Outwardly, there is nothing remarkable about Santa Marta Hospital and Clinic in East Los Angeles. A two-story, yellow-brick building on a side street off Brooklyn Avenue, it looks modern and well-kept, newer perhaps than its 13 years. One step inside the lobby and Santa Marta's takes on an ambiance all its own. There is a homey quality here and a warmth that stands out.
The lobby and corridors look as clean, gleaming and efficient as hospitals are supposed to look, but, for example, the grizzled old man in a serape and sombrero who was sitting one morning watching whoever went by with the look of one settled in for a long wait, was right at home--orange plastic shell-chair notwithstanding. It is a place where staff go by, joking among themselves or greeting visitors and outpatients in Spanish or English, hugging and touching occasionally. It is low-keyed, warm and pleasant. And somewhat puzzling.
Five minutes with Sister Blanca Yabar, and everything starts to fall into place. The ambiance is no accident. How could a hospital she presides over be otherwise?
Administrator of Santa Marta from the opening of the present 110-bed acute care facility with a staff of 400 in 1972 through 1976, and president of the board of directors since 1982, Sister Blanca fits no stereotype of an executive, businesswoman, person of authority or, even, graduate of an assertiveness course. In fact, it is not easy to imagine her as the grammar school principal she once was.
Sent to Los Angeles Born in the Basque region of Spain, she grew up in Pamplona and came to this country in 1959 because her superiors sent her. Her soft-voiced, accented English is fluent, and she stumbles with it only when she is flustered or upset.
She is a tiny woman in her late 40s, wearing a blue cardigan over her modernized, street-length white habit of the Daughters of St. Joseph. Her graying hair edges her short white veil. When she talks about herself, she tends to turn her serious hazel eyes downward, to the pencil or paper clip she twists in her hands, and when she is teased she reddens and laughs.
Humility, modesty and sweetness are qualities that seem to characterize her. Executive headhunters are not on the prowl for these virtues. For that matter, they are qualities that have come in for a fair amount of ridicule and disparagement of late, especially when applied to women, most especially when applied to nuns. Sister Blanca manages to convey them, however, without the theatricality of the self-effacement. There is no mistaking her strength.
As president of the board and superior of the community of eight nuns who live in the convent behind the hospital, her responsibilities are a mix that run from generally seeing "that things run smoothly" to working with the newly formed foundation that is fund raising for the hospital's expansion and operation, to overseeing the pastoral care program that the nuns provide patients and their families, to "giving the discounts" for poor patients unable to pay their bills.
Serving the poor is uppermost in her talk about the hospital. It is why Santa Marta, at first a 10-bed maternity ward and clinic consisting of a cluster of frame cottages, was started in the 1920s in the first place. Lately, small independent hospitals have been given little hope for survival. Santa Marta's survival is even more precarious.
"A big problem for us is that the government is cutting down (on funds), and our hospital is greatly affected by this. Seventy percent of our patients are Medi-Cal or Medicare recipients. And some of them are not eligible for this. They are here without papers. They are very poor. So we have to do something," she said. "We have to, because we are committed to serving the poor."
No sooner had she said that than a family, a woman on crutches, her son and his little daughter, was ushered into her office to discuss their bill. Bustling around a bit with papers between her office and the reception room, she drew the story from the woman in give-and-take conversation that bore no resemblance to an interview. The woman, who is uninsured and not eligible for Medi-Cal, had come to the emergency room with a broken ankle and the bill was around $300--high, Sister Blanca told them, because the emergency room is more expensive than the clinic. Within minutes they left, after Sister Blanca had held the baby, having been given a 30% discount and having agreed to accept payment for the bill in three monthly installments.
"I have the sole authority for giving the discounts," she said, explaining that her method was not to ask for proof and documents, but to find other ways to ascertain people's status, especially word of mouth from pastors and others in the community, and ultimately "to go on conversations."
Later, she made her rounds of the hospital and clinic, stopping frequently for informal hallway conferences, greeting two Cuban women, one a former patient, with kisses, backtracking to the emergency room a second time after a Spanish priest had arrived and asked that Sister Blanca personally attend while the doctor had a look at his infected finger. As she walked, she explained the building plans for a new emergency room and intensive care unit and an expanded clinic that will be called Ambulatory Care.
She is familiar with all the pluses and minuses of the existing facility: "The emergency room was converted from an employees lounge. As you can see, it is just provisional and it has been provisional for many years." In the crowded lab, she paused to smile admiringly at an expensive machine that runs through a variety of tests in rapid time. Her own description was that it is "the best" money can buy. Beyond that, she turned to a technician, asking, "What does this thing do?"
The most important point she wanted to demonstrate on her tour meant far more to her than machines or building plans, and she seemed concerned it would get lost or missed.
Clutching her hands to her chest as she slowed her step, she said: "Our charisma as Daughters of St. Joseph is to work in an atmosphere of prayer and build perfection. We use the model of the Holy Family at Nazareth, and we try to create a family environment and encourage this in our staff."
She would come back to that point often in the course of the day.
She sat patiently through a meeting with her administrator, Michael Diener, joining in agreement with him as he explained the hospital's situation. Santa Marta is going to survive, they are both convinced, and it is going to survive without giving up on the poor.
Hit by Cutbacks They had cut their operating costs back several years before the government cutbacks had hit, and had started to emphasize ambulatory care and outpatient surgeries rather than inpatient care whenever possible. They had been getting by without advertising and without fund-raising. That is no longer possible. (Last year the hospital had close to 2,600 admissions, and also treated patients through 400 outpatient surgeries, 900 emergency room visits and 1,400 clinic visits per month. They did so with operating revenues of $23 million.)
Diener was encouraged by Santa Marta's recent participation in the California Assn. of Catholic Hospitals. By joining them in purchasing groups, they will be able to cut expenses further. Beyond that, both advertising and fund-raising have begun. Funds have been secured for the new construction, but not equipment. And funds will be needed to supplement operating costs. Diener spoke of marketing surveys as he described the clinic's expansion into industrial care and "urgent" needs as opposed to emergencies, and the soon-to-start alcohol and chemical dependence program specially designed for Latinos, with emphasis on women alcoholics. They were not adding any new beds, just services.
The importance of that conversation did not escape Sister Blanca, but such conversations leave out what is most important to her, and that is her order, the Daughters of St. Joseph, and the philosophy they are trying to realize in their work at the hospital. She would rather, and did, spend far more time explaining the history of the order, founded in Spain during the Industrial Revolution to serve the working poor, especially women, and the importance of religious life. If the hospital seems to bear her stamp, she would have people know it is only because she is heart and soul part of such an order.
She was educated by the order she later joined at a boarding school in Pamplona, having been sent there after her mother was widowed. By the time she graduated, as a trained teacher, she had decided to join the sisters.
"I found in the sisters at the school the gifts of intelligence and common sense and at the same time, I found in them the simplicity that was so attractive to me. I knew other sisters who taught girls of the nobility. They lacked this simplicity. I felt they were a little bit pompous, and I didn't like that."
No Looking Back Although she was just 18 when she entered, there has been no looking back, she said. Despite whatever suffering she has known, difficulties experienced, not the least of which was being informed at age 23 that she was being sent to America, perhaps never to see her mother again, throughout all of it, she said, "somehow deep inside I have the assurance I've made the right decision. I have always felt that inner surety that God is with me and I am with him." (She has, as it turned out, returned to Spain and seen her mother several times.)
She talked about that painful acceptance of her passage to America, just as she talked about her later orders to stop being a teacher and grade school principal in Waco, Tex., and start, with no credentials or training, to be a hospital administrator in East Los Angeles: "These are the situations where you have the opportunity to really practice the vow of obedience you have made before God and man."
Her superiors thought she had the know-how, she said, and saw her as a natural administrator. "I learned a lot. I think I had the common sense to know a little about business and to listen to people who knew. It's not the things you really do but letting people who know how to do things help you. And I guess I had the gift given by God to distinguish what is true and not true."
'Bearing Witness' She is happy now to have the administration in the hands of Diener. That leaves her more time for the role a religious person should have in a hospital, she said, and that is "bearing witness to the presence of the Spirit."
She knows she appears modest and meek, and it does not surprise her that people might wonder how such a person could exercise authority.
"Well, let me tell you," she said, smiling, "I do know what is going on here. When a decision has to be made, if I and the sisters, after discussing it openly and studying it, if a decision has to be made, it is made and that's it. I don't find any difficulty in being firm in certain actions."
She returned again to the family spirit at the hospital:
"We're not the type of sisters that need to make their authority felt. We can be an authority without making someone feel 'you are under me.' That's not our style."