Practicing medicine, Spanish

Med schools offer training to boost Hispanic care

December 01, 2003|By Frank D. Roylance | Frank D. Roylance,SUN STAFF

Sandra Quezeda is sick. Again.

Nearly every Wednesday this fall, the student from Chile has walked into the University of Maryland School of Medicine with a complaint.

This time, she explains in Spanish, she is feeling opresion (pressure) in her chest, and dolor extrano (an odd pain) in her left arm.

Fumbling their Spanish verb tenses and pronunciation, a dozen doctors-in-training, seated around a conference table and on the floor, question her about her latest malady.

Haltingly, they draw out Quezeda's personal and medical history, but her symptoms scream heart attack. It's so agonizingly slow that cardiologist Marcelo Cardarelli finally jumps in. "This patient is dying!" he says. "We need to do something!"

The students laugh.

This is not an emergency clinic, after all, but the intermediate section of the school's new course in medical Spanish. It's one of a growing number of classes that medical schools across the country are offering to improve the care of a growing immigrant population.

Cardarelli, a native of Argentina and assistant professor of surgery, is guiding his students' Spanish and their medical strategy. Quezeda - a second-year medical student - is playing the patient.

At least 20 of the nation's 126 medical schools have offerings in medical Spanish, according to Dr. Deborah Danoff, associate vice president of the American Association of Medical Colleges. The University of New Mexico also has a course in medical Navajo, while New York University has a student-run course in medical Chinese.

NYU has been teaching medical students Spanish since 1970, with classes now open to all hospital personnel. Carlos A. Restropo, the program's Colombian-born coordinator and teacher, said his students leave the classroom and interview patients at Bellevue Hospital Center, where 30 percent to 60 percent of the patients may speak only Spanish.

"They start getting a flavor for different dialects, different accents they're going to hear," Restropo said. "They learn about Hispanic culture, the diet, some of the cultural beliefs."

Patients are more at ease and forthcoming when a doctor speaks Spanish - even beginner's Spanish. "Some become very patient, trying to speak Spanish a little slower," Restropo said. "They ask more questions, too. They just are very grateful."

Precision is difficult

Although many hospitals - including the University of Maryland Medical System - maintain lists of in-house and on-call interpreters, it's not an ideal system, Restropo said.

Not all interpreters have medical training, making precise translation difficult. Translation services available by telephone are expensive. More importantly, some emergencies leave no time for an interpreter to show up.

And while family members - often children - can help, Restropo said, "People don't want kids interpreting sensitive information. We don't want to put kids through that either."

Johns Hopkins Medicine in Baltimore is also teaching hospital personnel to communicate directly with their Hispanic patients. Almost 40 employees of the emergency, pediatric and obstetrical services at Johns Hopkins Bayview Medical Center are enrolled in a new, six-week, noncredit Spanish course.

UM's language program was organized by medical student Eric Scheier, who saw a growing, unmet need in the emergency room. The school launched beginning, intermediate and advanced Spanish courses last year, and offered them for elective credit this semester.

The U.S. Census Bureau estimated in January that 37 million people in the United States identified themselves as Hispanic. Of those who were older than 5 in 2000, 28 percent spoke English poorly or not at all.

Baltimore's Hispanic population increased 45 percent during the 1990s, to 11,061 in 2000. In Baltimore County, the number was up 80 percent, to 13,774.

One of those new arrivals was Wenceslau Mesias, 55, a Peruvian stevedore who arrived in the United States in 1993 with $250, no English and no idea how to obtain medical care. For the first years he was here, he said, "God was my doctor. He took care of me."

Now a warehouse worker in Baltimore, he seeks help with his high blood pressure and hip pain from the Spanish-speaking staff of the St. Clare Medical Outreach van. The clinic, sponsored by St. Joseph Medical Center, parks three days a week outside Catholic Charities' Spanish Apostolate in Fells Point.

Bill Gough, 49, a nurse-practitioner and the van's manager, said the poor and uninsured patients who step into the van are visibly relieved to find bilingual medical professionals, exclaiming, "'You speak Spanish? Ah! M-?Gracias a Dios!'"

`Tremendous barrier'

The scarcity of Spanish-speaking medical providers is "a tremendous barrier" to quality medical care, Gough said. He sees patients who have looked for help elsewhere, "and they have no comprehension of what's going on. They take their medicines wrong, and they don't follow the treatment plan."

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