Critical Connection

Language isn't the only thing getting lost in the translation as Hispanic patients struggle to communicate with English-speaking ER doctors

But no one in Arizona has complained. And nobody is standing at the border, informing new immigrants about their rights and handing them the phone number for the civil rights regional office in San Francisco.

Latino activists in Phoenix haven't gone the route of complaining to civil rights officials, either. The Zamora family didn't even file a complaint over Gricelda; their lawyer says his priority was taking care of the family through the lawsuit.

Federal regulations won't make hospitals more Latino-friendly, says Juan Guevara. He is director of the People of Color Healthcare Clinic, which recently opened through a partnership of St. Luke's Behavioral Health Center, Tempe St. Luke's, Mesa General Hospital and various Latino activist groups.

Hospitals are a long way from providing competent care to Latino patients, Guevara says, and the answer is separatism.

"Our community doesn't know or care about that law," he says. "It's just not being done.

"We figured out that hospitals are not going to do this," he continues. "We have not forgotten what happened [with Gricelda]. There is a serious lack of trust. Our communities don't trust those hospitals, so we decided to take it up on our own."

The idea behind the clinic is to reach people through community care and to show the hospitals -- which are contributing nurses and equipment but no cash to the clinic -- that there is a health-care market to tap there. St. Luke's and Mesa General are making an effort to treat people of color better, says Guevara, but the only language the hospitals understand is economics.

"What I'm talking about is, 'Do you want access to that market? Do you want to increase your market share? Do you want to make money off the Latinos and blacks?' That's the language they understand. They are being receptive to that."


Perla Flores is a Latina marketer in so many ways. Economic advantage is precisely the way she pitches Good Sam's interpreter program, saying you can't argue with the numbers.

"I think definitely Latinos are coming to the forefront of our economic pull. They have significant purchasing power and are an important part of our economic infrastructure and labor pool. I think people are noticing that," she says.

Flores believes that a program giving quality service to Latinos will draw in a valuable market for her hospital.

"I'm a marketer first," she says. "That way nobody can say I am doing this just because it's my people, although deep down inside my heart, I have been in their shoes."

Flores was born in Tijuana and came to the United States with her mother and siblings when she was 10. She grew up in the barrio del sol in San Ysidro, California, where she learned a new culture and language, but never forgot where she came from. She remembers her first health-care experience, when a machine injured her mother at her factory job. Flores was 11, and she interpreted for her mother at the hospital's ER.

"I was scared," she says. "She was our sole provider. There were four of us kids. I felt for her because she was in a lot of pain and couldn't express it to her health-care providers. On top of that I thought, 'How are we going to pay for this?' I was an 11-year-old thinking of that."

Flores appreciates the fact that children who accompany their parents to her hospital don't have to take on that burden. She also appreciates that the interpreter program creates opportunities for Latinas and Latinos in the health-care industry. She wants to mentor the young interpreters, and she can envision one of them having her job someday.

"These ladies are strong, in charge and can take a lot of pressure. And I'm not just saying that because I'm a Mexican woman and I can take a lot of crap. I have seen it in my own life. They are compassionate but strong, and that's a hard combination to find."

Many of the 12 Latina interpreters in the Good Samaritan ER were promoted from other hospital jobs. They not only translate, but also advocate for monolingual patients.

"They're like cultural brokers in a way," Flores says.

Language is the most basic and urgent need, but there is more to treating Latino patients. Making a proper diagnosis and influencing behavior often require understanding cultural nuances and culturally ingrained ideas about health care. That's why Irma Bustamonte gives cultural sensitivity training to both interpreters and medical residents at Good Samaritan.

The interpreters may be second- or third-generation Mexican-Americans who have lost touch with the more traditional aspects of their culture, says Bustamonte, who is Hispanic outreach coordinator for Phoenix Children's Hospital and a consultant for Good Samaritan.

"I think sometimes we take culture for granted," Bustamonte says. "We live our culture; we don't think about it until other folks say something like, 'Why do your people always do that?'"

Getting the medical community to fully appreciate cultural training can be a struggle, she says. "It's still seen as fluff. As far as culture goes, we are still just trying to raise awareness."

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