Finding a voice in the health care gap

Racial divide limits access to medical resources


Yliana Yado-Gonzalez figures she knows most of the approximately 1,200 residents at Caldwell's Farmway Village one way or another. She trades babysitting duties with families, works with some and volunteers with others. She also knows a good number of folks through their chronic illnesses, workplace injuries and general health woes.

Two, sometimes four times a week, Yado-Gonzalez visits valley health facilities where she listens to her neighbors' health complaints, asks about their medical history and rattles off the kinds of questions typically asked by health providers: Any medications? Allergies? Family illnesses? Where does it hurt? She then outlines a treatment plan and sends the patients home with after-care instructions.

Yado-Gonzalez holds no medical credentials, yet her voice often serves as the only link between her Spanish-speaking community and the predominantly monolingual medical system. Her neighbors tell Yado-Gonzalez of their aches and pains, she translates details from Spanish into English and then from English into Spanish. If all goes well, the patients go home with the right diagnoses and meds.

"These people don't have anyone to rely on and something drastic might happen when I'm not around," she says of her volunteered skills that sometimes mean the difference between seeing a doctor or staying home.

Social justice advocacy groups say medical interpreters like Yado-Gonzalez are in short supply across the nation, and that shortage is just one of the challenges that leads to racial disparities in heath care.

The Idaho Community Action Network (ICAN) and a coalition of organizations recently released a report detailing the chronic environmental, structural, institutional and interpersonal racism in the health care system that affect people of color. The report, "Closing the Gap: Solutions to Race-Based Health Disparities," notes that racial disparities in heath care constitute one of the nation's greatest public health challenges.

"We know that racial disparities exist in health, and we know they are not necessarily going away-and in some cases, they're increasing," says Will Pittz, a researcher with the Northwest Federation of Community Organizations. Language barriers top the list of local challenges, researchers say.

Local advocacy groups plan to petition West Valley Medical Center later this month for better interpretative services. Yado-Gonzalez says a lack of those services sometimes keeps folks at Farmway Village from seeking medical care at West Valley, a Caldwell hospital some refer to as "Death Valley Medical Center," due to challenges some Hispanics face when seeking treatment. "Closing the Gap" notes that access to health insurance, culturally appropriate care and race-conscious public policies are essential elements of an equitable heath care system. West Valley Medical Center CEO Mark Adams admits language barriers can be a problem at the hospital, but he and West Valley staff are eager to meet with ICAN to discuss ways to improve care for Hispanic patients.

Some of the nationwide problems detailed in "Closing the Gap" include misunderstandings regarding alternative medicine and health traditions practiced by some communities of color. Pittz says trust between a patient and health care provider can help overcome such problems, but trust is built on communication-something providers don't always have enough time or bilingual resources to do. That leaves volunteers such as Yado-Gonzalez to fill in the gap at facilities without interpreters on staff. But Yado-Gonzalez can't be in every exam room.

"Verbal communication is a doctor's number one diagnostic tool," Pittz says. "Without having an interpreter in the room, it's like practicing veterinary medicine."

West Valley Medical Center and ICAN are entering talks to explore ways to close that language gap. Leo Morales of ICAN says farm workers needed but couldn't access interpreter services when they were recently poisoned by pesticides while working in a Caldwell field.

"Closing the Gap" reports that people of color also experience environmental health racism because they're more likely to work and live in hazardous conditions. The crew of Hispanic workers experienced that kind of racism when they weeded a Caldwell onion field shortly after pesticides were applied to the crop. And that environmental racism lead to interpersonal racism after farm workers became ill. The crew toiled in the field during the early morning of July 6 when pesticides rubbed off of the plants and onto their hands and clothes. Workers say that a lack of water facilities prevented them from washing their hands and they ingested pesticides while eating lunch.

By the afternoon, many of the workers were at West Valley Medical Center and some were in critical condition. That's when field worker Maria Aguirre became the sole voice for many on the crew. Only one interpreter was on staff, Aguirre recalls, and that left her speaking for crewmembers and a handful of health care providers.

"If I hadn't been there, what would have happened?" she asks.

Adams says there are occasional pockets of time when interpreters are not available at West Valley. For the week of July 24, the hospital will have about 28 hours without an interpreter. A Mercy Medical Center spokesperson tells BW an interpreter is available 24 hours a day and the hospital does contract with Language Line Services, a company that provides interpretation services over the phone. The Language Line provides services in more than 150 different languages all day, every day. Some area facilities, such as St. Luke's Regional Medical Center, use individual contractors for interpretation needs, as well as the Language Line.

"It's always a challenge to have a certified interpreter on site, but we try," Adams says of West Valley.

Adams says the hospital does contract with Language Line, but the translation doesn't happen face to face and both verbal and non-verbal communication remains vital to good treatment.

"The result of these challenges is extremely severe-it's misdiagnosis," Pittz says.

"Closing the Gap" looks at cases of race-conscious solutions in health care facilities throughout the nation. One case study detailed how an Alaska health system helped close the racial divide by emphasizing the alternative medicine embraced by the native population and practicing culturally conscious care. Other communities helped close the gap by turning to traditional native diets as part of treatment plans, expanding health coverage programs and offering innovative interpretation services. The report details how some of these solutions could be applied to challenges in Idaho.

Adams says that for now, finding qualified medical interpreters is no easy task. Until more of those interpreters staff local heath care facilities, Yado-Gonzalez plans to accompany neighbor after neighbor to their doctor visits.

"I'm going to be here for these people ... because I'm their only voice."