Critical Connection

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

Bustamonte's job of explaining her people to white doctors is compounded by the diversity of the Latino people, making generalizations about Hispanics misleading. Some are Mexican-Americans who have been here for generations. Some are new immigrants from urban areas; some are from rural areas. Some are undocumented workers; some don't even speak Spanish.

None of this is made easier by the fact that some doctors are hesitant even to ask people about their ethnic identity.

"It's funny how politically incorrect ethnicity has become, but we can talk about sex at the drop of a hat," says Kevin Duke, one of two resident doctors who attended a recent class with Bustamonte.

The class isn't meant to be a comprehensive guide to Hispanic belief systems. This is Latino Culture 101 for gringos, where generalization rules. Bustamonte tries to explain complicated cultural concepts to her students, like marianismo, the idea that women should be like the Virgin Mary, and the hierarchy of family, with age and gender dictating who is in charge. She offers the doctors advice: Ask the patients what they think might be causing their problems, and don't be surprised if they have treated themselves with home remedies or don't follow doctor's orders.

"Sometimes you can find traditional beliefs underlying what people are or aren't doing to help their illness," she says.

In the quick 20-minute session she had with Duke and Ethan Bindelglas, another resident doctor, Bustamonte mostly fielded frustrated questions.

"So why don't they go to a primary care physician?" asked Bindelglas. "The fact that they go to the ER ends up being astronomically expensive, it's an inefficient way for them to get health care, and it's burdensome on them to spend eight hours in the ER. Why, if all these other clinics are out there?"

Duke chimes in with the answer before Bustamonte can respond.

"It's all about comfort. A lot of people have told me they feel more comfortable going to the ER," answers Duke.

Bindelglas says providing an ER interpreter is like treating the symptom rather than the cause.

"The comfort is we make it so easy for them to go to the ER by providing interpreters," responds Bindelglas. "It's stupid because it draws people into the ER who should be going to an urgent-care center. It's an incredible waste of resources."

Activist Guevara agrees that providing interpreters in the ER isn't going to solve all the problems, and a 20-minute cultural crash course barely scratches the surface of the major health-care issues facing Latinos.

A 1999 study by the Phoenix Behavior Research Center found that less than one-third of Latinos in the area had health insurance. A study released in March by the Centers for Disease Control found that 30 percent of Latinos in Arizona reported not being able to see a doctor because of cost. This was the highest percentage in the nation.

Uninsured people who think they can't afford health care often wait to go to the doctor until a condition has developed into an emergency. The ER is open after work hours, so people don't have to take time off. That may be the only time a family vehicle is available. New immigrants may not know they can go to primary-care clinics, and undocumented people may be afraid to seek services.

The result is generally a greater risk of health problems for Latinos in some areas where preventive care might lower rates. Hispanics in Phoenix are three times as likely as whites, for example, to get no prenatal care, and five times as likely to get inadequate prenatal care.

With clinics like the one Guevara has organized, activists hope they can move Latinos into the health-care arena before they have emergencies. And they can also make a dent in the kinds of diseases that flourish in isolated communities without a connection to health care.

Tuberculosis, for instance, can spread easily and become drug-resistant without good follow-through in completing antibiotic treatments. And in Maricopa County, Hispanics accounted for 40 percent of reported TB cases in 1999, even though they made up only about 20 percent of the population, according to the most recent census estimate in 1995.

"Interpreting programs put on a Band-Aid," Guevara says. "Our culture waits until an arm is falling off before going to the doctor. We're trying to change that culture."

It's a logical idea. But in the meantime, there is a nagging reality at hand. Hospitals must meet people where they are, and for the time being, they are in the ER.


Twenty-three-year-old Cindy Arteaga, a translator at Good Samaritan, is on her way to visit Sergio, a man from Chihuahua who is suffering from TB. Sergio first entered Good Samaritan through the ER, but he was admitted to the hospital a month ago.

When Arteaga isn't busy in the ER or in labor and delivery, she often floats throughout the hospital checking on Spanish-speaking patients. She explains to the front desk nurse that she is here to visit Sergio, and the nurse responds that he is in a bad mood. He's always in a bad mood. Arteaga just smiles and says she'd like to go in and keep him company.

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