Take my hand

In the complex and confusing world of modern medicine, many people need a helping hand, and that's where the navigator comes in

August 26, 2005|By Mariana Minaya | Mariana Minaya,SUN STAFF

WASHINGTON - When Dr. Elmer Huerta was still practicing oncology in his native Peru, he was disturbed by seeing too many patients coming in too late for treatment of cancer that might have been prevented. Some people had put "yerba buena," or good herb, on the huge tumors that were deforming their bodies in the belief it would dissolve the cancer.

Since then, he has immigrated to the United States and in 1994 established a cancer "preventorium" at Washington Hospital Center for detection and prevention in seemingly healthy patients. Yet even here, he has been faced with similar problems: patients resorting to natural remedies like yerba buena and postponing care.

To counter that, Huerta employed someone who understood Hispanic culture to be a patient navigator, or guide. "A navigator helps a patient overcome barriers, navigating the people through the turbulent waters of the American medical system, which is extremely complicated," Huerta said.

Huerta's clinic is among the models for an act recently signed into law that is intended to make use of the nation's medical system less daunting for everyone. It may play an especially important role for non-English speakers, who were estimated to make up about 18 percent of the U.S. population as of 2003. In Maryland, the figure was about 13 percent, according to the Census Bureau.

Apart from not speaking the language, many are uninsured and afraid of being deported or walloped with medical costs. They can be reluctant to visit a doctor, and some cling to their birth country's traditions of using natural remedies, like some of Huerta's patients who believe in the healing power of yerba buena.

Advocates say the additional guidance from navigators will ensure people get the kind of care and education they need to prevent the development of chronic diseases or detect them early when they are easier to treat.

Local clinics face similar problems in trying to help the foreign-born more quickly replace old ways with new.

The Columbia Health Center sees a number of Hispanics at its women's health clinic. Esther Aponte, an interpreter at the clinic and a Puerto Rican native, has heard of potentially dangerous practices, such as a pregnant woman eating a certain kind of clay for its minerals. Instead, women in prenatal care are told to take vitamins to ensure health.

Lisette Osborne, director of the community and family health bureau of the Howard County Health Department, said that the job of the clinic's staff is to respect traditions while providing the best possible care.

"You don't want to rob people of their culture, but you want them to be healthy, and you have to strike a balance," she said.

One of Huerta's patients, Ruth Aloras, originally from Bolivia, says that, although she is not a believer in traditional remedies, she knows a large number of Hispanic people who try them. Many go so far as to ask family members in their native countries to send them familiar herbs and remedies.

"Because of Dr. Huerta, many people have realized, maybe the herb helps, but you always have to go to a doctor," she said.

Aloras, 42, of Germantown, says she feels more comfortable in Huerta's clinic than in typical North American health care settings. "He is Bolivia-style," she said, referring to the Peruvian native.

Huerta's navigator, Diana Garcia, was helpful to her when she came to the clinic, said Aloras. Among other things, Garcia helps patients arrange appointments and screenings for high cholesterol or blood pressure.

Lessening distrust

Dr. Harold Freeman, director of the Ralph Lauren Center for Cancer Care and Prevention in New York, created the first patient navigator program in 1990 during his previous post at New York's Harlem Hospital. It is another model for the Patient Navigator, Outreach and Chronic Disease Prevention Act.

The patients he sees in New York, who are predominantly African-American or Hispanic, can hold incorrect notions about certain diseases that hinder their treatment. Some patients refuse a surgery because they believe exposing tumors to air will make them worse.

"My belief is some of that distrust can be abated if someone is in the system that talks like them, looks like them, and cares about them; someone they can relate to," said Freeman.

Under the new federal act, health clinics would apply for funds to employ navigators. The government expects to spend $25 million over the next five years.

The patient guidance would be in addition to the services of social workers and others that some medical centers already offer. For example, the University of Maryland Medical System supplied not only an interpreter but a social worker to Anna Rodionova, 72, of Columbia. The Russian immigrant said the social worker, Lindsey Levis, helped her to arrange transportation and to apply for financial aid to pay for treatment of pre-leukemia. "I would have died without her," said Rodionova, a native of Siberia.

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