Wednesday, March 7, 2007

Cross-cultural remedies for health care disparities

New center at Adventist to help overcome barriers to medical treatment

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Brian Lewis⁄The Gazette
Marcos Pesquera, of North Potomac, hopes to overcome the cultural and language barriers to health care experienced by minorities as the head of the newly formed Center of Health Disparities for Adventist HealthCare in Rockville.
Marcos Pesquera of North Potomac left his native Puerto Rico behind nearly 30 years ago to study at the Massachusetts College of Pharmacy. As he moved from behind a People’s drug store counter into retail pharmacy and managed care administration, he sometimes found himself in a totally unexpected role as a translator for Spanish-speaking patients.

He quickly realized that clear communication depends on more than just words.

Asked to translate between a young female doctor and an elderly Hispanic woman with congestive heart failure, he was baffled by the patient’s refusal to listen to the doctor’s advice.

‘‘[The patient] said, ‘She has no white on the top of her head, she looks like a kid,’” Pesquera said.

With the aid of an organizational chart showing that the doctor headed the department, he won the patient over.

‘‘It’s not just interpreting, it’s being a cultural broker,” said Pesquera, 46, the executive director of a newly formed Center of Health Disparities for Adventist HealthCare in Rockville.

In his new role, Pesquera wants to educate health care providers working at Shady Grove Adventist Hospital and other Adventist facilities to be ‘‘culturally competent” when it comes to treating minorities.

But the program will eventually expand beyond the doors of Adventist facilities, with training offered to Montgomery County firefighters and ambulance crews.

‘‘It’s all about breaking down the barriers that prevent [minorities] from having open access to good health care,” he said. ‘‘This center is not a building, it’s a front-line intervention to bring about change.”

The program includes asking bilingual staff to serve as interpreters after attending a three-day training session covering the legalities and also the practicalities of the role.

Translating every word said, not injecting opinions into the conversation and standing behind the patient to allow eye-to-eye contact between the doctor and patient are vital to overcoming cultural barriers, Pesquera said.

‘‘This is not rocket science,” he said. ‘‘But [the volunteers] serve as more than interpreters.”

Doctors and all staff will also be trained to be more culturally sensitive to the diverse traditions and cultural norms of patients hailing from Ghana to Korea.

And then there are some homegrown cultural issues to overcome, such an African American reluctance to join clinical trials caused by the abuses of the Tuskegee syphilis experiment. During that decades-long research, African-American males were denied appropriate medication so that the researchers could study untreated syphilis.

‘‘From that grew mistrust of [health care providers],” he said.

He also hopes to provide a better road map for minorities that have trouble navigating the health care system, he said.

‘‘It can be as simple as ensuring a patient with limited English skills knows how to get from point A to point B in a hospital and isn’t left wandering around the halls,” he said.

Simple awareness of diverse cultures goes a long way toward improving communication between doctor and patient, he said.

A prescription label reading take ‘‘once” daily, for example, can be read as the number eleven in Spanish with disastrous results. And while some doctors may be uneasy with the preference by some Middle Eastern women to have their husbands accompany them during consultations, to the patient it’s all about the husband showing a proper level of love and care.

‘‘There’s a clash of cultures at times, but it’s not about wrong or right. It just is,” Pesquera said.

Pesquera is also reaching out to the Annapolis legislators, testifying last month at the Maryland General Assembly on health disparity bills and the need to mandate cultural competency workshops for licensed health practitioners.

‘‘Every organization needs a strategy to combat disparities,” he said.

While the health disparities center is new to Adventist, Montgomery County Department of Health and Human Services has been targeting what is referred to as ‘‘under-served populations” since 1999, said Patricia Horton, special projects officer for the department. A county-run African-American Health Program targets high rates of infant mortality, diabetes and obesity, while initiatives for Latinos and Asian Americans address needs that vary from providing interpreters to health screenings.

The programs are paying off, she said, citing the improvement in county infant mortality among African Americans from 17.4 per thousand to 13.4 per thousand births.

But with the white infant mortality average 4 per 1,000 births, she said much more work must be done.

‘‘This is a collaborative effort involving education and outreach,” she said. ‘‘We’re happy hospitals are getting involved, and that Adventist is becoming a leader in [the issue of] health disparities.”

That leadership began in 2005 when Adventist HealthCare announced a series of initiatives to improve discrepancies under its ‘‘Vision for Expanded Access for Washington Adventist Hospital.” It set up a panel comprised of nearly two dozen health care experts that led to the center being established.

Pesquera said good intentions are one thing, but he plans to quantify exactly how well the program is working by issuing a ‘‘report card” by the end of the year. It will record the numbers of health care providers trained and feedback from patients.

Collaboration is key, Pesquera said, so the center is partnering with the county to improve care for the uninsured, with outreach groups like the African Immigration and Refugee Foundation, and with programs like Mary’s Center for Maternal and Child Care in Washington, D.C. Adventist is helping to open a branch of the clinic that provides care regardless of the patient’s ability to pay in either Wheaton or Silver Spring some time this year.

‘‘We want to reach all of our community,” Pesquera said.