A Beloved Doctor Bids Adios
Physician Returns to El Salvador After Years of Running a Clinic for the Poor

By Keith L. Alexander
Washington Post Staff Writer
Thursday, February 21, 2008

When Juan Romagoza moved to Washington in 1986, he cleaned the swanky mahogany offices of K Street lobbyists by day. At night, he saw Latino patients at a one-room clinic called La Clinica del Pueblo, a facility founded by Central American activists.

A refugee from the Salvadoran civil war, Romagoza, a physician, escaped to the United States in 1983 at the height of the conflict and lived in San Francisco for three years before moving to the District to live near other refugees.

After moving to Washington, he quickly became the clinic's first and only executive director. This month, after more than 20 years with the clinic, Romagoza, the clinic's most senior employee, resigned to return to El Salvador. On Romagoza's last day, patients, volunteers and fellow physicians gathered to say goodbye to the man who helped expand the clinic from a one-person operation to a multimillion-dollar center.

Romagoza is a soft-spoken man who smiles when he speaks. As he walks through the bright red and yellow waiting room, patients lament his decision to leave. "I'm going to bake you a pupusas," one patient said. "Will you stay then?"

The clinic has grown to a point now, Romagoza said, that it needs an administrator more than a physician. Romagoza wants to return to treating patients.

"I'm a doctor. I am not an administrator. I'm devoted to primary health care," he said. "We have qualified leaders in the clinic with great gifts. Now is the time to delegate."

The clinic employs 100 full- and part-time workers, has 40 volunteers and serves mostly the poor and uninsured. Many of the patients are illegal immigrants.

"Health care is a basic human right," Romagoza said. "We're not just curing people. We're defending people's access to health."

In July, the clinic received $1.5 million -- or $500,000 a year for the next three years -- as part of a grant from the federal government. The funds, Romagoza said, will help the clinic grow to serve about 6,500 patients a year, up from about 3,000. The funding will help offset the clinic's $7 million annual budget, 60 percent of which comes from private donations.

As a result of the funding, the clinic had to initiate a sliding fee scale based on patients' income. They pay what they can afford. But the majority of patients still aren't charged. Romagoza said that when the government announced it was granting the funds, many of his patients became fearful it meant the clinic would use the funds as a way to help identify illegal immigrants. But Romagoza said that's impossible because the clinic doesn't ask for the status of its patients, just their names and health concerns.

Romagoza said he plans to return to El Salvador in March to help care for his family and many of the working poor and other residents of that region. At 57, Romagoza's own health is starting to fade under the chronic stress of running a seven-day-a-week operation.

Before fleeing El Salvador, Romagoza was kidnapped and tortured by the military for treating poor farmworkers. His wife, a medical student, was murdered. Romagoza was shot in his left arm, leaving nerve control in that arm limited and thereby dashing his dream of becoming a surgeon.

When he moved to Washington, there was a growing Latino population but few health-care facilities where physicians were fluent in Spanish. More important, there were few health-care providers who understood Latino culture and the concerns of many Salvadoran refugees regarding health care and trusting physicians.

"They had interpreters at the door, but not beyond the door," Romagoza said.

At a clinic by Latinos for Latinos, there's an understanding that makes the patient feel more comfortable. "Culture heals," he said.

Rosa Bell, 54, of Mount Rainier, Md., has been coming to the clinic for 10 years. Also a Salvadoran native, Bell says she feels more comfortable at the clinic than she would at a non-Latino doctor's office.

"I like it here. I'm home here," Bell said.

Some Latinos are afraid to seek health care for fear of being deported or not being legal citizens. The word around the District, Maryland and Virginia is that patients don't have to worry about being deported if they go to La Clinica. Romagoza himself became a U.S. citizen in 1989 under political asylum.

Although 98 percent of La Clinica's patients are Latino, it does treat patients from other ethnicities.

The clinic has eight language specialists who are used by hospitals around the city to treat patients from several countries, including Ethiopia, China, Uganda and the Philippines.

In addition to primary health care for adults, the four-story clinic, which houses a chapel, provides HIV and AIDS services, as well as pediatric, substance abuse and mental-health services. The building at 2831 15th St. NW is located squarely in the heart of heavily Latino neighborhoods in Columbia Heights, Mount Pleasant and Adams Morgan.

"We created a refuge for documented and non-documented people. We wanted to create a place where people came to feel safe," Romagoza said. "That will continue, even though I'm not here."