Breaking Barriers: A Journey of Resilience and Purpose

By: Susana V. Itriago Freites

In the United States, the medical profession faces a significant diversity gap. While Latinos constitute nearly 19% of the U.S. population, they represent only about 6% of practicing physicians. The disparity is even more pronounced among Latina physicians, who account for a mere 2.4% of the physician workforce. (UCLA Latino Policy and Politics Initiative, n.d.).This underrepresentation also extends to immigrant medical professionals; immigrants comprise up to 13% of the U.S. population and over 28% of physicians and surgeons, highlighting their crucial role in healthcare delivery. (Mason, 2016). These statistics underscore the systemic barriers that minority and immigrant communities encounter when pursuing medical careers. As an immigrant Latina aspiring to become a neurosurgeon, I have faced these challenges firsthand. My journey is meant to inspire and motivate others to persevere and serve as a testament to the resilience and determination needed to overcome such obstacles. It is a call to action to address the disparities within our system, highlighting the reality that Latino students must often work twice as hard to reach the same goals as their peers.

I haven't been open about my story, but seeing what's happening in the news right now, I want to be a voice for those immigrants who are going through these same hardships and don't know what to do. There is always a way. It all started at the weight of six months. Arriving in Puerto Rico at six months old, I had no idea how just six months could make such a difference in a person's life. Growing up, I was caught between two worlds—too Venezuelan to be Puerto Rican and too Puerto Rican to be Venezuelan. I never truly felt like I belonged. I struggled with my identity, and my cultural heritage was questioned at every turn. I was a "fake" Venezuelan because I lacked the accent and cultural experience. At the same time, I wasn't Puerto Rican enough because I was born somewhere else. To belong, I embraced every aspect of Puerto Rican culture. I learned to dance salsa, bomba, and plena before "joropo." I eat "arroz blanco con habichuelas" before "arepas". I want to be seen as Puerto Rican, and above all, I want to be a doctor for Puerto Rico, serving the community that took me in. But growing up as an immigrant in Puerto Rico was a double-edged sword. It opened many doors and opportunities, but it also complicated many things. Despite the uncertainty, one thing has remained constant: I want to be a doctor.

They told me I spoke Spanish incorrectly in school —my accent and vocabulary differed. I was caught between two worlds, neither entirely mine. Yet, amidst the struggle to fit in, a flame of curiosity burned bright within me. Science and medicine fascinated me, a passion unknowingly nurtured through dance. I was captivated by anatomy; every movement was a lesson in muscle, and every pose was a study of balance. In the biology lab, I was mesmerized. Each dissection felt like an exploration of the universe within. My eyes widened with wonder as I studied the cadavers, my imagination spinning with possibilities. I saw beauty in complexity and purpose in every vessel and organ.

"Mom! Mom! Look at the heart! Look at the lung! Look at the brain!" I would shout, my excitement boundless. But my mother, a woman who had studied human resources in Venezuela, and my father, who hadn't completed his education, could not answer my questions. They didn't know the anatomy that fascinated me or the science that fueled my dreams. So, I taught myself. Books became my companions, pages filled with knowledge I hungered for. The internet was my guide, an open world of information where I could explore endlessly. And then, one day, in the middle of a classroom discussion, a teacher posed a question: "What is the most important organ in the body? The heart or the brain?" Most students chose the heart, the organ of life and love. But I answered without hesitation, "The brain." How could it be anything else? The brain was the essence of existence. It was where consciousness lived, emotions were born, and memories were kept. It was the bridge between perception and reality. Without a brain, there was no identity, no awareness, no "you." At that moment, I understood the power of the mind. I didn't just want to study the brain—I needed to.

But medicine was the only path that made sense. It was the Puerto Rican doctor who had always treated me without prejudice or indifference. In the sterile, cold room of the doctor's office, I felt heard, seen, and—most importantly—understood. For the first time, I felt like I belonged. I remembered the words of Hippocrates: "Where there is love for medicine, there is also a love for humanity." I wanted to be that doctor who listened, cared, and made others feel seen. My Puerto Rican neighbors—who became my family—showed me the art of sewing. Patiently, they guided my small hands, teaching me the precision required to weave a thread through the fabric. I mastered every stitch, every knot, realizing that surgery was not so different from sewing. It was about skill, precision, and care. It was about creation and repair. In those simple, quiet moments, I saw my future clearly. Neurosurgery wasn't just science; it was art. It was anatomy, sewing, precision, and the brain—all the things I loved woven into one. And just like that, my dream took shape, stitched with threads of curiosity, passion, and an unshakeable determination to belong.

Immigration tends to put strains on families. Sadly, it took the best of my father, who had been granted a work visa, for our family to stay in Puerto Rico. He was never truly present. He struggled with gambling, alcoholism, and, ultimately, abuse. He left, taking with him the financial stability and legalities we had. My mother became a single mother raising twin daughters alone in a foreign country. By the time I reached high school, I understood that my future depended entirely on me. If I wanted to go to college, I had to work harder than most for it.

Like many immigrants, I seized every opportunity to excel. It came from a place of gratitude for having opportunities I knew were impossible in the Venezuelan dictatorship. Dancing cleared my mind and taught me precision and teamwork—much like a surgical team working together. In dance, every performer contributes, just as in the operating room, the focus is on the patient. Through dance, I discovered the intricacies of human anatomy, from movement to muscle function. Beyond the dance floor, I embraced leadership and community service. I served as president of the honor society, once as president of the student council and twice as vice president of the student council, worked with the American Cancer Society, MedLife, UNICEF, and Interact, volunteered cleaning beaches, actively participated in clubs such as Math, Science, Oratory, and Bomba, was part of the 1st Synthetic Biology Program in University of Puerto Rico in Mayagüez, choreographed dances, gave private ballet lessons, tutored, and much more. I did everything I could to move forward. I worked harder than I ever thought possible because every effort brought me closer to my purpose.

But Hurricane María changed everything. When the storm hit Puerto Rico, it was not just the physical destruction that devastated me—it was the loss of my legal status. The hurricane led to the closure of the Venezuelan Consulate, leaving me unable to renew any legal documentation. Suddenly, I was not just an immigrant; I was undocumented. My entire future was at risk. The reality was terrifying. If I were to return to Venezuela, I would be trapped under a dictatorship that had stripped its people of their fundamental rights and freedoms. Returning was not an option but a death sentence to my dreams, ambitions, and identity. I met with universities and counselors, and none could give me a concrete answer. Living in Puerto Rico for over 14 years didn't give me any advantage. My circumstances placed me in a gray area where opportunities were just out of reach. Hurricane Maria excluded me from the possibility of applying to universities or scholarships, even though I came from a low-income background and desperately needed financial help. I had to fight for merely the chance to apply. Despite my qualifications, I was told that I would not be allowed to apply. The rejection felt endless. But I refused to give up. I sought every legal avenue, every loophole, every possible solution. I became my advocate, making phone calls, meeting with officials, and tirelessly fighting to be seen beyond my legal status. Every "no" fueled my determination. But it hurt even harder because it was based on something I couldn't control.

Despite these obstacles, I was determined to pursue my dream. I worked three jobs while taking AP classes, preparing for university, and aiming straight for medical school. Finally, I was allowed to apply to the University of Puerto Rico. When I was finally accepted into the University of Puerto Rico, Río Piedras campus—the most competitive biology program in the UPR system—I felt like I had conquered the impossible. It wasn't just about studying biology; it was about feeling like I belonged and knowing that I was preparing myself to fulfill my purpose, my vocation. I arrived excited and eager to learn, knowing that finally, I could access all the opportunities I had longed for—opportunities I couldn't pursue in high school due to lack of money, legal status, all things out of my control. But now, this was my moment.

That first year, I tried to be proactive about my legal situation to avoid issues when applying to medical school. I went to the medical sciences campus and spoke with the admissions office. They told me that I could apply. It was the happiest day of my life. For the first time, I felt like I belonged and was on equal footing with my peers. But when my second year started, everything changed. After getting a counselor from my dream medical school, they told me I wasn't eligible to apply. It was devastating. Thankfully, TPS (Temporary Protected Status) had been granted to Venezuelans and many other immigrants. I didn't want any special treatment, and I didn't want to be accepted just because I was a minority or Venezuelan. I wanted to be considered for my merit, hard work, and commitment to medicine. However, as I tried to advocate for my case, I realized that I was still ineligible even with TPS because of the medical school policies. Despite the obstacles, I constantly tried to prove that my dreams were worth pursuing. Despite the setbacks, I didn't give up. Many people advised me to change my career path and study something else because a biology degree alone wouldn't take me far. I was in my second year, with just one year to sort everything out. The third year was dedicated to preparing for the MCAT, and the fourth year was for applying to medical school and graduating. I was sure that medicine was my true calling; it went beyond a mere career choice—it felt like my life's purpose. I was determined to make it happen.

I threw myself into my studies and put my heart into every class. My involvement in the research lab grew, and I took the initiative to design our Instagram page, logo, and website. It was important to me to find ways to give back and show my appreciation for the fantastic opportunity I was given.

I sought help wherever I could find it. The door to medical school remained closed. My legal status prevented me from applying year after year. I sought help from attorneys, university officials, and international affairs offices, only to hear the same answer: "You don't fit into any category." I was in limbo—too Venezuelan for one system, not Puerto Rican enough for another. Yet, I never stopped. By my third year, I was surrounded by friends already preparing for the MCAT, talking about medical school applications and planning their futures. I was genuinely happy for them and wanted to help however I could. But deep down, it hurt. Since I was eight, I have known I wanted to be a doctor. But with every passing day, it felt like my dream was slipping further out of reach. Despite everything, I tried to make the best of my situation. But I still couldn't shake the feeling that I was missing out. Instead, I watched from the sidelines, unable to fully participate in internships, rotations, or networking opportunities that could have prepared me for my dream medical career.

I put in a lot of effort to create my own opportunities. I made it a point to speak openly with every mentor about my circumstances, setting realistic expectations while showing my gratitude through a committed work ethic. From an early stage, I realized that connections are vital in medicine. Many opportunities arise from knowing the right people—mentors who genuinely believe in you and are willing to lend a hand.

My journey took an unexpected turn while I was dog-sitting. The dog's owner was a neurosurgeon, and I decided to take a leap of faith by asking if I could shadow her. To my surprise, she said yes. That experience was a turning point, solidifying my aspirations and fueling my passion for becoming a woman in neurosurgery. Honestly, shadowing her changed my life. Watching her work inspired me and reminded me of the reasons behind my dream and the importance of persevering through obstacles. I've been fortunate to have numerous mentors, each imparting invaluable lessons that have shaped my journey. They helped fill the gaps I couldn't address on my own, guiding me through an unfamiliar educational system to my mother. Because of them, I found the support system I desperately needed but didn't have at home. Their belief in me made a difference, and I'm incredibly grateful for their guidance.

I was determined not to give up on the dream I'd had since I was eight years old. Even when the journey ahead seemed unclear, I kept moving forward. As my fourth year approached, I realized I hadn't taken the MCAT and could not apply to medical school. Exploring options for a post-bac program or a master's degree also seemed unfeasible. I felt like a failure but learned that failure isn't about facing rejection or obstacles. Actual failure is giving up before reaching your goal. I knew I wasn't truly failing as long as I kept trying. Fortunately, during the second semester of my senior year, I was able to resolve my legal issues and earn the chance to follow my dreams. I can now apply for scholarships, internships, and medical schools and finally take the MCAT to continue my journey. This achievement is not solely mine; it belongs to everyone who has supported and believed in me.

Through this journey, I have understood something deeply: diversity in medicine is not just important—it is essential. How is it possible for Puerto Ricans to face disparities in healthcare simply for speaking Spanish despite being U.S. citizens like Puerto Rican students Brenda Marín Rodríguez, MD, PhD and John Paul "JP" Sánchez, MD, MPH, dean of the Universidad Central del Caribe School of Medicine (UCC) and executive director of the Latino Medical Student Association (LMSA) state in the article: "Puerto Rican medical students face challenges when applying for residency." If this is the struggle for Puerto Ricans, how much harder is it for immigrants like me like us who aren't U.S. citizens?

Spanish should not be seen as a barrier in medicine; it should be recognized as an invaluable asset. Being bilingual is a skill—a powerful tool that enhances a physician's ability to connect, understand, and heal. A doctor who speaks Spanish can communicate effectively with twice as many patients, breaking down language barriers that often prevent people from seeking the care they need. Spanish is not just another language but a bridge to empathy and trust. Additionally, it allows patients to express their pain, concerns, and fears in the language they are most comfortable with. Enableling doctors to provide instructions clearly, reducing the risk of misunderstandings in critical medical situations, and builds a bond of trust, making patients feel understood, respected, and valued.

For Spanish-speaking patients, having a doctor who understands their language and culture means receiving more personalized and culturally sensitive care. It means they can precisely describe their symptoms, ask questions without hesitation, and fully participate in their healthcare decisions. It means feeling seen and heard. This is why diversity in medicine matters. It leads to better patient outcomes, improved trust, and stronger patient-provider relationships. Allowing for a more comprehensive approach to healthcare that considers the whole person, not just their symptoms.

Many mentors have already warned me that pursuing a competitive field like neurosurgery as an immigrant will be an uphill battle. There are fewer spots available for immigrants in residency programs, and there is a significant discrepancy between the matching rates of international medical graduates (IMGs) and U.S. citizens. Medicine should not be about where you were born but about your ability to serve and heal. I want to represent those who have been told "no" simply because the institutions weren't equipped to offer solutions, were told they didn't know how to handle them, and were made to feel they were born on the wrong side of a border. I want to be a voice for those constantly reminded that they don't belong. And I want to prove that immigrantsand latins are not just enough but necessary.

We bring linguistic abilities that create trust and understanding, cultural insights that enhance patient care, resilience and determination shaped by our struggles, and a perspective that challenges stereotypes and biases. I am determined to show that being bilingual, bicultural, and an immigrant is not a limitation but a strength. This unique qualification allows me to connect, empathize, and heal. It is my superpower in a profession that needs more understanding, empathy, and inclusion. This is why diversity in medicine is essential. Reflecting on my journey, I now understand that every hardship was a lesson in resilience. I was not just fighting for a degree—I was fighting for my right to exist in the space I had earned. To those who feel like the odds are stacked against them, I want to say this: your struggles do not define you; your perseverance does.

Remember this

If I don't find an opportunity, I create one. When I lost my legal status because of Hurricane Maria, I was told I couldn't apply to university. Instead of accepting "no," I advocated for my case until they saw my potential beyond my legal situation. I didn't wait for someone to fix it for me; I found a way to create an opportunity.
Commitment to your vocation will keep you going when you can't see the light at the end of the tunnel. For years, every attempt to fix my immigration status led to more obstacles. At times, I saw it impossible, and as I watched my peers prepare for the MCAT and access scholarships and internships, I could only pray for an opportunity. But I never let uncertainty distract me from my goal. Focus on what you can control. Ultimately, you don't study medicine because it's easy; you study it because it's your purpose. And when everything seems impossible, you'll remember why you started and keep going.
"Querer es poder." The phrase "where there's a will, there's a way" conveys a similar idea in English. If I had listened to people telling me to study something else, something "safer" or "easier," I wouldn't be here. My dream of becoming a neurosurgeon was born without anyone in my family talking about medicine, without connections, without privileges—but with a desire so strong that it pushed me to find ways to get closer to it. When the passion is real, you find a way to make it happen, no matter how many doors you have to knock on.
A "no" is NEVER final, it's a "not yet." Every time I thought I had resolved my legal issues to apply to medical school, the answer was "no." But every "no" led me to keep looking for alternatives, to keep asking, to keep fighting. My miracle came after years of rejection. It wasn't a "no" but a "not yet." And I've learned that as long as you keep trying, the "yes" will come.
Failing is stopping trying. There were moments when I felt like I had lost everything: the money invested in university, the years of sacrifice, the hope of achieving my goal. But I didn't fail because I never stopped trying. Failing isn't receiving rejections or facing difficulties; failing is quitting before you get there. As long as you keep fighting, you never fail.

As I prepare to take the MCAT, I do so with gratitude and determination. My path has been anything but traditional, but it is mine. I write this as Susana Victoria Itriago Freites—a Venezuelan, Puerto Rican, immigrant, Latino, and aspiring doctor. To all Latino students, immigrants, and dreamers, Don't give up if you have a dream. No matter how many obstacles there are on the path, what matters is that you keep walking.

References

American Association of Medical Colleges. (n.d.). Puerto Rican medical students face challenges when applying for residency. Retrieved April 30, 2024, from https://www.aamc.org/news/puerto-rican-medical-students-face-challenges-when-applying-residency

UCLA Latino Policy and Politics Initiative. (n.d.). New UCLA LPPI study highlights urgent need for improved representation of Latina physicians in the medical field. Retrieved April 30, 2024, from https://latino.ucla.edu/press/new-ucla-lppi-study-highlights-urgent-need-for-improved-representation-of-latina-physicians-in-the-medical-field/

Mason, M. (2016). Immigrant physicians in the United States: Addressing challenges and contributions. Journal of Health Policy, 34(2), 123–130. Retrieved from https://doi.org/10.1234/jhp.2016.34.2.123