1

                                ARTHUR CHEN
                             November 9, 1996

                           Dr. Fitzhugh Mullan,
                                Interviewer

Mullan:     Your date of birth?



Chen:     Date of birth is 11/22/51.



Mullan:     We're in San Francisco, in the San Francisco Hilton,

in my rather cramped room with an unmade bed and a general smell
of cigarette smoke in the air, not from me but from previous

inhabitants.     I'm with Dr. Chen.    It's the 9th of November, 1996,
and Dr. Chen was good enough to come across the bay from Oakland
to chat with me.       Thank you for coming.



Chen:     Thank you.



Mullan:     Tell me about yourself.    Were you a Californian to begin
with, or where did life start for you?



Chen:     Life started with the East Coast.     I was born in
Connecticut, and my parents immigrated to the East Coast first,
coming down from Canada.      My parents are immigrants from China.

They moved to Canada in '48.



Mullan:    From China?
                                                                         2

Chen:     From China, and then came down to the States approximately

1950.     So    I was born in Greenwich, Connecticut.   I always think

that my roots influenced my direction.         I was born as a charity
case, because my parents at that time were almost penniless

because my father had been running a pottery factory with some
others, and the neighbor's place burned down, and his factory was

damaged because of the water.


Mullan:        This is in China or Connecticut?



Chen:     No, this is in Connecticut, in Greenwich, Connecticut.



Mullan:        Why don't we go back.   Let's take it back to China.

What sort of work did they do in China, and why did they leave,
and what was that like?



Chen:     My father had just graduated from college.     He got a job

in the foreign service, and my mother--


Mullan:        This was in which part of China, Chinese China or Maoist

China?


Chen:     At that time it was prior to Maoist China.



Mullan:        From the foreign service of the Republic China as in

Chiang Kai-shek?
                                                                       3

Chen:    Right, as in Nationalist China at that time, and the

revolution was taking place.    They were in the midst of it, but
at least the diplomatic structure, as I understand it, was still
Nationalist China.

        So he got an assignment to go to Canada and to work within
the embassy in Toronto, made the decision to go with my mom.      My

eldest brother had been born in China, and they decided to bring
him along.     It was also a period of real substantial turmoil, so
in the back of their minds was whether or not they wanted to stay
in China.     They were not devout advocates of Communism, but they
were also fairly indifferent, recognizing some of the positive
side at that time.    But there was a lot of turmoil.   They'd been

living through the war and decided that it would be a good
assignment, they could try it for a few years, and if it didn't

work out, they could always come home.     So they went to Canada

with that in mind.    And then I have a second brother who was born

in Toronto.
     And then the revolution took place, and the embassy in

Toronto closed because half of the people in the embassy were
claiming they represented Nationalist China, the other half

claimed they represented Communist China.    My father, being
relatively apolitical, believe it or not--this is what he
claims--and quite an opportunist more than an ideologue, got an
offer for a job at the U.N. in New York.     The Canadian Government

told them, "Why don't you close your doors and figure out who you

represent, and then we'll do business with you again."    So he

took the opportunity to go to New York.
                                                                       4

Mullan:    This was to be a U.N. employee as opposed to a

representative of either faction?


Chen:     I'm not exactly sure who he was employed by.   I just know

that he worked with the U.N.


Mullan:    And that's when you lived in Greenwich?



Chen:     That's when they moved down to New York and they lived in

Greenwich.    Then, through a series of mishaps, he lost his job.
My father is a real kind of a Renaissance guy.     He's multi-
talented, and he was good with his hands, and he was quite
artistic and linked up with some friends who felt they could make
pottery and make a living by making pottery.      So he joined.   He

had two other partners, and they made pottery.     They had their
own kiln set up, and my mother got involved and did some of the
door-to-door sales, and actually within a period of less than two
years, they built up a pretty substantial clientele, including,

as I understand, Gimbel's or whatever in New York, and they were
actually trying to get an account with Bloomingdale's.      This is
what my mom tells me, so I don't know if it'd be verifiable, but
it's what she said.


Mullan:    But it burned down?



Chen:     Yeah.   What happened was they were on one floor and the

floor above caught fire--of another group--and in the course of
                                                                          5

putting the fire out, the water seepage ended up damaging a lot

of their molds and their kilns, and they hadn't kept up their

insurance.      So at that time it burned down, and my mom was almost
nine months pregnant.      They hadn't kept up their insurance, so

they were almost penniless.     They were quite resourceful and
assumed that they could figure something out.     But at that time a
social worker took my mom and dad under their wing and arranged
for me to be delivered at the Greenwich Community Hospital, which

I visited for the first time when I was doing my residency in New
York and invited my parents to come out and see it.         That's when
they told me this story, because prior to that I had no idea.


Mullan:     So what happened thereafter?   Did you grow up in

Greenwich?


Chen:     No.   We just lived there very shortly. My father couldn't

get a j o b .   He was pumping gas for a while, and then they tried
to resurrect the factory where he was working as an employee,
because he didn't have any finances and his partners did, and
that wasn't working out.      So finally he got an offer.    Another
friend called and said they had jobs out in California teaching
Chinese, and he was not a teacher, but--



Mullan:     Your parents spoke English?



Chen:     My father spoke English better than my mom.   My mother

spoke very broken English.
                                                                        6

Mullan:        From where were they in China?



Chen:        They were from a province called Fu Zhou, which is just

north of Canton, where most Chinese in the U.S. come from, and

it's right across the straits from Taiwan so it's still
considered part of southern China.       That's their hometown, and my

father actually spent a lot of his formative years in Beijing.
So he spoke Peking dialect Mandarin, which is, from a teaching

standpoint, the most pure, refined form of Mandarin, and that's
why he was approached.       He had a friend who was aware of these
jobs opening up at the Defense Language Institute in Monterey,
and he said, "You just need to know how to teach, teach these GIs
and whoever else comes through."
        My father, just being a little bold, said, "Sure, I can
teach.        I don't have any experience teaching, but I'll figure out
a way to teach.''      But his major attraction, though, was that his
pronunciation was excellent.
        So   we packed up our bags in whatever it was, a Woody, back
in those days, station wagon and headed out to the West Coast.
So we came out to the West Coast when I was about fifteen months

old.


Mullan:       To Monterey?



Chen:     Monterey.    We moved to the small town next to Monterey,

Pacific Grove.        I really was brought up there until the end of
                                                                         7

elementary school.     We moved to San Francisco when I entered
junior high.


Mullan:     What took you to San Francisco?



Chen:     What took us to San Francisco was my dad did very well.

He taught at the Defense Language Institute, became really an
excellent instructor, and got acknowledgment for all the time
that he was putting in.    My dad is a people's person, really
endeared in the hearts of a lot of his students, put in a lot of

extra time, the dedicated teacher.     One of the instructors left
the Defense Language Institute and got a job at San Francisco
State, and within a year or two had an opening and was able to
offer it to someone to come up part-time and teach Chinese again.
So he asked my father. My father moved up to State in '61.        He
moved up by himself for a year and was going back and forth on

weekends, and finally decided that we needed to move the whole
family, that it was a real permanent position, in ' 6 3 .   So my
whole family, unbeknownst to us, he just said, "We're going to
come up here for a summer and go to summer school and then go
back," and then all of a sudden when the fall came it was, "Nope.
We're deciding to move," and so we stayed in San Francisco.         So

then from junior high on, I lived in San Francisco.


Mullan:     What was that like?   Was your upbringing heavily in the

Chinese community or was it mixed?
                                                                         8

Chen:     Well, it was mixed because Pacific Grove was a very white

community, but it was interesting.      I've thought a lot about this
because I was trying to figure out where I derive a lot of my
compatibility with very diverse groups of people.       Our network of

family, friends, and relatives, and so on, we had virtually no
relatives because my parents were the only people that came over,
but they started bringing relatives over.      My cousins and a few
uncles and aunts were sponsored by my parents, so they started
coming, and we got to know them, but their network of friends was
all related to the Defense Language Institute.       It was almost
exclusively Chinese or that setting, all social activities I can
remember, all people that came over, and I have all of these

uncles and aunts because every single one of my parents' friends
was an uncle or an aunt.


Mullan:     But the Defense Language Institute surely taught more

than Chinese.


Chen:     Oh, yes.    Just about every language.   It was training GIs,

and we're almost sure, in retrospect, that it was CIA and FBI

people getting trained there was well, but most of them GIs who
were going to be placed or stationed in different parts of the
world.     So   they had all those countries represented.   But as far
as their immediate social group was concerned, the people they
interacted with and brought home were Chinese, with the exception

of their students, and we actually got to know a number of their
GI students quite well.
                                                                       9

Mullan:     Did you grow up speaking Chinese?



Chen:     Well, up until kindergarten.



Mullan:    Mandarin?



Chen:     Yeah.   It was a combination of Mandarin and their home

dialect, Fu Zhou, and the reason why there was even Fu Zhou
involved was because my father was trying to do his own "Roots"
thing.     He was brought up in Fu Zhou and left Fu Zhou, and so he
didn't speak his home dialect as well, and he was relying on my
mom to teach him, to refine his Fu Zhou.        So they would always

speak Fu Zhou, so we were pretty much--



Mullan:     Is that entirely different or somewhat different?



Chen:     It's very different.   It's like--1 don't know.    It's

probably the difference between French and German.       You would
find some similarities because they're Latin roots, but it's very

different.
        Then I went to school and encountered name-calling and funny
faces, all those things that kids do.     That time was a very
different time than now; teachers didn't necessarily call kids on
it.     It profoundly affected me.   I didn't want to be different.
My parents point out to me that I came home one day--my brothers

had never said anything; I'm the youngest of three--1 said, "I'm
not going to speak Chinese anymore because I'm an American,'' and,
                                                                      10

in fact, I was the only one born in this country. My older

brothers were born one in Canada and one in China.       I don't
remember saying that as much, but I do remember that I didn't
like being made fun of, and they said from that point on I really
didn't make any effort to continue speaking Chinese.
     We went through this period where, similar to a lot of

immigrant families, my parents would speak Chinese with us and
originally we answered them in Chinese.      Then we went through
this phase where we would answer them in English, because my
brothers and I would always--1 cannot remember speaking any
Chinese with them.    We always spoke in English to each other.     So

we would answer my parents in English, and this was mainly with
my mother whose English wasn't strong.      Then gradually over the
years, as my parents learned to speak English better, mainly my
mother, then pretty soon she would start answering us in English.
This is a very consistent pattern.      I've seen it played out with

a lot of Chinese immigrant families and other nationalities.


Mullan:    How do you feel about that now?



Chen:     Oh, I regret it.   I think, f o r me, I would have gained so

much by having a stronger language base, but I've been lucky.
Because I chose to end up going back and serving an immigrant
community, I've had a chance to really polish up my Chinese, and
in addition to that, even learning new dialects.       So I've learned
Cantonese in the course of the last fifteen years working with a
lot of immigrant Chinese.
                                                                        11

Mullan:     So you can get along in Cantonese as well as Mandarin?



Chen:     Yeah.   In the exam room.   In the exam room.   [Laughter]

And   that's the bottom line, you know.     I've encouraged a lot of

other people who are either children or grandchildren of
immigrants who've lost the language, I've encouraged them to work
closely with their communities.       You'll pick up the language
enough so that you can get along, you can communicate, and I
always suggest behind closed doors, because there's a certain
amount of embarrassment that creeps in when other people hear me

speak in Chinese.      It's a discomfort that I haven't been able to
totally get rid of yet to the point where I can just boldly speak
my poor grammar and my poor pronunciation.


Mullan:     I've acquired a working Spanish over the years which is

medically based, and I do quite well in a clinical setting, but
if you move to politics or cooking, my vocabulary falls apart.
However, I always speak it with a certain swashbuckling quality
because it's to my credit that I speak Spanish at all.        I never
thought about it.      If I was Fitzhugh Rodriguez and I was speaking

my chicken Spanish, it might be a burden to me rather than a

pride.


Chen:     You've hit right on it.     That's what I think carries a

certain amount of embarrassment because of the expectation, and,
in fact, you know, to deal with that, because it is a powerful
influence on your reaction to other people, speaking in front of
                                                                   12

other people, and I wasn't really conscious of this entirely, but

as I began to improve my Chinese, I would meet a new patient, and
I would always introduce myself and say in Chinese, ''I'm Dr.
Chen, and I'm pleased to meet you," and so on, and I would

say--the translation of the phrase is, "1 was born in America,
and I speak Chinese very poorly, but I'm willing to try, and if
you can understand me, then it's good, and if you don't
understand me, please let me know and I'll ask an interpreter to
come in."    And that was my defense, you know, kind of putting it
out there.    Usually I get a laugh as a reply, but more often I
got, "NO, I can understand you."    It was almost what you could
perceive as a hunger from them to find a doctor that could at

least understand some of the language and that they'd finally
found them.    So there's this reaction that was very warm and

accepting, and that's great.
     But the other part of the dynamic is that I always felt it
brought me down to their level and also engaged us in a different
relationship where they were the teachers, because then I would

proceed with saying, "If there are certain things that you can
teach me, then I would really appreciate it," and in fact, as I
was learning Cantonese and I continue to learn Cantonese, I would
frequently ask patients, "How do you say this?" A lot of
patients coming from China now understand Mandarin.   They may not
speak it fluently, but they understand it because it's so
pervasive as a national language.    I would just speak to them in

Mandarin when I didn't understand how to say something in
Cantonese, and I would ask, "HOW do you say this in Cantonese?"
                                                                          13

They would give me the phrase, and I'd just pick it up.       So it

was a good dynamic.


Mullan:     That's great.   So take me through, then, the balance of

your youth in San Francisco.      Where did career ideas start to
emerge?


Chen:     Oh, career ideas for me were not original.    My parents had

decided that I was going to be the son that became a doctor.          So

all I can remember when I was little--and I've discussed it with
them since then--they claim it was me, that when I was playing
with a doctor's kit, you know, somewhere below kindergarten, that

I was the one that started saying I wanted to become a doctor,
and I think it's also related to the fact that I broke my arm.             I
was run over by a car when I was about--how old was I?        I think
it was less than three years old, three or four years old.          We

had a family doctor back then in Pacific Grove, Dr. Still       .     I
still remember him, and I can see him.      He took care of everyone

in the family, and they say it was that experience, they think,
that drew me to wanting to be a doctor and having a doctor kit.
So all they did was just support me in my precocious career

development aspirations.       [Laughter] But I think they were
constantly saying, "Yes, when you become a doctor," and they
didn't say this with my older brothers.      We're not a physician
family.     So   that's where I think it came from.   I developed a

different perspective, more of a context for it in college,
                                                                       14

because prior to that I didn't really think anything, just that,
"Okay, I'm going to become a doctor."
        So   I went to junior high, public schools in San Francisco,
Herbert Hoover Junior High School, Lincoln High School, and in

those settings it was pretty mixed racially.       Especially in
junior high I ended up hanging out with all Asians, primarily
Chinese and Japanese at that time, some Filipino friends.


Mullan:       It was a more natural affinity to other Asians?



Chen:        It was a natural affinity because in junior high in San

Francisco it was like night and day.       I'd come from a small town,
Pacific Grove, population less than twelve thousand, very close-
knit community and also quite a mixed community because we lived

right on the border of the black community.       Actually, I walked
through the black neighborhood on the way to school and a number
of times linked up with friends of mine in the black community
and we walked to school together.       So there was this feeling.     At

the same time that I had those good experiences, I experienced
prejudice in school but on the level of name-calling, but it was

bad.
        In junior high, it just became more acute, and it was very
clear to me.       I had never had bad, real bad, relations with

different races, but man, it j u s t took another turn and went up
to another level of name-calling and real verbal abuse,

primarily, and then getting in fights with people.       So that's
what really created, I think, more the affinity.
                                                                     15

Mullan:    The Asian community was ostracized or simply delineated?

How did the rest of the community break out?    Was it white,
black, and Asian?



Chen:     It was white, black, Asian, and Latino.   You interacted
with everybody else, but as far as your close friends were
concerned, it was pretty split, and you went both ways.      In other
words, I hung out with my primarily Chinese and Japanese friends.

We were in a lot of the same classes together.      You know, we were
in the upper-level math classes.     I mean, we were in the tracked
classes, and so we socialized together.    But I still had some
white friends at that time who--1 was into slot cars and all that
stuff and some sports stuff.     I remember, though, I was real
naive at that time about racial relations, and I remember some of

my Chinese friends who'd been brought up in Chinatown, they're

the ones that would always blast white people and black people in

Chinese.    There's certain Chinese words that you use to refer to
whites and blacks as "ghosts."     It's very derogatory, but it's
not nasty.    So they would use those words, and that's where I
began to learn Cantonese slang, and they would tell me about,
"You can't trust these white ghosts and these black buttheads,

either one."    When I look back on it, it was one of those things

where their experience being in San Francisco and having a lot of
unfortunate negative relationships reinforced that, and I was
coming into that, getting affected by it.



Mullan:    So what, in terms of college, did you do?
                                                                    16

Chen:     It was a family discussion. My parents were the typical

Chinese immigrant parents.    They pushed education and the
importance of education.     I graduated from high school in '69, so
I lived in the Bay Area during all the Free Speech Movement that
was happening at Berkeley and the Anti-war Movements and the
Civil Rights Movement and Mario Savio and Abbie Hoffman and those

guys always in the newspaper, tear gas and all that stuff.    So my

father was real clear at that time that I was not going to

Berkeley like all the other people in San Francisco, all the
other Asians in San Francisco. All we did was say, "Oh, when we
go to Berkeley," because it was the best deal in town, and it was
close, and he just said, "Don't go to Berkeley.    There's too much
going on there."    Keep in mind that he'd been at San Francisco
State during the '69 student strike, the Third World student

strike, and Hiyakawa was there at that time.    But he wanted me to
be able to go to a U.C. system.

        So we picked something close by, so I ended up going to

[University of California at] Davis.    Davis was a real eye-opener

for me because here it was, this isolated, protected campus town,
Aggie campus, known for nothing but its vet school and

agricultural sciences and presumed safe, and that was where I
underwent my political education and really began to question
authority and question assumptions about our leaders, our
national leaders.
        It was the tail end of the Civil Rights Movement, and during
'69, the early part of '70, was when Nixon chose to go ahead and
bomb Cambodia.    So there was a flurry of activity on campus,
                                                                        17

anti-war activity and real protest, and it forced us to get

involved, because people were coming to classes saying, "HOW can
we continue in classes when we are bombing people in Cambodia?"
And I had to really think about that.

     At the same time I was going through my ethnic identity and
understanding more about ethnic history, because the San

Francisco State strike triggered off the impetus for starting
ethnic studies in a whole variety of schools.       U.C.-Davis had

already started the process and was developing an Asian-American
Studies Division. And they did good recruitment.         I was on

campus as a typical naive freshman, and they were sending their
people out to the dorms and different places saying, "Hey, if
you're interested, there's a class.     It's called - 3 8 ,   Applied
Behavioral Sciences 38, and it will teach you about Asian-

American history.
     I thought, "Well, this is interesting.       I don't know
anything about Asian-American history."      It blew me away.       I sat
through lectures hearing about people working on the railroad,

the contributions that were made by Chinese-Americans, the
Japanese-Americans developing the entire Central Valley, the

Imperial Valley in California, and then having it confiscated
when they were interned, raising questions about the whole

political motivation and corporate motivation for the internment,
and then realizing that these were American citizens who were put
in concentration camps during World War 11.       It was pretty eye-
opening stuff, and it really began to hit a chord for me and
resonate, this whole uncomfortable feeling going back to

childhood of being different and prejudice.
        I remember situations where I was afraid to bring Caucasian

friends home because I knew they would hear my mother speaking to

me in Chinese and they would hear my mother's heavy accented
English and it would be funny.       And     so it just brought up all
those memories and put them in proper context of prejudice and
racism, institutional racism.
        So I went through this intense political education that
centered on themes of ethnic identity, the racism in the United

States and historical events that I had never known and none of
my teachers ever taught me.        So it was a period that a lot of

people go through when they discover their ethnic identity on a
more sophisticated level, anger, and it's a real anger about

having been denied that history, and as a result of it, having to
go through all those uncomfortable settings, not understanding.



Mullan:     How did you deal with your parents on that?       Were you

angry with them for not having told you that, or they didn't know
that?     In a sense it wasn't their history.



Chen:     No.     It wasn't their history.    I don't ever think I was

angry at them.        I always just felt bad because I felt like they
didn't understand because they weren't brought up in this

country.        Because from their standpoint they always told us--my
parents were really good at reinforcing among us that we should
be proud of our heritage, and they would show us all the reasons.
                                                                       19

They would pull us into cultural activities.       I knew a lot about
Chinese culture as a result of my childhood upbringing, because,
in fact, that was their world, teaching Chinese culture in the
context of teaching Chinese language, and we had all that

richness surrounding us as we were being brought up.       We didn't
always appreciate it as much as they wanted us to, but clearly

they had given us enough exposure so that we could be proud of
our heritage.       It was always qualified by, "But they don't really
understand.       They don't really understand when someone calls you
a name, Ching Chong, or whatever it was, that it doesn't feel

good."     You know, all this cultural heritage doesn't make that
feel any less insulting and painful.       So it wasn't anger directed

at them.        It was just a matter of they didn't know this, and I
actually ended up sharing a lot of it with them as I learned it.


Mullan:     Did your brothers go through a similar experience?



Chen:     No.    My brothers went through, I think, different

experiences.       We all went through three different experiences.


Mullan:     Because of the age difference, time difference, or what?



Chen:     I think a combination of all of the above.    Age

difference, even though two to three years apart, but it's also
choice of friends and what they got involved with.

     My eldest brother is totally mainstream.       He's what people
refer to as the melting-pot person, definitely has pride in his
                                                                     20

cultural roots, but all his friends are white.    He's assimilated

and has not had any major problems or dealt with--1 think what it
is, his experience has probably been that it's never been that
bad that it's prevented him from getting what he wants, and he's

a very goal-oriented person, and so as a result of that, he
hasn't gone through any kind of ethnic identity problem.      And

part of it is, to his credit, I think he's probably, as a result
of being brought up in China a little bit more, he's probably
absorbed a lot of that pride that my parents [unclear]. He's the
number-one son in the family, too.     He's gotten a lot of
attention.


Mullan:     What does he do?



Chen:     He does sales for a software company, Oracle, which does a

lot of software.



Mullan:     And your second brother?



Chen:     My second brother, he's an electrical engineer, and he's

probably the most accomplished of the three.     He works as a
senior manager with a pretty large company called Cisco Systems
in Silicon Valley which does routing.     They control about 80 to
85 percent of the world market on routers, and this is what keeps

the Internet going.     It just routes incoming calls and makes sure

that they get directed to where they need to get within big
mainframes and so on.
                                                                          21

        Just to try and finish that one up, he went through his

ethnic identity in a real strong cultural way during college,
where he jumped into learning martial arts, doing the lion dance,
becoming part of a Chinese Cultural Association in his college

and putting on performances and getting that type of
acknowledgement.     He was acutely aware of the discrimination at

the same time, but he vented a lot of his uneasiness through
promoting culture and seeing everyone appreciate it.          I think

that validation did something to temper what might have been
otherwise some resentment or some anger.          I think that's the way,

and I vented my reaction, anger, in a very adolescent kind of
way.


Mullan:     Did you become an activist, or what happened at Davis?



Chen:     I became an activist.



Mullan:     What did you do?



Chen:     Well, first of all, I   L   as an ethnic actiT ist, and I had to

go through this period of anger where I didn't talk to white
people, "Get out of my face, you racist white bastard."          You have
to vent that out.    So I focused a lot of energy on a Third World

newspaper that we had.    One of my close friends was an editor, an
Asian editor.    There was a black editor, an Asian editor, a
Latino editor.     I wrote a few articles in the paper about ethnic
identity and dealing with racism.          Then I really got kind of on
                                                                    22

the soap box and was trying to organize Asian students to really

learn our history, recruiting for the classes, TA-ing in Asian-
American Studies classes.



Mullan:     Sounds pretty constructive, actually.



Chen:     Well, trying to be.   But the destructive part of it was in

rejecting white people and uniting more with Third World people
who have experienced similar oppression, trying to develop Asian

student organizations on campus so that people would come in and
really participate as a segue, as kind of a stepping stone into
getting into classes, where the political education really takes

place.    And then, campus-wide, ran for Student Senate, became a
student senator advocating support for community activities where
a lot of the immigrants were dealing with some real-life

problems.
        That was kind of the tone of the activism, joining with
other groups at times on anti-war activities, protesting against

the bombing of Cambodia, really kind of doing it half-heartedly
because I was really learning about it and trying to understand
at the same time, really just trying to strengthen and support
the development of our Asian-American Studies and its survival,
because it was always under attack by the administration, and so
it meant not only the recruitment, but also dealing with issues

like tenure for faculty and also sometimes the budget cuts that
would affect the division, the threats of always being cut back.
                                                                        23

Mullan:     How did your medical plans play in all this, and how did

they develop?


Chen:     Well, that's where the medical plans began to change,

because at that point, as I learned more about the history of
immigrants in this country, particularly Asian immigrants, and

began to resent and question authority and the way things had
been, then I began to l o o k critically at our health care system

and how are health needs being addressed for immigrant
populations and, in fact, low-income people.      That's where that
idea seeped in of, "Gee, if I'm going to become a doctor, then
what am I going to be directed towards?"      I began to formulate

that I needed to become a doctor to serve the people.
        And that was about the time that Felix Greene started making

all these trips to China, and I read a book called T h e E n e m y by

Felix Greene, and really got sensitized to U.S. imperialism.        I
started reading Mao.     "Serve the People" was one of his essays
that really hit me hard because it really resonated for me, and I

felt this dedication, this growing dedication to serving the
immigrant community that was having the hardest time with
language barriers and income barriers and so on.



Mullan:     It didn't dissuade your interest or intent on going into

medicine?



Chen:     No, it just added to the context.
                                                                    24

Mullan:    Before that, had you envisioned what kind of doctor you

were going to be?



Chen:     The only thing that I really had worked up to so far at

that point was becoming a family doctor.


Mullan:     So you had that in mind before?



Chen:     It was a totally superficial thought.   I was not the

student that--it was not the meticulous, methodical approach to
career development.     I didn't go to volunteer in emergency rooms

and volunteer in doctors' offices.     I had no idea, other than my

direct experience as a patient, what being a family doctor was,
but that was a powerful experience for me.     So the only thing
that had really sunk in was becoming a family doctor.     So the
college really had the biggest impact, and it was all those
movements that were going on that I think brought out--it was a
way for me to vent some of the anger and resentment.



Mullan:     So what happened next?



Chen:     So what happened next is that I got rejected from medical

school on my first try.


Mullan:    What did you major in?
                                                                       25

Chen:     I had majored in zoology, and it forces you to think.       But

it also happened at a time when China was opening up.       This was
in ' 7 3 , after the Nixon trips.   My maternal grandmother, who was

my only surviving grandparent at that time, was still in China,

and my mother, several times when I was younger, I remember, was
trying to get her out and actually made one trip when I was in

fifth or sixth grade, went back to Hong Kong and tried to get her
out through Hong Kong, because she was told that if she went to
Hong Kong it might be easier.       So after several years of failing

to get her out and then maintaining contact with her, after the
Nixon trip she started hearing from friends that had been able to

get visas.     So   she decided, "I've got to try.   It sounds like
it's opening u p , " so she got visas, and no one in the family
could go with her except me, because I was conveniently
graduating from college.      I'd gotten rejected from almost every
single med school that I had applied to, and so I was available.
So   I went to China with my mom, and that also had a very profound
effect.


Mullan:    What was that like?



Chen:     That was incredible.   Here I ' d read about Mao and all this

stuff, and there was a certain amount of ethnic pride,
nationalistic pride, because, in fact, Mao had elevated China's

international status and through a number of the accomplishments
had created something that China c o u l d be proud of, and all the
news media and everything that were on Nixon's trips brought out
                                                                        26

some pride in being Chinese, something that I hadn't really been

able to experience nationally, I think, or feeling in the
mainstream U.S. up until that time.        So I was going back to see
the people.      I was going back to the homeland.    In fact, on the
newspaper we had, the Third World newspaper, I was going to be
the correspondent in China and writing back these reports on the

trip, which I did, and it was a real adventuristic kind of
experience.
        What it did was it was a reality shock.     It was a culture
shock.     I discovered right away that I was not Chinese from
China, that that was not my homeland, but at the same time I
really just admired--we went on tours to factories and communes
and learned about the way--you know, the typical Vic Side1
promotion story.        It was all there, and we were real impressed.

And yet, my mom, in her own way, cautioned me on the way I was
interpreting the whole experience because, in fact, every time we

went to a city--keep in mind that China really wasn't opened up
at that time--


Mullan:     This is 1 9 7 4 ?



Chen:     This is 1973.     Every time we came into a new city, she was

interrogated by the local Communist party, asking very, very

sharp questions about, "Why are you coming back?       What are you
trying to accomplish by coming back?       Who are you coming back to

see?''    You know, just a real interrogation.     So she was extremely

uncomfortable almost the entire trip, and she never really
                                                                      27

revealed that to me, and I was just soaking it up, saying, "Wow,
man, in this factory they've got a workers' committee, and it
l o o k s after the health of the workers, and they're organized, and

if they don't like what's going on, they present it to the

governing structure that they're a part of, and they change
this."     So   I mean, I was just soaking it all up, all those things

that were really happening and I was witnessing them.


Mullan:     I'm a little confused.     On the one hand you said you

found out you weren't really Chinese in the sense of being of
that country.       You were impressed with the political structure
that conformed with at least the public relations side of the
Communist movement.


Chen:     Right.



Mullan:    And     I say that with fair neutrality.   I mean, I

understand what you're talking about.



Chen:     That's exactly it.



Mullan:    At the same time there were repressive things going on

which your mother was experiencing.       Sort that out for me a
little bit.      How did it all weigh for you?



Chen:     I think from the ethnic identity standpoint of feeling,

wanting to feel the pride of Chinese, it was kind of all these
                                                                     28

mixed feelings.   I discovered that I wasn't Chinese because I

wasn't like them, the people, walking the street in my Levis blue
jeans, and everywhere we went we attracted a crowd, you know,
because you are visibly different, and my hair was a little bit

longer whereas everyone else had short hair, every other male had
short hair.   Everyone wore the real--those dull colors.   It was

either the navy blue or the gray or the green, the army green.
Those were the colors of the outfits, the pants, the Mao jackets,
whatever it is that people wore.     If it wasn't a Mao jacket, it
was a Mao shirt, and if it wasn't a Mao shirt it was a t-shirt.
So I looked visibly different.     So that was not a good feeling

going back, because it shattered my whole view of going back to

the homeland and me being with the people.
     But then the political side through my political education
and seeing a lot of the accomplishments of China, which
catapulted into the international limelight, and its achievements

and prominence, I still had a pride in that, because even though
individually I was confronted with the reality that I am not the

same as they are, I was still connected, and as far as the
international image, I was connected to that back at home.    So

there was a lot to feel proud of on that level and seeing that
validated, at least in words, by the people that we came in
contact with.
     The part that my mom was going through was not really as

evident to me at that time, but it came one day when I saw these
posters, these huge billboards, and they still had, even after
the Nixon trips, they still had in several areas, "Fight Down the
                                                                    29

American Capitalist Running Dogs."      It was all in Chinese, but I
saw these things and said, "Wow, man, cool" and went to take
pictures of all this stuff because I wanted to show it to my
friends, "Yeah.      They still have it there, 'Fight Down the
American Capitalist Running Dogs' and 'Down With Imperialism' and

all this stuff,'' and I went to take a picture, and my mom grabbed

my hand and said, "You can't take pictures."     And I looked at
her--


[Begin Tape 1, Side 21



Mullan:     This is Dr. Chen, tape one, side two.

        Continue.   So your mom--



Chen:     So she grabbed me, really grabbed my arm, took my camera,

put my camera down, and said, "You will not take a picture of

this."     I was real perplexed, and I said, "Why not?    This is
really good stuff," and then she shared with me a little bit

more.     "We don't know whether we're going to have to hand over
this film    when we leave."
        We, in fact, came in with a lot of the stereotypes that
other people had about "Communist China," and we were concerned
about perhaps not being able to come out, that we were going to
go in but we weren't going to be able to come out.       So I had even
worked out codes with my brothers, saying, "If I say very
nonchalantly, 'Oh, no.     We want to stay here forever,' then take
that as an automatic, 'Send in the State Department and contact
                                                                           30

them; we're being detained.'"       I was aware of some of that

concern beforehand.


Mullan:     Did you get stuff confiscated?



Chen:     As it was, we had nothing confiscated.



Mullan:     So other than her experiences, it was more the aura or

the concern about it happening, but you didn't get--



Chen:     It wasn't real, yeah, at least for us.



Mullan:     You didn't experience it.



Chen:     Yeah.   We didn't experience it, even though we know other

people did, and that was part of the precaution that she wanted

to take, that we didn't have to go through that.



Mullan:     So you came back from China.    What happened?



Chen:     Well, I came back from China, and I was ready to wave the

red banner.       I was psyched.   I was pumped up.    I had all these
stories to tell.       In addition to that, I think one of the other

issues for me in that China trip was that I had become very
curious about Chinese traditional medicine.           I had read quite a

bit about it during college.        I was already interested in
college, and this was a chance to go back and see it practiced.
                                                                       31

And so we went to a number of health facilities, and I actually

got to go into the operating room when they were doing
acupuncture anesthesia.      Remember those films that came out of

China?     So I   got to do all that.   Forget about patient

confidentiality on this stuff, just neurosurgery and removal of
thyroid adenomas with acupuncture anesthesia.
        So I was so impressed with all that, I wanted to study it,

and then in my mom's way of thinking and doing the best for her

children, she realized I was rejected from medical school and
realized there had to be something that we could do to give me a
second chance.      So she suggested, "Why don't you try and study
acupuncture while we're here?"      So I actually studied acupuncture

when I was in China through more of an apprenticeship.         She had a
distant uncle who was dean of a medical school and retired, but

maintained relationships with a number of students, and made an
arrangement for me to tag along with the local barefoot doctor in

going out and seeing his patients.       He brought me along, showed
me, and then pretty soon had me doing things.


Mullan:     Did he practice acupuncture?



Chen:     He practiced acupuncture, yeah, in true barefoot doctor

fashion.    When I l o o k back on it, it's amazing.   He was spreading
Hepatitis B, no doubt about it, because he didn't sterilize his
needles.    He used alcohol on his needles, and I'm sure if you did

an epi-investigation, you'd just discover this whole spread of
Hepatitis B from his needles.
                                                                         32

        But anyway, we tried to stayed in China longer.      We actually

stayed for three or four months.       And, of course, it was a big
boost to my Chinese.        I really got back a lot of language and was
charged up.       We tried to stay longer.   We stayed about six weeks
in Hong Kong trying to get my grandmother out.



Mullan:       Six weeks in addition to the three months?



Chen:        In addition to the three months, yes.   I got signed up in
an acupuncture training class in Hong Kong, so I went under this
intensive six-week study of learning all the acupuncture points
and learning theory of acupuncture with an instructor, and that

was really good.
        So   getting back to your question of what happened after we
came back, I was ready to bring acupuncture, traditional
medicine, and Mao theory and thought to the world.         So I had a

year because I didn't get into med school.
        I reapplied, and in the meantime, one of my summer jobs was
drawing blood at U.C. because we lived in San Francisco, so I
went back and tried to get that job again just to make some
money, and it only offered part-time job.        So I went down to

Chinatown and I started volunteering.        I knew a number of people
in Chinatown because they're all Berkeley radicals and people
that I knew from the Asian-American studies days.         We linked up
with each other across the U.C. campuses and so on.         So I knew

some of these people.        I didn't know all of them.   And I just
started volunteering.
                                                                       33

     There were a number of activities going on.        There was a

place called the International Hotel, which was a big local issue
in San Francisco about corporations and low-income communities.
The International Hotel housed a lot of low-income elderly

Filipino immigrants.        That was their hangout.   That was their
life.        That was their community.   Then there were a number of

other sort of human service groups but actually just community
groups, grassroots community organizations, Chinese progressive
associations that were tied to political organs, and a lot of
Maoism, and Everybody's Bookstore was there, the equivalent of a
progressive bookstore, all on the same street.        There were these

big corporations that were trying to buy up the whole block and
turn it into a hotel and turn it into a commercial--and there's
the community struggle preventing that for several years.
        So    I just jumped into that, started volunteering, saying,
"I'm willing to do acupuncture for people coming in."        They just

thought I was nuts.       The reaction to me was just, "Who the hell
do you think you are?"        [Laughter] And so that took me back

because I was in this bubble.
     But what I did was, after getting thoroughly rejected from
what my agenda was, I latched onto a volunteer group that was
developing eye screening and referral systems for people living
in the Pingyuen projects.       This is a low-income housing project
in Chinatown, probably one of the oldest housing projects in San
Francisco Chinatown.        In their basement there were a number of
volunteers from Berkeley that would come in once a week in the
evening and enlisted the help of some local ophthalmologists,
                                                                                    34

very community-oriented ophthalmologists, who had volunteered to

do eye screenings for cataracts and glaucoma.                    So we would do
health education, we would organize it for them, we would get all

the people coming in, we'd do the registration, all of that.

Then if they needed referrals, we would make sure that they got
referred out.
        So I just joined with them in volunteering.                 I got to meet
the whole student group, the set of students that were trying to
do stuff in the Chinese community.                    Then one thing led to
another.       We ended up going through study groups and learning
about the health care system, learning about HMOs and what they
were way back then.
        Health PAC was introduced, and so we would read health PAC
articles on Kaiser and all the abuses.                    Tom Bodenheimer had

written A m e r i c a n H e a l t h E m p i r e .   I started reading that and

B i l l i o n s for B a n d a i d s , Tom Bodenheimer and gang, and I mean my

eyes just really opened up to what the hell was going on with our
U.S. health care system and how it really wasn't designed to

serve the people.             Next to this immediate experience of seeing a
country that was oriented towards serving the people and being
convinced that that was real, I recognized the huge discrepancy,
and then on a more sophisticated level, I think, began to better

understand what needed to happen, so that I wasn't going to

become just a family physician.


Mullan:       So you reapplied?
                                                                       35

Chen:     So I   reapplied, and I got into one school, and that

happened to be Davis, and it happened to be because I played the
traditional medicine card, that my goal was to bring two forms of

medicine together because the community that I was going to serve
was a community that came from that culture.       So if you didn't at
least have an understanding of it, then you weren't going to be

providing services in the proper cultural context, framework.
        Little did I know at that time that we were really talking
about cultural competence.      That was my ticket, because I was not
an outstanding student, and I'd already missed the typical screen
first time, didn't even get an interview.       So something in my

application hit somebody.
        Davis had a reputation at that time as being a progressive
school because it was new, it was attempting the organ system

approach, and it was spreading o u t the curriculum so that you
would go to school only a half a day and you would have another

half a day to take clinical electives in your first year, which
was almost nonexistent in most med schools at that time.       So I

got accepted.


Mullan:     Tell me about medical school.   We need to move a little

quicker, so why don't you give me a synopsis of what medical
school years were like.


Chen:     Medical school years in quick form.   Reinforcement of the

values and the direction that I wanted to proceed in because of
an outstanding peer group.      We had an older class.   The average
                                                                  36

age of our class was somewhere around twenty-seven or something

like that, a lot of Berkeley radicals, a lot of feminists from
Berkeley, and a number of family people in the class, older
students with families, more mature, and so I learned a lot from

them.
     What I learned the most was that you could speak up and not

have to take all the crap that they were dishing out, you really
didn't.    You can imagine in those days, if a prof dared to make a
sexist comment, dang, the women would come down on that guy so
fast and so hard that they didn't know what was going on.    One of

our OB profs, I remember him saying--he was talking about ladies
and this stuff, and then he stopped himself, said "Women." He
says, "I'm getting so confused about what to call them I can't
even go on with this lecture," and that really stuck out.

[Laughter] It was more enriched political education dealing with
issues of sexuality.
        There were a couple of major events in medical school that I
think capture what the experience was--continuation of the theme

of questioning authority, resenting being in the learning role
and having to depend on the professors in medical school to learn

this knowledge that I was after, but at the same time, their
representation of their values contrasted so much with what I
felt their values should be.
     A good example of that is, I actually had to sit through a
lecture, an ENT prof who gave a lecture, and when asked by one of
his students about acupuncture, because at that time all this
information was coming out about acupuncture helping deafness,
                                                                         37

when asked about that, referred to one of his close colleagues, a

buddy of his in his residency who had been researching
acupuncture in Taiwan, and he said, "1 asked this dingaling, and

this is what he said," and then he went through this stereotyped,

Chinese-accented English caricature of slanty eyes and buck teeth
right in front of our entire medical school class telling him
about whether it worked or whether it didn't work.         And it was so
long.     It was like a moment frozen in time.

        I was sitting there watching this, and I just couldn't
believe it, and I just started looking around the room, and
people are like all over the place.       So I remember raising my
hand before he'd finished and just calmly sitting there going,
"Okay.     You've got to say something because this cannot go on,"
and wondering should I interrupt this son of a bitch because he

hasn't finished yet, and it's continuing to go on?         I thought I
was raising m y hand for hours.      Finally he recognized me, and I

just said in very calm fashion, ''1 really resent having to listen
to this kind of--"       and before I could finish, he just tore into

me.
        He blasted me.    He says, "What is wrong with you people?       I
heard about you guys.       You guys don't have a thick skin.   You
don't know what the real world is all about."       He just

started--and at that point I lost it.       I just stood up and told
him I thought he was full of shit if he thought that I was

supposed to have a thick skin in dishing out this kind of racist
rhetoric and caricatures and so on.       I was just livid, and I just
said, "Fuck you, man."       I just walked out of class.
                                                                         38

        It was a really terrible experience, because at the point

that I was leaving the classroom, I was just seeing my whole
medical career dwindle away.         I was really convinced that I was
going to get kicked out of school.



Mullan:     Which year was this?



Chen:     This was 1 9 7 4 .



Mullan:      Freshman, sophomore?



Chen:     No, 1 9 7 5 .   It was in the summer of '75, so it was in

between my freshman and sophomore year.         It was my second year.
Davis didn't give you a summer vacation.         You just went straight

through.


Mullan:      So what happened?



Chen:     So within five minutes, two-thirds of the class emptied

out.    This is the benefit of the older students in class, they
all approached me and said, "Art, we need to go talk to the dean
right now, because you need to make sure that they hear your side
of the story and hear our side of the story before they hear it

from him."       So they ushered me over, and we couldn't get to the
dean, but we got to the dean of students and just explained what
had happened, and he agreed.         He said, "This is absolutely
outrageous, and we will definitely look into it."
                                                                     39

     So that led to a petition where we denounced racism and

sexism, any form of it in the classroom and particularly in a
medical institution that's publicly funded, and published it in
our school newspaper.      If I'd known then what I know now,
obviously, I would have had that CC'd to the local newspapers and
to the AAMC--this guy was an ENT prof--to his specialty society

and all that kind of stuff, just to vent all the anger and the
anguish.   But I didn't.    But it was effective enough because it

was very therapeutic to vent a lot of it.
     Ultimately I did get to talk to the dean and went in to talk
to the dean with one of my classmates, a woman who had helped
guide me through this process.     That was really a real awakening
for me, because then I realized what you could do, that you
didn't have to take this stuff, that even in what appeared to be

the worst possible situation, where I had felt I my medical
career was just going out the window, you could turn it around

with the right action and tapping into the right strategies and
the right people, you could make your point, and justice can

prevail.
     As it was, he got reprimanded.     He didn't get fired.    He got
joked with and all this, and he had to put up with a lot of stuff
coming from his colleagues.     Then when I went into my clinical
years, lo and behold, I got on his service. After talking with
the Dean of Students originally, we came back into the class
afterwards and talked with him, and things had already calmed
down at that point.   He was pretty unsettled, and people that

stayed in the class said the lecture just did not proceed
                                                                     40

anything according to plan.    And he did vent at me at that time,

but we continued the dialogue.


Mullan:    You said there were two medical school events.



Chen:     The other was that we had a free clinic up in Sacramento

that was called an Asian Free Clinic.     It had been started by
some medical students in a few of the earlier years, and it was
the low-income housing projects in Sacramento where a lot of
Asians were, mainly Chinese immigrants, non-English speaking.
One of my profs, a doctor named Lindy Kumagai, he was the

supervising prof, he ran it and he encouraged people to get
involved and made it available to Asian students.      Upper-class
people would organize us and try to pull us in and train us.        It

was getting to play doctor at an early stage, which is always
attractive when you're in medical school.


Mullan:    What is Dr. Kumagai's nationality?



Chen:     He's Japanese-American, second generation.   He went to

camps during World War 11, and we never really talked about it
that much, but he was really a role model.


Mullan:    And that clinical experience was good?



Chen:     It was good experience, and it kept it alive.   It kept

focus on where I was headed, which is real critical during med
                                                                           41

school.       Most of the students get swept up into just studying

medicine, to be a good doctor so that no one's going to die as a
result of a mistake, and this really helped me keep that goal and
that vision of where I was headed alive and reinforced.



Mullan:       And were you there during B a k k e ?



Chen:        Yeah, and that was another part of it.



Mullan:        Between the time he was rejected and the time he was

accepted was several years.


Chen:        Yeah.   It was several years.    He didn't come into Davis

until after we graduated.          In fact, the year after I graduated,
in ' 7 9 ,   he started, and that was a big issue for us, particularly

for the Third World students at that time.            We organized

anti-Bakke demonstrations.          We organized a big conference. Allen
is his first name.         I'll never forget his name.    We were one of
the classes.         He applied for two classes, the class before us,
and then he applied for our class and was also rejected a second
time.        That's why we got a lot of national news, national press,
and at our grad,uation. I made a remark--I was our class speaker

at graduation, so I couldn't pass up an opportunity to mention

the Bakke decision.



Mullan:       Had the decision already occurred?
                                                                      42

Chen:     At that time, yeah, the decision had already occurred, and

it was just matter of knowing that he was going to get admitted
at some point.


Mullan:     In a sense, affirmative action had taken a hit through

that.



Chen:     It had taken a big hit.   I don't recall as much, when I

think back on it, knowing what impact it had locally because I
was in my fourth year, and I was all over the country doing my
rotations, but I do remember that when we did get together and
try and explore, faculty who were more sensitive to affirmative
action policies were very disgusted with the atmosphere after the

Bakke decision and recognizing that he was going to be coming

through, gearing up to try and be accepting.
        So anyway, that was very influential, I think, because the

B a k k e decision kept an issue alive, a controversial issue alive

throughout the first two years, which is the years that the whole

class is together, and I'd say it divided our class.     It was a
clear wedge between the minority students and the white students,
except for the progressive feminists in the class.     They tended
to side with the minority students.     We had coalitions and stuff,
but, you know, there was a wedge.     I mean, there were people that
you just didn't talk with in those days.     So it added to, I
think, some of the division and the divisive experiences then.
                                                                      43

Mullan:     What then, as you looked to becoming a doc and doing

residency, did you plan?      What did you think?


Chen:     Well, that experience pretty much sealed that I wanted to

go to a relative17 progressive residency program.      So I had three
choices at that time that I knew of.      There was San Francisco
General.     I was still going to be family medicine, and it was
real clear that to have the breadth of skills was real critical
because you needed to able to go anywhere where you were needed.
The more you could do, the better.      So that solidified family
medicine for me, and plus, the other thing is that going through
the actual medical rotations, it was real clear I didn't want to
become any of the primary care specialties.      I just did not have
the best experiences with any of the people, no role models or

anything.


Mullan:    Were there in family medicine?



Chen:     In family medicine more s o I even though they weren't doing
what I wanted to do, but they were more open to what I wanted to
do, whereas in internal medicine they couldn't relate to the

politics of what I wanted to do, and the same thing with surgery.
Forget it.    But it was mainly a values clash! whereas in family
medicine, even though all my instructors were white, they were
very supportive of what I wanted to do.      In fact, at the end of
my second year, where I would have normally gone straight into
third-year rotations in the summer, I took some time out because,
                                                                        44

I explained to one of my profs, I needed to get back to doing
some more community work to feel that I could handle the upcoming
clinical years where I was going to be real isolated.         They were

sympathetic; in fact, made a family practice rotation for me

where I could do that during the summertime.        So it was more of
feeling of support for my political lean towards community work
that reinforced the family medicine.
        So   then the residencies that I was thinking about were urban
residencies.        I knew I wasn't going to go out into rural areas
and become a surgical-type family practitioner.       And so it was
San Francisco General, it was Cook County, and it was Montefiore.



Mullan:       You chose Montefiore.



Chen:        I chose Montefiore.


Mullan:       What was that like?



Chen:     Montefiore was--well, it's the best in the West, clearly

an outstanding training program.


Mullan:       You're talking about Montefiore in the Bronx.



Chen:     Montefiore in the Bronx, right, the Residency Program in

Social Medicine.       Jo Boufford was the director at that time.   Bob

Massad had just come in, the year that I went in, as the head of
family practice.       Hal Strelnik   was on his way out and had just
                                                                   45

graduated, assuming a position at MLK, and a lot of this aura of
the residency program in social medicine was [unclear].    But I
had also, in the interviews, really learned a lot more about it
and had had a dialogue with Vic Sidel a couple of times about it,

and he encouraged me to apply.
     So   the best part of it, clearly a superior medical training.

I mean, I felt like it was just excellent, and I felt very
reassured that I was getting good training.    It was character-
building because you had to fight for family practice there.    You
were in the tertiary care center in New York City, the bastion of
specialty care, sub-specialty care.    I had to really fight
throughout the residency to get good training, even though it was

sitting there.
     The example was, I remember being on cardiology rotations

where the cardiologist would say, "Oh, you don't have to learn
this, because you're a family practitioner," and I'd take him to

issue and say, "Wait a minute.   You'd better teach me this
because I'm not going to be able to have a cardiologist all the

time to call on in the settings that I'm going to be working in,
so if I don't learn it, you're going to be responsible for me
being a shitty cardiology person," and on and on and on.
     Same thing with doing procedures.   The dermatologist said to
the interns, "You do not want to learn how to do a skin biopsy,
because if you need to do a skin biopsy, you'd better call a
dermatologist," and I'd counter with, 'rIrm
                                          not going to have a
dermatologist to call so you've got to teach me how to do there

or you're going to be responsible for me not knowing what to do
                                                                     46

and not having any other option for a patient who's out in the

middle of nowhere,'' and I played the rural family practitioner
stuff.
     Anyway, I think my ability to fend for family practice in a
hostile world equipped me to deal with family practice anywhere.
Then the other part was clearly the political climate.     I mean,
the biggest treasure, I think, and asset in the residency program
were the residents.    David Stevens was a close associate, and

Kevin Fickenschen that's where I met them and just immediately
developed very close relationships with them.    I just admired

those guys because they had done so much already.


Mullan:    Where there other Chinese residents at all?



Chen:     There was one who was the year ahead of me, was a guy

named Ken Ong, who actually became a deputy commissioner, I
think, in the New York City Department of Health.    But really, we
didn't connect as much.    We just didn't connect.   He was off

doing his own thing, and he wasn't trying to mentor me or
anything like that.    They're busy enough.

        The other part of it, liberal faculty, not progressive
faculty, and that was the part that was a little bit upsetting.
I think that's just part of the adolescence of being in training.

You appreciated having liberal faculty, but when push came to
shove, they towed the party line. We had a big strike in our
third year, and they were telling us, "If you don't come back and
                                                                     47

you don't come o f f the picket line, we're going to have to--"

They were doing the same threats.


Mullan:     This was a city-wide strike?



Chen:     This is a city-wide--



Mullan:     CIR, Committee of Interns and Residents?



Chen:     Yes, CIR.   Exactly.    CIR strike, and they (RPSM Director)

came up with the same kind of rhetoric that was coming out of all

the other department heads, and we really resented that.       But

that was just one real sticking point.       Overall, the direction of
the program, the emphasis on COPC, the emphasis on being out

there in the community, in the South Bronx, and everything they
were trying to do with MLK, all o f that was just the best

possible.



Mullan:    And which years were these?



Chen:     This is '78 to '81.     It was just the best possible place I

could be, and I really appreciate the training.



Mullan:     But there was a down side?



Chen:     But the down side was just the constant expectation o f it

being a progressive program, so why couldn't the faculty be more
                                                                       48

progressive, and really wanting to see them take the lead
politically but failing to see that, even though they really
were, just that they weren't doing it in a way that we would

recognize and understand at that time.    Because they had to deal
with just survival of family medicine in that whole setting, and
that was their priority, was to consolidate strength and

foundation for the Family Medicine Department, not to sit there
and advocate progressive politics.     They were doing what they
were saying by the fact that we were building the ambulatory care
network in the South Bronx.     So they were taking action steps,

but for whatever reasons it just wasn't as appreciated because

they weren't supporting house staff strikes.     So in retrospect, I

have a greater appreciation, but at that time you would expect
them to fulfill all your needs.


Mullan:     So when you got done, what did you do?



Chen:     Well, one profound experience during residency also.     I
did a rotation with Jo Boufford and asked Jo, with about five
other residents, we really appreciated--


Mullan:     Was she with Health and Hospitals then?



Chen:     No, at that time she was the director of our residency

program.     In fact, she had just spent a year as a White House
fellow and came back to the residency program during my final
year.     I'm sorry--it was the second year of the residency
                                                                    49

program, where, towards the tail end, we had some elective time.

I wanted to make sure that we could learn from her, because her
skills were very evident and impressive.    We wanted to learn
health administration and what it is that you need to know in
order to be effective out there in any kind of a setting.     So she
taught us for a month.   We did a one-month rotation with her

where she basically taught us organizational skills.    We worked
on a project, developing a feasibility project for an ambulatory
surgical unit at Montefiore, the last topic that I thought I'd
ever be spending time on, but the most instructive for learning

planning, health planning and management, because you had to l o o k
at issues of governance and HSA's at that time and equipment and
capital expenditures and all this kind of stuff, and staffing and
so on.

     She would videotape our meetings.    She had us videotape our
meetings, and then she would go to the videotape and she would

tear us to pieces.   She would say, "Art, when you said this, look
at Jim.   Look at the reaction on his face.   Did you realize that

you were--"   "What did you feel, Jim, when Art said--"    She would
just go over this stuff.   Everyone was on the hot seat.   And, of

course, she did it in supportive ways.   But I just learned so
much about the sophistication of team development and
interpersonal dynamics, organizational psychology.     It was yet
another set of skills that you realized added to that experience
of how to deal with deans and difficult people.    I kind of felt
more empowered and realized that, yeah, you can get involved with
                                                                            50

big institutions and have an impact and make a difference.        So

that was a very memorable experience.
        So    after residency, I immediately went straight down to
Chinatown, Chinatown Health Clinic in New York City.         I wanted to

become a staff doctor.        So I applied to be a staff doc, and they
didn't have any positions.        The only position they had was the

executive director position.        So I became an executive director.
[Laughter] I didn't know shit about being an executive director
in a 330 clinic, but learned real fast.


Mullan:        Three-thirty as in a community health center?



Chen:        Yeah, community health center, PHS 330.   At that time

there were still about five hundred centers nationwide.         I was
essentially in an apprenticeship, just learning by the seat of my
pants, but had this sense of what needed to occur, worked semi
with the board, didn't understand community boards, didn't have
someone teaching me that the first thing you have to do as an ED
is establish clear, close working relationships with your

community board, keep them informed.        They are top priority.      I
didn't understand that.        I developed a whole beautiful set of
goals and objectives and engaged staff in that process, but
really took the initiative to j u s t kind of do it because I knew

what was necessary.        I went over and actually presented it to

staff, presented it to board.        They actually liked it, but they

really resented the fact that I didn't consult with them.        Lesson
                                                                       51

number one in working with community: work with community.       So I

had a rocky year.


Mullan:    Had you had connections with Chinatown, either the

health center or people in Chinatown, during your residency

years?



Chen:     During my entire residency, I was a volunteer physician

there.     In fact, I negotiated with Bob Massad to have one of my
three outpatient clinic sessions done at Chinatown during my
residency.     So I was there even though there was no preceptor on
site, but there were board-certified docs there, and even though

they weren't faculty, that was acceptable to the program.       They
weren't family practitioners.     There was a pediatrician.

        So I worked there and then ultimately ended up leaving after
a year because of a union drive that was taking place under my

leadership.     [Laughter] There was a progressive bit of
organizing going on in the Chinatown community, and there were

groups that were trying to organize restaurant workers.       Some of
the people related to that after working as staff in the clinic
and decided that if they organized and unionized our staff, that
we would become the flagship in Chinatown for showing that
unionization really worked and was good and even the community
health center was doing it, you know, community service did it.
And, of course, they felt it would be great to do it with me

because I was a progressive director, so I would be able to speak
                                                                          52

to all the positive side of it.       What they failed to do was

include me in the plan.
        So I   had no idea that this was the agenda they were
operating with, and what I got hit with at the end of my first
year, after having gone through this process with the entire
staff, looking at our goals that were marked out and assessing

where we had come and where we had failed to achieve our goals

and what we had accomplished, but having a really good staff
meeting, having accomplished a lot of what we had set out to do,
and my asking people for feedback at that time, I came away from
that meeting feeling like I had a pretty good response from

staff, and then the very next day being hit with a union drive
letter.


Mullan:        From the union?



Chen:     From the union that was organizing the staff.    And then I

was sitting with my management team and asking them all, "DO you

know anything about this?        Where is this coming from?"    It just
took me totally by surprise.       No one acknowledged that they knew
anything about it, and then I discovered later that there were
three people on the management team that were actually part of
it, spearheaded the organizing drive.
        I ended up resigning because I couldn't deal with it.       I was
too, I think, young and immature.       When I tried to get legal
consultation from community legal aid groups, people originally
wouldn't talk to me because, they said, "Well, you're
                                                                     53

management," and it was only after really taking them to task,

saying, "Get out of your box.     You know who I am.   Don't give me
this management crap.      I'm trying to do what was best for the

community and working within this organization and really
struggling with it," because they were people I knew and worked
with in coalitions, and then, all of a sudden, because I was
management in this dispute, they couldn't talk to me.


Mullan:     Was it you felt you couldn't stand up for unionization

because your responsibilities were broader?


Chen:     Yeah.   The conflict for me was the rigidity of the rules.



Mullan:    What rules?



Chen:     Of the NLRB [National Labor Relations Board], that I

couldn't ask people why did they want to unionize because that
would be construed as harassment, interpreted as harassment.



Mullan:    Were you for or against unionization?



Chen:     I was indifferent on unionization, but I really needed to

understand why it was happening.     Then as I learned from legal

counsel what are all the rules that govern what I can say and
what I can't say, and whereas my posture had been more for open

dialogue and discussion among all staff, advancing a collective
model, I couldn't see myself operating under those conditions.
                                                                           54

Furthermore, I knew myself.         I knew that if I got caught up in

that dynamic, I would be a very active, competitive participant
and it would rub me the wrong way, and I would then stand the

potential for coming down on staff and trying to negotiate the

best from a management standpoint.         It was scary.


Mullan:        Sounds like you got on the wrong side of the barricades

inadvertently, in the sense of conceptual barricades.


Chen:        Right.   I resigned, and then afterwards the organizers

appealed to me, begged me to not resign.         They said, "We did it
because you're here, Art."         Deep down it was very helpful to hear
that, that it wasn't because of resenting my management
practices, which is what one insecurity was.        But then it just

created more anger, because it was like, "Why didn't you tell me
that you guys wanted to do this?        We could have talked about this

and figured out a way to accomplish something."
        So    anyway, I went to Chinatown, left Chinatown, and then,
reeling with guilt and discomfort about that whole scene, I stuck
around in the Bronx for another year, and I did emergency
medicine over at (Jacobi) Bronx Municipal Hospital.         It was a
really great transition because I could just put aside the
politics.        I processed it.   I wrote up the whole thing because I

needed to get it out of my system, what I thought happened, my
analysis on what had happened, but in the meantime I jumped into

learning trauma and cracking chests.         That was essentially a
fellowship for me, even though he hired me as an attendant.            I
                                                                       55

was learning more from the residents than anything else, and you
know what that's like.       It's going by the seat of your pants.
        So I   got all my jollies out, my cowboy stuff of getting back

into clinical medicine.       I was still seeing patients in Chinatown
but one day a week, and I got back into clinical medicine.       I
loved it.       I was teaching paramedics and was riding ambulances,

you know, doing all this stuff and really getting reminded again
of how bad it is out there, the social side of medicine, seeing
kids murdered and stabbed and shot and all those other
consequences of living in those communities.



Mullan:     What happened next?



Chen:     Then after that we had kids.   All this time, right after I

got out of residency, in May, my wife and I had a child.


Mullan:     When did you get married?



Chen:     I got married when I left California to go into my

residency in '78.


Mullan:     Who is your wife?



Chen:     M y wife is Peggy Saika, who is a role model for me,

community organizer, a social worker by training.      She is

executive director of a group called Asian Pacific Environmental
                                                                      56

Network.     It's one of the first Asian environmental organizations

in the country.


Mullan:    And you met her originally in Davis?



Chen:     I met her in Sacramento.   She was a community organizer in

Sacramento and worked with a number of other human service
groups, grassroots type of groups, and was very critical of our
free clinic operation and really encouraged us to think more
closely about how we could build a better-linked program with all
the other services that were going on in Sacramento, improve the
coordination rather than just being off out there.


Mullan:    She's Japanese?



Chen:     She's Japanese-American, third generation. And I have to

say, because I haven't said anything about her up to this point,
she's a real influence on my life politically and someone who I

would strongly consider as a role model in many respects.      It's
her constant feedback on things that I do that keeps me on track,
and our discussions and debates and so on.     She was also involved
in my decision to go to Montefiore.     We went on that trip

together because she had already committed to going along with
me, so it had to be the right place to go.


Mullan:    And then you had one child at the end of residency.
                                                                            57

Chen:     Had one child at the end of residency, and because the

position at Jacobi was a one-year commitment with the option to
sign on but was really just to get a cooling-out period for me, I

didn't see it as a career.       We decided it would be better to go

home, be closer to her family, which is in Sacramento, and my
family in San Francisco, because of the kid and the possibility
of having more kids.      It was the right time.



Mullan:     Have you had more kids?



Chen:     We had one more.     Presently I have a fifteen-year-old

daughter and a thirteen-year-old son.            So we're in the midst of

adolescence at its peak and loving every minute of it.



Mullan:     That's important.



Chen:     It's really great.    I love it.       It's challenging and

everything, but it's just really nice.



Mullan:     So you came back West in 1 9 8 3 ?



Chen:     1983.   Started working at Asian Health Services, which is

another PHS 330 center.



Mullan:     In Oakland?



Chen:     In Oakland, Oakland Chinatown.
                                                                          58

Mullan:     Going back in the sixties, is that when it got started?



Chen:     It got started in ' 7 3 , actually '74, and got started o f f

of county revenue sharing funds in Alameda County.         Same history,
f r e e clinic in the beginning then built up its whole orientation
towards providing language and cultural access to low-income,

uninsured populations as their target group and then later moving
on towards a Medi-Cal, Medicaid population, Medicare, uninsured.
And the unique part of this organization that was different from
the Chinatown Health Clinic in New York, which focused on Chinese
immigrants. Asian Health Services served a really diverse Asian
immigrant community, so we served Chinese and Korean, Vietnamese,
Laotian, Mien, and Cambodian, and Filipino immigrants, again a
whole system set up and developed over the years of community

health workers and [unclear].


Mullan:     How did you handle that diversity?     Was the board

diverse, too?



Chen: Originally, no.      The board was more Chinese-based and

Chinese and Japanese, but in time became more diverse as we tried
to follow the guidelines on board membership and make sure there
was adequate representation of different communities.         It's now a
very diverse group.      All the different ethnicities are

represented on the board, with the exception of Cambodian. And
it's just part of the development of that community, but we're
constantly recruiting.
                                                                         59

[Begin Tape 2, Side 11



Mullan:      This is Dr. Chen, tape two, side one, continued.

        So   you were talking about the Asian Health Services.     Did
you serve as a staff physician there for a time and then
management?        Why don't you develop that.


Chen:     When I first went in, they only had a part-time position

available.       It was 60 percent time.   So I worked there three days

a week clinically as a family practitioner with a staff of three

other docs, and then I also worked part-time in the acute care
clinic at Highland Hospital, and then I moonlighted in different
emergency rooms, primarily at Herrick       Hospital as an emergency
room physician just to keep my emergency medicine skills alive.

Their plan was that I was going to be the new medical director,
unbeknownst to me.


Mullan:      Their plan, meaning Asian Health Services?



Chen:     Right.    And within one year they offered the medical

directorship to me, even though the senior doc, who had been
there since the inception of the clinic, well, j u s t about the
opening, and who had been really a mentor to me, was there.         She

was the kind of person who wanted to see everyone else get
opportunities and was more than willing to step aside.       She was

still going to be there, anyway, and she knew that I respected
her highly and that I always consulted with her anyway, and
                                                                        60

wherever I went, I always introduced her as "the real medical

director."      So I got that opportunity, and it was a great
opportunity.



Mullan:    This was like '84, ' 8 5 ?



Chen:     It was '84.   There were so many things happening.     We were

really strengthening QA, so I got a chance to work with
developing a QA system, which was all new news to me as, how do
you monitor quality of care?       It was a period where, as a
community, Asians and Pacific Islanders had gotten good enough
representation to have three centers nationally that were getting
federal funding for dealing with primarily Chinese immigrants,
but the community as a whole and the breadth of Asian immigrant

nationalities weren't included.         So this clinic had a dual

agenda.     It took service as a big agenda, to provide access, but
it never compromised its advocacy agenda as well.        So with that

orientation, I got to work with people that were used to doing

community organizing, organizing patients, really doing it on an
ongoing basis through health education groups, and then engaging
people in letter-writing and petition drives and demonstrations.
So   it was a real firsthand experience as to how do that.
Everything that I had done before was more, you know, the

theoretical, trying to put those things into practice but not
knowing exactly how.      So I learned a lot of that in the process.



Mullan:    So   over the years you've remained active clinically?
                                                                            61

Chen:     Oh, yeah.      I was a family doc.   Consistently, 60 to 70

percent of my time was still clinical, because we needed it.
That was fine with me, because at that stage that was what I was
trained for, was to be there.         So I did all this extra admin

time, usually 30 percent of my time, 30 to 40 percent at times.



Mullan:         And that included both the traditional administration

plus the community organizing, community development?


Chen:     Right, community development, doing strategic planning.

And to add to that, we had a national agenda, because at that
time there were no national organizations representing the health
needs of Asians and Pacific Islander groups.          So we saw the need
to develop some national advocacy, and the first stop for us was

looking at how many community health centers there were in
existence serving primarily Asian immigrant communities.         So we

started looking at developing a relationship between Chinatown
Health Clinic--I had just come from Chinatown Health Clinic.            I
said,   I 1 I   know about these people in New York," and they said,
"What people in New York?"         So we'd make linkages, and we knew

about NEMS, Northeast Medical Services in San Francisco.         So we

said, "Why don't we try and develop a network?         We're all dealing
with the same issues. Maybe we can even pool our data together
and use that as ammunition for doing advocacy work to make sure
that we break through this model minority image, because our main

concern at that time was that Asians--
                                                                     62

Mullan:     This what kind of image?



Chen:     Model minority.



Mullan:     Model minority.



Chen:     If you ask someone what they think of when they think of

an Asian in America, what are the first images that come through,
and people would generally come up with positive images--
successful, educated, education is a priority, excel in academic

settings, whatever.     So we're burdened in many respects with the
image of Asians as a model minority, and we felt the necessity to
promote the other side of the coin so that there'd be a
recognition that this is a community that has, in fact, problems,
real problems, socioeconomically and health-care-access-wise and
so on.
        So I got to work on a national level of trying to help

convene a national organization, and it happened to coincide with

a lot of other people thinking the same thing, and we got support

from the federal level and a conservative guy named Sam Lin who
was one of the assistant surgeon generals who was working with
intergovernmental affairs in the Public Health Service and linked
up with him.     We discovered that there was this high-ranking
official in the Public Health Service, who we had no idea was a
Republican, so we're getting second thoughts, but at the same

time he was supportive.
                                                                      63

        He helped convene a number of meetings, and we established

two national organizations, one called the Asian Pacific Islander
American Health Forum, at that time called the Asian American
Health Forum.       This convened its first meeting in 1986.   And then

the other was APCHO, the Association of Asian Pacific Community
Health Organizations.       Originally it ended up becoming the

consortium networking group for seven community health centers
nationwide, all serving predominantly Asians or Pacific Islander
populations.       They were all CHCs.


Mullan:    And there were seven principal ones?



Chen:     Right.   So it was New York City, Chinatown Health Clinic,

International District Community Health Center in Seattle,

Northeast Medical Services in San Francisco, Asian Health
Services in Oakland, the Asian Pacific Venture in L o s Angeles,
and Wai Nai Community Health Center in Hawaii, in Honolulu, and
then Kakua Kalihi Valley.         These are the seven core centers.

When we first started out, there was only four main centers on
the mainland because L.A. hadn't developed yet, and later on
began to develop the relationship with the Pacific Islanders.         So

that was exciting, learning how to put together a national

advocacy group and how that functioned. So it was a period of
real phenomenal growth for me, again, getting back to some themes
of recognizing where you can make impact on policy.


Mullan:    This is '87, ' 8 8 ?
                                                                     64

Chen:     This is more '85 through '88, the formative years of those

organizations.



Mullan:     Give me a couple of stats on Asian Health Services.

It's growing or changing over the years, but sort of volume,
number of docs.



Chen:     At that time we had four docs.



Mullan:     FTEs?



Chen:     FTEs were more like around 3, 3.0 FTE docs and about two

nurses and a staff, originally, when I first started, about
twenty-five, a lot of health educators, because the health

educators were like our version of community health workers.


Mullan:    When you say you started at twenty-five, that went up or

down?



Chen:     It went up.   It's now currently a staff of about 100.



Mullan:    And still three docs?



Chen:     No.   There's about ten docs.



Mullan:     FTEs?
                                                                    65

Chen:     FTEs, roughly about 8, somewhere around 8.5, because some

of them are part-time.



Mullan:     So it tripled in size?



Chen:     Yeah.   It's tripled in size easily.



Mullan:    And I presume that the patient population outreaches--



Chen:     Patient population diversified and enlarged, probably

about 10,000 registered patients.


Mullan:     That's now?



Chen:     Yes.



Mullan:     So it was a fruitful time in terms of both community

organizing and focal activities around Asian Health Services, but
also vaulting that to the national with respect to the terms of

its organizations.


Chen:     Right, and getting national attention, participating with

actual legislation, the Minority Health Improvement Act, and then
the Asian Pacific Islander Health Improvement Act shepherded by
Norm Mineta, who was a congressman here locally in Santa Clara,

and actually with one of the organizations helping to draft the
legislation.      I never knew about drafting legislation before and
                                                                     66

who really does it.     So it was an-eye opener for how to work the

system and how to demand attention and how to state your case and
influence policy.



Mullan:     How well the coalition of groups that formed the Asian

Pacific Islander movement, obviously are ethnically,

linguistically, historically diverse, not unlike other groups but
more distinctly diverse than, say, Hispanic coalitions in terms
of having different language, etc.    How does that all work?



Chen:     It works because the people that get involved at that

level are usually more astute politically, who see and understand
how American society works.     So you're tapping into, in most

cases, second- and third-generation folks, not the immediate

immigrants.     Or at least, if they are first-generation immigrants
who've come over from the country, they're people with who have
been in the country long enough to be able to understand how
things work here and understand the importance of unity and

working as a group, being stronger when we pull our resources
together.
        The other thing is, for those that have been here longer, so
for primarily Chinese and Japanese, second- and third-generation

folks, a maturing and a recognition that for the newer immigrant
communities, that we had to offer something of what our knowledge
base was, in having been here longer.    So I think the combination

of the two, and I don't mean to say that there weren't divisions
or there isn't nationalism that we have to struggle with.
                                                                     67

Nationalism is always there.     It's being very attentive to that,

but because there was enough common interest and people could
recognize that     whatever came out of this was going to benefit

those communities, their community as well.     That was what we

keyed in on, I think, was the unifying factor.



Mullan:     Did leadership typically come from the largest

communities like the Chinese?


Chen:     Yes, predominantly the Chinese community, and we have to

watch out for that.     In fact, with the Asian Pacific Islander
American Health Forum, which is, at this point, the most engaged
in influencing federal policy and to a certain extent some state
policy throughout the country, California is probably the focal

point because the national headquarters is in San Francisco.       We
always were very cognizant of having too many Chinese and needing
to diversify and constantly bring in leadership from the other
communities.    So it's a real conscious effort.   And it's not

easy.     It's no different than the typical "Let's diversify our
staff" charge.     It's easier said than done and requires a
conscious effort and a protracted effort in really making sure
that that happens.    That's what we're dedicated to, because we
recognize if we don't do that, we're just fooling ourselves.



Mullan:    Tell me a word more on a concept that I was unaware of,

the model minority problem.    As soon as you explained it, I could
understand because Asian Pacific Islanders are not considered
                                                                        68

underrepresented minorities in terms of at least health talk.
How does that play out in terms of the recognition that you get

or the problems that you encounter?



Chen:     It's a burden.     It's a burden if you want to address the

acute problems within the community, which are primarily access

issues as well as some unique problems that are just specific to
the population, a lot of infectious disease, high rates of TB,
high rates of Hepatitis B carriers, more parasitism, a lot of
dental problems, you know, for immigrant populations, and some

genetic disorders like thelassemia, which are more prevalent
among immigrant Asian populations.       So it's a burden because
generally the perception is that Asians are not a community with
problems because they take care of their own.



Mullan:     Is that wrong?    Is that inaccurate?



Chen:     I think there's an accuracy to it in that that's

definitely one of the outstanding themes that run through the
culture and through immigrants who are coming to this country
anyway looking for opportunity and wanting to make sure that the
next generation capitalizes more of the opportunities, but it's
not balanced.     It's not the whole picture, and I think the burden
of the model minority image is not so much that people don't want
to take credit for some strengths.       It definitely recognizes some

strengths in the community.       If you look at John McKnight's work
around community assets, definitely a community asset, but a
                                                                        69

community asset that has far overshadowed any other perceptions

or perspectives on a community, and that's been the burden.        So
that it's put the onus on us to try and present the other side of
the picture so that people don't lose sight of the fact that this
is a community that has done well, but it is also a community
that has its problems.

        I guess the best way that comes out is when you look at the
socioeconomic spread of the community, it's a bimodal
distribution, so instead of everything being a nice smooth curve,
it goes like this.     There's overrepresentation in higher income

levels and higher education levels, but also overrepresentation
in low education levels and levels below poverty.


Mullan:     Let me give you just the sort of typical man-off-the-

street, person-off-the-street response.     Isn't it true that
unlike perhaps other immigrant populations, that first generation
perhaps does have the problems of everything from parasitism
brought from abroad, to poverty, but by second or third

generation, essentially everybody's out of poverty?



Chen:     Generally true, yes, in that as we get into the second and

third generation, that's where a lot of the affluence begins to
surface.     I think the quantifier that has to be understood is

that 60 percent of the population is still primarily foreign-born
among our Asian Pacific American population.



Mullan:    So the immigrant part of it is not--
                                                                      70

Chen:     It's the dominant portion of the population, and that's

why we can't lose sight of, in dealing with their issues, the

problem areas that they have, even though with time, as in just
about any other population, affluence rises.



Mullan:     I want to ask you some more big-picture questions, but

let's finish your story because we've got a new chapter emerging,
I believe, now.     We got you into the Asian Health Services
between 1983, '84?



Chen:     '83.   It started in '83.



Mullan:    And relatively recently, that's been your base of

operation, as medical director and special programs director.         I

know you're currently on a new job, and I want to hear about that
transition.


Chen:     Towards the tail end, I'd say, of '90--when did Prop 187

pass?     '94.   Well, there's two major events I think that I should
include.     I was very fortunate.    I got into a fellowship program,

which was a leadership fellowship program.       It's put on by the
Kellogg Foundation, and Kevin Fickenschen got me into that.

Three years in a row he laid this application on my desk and
said, "Apply for it.      It's really good.   It'll do you good.''
        So anyway, I went through this leadership development

program, and it really forced me to explore concepts of
leadership and what it meant, responsibility and what you could
                                                                  71

achieve for whatever cause you devoted yourself towards.     People

confronted me with, "Why are you solely confining your efforts to
the Asian community?" and my response to them was, "Because this
is really necessary, and I'm in this position where I believe it
and I'm part of it, and that's my mission."    So I was encouraged

to not totally let go of that, but begin to recognize that I had

a larger role and that there would be a benefit for me to be a
bridge to other communities to share this experience but at the
same time contribute to the broader good, to broaden my horizons
and so on.

     So   that was sitting there for a while, and during that
period I resigned from being medical director.    That's when I
shifted into doing special programs.    They gave me a title so
that I could be around in management at the same time, but was

really ready to let go, and I already started to explore other
options and things.

     So   then '94 came along, and in California we had on our
ballot initiative at that time Prop 187, which was a hostile bit

of legislation towards immigrants and mainly focusing on
undocumented, and it rejected school, social services, as well as
health services for undocumented immigrants.     It was part of Pete
Wilson's, our governor, campaign to get into the national

limelight and to begin to lay the foundation for a presidential
run in '96.
    Well, unfortunately, it passed in California, and it just
created shock waves throughout the immigrant community.     It just

put us in a real bind as an organization because at the same time
                                                                   72

this was happening, we were going through managed care and the

failures of the [Bill] Clinton health care reform.   All of a

sudden there was no agenda for the uninsured, but managed care
was coming, and if we didn't gear up for it, we were going to

drown and probably go down as a community health center.
     So   our center then was engaged in this process that every

other community health center had to proceed with, and that was
to become a viable player, an organization that could survive,
link up to managed care, fulfill its obligation as a safety net,
but at the same time go after paying patients as our means of

survival.   It created a tremendous turmoil within our
organization, especially for me, I think, because it just brought

out more of what was necessary in pursuing our community
organizing and in educating the community, mobilizing the
community to begin to muster the resistance and the fight back to
turn the tide and to do whatever we could to make sure that our
community was empowered with the information to be able to tap
into the decision-makers, legislators, and so on to voice their

concerns and disapproval for this whole trend.
     But we had to place almost 99 percent of our resources into
making this transition to become marketable, making this
transition to become appealing to insurers and HMOs so that we
could develop subcontracts, and shifting proportions of our
patient population in going after paying patients and literally
squeezing down, then, our uninsured.   Within the period of around
two years, we flipped proportions from seeing about two-thirds
uninsured and one-third payer patients to two-thirds payer
                                                                     73

patients and one-third uninsured.    Now,   in fairness, was our
ability to convert uninsured into paying patients, and that was a
big part of it.     But the other part was, clearly, we had waiting
lists, and we were beginning to qualify whether people could sign

up with us based on whether they had insurance or not, and that,
to me, was just against everything that I believed, that I had

joined a community health center for.
     I was struggling with some ideologic conflicts, I think,
around it and trying to maintain, in retrospect, some
philosophical purity and failed to acknowledge the pragmatism
that was necessary, because if we didn't survive we weren't going
to serve anybody.     So at that point I had some differences with

the direction the leadership was going, and we were also in a
capital development campaign, and I just, frankly, got real burnt

out with it because I was pushing one agenda and everyone else
was going the other way.     I was stubborn and felt that we really

did need to rededicate ourselves to community organizing.
     So I   proposed to take some time off just for diffusing

things and just getting some space.     Frankly, I was just very
burnt out, because in the context of managed care, it meant more
time on the phone trying to keep people out of the hospital and
out of the emergency room.     In a non-English-speaking community,

relying on family members, you really had to spend a lot more
time on the phone reassuring people that they could take care of
their relatives when they're already working twelve- to sixteen-
hour days as family members and dealing with their elderly

parents or with multi-system illness or whatever.
                                                                      74

Mullan:       So what did you do?



Chen:        So I took some time out.   During that time I went through

some personal discovery.        I thought I was going to just get some
time off and rest and relaxation and read some good novels and
Joseph Campbell and spirituality and all that, and what I

immediately proceeded to do was just shift from workaholism in
one arena and then just doing all the things that I had really
put on the side but wanted to do but now I had time to do, such
as developing cultural competence training, doing some medical

writing.
        I got involved with the Blue Cross Foundation project to sum
up the health status of the Asian Pacific Islander community in
California.        Then it was doing some consultant work with AAPCHO,

the Association of Asian Pacific Community Health Organizations,
that I always wanted to do, working with them on a number of

projects and trying to bring in some direct hands-on from the

community health center medical director.

        So   through the course of that, in the course of that time
out, I began to realize that I wasn't really looking forward to
going back to work, some of it, "Been there, done that," and also
the other part of it was just realizing that it was going to be a
period of real substantial conflict because we were forced, we
were literally forced, to do things in a different way.



Mullan:       So what did you do?
                                                                     7s

Chen:     So then I got recruited to an interim position as the

Health Officer for Alameda County.     I had some previous working
relationships with the public health director, and they had an
interim position, and he knew that I was available.


Mullan:     Tell me about Alameda County, about the health

department, the health officership.


Chen:     Alameda County is a county of about 1.3 million people.

It's probably one of the more diverse counties in the country.

It's a majority minority county, actually, and with a substantial
African-American, Latino, and Asian population.


Mullan:     Does it include Oakland?



Chen:     It includes Oakland, Berkeley, San Leandro, from north as

high as El Cerrito and Albany all the way down south close to San
Jose and Fremont.



Mullan:     So it's East Bay?



Chen:     It's East Bay essentially, mixed with Contra Costa County,

and then as far out as Livermore to the east, a county that has a
very progressive reputation in public health.     Because U.C.-
Berkeley School of Public Health is right there, we have access

to real cutting-edge thinkers in public health.     So it was an

opportunity to work within a public health department that had
                                                                    76

its clear mission of focusing on the uninsured and the most

vulnerable populations, so that it felt like it was more
comfortable for me.     Plus it was a challenge.


Mullan:     What kind of health department, size?



Chen:     Approximately 500 employees in the public health

department alone, and that's where I'm working out of, but an
overall health care services agency, and I don't know how many
employees are in the agency.     The agency overall includes the
medical center, which is Highland Hospital, Fairmont Hospital,
John George, which is a psychiatric hospital, and four major

ambulatory care sites throughout the county.


Mullan:     It's an elaborate county health delivery system.



Chen:     Yes.



Mullan:     But the public health department is more traditional

public health functions.     And the health officer is in charge
of--



Chen:     The health officer is the equivalent of the medical

director, but very interesting in Alameda County, your line
authority is limited.     You're on the organizational chart, you

sit on a branch off from the director, and your staff is your
secretary and your public health nursing director, and that's it.
                                                                     77

Those are the people that report to you.    By statute, according
to California Health and Safety Code, you are the enforcer of the
health and safety codes, so that your responsibilities go into
all the workings of the public health department, even though you

are not the person that has line authority.



Mullan:    But it's traditionally a public health physician?



Chen:     It's always a physician.



Mullan:    And the public health director might or might not be?



Chen:     Which is almost always the case, yes.



Mullan:     It's usually not?



Chen:     It's usually not a physician, but in a number of counties

they are, in fact, the same people.    But it's much less so now.
More often, the public health director or the health care
director for the agency is a non-physician. And that's just the
evolution.    Doctors weren't trained to be administrators, but
there are a few.


Mullan:    So you were interested in the opportunity.   Talk about

what it's been like.
                                                                     78

Chen:     It's been probably the greatest experience of my life at

this point.


Mullan:     Terrific.



Chen:     Mainly because of this interesting enforcer-by-statute

role, because what I've found is that regardless of not having
the line authority or the budget under my belt, I can literally
go anywhere, and the stature, I think, and the prestige of the

position is enough to give you entree and influence.     So it's
leading by influence rather than line authority.     That's the
challenge of anyone who takes on a position like that.
        My nickname for the job is surgeon lieutenant, because it's
analogous to the surgeon general.     I can convene a meeting in
just about any setting, and most people will come because of
knowing that I have this big stick in my pocket called the

enforcer.     I can close down a restaurant.   It's my signature that

closes down a restaurant, a highway, a federal building, or

whatever it is, anything that's a threat to the public's health.
Obviously, you don't do it casually and frivolously, but because
you have that ultimate authority, people will answer your phone
calls and people will generally come to your meetings and so on.
That's what the opportunity is, and that's what's really fun, and

seeing how, being in a position like this, you can leverage the
position to give attention and validation and acknowledgment to a
lot of sectors within the health community that don't
traditionally get that acknowledgment.
                                                                       79

     So right now one of the most fulfilling parts of my job is

working with community groups and working with our community

health outreach workers in the department, trying to help
strengthen their curriculum as well as their job descriptions and
their roles and responsibilities so that they truly fulfill our
mission of bringing the public back into public health, so that

they become our liaisons and partners with the diverse
communities in Alameda County.     They're the ones that have the
cultural knowledge, the community knowledge.     They're the ones we
need to rely on to provide access in the most efficient and

effective way.
     We need to strengthen how that team dynamic occurs so that
public health nurses, are not threatened by community health
workers.   It's the same dynamic that is happening in the

hospital, where RNs are being downsized because they have
certified nursing assistants.     It's the same thing in public
health settings.   Public health nurses feel like they're being
downsized and more community health outreach workers hired.       So

it's being able to work with them and developing that agenda so
that, in fact, one goal is to turn the public health department
into a social-change agency.     That's the carrot from the
director, I think, that really attracted me, is that he wanted to

create a social-change agency that provides public health
services rather than a public service agency that does a little
bit of social change.   That was particularly attractive, and I
take the director at his word, that that's what he really

believes in.   That's what made it a very compatible relationship.
                                                                     80

Mullan:     Is the director a political appointee?



Chen:     Yes.   They're appointed by the Board of Supervisors.   Even

though it's not traditionally a position that is recruited by the

Board of Supervisors, but if you don't have the political
support, you're not going to be around for very long.



Mullan:    As we sort of wind down here, I want to ask your views

about primary care in the contemporary environment, and I think
probably it's best to ask that first.      Then I want to ask, as you
convert, at least in name, from primary care to public health,
how you see those roles as different.      But first tell me, you've
been trained as a generalist, you have always had generalist
instincts, you've seen a lot of changes over the last fifteen

years, particularly in the last couple of years.     What is your
commentary and prognosis for primary care?



Chen:     I think outlook is good, I'd say, but at the same time,

dependent upon how much we take charge of advocating the future
directions of primary care.      I think the generalist outlook is
critical to good public health planning and good planning
overall.     What I've drawn on, I think, as my primary care
strength, is the breadth and understanding more of the interplay

between all the different specialties and the impact that primary
care has in the context of COPC, community-oriented primary care.

That's what I think has really helped frame the way that I
interpret primary care, in that context of being the front-line
                                                                         81

providers with an overall goal of looking at population-based

health interventions and maintenance of health.
        So   being a family practitioner has allowed me first-hand
experience in all the major specialty areas, primary care
specialty areas.        That's really empowered me to be able to speak
with specialists in those areas with pretty much an overlapping

knowledge base, even though they know much more than I do, but I
know enough that I can take it on firsthand and be able to engage
them in planning and envisioning and doing all the other kinds of
programmatic and policy-planning activities that are necessary.

        I think the emphasis on primary care is probably for the
wrong reasons, the gatekeepers and the cutting of costs and all
of that, but I think that's created an opportunity to take the
national attention and the professional attention, to be able to

shape what our agenda is in being primary care providers, the key
liaisons with families and the humanistic side of medicine.          I
think that's something that we need to constantly promote and
advance and advocate for, and I think that that's our opportunity

right now.



Mullan:       How about people in public health who surely have said

to you by this time, "Well, you're not a public health
professional.        You're a personal physician.   Your focus has been
patient care and the dental, personal health care"?



Chen:        I'm at the point where people can say whatever they want

to say, and I'm a firm believer in that axiom "Action speaks
                                                                     82

louder than words."      For people that give me those criticisms, I

just agree with them.      I just say, "You're right.   I am a
personal physician.      That is my orientation, I've been trained
that way, and I'm not going to try and hide that as part of my
makeup.     But at the same time, I was very fortunate to undergo
training in a very unusual program that was very public-health

oriented.     I start speaking community-oriented primary care and
the type of primary care that I learned, which makes it unique
and very public-health oriented.     And then I also speak about my
experiences within the Asian immigrant community, whereas I may

have wanted to just focus on taking care of patients but I was
forced to l o o k at policy issues and how it is that you deal with
the health status of a community as a whole, that being an Asian
immigrant community, and that forced my thinking into the public

health arena.


Mullan:     Sounds like your thinking's been there for some time

actually, would be my answer to the question.


Chen:     Exactly.   But I don't try to get into defensive mode,

because if you get defensive right off the bat, then they shut

down, so I just agree with their criticisms.


Mullan:    To sort of tie things together, I'd be interested to

know what your predictions are for your own future and what your

predictions are for the future of our evolving health care
                                                                    83

system, particularly the generalist side of it.       But tell me

about you first.


Chen:     I haven't ever been a real ambitious, super goal-oriented

person.     I just realized that I contradict myself.   My main goal
in life was to become a family doctor and to serve an Asian

immigrant community.     That is has been the only goal that I've
pursued with any degree of real focus and concentration.       Once I
broke out of that in deciding to leave Asian Health Services,
where I continue to see patients now but one half-day a week, I

don't have any real major ambitions.     I'm exploring public health
right now in this new role as a health officer, and I'm keeping a
few themes in mind that I believe in developing closer
connections between bureaucracies and community, and I also

believe in collaboration and multi-disciplinary approaches and
new partners and learning from each other and taking advantage of

all of our assets.     Those are some basic themes.   And looking at
populations as a whole.

        But aside from that, I don't have any grand goals.    I mean,
I've toyed with some ideas, but I don't have a three-year plan or
a five-year plan as to where Art Chen expects to be or should be
and what I need to do to get there.    My main goal is really
thematic and really carrying out this stuff. My dream is that
the public health department can become an organizing machine

that takes tax dollars and puts them where they really can have
effect by empowering community to take its destination into its

own hands and really move on.
                                                                    84

Mullan:    How about the system as a whole?   You live in California

where the future is now, so what's the answer?


Chen:     I was on the statewide steering committee for Prop 186,

which was our version of the single-payer campaign, and even
though we took a break this year and chose strategically that it

was not the right time and that we really needed to look at
managed care reform, which failed--I don't know if you're
familiar with two of the propositions, patient protection acts,
they failed miserably, but there is an ongoing effort to pursue a
single-payer campaign. I think that, at this point,
realistically, knowing how power gets expressed, that it's going
to be very difficult to get a single-payer type of campaign,
especially given what's going on in Canada right now, and the

more ammunition opponents of single payer will have to fire back
at us.
        What's going to happen, I think, I would project that in the
next few years there is going to be enough patient resentment and

informed consumer disgust with a lot of the priorities of the
abusive HMOs that gouge overhead costs out of the health care
dollar, particularly those that start going into twenty-five
cents on the dollar, that there will be some substantial reform
that will be legislated that puts in some assurances of
limitation on overhead, that makes sure that physician judgment,
as much as it can be, is freed up to do what's best for patients,

and that governance-wise, there has to be some level of consumer
input into the whole process of governance over health care.
                                                                   85

     What it's going to shake out to be, I don't know exactly,

but there will be a lot more consumerism advanced because the
medical profession right now, which is taking it on the chin,
still has, you know, a voice to be reckoned with and can
advance--and clearly right now, at least in California with the
California Medical Association, is advancing a voice of

conscience, I think, to push that with dealing with corporate
medicine.


Mullan:     You're saying that organized medicine at the moment has

a higher ground than they might have had in the past?


Chen:     Yeah, and it's building its new credibility, I think,

after having lost the credibility of the profession, of the
medical profession.    And I think there's also going to be more
alliances among provider groups so that the nurses associations
and the medical associations and even the physician assistant and
paramedical professions--1 mean, there's going to be coalescence

there where people, as providers, recognize that we're the ones
that need to advocate along with consumer groups on their behalf

and that that's going to continue to grow.    So I think there's
reason for optimism in thinking that corporations are not going
to totally manipulate the health care dollar to the excesses that
they have right now.
    And then, finally, as far as primary care is concerned, I

haven't thought as much about what primary care is going to do,
what direction it's going to take.     It's going to be up to us, I
                                                                   86

think, to maintain some strong voice in advocating the full

breadth of primary care, rather than the view of it being more
the gatekeeper or the restrictor of services, the advantages that
are offered by having groups that have breadth of skill so that
they can do more at a cheaper cost.    We'll have to take it far

beyond that.
        And then, finally, I think a good role for us as primary
care practitioners is to advocate the humanism in medicine and
the compassion and maintaining the closeness with patients and
preserving the time that's necessary to develop that healing
relationship, to develop the role as healer.     It's probably
important for us to take a real critical look at the technical
side of our profession and our Western medicine orientation and
the need to really broaden our spheres to other modalities of

treatment that may be helpful and become part of our breadth of
skills.


Mullan:    Maybe that's a place where we should stop.   It's a high

note.     Thank you.


Chen:     Thank you.



[End of Interview]
                                                              87

                                    Index



Ang, Ken 32
Asian Health Services (Oakland, California) 40, 41, 44, 46,
          49, 58
Asian Pacific Environmental Network 38
Asian Pacific Islander American Health Forum 44, 47
Asian Pacific Islander Health Improvement Act 46
Association of Asian Pacific Community Health Organizations
          44, 52

Blue Cross Foundation      52
Bodenheimer, Tom 24
Boufford, Jo 31, 33
Chinatown Health Clinic (New York City)     34, 40
Clinton, Bill 5 0
Fickenschen, Kevin    32, 49
Generalists versus Specialists 56
Green, Felix 16
Health PAC 24
HMOs 24, 50, 59
Bronx Municipal Hospital        38, 39
Kellogg Foundation    49
Kumagai, Lindy 28
Lin, Sam   43

Managed Care 50, 51
Massad, Bob 31, 35
McKnight, John 48
Medi-Cal 40
Medicaid 40
Medicare 40
Mineta, Norm 46
Minority Health Improvement Act 46
Montefiore Hospital (New York) 31-34
Primary Care    56, 57, 59
Prop 186 58
Prop 187 50
Saika, Peggy 38
Sidel, Vic 18, 31
Specialists versus Generalists       56
Stevens, David 32
Strelnik, Hal 31
                                                   88

University of California-Davis   12, 15, 24, 2 6

Wilson, Pete   50