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The Courier-Journal Louisville, KY
Hispanics Health Care: Irregular Medical Treatment Is Tied To Cultural, Economic Issues
By LINDA STAHL
May 13, 2004
Hispanic Americans are at very high risk for diabetes, heart disease, high blood pressure, kidney disease and on-the-job injury.
Some of their children are among the most overweight in the country.
And their teens and elderly have higher rates of depression than blacks or whites in the same age groups, studies show.
Yet more than any other group, Hispanic Americans have no regular source of health care, according to the U.S. Department of Health and Human Services.
"Many Hispanics are poor and uninsured. Staying on a job or in work is their top priority. Their health goes to the back burner," said Haydee Canovas, a Louisville nurse practitioner, who said about 80 percent of her patients are Hispanic at Internal Medicine Consultants, where the entire staff is bilingual.
Major health problems such as high blood pressure and diabetes are often way out of control when Hispanic patients reach her. A few weekends ago, a new patient suffered a dire consequence of long, untreated high blood pressure - he had a stroke.
Hispanics make up the nation's largest minority group at 14 percent of the population and are expected to make up 25 percent by 2050.
In Kentucky, the official Hispanic population increased 173 percent between 1990 and 2000.
Ron Crouch, a demographer at the University of Louisville and director of the State Data Center, said Kentucky ignores the needs of Hispanics at its own peril.
The 2000 Census put the Kentucky Hispanic population at almost 60,000, although other estimates, including those of local and state governments, put it at 100,000 to 135,000.
A federal report says barriers to health care include problems with:
Canovas said she had one patient with diabetes who told her he had the disease because of a "susto," which means "magic fright" in Spanish.
"I had to handle that with care," she said. "I didn't want to deny his cultural values. I told him that scientific research shows that obesity and genetics play a role in diabetes."
The man acknowledged that his father had diabetes. She built on that fact without arguing about the "magic fright" belief.
Helping teach Hispanics about signs of health problems and behaviors that can improve their health is part of what Ernie Romero does. He is a Hispanic culture specialist with the Purchase Area Health Education Center at Murray State University.
"We're trying to educate the Hispanics on their diet," he said. "At our health center, we try to teach the women and children and hope that indirectly we reach the man of the house."
He said diets high in starch, sugar and fat are a problem. "We saw a kid who was between 2 and 3 years old who was drinking a gallon of whole milk a day. The mother couldn't figure out why he was so obese. We got her to switch to 24 ounces of skim milk daily."
Romero said diabetes is the No. 1 problem among those he sees.
But diet is not the only culprit. "When they are in their native land, they do a lot more walking. Here, they get from place to place by vehicle," Romero said.
He said soccer is sometimes a saving grace for young people, as are community dances, but more physical activity is needed for many to combat their major health risks - obesity and diabetes.
At St. Rita Catholic Church in Louisville, there is a dance academy for Hispanic girls, which provides them with exercise as well as a way to build their self-esteem and fight depression.
But opportunities for Hispanics to be more active are lacking in general, said Canovas, who used to lead a walking club for Hispanic women in Shelbyville called "Adelante Mujeres," which roughly translates to "Onward Gals." She said she had to give it up because of her professional responsibilities.
"With obesity and overweight rampant, I'd like to see some programs develop" for Hispanics, she said. Canovas explained that many Hispanic women are reluctant to exercise in front of men, and such cultural issues must be considered.
An admirer of the Weight Watchers program, she said she thinks the company is missing a market by not offering local Weight Watchers meetings in Spanish.
"Everybody needs to take responsibility," argued Canovas, who was National Hispanic Nurse of the Year in 2002. "Many businesses need to be operating in both Spanish and English."
Last week, she helped organize and conduct a free workshop at the Americana Community Center aimed at luring foreign-language speakers, including Spanish speakers, into nursing careers.
Claudia Peralta-Mudd, an international program specialist for Louisville metro government, said differences in the health-care system of the United States and countries of origin also create hardship and confusion.
Many were used to universal health-care coverage in their native country and got medicine over the counter that requires a prescription here, she said.
A report on genetics and responses to medicines, issued early this year by the National Alliance for Hispanic Health, concluded that not only are barriers to health-care services a problem for Hispanics in the United States, so is a lack of basic medical research focused on them.
"The Hispanic response to specific drugs used to treat common chronic conditions (asthma, diabetes and cardiovascular disease) is not well-understood. For example, although the differences between African Americans and Caucasians in the effect of drugs used to lower blood pressure are well-studied, little is known about the response of Hispanics," said the report, "Genes, Culture and Medicines, Bridging Gaps in Treatment for Hispanic Americans."
Romero in Western Kentucky and Karina Barillas, coordinator of the Hispanic/Latino committee at St. Rita church, also talked about the high incidence of tooth decay among Hispanics.
Romero has been working to get mothers to use less fruit juice in baby bottles. Barillas said the church has offered dental-hygiene classes in Spanish and will do so again.
The church is also working to set up free mammograms for Hispanic women, who have a lower rate of breast cancer than women in other groups but have a high rate of late-stage cancer because of a lack of screening.
A shortage of interpreters at hospitals and clinics is a big concern of advocates for Hispanics as well as of researchers.
Gioconda Guerra, director of the Louisville-based Hispanic/Latino Coalition, an advocacy group, said that the lack of a competent translator can add to the unease a patient feels and further alienate her from the system.
Some local clinics and hospitals use 24-hour telephone translation services when interpreters aren't available. Guerra said a Hispanic woman recently went through a complicated and long labor and childbirth at a Louisville hospital without a Spanish translator on hand.
She said a nurse who knew a little Spanish helped, but that, in her opinion, wasn't enough.
The National Hispanic Medical Association, formed in 1994, is trying to pattern itself after the American Medical Association, founded in 1847, said Dr. Elena Rios, the president.
Rios said the association is a network of Hispanic doctors, and doctors who care for Hispanic patients, focused on promoting research, providing better quality care and improving the health of Hispanics.
To get help
If you know someone who speaks Spanish who needs health services, here are several national help lines they can call for free advice in Spanish. There are also Internet sites and local organizations.
Su Familia, National Hispanic Family Health Helpline, (866) 783-2645 , 9 a.m. to 6 p.m. Eastern time, Mondays through Fridays. Refers callers to local health- care facilities and clinics. Sends bilingual fact sheets on variety of health topics such as diabetes and cancer. Sends healthy recipes for lowering cholesterol and controlling blood sugar. All health advice is confidential.
National Hispanic Prenatal Healthline, (800) 504-7081 , 9 a.m. to 6 p.m. Eastern time, Mondays through Fridays. Answers questions on prenatal care, locates local bilingual prenatal care programs and sends fact sheets.
National Indoor Air Quality Hotline, (800) 725-8312 , 9 a.m. to 6 p.m. Eastern time, Mondays through Fridays. From mercury to asthma to radon, this help line answers questions about keeping the air at home healthy. Provides referrals, education and radon test kits.
On the Internet:
Access Spanish-language fact sheets about numerous health topics at www.hispanichealth.org/healthfacts.lasso on the National Alliance for Hispanic Health Web site.
Health problems of Hispanic American and Latina women are dealt with at www.4woman.gov/minority/hispanic.htm on The National Women's Health Information Center Web site. Some publications in Spanish are listed.
Local sources of information and help for Hispanics:
Hispanic/Latino Center and Hispanic/Latino Coalition, an advocacy and resource center, (502) 636 9121 . Answers the phone in Spanish.
Office of Women, Louisville Metro Human Services, M. Gabriela Alcade, director, speaks Spanish. (502) 574-5375 .
Americana Community Center, which has a free health clinic each Wednesday, (502) 366-7813 .
Louisville Metro Health Department, which has translation services by phone at clinics and public health brochures printed in Spanish, (502) 574-6520 . Learn about free department clinics and nonprofit affiliated health centers where people pay according to their ability.
Louisville Office for International Affairs, (502) 574-1457 , for international program specialist, Claudia Peralta-Mudd, who answers her phone in both English and Spanish. Can help direct you to health resources.
Center for Women and Families, 24-hour hotline, serves immigrant victims of domestic violence and sexual assault. Uses AT&T language line and has bilingual staff. Call toll-free (877) 803-7577 .
Women's support groups in Spanish in Louisville and Shelbyville. Cover prenatal education, parenting, dealing with isolation and depression, and domestic violence. Held at a variety of locations. Call Maria Scharfenberger, (502) 439-9459 in Louisville or (502) 633-5683 in Shelbyville; Karina Barillas, (502) 581-7244; or Jana Mayer, (502) 581-7231 . All three women speak both English and Spanish.
- Linda Stahl,
Seven health issues facing Hispanics
Seven severe health problems facing the fastest growing minority in the United States
One-third uninsured, more than any other racial/ethnic group.
Almost two times more likely to have diabetes than non-Hispanic whites.
More likely to die or get hurt on the job than any other racial/ethnic group.
Twice the risk of kidney disease as non-Hispanic whites.
Children are 13 times more likely to be infected by tuberculosis than non-Hispanic whites.
The percentage of children ages 4 to 12 who are overweight is 2 1.8 percent, putting them ahead of blacks and non-Hispanic whites, according to a 1998 study.
Among Mexican-Americans, the largest subgroup of Hispanic Americans, 73.4 percent are overweight, a rate higher than that for blacks and whites who are non-Hispanic.
*According to the federal government definition, Hispanics are an ethnic group descended from the old Spanish Empire and include the Spanish-colonized peoples in South and Central America, Mexico, Cuba, Puerto Rico and other areas. They may be of any race.
Sources: American Obesity Association, Journal of American Medical Association, U.S. Department of Health & Human Services, The American Kidney Fund, American Diabetes Association, Bureau of Labor Statistics, Journal of Clinical Endocrinology & Metabolism, U.S. Census Bureau.