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Democrat & Chronicle
The Hispanic Boom: Bridging Barriers To Care, Community Fights Language, Culture Gaps In Medicine
By Matt Leingang
September 29, 2003
Medically speaking, Dr. Carlos Jimenez-Rueda provides health care to his patients like any other physician: Diagnose and treat.
But the language spoken inside his Rochester office is almost exclusively Spanish.
More than half of Jimenez- Rueda's 2,000 patients are Hispanic - largely Puerto Rican-born residents who are able to speak English but prefer to use their native Spanish when explaining sensitive, and often complicated, medical needs.
It makes for a more accurate diagnosis because nothing gets lost in translation and the doctor-patient relationship is not disrupted by an interpreter, says Jimenez-Rueda, a 72-year-old native of Paraguay who opened his office - Clinica Pan Americana - on Portland Avenue in the late 1980s.
Patients also feel more comfortable here.
"It's a place of familiarity," says Carmen Fernandez Teremy, 66, of Irondequoit, who was born in Puerto Rico. "Being here raises my level of comfort, and that's what you want when you have to see a doctor. I don't ever fear that he doesn't understand me."
Hispanics are the fastest growing minority population in the area, and the medical community has had to adapt to them.
Indeed, more Hispanic doctors and nurses work in health care than 20 years ago, and Rochester's hospitals have beefed up Spanish translation services.
Hispanic civic leaders are represented in some of the top area medical circles. Julio Vasquez, president of the Ibero-American Action League, was appointed last year to the Board of Trustees of the University of Rochester Medical Center.
In many ways, the local health care system has struggled to keep up with the demographic shift:
* Of 2,500 practicing physicians in the Rochester region, only 45 are Hispanic, according to a 1999 study by the Finger Lakes Health Systems Agency, a local planning group. While Hispanics don't obtain health care solely from Hispanic practitioners, there is nonetheless a disproportionately low ratio of Hispanic physicians for the population.
* That same study - which remains the most comprehensive measurement of Hispanic health in Rochester - determined that translation services at hospitals and other health care centers vary in their availability, consistency and quality. About 25 percent of local Hispanics are more comfortable communicating in Spanish or do not speak English at all.
* Despite significant growth in the Hispanic middle class, many Hispanics remain stuck in low-paying jobs that don't offer health insurance. About 21 percent of Hispanics lack health insurance - twice the rate of all other populations in Monroe County.
Those barriers to health care help explain why Hispanics are least likely to participate in regular health screenings and more likely to develop chronic diseases such as high blood pressure and diabetes.
"Culturally, Hispanics come from many different countries of origin, and they are not a homogeneous group. The same is true in terms of their health," says Dr. Carlos Ortiz, a pulmonary specialist at the UR Medical Center and a native of Puerto Rico. "Depending on where they live, their level of education and their type of job - all that influences the way Hispanics seek out medical care."
Dr. Jimenez-Rueda has a favorite saying: Treat a Hispanic patient and you've got the whole family to deal with.
It's not unusual for Jimenez-Rueda to examine an elderly Hispanic - a family patriarch or matriarch - with sons, daughters, grandchildren and cousins all in his examining room.
Hispanics have a tight family structure that carries over into medicine - a valuable asset in the face of so many barriers to health care, he says.
"If one member of 'la familia' gets sick, everyone assumes responsibility for their care," Jimenez-Rueda says.
That's one reason why Hispanics typically shun nursing homes, says Susan Costa, vice president of the Latino Alliance and former executive director of the Health Association in Rochester. In fact, local Hispanics with ties to Puerto Rico often return to the island to live out their retirement years with extended family.
The bond of family contributes in other ways.
Young, unwed Hispanic women who get pregnant - 65 percent of all Hispanic births are recorded as out-of-wedlock - tend to stay with their parents so they have more emotional and financial support, Costa says.
As a result, these pregnancies have relatively good outcomes, resulting in few low birth-weight babies or infant deaths, according to the Finger Lakes report.
Who are the Hispanics living here? The 2000 census counted nearly 48,000 people of Hispanic descent living in Rochester and the region. Most - 32,078 - are of Puerto Rican origin.
In a nod to the growing Hispanic community, ViaHealth Inc., which owns Rochester General Hospital, recruited about 60 nurses from Puerto Rico to work here in the 1990s.
"Surgery is frightening enough, but if you don't know English and can't understand what a surgeon is telling you, it makes the experience even worse," says 30-year-old Ivelisse Vicente, an operating room nurse at Rochester General who came from Puerto Rico in 1997 and is able to translate for patients when needed.
Traditionally, physicians in private practice who don't speak Spanish have dealt with the issue by letting bilingual family members do the interpreting.
But relying on a family member or friend does not work well because medical terminology may get lost in the translation and lead to mistakes, experts say. Also, a relative may inhibit the patient from revealing embarrassing details, such as sexual history or drug use.
Some larger health clinics employ bilingual nurses or hire translators, but translation services can be spotty.
Angel Ortiz, an 82-year-old retiree from Rochester, plans to return to his native Puerto Rico next month because his health is poor and the communication barrier with his doctor is too great. Ortiz speaks very little English.
Ortiz has high blood pressure and kidney disease. He makes monthly visits to one of the city's community health centers for low-income people - a center that has two Spanish interpreters, but Ortiz says the interpreters are rarely made available.
"They think that because I know a little English they can stick me in a room alone with the doctor," says Ortiz, speaking through an interpreter. "It's frustrating. The doctor asks me questions - like whether I understand how to take my medicine - and there are times when I say yes to things that I probably should say no to."
Full-time Spanish interpreters have been a fixture at Rochester's largest hospitals - Rochester General and Strong Memorial - for two decades, although staffing levels vary.
Rochester General has one full-time Spanish interpreter during daytime hours; Strong Memorial has three. At night, Strong uses an on-call system, while Rochester General relies more on bilingual staff members - nurses and doctors - to translate when needed.
Both hospitals maintain that their staffing levels are sufficient.
Given that nearly 1 in 5 local Hispanics lacks health insurance, the Rochester area still has a long way to go.
Rochester is fortunate to have several community health centers - "safety nets" that offer sliding-fee discounts for patients who don't have health insurance. These centers - the two largest being Westside Health Services and the Anthony Jordan Health Center - are the source of medical care for 40 percent of area Hispanics.
But within the past year, health care organizations have renewed efforts to improve access to health care.
Workers from the Ibero-American Action League go door to door in the city's Hispanic community, educating people about the types of health care available to them - from low-cost private insurance plans to the state's Medicaid program.
They also work with the owners of small businesses, which have a large Hispanic employee base, to try to find affordable medical insurance plans that they can offer their employees.
Since January, when the Ibero program officially began, more than 200 people have been enrolled in either a private insurance plan or government insurance.
But there are added barriers in delivering health care to the estimated 7,000 Hispanics living in rural areas. Most are seasonal workers from Mexico; others are Mexican immigrants who have settled here.
The undocumented status of many of these farm workers does two things: prohibits them gaining access to government safety net programs such as Medicaid, and it scares them away from hospitals and most doctors' offices, says Barbara Linhart, vice president of clinical support services at Oak Orchard Health Center in Brockport.
Oak Orchard has reached out to the migrant community, offering them payment discounts and transportation - vans that take migrants to and from the health center, where, by law, all medical care is confidential and no information is shared with federal immigration agents, Linhart says.
These efforts have helped improve the health of migrant workers in many ways, from reducing the spread of communicable diseases, such as tuberculosis, to providing critical prenatal care to expectant mothers.
"For many of these workers, the ones who come from extreme poverty in their native lands, this is their first exposure to Western medicine," says Rosario Rangel, a former migrant worker who settled in Brockport 30 years ago and now runs the outreach program at Oak Orchard.
"Our message to them is simple: Don't be afraid. We are here to help you."