New course aims to bridge gap between Hispanic patients and health providers

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Most people wouldn’t delight in listening to strangers complain – day after day, in graphic detail – about personal health issues, but Rachel Neugebauer, 20, is a bit different. She found it thrilling. The UA junior, who is double majoring in biochemistry and Spanish, spent the early summer as a pharmacy intern in the Dominican Republic, a Caribbean nation on the Island of Hispaniola.

And thanks to a new UA course -- which is gaining the attention of area health care providers -- Rachel not only understood the woes brought into the “Botica” by her Spanish-speaking customers, she knew the names of the “medicinas” used to treat them.

Rachel credits an entirely different sort of prescription written by another kind of doctor for helping her make the most of her internship.

That powerful potion was Spanish Conversation for Health Care Professionals and First Responders, a course launched this past spring by Parizad Dejbord, associate professor of modern languages at UA.

After first conceiving of an interdisciplinary program linking Spanish and health care, Dejbord reached out to Karen Fitzgerald, associate instructor of nursing in the College of Health Professions who, with her health colleagues, gave Dejbord and others in modern languages some guidance and encouragement in developing the courses. (Dejbord’s colleague, Matt Wyszynski, an instructor in modern languages, is teaching a companion course in medical Spanish composition this fall.)

Although there are medical Spanish courses offered on CD and the Internet, few are offered on accredited university campuses – an environment that allows for close collaboration among students and professors.

Rachel had about a dozen classmates in her conversational medical Spanish class last spring, including nursing, pre-medicine and EMT majors.

“We were able to practice speaking with each other a great deal, simulating interactions among various types of doctors and their patients. This class provided me with a very firm grasp on medical Spanish, and carried me through my entire experience at the pharmacy,” Rachel wrote on the modern languages departmental web site. “Overall, it helped me to be a more productive worker and learner.”

These sorts of classes are vital to the future of U.S. healthcare, according to a study by the Robert Wood Johnson Foundation. Bridging the communication gap between Spanish-speaking patients and English-speaking health workers encourages routine and follow-up care which, in turn, creates a healthier (and less costly) population. But that’s far from the situation now, the report notes.

“The problem (of language) so inhibits communication between patient and provider that one in five Spanish-speaking patients has not pursued care when needed because of the language barrier,” according to the foundation report.

Providers see helping Spanish-speaking patients benefit more from the health care system as an important priority. Nearly 7 in 10 providers surveyed by the Robert Woods Johnson Foundation see the issue as one of the most important priorities.

Officials at Akron Childrens Hospital, a highly honored regional pediatrics medical and research center, agree. The hospital has arranged to bring the conversational medical Spanish class to employees such as medical assistants who might not otherwise learn the language but have frequent contact with patients. The details are still being worked out, but the 15-week course will begin in January and does not require any previous Spanish language training, said Richard Biering, director of Training and Development for the medical center.(The on-campus class has a prerequisite of two years.)

Childrens Hospital has an extensive communications and language program, including a group of interpreters on call as required by law. But this will extend their program’s borders to various parts of the organization as yet untouched, he said.

Rachel has three words of advice for anyone thinking of taking the course: Go for it. When Rachel saw Dejbord’s new class on My Akron, she rearranged her entire spring schedule in five minutes just to take it.

When I saw it was being offered, I went whoo-hoo,” she said raising her arms in a cheering motion and smiling broadly. “I knew this was a perfect class for me.” Spanish had always been one of her best subjects, even in high school, she said.

Rachel hopes to extend her ties to UA by attending NEOMED, a consortium of hospitals and teaching centers (including UA) that has both a medical school and a College of Pharmacy. She wants to be a bilingual pharmacist and, of course, a world traveler.

She credits her medical Spanish class with helping her toward both goals.

“During that month-long-internship, I wouldn’t have learned half that much in twice the time if I hadn’t taken medical Spanish,” said Rachel, a graduate of Green High School in southern Summit County. “Because I understood what was being said, including all the medical terms, I was really able to understand the pharmacist’s explanations of the ailments, the drugs and how the drugs worked in the body. It was truly amazing.”

Rachel believes her knowledge of medical Spanish will not only help her in daily dealings with patients but will give her a competitive edge in her career.

“I’ll have something very important to offer prospective employers,” said Rachel. “I saw at the pharmacy how valuable my new skill will be. Taking that class was one of the best moves I could have made for my future – and it was fun.”

What better rating could a student give a course – in any language?

Associate Professor of Modern Languages Parizad Dejbord and her colleagues created Spanish Conversation for Healthcare Professionals and First Responders (and a companion course in composition) in large part to help students such as Rachel Neugebauer, who will be working and raising families in a country with a face much different from the one it has now.

The number of Latinos living in the United States has skyrocketed in the past three decade and is projected to continue to grow rapidly. By the time Rachel hits her stride in mid-career, one in four Americans will be of Hispanic descent, the government estimates.

Sixteen states, including Pennsylvania, now have Hispanic populations greater than 500,000 according to the U.S. Census Bureau. In California, whites became a minority for the first time a year ago. In Summit County, the Hispanic population rose 81 percent from 2000-2010. Of course, many Hispanics speak English as well as Spanish; some of those speak no Spanish at all. But older adults and first generation immigrants -- the largest group of healthcare consumers – speak Spanish almost exclusively.

A commitment to healthcare and biomedicine

Dejbord and her colleagues also considered the region’s – as well as UA’s -- growing commitment to healthcare and biomedicine. Northeast Ohio is now home to nearly 800 biomedical businesses with more than 230,000 health care and bioscience workers. Biomedical businesses have attracted more than $1 billion in new investment since 2003, and the region’s biomedical industry has grown by 37 percent in the same period. In recent years, area leaders haves created the Austen Bioinnovation Institute in Akron, the Cleveland Health-Tech Corridor, the Global Center for Health Innovation and the Biomedical Corridor In Akron.

But what struck Dejbord most profoundly were the numerous studies she read showing the large number of Hispanics in the United States who neglect healthcare solely because of the language barrier they have with providers.

According to a report by the Robert Wood Johnson Foundation, many providers have taken a haphazard approach addressing the issue. Although a 1964 law requires any medical facility receiving federal money to have a translator on hand, it’s hardly an effective fix.

Understanding a culture and its people

Translators aren’t always available when needed, and their skills at conveying nuanced medical information are often imperfect, according to those surveyed by the foundation. And since many medical facilities such as private offices and for-profit surgical centers don’t receive federal money, the law’s scope is somewhat narrow. In those cases, panicked providers often grab the first Spanish speaker they find, be it a janitor or the 10-year-old son of the patient, who might be reluctant to convey distressing or embarrassing information.

And it’s not just language that creates barriers. Non-Hispanic providers who don’t understand Latino culture may be dismayed by some everyday habits and long-honored traditions and vice versa, according to Dejbord.

“In the Hispanic culture, you want la familia around you during difficult times,” she said. “A non-Latino physician or nurse may find that unacceptable. That could lead to arguments, a general deterioration of the provider-patient relationship and, in turn, patient care.”

That’s why Dejbord includes discussions of cultural issues relating to health in her medical Spanish class.

About 20 percent of Hispanics will avoid getting medical help because of the language barrier, according to the Woods Foundation report. Nearly seven in 10 providers surveyed see the issue as one of the most important, if not top, priorities.

“My colleagues in the Spanish section and I realized this was something we needed here – that a lot of people needed on a number of levels,” said Dejbord. “It just makes sense.”