Small towns trying to deal with growing Hispanic population
Health care providers trying new ways to help
Sunday, July 01, 2007

By Martha Raffaele, The Associated Press

HANOVER, Pa. -- Encouraging Hispanics to get flu shots in this rural community just five miles from the Maryland border was a tough sell for Gino Salazar.

Whenever the part-time community health worker at Hanover Hospital told them about the hospital's vaccination clinics, they resisted, fearing the shots would make them sick. But when the hospital took the clinics to churches with predominantly Hispanic congregations late last year -- with Mr. Salazar, a native of Peru, making a pitch at the Sunday services -- they came in droves.

"We thought if they saw one person going in [for a shot], then everybody will start coming in," Mr. Salazar said. "It became a mass vaccination."

Mr. Salazar, who works full time at an apple processing plant, serves as a bridge between Hanover's growing Hispanic population and the community agencies that provide health care or social services. He was hired in November as part of a broader effort by the hospital to improve services to Spanish-speaking residents.

As more Hispanics move into America's rural communities, health care providers like Hanover Hospital are being forced to re-examine how they deliver services and consider new ways to help them overcome language and cultural barriers that obstruct access to care.

Hispanics are projected to become the largest rural minority population by 2025, according to a U.S. Department of Agriculture analysis of census data. Their population nearly doubled from 1.4 million to 2.7 million in rural towns between 1980 and 2000, with Hispanic representation among rural residents rising from 3 percent to 5.5 percent during the same period.

A major factor is tighter border security -- particularly after the Sept. 11, 2001, terrorist attacks -- that makes constant travel between work in the U.S. and family in Mexico more difficult for illegal immigrants.

"They discover that crossing back and forth ... no longer is easy and no longer is cheap, and they tend to bring their families with them," said William Kandel, an Agriculture Department sociologist. "There are a large number of children being born here."

Some of the most acute problems caused by the Hispanic population boom are in the southwestern states along the U.S.-Mexico border, where impoverished border towns lack basic services such as running water, said Amy Elizondo, vice president of program services for the National Rural Health Association.

"You see a lot of overflow in emergency rooms," in the border communities, Ms. Elizondo said. "You're looking at Third-World country type problems."

In rural communities that have adequate basic health care services, the challenge is in making Hispanics aware of what is available and making it easier for them to get to hospitals, clinics and doctors' offices.

Migrant workers present a special challenge because of their nomadic lifestyles, said Candace Kugel, a nurse practitioner from State College affiliated with the Migrant Clinicians Network, a national organization of health care professionals who serve migrants.

"People who move because of their work are constantly being uprooted, and so if they are involved in care for a chronic illness or a pregnancy, for example, they are not necessarily going to have good continuity of care," Ms. Kugel said. "You might have a pregnant woman who has maybe two or three visits in a row, and then she moves and it takes a month or six weeks to find a new provider."

Loretta Heuer, chronic disease coordinator at Migrant Health Services Inc., in Moorhead, Minn., tried to attack the problem of diabetes among migrants in North Dakota, Minnesota and Texas under a program begun in 2000 that paid certain members of the migrant community a small stipend to work as "lay educators" on the disease.

The educators organized support groups or prevention screenings that typically took place at local churches after Sunday services. Participants were able to share their concerns with someone who spoke their language and could provide information about diabetes symptoms and advice on how to monitor their blood sugar.

"They were also able to talk about it with families and give them a better understanding of the disease," Ms. Heuer said. "Sometimes, if you have low blood sugar and you're irritable, your family members may just think you're being crabby."

Bringing services to Hispanic residents can go a long way toward overcoming some health care obstacles, said Mark Holmes, vice president of the North Carolina Institute of Medicine, a nonprofit organization that analyzes health policy issues.

"It really cuts down on transportation time, and transportation may be a considerable barrier," Mr. Holmes said. "There's also a big issue of trust. When you have repeat visits, and lay the groundwork for explaining who the health care providers are and what they do, that helps."

In Hanover, the hospital and a local counseling center jointly hired Dr. Carol Vidal, a Spanish psychiatrist, to study the needs of the Hispanic community in late 2005. The Hispanic population of Hanover and surrounding areas was estimated at 5,600 last year, more than double the number counted by the 2000 U.S. Census.

After interviewing residents between January and April of 2006, Dr. Vidal found that language barriers, a lack of transportation, long work hours, perceived discrimination and deportation fears among illegal immigrants are among the obstacles to basic health care.

"I was surprised by the amount of hours they were working, how they were trying to deal with family and work time," Dr. Vidal said.

Even before Dr. Vidal completed her research, she recommended the hospital revamp its translation services, said Flavius Lilly, the hospital's vice president of organizational and community development.

The hospital hired two bilingual patient relations coordinators to assist emergency room patients last fall and hopes to hire two more to provide around-the-clock service. Previously, it employed a telephone translation service that patients felt didn't provide adequate help.

Luisa Wolfe, a Colombia native, is one of the new patient-relations coordinators hired by the hospital as a result of Dr. Vidal's study.

"When we come out [to the front desk] they're pleasantly shocked," said Ms. Wolfe, who is also an interpreter for the Adams County Courthouse in nearby Gettysburg. "They say, 'We didn't know there was anyone here who could help us,' because there was no service before."

The hospital also has developed a bilingual pamphlet listing organizations in the region that serve Hispanics, and it sponsors a monthly Spanish-language newsletter called Conectese, which contains information on topics such as health, education and job openings.

Additionally, the hospital is part of a year-old coalition of community organizations called Hanover Juntos, or Hanover Together, that strives to promote cultural understanding between Hispanics and the community's predominantly white Pennsylvania German descendants.

"There are healthy ways and appropriate ways to bring the two communities together that the way they interact is mutually beneficial and adversarial," Mr. Lilly said, citing a Hispanic film festival the hospital sponsored last fall as an example. "Part of our philosophy has been, if you alienate a group of people even more than they already are, you create social problems that didn't exist before."

http://www.post-gazette.com/pg/07182/798200-85.stm