Articles

Folk Illness and Traditional Remedies in Latino Communities

Practice Manager’s Corner
Great news about Synagys
 
A Message from Dr. Ed Berman,
Colorado Access Senior Medical Director for Children Services
 
Immunization Update
By Robert Brayden, MD

The KidSuccess Program
at Jewish Family Service
 
Announcing an Interactive Cross-Cultural Communications Website
Designed Especially for Healthcare Professionals

Ongoing Services
- Postpartum Depression Screening For Mothers And Training For Your Practice
- Child Psychiatrist Available to Provide Conferences for You In your Office
- Child Psychiatry Telephone Consultation on Medicaid Children
- Provider Resource Hotline for Children with Chronic Illness
- Integrating Developmental Screening In a Pediatric Practice
- Medical Spanish Training For Your Office Staff
- A Spanish Course For Providers
- The Cross-cultural Curriculum for the Department of Pediatrics
  The syllabus is now available for you and your practice

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Folk Illness and Traditional Remedies in Latino Communities

 
By Marcia Carteret © Copyright 2008
 
Folk illnesses are health beliefs and practices shaped by the cultural conventions of a specific group of people. Folk illnesses (sometimes also referred to as lay health beliefs) have specific causes, preventions, and cures based on wider theories of illness (e.g., humoral, Ayurvedic, biomedical) click here to learn more, but may also include local health beliefs and values not related to the major theories of illness. Because folk illnesses and remedies are shaped by the way people in specific cultural groups think about the body in health and illness, common practices vary significantly from diagnoses and treatments of the modern Western medical community.
 
Folk illnesses tend to carry religious overtones as well as a range of symbolic meanings with social and psychological dimensions. A person suffering from a folk illness is often seen as expressing emotional distress through the physical body. Such distress may arise from conflicts within the family, or from the larger social world that the individual inhabits. Perhaps the patient failed to observe social norms or perform essential rituals. Or maybe his illness has been caused by an evil spirit. Traditional healers within a particular culture are trusted to recognize, interpret, and treat folk illnesses using therapies that are congruent with the particular lay concepts of illness that underpin the condition. It is important to keep in mind that in the US, a family’s belief in folk illnesses and its use of traditional healing remedies depends on such factors as ethnicity, national origin, region, and levels of acculturation.
 
In Latino communities in the US, four of the most common folk illnesses are empacho, susto, Mal Ojo (evil eye), and Mollera Caida (fallen fontanelle). A brief description of each is given here followed by some useful links with more extensive and detailed information about Latino folk illnesses and cures.
 
Empacho – A form of stomach upset which is believed to be caused by undigested food getting stuck to the walls of the stomach or intestines causing an obstruction. It is thought to result of dietary practices including excessive eating, consuming spoiled foods, eating at the wrong time of day, or combining the wrong foods. Symptoms include anorexia, vomiting, diarrhea, bloating, cramps, and stomachache. Treatment includes dietary restrictions, herbal teas, abdominal massage with warm oil, and pinching the skin on the back and pulling it until it pops. Most treatments for empacho are harmless. However, multiple cases of lead toxicity have been documented among children whose empacho was treated with powdered folk remedies (called greta, azarcòn, or albayalde) containing high concentrations of lead oxide.1-2
 
Susto – A “fright sickness” is caused by a frightening or traumatic experience. Symptoms include lethargy, anxiety, depression, insomnia, and irritability. Culturally stressed adults (women more often than men) are most likely to suffer from susto, although children may also be afflicted. The onset of the disease generally follows a sudden frightening experience such as an accident, a fall, witnessing a relative's sudden death, or any other potentially dangerous event. Research shows that knowledge of the existence of susto is a major contributing factor in improving the condition. The treatment includes herbal teas, covering the face with a cloth and sprinkling holy water, and spitting a mouthful of water or alcohol into the patient’s face unexpectedly, and cleansing ceremonies called limpieza performed by spiritual healers called curanderos.
 
Mal Ojo – Translates into evil eye and is caused by a person with a “strong eye” who admires a child without touching them. This can occur intentionally or unintentionally. The illness is believed to occur because a spell has been placed on the child by a person who secretly covets him or her. The strong eyes are believed to “heat up” the child’s blood, resulting in symptoms such as fever, inconsolable crying, diarrhea, vomiting, aches and pains and a gassy stomach. Mal Ojo is one of the most commonly reported folk illnesses reported by Mexican parents. Treatment consists of taking a child to a folk healer for herbal remedies and ritual cures such as passing an egg over the body and then placing it in a bowl under the child’s pillow overnight. If the egg is cooked in the morning, then the child had “mal de ojo.” Sometimes a lemon, chili pepper or rue is used in place of an egg. Some Latino parents place an amulet on infants, known as azabache, which is worn on a necklace or bracelet and is believed to protect against mal ojo. Necklaces and bracelets may place infants at risk for strangulation and other accidents. A safe and culturally sensitive alternative is to pin the azabache on the inside of a garment.3
 
Mollera Caida – Translates as sunken fontanel and is believed to be caused by pulling a baby away from the breast or bottle too quickly, having the baby fall to the ground or carrying the baby incorrectly. These actions are believed to make a baby’s soft palate sink in so it has trouble feeding and swallowing. Symptoms include poor suck, irritability, sunken eyes, vomiting or diarrhea. Treatments include pushing on the baby’s palate with a finger, holding the baby upside down over a pan of water and slapping the bottoms of his feet, or applying a poultice to the fontanel. The symptoms of mollera caida might, of course, in western medicine be a sign of dehydration. Treatments involving holding babies upside down can be dangerous or even fatal and parents should be made aware of this.
 
For further study of folk illness and traditional remedies common in Latino communities check out these links. If you would like to recommend additional resources to our website readers, please email marcia@dimensionsofculture.com
 
Folk Medicine in Hispanics in the Southwestern United States
http://www.rice.edu/projects/HispanicHealth/Courses/mod7/mod7.html
 
Common Latino/Hispanic Folk Illnesses
http://itdc.lbcc.edu/chispa/DYKT/chispa_folkill.htm

 
References

1. Bose V. Vashnita, K. O’Loughlin BJ. Azarcon por empacho – another cause of lead toxicity. Pediatrics 1983;73:106-8.
2. Center for Disease Control. Lead poisoning from Mexican folk remedies – California. MMWR Morb Mortal Wkly Rep 1983;32;554-5
3. Flores, G. Culture and the Patient-Physician Relationship. Journal of Pediatrics 2000; 136:14-23

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Practice Manager’s Corner

 
Great News About Synagys
The leadership of the Colorado Department of Health Care Policy and Financing, which oversees Medicaid and CHP+ in Colorado, is happy to announce an increase in reimbursement for Synagys. They have listened to your feedback and have adjusted the reimbursement from $771.40 up to $933.35 (WAC plus 10%). This will be effective February 27, 2009. We will all hope that the price next year from the manufacturer does not go up.

Next Practice Manager’s Network Meeting: February 19th
Don’t forget that the next PM meeting will be held Thursday, February 19th from 12 – 1:00 pm in the Mt. Sneffels Conference Room on the third floor of the main hospital at Children's Hospital. Please submit topics for discussion to me at poole.steven@tchden.org. More details to follow about location, etc.

          Agenda
          Reimbursement in 2009
          Discussion of current problems and concerns and what additional assistance you need
          Medicaid's and CHP+ requests regarding medical home standards
          How to use the Medical Home Index
          A Program to help any student with mental health or learning problems

Prescription help for patients
As outlined in Chapter 8 of the Resource Manual on our website (www.cchap.org), there are many options for patients who need assistance with their prescriptions. Many of the bigger pharmacies (Walmart, Walgreen’s, King Soopers) now offer generic meds for $4.00. Another great service is called the Colorado Cares Rx Program, and can be found at www.ColoradoCaresRx.com. This program is a mail order program that costs from $20-$40 for a 90-day supply of medication. This is especially good for your children who have chronic conditions and who take regular medication.

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A Message from Dr. Ed Berman,
Colorado Access Senior Medical Director for Children Services

 
We are pleased to announce that the CHP+ immunization fee schedule offered by Colorado Access will be updated. For dates of service February 1, 2009 and after, Colorado Access will process separate reimbursement for vaccine codes and administration codes for covered immunizations given to CHP+ offered by Colorado Access members.

Reimbursement

Vaccine Code:

• Vaccines will be allowed at 100% of AWP (Average Wholesale Price).
• The vaccine fee schedule will be updated quarterly. 
• We will be adding new childhood vaccine codes to the CHP+ offered by Colorado Access immunization fee schedule.
• You can request a copy of the vaccine fee schedule from your Provider Relations Liaison.

Administration Code:

• The first administration code will be allowed at $9.50.
• Each additional administration code will be allowed at $6.50.

Remember, please bill the proper vaccine code and administration code.

If you have any questions, please call the Colorado Access customer service at
(303) 751-9021 or 1-888-214-1101.

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Immunization Update

 
By Robert Brayden, MD
 
Hib shortage
The shortage of Haemophilus influenzae type b (Hib) vaccine has hampered the vaccination of toddlers with the final dose of Hib vaccine since late 2007. The shortage of vaccine is the result of a voluntary cessation of Hib vaccine production by Merck. Though no injury has ever been documented, the possibility of vaccine contamination could not be disproved, and thus Merck is taking steps to change the production of this vaccine.

In October 2008, Merck reported that it had identified additional manufacturing changes that were needed and which required FDA approval. The resumption of vaccine production is now expected in mid-2009.

Remember that American Indian/Alaska Native children and children with immunosuppression should receive all Hib doses, despite the shortage.

For more information: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5746a2.htm

MMRV will return
In Febraury 2008, post-licensure study of the MMRV vaccine found that febrile seizures were increased in infants after receiving the MMRV combination vaccine, compared to the MMR and varicella vaccines given separately. The increased rate of seizures resulted in about one extra febrile seizure occurring for every 2,000 children in the 7 to 10 day post-vaccination period. In a lifetime, the risk of a febrile seizure from all causes is 4% or 1 in 25.

Varicella plaque-forming units (PFUs) in the MMRV vaccine are 7 times the amount of varicella PFUs in the varicella vaccine given separately. The need for these extra PFUs is to allow for an equivalent response to varicella compared to the response when given in a separate location. I presume that it is this increase in PFUs that leads to the increase in febrile seizures.

The effect of MMRV and rate of febrile seizures for 4 to 6 year olds is unknown. Theoretically it should be lower, since the second dose of MMRV leads to lesser degrees of fever compared to 12 to 15-month olds and febrile seizures are also less common in this older age group.

For more information: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5710a3.htm


2009 Immunization Cards are available from the Colorado Children’s Immunization Coalition (CCIC)

CCIC is making vaccination cards available to clinicians upon request. Log on to: http://www.childrensimmunization.org/. On the left-hand side of the page, click on “Order Materials”, answer 2 questions and then order what materials you need. The cards have an opening in the plastic sleeve to allow them to attach to a nametag.

Four cards are available from CCIC. Two schedule cards are available, one for children and one for adolescents. A childhood screening questions card is available (which nurses should particularly like), and a card is available which provides vaccines needed to be in compliance with the 2009-2010 School Regulations.

Save the date: CCIC S.O.U.P. Fundraiser:
CCIC will hold the 2nd annual S.O.U.P. (Shots Offer Unrivaled Protection) Event. It will be on the DU Campus at the Cable Center on Thursday, April 23rd. Watch for more information.

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The KidSuccess Program
at Jewish Family Service

 
The KidSuccess Program at Jewish Family Service offers mental health counseling and support in 11 local Denver Public Schools. Master’s level clinicians offer individual, group and family therapy at each school as well as at the JFS office (located in Tamarac Square Plaza) if a family prefers. We work closely with teachers, principals, school social works, school psychologist, etc. to provide a supportive and successful school environment. JFS therapists work with students and families that have a myriad of issues including, but not limited to, emotional and behavioral problems, grief & loss, mood disorders, anger management difficulties, and anxiety. As you know, emotional problems frequently manifest in physical form. JFS is looking to partner with pediatric offices in an effort to build a reciprocal working relationship and offer students and families a medical home. In return, pediatric offices would have a place to refer students and families with mental health or parenting concerns. It is especially helpful to work together with parents that have a difficult time following through on medical and mental health recommendations, parenting tips, etc.
 
CCHAP very much encourages your practices to utilize this wonderful service.

        List of Schools in which JFS provides the KidSuccess Program:

1. Ashley Elementary- 1914 Syracuse St; Denver, CO 80220
2. CEC Middle College- 2650 Eliot St; Denver, CO 80211
3. Cory Elementary- 1550 S. Steele St; Denver, CO 80210 
4. Emily Griffith High School- 1250 Welton St; Denver, CO 80204
5. Hamilton Middle School- 8600 E. Dartmouth Ave; Denver, CO 80231 
6. Merrill Middle School- 1551 S. Monroe St; Denver, CO 80210 
7. Phillip’s Elementary- 6550 E. 21st Ave; Denver, CO 80207
8. Steele Elementary – 320 S. Marion St; Denver, CO 80209
9. Thomas Jefferson High School- 3950 S. Holly st; Denver, CO 80237 
10. Whittier (ECE-7)- 2480 Downing St; Denver, CO 80205
11. Florida Pitt Waller (K- 8)- 21601 E. 51st Place; 80249 

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Announcing an Interactive Cross-Cultural Communications Website
Designed Especially for Healthcare Professionals

dimesionsofculture.com

 
Register now! Click the link above and get full access
with your own secure login and password!

A Website to Support On-going Training for Healthcare Professionals in Colorado

Because culture can have important clinical consequences, this website is devoted to supporting the self-development of healthcare professionals in basic cross-cultural communication competencies that impact health outcomes for patients. In place of the typical "diversity training" approach, practical communication strategies are emphasized that can be put to use immediately in private practices, clinics, and hospital settings.

An Interactive Website for Building a Learning Community
 
The content of this cross-cultural communications website focuses on reinforcing key concepts presented in cross-cultural communication trainings by Marcia Carteret. Additionally, this site presents the opportunity for physicians and staffs in multiple healthcare settings to interact with one another through threaded discussions. Because nothing can replace real life experience in the learning process, a virtual learning community will make it possible to share true stories and post useful questions while culture and medical experts facilitate discussions.
Website Features
Listed here are the pages that currently make up dimensionsofculture.com. Please note that some pages require a login and password because only select groups of healthcare professionals, including all CCHAP pediatric practices, will have full access to the “community” pages.

Public Pages

• Home Page
• Greetings from the Site Editor
• Culture Calendar- Monthly religious and cultural holidays
• Culture Quest – Information about cultural happenings in our community, as well as statewide and nationally.

Healthcare Community Pages (Login/Password Protected)

• Newsletters – Monthly articles addressing key cross-cultural communication topics written by Marcia Carteret and other guest contributors.
• Interactive Forums – an interactive on-line community dialogue between healthcare professionals about communicating with patients from different cultural backgrounds. 
• Provider Profiles – An ongoing series of profiles introducing some of the dynamic and culturally diverse doctors working in the CCHAP network of pediatric practices
• Culture Ambassadors – A panel of representatives from cultures around the globe, with a strong focus on the cultures most heavily represented across out state.

This website is designed to meet the needs of the healthcare community served by Colorado Children’s Healthcare Access Program. If you are a participating CCHAP provider or staff member and have suggestions for the website, please contact Marcia Carteret at mcarteret@gmail.com or 720-777-3124. Your comments and suggestions will help make dimensionsofculture.com an effective tool for learning and community building.

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Postpartum Depression Screening For Mothers
And Training For Your Practice

Postpartum Depression is a significant public health issue affecting 1 out of 8 new mothers. In Colorado, it is underidentified and undertreated. The Rose Community Foundation has funded Dr. Brian Stafford and The Kempe Center¹s Postpartum Depression Intervention Program to provide Free Medical Education and On-Site assistance to practices in the Denver Metropolitan area in order to assist their identification, education, treatment, and referral for women with this condition. Practices will receive a free talk as well as a free tool kit and fliers and brochures to assist them. This provider education is paired with a public awareness campaign on this issue titled, 'Oh baby, this isn¹t what I expected.' Interested practices or practitioners should contact the Kempe Center at 303-864-5845 or Dr. Brian Stafford at tafford.brian@tchden.org to schedule the on-site pre-clinic or lunchtime training.

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Child Psychiatrist Available to Provide Conferences for You In your Office

Rick March, MD is a child psychiatrist at the Mental Health Center of Denver.  He is available to provide teaching on a variety of child Psychiatry topics (below) in your office.  He is also willing to discuss cases with you, as well.  Please contact him to take advantage of this wonderful opportunity.
He can be reached at Rick.March@MHCD.org

Here are some of the topics he can cover for you.

• Diagnosing Depression in Children and Adolescents
• SSRI’s and Black Box warnings
• Suicide and self-abuse
• Diagnosing Bipolar Disorder in Children and Adolescents (including differential diagnosis)
• Atypical Antipsychotics
• Mood Stabilizers and Antidepressants
• Pediatric Psychopharmacology and the FDA
• Kid with ADHD who don't get better on stimulant medication
• Psychosis in Children and Adolescents

And, remember there is a child psychiatrist on call available by phone for your Medicaid children…..

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Child Psychiatry Telephone Consultation on Medicaid Children

The Behavioral Health Organizations and the Mental Health Centers in the greater metro area have very generously made available telephone consultation by child psychiatrists to help providers in CCHAP – affiliated practices manage their  Medicaid children with complicated mental health issues or complicated medication regimens.   These child psychiatrists are also willing to come visit your practice to get to know you and even to discuss cases.   We are very grateful for this very generous support for your Medicaid children.

Denver County – Rick March, MD – 303-504-1520
Jefferson County – Don Bechtold, MD – 303-432-5172
Adams, Arapaho and Douglas Counties - Joe Pastor, MD – 303-853-3888
 

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PROVIDER RESOURCE HOTLINE

(Clarification of previous information)

To Help You Find All Appropriate Services and Resources
           for Your Chronically Ill or Special Needs Patients

Including Case Management or Care Coordination for the Child

And Education Resources and Support Services for Their Parents

                       Call  1-877-731-6017

                       Fax: 303-691-0846

                       Email: providerhotline@familyvoicesco.org

The PROVIDER RESOURCE HOTLINE assists  providers to identify all appropriate services and resources for children with chronic illness or special needs and for their parents:

• Case management
• Care coordination
• Specialized services, resources, medical equipment, therapies
• Parent/patient education about chronic illness / special needs
• Parent/patient support services
• Help in finding funding for uncovered services

Examples:

• You are seeing a new patient (new to Colorado) who is an infant with 22q Deletion Syndrome,  congenital heart disease, cleft palate and an oxygen requirement of undetermined etiology.  Parents want to link up with all of the support services and a parent group like they had where they used to live.
• A child with multiple developmental delays also has behavioral problems.  The parents are not sure they are getting all the help their child is entitled to and they want a parent  support group and they are asking for counseling.
• A parent with a disabled child wants your help in applying for some sort of waiver that you aren’t familiar with.

Monday thru Friday from 8AM to 4PM
Voicemail available 24/7

Provides follow-up with the provider office and with the family

CLARIFICATION 
Contact Erlinda or Lorena with CCHAP at PHONE 720-744-5522; FAX 303-751-9048
  –   When you are only wondering about socio-economic issues like food stamps, housing, Medicaid 
        eligibility, legal aid, abuse, etc.
 
If the hotline can answer your questions immediately, you can pass the information to the family while they are in the office or we can contact the family and give the information to them.

If the information is not immediately available, we will research the question or case and provide the information to you and the family later in whatever manner you and the family wish (via phone, fax, or email).

If you feel the family needs more assistance or follow- up, just let us know and share the family’s contact information with us or provide the family with our number for them to contact us directly.

When contacting us, please provide us with the following information:
Your provider office and PCP name
Name of Child
Date of Birth
Medical Condition / Primary Disability
Type of insurance
Resource or service requested
Who should we contact with information?
Family Contact Information
How is it best to provide information back to you: phone, fax, email or voicemail

DOWNLOAD A REFERRAL FORM CLICK HERE

DOWNLOAD AN 8.5 x 11 FLIER TO KEEP ON HAND AS A REMINDER  CLICK HERE

Next time you see a special needs child, call us to see how we can help

Questions about the hotline?  Call 1-877-731-6017

The Provider Hotline Is Sponsored By
Family Voices and CCHAP

 

   

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Integrating Developmental Screening
Into a Pediatric Practice

• The Colorado Assuring Better Child Health & Development (ABCD) project has received a three year grant to provide training and technical assistance to providers to implement a “validated” developmental screening tool at well child visits for infants/toddlers birth to five.
• The ABCD project is partnering with CCHAP to provide training and support to pediatric practices to implement developmental screening.
• Medicaid will reimburse $34.00 to providers if you use a standardized, validated developmental screening test at an EPSDT visit.
• The Colorado Chapter of the AAP supports the ABCD project.
• Early detection and intervention improves outcomes.  Many delays in children’s development are missed in the first 4-5 years of life without a standardized, validated screening test. 
• The most time-efficient tool is one in which the parent completes a questionnaire.
• To comply with 2010 recertification guidelines by the American Board of Pediatrics, documentation will be required to show levels of involvement in practice improvement initiatives. By implementing the use of a “validated” developmental screening with a sensitivity and specificity rating of 70% or greater like the ASQ or PEDS, practices are taking steps to integrate quality improvement into their practices.
• What providers are saying about implementing either the ASQ or the PEDS parent questionnaire developmental screening tools:
  •  
    • It takes 1-2 minutes for an MA, LPN or RN to score.
    • It takes less than a minute of the provider’s time if the MA, LPN or RN scores the questionnaire.
    • In many instances, it reduces the length of the visit.
    • It helps providers concentrate on the concerns/priorities of the parents.
    • It reduces the number of concerns that come up as you are walking out the door at a well care visit.
    • It improves patient satisfaction.
    • It promotes positive parenting practices.
    • It increases provider confidence in decision-making for when to refer a child for further developmental evaluation.
• Eileen Auer Bennett, the Colorado State ABCD Coordinator and her team are available to assist providers in getting started. Training and technical assistance will be provided to practices to implement a standardized tool such as the ASQ or PEDS. Support will also be given to office staff on how to incorporate a standardized developmental screening tool into the current office work flow.

For more information, please contact:
            Eileen Auer Bennett
            720-333-1351
            ileanben@yahoo.com

The Ages & Stages Questionnaire (ASQ) is a well respected screening tool.  It has the best sensitivity and specificity.  It is standardized across various common minorities.   Health care providers have identified the following advantages:

• Parent completed—Parents are partners in their child’s
  assessment and intervention activities.
• Serves as a talking guide with parents identifying a
  child’s strengths as well as things the child is not
  doing yet.
• Practical—Scoring takes 1-2 minutes and can be done
  by paraprofessionals.
• Cost-efficient—May be photocopied repeatedly.
• Scoring is simple—Only three responses:
  1. Sometimes, occasional or emerging response from
     child = 5 points
  2. Yes, child performs specified behavior = 10 points
  3. Not Yet = 0 points
• If the child’s total score falls in a shaded area of the bar
  graph for any developmental area, further diagnostic
  assessment is recommended.

• Developed out of four cross-validation studies on a
  nationally representative sample of families.
• Uses parent concerns or judgments about the child’s
  development and behavioral status.
• Easy to score—two minutes to elicit and interpret.
• Enables health care providers to determine the need to
  refer and where.

Visit www.pedstest.com to view and order the PEDS tool online.

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Spanish Interpretation Training for Pediatric Practices

An assessment of each individual’s skill level will be done during a 5-10 minute phone call prior to first telephone conference/class.  Maria will contact you to schedule this initial individual telephone call upon receipt of your registration email.  A certificate of completion will be given after completion of all 6 sessions. The faculty is Maria Soto, a certified Spanish interpreter and trainer with International Language Services.

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Abe Grinberg MD, FAAP MPH
   

Language as a Communication Barrier in Medical Care for Hispanic Patients
 

           Communication with patients and their families is essential in providing quality medical care. Cultural and language barriers create a void in the delivery of safe health care, customer satisfaction and quality of care. The public debate on how to bridge cultural and language barriers has a long history. The use of formal interpreters and translators is associated with the ability to eliminate these barriers; however, the ability to communicate directly with health professionals in a common language is associated with an increase level of trust in medical settings.

           There are 7 important points to have in mind when addressing cultural and language barriers with the Hispanic patients and their families:

1. The number of people speaking a language other than English at home and the number of Americans Limited in English Proficiency (LEP) in the United States is significant. It is expected that the total number of people in these two groups will continue to increase at a faster rate than the one of the general population in the USA. About two thirds of them are Spanish speaking individuals (₁) (₂).
2. Multiple studies document that quality of care can be seriously compromised when Spanish LEP patients need but do not get translation and interpretation services (₃) (₄).
3. Studies also document that the quality level of interpretation offered by bilingual providers and professional hospital interpreters is high. However, the quality of interpretations offered by hospital employees who are not professional interpreters, family members, relatives, friends, and ad-hoc translators are many times incorrect and of poor quality (₅).
4. Interpretation errors are common. About 60% of the errors have potential clinical consequences. Even professional interpreters commit significant errors about 50% of the time (₅).
5. Patients, who interact with a bilingual provider, frequently rate them as more friendly, respectful, and concerned when compared to those who interact with a translator or interpreter. Patients and families who are taken care by a provider who speaks their own language frequently have a more accurate recall of critical information about the encounter than those who interact with a provider who uses a translator or an interpreter(₆)(₇).
6. There are data that suggest that the length of hospital visits, the incidence of any testing, the cost per visit and the number of hospital admissions are decreased in those patients who interact with a provider who speaks their own language when compared to those providers who use a translator or interpreter during the course of the medical encounter (₈). 
7. There is evidence that courses in Medical Spanish can help health care professional achieve fluency in Spanish at the functional level and promote cultural awareness that strengthen communication skills. The promotion of such courses is associated with decreased interpreter use and increased patient and family satisfaction (₉).

          Bear in mind that Hispanics embrace people when they make an effort to speak their own language. They tend to be tolerant and have a tendency to develop relationships that are based on friendship and respect. You will make them fill comfortable and help them feel that you are concerned about their medical care.
 
          “Dele a un hombre un pescado y él comerá por un día. Enséñele cómo pescar y comerá por el resto de su vida” (Lao Tzu. Filósofo Chino).

1. 1. Flores Glenn. 2005. The Impact of Medical Interpreter Services and the Quality of Health Care: A Systematic Review. Medical Care Research and Review 62: 255-299
2. Colorado Alliance for Immigration Reform. U.S Immigration Data, Projections and Graphs. Retrieved: October 2, 2008. http://www.cairco.org/data/data_us.html
3. Flores, Glen., Abreu, Milagros., Schwartz, Ilan., and Schwartz, MD, and Hill, Maria. (2000). The importance of language and culture in pediatric care: Case studies from the Latino community. The Journal of Pediatrics. 137 (6): 842-848
4. Flores G. Language Barriers to Health Care in the United States. NEJM 2006; 355:229-23
5. Flores G., M.B. Laws., S.J. Mayo., B. Zuckerman., M. Abreu., L. Medina and E. J. Hardt. 2003. Errors in clinical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 111: 6-14
6. Baker, David W., Hayes, Risa., and Puebla Julia. 1998. Interpreter Use and Satisfaction with Interpersonal Aspects of Care for Spanish-Speaking Patients. Medical Care. 36(10):1461-1470 
7. Seijo, R., H. Gomez and J Frienderber. 1995. Language as a communication barrier in medical care for Hispanic patients. In. Hispanic Psychology_Critical issues in theory and research, edited by A.M. Padilla, 169-181. Thousand Oaks,Ca: Sage.
8. Hampers, L. C and., McNulthy, J.E. 2002. Professional Interpreters and Bilingual Physicians in a Pediatric Emergency Department. Arch Pediatr Adolesc Med. 156:1108-1113.
9. Suzan S. Mazo., Louis C. Hampers., Vidya T. Chande. Steven E. Krug. (2002).Teaching Spanish to Pediatric Emergency Physicians: Effects on Patient Satisfaction. Arch Pediatr Adolesc Med 156: 693-695

Course in Medical Spanish customized for pediatric care providers. Once a week for 12 weeks (2 hour class), includes also 6 month internet access to “Spanish for health care course”. Flexible schedule to accommodate participants’ preferences; Classes take place at the providers’ office for groups of 8-12 students.
$ 389 dollars per student. Includes 6 month internet access to the on line training course.
          Contact: Abe Grinberg MD (720) 748-7669.
          abe@bilingualmed.com my web-site www.bilingualmed.com

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The Cross-cultural Curriculum for the Department of Pediatrics
The syllabus is now available for you and your practice

There is a syllabus available on the CCHAP web site that covers a variety of topics related to cross cultural health care.   Click Here to view the entire curriculum or visit www.cchap.org/cchc-syllabus/. The following topics are covered:

Demographics of Colorado’s Children

Health Disparities among Colorado’s Children

Health Disparities
              Poverty
              Genetics 
              Environmental exposures 
              Life style behaviors 
              Provider’s ability to understand/accommodate the patient’s / parent’s culture
              Provider’s ability to communicate well with families
              Patient’s / parents limited English proficiency
              Patient’s / parent’s limited health literacy 
              Disimination

What can Providers do to improve outcomes?

Race, Ethnicity and Culture (Definitions)

Cross-cultural Communication 
              Generalization versus stereotyping 
              What providers need to know about culture? (Dimensions of culture) 
              Basics of cross-cultural communication

How to communicate with and help families with Limited English Proficiency

How to communicate with and help families with Limited Health Literacy

The Cross-cultural Health Care toolkit 
              Keys to success in cross-cultural communication 
              LEARN mnemonic 
              Cross-cultural health care Review of Systems

Case Studies

Examining our Own Personal Biases

8 Steps You Can Take to Enhance Your Skills in Cross-cultural Health Care

The Institute of Medicine’s Guidelines

The CLAS Standards (Guidelines for organizational change)
  
References

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 CCHAP Home > Newsletter Articles > Newsletter Twenty-Six, February 2009