Prior to considering being a PA, I was a high school Instructor of Biology, Physics, Chemistry and Mathematics in my hometown of Cidra, Puerto Rico from 1971-1988. At the same time I enlisted in the Puerto Rico Army National Guard and trained as an Infantry Medic at Fort Sam Houston in San Antonio, Texas. Returning from Basic Training, I returned to teaching at the High School. As my dual profession continued, I noticed that there were vacant positions in the National Guard, whom nobody had requested. I requested the program and was accepted to go on Active Duty to become the first PA in the Army National Guard of Puerto Rico. The University of Oklahoma PA Program was also based at Fort Sam Houston. The Clinical Rotations were selected at Womack Army Medical Center at Fayetteville, North Carolina. I continued my teaching job at the same time as being a “weekend warrior”. No PA positions were available in PR at that time. While training in our Military Clinic duties, I met the Chief Ambulatory Care at the VA Center. He wanted to improve Ambulatory Care in his service. The position was approved, and I began work as PA with Ambulatory Care at the San Juan VA. My work continued for 9 years after which I was offered to work in the Inpatient Nursing Home Unit, participating in the Blind Rehabilitation Service. While blind and partially blind patients received education dealing with their blindness, we assured their medical stability with the assistance of Specialty Clinics.

What are some of the most memorable experiences you had while working as a PA at the VA Hospital?
Most memorable experiences are related to the satisfaction of taking time to listen to patients providing answers to their health inquiries. I was able to assist former teachers, students who later in life served in the military, soldiers with whom presented illness and seek assistance at the VA. Serving Veterans who lost vision suddenly and we provided assistance to maintain function. Assisting patient family on orientation about conditions, including female veterans.

What were some of the challenges you faced as a PA in Puerto Rico, and how did you overcome them?
The challenges which I encountered in the VA were various, but two major ones had to be considered. The need to work with healthcare personnel who had no idea of the PA and were not very happy about it. I must thank my attending physicians who were very motivational about my work. Explaining to patients what we are and how we can assist them in feeling better as my personal goal. With time came onset of nurse practitioners and clinical pharmacists who also became partners in healthcare that were also work sharing entities.

How did your role as a PA evolve over the course of your career?
Being the only PA in the San Juan VA, presented to me a very important goal to promote the profession with VA Personnel and at the same time satisfied customers would present their satisfaction in their communities. It was an excellent opportunity to assist PA students who established contact with me to participate in Clinical Rotations establishing Educational Agreements with programs stateside and the VA in Puerto Rico. This gave them opportunities to work with Spanish-speaking Patients and healthcare personnel. We provided PA Students from Nova, George Washington, and other PA Programs. With time, a Cohort PA Program from Chatham University was established in coordination with Bayamon University and the VA. Clinical Rotations in our VA established the groundwork for Clinical Service Chiefs to consider establishing PA Positions, first of which was the Dermatology Department.

How do you think the healthcare system in Puerto Rico has changed since you first started your career?
Healthcare in Puerto Rico has changed greatly since I began in 1988. Previously, there were clinics in every city of our island. These clinics were staffed with nurses and physicians who had to serve several years upon completion of their preparations. These clinics were serviced by the government. These were privatized and some were closed, and private facilities surfaced. Many specialized physicians, upon completion were offered better employment stateside and decided to leave the Island. Past healthcare needs have increased significantly. As indicated, the onset of nurse practitioners and clinical pharmacists in the VA is not an alternative in the communities.

What changes or advancements would you like to see in the PA profession in Puerto Rico?
The creation of the Law 71, regulating the Medical Assistant profession is not an alternative to solve the healthcare crisis. The law only permits a “didactic interview” for the evaluation of a patient, but orders and decisions are signed under the attending physician. Using the PA name is not synonymous for good healthcare. The PA-C has all the privileges for providing excellent healthcare. This is provided in the VA and the other Federal Facilities for not provided in the law. Not in the community.

What advice would you give to the next generation of PAs entering the field?
Puerto Rico is a huge political environment. Decisions are political-benefit care. I would recommend to the new PA generations to prepare as much as possible. Remember that PR is a Bilingual Healthcare environment. You must be able to communicate completely. If you are not sure, please seek advice. We need you!

How have you been staying involved in the medical community since retiring, and what are your plans moving forward?
Since my Retirement from the VA, I was given the opportunity to teach at San Juan Bautista’s PA program for a year and meeting their wonderful students. I visited some of the clinical sites and received excellent comments from the Community Attending's.

Looking back on your career, what are you most proud of?
I am very proud of being a PA, serving my people, veterans, and community. I feel good about being a Veteran and serving Veterans. I feel good about being able teach PAs.

Is there anything else you’d like to share with our readers about your journey or the PA profession?
I would like to comment that in PR many politicians are in need of education in relation to the PA and their capabilities as permitted in the Federal Facilities. Law 71 needs to be updated in order to provide complete practice for the PA-C. Various Puerto Rico Resident Commissioners were visited in their Washington Office and later elected as Governors of PR and no changes have been provided. The Healthcare needs of our community cannot wait too long.