Amber Sandoval-Griffin, Times-Picayune, August 15, 2009
Tulane Medical Center officials note that they serve many Hispanics and, with language interpretation available for years at the downtown ER, don’t know how the service breakdown reported by Ramirez could have happened. But the immigrant’s experiences sound quite familiar to advocates for Hispanics in New Orleans.
Ramirez is one of large numbers of Hispanics–many of them drawn to the area by rebuilding jobs after Hurricane Katrina–who say they face several hurdles in obtaining medical care.
Like other working-class or low-income people, immigrant Hispanics are troubled by limited public transit options and lack of money for out-of-pocket fees. But they face additional problems that arguably make them the metro area’s most vulnerable population, medically speaking: language barriers, exceptionally low rates of medical insurance coverage, and their own anxiety in providing personal information to medical providers–out of fear that it could lead to closer scrutiny of their legal status in America.
Dr. Jaime Bustamante, medical director of an international services department at Ochsner Foundation Hospital, said emergency rooms are rife with Hispanic patients who, lacking any relationship with a doctor, appear with urgent and nonurgent needs. Some of them are undocumented, and they require a sophisticated response, he said.
As of 2007, about 9 percent of Jefferson Parish residents and 4 percent of Orleans Parish residents identified themselves as Hispanic or Latino, according to sample surveys by the U.S. Census Bureau. But experts say such surveys don’t account for many undocumented Hispanic workers and their relatives.
Lost in translation
The most prevalent obstacle for Spanish speakers seeking medical care is the language barrier. This gap is frequently seen at the front desk of a hospital or on the phone when someone tries to book an appointment–and is cut off immediately because the receptionist doesn’t understand them.
Beyond the front desk, access to trained medical interpreters also is a major hurdle as patients try to explain their needs in Spanish. Although many facilities have bilingual staff members, experts say that’s not the same as having an interpreter who specializes in conveying the patient’s needs to the physician or nurse.
Among seven major hospitals in the metro area with emergency rooms, four offer medical interpreters on site, at least during regular office hours. The remaining three rely on an interpreter phone line. But miscommunication is a risk with such phone lines, and they prevent more nuanced exchanges between patients and doctors, some say.
In addition to the language barrier, a lack of medical insurance poses a challenge, for medical providers as well as patients. It is a national problem: According to an analysis of 2008 census data by the Kaiser Commission on Medicaid and the Urban Institute, Hispanics comprise 15 percent of the population but make up 32 percent of the total uninsured population in the United States. And health officials say such numbers ring true in New Orleans.
Also, many Hispanics in New Orleans work in transient construction jobs that typically do not offer medical insurance. Out-of-pocket fees usually charged by clinics, even on a sliding scale, prompt many to avoid preventive care visits.
Even when Hispanic patients find out about free or low-cost clinics that have bilingual staff members–as in the case of Common Ground and Daughters of Charity clinics–transportation is a hurdle. Many immigrants do not have a valid driver’s license or a car and must rely on public transit services that remain drastically reduced from pre-Katrina levels.
Many undocumented Hispanics, meanwhile, view health workers as authority figures and fear that their personal information could be reported to immigration officials–perhaps leading to deportations. Health workers say the fear is unjustified; nevertheless, it is common for Hispanics new to the area to provide false identification or incorrect addresses to health care providers. And that gets in the way of communication about follow-up treatment.