Culturally Sensitive Medical Care
By Thomas Schalow

where to find Health Information in Spanish Beware Medical Miracles

The patient, a middle-aged woman, limped into the medical clinic complaining of a red, swollen toe. The pain was so great that she could barely put on her shoe, much less walk. Albert Peinado, M.D., a recent graduate of the University of Southern California's (USC) medical school, examined the woman, who spoke no English.

"Don't worry," he explained in Spanish, "we'll simply cut off your toe, and have you out of here in no time."

The woman gasped. "The entire toe, doctor?"

"I meant toenail!" he reassured her in Spanish, realizing his mistake. The patient was suffering from nothing more serious than an infected hangnail.

Sometimes Hispanics turn to illegal clinics, because they can’t find linguistically and culturally competent medical care in licensed venues

This mix-up occurred with both parties speaking Spanish. Imagine if they had been unable to communicate in the same language, and you will appreciate the level of anxiety many Hispanics experience when seeking medical care.

Peinado was inspired by his Mexican-American grandparents to enter a profession where he could help his fellow Hispanics. Now a prominent physician with a thriving practice in Bakersfield, California, Peinado worries that there aren't enough young Hispanics to follow in his footsteps.

Many regions of the country are experiencing a physician shortage. When it comes to Hispanic physicians, the shortage is even more acute. According to the federal Health Resources and Services Administration, at the end of the last decade, only four percent of active patient-care physicians were Hispanic. The American Medical Association reports that only 6.1 percent of medical school graduates in 2002 were Hispanic. These are discouraging numbers indeed, considering the Hispanic population boom.

Many experts believe the shortage of Hispanic doctors is a direct result of Proposition 209 in California, and the 5^th Circuit Federal Court decision in Hopwood v. Texas. Both undermined affirmative action policies proven to help Hispanics overcome barriers to higher education.

Whatever the cause of the shortage, there is no dispute that it is having an adverse impact on the health of Hispanics. A recent study by the Commonwealth Fund of New York, found that one-third of Hispanics said they had problems communicating with their doctors.

Hispanic Health Factoids Among those Hispanics who need an interpreter to communicate with their doctor, only half have had one. Nearly a third of Spanish-speaking patients have walked away from a doctor’s visit only partially understanding what the doctor has said. Close to 30 percent of Hispanics—more than 11 million—are uninsured. That is twice the rate of the overall U.S. population.

Poor communication, or no communication due to lack of access to licensed doctors, can lead to disaster. Sometimes Hispanics turn to illegal clinics, because they can't find linguistically and culturally competent medical care in licensed venues. Numerous deaths have occurred after patients received treatment by unlicensed, untrained providers. Another common phenomenon is that immigrants will travel to Mexico to receive health care there, rather than try to maneuver through an unfamiliar system in this country.

Perhaps nowhere is the shortage of Hispanic physicians as critical as in California. Hispanics make up nearly one-third of the state's 35 million residents. State health officials estimate that three to six million working poor Hispanics have no access to medical services, especially in rural and agricultural areas with large immigrant worker populations. In 25 of the state's 58 counties, there are areas with fewer than 145 physicians of any ethnicity per 100,000 people (one physician for 690 patients).

California has adopted two new laws that seek to address this problem. One law will allow 30 primary care physicians from Mexico to practice in California under close supervision. The other law provides grants to help pay medical or dental school tuition for those willing to practice in the state's underserved areas.

With California taking steps in the right direction, can the rest of the country be far behind? There is still a long way to go, but the prognosis for "culturally sensitive" health care for Hispanics is encouraging. According to a spokesperson for the Association of American Medical Colleges (AAMC), the organization remains "committed to increasing the number of underrepresented minorities in medical education." In addition to numerous scholarship awards, the AAMC sponsors the Minority Medical Education Program. That program provides free tuition, room, and board for a six-week summer medical school preparatory course that helps promising, highly motivated minority students gain admission to medical schools.

And, although affirmative action is a thing of the past at many public institutions, numerous private medical schools have active minority outreach programs.

Hispanics and Spanish-speaking non-Hispanics are doing what they can to break down the barriers to health care. The School of Medicine at the University of North Carolina, Chapel Hill, offers a medical Spanish course to its medical students. The course teaches students not only basic terminology, but cultural issues, such as the importance Hispanics place on family when it comes time to make health care decisions. "By 2030, the Hispanic population will be the largest minority in the United States. We need to serve this population," says Marco Alemán, M.D., assistant professor of medicine and the course director.

A student organization at the medical school, Spanish-speakers Assisting Latinos Student Association (SALSA), provides a forum for the practice, development, and improvement of Spanish language and cultural skills, in particular for use in the health care setting. Members practice scenarios focusing on particular health problems and work to improve their Spanish medical vocabulary.

Our nation's leaders in Washington are also addressing the problem. In February 2002, Health and Human Services Secretary Tommy Thompson announced that $90 million had been earmarked for scholarship and loan repayments to doctors (and other health professionals) who agreed to serve for two to four years in underserved rural and inner-city areas. A few months later, President Bush appointed the second Hispanic in history, [Dr.] Richard H. Carmona, to serve as Surgeon General. In November 2002, Thompson announced that his agency had budgeted $85 million to support the elimination of health disparities among racial and ethnic minorities, noting that Hispanics and other ethnic minorities "suffer an unequal burden of death and disease."

On the local level, community organizations, such as the Latino Education Project, Inc. of Corpus Christi, Texas, are working to develop culturally sensitive, community-based health promotion and disease prevention programs. The goal, says the project's director, is to educate Hispanic seniors about the prevention of diseases that impact Hispanics disproportionately, such as cardiovascular disease and late-onset diabetes.

There is also much activism within the medical profession itself. Hispanic health care providers are forming organizations and becoming increasingly proactive in the quest to bring others into the profession. The newly formed California Latino Medical Association (CALMA) is aggressively lobbying elected officials and business leaders, pointing out the need for greater access to medical care for Hispanics. The group is also committed to mentoring young Hispanics in the sciences.

One CALMA member is determined to give back to the community. "I never would have dreamed that we, as Hispanic doctors, could become such a powerful force. If we band together, we can really have an impact," says Peinado.

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Now check out some sites that are useful resources for health information in both Spanish and English. Plus learn how to spot a medical scam.

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