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Reaching Out To Hispanics
by Elizabeth Lynch
July 4, 2004
Irma Arce visits Maria Souffront's home at least once a week.
They talk about how the mother of two who moved to New York from Puerto Rico nine years ago can make traditional meals, but without all the carbohydrates and fat.
The program is one of several preventive and proactive efforts to reach out to the region's growing Hispanic community. The outreach is designed to provide Hispanics -- many of whom are new immigrants with few resources -- with the tools and information they need to combat an increasing prevalence of diabetes, obesity and other health problems.
A report titled ''Genes, Culture and Medicines: Bridging Gaps in Treatment for Hispanic Americans,'' released in February by the National Alliance for Hispanic Health and the National Pharmaceutical Council, found Hispanics have less access to medication, including prescriptions for asthma, cardiovascular disease and depression. And that cultural and communication issues are barriers to quality health care.
Home visits helpful
Souffront was referred to Arce, a nutrition program educator at the Dutchess County Cornell Cooperative Extension, by her daughters' pediatrician. Recently, she sat in the small kitchen in her City of Poughkeepsie apartment, reviewing food labels with Arce.
''I ... do home visits and review nutrition according to what their needs are, I review their budget and their meals and show them how to use their food stamps and dollars better,'' Arce said. ''I show them how to make food healthier for the children but also for them to like.''
Souffront appreciates the help.
''I understand more now,'' the single mother of two said.
Locally, there are several programs reaching out to the Hispanic community, low-income families and illegal immigrants to improve their access to health care and health information.
''I think a lot of the changes that need to happen need to happen at a larger level than in our community -- it's not just the Hispanic folks, it's the working poor,'' said Jen Drake, program coordinator for Dutchess County Healthy Families, a not-for-profit organization that works with the county health department. At the time, the agency's clients are more than 50 percent Hispanic, and many are illegal immigrants.
Her agency is working with Mari, a 22-year-old illegal immigrant from Puebla, Mexico, and her 2-month-old son, Alex. Mari asked that her full name not be used because she feared she would be deported.
The single mother and her child, both have heart conditions that require treatment. Although Mari received medical care during her pregnancy, that ended after the baby was born. She also has diabetes.
Alex is eligible for federal medical programs, but his mother is not. He will need surgery for the congenital heart defect before he is a year old. The left chamber of his heart is undeveloped and the muscle is overtaxed compensating for it, according to a note the doctor gave Mari.
Although the child's father provides money, Mari sometimes must use it to pay for transportation to her son's medical appointments -- at least six a month. As a result, she relies on the local food banks and often goes without food herself, exacerbating her diabetes.
And she can't work, because the baby cannot be put in child care because of his heart condition.
Through a translator, Mari said she has no options. There is no chance of her qualifying for federal medical programs because there is almost no chance of her obtaining the needed documents to be in the country legally.
''We are still going to send her to a doctor and hopefully they won't push her away,'' said Maria Morales, a community health workers with Dutchess County Healthy Families.
Statewide, there have been several efforts to provide health insurance for those who do not have it.
Child Health Plus provides insurance for children regardless of their immigration status, and there are health services for pregnant women, also regardless of whether they are U.S. citizens.
But, Drake said, ''For folks new to our community, a lot of people may not know who to go to.''
For many in the Hispanic community, especially those who have recently immigrated, their first stop for health care is the emergency room, said Anne Nolon, president and chief executive officer of Hudson River Community Health, which operates 11 clinics in the Hudson Valley region -- including five in Dutchess County, two in Poughkeepsie, one each in Beacon, Amenia and Dover, as well one in Ulster County's New Paltz.
''They come to hospitals for care because that's the only place they know,'' Nolon said.
Role of matriarch
In response, Hudson River has placed community care partners in hospitals in Peekskill and is working to put one in Poughkeepsie's hospitals. The care partners will help set up follow-up visits at one of the clinics, or with the individual primary care physician.
''It's a little step to help improve the connection between routine and primary preventative care,'' Nolon said.
Key among the barriers to health care facing the Hispanic community is cultural difference.
''Any health education approach needs to reflect the lifestyles and cultural habits of the group you're working with in order to be effective,'' said Katherine Brieger, vice president of community initiatives and a registered dietitian with Hudson River Community Health. The efforts, she said, go far beyond translating brochures and instructions into Spanish.
Many women from small villages and towns where access to doctors is difficult don't see a need to get prenatal care during a pregnancy.
''It's not part of their experience,'' Drake said. So the challenge is to explain to them the health benefits for them and their child.
''Hispanic parents are totally driven to get their children into health care,'' Nolon said.
But there is a general reluctance for women to go to see a doctor by herself, Nolon said. Generally, the preference is for the husband or an older relative to accompany her. But because many lack a valid driver's license or a car and because the men work long hours, women generally don't seek out health care.
And men would have to lose pay if they took time off to visit a doctor.
''It's just not in their vocabulary to give up a day's work,'' Nolon said.
Particularly in the Hispanic families, several generations often live under one roof and the grandmother typically is viewed as the expert on food and health.
''If their grandmother doesn't buy into the change, nothing is going to change,'' Brieger said. So one strategy has been to include the entire family and to invite the grandmother figure to the classes.
Programs often include topics such as the proper portion size for children and adults, and encouraging mothers to use low-fat milk for their children, said Christine Sergeant of Cornell Cooperative Extension.
Or they may serve both beans and meat at a meal, not realizing both foods are high protein sources.
''We have some very special cultural issues when dealing with a Hispanic family,'' said Sergeant, reiterating the cultural tendency to respect the opinion of an elder woman in the family over a physician.
The program sends educators such as Arce into Hispanic homes. But since many are illegal immigrants, they are afraid to sign up for government programs even if they are eligible for them.
Hudson River Community Health is working to overcome those fears.
The group of health clinics has sponsored a photo outreach project titled ''Communities Without Borders,'' which includes pictures and the experiences of Poughkeepsie residents who immigrated from Oxaca, Mexico, as well as photos of their relatives in Oxaca.
''There are families in Mexico who have never seen their grandchildren,'' Nolon said.
But the participants also become health promoters, she said.
''They get the word out in a much deeper way than we've ever been able to do in the past,'' Nolon said.
If you know someone who speaks Spanish and needs health services, here are several national help lines they can call for free advice in Spanish. The help lines operate 9 a.m. to 6 p.m. Monday through Friday.
-Su Familia, National Hispanic Family Health Helpline: 1-866-783-2645. Refers callers to local health facilities and clinics. Sends bilingual fact sheets on topics such as diabetes and cancer. Sends healthy recipes for lowering cholesterol and controlling blood sugar.
-National Hispanic Prenatal Healthline: 1-800-504-7081. Answers questions on prenatal care, locates local bilingual prenatal care programs and sends fact sheets.
-National Alliance for Hispanic Health: www.hispanichealth.org. click on "Health Fact Sheets" under Resources.
-The national Women's Health Information Center: www.4woman.gov. click on "Minority Health" and then click ""Hispanic American/Latina."
-Dutchess County Healthy Families: 845-452-3387
-Cornell Cooperative Extension in Dutchess County: 845-667-8223 ext. 133; www.cce.cornell.edu
-Hudson River Community Health: 1-877-871-4742; www.hrhcare.org
HEALTH ISSUES FACING HISPANICS
Here are seven severe health issues facing Hispanics * -- 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 21.8 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 America, Central America, Mexico, Cuba, Puerto Rico and other areas. They may be of any race.
(Sources: American Obesity Association, Journal of the 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.)