Contact Us

Make A Gift

SPH Home

UC Berkeley Home

Search...

Home Fall 2012 Magazine Alumna Spotlight: Melanie Tervalon MD, MPH 84
HOME

CURRENT ISSUE

PAST ISSUES

ALUMNI NOTES

IN MEMORIAM

ONLINE FEATURES

NEWSLETTER

Alumna Spotlight: Melanie Tervalon MD, MPH 84

BY ABBY

COHN

"3

OCTOBER 26, 2012

Share

r. Melanie Tervalon is outspoken about being humble. The Oakland pediatrician and community
activist wants doctors to loosen the reins of power, become more self-reective, and do a better job of
listening. Too often, even the most well intended physician overlooks the wisdom of true experts in the
health care settingthe patients themselves.
The story of the person across from you is the story you need to pay attention to, counsels Tervalon.
Known as cultural humility, Tervalons approach aims to ensure that increasingly diverse populations of
patients get the high-quality and respectful care they deserve. It was introduced 20 years ago at Childrens
Hospital and Research Center Oakland as part of Tervalons pioneering Multicultural Curriculum Program for
doctors-in-training at the innercity institution.
It was time to turn on its head who was the teacher and who was the student, says Tervalon, who has long
championed health equity and other social justice causes. As a consultant and Childrens Hospital professor,
she gives talks and training on cultural humility and a number of multicultural health issues.
Cultural humility encourages physicians to politely ask about the needs and practices of those seeking
treatment and to avoid assumptions or snap judgments based on gender, ethnicity, economic status, or
other aspects of a patients identity. Doctors are coached to commit to ongoing learning and self-critiques.
Not surprisingly, the concept runs into occasional resistance from a target audience not known for its
meekness.
Often I nd that physicians recoil a bit from the term humility, Tervalon says. We use the term to remind
us to not be so arrogant or prideful or really think that we have to be all-knowing and all-knowledgeable
which of course we cant be.
The curriculum program at Childrens ran for a decade. Parents, community members, and historians were invited to attend and lead informational forums about
various cultural groups. The project gained national recognition and was reproduced in other medical centers and workplaces. To our knowledge, there wasnt
anything like it in the country, says Tervalon.
Advocating for change, often loudly, is a familiar role for her. Over the course of her career, shes donned the hats of clinician, health strategist, educator, and adviser
to grapple with such thorny problems as racial and ethnic health disparities, childhood obesity, and HIV/AIDS prevention and education.
I was not raised to be quiet, says Tervalon.
Indeed: Tapped as a commencement speaker at her graduation from the UCSF School of Medicine, Tervalon unleashed a blistering attack on the racism, classism, and
sexism shed witnessed during training. Her May 1980 address became known as The Speech. She related how a second-year resident had used a racial epithet to
describe an African American patient and cited how another resident presented a dying white alcoholic, jaundiced and bloated by failing organs, as the yellow
pumpkin.
We have often felt dehumanized, ashamed, and unable to call our teammates colleagues, she told the audience.

Reecting on that experience, Tervalon says, I had no idea what medical school would be like. When I got there, I was horried.
Dr. Vicki Alexander, who has known Tervalon for 40 years, praises her friends courage to speak out against injustice. Melanie would stand up and call it what it was,
says Alexander, the retired director of the City of Berkeleys maternal child and adolescent health program.
Tervalon gives credit to her strongly identied African American family in
Philadelphia. Her mother was a school teacher, and her father a policeman.
My mother taught me to read when I was three and was going to make sure all
the doors were open to me, she says.
Heavily recruited by Ivy League colleges, Tervalon accepted Radclies oer in
1969. She immersed herself in a thicket of demonstrations demanding the
establishment of a campus center honoring W.E.B. Du Bois, Harvards rst
African American doctoral recipient. When her freshman-year activism earned her a suspension, she headed west and didnt return. Landing in the Bay Area, she
threw herself into progressive political activities. Tervalon joined a Cuba solidarity brigade, managed the Oakland oce of Black Panther leader Angela Daviss
defense committee, and at one point shared housing with Davis.
Davis asked her what she wanted to do with her life, which spurred Tervalon to return to school. After getting a bachelors degree in genetics at Berkeley, she made a
beeline to UCSF for her medical degree. By becoming an MD, Tervalon wanted to serve the black community and gain a solid platform for her activism. An interest in
public health led her back to Berkeley after residency. She studied maternal and child health at the School of Public Health from 1983 to 1984, and completed a
health policy fellowship at UCSF in 1989.
Two years later, a horric incidentthe beating of black motorist Rodney King in Los Angeles sparked the cultural humility project. Tervalon was working as an
attending physician at Childrens when Kings beating caused simmering racial tensions among the ethnically mixed sta to boil over. Many nonwhite workers felt
patronized by white physicians and were troubled by the treatment of patients of color.
A hospital executive asked her and other sta members to sort out the turmoil. With the administrations blessing, Tervalon and others organized the educational
sessions, which attracted enthusiastic crowds of sta and local residents. At gatherings highlighting the backgrounds of African Americans, Latinos, Asians, whites,
and other groups, speakers shared historical facts, health practices, poetry, and their past hospital experiences.
Many stories emerged. Among them was a cautionary tale related by a distraught African American mother. She had brought her son to Childrens one night for an
asthma attack and left feeling as if she was under a cloud of suspicion. The white medical student examining her son had mistaken scars on his body for evidence of
past abuse. He began questioning the boy until discovering the origin of the marks: They were lingering reminders of the major surgery the child had undergone as a
fragile premature baby. By this time, the mother felt mistrusted and mistrustful.
For Tervalon, the visit clearly illustrated the need for cultural humility. We have to check ourselves, check our biases, she says. Practitioners should be respectfully
curious of patients and their families, and take time to listen in ways we havent before. Cultural humility also calls for doctors to become community advocates
and for hospitals to provide institutional support.
The program had a powerful impact at Childrens, she says. Communications improved. The hospital introduced language and translation services for non-English
speaking patients. And many interns and residents who embraced the principles of cultural humility are scattered around the country now, she says.
Jann Murray-Garcia MD, MPH 94, a fellow pediatrician who helped develop the concept, says cultural humility oered an alternative to the prevailing emphasis that
doctors acquire cultural competence in their patient interactions. Learning to care for patients from dierent backgrounds should be an ongoing process, she says,
rather than the mastery of a set of facts. This was not about ten things you do with a Cambodian patient, says Murray-Garcia, who calls Tervalon one of the most
talented, self-sacricing and powerful people she knows.
Fittingly, Tervalon is more humble: I feel as though I have made a small, important contribution to the work of making change.
3 COMMENTS

TANG CHENXIAO on MAY 26, 2013 1:55 AM

Well, it is a common phenomenon that doctors rely more on devices to examine patients disease. Though CT, MRI, X-rays may present more specic
evidence for the detail circumstances about patients, doctors still need to ask about patients and hearken what they say. Also, communication can provide
psychological treatment.
In China, we face the same issues. Doctors are meticulous when handling the treatment, providing all-rounded laboratory tests, because these tests
provide evidence and can protect doctors if patients want to charge the doctor for a failing treatment. But, doctors overlook the relationship patients. If
we can use the minimum money to achieve the same treatment goal, there seems no need to do all the tests. Doctors should emphasize on basic physical
examinations rather than completely relying on instruments.
REPLY

DIANA on NOVEMBER 9, 2012 12:26 AM

Humility yes but also, providing a well performed basic physical exam. Doctors need to take a lesson from Dr. Abraham Verghese, from Stanford
University who has launched and eort to reemphasize the importance of the patient-doctor relationship, gleaning all that is possible from the hands-on,
low tech physical exam. I rst read about his observation that too many doctors take short cuts when it comes to the physical exam in his fascinating
memoir called The Tennis Partner. I am appalled that this vital examination has fallen by the way side and that so few doctors today place their hands on
patients, instead relying on gadgets, devices and lab tests to reveal patients stories. Its no wonder medical costs seem uncontrollable
REPLY

WANDA DAVIS on NOVEMBER 7, 2012 10:50 PM

Dr. Tervalons quotes We have to check ourselves, check our biases and Practitioners should be respectfully curious of patients and their families, and
take time to listen in ways we havent before. Is true for all professionals.
REPLY

Leave a Reply
Enter your comment here...

Contact Us

Subscribe to our Publications

UNIVERSITY OF CALIFORNIA, BERKELEY

2014 UC Regents, All Rights Reserved