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The Orange County Register (KRTBN)
Irvine, Calif., Medical School Adds Hispanic Language, Cultural Program
By Courtney Perkes, The Orange County Register, Calif.
June 10, 2003
Maria Blas understood little as a nurse explained in a flurry of English that she needed to check her 6-year-old son's vision and hearing. The nurse gestured and tossed in the word ojos, or eyes.
Then Dr. Robert Tran entered the exam room at the UCI Family Health Center in Santa Ana.
In Spanish, he asked Blas if she wanted to accompany her son, Pedro Ascencio, down the hall or wait. Later, he examined Pedro and jotted notes on his medical history and performance in school. Tran complimented Blas for helping her son with his homework and told her Pedro needed a dental check up.
"He knows how to speak Spanish," said Blas, 28, who took a morning off without pay from her factory job and rode the bus to the appointment. "If I don't understand something, he can give me an explanation."
Latino health advocates would like to see such encounters become more common to meet the needs of the growing Latino population in Orange County and across the state and country. Doctors at the University of California, Irvine spent two years developing a program that would train future doctors to better care for patients like Blas and her son.
The program will add a fifth year to medical school and involve intensive language and cultural training. Such a program could also boost the number of Hispanic doctors, which currently comprise only 4 percent of physicians in the state, according to the California Latino Medical Association. Hispanics comprise 32 percent of Californians.
Students, who must already speak basic Spanish to be accepted, will learn everything from epidemiology of medical conditions common among Latinos -- such as diabetes -- to Latin American geography, so they know the origins of their patients. They will learn about family structure, so they won't be surprised when multiple relatives come along for appointments or when patients seek medical advice from extended family.
"When I tell you I need to talk this over with my grandmother in Puerto Rico before making a decision, I want you to say, `Sure, let me know what she thinks,' not `Why do you need to talk to her?,'" said America Bracho, chief executive officer of Latino Health Access in Santa Ana.
Both Bracho and Christine Gonzalez, executive director of the California Latino Medical Association, have discussed the program with UCI doctors.
"Latinos are composed of very different cultures," Gonzalez said. "Their approach to health care is very different. Mexican women, for example, are extremely reserved. They don't necessarily tell their physician everything that is wrong with them."
Tran, who also speaks Vietnamese, studied Spanish in college and also picked up the language through travel and work in Mexico. He said when he treats patients he must take into account their backgrounds and finances. For instance, he would not want to prescribe an expensive drug to a patient who could not afford the medicine.
"It can be difficult because of the subtleties of communication, understanding the complexity and a patient's background," Tran said.Medical advocates said programs such as UCI's can decrease the need for translators. They say friends or family may not know how to explain medical terms or they may withhold information in an effort to protect their loved one. Additionally, patients may not feel comfortable disclosing personal information to someone other than their doctor.
Dr. Alberto Manetta, senior associate dean of educational affairs at the medical school and the developer of the UCI program, said properly trained doctors can learn how to best serve patients hard-pressed by work, child care and transportation. They can also better communicate with their patients by understanding common expectations and practices popular in Latin America, such as alternative medicine.
In his own gynecology practice, Manetta, a bilingual native of Argentina, said he found a way to reduce the number of visits for his Latina patients, who sometimes struggled to make follow-up appointments. He began offering Pap smear results during the same appointment as the test. He said when other busy women heard about the program they liked the idea, too.
Manetta said many Latinos are also accustomed to a quick diagnosis from their doctors. Knowing that preference, can encourage doctors to explain why they need more time or tests.
"Just knowing about those things raises your sensitivity about expectations," he said.
Julian Noyola, 32, of Tustin paid $35 for a visit with Dr. Tran after he injured his leg while playing soccer. He said many of his friends don't go to the doctor because of the expense, but are worse off in the end.
With medical care superior to his experience in his native Acapulco, Mexico, Noyola said he was grateful for an affordable trip to a Spanish-speaking doctor.
"I can earn more money if I get better fast," said Noyola, an uninsured cook at the Claim Jumper, who missed two weeks of work. "That's why I came."
UCI HOPES TO IMPROVE ACCESS BY DEGREES
Beginning in fall 2004, UCI's College of Medicine plans to offer the Program in Medical Education for the Latino Community, or PRIME-LC.
The five-year program will eventually accept 12 new students a year in addition to the regular medical-school class. Due to state budget constraints, it's too early to say exactly how many students will begin the program in the inaugural class, according to University of California Office of the President. Graduates will receive a master's degree in environmental health science and policy in addition to their medical degree.
Study will take place in Irvine as well as in Cuernavaca, Mexico. Students will perform their residencies working with predominantly Latino patients. UCI officials are working to provide scholarships and loan forgiveness in order to recruit students and offset the expense of an extra year of school.
The program is open to Latino and non-Latino students alike. For more information, visit www.ucihs.uci.edu/PRIMELC
According to a February 2003 survey by The Commonwealth Fund, a private foundation supporting independent health research, Hispanics are far more likely than whites or blacks to lack health insurance. Latinos who do not speak English fluently face even greater health care inequities because of difficulty communicating.
The study found:
--61 percent of Spanish-speaking Hispanics surveyed lacked health insurance. Among English-speaking Hispanic adults,
--36 percent lacked insurance. That figure was 20 percent for whites and 30 percent for blacks.
Among uninsured adults,
--66 percent of Spanish-speaking Hispanics did not have a regular doctor, compared with 37 percent of whites and 44 percent of blacks
Spanish-speakers also reported trouble understanding prescription bottle information and health literature.
Meanwhile, other studies have found that obesity and weight-related type 2 diabetes are increasing among Latino adults and children. Researchers have also found that asthma disproportionately affects Latino communities because of inadequate access to health care and higher environmental risks.