http://www.nwaonline.net/articles/2006/ ... health.txt

Language, Insurance Affect Hispanic Health Care

By Lori Harrison-Stone
The Morning News
ROGERS --Hispanics want healthy babies, proper medical advice when they’re ill and compassionate care for grandma and grandpa — the same family health concerns of everyone. They’re just less likely to seek that care if language or insurance are problems.

Factors such as income, employment, health insurance status and English speaking ability affect health, according to the Arkansas Racial and Ethnic Health Disparity Study Report published last year by the Arkansas Minority Health Commission.

The report notes that in Arkansas, as in the United States, blacks and Hispanics are more likely to live in poverty, be unemployed, be less educated and lack health insurance. Language is also a barrier for Asian and Hispanic residents. The inability of a health care provider to communicate with a patient has a “potentially devastating” impact, according to the report.

Mary Ann Shope, director of advancement at Arkansas Health Education Center in Fayetteville, agrees with the report that language can be an obstacle in health care.

Teaching interpreters who work in health care to translate medical terms is a must, Shope said.

The center, with the help of grant money from the Northwest Arkansas CommunityCare Foundation, is offering medical translation classes for Spanish interpreters working in the health care field.

Shope noted that there are few Hispanic health care workers. Seeing a doctor or being treated by a nurse who is the same ethnicity helps many patients trust the care provided. Shope said trust was an issue noted by participants in focus groups used in the Racial and Ethnic Health Disparity Study.

CommunityCare Foundation funding is helping pay for short courses aimed at attracting bilingual students for future careers in medicine. The center provided a two-week program during the summer to juniors and seniors at Springdale High School for several years and is planning a one-week summer course this year for ninth-grade students.

Shope said reaching the students early may help spark a lifelong commitment to the health care field and help them to see what types of courses need to be taken in high school to help them get into college.

“We want them to know that pathway exists,” Shope said.

Healing Language

Nellie Cordova, coordinator of multicultural programs at Arkansas Health Education Center, runs Spanish language medical interpretation classes. She said communication issues can cause all sorts of problems for patients.

“It can lead to either medical problems, health problems or even death,” Cordova said. “We tend to think anyone bilingual can interpret, but I certainly wouldn’t go to the court system or even a plumber and try to interpret.”

Cordova noted that although interpreters have to be certified to work in the court system, the only state requiring official certification for medical interpreters is Washington.

Cordova began working as a medical interpreter 11 years ago at St. Mary’s Hospital and has since spent time trying to educate herself. At first, she said, she couldn’t find Spanish-English dictionaries specific to medical terms. On visits home to Guadalajara, Mexico, Cordova said she questioned relatives in the medical field to learn the terminology. She also attended training in North Carolina, a state that dealt with an influx of Hispanics before Arkansas. The dialects within Mexico alone are so varied it makes it difficult to interpret, she said.

Learning to interpret for medical care has to include terminology for anatomy, physiology and ethics. Interpreters are taught that they’re not advocates but interpreters, “more like a mirror image,” Cordova said. The courses she teaches includes two classes — one with basic medical information and another that includes anatomy and physiology terms.

A third course could be taught on the cultural differences, she said, noting that cultural misunderstandings can cause problems between doctor and patient.

For example, she said doctors often need to ask if the Hispanic patient has seen a healer who may have prescribed herbs. They also may need to ask if the family eats from pottery, which may have lead in the glazing and cause high lead levels in a child.

Also, she said, in the Latino culture a doctor tells the family about a serious medical condition and works with the family on treatment options. Latinos want the patient to concentrate on recovery and bad news is thought to negatively affect that. Many have a hard time understanding that in this country the patient has to be told about his or her condition and decide treatment, she said.

“Our major goal is for all Northwest Arkansas health facilities to be able to provide information that all patients need,” Cordova said.

About 70 interpreters have taken the course on medical terminology locally, many were trained in Rogers at St. Mary’s Hospital, which has held two courses and is conducting a third.

Tree Of Life

Tree of Life Family Health Center in Rogers, a ministry of Mercy Health System, has two staff members who have been through the medical terminology Spanish course, said David Engle, center director.

Tree of Life offers four health care programs that serve a different population than what was envisioned in 1992 when the clinic opened. Engle said the clinic’s bilingual clients make up approximately 20 percent in the medication assistance program, 60 percent of the pediatric clients, 64 percent of the family practice clients and 57 percent of the prenatal care clients.

The clinic has 11 full-time employees, including five who speak Spanish. The staff includes two doctors and a nurse practitioner.

Tree of Life services aren’t free, but its fees are based on income and it accepts Medicaid patients. Engle said the clinic doesn’t refuse care if a patient can’t pay. The clinic’s budget is supplemented by United Way, grants, church organizations and donations.

“Generally speaking, the Hispanic population is willing to pay,” Engle said. “I don’t think they’re walking in the door expecting a free doctor’s appointment.”

Most of those served by the clinic are without private health insurance, and some of the Hispanics seen at the clinic are undocumented. Engle said that’s not a concern that will keep them from treatment at Tree of Life. He recently explained to a clinic patient who was using a false name that she wasn’t in trouble at the clinic, but it could be an issue if she had to check into the hospital.

State legislation last year that provided prenatal care for undocumented individuals through Medicaid helped the

Tree of Life clinic get reimbursement for services it was already providing. Engle said

the issue became “a political

hot button,” but the clinic

doesn’t see it as such because the goal is healthy babies despite the parents’ residence status.

Tree of Life began serving more patients last year when it moved from a three-bedroom house to a 6,600-square-foot office. The clinic serves an average of 65 pediatric patients per week, 57 in its family practice and 47 for prenatal care.

“What this clinic does is serve the community needs,” Engle said.

State Interpretation

Ann Wright, health communication and marketing expert for the Arkansas Department of Health and Human Services, said caring for the Hispanic population is a big part of what the Health Department does in many Arkansas counties.

In four counties where the Health Department is serving the biggest Hispanic populations — Benton, Carroll, Sebastian and Washington — the department served 54,788 Hispanic clients last year. Nearly 49,000, or 89.2 percent, of the Hispanic clients needed an interpreter. Of those served, nearly 7,000 were seen by Health Department staff for maternity, family practice or other medical needs. More than 48,000 were provided services through the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC.

The Health Department serves Hispanic clients whether or not they are documented, Wright said. She called public health services “a safety net,” explaining that the department’s work to fight tuberculosis and other communicable diseases can’t be limited to those who are citizens or documented residents.

“We’re going to offer that no matter what,” Wright said. “It’s kind of our goal.”

Wright said three services are provided to undocumented individuals through the Human Services division — emergency medical services to those who qualify for Medicaid, services for pregnant women and services for victims of child abuse.

The big issue, she noted, is breaking down language barriers to make sure correct information is getting to the Hispanic population and to help the department meet the community’s needs. The department’s Office of Minority Health provides brochures and other informational material in Spanish and

uses interpreters.

Each county office also addresses the issue in its own way. Wright said that in Benton County, the department offered a workshop on diversity for its staff last year. The Benton County unit also has a part-time bilingual nurse practitioner and uses interpreters.

The Washington County unit has an outreach worker for the Hispanic population who focuses on communicable disease contacts and medication compliance and offers assistance to health care workers relating to cultural information or access to care issues. Washington County also provides nutrition and breast-feeding classes in Spanish, in addition to providing health fairs and Spanish-language health information.

Studying The Issue

The Office of Minority Health, a division of the U.S. Department of Health and Human Services, reports that Hispanics have the highest uninsured rates of any racial or ethnic group within the United States.

According to the Web site for the office at www.omhrc.gov, a 2002 report from the Centers for Disease Control and Prevention found that private insurance coverage among Hispanic subgroups varied. The study found that 37 percent of Mexicans were without insurance, as were 19.5 percent of Puerto Ricans, 20.5 percent of Cubans and 32.9 percent of other Hispanic and Latino groups.

The Arkansas Racial and Ethnic Health Disparity Study Report attempted to provide an accurate picture of the disparity in health care but found a lack of data to be an obstacle. One strong recommendation coming from the study was a need to more accurately track health data based on race and ethnicity.

There was, however, enough data for the study to point out “large disparities in death rates and disease burden” between minority and nonminority populations. The study also found that these disparities seem to be worsening for specific diseases such as colorectal cancer, breast cancer, prostate cancer and diabetes.