Wyoming Medical Center welcomes Christina Jara, MD, and Maxim Salva, MD, to Casper. The married internal medicine specialists met during medical school in the Philippines and are excited to join our primary care team.
Dr. Salva welcomes new adult patients at Mesa Primary Care. Dr. Jara is board certified in internal medicine and completed a fellowship in palliative care. She welcomes new adult patients at Sage Primary Care.
“Palliative care is a field of medicine that has a lot of misconceptions. People think that it might be just for a dying patient, but it's actually different from hospice,” she said. “Hospice is really for end-of-life care. Palliative care can be started even at the time of diagnosis of any kind of chronic or life-limiting illness. Even if you're getting concurrent treatment, you can have palliative care on board.”
Read more about Drs. Jara and Salva and learn about their backgrounds in the interview below.
Where did you grow up and how did you become interested in medicine?
Dr. Jara: I grew up in Manila, Philippines. Mine is basically a family of doctors. My dad was a cardiologist and my mom is a community doctor. Three out of five of their children are doctors, including me. I am the youngest of five.
Dr. Salva: I grew up in a small town in the Philippines as well, and my father was the town’s doctor. My mom is a nurse. She migrated to the United States in the 1980s, I actually have a lot of siblings and many of them are in the medical field as well. I'm the only doctor in the family besides my father.
Did either of you feel like medicine was almost an expectation for you?
Dr. Jara: For me it was a personal choice. My dad actually told me, “Don't go into medicine if you don't want it because it's really a very hard, long road. If you're not dedicated and committed to it, don't do it.” So, medicine was my own choice.
I really just wanted to do something with purpose and to be able to help people.
Dr. Salva: When I was young, we had a clinic at home, and I saw how well loved my father was by his patients. He would also bring me to the hospital. I’m a junior, and my father is the senior, and I think that also played a part because I have to carry on the torch.
Tell us about your training.
Dr. Jara: We both graduated from the University of the Philippines. Aside from the four years of medical school, you also have to do the internship on your fifth year before graduating, so we were working in the Philippine General Hospital. That was the tertiary hospital in the Philippines where the most complicated cases are sent. We treated a lot of patients with limited resources, so you really had to use all of your training and really use your brain in diagnosing them. You couldn’t just order a CAT scan and the results will pop up in a minute. A lot of times we had only the patient’s medical history and the physical exam. You had to be really attuned to the patient to make the diagnosis and treatment plan. Really, I think that was a great learning experience.
Dr. Salva: We really learned that we had to see the patient as a whole, and not just a set of symptoms. There are just so many social factors that come into play, and that's why we're glad that we got the training from that institution.
Dr. Jara: Absolutely. We were classmates in medical school, that’s where we met.
We graduated in 2013, and I took the board exams in the Philippines which allows me to be a general practitioner there, and started working in rotations. During that time, Maxim started talking about leaving for the United States.
Dr. Salva: Most of my family is here in the U.S.
Dr. Jara: So I had to decide whether to go with him or stay in the Philippines. We were in a long-distance relationship for some time while I was a doctor in the Philippines. I was studying for my board exams in the United States and then I came here for my residency.
Was it a hard choice? Did you want to stay in the Philippines to practice medicine?
Dr. Jara: If I'd never met him I would stay. Yeah.
Dr. Salva: But I made it pretty easy for her.
Dr. Jara: To answer the question, I would have stayed in the Philippines if it wasn’t for him. My family is there and, in our training, we learn about serving the Filipino people in the communities. But, my family understood my decision because, of course, I would be starting my own family.
Dr. Salva: With me as well, there was always this inner conflict about staying to serve Filipino people or going to the U.S. to be closer to my family. But if you see medicine as a service to humanity, not just to your own countrymen or to the people in your town, that answers all those questions.
Dr. Jara: Wherever you are, you’re going to be helping people.
So, where did you go next?
Dr. Jara: I did my internal medicine training in Englewood Hospital and Medical Center in New Jersey for three years. Then I then I did my fellowship in hospice and palliative medicine at Jamaica Hospital Medical Center in Queens, New York.
Dr. Salva: I did my training in Montefiore Hospital just north of New York City. I graduated just this year actually, so now it is my turn to follow Christina to Casper.
What interested you in palliative care?
Dr. Jara: During my residency and in my ICU rotation, we saw a lot of complicated cases. I was on the code team, and I always seemed to end up being the one talking to families and, you know, starting these hard conversations. I think I saw the importance of having these difficult conversations and really trying to uphold the goals of the patient and the family. Doctors, of course, we're trained to treat disease and to save lives. But every patient is an individual, so treatment should be a patient-centered approach, and in palliative or end-of-life care, it should also be a family-centered approach. Sometimes patients make decisions based on what they think their family would want. So, I mean, there are a lot of factors to consider.
Usually, physicians will ask for palliative care for their patients. There are a lot of diseases where palliative care is appropriate such as cancer, heart failure, COPD, chronic kidney disease. There are a lot of medical illnesses that palliative care can not only help in alleviating the symptoms, but in improving the life of the patient. That’s really what I want to emphasize because people might be scared to hear “palliative care.” They might think, “Am I dying?” It’s not that. It's not about my goals for you as a patient. Palliative care is really about the patient. Palliative care doctors help guide the patient in making those tough decisions that are coming.
So you will see patients at Sage Primary Care, and also help families who are seeking palliative care at Wyoming Medical Center?
Yes, but we don’t know exactly how it will look yet. I will have my patient panel at Sage, and we will be introducing the palliative care piece to physicians around town. It is exciting. There is definitely a need for it. I think every hospital needs a palliative care physician.
And how did you become interested in internal medicine, Dr. Salva?
Dr. Salva: It goes back again to my family. There was a time that I grew up with my grandparents. Taking care of elderly people really appealed to me
What do you think of Wyoming so far?
Dr. Salva: It is really beautiful, but I’m a little worried about the winter because I heard it can be really harsh here. But, as with everything, we’re adaptable.
What are your impressions so far of Wyoming Medical Center and the medical community here?
Dr. Jara: I think Wyoming Medical Center values integrity and a patient-centered approach to medicine. I think that if you go by that, you will be doing the best for your patient.
Dr. Salva: The people are so friendly and very nice. Very accommodating. I know it’s going to get very cold, but that gives us warmth.
What are you most excited about?
Dr. Salva: Because we were both in training, I am excited to be independent in managing our patients.
Dr. Jara: For me, being in primary care, it will be forming that relationship with the patient and being able to follow them through and get to know them personally.
Dr. Salva: Yes, building those relationships and the lives that we will be touching, and lives that will touch us as well.