Dr. Ernesto Gonzalez-Martinez was born in Aguadilla, Puerto Rico, and trained at the University of Puerto Rico. In 1972, Dr. Gonzalez-Martinez graduated from the Dermatology Training Program at Harvard Medical School and later became Chief of Dermatology Ambulatory Services at Massachusetts General Hospital.
Dr. Gonzalez-Martinez established the first Hispanic Medical Students Mentorship Program in the country, reaching across all four of Massachusetts’ medical schools. He also served as Associate Director of the Multicultural Affairs Office and as a founding member of the Diversity Committee at Massachusetts General Hospital. Dr. Gonzalez-Martinez is a Professor of Dermatology at Harvard Medical School and Dermatologist at Massachusetts General Hospital.
- Where does your passion to serve people experiencing homelessness come from?
I grew up in Puerto Rico with my brother and mother and we were very poor. We didn’t have running water, latrines, or basic resources. My father died of tuberculosis (TB) when I was five years old, so my mother raised us by herself. TB was an epidemic at the time, and eventually all the members of my father’s family and two of my mother’s siblings also died from it. My mother worked extremely hard to get my brother and me out of that environment and to ensure we had a quality education—something she could never afford for herself. She often told us about a period in her youth when she, her mother and two of her seven siblings were homeless. They lived underneath a house on a cardboard ‘floor’, without sanitary facilities, eating whatever they could find.
My mother also shared stories about the discrimination she faced in her life. She was Black, and my father was an entitled white Spaniard who never worked. My father began drinking and eventually became sick. My mother worked for his family as a maid to provide for me and my brother. During this time, my brother, mother, and I experienced a lot of discrimination, even within my own family on my father’s side. In fact, my father’s family treated my mother, who worked 12-15 hours per day for them, as if she was just a slave. They called my brother, who has darker skin than I do, ‘Negro’ and me ‘Blanco’—referring to him as ‘Black’ and me as ‘White’.
My brother and I also lived through a lot of discrimination at school, not only because of our skin color, but also because we were poor. We were ridiculed for how we dressed and because we lacked the resources that the other children had. We felt really isolated, but my mother always made us feel valued, especially by reading to us. She read us newspapers, books—anything she could get her hands on—to develop our own reading skills. She had no money, no support from our own family, but she felt that it was her responsibility, as a single mother, to keep us moving toward a better life. And she did.
Despite our lack of financial resources, a lot of positive things happened that allowed me and my brother to get an education. First, as a 5th grade honor student, I obtained a $25 per year fellowship that covered my schooling through high school. The fellowship also allowed me to attend the University of Puerto Rico, with all expenses paid including books and housing. My brother did not receive the same fellowship, but the governor of Puerto Rico expanded the program to include siblings if they were also honors students. So he and I were both able to attend the University. We were competitive with one another, motivating us to do well in school. So it was beneficial for both of us to attend college together. My brother was always more dedicated to his studies than I was—I was also dedicated to music and dancing. My mother was extremely proud when we both graduated from the University with honors. After which, I dedicated my life to medicine and my brother became an economist and a professor in Puerto Rico.
After University, I moved around a bit. First, I took a job as a chemist to help support my mother and brother. I worked there for a year and a half, but experienced more discrimination there, receiving a quarter of the salary that Americans received working in the same position. Then I met my wife and we moved to New York to be closer to her family. From there I applied to medical school and was accepted to the University of Puerto Rico— again, all expenses were paid by because of my track record as an honors student. So, we moved back to Puerto Rico. In my last year of medical school, I received a letter calling me to service in Vietnam. I served as a battalion surgeon from 1967-1968, then spent another year in Maryland finishing my commitment to the armed forces. It was a humbling time.
I have always respected and admired my mother, what she lived through, the efforts she made, and the way she raised us. I always felt that I must not fail her and had to do something with my life. Looking back, both my brother and I credit our mother with our achievements. We both try to instill the lessons she taught us in our own children: to be humble and to value education (they are all doing very well, for the record). All of it is a testament to our mother.
2. Why did you decide to focus on dermatology?
My education in Puerto Rico was excellent and my brother and I had incredible teachers—they were one group that never discriminated against us, in my view. In medical school, I had some especially excellent teachers in the dermatology department, and I wanted to be like them. Then one day when I was in Vietnam, my commanding officer asked all the physicians in the division if we had a specialty. I replied I was most excited about dermatology and suddenly I became the dermatologist for the whole division! Needless to say, I got a lot of hands-on training there, especially with people exposed to lots of humidity and wetness and infections affecting the skin. I read every dermatology book I could find. I saw a lot of cases and received a lot of referrals. I’m sure I missed a lot of diagnoses, but I felt that I was doing good work and people felt that they could depend on me.
When I returned to the U.S., I was assigned to a hospital near D.C. and saw more patients with skin diseases. I spent another two years studying dermatology back in Puerto Rico where I met Dr. Thomas Fitzpatrick, the Chief of Dermatology at Harvard Medical School. He was in Puerto Rico to conduct research on a medication to treat melasma (a pigmentation of the skin, common in Puerto Rico). Somehow, I got involved in this effort even though I had no prior research experience. I served as the primary contact and translator for the patients. As a result, he invited me to finish my training at Harvard (which I did not think I deserved) and I accepted!
I returned to Puerto Rico after graduating from Harvard to care for my aging mother who was sick. We lived there for four years, raising our three kids, until I received a letter from Dr. Fitzpatrick. He asked me to return to Harvard as a faculty member. So, in 1976, I became an instructor in dermatology at Harvard Medical School. This was another unexpected serendipity in my life—someone took an interest in me and gave me an incredible opportunity.
3. How did you become involved with the Boston Health Care for the Homeless Program (BHCHP)?
As a faculty member at Harvard, I used to spend a lot of time defending minorities during the admissions process. Admissions discussions reminded me of all the discrimination that my family and I suffered in Puerto Rico. There were not too many of us at the faculty level that could make a case for minority students. I worked closely with the Office of Minority Recruitment and was a member of the admissions committee for 17 years. Through that work, I saw the extra effort that minority students had to make to get into Harvard. Many of them were poor. All of them had experienced discrimination. Eventually, I decided I wanted to do more than just being on the admissions committee.
One day, a resident on my dermatology rotation, Dr. Jim O’Connell, invited me to come see what his program (BHCHP) was doing for the unhoused population. Remembering my mother’s struggles with homelessness, I went to visit the original location—a primitive building with minimal facilities (compared to the current building) in Jamaica Plain. He gave me a tour and I was enamored with what he had done. It was amazing that a single person could accomplish all that he had. So, on the spot, I basically offered to visit every month and offer free dermatology clinics to patients.
The clinics were challenging in the early days. The dermatology services we could offer were extremely limited due to budget. We had to build relationships with pharmaceutical representatives and convince them to donate medications that BHCHP couldn’t afford to buy. Each month, I would see patients, dispense what medications were available, and serve as an ad hoc consultant for the BHCHP care team. In 1999, we published our first paper examining if skin diseases in the homeless population were similar to, or different than, the general population.
When the clinics began, we didn’t even have written medical records for most patients, making quality care very difficult. When Dr. Jennifer Tan came on board, she revolutionized what we were doing by implementing an electronic medical record system (EPIC) and recording everything we were doing. Then she wrote a proposal convincing the MGH Department of Dermatology to require all residents to spend time with the homeless population—which every dermatology resident has done for the past 12 years.
My ultimate vision has always been that our patients should be able to receive their dermatological care, and all the services they need, where they felt most comfortable, usually at BHCHP. I never want to refer a patient to a hospital where they may feel discriminated against. This is a lofty vision for our clinic because it requires additional equipment and resources. Thankfully, we have been blessed to connect with a wonderful benefactor, Norman Knight, who has significantly supported expanding our clinic’s capacity. My vision is probably not fully attained, but we are so much closer than before! So many people have contributed to the program’s success, and I am so grateful to them all.
4. Can you talk more about the dermatology for people experiencing homelessness ‘ambassadorship’ that you’ve been developing and what you hope it will address?
I did clinical service for many years and loved seeing patients. Now, however, I am at a point in my career where I’d like to have an impact at a broader level, too. I’m not as physically able to do clinical work as I used to be, but there is a lot I can do to address system and policy changes to improve people’s lives. I want to confront the stigma of experiencing homelessness. People say flippant things like “homeless people just don’t want to work.” Even being labeled as ‘homeless’ can be stigmatizing for some people who are economically disenfranchised. And of course, many people need mental health services and addiction services, and they could move forward with their life with more resources like education, jobs, and housing.
We need to be discussing these issues at a systems level, which is why I’m very excited about creating an ‘ambassadorship’ on homelessness. It all started a few years ago when some colleagues at MGH Dermatology started raising funds to dedicate a Chair in my name dedicated to skin care for people experiencing homelessness. They raised a good amount of money, but not enough to meet what’s needed for a Chair. So, I started thinking about how to use the money in a different way. I came up with the idea of funding an ambassador that could travel around the nation advising on how to develop ‘centers of excellence’ that employ best practices to care for people experiencing homelessness. This ambassador would serve to unify these centers and to put meaningful political pressure on the federal government to focus on this population. I think eradication of homelessness is not a “pie-in-the-sky” idea. I think we just need stronger coordination.
Obviously, the person who receives this ambassadorship must have a passion for this work and a commitment to this population. My hope is that this ambassador can help more people start to see homelessness not as a personal inconvenience but rather from the perspective of someone who is affected. My hope is that the ambassador can drive better coordination and unity to eradicate the issue. I have seen what amazing things can be achieved by passionate individuals when they put their minds to it.
