Para millones de estadounidenses con conocimientos limitados de inglés, encontrar proveedores sanitarios que hablen su propio idioma sigue siendo un reto.
ByPeter White
English Version Included
(CDC photo via Unsplash)
El Centro de salud familiar Thomas Family Health Center de Nashville atiende a pacientes de todas las edades, tengan o no seguro médico. Esta clínica comunitaria forma parte del Ascension Medical Group, un sistema de salud católico grande que brinda servicios de manera altruista a través de hospitales y clínicas en 16 estados.
Este popular Centro está situado en la zona oeste de Nashville, justo al lado de la iglesia católica de Santa Ana, en Charlotte Avenue. Ambos lugares atienden a una población mayoritariamente inmigrante y llevan allí más de dos décadas.
La clínica está abierta 45 horas a la semana y ofrece cuidados primarios a mujeres inmigrantes y a sus hijos, así como a pacientes con enfermedades crónicas como la diabetes.
Se ofrecen exámenes físicos, citologías (Papanicolau-pap smears), análisis de sangre, recetas a bajo costo, vacunas y vacunas contra la gripe. Las madres hispanohablantes embarazadas o con hijos pequeños charlan amistosamente con el personal de recepción, que es bilingüe. La mayoría de las enfermeras y médicos también lo son.
Servicios de salud culturalmente apropiados
Pero el Centro de salud Santo Tomás pudiera ser la “gran excepción” en el mundo de los servicios de salud. Catorce millones de personas en EE.UU. no hablan inglés, mientras que 25.5 millones dicen hablarlo “no tan bien”. Sin embargo, encontrar proveedores que hablen al menos una de las múltiples lenguas que se hablan en EE.UU. es una tarea difícil que impide que las personas que no hablan inglés o tienen un dominio limitado de este idioma reciban la atención que necesitan.
En lo que respecta a los servicios preventivos, hay más personas con un nivel de inglés bajo o nulo que no se han tomado la tensión arterial ni se han revisado su nivel de colesterol en los últimos dos años, no se han vacunado contra la gripe ni se han hecho un chequeo médico, ni han ido al dentista en el último año.
Exámenes de detección del cáncer
La Dra. Ingrid J. Hall, epidemióloga de la División de Prevención y Control del Cáncer de los Centros para el Control y la Prevención de Enfermedades, publicó recientemente un estudio sobre adultos hispanos que relaciona el dominio del inglés con el acceso a los servicios sanitarios.
Hall midió las diferencias entre tres grupos de pacientes. El grupo de control, blancos no hispanos, tenía el porcentaje más alto (84%) de asistencia sanitaria regular. El grupo que se sentía cómodo con el inglés (78%) ocupaba el segundo lugar. Sólo el 69% de los hispanos que se sentían poco cómodos hablando inglés tenían un proveedor habitual.
La epidemióloga dirigió la campaña del CDC (Centro de control de enfermedades) para concienciar a más mujeres de la importancia de hacerse mamogramas para detección temprana del cáncer de mama.
Educación sobre salud
“El dinero que recibimos del Congreso va directamente al Estado. Luego animamos a nuestros socios estatales a asociarse con organizaciones comunitarias que llegan a las poblaciones a las que queremos atender”, declaró Hall en una rueda de prensa de Ethnic Media Services el 21 de julio.
Las pruebas de detección periódicas y el diagnóstico temprano pueden reducir las enfermedades y muertes por cáncer de mama o de cuello uterino, especialmente en mujeres mayores de 50 años, que representan más del 75% de estos cánceres.
Para mejorar la educación sobre salud y hacer frente a los obstáculos a la atención sanitaria será necesario un enfoque “múltiple” que incluya educación, considerando las disparidades en los seguros y otros aspectos sociales importantes que influyen en la salud, afirmó Hall.
(CDC photo via Unsplash)
For the millions of Americans with limited English proficiency, finding providers who speak their language continues to be a challenge, hampering access to quality care.
By Peter White
The St. Thomas Family Health Center in Nashville serves patients of all ages whether or not they have insurance. The community clinic is part of the Ascension Medical Group, a large non-profit Catholic healthcare system with hospitals and clinics in 16 states.
This popular center is located on Nashville’s west side, right next to St. Ann’s Catholic Church on Charlotte Avenue. Both minister to a largely immigrant population and have been there for more than two decades.
The clinic is open 45 hours per week and provides primary care for immigrant women and their children as well as patients with chronic illnesses like diabetes.
Physical exams, pap smears, blood tests, low-cost prescriptions, vaccines, and flu shots are all available. Spanish-speaking mothers who are pregnant or have young children chat amiably with the front office staff who are all bi-lingual. Most of the nurses and practitioners are also bi-lingual.
Culturally-Appropriate Health Care
But St. Thomas may be an anomaly in the health care world. Fourteen million people in the US do not speak English, while 25.5 million say they speak it “less than very well.” Yet finding providers who speak at least one of the panoply of languages spoken in the US is a difficult task that prevents non-English and limited English proficient speakers from getting the care they need.
When it comes to preventive services, more people with little or no English have not had their blood pressure taken or cholesterol checked in the last two years, have not gotten a flu shot or had a physical or seen a dentist in the last year.
Cancer Screenings
Dr. Ingrid J. Hall, an epidemiologist with the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention published a recent study of Hispanic adults linking English proficiency to access to healthcare services.
Hall measured differences between three groups of patients. The control group, non-Hispanic whites, had the highest percentage (84%) of regular health care. The group who were comfortable with English (78%) was second highest. Only 69% of Hispanics with limited comfort speaking English had a regular provider.
The epidemiologist led the CDC’s campaign to make more women aware of the importance of getting mammograms to find breast cancer early.
Health Literacy
“Our money from Congress goes directly to the state. Then we encourage our state partners to partner with community based organizations that are going to reach the populations that we want to reach,” Hall said at an Ethnic Media Services news briefing July 21.
Regular screening and prompt diagnosis can reduce illness and death from breast or cervical cancer especially for women over 50 who account for more than 75% of those cancers.
Improving health literacy and addressing barriers to care will require a “multi-pronged” approach including education, insurance disparities, and other social determinants of health, said Hall.
Changing Demographics
Dr. Latha Palaniappan, Co-Founder of Stanford CARE, explains why patient translators need not just language skill but also to be trained to work in healthcare settings.
Dr. Latha Palaniappan, co-founder of Stanford University’s Center for Asian Research and Education — CARE — said the demographics of the U.S. population have changed dramatically in recent decades.
From 1980 to 2019, the number of people in the US who spoke a language other than English at home nearly tripled, according to the U.S. Census Bureau. Sixty-seven million people in the U.S. speak a language other than English at home.
Chinese, Korean, and Vietnamese are the top 3 languages of households that have limited or non-English speakers. Fourth most common is Russian, Polish, and other Slavic languages grouped, and then Spanish, said Palaniappan, referring to US Census data.
Longer Hospital Stays
These non-English speakers are a very significant proportion of the population, said Palaniappan. And patients whose providers don’t speak their language reported receiving less health education, worse care, and lower patient satisfaction.
“The length of stay if an interpreter isn’t used at admission or discharge at a hospital stay is increased by 3 days. There’s increased thirty-day readmissions, for instance, among congestive heart failure. There’s more infections, falls, surgical site infections, pressure injuries, delays in surgery, and problems with medication management,” said the physician.
“Under section 1557 of the ACA (Affordable Care Act) health care providers are required by law to provide qualified interpreting services free of charge,” Palaniappan noted. But saying that doesn’t make it so.
Providers often rely on informal interpreters like friends or family members, but that is generally prohibited except in emergencies. Nothing is better than an in-person interpreter, but telephone or video based interpretation works and can be cost effective, she said.
Systemic Change
Dr. Elena V. Rios, President & CEO, National Hispanic Medical Association, discusses the lack of funding for translation services for low English proficiency (LEP) patients.
Dr. Elena V. Rios is President & CEO of the National Hispanic Medical Association, (NHMA), representing 50,000 Hispanic physicians in the US. The mission of the organization is to improve the health of Hispanics.
Only 15 states actually have Medicaid that reimburses for language services. “So we need to change the system. We need to reimburse language services for providers, for hospitals, for clinics, for doctors offices,” Rios said.
“Language services could be helped by having more doctors or nurses, for example, from those countries that speak the languages that are needed here,” she said.
“There’s definitely a need for reimbursement at all levels but especially in the poor communities that don’t have top jobs or don’t have higher incomes. Most people don’t go to the doctor because they can’t pay for it and they don’t have insurance. So we continually need more prevention,” said Rios.