San Diego clinic delivers more than health

January 19, 2012

La Maestra Clinics director Zara Marselian and First Lady Michelle Obama.

By Marty Graham

Zara Marselian sits in the top-floor conference room of the recently completed La Maestra Clinics headquarters. One of the few tall buildings in the heart of City Heights, its windows look east to rooftops and mountains, fast food restaurants and the crowded streets of one of the most diverse neighborhoods in the nation.

A relentless advocate for immigrants and their impoverished neighbors, Marselian is already plotting the organization’s next steps to support the community she serves with great vigor and compassion. She hasn’t had much time to look out the windows – she sees her community at the street level.

“There is so much need here,” Marselian says. “We are here to learn how to make the services work for the people who need them most. This is our community and we serve it best by building our circle of care for the community.”

Dr. Dorothy Zirkle, director of health services for Price Charities said that for Marselian, everything begins and ends with the community.

“It started with her mother, who opened her doors and her heart to the less fortunate, and Zara brings her own intelligence and compassion to each and every decision,” Zirkle said.

La Maestra's City Heights clinic.

City Heights is one of the largest centers for refugee resettlement in the nation. Last year, more than five thousand refugees came to City Heights, more than any other neighborhood in the country. It has welcomed people from Vietnam, Cambodia, Iraq, Somalia and Eritrea, the Sudan, and most recently, Burma.

Immigrants and refugees – many of the clinic’s clients are Latino, from Mexico and Central America – arrive with limited English, limited funds and opportunity limited by a multitude of obstacles to gaining work, education and control of their lives that include poor health.

“This work is a vocation,” Marselian said. “ It teaches you to be very strong on your instincts and to stay focused.”

Marselian, 51, is the executive director of La Maestra, a string of community-based clinics that began with a project to help immigrants pursue legalized status after Congress granted amnesty in 1986. She worked at getting legal status and citizenship for people, while discovering how limited their access to healthcare was.

That need inspired Marselian to build a network of medical clinics focused on improving the clients’ overall health – as well as treating illness, clinics in houses in the neighborhood where people lived. The clinics take innovative approaches to reach them within the bounds of their own culture.

“Her clinics have taken on the most challenging patients,” said Rene Santiago, Deputy Director of San Diego County Health and Human Services. “She brought a lot of very good, very effective ideas for working with pregnant moms and kids, to protect their health and their futures.”

La Maestra’s 34,000 square foot main clinic built to the highest standards of green, was constructed with $24 million in gifts and grants, including $1 million from the Kaiser Permanente Foundation. The clinic anchors four-block redevelopment project with the City of San Diego and Price Charities that includes hundreds of apartments and homes, retail and office space, an education center and community gathering spaces. The idea was to create a community hub, with access to bus lines and other community resources, including the San Diego Children’s Dental Clinic run by La Maestra across the street.

La Maestra also maintains medical and dental clinics in Lemon Grove, National City and Paradise Valley, and in El Cajon, where a growing Chaldean population has gathered. Marselian has formed partnerships with clinics ranging from Native American tribes to the San Ysidro Health Center at the border. The clinics strive to accommodate the patients, and use technology to do things like live video conferencing of specialists whose offices and practices are beyond the reach of their clients.

“A lot of our clients are here because of domestic violence, political persecution, substance abuse, and problems specific to their cultures,” she said. “They are here because they are survivors but they need to not be survivors to become able to do well here – they need to be thrivers to become part of this country.”

The lobby of the City Heights clinic is filled with Sudanese and Laotian families, sitting with Salvadoran and Mexican immigrants. The in-house pharmacy dispenses in no fewer than four languages, and Marselian says that 20 languages are spoken in the clinics every day..

“We need health care that’s culturally competent,” Marselian said. “Our employees are representative of the population we serve and we have medically trained cultural liaisons, people who understand the medicine and are culturally aware to help our clients understand the process.”

For example, trying to persuade a Burmese immigrant to undertake the challenges of fighting diabetes is a big task, since diabetes isn’t understood to be a disease by many Burmese.

“In certain cultures, the knowledge has to come through elders, or a religious-accepted medium,” Marselian said. “The message has to be respectful of people’s beliefs.”

The clinic’s innovative approach had led to looking for ways beyond medical treatment to help the impoverished immigrants find their way. The project grew into a food pantry, two dental clinics and providing social service towards self-reliance.

The challenge of reaching and effectively serving her clientele is what keeps her most interested in her work.

“The more I do know the more I don’t,” she said. “I don’t have answers but I’m going to find them in the community were I’ve always found them. I can’t step back and say that’s not my business, not my problem,” she added.

The mother of two grown children and an adopted five-year-old, Marselian grew up in a home with a Croatian immigrant mom who helped her immigrant neighbors. She doesn’t talk much about her childhood, but a story from it appears in her book,, that was published in October.

The challenge of reaching and effectively serving her clientele is what keeps her most interested in her work.

“The more I do know the more I don’t,” she said. “I don’t have answers but I’m going to find them in the community were I’ve always found them. I can’t step back and say that’s not my business, not my problem,” she added.
Instead, she looks to the future. Marselian’s latest vision is helping people with micro-loans and micro-businesses, the seed money to start community building in earnest.

“We need to create more jobs so we are looking at ways to use our resources, for example, we are looking at helping create a laundry business with our clients instead of contracting to have our laundry done outside City Heights,” she said. “If it works, they can build a business, get more accounts, hire in the community. You can spin it off.”

She’s very concerned about how hard the recession was on the communities she serves, and uses all her resources to help clients find sustainable work.

“We want to leverage on our services so they help and help and help,” she said. “When we enter into contracts, we ask our partners to hire our people and promise to send them our best people.”

Getting funding for projects takes time – something that takes some getting used to for someone who has as many good ideas as Marselian. Each project is an uphill battle for funding and staff, and to figure out how to make it work for clients.

“I get a lot of rejection. I can advocate until the cows come home because I know we are advocating for the uninsured, the unincluded, the uncertain,” she said.

A master at grant writing, Marselian has waited as long as seven years to start the first dental clinic – in a building rehabilitated by clients and friends.

“I’m very impatient but I will be patient for certain things, some programs are such good ideas you make yourself wait.” She said. “You can just taste it.”

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