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Hispanic population overcoming
challenges
by
Heather Woolwine
Public
Relations
The 2000 census showed that South Carolina’s Hispanic population more
than tripled in the last decade. The latest 2004 data shows a 128.57
percent increase in the number of Hispanics living in the Charleston
area since 1990, although the data does not include illegal immigrants.
At MUSC, the number of Hispanics seen for services doubled within the
last two years alone.
In honor of National Hispanic Heritage Month, raising awareness about
the issues and challenges pertinent to the Hispanic patients, students,
faculty, and staff on campus marks a steady advance to a better
understanding of those with Hispanic heritage.
Making
a difference: The Office of International Programs
Consider Susan Brooks one of MUSC’s resident experts on Hispanic
culture and immigration to the States. Helping all internationals
navigate MUSC for study, work or because a family member is cared for
in the medical center, Brooks stands on the front lines of many issues
involving a growing Hispanic population at MUSC.
As one coordinator of events honoring this month’s National Hispanic
Heritage Month and cultural diversity throughout the year, Brooks’
sensitivity to those arriving to the U.S. for the first time is well
known about campus.
“Susan has been very helpful to me over the years, and she is a big
part of improving the climate for Hispanic professionals and patients
at MUSC,” said Juanmanuel Gomez, M.D., Infectious Diseases.
“The challenges faced by Hispanic and Latino students are much the same
as our ancestors faced when they settled this fine country,” said
Brooks, Office of International Programs director. “There is the
problem of finding food, shelter and basic survival. We now translate
this into eating at McDonald’s and living at the Courtyard Apartments.
Early settlers could not communicate with the American Indians and
internationals in general face the challenges of communicating in
English.
“When I meet new internationals on campus, I try to imagine the
countless faces, colors, and sounds they must see and hear. He or she
is now immersed in an alien environment full of questions and personal
challenge. Where do I get groceries? How do I get to the store?
What is a social security number? How do I address my professors? Do I
speak in class? Where are my classes? How do I dress? Will I make
friends on this new campus? Have I made a mistake coming to live
so far from my family and friends?”
“When you move out of your own country, everything is a challenge; the
language, the culture, and adjusting to the new life without your
family,” said Marcela Escobar-Gomez, M.D., International Programs. A
volunteer instructor for MUSC medical Spanish courses for four years
and a volunteer translator for
the hospital and outpatient clinics at MUSC and in
the Tri-County area, Escobar previously worked with David Apple, M.D.,
in the Storm Eye Institute. “I don’t think it is an easy path for
any foreigner to enter in the system because the process is hard and
long. Sometimes you see highly qualified medical professionals trying
to enter in a residency program after years of experience and practice
even in their own countries,” she said.
Escobar’s husband, Gomez, agrees. “For people coming from South America
to the U.S., it’s very difficult because Americans don’t realize that
not everyone speaks English or has the same visions or cultures,” he
said. “People here might see us as a minority, not realizing that
frequently when a physician is able to come to the U.S. and comply with
the requirements to practice medicine, it implies a high level of
training. Generally, not everyone is able to achieve such a level of
education in Hispanic countries. While language might be a barrier, an
underachiever mentality that people stereotype minorities with is not
there.”
Dispelling a common misconception, Brooks stated that many
international students that arrive on campus speak multiple languages
and seek to improve or strengthen their English communication skills
once they arrive. A class of students, postdoctoral fellows, and
faculty who must meet the highest academic standards and professional
standing before arriving in this country, these professionals deserve
utmost respect and consideration.
“The language barrier is a big challenge because you don’t want others
to believe that you are unprofessional or don’t know what you are
talking about,” Gomez said. “I felt that way when I first came here and
lots of people do when they first arrive. The father in the movie ‘A
Walk in the Clouds,’ by Mexican director Alfonso Arau, captured this
when he said, ‘I might speak with an accent, but I do not think with an
accent.’ But as I’ve spent time here, and especially at MUSC, I don’t
think this is as big of a problem anymore.”
In addition, international professionals, including Hispanics, must
deal with working or studying in a research environment for the first
time. Many Latin and European countries prefer perfecting clinical and
practical skills and focus less on research. “It’s a challenge to get
on the bandwagon once you get here, especially when you haven’t really
been trained in research writing,” Gomez said.
“Every international student and postdoctoral fellow knows that the
Office of International Programs is here to help,” Brooks said. “There
are special programs and services in place to answer all of their
questions. Mentors from their homeland are ready and willing to
assist with transportation, housing and essentials for living and
working in the Charleston area. Host families are waiting to reach out
in friendship. It’s also important for everyone on campus to put
yourself in his or her place, be considerate, polite, and take the time
to help when there is a question or problem. A few moments of
kindness can yield an exciting lifetime friendship.”
“MUSC is working on improving its service within the Hispanic
community,” Escobar said. “The number of Spanish interpreters is
growing and they are developing a system to certify them. New groups
like the Alliance for the Hispanic Health were created to provide
opportunities for the health care professional to collaborate with the
health needs of the Hispanic community. Those and many other
initiatives are the first steps in filling a need for the Hispanic
community.”
Like his wife, Gomez also thinks that things have improved since he
arrived here nine years ago.
“There has been lots of change and improvement, like they are handling
visas and paperwork in the U.S. much better now,” he said. “The
university is doing a good job to reach out to those from abroad. I
understand they don’t have the same resources that many larger
institutions like those in California or New York have. Now, people
understand how to better incorporate Hispanics into the MUSC
population.”
Changing
the clinical picture
Hispanic patients' cultural norms and health beliefs are not well
understood by health care providers in S.C.
It’s not as simple as not understanding English, because Hispanics also
incorporate different gestures and body language into their everyday
communication. A gesture that may seem appropriate to a physician or
nurse born and raised in the U.S. may come off as offensive or
threatening to someone from another area.
Lack of health insurance and poverty in the Hispanic population also
document inaccessibility to health services, and therefore Hispanic
patient populations see higher rates of teen pregnancy, unintended
pregnancy, tobacco use and suicide; increased use of emergency rooms;
less overall satisfaction with care for Hispanics; limited English
contributes to ordering more tests than may be necessary for a patient;
less follow-up after emergency room visits; more hospitalizations for
preventable conditions; and fewer non-urgent regular physician visits.
To combat the numerous challenges that health care professionals face
in coordinating and providing care for the growing Hispanic population
here in Charleston, members of MUSC’s College of Nursing received
funding for The Hispanic Health Initiative.
Deborah Williamson, Ph.D., CON associate dean of practice, and Charlene
Pope, Ph.D., CON assistant professor, received funding from the Duke
Endowment ($350,000) in July to enhance cultural competency and
linguistic appropriateness among nurses. Additionally, the grant
focuses on recruitment and retention of bilingual nurses, support for
faculty research related to Hispanic health, and promotion of health
policy that improves health access for immigrant populations. Another
five-year HRSA grant for $1.4 million awarded in September will expand
the initiative.
“We have several goals associated with the grant,” said Jason Roberson,
the initiative coordinator. “We want to increase the number of Hispanic
students interested in health related careers, particularly nursing,
and the number of bilingual and Hispanic nursing faculty. We also want
to build cultural and linguistic awareness and sensitivity about
diverse Latino cultures and existing health needs and communication
competence education for working with multi-lingual and multi-cultural
populations, utilize faculty, staff, and students engaged in health
disparities research to develop evidenced based interventions to
improve health services, and establish a strong focus on Hispanic
health within the CON for the developing Center for Vulnerable
Populations as a resource to the community and to health policy.”
“When specifically considering the Hispanic patient population, it is
essential to understand the cultural values of the patients, and above
all, avoid cultural profiling,” Brooks said.
“People are people, and everyone should be treated in a courteous,
professional and helpful manner. A culturally competent health care
worker will consider the specific cultural needs of the patient and
have a clear view of the expectations of the patient as well as
the goals required for treatment.”
“It is important to provide Hispanic patients the same high quality
patient care and part of that is to communicate effectively with them,”
Escobar said. “Also, the family is the center of the Latino society and
determines many of the decisions made concerning the medical needs of
the patient. It is important for health care professionals to
understand those aspects.”
Trying to collaborate with other entities around campus so that efforts
to help are all on a similar page, Roberson mentioned increased
community collaboration as well. “We’re working with many other
programs in the community including Our Lady of Mercy on John’s Island,
home visits with Charleston County’s First Steps program, Communities
in Schools for teen pregnancy counseling, and AHEC and DHEC,” he said.
Understanding
cultural differences
by Susan Brooks, Office of
International Programs and excerpts from “The Latino Patient,” by Nilda
Chong, M.D., Dr.Ph.
“Hispanics and Latinos retain at least three basic value sets. First,
there is more emphasis on the family and collectivism in Latin
cultures. This differs greatly from more dominant cultures, which laud
individualism. Second, there is a desire to seek harmonious
relationships and cooperation at almost any cost. This does not
match the general mainstream cultural focus on personal, social and
financial achievements. Third, respect is gained as a consequence of
age, gender and hierarchy rather than success as defined by the
dominant culture. The measures of success differ greatly per Hispanic
culture.
Cultural diversity must be addressed at every level of patient care:
doctors, nurses, and staff. For our Spanish-speaking clients,
there are ongoing efforts to assist our faculty and staff in cultural
competence. There are Spanish translators available to assist with
communication. We have committees actively seeking to better meet
the needs of our Spanish speaking patients and their family
members. We must continue this valuable dialogue. The best
way to become culturally competent is through experience. A smile
translates a true willingness to be of assistance and makes a
difference. Take a little more time to get to know your patients and
where they come from. If you do not know where to begin, ask about
where they come from and about their family. See the joy and pride
that radiates with simple, caring dialogue.”
Friday, Oct. 7, 2005
Catalyst Online is published weekly,
updated
as needed and improved from time to time by the MUSC Office of Public
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