EVERETT — Kafiya Arte remembers trying to explain medical terminology to her mother when she was just an elementary school student in the Lakewood School District.
Her mom, a Somali immigrant who was attending Skagit Community College for a nursing certification, spoke English as a second language, so Arte would help interpret her homework.
“That was when I decided I wanted to be a doctor, because I thought it was so cool,” Arte said.
In many ways, Arte felt like an unlikely candidate for a medical career. She faced barriers of race, gender and socioeconomics. She didn’t know any physicians personally, and she wasn’t sure how to start down the path toward her degree.
Arte, 30, now practices as an internal medical resident at the Washington State University Elson S. Floyd College of Medicine Internal Medicine residency program in Everett. She works primarily with low-income patients, a focus she is “better equipped to understand” based on her own experiences, she said.
“It sounds super corny, but if you just knew what I went through to get here, you would understand,” Arte said. “I’m just happy to be here. It’s such a full-circle moment for me.”
‘Little glimmers of support’
Arte grew up as “like one of two” Black families in the Lakewood School District. She lived in Marysville with her parents and five siblings.
She “grew up in poverty,” she said. In middle school, she had to leave class early to pick up her younger sister from daycare because her parents had to work. Through high school, Arte held two jobs to financially support her family.
“I worked at IHOP at Lakewood Crossing and then I also worked at the UPS store, because my family needed the money,” she said.
According to a diversity in medicine report from the Association of American Medical College, just 5% of active physicians identified as Black or African American in 2018. About 64% of working physicians were men.
A more recent study published in the Journal of the American Medical Association Network Open indicates the vast majority of working physicians come from high-income households.
“I was never really encouraged to pursue medicine … but I always knew I could do it,” she said. “And I would have little glimmers of support.”
As a high school sophomore, she started her medical assistant certificate from Sno-Isle TECH Skills Center. As a junior and senior, she took Running Start classes at Everett Community College.
“Being in those classes … with people with all different backgrounds, I remember actually feeling for the first time that I wasn’t the weird one. I wasn’t the one with the weird background or all of the different cultural norms,” Arte said. “I got into anthropology while I was there, and I got into archaeology while I was there. It actually turned me a little bit away from the sciences, but that actually ended up being a good thing, too.”
On her 18th birthday, her boss at the UPS store gifted her a “play doctor kit” as a nod of approval, she said. Her final year of high school, she volunteered at Providence, where she wheeled an “activity cart” around to waiting rooms and patients’ bedsides to offer board games, puzzles and reading materials. She also trained other volunteers.
‘I couldn’t relate’
After high school, Arte struggled some with the academic rigor and huge class sizes in her pre-med program at University of Washington. She continued to work two jobs to help her family, and she commuted to the Seattle campus every day because she couldn’t afford on-campus housing.
“It was an extremely challenging and isolating time in my life. I couldn’t relate to any of the other pre-med students who lived on campus and could study 24/7, eat however many meals in a day they wanted and could afford to get the overpriced snacks available on campus,” Arte said. “I was on such a tight schedule constantly. Studying while on my work breaks was grueling. I remember that a ‘day off’ for me meant having a day where I only had to do either school or work, and not both in the same day.”
About halfway through her second year, she enrolled in closer, more flexible courses with smaller class sizes at UW Bothell and Everett Community College. The decision helped improve her grades and keep her on track, she said.
For three years in undergrad, Arte served as a medical volunteer in Ghana. There, she said, she “truly learned the importance of primary care and preventative medicine,” and she raised funds to start a community center to help patient education. She also learned how to stay creative and thoughtful in treatment from the “resourceful” physicians in Ghana, who didn’t have access to the same medical technology as U.S. doctors.
Arte finished her “hard science” degree requirements at the smaller schools while also working toward her bachelor’s in medical anthropology and global health and a minor in human rights.
Her path to medical school brought even more challenges.
Arte took the MCAT, a required medical school entrance exam, without any preparatory courses, because they were “prohibitively expensive.” Most courses range from $400 to $2,000. Her first two years out of grad school, she was rejected from every medical school program she applied to. On her second try, the applications again came back with a “no,” with the exception of Ross University, an international medical school on the Caribbean island of Dominica, population 70,000.
“That’s when I thought I had finally made it,” Arte said. “I was resourceful, creative, diligent and committed throughout my journey to medical school and it paid off. … (Ross University) really was my last shot.”
Just five months into her program, Hurricane Maria ravaged the island and destroyed the school and the apartment where Arte lived. She and her classmates evacuated and spent seven days “of gritty survival” before being rescued by U.S. Marines, she said.
The school offered an option for students to complete the semester on a “cramped trans-Atlantic ferry boat that was converted into a makeshift medical school,” Arte said. She accepted the offer.
“My cohort is still legendary at my medical school until this day,” she joked.
Arte’s time “floating off the coast of St. Kitts” was the first in her life when school was her sole priority. With no extra jobs or places to be, she “finally learned how to learn for long-term retention.”
She completed the year with her first medical school 4.0 GPA, she said.
“And after that, I thrived in medical school,” Arte said.
Her program eventually moved to the United States. She finished the final two years of graduate school in temporary locations in three different states. Financial need spurred Arte to eventually get a new job, this time as a medical school tutor. She said it became easier to balance work and school, because they built on one another.
She graduated in November 2021, with honors.
‘I’m home now’
After graduating, Arte worked as a faculty member at her medical school alma mater, which by then had relocated to Barbados. When it came time to start her residency, she was matched with her first choice: Washington State University’s residency at Providence.
“I got to bring my long journey full circle back to Providence Hospital, where I first volunteered for my high school senior project, the time I truly decided that I was going to become a doctor,” Arte said. “I’m home now.”
As a local, she can manage her patient’s care better because she knows the community. For example, she can recommend pharmacies close to their homes to cut down their commute, or relate to their personal lives, she said.
“The ability to actually feel like, ‘I’m part of the community and I’m helping my community,’ was a theoretical wish of mine, but now it’s actually happening,” Arte said. “I know their high schools. I know their colleges, and I know their grocery stores. My pharmacy is that Walmart, too, so I feel very present.”
Arte’s winding path to becoming Dr. Arte colors all the work she does, she said. She relates to low-income patients whose first visit to the doctor in years is made to the emergency department. In fact, she was a recipient of Providence’s “charity care,” a program that offers special funding for uninsured or low-income families to cover emergency medical bills.
“I understand what it’s like to have to go to the emergency department for basic health needs,” she said. “I myself sought care in Providence’s emergency department for tonsillitis that I had let fester for far too long due to my fear of accruing a medical bill.”
Arte focuses her work on helping those patients understand the health care system, so they can benefit from primary care, preventative medicine and more equitable health care access.
One of her favorite rotations as a resident includes volunteering with MercyWatch, a nonprofit that provides “street medicine” for unsheltered people. Arte said the program is “a small solution” that’s beginning to bridge the gap between marginalized communities, health care and equity.
“We go out into a lot of the hidden corners of Everett and provide direct medical care to the houseless population. And that’s super awesome, super rewarding,” she said. “It’s nice to let the houseless population know that we are willing to meet them where they are at, literally and figuratively.”
As a teenager, Arte felt like hers was one of few families that struggled with poverty. But her coursework and residency have shown her that “it’s a whole world, actually.”
“And the whole structure needs to be addressed by somebody like me,” Arte said. “So I feel really empowered knowing that I do come from this background, and that actually means I really am better equipped to understand what a solution looks like.”
Mallory Gruben is a Report for America corps member who writes about education for The Daily Herald.