This week Katy Dycus talks to Dr. Juan Guerra about his bilingual picture book, The Little Doctor/El Doctorcito (Piñata Books) about a Salvadoran boy’s efforts to help interpret (Spanish into English) for his grandmother at the doctor’s office…
Katy Dycus: Will you tell us about your book – El Doctor/El Doctorcito?
Dr. Guerra: It’s basically nonfiction, a memory of events that happened in my life when I was young. I came to the U.S. from El Salvador at the age of four. Thank goodness, my grandparents were very healthy, but from time to time, they had to go to their appointments, and it was us kids who served as interpreters.
I like to view my book as a simple and yet complex text. It talks about culturally sensitive healthcare, linguistics, how you relate to a provider and vice versa. What kinds of biases get presented when there’s a disconnect—linguistically and culturally? That was my story, and it begins with the simple introduction of ‘how do you become a doctor?’
KD: And just as important, why do you become a doctor?
Dr. Guerra: Yes. This was a question people kept asking: Why did I go into medicine? Primarily, how does a male get involved in women’s health as an ob-gyn? When I was in my third year of medical school doing my rotations at University of Illinois, I was there at a time when there were many migrant farmers going into the area (Peoria, Illinois). I was on labor and delivery and I found myself and the janitors as the only people who spoke Spanish. It was empowering to provide some comfort in speaking their language and giving them vital information on this, the happiest day of their life, delivering a newborn.
People have often asked me how I got into medicine being Latino and an immigrant. Usually things are stacked against you. I didn’t meet my first Latino doctor until I was at university. People ask, “Why do you need a kid to serve as an interpreter? Why isn’t there a clinic or staff to provide those services?” At the time I was growing up, that was unheard of. You just had to grin and bear it and hope that the visit went well. In an industry that prides itself with science and solving problems and curing disease, you know, it could do a lot better.
You can’t build rapport between the physician and patient if you can’t communicate, so that was a very early and important lesson that I thought needed to be shared, and I thought, why not share it with children? I knew I wasn’t the only one in that situation.
KD: How have kids reacted to your book?
Dr. Guerra: During book readings I have heard kids say, “Yeah, I go to the doctor with my grandmother, I go with my tía and do the same.” When I’ve gone to schools where there are lots of Latino students, the reception has been tremendous.
KD: So these are the kids who can read the bilingual text in its entirety. Did you write the book first in English and then translate it or vice versa?
Dr. Guerra: While I think in Spanish and English, I wrote my manuscript notes in English. All of the early drafts of The Little Doctor/El Doctorcito were in English. The publisher had their own translator, Gabriela Baeza Ventura, who prepared the Spanish version.
KD: Are there any differences in the two versions of the book, or any challenges you faced during the editorial process?
Dr. Guerra: The two versions are the same. I was very happy how the message was delivered to the reader, especially with the help of illustrator Victoria Castillo. The only challenges I faced in publishing this book were from individuals who opposed the idea of a need for a culturally and linguistically-sensitive health care system. The reality, however, is different. Patients who face a lack of linguistic and cultural congruence with their healthcare system may have worse healthcare outcomes. This is quite a challenge that is far from being resolved!
KD: I think a particular strength of your book is demonstrating how children can make an enormous difference, not only in the life of their family but also in their decision to pursue a career that will serve others. I love that this book will encourage children to think about their own futures as well as the role their own culture can play in helping the community.
Dr. Guerra: The Little Doctor/El Doctorcito also describes the genesis of the creation of a clinic devoted to the health care needs of diverse populations. When I first proposed the idea of a clinic staffed by bilingual, culturally-sensitive staff, I was met by nay-sayers who felt I would be segregating the medical center. My response was that the medical center was already segregated; those that spoke and read English could navigate it much easier than those who did not. Why not try and engage all patients? Thus, Salud en Espanol was born at Kaiser Permanente Oakland in 2009.
KD: That’s truly inspiring. Hopefully, this clinic serves as a model for future clinicians. How did you find the time to write, given all of your responsibilities as a physician?
Dr. Guerra: The Little Doctor/El Doctorcito began as a journal entry while I was working as a physician in Oakland, CA. I told myself that writing a children’s book could definitely be done, especially since I was sharing a powerful message to communities interested in hearing it. I would wake up at 4 AM and try to write before the kids woke up and going off to work. I did this for about two years. There were times that I would just let the notes sit for weeks, before going back and editing. I also took two online children’s book writing classes, where I received feedback about my children’s book manuscript. After about seven years of rewrites and edits, I felt confident to send the manuscript to publishers.
KD: How did you find your publisher Piñata Books?
Dr. Guerra: I joined the Society of Children’s Books Writers and Illustrators (SCBWI) and learned so much about the publishing process. I learned about the publishers that might be interested in my book. I knew that the larger, mainstream publishers would not find my book commercial enough to support. I was looking for a smaller publisher with a track record in publishing and supporting bilingual titles. This narrowed my search to about 60 publishers. I sent manuscripts to all of them. Much like my experience with getting into medical school, I received rejection letters day after day! Then one day I got the letter from Piñata Books expressing their interest in my book; deep down, I figured they would be the one!
KD: What are you working on currently?
Dr. Guerra: I am busy writing a second children’s book (also with a medical theme) and promoting The Little Doctor/El Doctorcito. As the pandemic passes, I hope to get out and do more book readings at schools. I have more free time now that I’ve just retired from medicine.
Last week, while I was collecting everything and cleaning out the office, I started to leave with my boxes, and who was I engaging with but the janitor in the office. My career began that way, with the janitors who would help interpret during newborn deliveries, and it ended that way. It’s a full-circle story.
Katy Dycus is a writer and educator based in Madrid. She holds a Master of Letters in British literature from the University of Glasgow and works as a staff writer for the anthropology publication Mammoth Trumpet.