open the clinical viewer and he can start looking for the patient information, like the background, the diseases that the patient has. 

Ricardo: So the good thing is that they collect a lot of information because they receive information from different hospitals, clinics, and we can use that information to do a lot of good things like research. So that's what I did [00:13:00] during summer. Actually, we have a lot of projects and, but there is. Three main projects. 

Ricardo: The first one was the importance of health information exchange. And actually, this was a a study that Dr. Chantel started with a physician in El Paso, and they want to know if the health information exchange change the behavior or how the, the physicians in the emergency room manage people. 

Ricardo: So, this is a paper that we already submitted, so it is for revision now. And, and we are happy that we finished this, this paper. That was one of the projects. The other one, a big one, is syndromic surveillance. And syndromic surveillance is a public health monitoring method that help us to find or reach the outcomes early. 

Ricardo: The traditional way of doing surveillance is once we have the results of the laboratory, [00:14:00] we know that something is growing, right? Mm-Hmm. , an outbreak is starting, but syndromic surveillance is trying to get the symptoms early or collect a group of symptoms and call syndromes. To see if we can get the information early and act early as well. 

Cougar: Yeah, get ahead of things. 

Ricardo: Exactly. Love it. Yeah. So, I was in charge of see how we can use the information that the company has to do this surveillance. So I was preparing the syndromes, that is, this combination of symptoms. So I was doing a lot of syndromes, like syndromes in respiratory sy systems or digestive systems. 

Ricardo: And that was part of, of, of my, of my job there. So, it was a, a big project. We are still, we are still working in that. Actually, I'm still working with them. Now part time, but I'm still working in, in that [00:15:00] project. 

Cougar: That's wonderful. So you made some great connections and networked well there. So now that you're back in Provo, you're still helping on these projects. 

Cougar: Yes, yes, 

Ricardo: yes, 

Cougar: yes. Terrific. 

Ricardo: But I have one more project that was the most exciting for me. And it was because I was sitting in my workplace and my boss came and he gave me a dataset. And he told me, okay, with the data set, I want you to explore the data set and see what conclusions you can have about diabetes in El Paso. 

Ricardo: And I say, okay. I was happy about it. And I opened the data set and it was actually a, 100, 000 observation in that data set with a lot of demographics lab results. So it was like, I was excited. 

Cougar: Wow. 

Ricardo: So I started looking at the data and working this diabetes to try to create some conclusion of the data. 

Ricardo: And what we did is that I use [00:16:00] one information that we have in the data set that is called the API. HbA1c test. The HbA1c test is a laboratory test that tell us the mean of the blood glucose in the last three months of a patient. And this test is used to know how well the patient is doing. If a patient receives a treatment because he's suffering from diabetes, the clinicians can know how well they are doing, measuring this HbA1c. 

Ricardo: So I use this HbA1c, and I got the mean of this value in El Paso to see if the patient in El Paso were doing great or not. So this, I didn't know that it would be so. And there, in El Paso, there is an alliance called the Diabetes Alliance, where they really like the results because they want to know if the programs they had were working, what else [00:17:00] they can do. 

Ricardo: So that was one of the results. Another result that we God is, I compare patients with pre diabetes and diabetes to see what are the difference in risk of getting a disease. And I found that of course, it was expected, but it was important to document it that patients with diabetes have more risk. 

Ricardo: For example, in cardiovascular disease, there is five more risk of getting a circulatory disease than people with prediabetes. And this was also important results because now in El Paso, they are focused on helping people with prediabetes in being aware that they have low risk and they can do something. 

Ricardo: Because it's a disease that we can reverse, right? We can help those people to not progress to, can we talk? 

Cougar: Yeah, you're doing so well. But it, it, it, it, I don't know if everyone knows that you can have diabetes or. [00:18:00] Pre diabetes and then through behavior change and modification no longer be considered to have diabetes, right? 

Ricardo: Exactly, and that was the point. I wasn't. Oh, yeah, sorry. 

Cougar: Yes. Yes. So go ahead make that point because not everyone knows that 

Ricardo: So we use this comparison between these two groups to let know these Diabetes Alliance that they can do something for this group of people that are the pre diabetic people Because they don't know You Actually, that they can revert the disease. 

Ricardo: That if they change the lifestyle changing or, or they improve the diet. They actually can reverse, they can be normal or they can reduce this risk. So I think that was important. They like as well that the result. And actually I was invited to share that result in a big meeting with a really important people. 

Ricardo: I was scared and I was intimidated for the people that [00:19:00] researches that were there. from different universities there in El Paso. But they liked the results and I hope they can use that information to do some changes. And this is about the diabetes, and prediabetes is important because actually in the U. 

Ricardo: S., 96 million people suffer from prediabetes. And 80 percent of Don't know. 

Cougar: Don't know. That 

Ricardo: they have, they don't know, sorry, that they can change or they can avoid the progress of the disease. 

Cougar: Yeah. They truly can reverse it. 

Ricardo: They can. 

Cougar: Which is remarkable with some lifestyle changes and what I would just call behavioral medicine. 

Cougar: Yes, correct. And so, feeling like, oh, I'm doomed. This is, you know, my physician told me that I have diabetes or I'm pre diabetic, recognizing that's a wake up call. And it's not too late to make some changes to your diet and your lifestyle. [00:20:00] I now know why every time I'm in the hallway, a colleague says, you got to talk to Ricardo on the podcast because he did some amazing stuff. 

Cougar: You must be very good at your data analysis. And I feel for you when you say, Oh, it was scary presenting in front of a bunch of more senior academics. You represented us well, you represented yourself well. What a cool thing to just be a data set. Say, you know what? I've got some skills and the things I don't know yet I'm gonna Google and I'm gonna figure it out I'm gonna be able to get through this data set and draw some conclusions Get us a snapshot of what's happening in El Paso Are the programs because you mentioned that there are numerous groups here working to tackle diabetes in the El Paso area Are some of their efforts paying off or are they seeing good things happen? 

Ricardo: Yes, I think They are proud of the things that they are doing, and this alliance involves like 20, probably, organizations, so it's a big [00:21:00] alliance. And all of these organizations are collecting information and sharing information to see what else they can do. So, what I have heard is that they are doing. 

Ricardo: for people in El Paso. So they are improving. And now that they have at this baseline in the mean of the HBA 1C, they can then in the future see how they are doing. 

Cougar: Really cool. So that's great. What a great indicator is what I'm going to say because so much of what we do in public health is we ask people questions and we're reliant upon self report. 

Cougar: But here you actually have a lab test saying, no, this is a marker depending on, you know, regardless of what they're saying, there's, you know, their self report about nutrition and their behavior, how they think they're feeling. You've actually got the science there. Very cool. So, oh my heavens, I have some questions then about your future, because you, you clearly have this capacity to research and to do it well. 

Cougar: And you [00:22:00] recognize that it's important that, that research really can guide our practice. It should guide our practice. And, and that there's a trickle down effect there. You might be sitting, In in a lab and looking at a computer for 12 hours straight, but what you're doing is impacting population health and informing, you know, the alliance and their efforts on the ground. 

Cougar: So, as you look at your future moving forward. It has to be very enticing to practice medicine and, and to be in a hospital or clinic setting. But it might also be very enticing to, to work in public health with any number of these wonderful nonprofits or, or even government agencies. But I can see a, a third option here too, which is to research and, and get into academic medicine. 

Cougar: What do you think the future holds? Maybe I should ask your wife. She's not here. Maybe I should ask her what you're going to do. 

Ricardo: That's a difficult question. And actually, I, right now, I [00:23:00] think in a spot in my life that I, in an intersection where I have to decide. And I miss a clinical part of medicine, but I like research, so actually I'm applying for a Ph. 

Ricardo: D. this coming month, so I don't know if I have to go to the temple this week and see what happens. 

Cougar: I should have known that's how you're going to decide, yeah. Talk it out with your family and with, you know, what I like to call my people. You know, extended family, my wife, my kids, get on my knees, and as you just mentioned, go to the temple and seek the guidance of the Holy Ghost. 

Ricardo: That's a great advice. And I actually, I did that. I asked first my wife what she think about to do a PhD because it is four or five years more that I have to study, right? And I've been studying for more than 12 years, I think. It's wonderful. She support me and say, you can do it. You are good for [00:24:00] this. So now I have to receive the approval of our Heavenly Father. 

Ricardo: Yeah. Yeah. Well. 

Cougar: What a blessing to have a supportive family. And this is coming from a guy who was in graduate school and working full time for nine years. And the sacrifices that my amazing wife and our oldest children made. And there's times when you're just thinking, I can't do this anymore. I can't keep all the balls in the air. 

Cougar: So to speak, you're juggling too many responsibilities. And, you know, because we've talked a lot about the Lord this afternoon the Lord increases our ability to do and to perform. Yeah. That's the enabling power of our savior's atonement in so many ways. I'm preaching to the choir, Ricardo, because you've already demonstrated that this is a pattern for you throughout your life. 

Cougar: Can I ask? Thank you, 

Ricardo: because it's always nice to hear that more people pass through those things, right? Yeah. I'm not alone in that 

Cougar: part. Well, I think you would do a PhD in two and a half or three years. I think it took me like [00:25:00] seven, so. Let me ask though, because we're talking so much about the gospel and about receiving that divine guidance for the decisions we make in our life. 

Cougar: Can I ask? Yeah. How you or your family were introduced to the Church of Jesus Christ of Latter day Saints? 

Ricardo: Yes, my parents received the missionaries when they were like 17 probably. Wow. So they got baptized in that year. Then my mother and my father met each other in the church. They got married and I've been in the church since then. 

Ricardo: Since I was born. 

Cougar: Wow. So cool. And did your parents live in Quito as well? 

Ricardo: No, actually they live here. It's a long story. So they have been here for 10 years. And one of the reasons that I'm here as well is, is because they are here. And my mother motivated me to came. So yeah. So cool. [00:26:00] Another big story. 

Cougar: Wonderful that you have family here too. Yes. Well, is there a house in Ecuador that I can go stay in when I want a vacation? Yes, yes, yes. Just let 

Ricardo: me know and you can go. Yeah, 

Cougar: I love it. We have a 

Ricardo: nice place there. So you can go. Yeah, 

Cougar: no, truly one of the most beautiful places I've ever been. In fact, I was in Keto with Drs. 

Cougar: Crookston and West, and we had an extra day, so we were there for a child nutrition project. We had an extra day, so we rented a car, and we wanted to drive out and see the mountain, Cotopaxi. And it was very cloudy and overcast. So we, we really couldn't see most of the mountain until we got right to the base of them, the drive from Keto down to Code Epoxy, one of the most beautiful drives I've ever been on to the extent where we got home a week later. 

Cougar: And I think all three of us independently were on our laptops looking at Zillow, seeing are there any [00:27:00] properties that we could purchase and can Americans purchase land in Ecuador and how do we do this and we're all broke, but how do we figure this out? That is how smitten we were with your country. Oh, thank you. 

Cougar: I'm 

Ricardo: glad to hear that. 

Cougar: So, oh, my heavens, Ricardo, thank you for your time. Maybe one question on the way out the door, and I always ask this of guests, and I never give them a heads up. So it's always fun to see you just kind of shoot from the hip. Is there a book that you're reading? Is there a podcast you're listening to? 

Cougar: Of course, so much of your work is towards your academic studies. Is there something that has you excited? Because, you know, it's really important that we find something It keeps us passionate and engaged and always wanting to learn and grow and develop more. Is there anything you can share with our listeners? 

Ricardo: Actually, we are reading in class one book that is called How Will You Measure Your Life by Clayton Christensen. Yeah, Christensen. So, [00:28:00] that book is really good. It has been really good. I mean, I have had a lot of good, really good impressions, because these books let us know how we can be happy with the things that we are doing. 

Ricardo: And one of the phrases that Clayton Christensen says in the book, I remember one conference in, like, ten years ago. When I was struggling medical school and I said okay, I'm not enjoying what I'm doing because I think that I would like to be a doctor already and I will be really happy and the things will be better, but it's not that the point. 

Ricardo: So in the book says that we need to enjoy the journey. No expect the outcome to be happy. And in this conference, Elder Bernard talked something like that, and the message, and the speak title is Of Regrets. And [00:29:00] he told the story when he ride the bicycle with his wife, and he said that he didn't enjoy go to the house again. 

Ricardo: He enjoyed the path of this journey, or see the mountains, to see the sun. So, that's something that really touched my heart because I was struggling with that. So, I realized that I don't need to expect something or, or try to reach something in the future to be happy. So I have to enjoy the path. And that's something that I've been doing since then. 

Ricardo: And probably this is an advice for all people that are listening that we need to enjoy what we are doing. Just each step. 

Cougar: Yeah. Oh, that's a great message for everyone, including myself. Just, you know, don't delay your happiness and the joy that you feel, because it's not about that destination. It is about that journey. 

Cougar: I think we all know that we've learned that multiple times, but we need to be reminded of that. 

Ricardo: And I recommend [00:30:00] everyone, if they can read this message. of regrets and resolutions. I think it's the conference in two thousand 12 probably. It is awesome. That message. 

Cougar: Yeah. Very cool. Ricardo Noriega. Thank you so much for your time. 

Cougar: Thanks for being a terrific guest on the White Health Podcast. All the best to you, my friend. You have exciting things in your future. 

Ricardo: Thank you so much, Greg. 

Cougar: You bet. Thank you for joining us today. Catch us on our next episode and don't forget to subscribe to future Y Health episodes.