In A Common Voice
As the population of Hispanics in the Indianapolis area has surged
over the last decade, so too has the need for IUSM physicians to
learn their language and the nuances of their culture.
He bobs and weaves at the waist, a half-pint-sized prizefighter
whose plump arms throw piston-powered jabs and uppercuts that would
make Oscar De La Hoya proud. Float like a mariposa, sting like an
abeja. There's no ringing bell, but Sarah M. Stelzner, MD, eases
six-month-old Juan Daniel Martinez-Calderon onto a padded table,
unloops the stethoscope from her neck and gently begins her examination.
Dr. Stelzner transforms into a whirling dervish of doctor, listener,
playmate and teacher. She converses with the parents about their
son's eating and sleeping habits, answers their questions about
his development in relation to his condition (Down syndrome), kneels
to have playful eye-to-eye talks with Juan's older brother and sister,
and quizzes third-year medical student John B. Reinoehl about vaccinations
the infant will need at the next visit.
"Well, I feel pretty good about that. The parents are doing
just a great job. Active little guy, wasn't he?" says Dr. Stelzner,
assistant professor of clinical pediatrics, smiling as the family
leaves the room, the older siblings clutching children's books Mr.
Reinoehl fetched for them.
Indeed. Active is the operative word at Wishard Health Services'
Primary Care Center. Staffed by IU Medical Group-Primary Care at
the IU Medical Center, the center not only offers quality health
care but a specialized service to the community. Like most clinics,
its services range from physicals to lab tests. But in recent years
it and other IU-Wishard clinics throughout Indianapolis have taken
steps to meet a new need: to bring aboard more Spanish-speaking
physicians, nurses and support staff to better serve the surging
number of Hispanic patients they see.
Hispanics are people of Spanish-speaking ancestry who may belong
to any race. According to the U.S. Census Bureau, the Hispanic population
in the Indianapolis-Marion County area escalated from 8,400 in 1990
to 34,000 in 2000, a majority of whom are Mexican immigrants such
as the Martinez-Calderon family, who moved to Indianapolis three
years ago.
Talking The Talk
Growing up in New York City, Mary R. Ciccarelli, MD, frequently
drew upon the Spanish she learned in high school and from her co-workers
at JFK International Airport. But when she moved to IUSM for her
residency in the mid-1980s and returned in 1991 as a faculty member,
she rarely encountered Spanish-speaking patients. Today, she talks
the talk at least four times a day.
"Most of the Hispanic patients I work with now are new immigrants,
arriving here within the last three years, and they still are learning
our language," says Dr. Ciccarelli, associate professor of
clinical medicine and pediatrics, who describes her level of proficiency
as "conversational as any Spanish-speaking eight-year-old."
The number of Spanish-speaking faculty and staff at all Clarian
Health Partners facilities - IU Hospital, James Whitcomb Riley Hospital
for Children and Methodist Hospital - has increased in recent years,
especially in the outlying clinics. However, the challenge to hire
more Spanish-fluent staff and to train them remains a priority.
When the need arises, Clarian's office of customer and volunteer
services offers interpretation and translation services to staff
and patients.
Further, a recent two-year Clarian Values Research grant will enable
IU medical students, residents and staff to hone their Spanish-speaking
skills, broaden their understanding of Hispanic culture and social
traditions, and engage more actively in providing clinical services.
The IU School of Dentistry also is involved in the project.
IUSM's Office of Medical Service-Learning (OMSL) also promotes
and encourages its faculty and students to take advantage of its
Medical Spanish program, which Dr. Stelzner helps supervise. The
course, available since 1999, covers the principles of pronunciation,
social Spanish, medical Spanish and the culturally appropriate approach
to the Hispanic patient. OMSL also conducts "Super Shot Saturday"
twice each year, offering immunizations to Hispanic youngsters,
and sponsors the Canali Health Education Outreach in rural Mexico.
Late last year, a $492,000 grant from the Robert Wood Johnson Foundation
funded a three-year comprehensive program to assist Latino patients
with diabetes. The program, devised by Charles M. Clark, MD, professor
of medicine and pharmacology/toxicology, and David Marrero, PhD,
associate professor of medicine, will be established at IUSM's Westside
Community Health Center.
That program will be designed to collect basic data used to formulate
treatment plans. Patients will be asked about their social and medical
history, social and medical risk factors, general medical history,
diabetes history and reason for the medical visit. The responses
chosen by the patient on the touch-screen monitor will be printed
out for the health care worker showing the responses in English.
Those responses also will be automatically incorporated into the
electronic medical record system for future reference.
The School's National Center of Excellence in Women's Health also
has launched a project to educate local Hispanic women about breast
cancer.
At Wishard, the outreach effort has been particularly active. In
addition to
translation and interpreter services and a certification program
for bilingual interpreters, Wishard offers Spanish-speaking patients
courses in pediatric and adult CPR, prenatal care, smoking cessation
and prevention programs for teenaged pregnancy, AIDS/HIV, STDs and
tuberculosis.
Walking The Walk
Understanding Hispanic patients and their needs is more than just
learning the language. It's knowing their culture, much of which
can be steeped in social tradition, folk medicine and even mysticism.
For example, personalismo (personal touch) is a gesture of respect
and sign of warmth when a physician or nurse asks the patient about
family members and remembering important events in their lives such
as births, marriages and deaths.
Building bridges also transcends language, culture and even medicine,
notes Dr. Stelzner, who spent much of her childhood in South America
and in Spanish-speaking areas of the United States. It means anticipating
needs that might not be quite so visible.
"The biggest challenge we face is helping newly immigrated
children and teens. Many lived with grandparents or other family
members in their home country while parents established themselves
here," Dr. Stelzner says. "These youngsters now find themselves
in a totally different environment. They are in schools and neighborhoods
that are drastically different than the worlds they left behind.
Working with other groups and agencies, there will be a continued
need for activities to help them adjust and to decrease their risk
of depression and stress."
Dr. Stelzner credits local groups such as the Hispanic Education
Center, the Hispanic Center (especially for its assistance with
mental health services), churches and schools as being key partners
in helping promote and facilitate health care and services to Indianapolis'
emerging Latino community. And for good reason.
"It's fairly basic," observes Dr. Ciccarelli. "You
can have the best hospitals, clinics and staff in the world, but
you can't provide the best possible health care to your patients
if you cannot communicate with them."
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