Since 1991, Daley has been part of a unique collaboration to deliver better health and social services to children in mid-city San Diego. This innovative program, called New Beginnings, includes a school-linked clinic at Hamilton Elementary School. It is among the first such experiments in the nation and reflects the hard work of many agencies and citizens.

New Beginnings is located in an ethnically diverse area of San Diego, which was designated by the federal government as an economic empowerment zone. In 1994, 400 citizens met and drew up a community plan that Daley describes as "beautiful." The plan called for improved healthcare access and more science and arts education to build on community strengths and prepare the young to enter the labor force.

Daley has been part of the process since 1991 and when New Beginnings came together, she says, "It was like a miracle was happening. Not a miracle. It was in the wind. People recognized that they wanted to test these new ways of doing business. They wanted to work together because they knew they couldn't do it alone. This is an opportunity for students to see the richness of collaboration and that the process takes time."

UCSD School of Medicine was invited by the community to join the New Beginnings partnership, which includes the San Diego County Departments of Social Services, Probation, and Public Health; City Housing Commission; San Diego Unified School District; and community college and other non-profit agencies in the community.

This community medicine experience gives medical students and residents an opportunity to learn how to work with groups, sometimes in complex agency relationships. "Physicians are usually chosen for their ability to work alone. We are good at making emergency decisions. We're not trained to work by committee, but there are times when we're taking care of patients when we need to cooperate with others."

"If you enter a new community, you need to know who you should be setting up relationships with over time in order to maintain a high level of education and economic sustainability in that community."

Part of relationship building is communication. She comments, "The first thing you do when you go to a community meeting is you listen. You let the community speak, even though you think you know what needs to happen. Then you say, 'This is what I have. Do you think it will be useful? Does it help shed more light on this issue?'" She adds, "I offer this as a strategy. We're all very good-hearted people, but we frequently alienate our colleagues who are part of the solution."

Daley has wide-ranging experience in the process of leading and collaborating. She is an alumna of both the Kellogg Leadership Fellowship program and of LEAD San Diego, a local leadership program. She has traveled to Iceland, Norway, Brazil, Russia, China, and Nigeria to watch grass roots political action processes first hand. And in 1993, she was invited by the U.S. Secretary of Health and Human Services to talk with his advisory board about New Beginnings.

She hadn't always planned to practice medicine in community settings. Initially, she planned to do research, entering a postgraduate microbiology program at the University of Colorado. Contact with medical students and faculty inspired her to pursue an M.D., Ph.D. program at UCSD School of Medicine. It was not until her third year of medical school that Daley decided she preferred clinical medicine to medical research.

Daley graduated from UCSD School of Medicine in 1975. She joined the Comprehensive Health Center in southeast San Diego as an ambulatory pediatric fellow in 1979. She stayed for eleven years, becoming executive director of the Center before leaving in 1990 to join the faculty of the UCSD School of Medicine. Through her efforts, the Health Center is one of the sites students may choose as part of the Pediatrics Core Clerkship.

As Assistant Dean of Diversity and Community Partnerships for the medical school, Daley has also implemented a number of middle, high school, community college and undergraduate school academic enrichment programs that help students from disadvantaged backgrounds pursue health and science careers. Science enrichment programs like the Community Outreach Partnership Center and the UniversityLink Summer Residential program introduce students to scientific inquiry in grades 7 through 12 and community college, preparing them for the competitive admissions process in health and medicine.

"We're setting up a pipeline of students and a network of participating schools, as well as interested healthcare providers and scientists, to nurture these students," she says.

Retention is just as important as admission to medical school. In programs like the Hispanic Center of Excellence, Daley works to retain students and faculty from nontraditional backgrounds. The Center not only supports Latino students and faculty, but also teaches everyone involved - faculty, staff, and students - about Latino culture and healthcare issues.

She is able to work with students and parents from a base of empathy. She moved from Panama to Los Angeles at age twelve. "When I look at the kids on the playground at Hamilton, I really think of myself when I first came to this country." Raised by her grandmother in Panama in a one-room house without plumbing or electricity, she studied her lessons by the light of a kerosene lantern. After she moved here, Daley remembers being afraid to go outside, to go to school, to make a mistake among her new American schoolmates. "You get teased; you get beaten up - because you are different."

Daley realizes that the next generation of health care providers must be a diverse group. Not only ethnically and economically, "they need to be diversified in their thinking. The people that we're training need to be citizens of the world, as well as citizens of this nation. We have to ensure that the curriculum is designed to prepare them for that challenge and that they are allowed the opportunity to work with a diverse group of citizens."

Daley has taken her work in the community from service to scholarship. Under her leadership, university-community partnerships have evolved into major initiatives at UCSD School of Medicine. For example, UCSD was the first school of medicine in the nation to receive a Community Outreach Partnership Center award from the Department of Housing and Urban Development. The school has also established the San Diego EXPORT Center, a major initiative funded by the National Institute on Minority Health and Health Disparities. The EXPORT Center focuses on research, education and training of health professions students, faculty and community based health care providers in minority health issues and disseminates information to our communities about health disparities affecting various populations.

In the 1970s and 80s, at a time when choosing to do community clinic work was not a typical career choice for a young physician, Sandra Daley made a commitment to it. She also saw it as a way to make a statement to those coming behind her.

"Young physicians will eventually hit the barriers that we all hit and will be ready to look behind the scenes at how to break them down. I think it begins by having to do some work in community. One exquisite moment for me was when a resident said, after being in meetings with me all day, 'Dr. Daley, it's amazing what we don't know.'"