Doctors, please: “habla culture,” not language

"600 Words" by Esther J. Cepeda

If the English language unites us as a country, and other languages are what supposedly divide us, then cultural understanding is the bridge – and the best hope – for fixing health care inequities for U.S. minorities.

The Robert Wood Johnson Foundation recently announced it was going to devote $300 million to setting national standards to fix the problem, noting – just to take diabetes as an example – that African Americans lose legs to amputations at a rate nearly five times that of whites.

While the Johnson Foundation grant is designed to "reduce racial and ethnic disparities," none of their information even mentioned Hispanic/Latino patients, but I can tell you we aren’t far behind. The National Diabetes Education Program of the National Institutes of Health says that on average, about 2.5 million, or 9.5 percent of Hispanic and Latino Americans aged 20 years or older have been diagnosed with diabetes. Mexican Americans and residents of Puerto Rico are almost twice as likely to have diabetes as non-Hispanic whites of similar age, and are two to four times more likely to have their legs amputated due to the disease.

As with diabetes, obesity, breast cancer, Alzheimer’s, and so many other diseases, the impact on minorities is far greater than on white populations. And though the most-prescribed salvo is eliminating medical professionals’ language barriers, it’s obviously not just about linguistics.

Constantina Mizis, a nationally-recognized expert in the field of cross-cultural healthcare and the Multicultural Outreach Manager for the Greater Illinois chapter of the American Alzheimer’s Association, says, "You can’t think about speaking a language, you have to speak culture. I tell doctors and nurses that culture – the collections of how different groups of people see and feel life, death, joy and even their health – paints everything."

With such a wide assortment of cultures – not just in the population of sick people, but in the corps of doctors and nurses practicing medicine today – the most important cultural/linguistic tools for healthcare providers are open ears and eyes.

Understanding that, according to a June 2007 study titled Cultural Characteristics of African Americans: Implications for the Design of Trials that Target Behavior and Health Promotion Programs, African Americans’ driving cultural forces are religion, family structure, general mistrust of Caucasians, a feeling of being undervalued and not respected as a people, a feeling of limited resources and limited opportunities to make lifestyle changes and a deep desire to preservation their ethnic identity, is crucial.

Knowing that level eye contact, warm greetings that include hugs and hand-holding, chit-chat before and after asking for a count of ailments, and showing reverence are key to winning over Latino patients is also very important.

And yes, the highly educated doctors and nurses caring for us should know that certain cultures aren’t going to respond to "prescriptions" such as cutting down on rice – a staple in Latino and Asian households – or to going out for long walks which are, sadly, a danger in many minority communities.

But most important are the skills of trained observers, which might really go a long way to bettering healthcare for patients of all colors and ethnicities.

"It’s not just what [health care practitioners] say or in what language," Mizis says, "it’s how they say it. Notice if the patient is intimidated, look at the body language, talk in simple language and be friendly. It’s all about gaining patients’ confidence."

Esther J. Cepeda writes the “600 Words” & “Pregunta del Dia” columns, and is also a Director at the Chicago-based United Neighborhood Organization. Her reporting and opinions do not necessarily reflect those of UNO. “600 words” is a registered trademark of EeJayCee, Inc., Copyright 2008. May be reprinted with permission, contact eejaycee@600words.com