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The patient stormed out of the doctor’s office and headed straight for the reception desk, banging on the plexiglass partition that separates patients from receptionists in this busy Mission District primary care practice.

Kattia Balestier, the lead front desk worker, looked up calmly at the 60ish, red-faced, glowering man. “You were not happy with the services?” she asked quietly.

She patiently listened to his concerns, then offered him an appointment with another doctor in the practice.

Balestier, an immigrant from Costa Rica, has been working for this same practice, now known as Altais Medical Group Bay West, since she arrived here over 40 years ago.

She has witnessed the changes in our healthcare system from the frontlines, manning the front desk of this Mission District practice that serves many immigrants, low-income families, and the working poor.

A practice that once felt like a family business is now corporate owned. There’s more bureaucracy, doctors are busier, with less time for each patient. Because insurance reimbursements are lower, there’s more pressure to generate income and reduce expenses, she said.

Yet it remains an important outpost of medical care for the neighborhood, and 40 percent of its patients are Spanish speaking. Despite the changes, Balestier said she’s “blessed” and still loves working there.

A petite woman, she exudes empathy with a clear gentle voice and a friendly, direct gaze through deep-set brown eyes. She manages the hectic front desk with cool grace, effortlessly switching between Spanish and English.

Balestier addresses many by their names, asking about their lives and their health. “Sometimes people get frustrated, and I understand, but I try to de-escalate and give them some directions to help.”

On the job since 1986

She started in 1986 cleaning offices and “just stayed,” she said. “I never looked for a job in my life.” The practice, originally called Bay West Medical, was founded by four idealistic family practice doctors on Silver Avenue in the Excelsior.

When the practice, which has changed names and ownership several times over the years, moved to Valencia Street, she followed and has been there almost 40 years.

How many doctors, physician assistants, and nurse practitioners have come and gone since she started? “Oh my God, I want to say, maybe 50, 60, more?  I can’t even begin to count.”

At 63, she still works full time and has no plans to retire anytime soon. “I have seen patients who were babies, and now they come back to me with their own kids. Babies that now are adult patients, that is so amazing to me.”

She was born in 1962 in Guadalupe, a suburb 15 minutes outside of San Jose, Costa Rica. Her father owned a successful supermarket, and when her mother came to work there as a cashier, he courted her.

Her dad was 32 years older than her mom, and they had three kids. Balestier is the youngest.

Isn’t Kattia an unusual name for a Latina? She shrugs, “My mom saw a Russian movie, and she loved this Russian name, Kattia.”

From Costa Rica to San Francisco

Balestier attended a private high school in Guadalupe and listened to the Beatles, Elvis, and Simon and Garfunkel, along with the local Spanish music. At 19, after one year of college and unsure of her direction, she decided to visit her aunt and uncle in San Francisco. Aunt Hilda lived on Valencia Street.

“The plan was to stay for three months, but I never left. Also, I was getting away from an emotionally controlling boyfriend back there. It was easier to stay.”

What was it like here when she arrived in 1982? “It was so exciting, just amazing, the people were so friendly, and then the city itself: so, so beautiful.”

She babysat for her cousin’s small kids and took English classes at the Senior Center on 30^th Street (now OnLok). “I was very shy to speak. I understood more English than I spoke, I can tell you.”

She started attending a Pentecostal church, Lirios de los Valles (Lilies of the Valley), where she met her now ex-husband, a musician born in New York, the son of Puerto Rican immigrants. He played drums and composed Gospel songs. She married him at age 20 in 1983.

Her parents came for the wedding, then decided to stay and took odd jobs, one of which was cleaning offices. Sometimes, she went along to help. That’s how she came to Bay West Medical, where the office supervisor saw her potential and hired her for part-time filing and setting up charts.

Her daughter Priscilla was born in 1984, followed by Olivia in 1987. When her youngest turned 7, she went full time.

When she started the job, Balestier was cleaning, filing, and putting together medical records. “I was just fine doing that,” she said. Then she was asked to work the phones. “It was horrible and scary.  Doctors would call and yell if you kept them on hold too long. There were so many calls at once.”

Doing it all by hand

There were no electronic medical records then. “Everything was paper: appointments, messages, all by hand. It was very challenging.” She never studied medical terminology and said, “my spelling wasn’t great, often I had to use a dictionary or ask coworkers for correct spelling.”

But dealing with people was something she excelled at. “I could relate to them; I can be very patient. I love what I do, and I liked it from the beginning.”

Forty years of greeting patients, answering their questions, explaining insurance and Medicare/Medi-Cal to them, translating and interpreting for monolingual Spanish language patients, has given her a perspective on our fragmented health care delivery system,

 “I have seen so many changes in health care, and it’s sad, it’s very sad:  The older patients need more time, more care, more medications. But I see them not get the meds they need ‘cause Medicare doesn’t cover them, and they don’t understand.”

She cannot fill out forms for them, but she can explain their options: “So I will tell them to get help from the Medicare office, to get more information because they might be eligible for Medi-Cal as well.” (Medi-Cal serves the low-income community.)

Even educated patients, professionals with employer-based health insurance, sometimes don’t understand their plans, she said.

Navigating a tricky system

“Often, younger people are confused about how their insurance works; sometimes their plans get changed, and they don’t even know it. It’s so hard because the insurance companies try not to pay, and it’s a whole process to appeal. I explain all that.”

Since the last doctor who founded the practice retired last year, “no one has been there as long as me,“ she said.

Her daughter Priscilla was a little girl when Balestier started. Now, at 40, she’s been trained and works alongside her mom as a medical assistant, taking vital signs, giving vaccines, and assessing patients ahead of the doctor’s exam.

Balestier is deeply loyal to the mission of primary care in a neighborhood setting that was the vision of the founding physicians. She recalls the early years:

“Sometimes there were issues when the doctors in the practice didn’t get along, didn’t see eye to eye. That was super hard ’cause it was like a home, and we were a family,” she said. “We worked it out. One of our founding doctors even played Santa Claus every Christmas.”

The practice feels very different these days. After the four original founders retired and sold the company to a corporation, she said, “things are much more rigid. Even my manager has a manager.”

Doctors can’t spend as much time with patients, and few stay till they retire, as the founders did.

“This place was always so busy, two of us checking people in, lines out the door and the waiting room packed,” she said. “Now, we have traveling doctors, we use them because we need to, but the patients get bounced around and don’t have the same relationship with one established primary care doctor like before.”

The COVID-19 pandemic took its toll as well. Balestier watched as doctors left the profession, retired, or took other jobs.

“COVID was a hassle because we had to change to video visits; it was very hard to explain how to Zoom to older patients, but they still needed care,” she said. “We closed, and then when we re-opened, I was by myself on the phones cause my pregnant co-worker was rarely there.”

Clearly, someone who has kept the same job for four decades isn’t one to make quick changes. Laughing, she says, “I was 46 when I learned to drive, and 55 when I became a citizen in 2017.”

She cared for her father in her own home till he died at age 89 in 1996. After her husband died, Balestier’s mother moved back into the family home in Costa Rica, but Balestier has no plans to retire there. Her daughters, she said, will never move there.

She is devoted to fitness and enjoys taking long walks, exercising, crocheting, and knitting. She has another passion as well: “I love to watch the Giants play; it may be one of my favorite things to do during baseball season.”

Her work takes lots of energy, and she notes, “I am getting older. Though I’m a strong person, I have less patience than I had before.”

But she plans to stay on.

She is grateful for the work that has allowed her to support her family and to be of service.

“Most patients are so appreciative, and I still feel I am in my right place; I feel blessed. This is the place for me. I knew that from the very first year.”