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By Amarica Rafanelli
At Baptist Community Health Services, about one-third of patients are Spanish speaking. But at the organization’s call center, only a handful of staff members are bilingual. 
“We would have to either put [patients] on hold and see if someone is available to speak to them, or tell them to call back somehow,” said Nancy Tardy, the director of the call center.
Because the call center serves as the main entry point of care for the Richmond, Virginia health center, these patients were at risk of not getting medical attention. They might not call back, or even hang up out of frustration.
A solution came in the form of an education session: the Medical Spanish session offered by the nonprofit group The MAVEN project. Through funding from Direct Relief, they provide educational services to physicians caring for underserved patients. This particular session was designed to help non-Spanish-speaking providers communicate clearly and effectively with Latino patients.
Providers learned key phrases and medical terms in Spanish, and culturally appropriate ways to provide care.
“They learned the basics on how to greet the patient, how to take the message and how to book the appointment,” said Tardy of her staff members who attended the session.
According to Tamara Ríos, who presented the Medical Spanish session, being bilingual in a patient’s language is not a requirement for providing culturally competent care. Instead, her education sessions focus on the basics.
“We certainly would never state that you will be fluent after taking any of our classes because that’s not realistic, but we do present concepts in a way that you can apply immediately in the medical setting, so it’s a correct, but simple Spanish,” she said. 
For example, Ríos teaches providers to use “key power verbs” which can be used to quickly give patients advice or recommendations. “So an example would be ‘necesita,’ [which means] ‘you need to,’ and then you can add on the infinitive,” she explained.
For Tardy’s staff, knowing this level of Spanish has made the difference between patients hanging up and patients getting care. “This class was like a blessing,” said Tardy. 
But providing culturally competent care is not just about language. Providers must also understand differences in communication styles, along with important cultural beliefs and practices. 
“There are different views of what causes disease and different views of what you can do when you are sick,” explained Dr. Gregory Juckett, a former professor at the West Virginia University School of Medicine and researcher specializing in culturally competent care for Latino populations. 
Some beliefs held by Latin American communities counter those held by standard Western physicians, Juckett said. For example, it is common for illnesses to be considered either hot or cold conditions.
Juckett gave the example of high blood pressure, which some think of as a hot condition that should be treated with a cooling remedy, such as lemon tea.  
At times, this view of disease can impede on the successful treatment of a patient, Juckett explained: “Basically you’re dealing with two different worldviews and sometimes these worldviews conflict with each other.” 
He has had mothers refuse vitamins for their children who have fever or illness “because vitamins are considered a hot therapy and therefore it wouldn’t make sense to use vitamins, something hot, to treat something that’s hot.”  
However, most of the time these traditional treatments can be used in tandem with Western medications or lifestyle changes, said Juckett. With some patients who have moderately high blood pressure, he will pair a culturally appropriate therapy with diet and exercise for a three-month period and monitor the patient’s condition.
If the patient improves, so much the better. If not, he negotiates: “We try to accomplish a compromise where we hopefully take some of both worlds and use them together.” 
This approach is common among many of the providers interviewed for this story, including Dr. Marianny De Aza from Health Brigade in Richmond, Virginia. De Aza is a Native Spanish speaker from the Dominican Republic and manager of the Health Brigade’s medical clinic. 
“The whole agency is bilingual because of the need of the bilingual staff to help with the Spanish-speaking patients,” who account for 80% of the clinic population, she said.
De Aza said she often encounters cultural beliefs that conflict with the treatment she has prescribed. “I have a lot of patients telling me ‘I’m not diabetic’…or ‘I don’t want to take Metformin,'” she said, referring to a treatment for diabetes. One of her patients used cold chocolate to manage her high blood pressure, rather than the medication she was prescribed. 
“I do not tell them [their therapies are] not going to help them. I just explain to them that there has been a lot of studies that have proven that if we help you with this type of medication, in the long term, the quality of life is going to be better,” said De Aza. 
As a Latina raised in the Dominican Republic, De Aza understands her patients’ perspective. “A lot of us have been raised by our abuelita giving us remedies and they cure us, they work,” she said.
This kind of understanding is key to developing trust with patients and helping them attain better health. In her sessions, Ríos encourages providers to ask questions that acknowledge traditional healers and therapies.
When asking about their health history, for example, providers can ask patients, ‘‘’Have you seen any other provider, yerbero, doctor, santero, curandero?'” she explained. “That way it signals to us, ‘Okay, everyone is on the same team.'” 
In addition, Ríos educates providers on differences in communication styles and expectations. It all begins with the introduction.
She explained that, while it’s typical in the U.S. for providers to skip over pleasantries and get right to the medicine, this can feel abrupt for patients accustomed to receiving care in Latin America. Instead, Ríos encourages providers to ask patients their names, ensure they are pronouncing them correctly, and always ask about their family. 
“Family is very much involved in the decision-making process of anything…particularly with the health of the patient,” said Ríos. This warm welcome adds a personal touch to the visit, or “a little version of ‘personalismo,'” that can ultimately determine the care a patient will accept and receive. 
At Health Brigade in Virginia, De Aza is working with her non-Spanish-speaking staff to help them better understand their patients. She’s been using the slides from the MAVEN Medical Project session to teach basic terms and phrases, such as “me duele” (“it hurts”) or “cabeza” (“head”), and add the personal touch Ríos describes.  
“Of course, they’re not going to be Spanish speaking or fluent, but at least they can connect with a patient,” said De Aza. With just a minimal level of Spanish, providers can understand what’s bothering the patient, what kind of care they need, and how to provide that care in a way that respects their culture and desire for treatment. 
At Baptist Community Health Services, about one-third of patients are Spanish speaking. But at the organization’s call center, only a handful of staff members are bilingual. 
“We would have to either put [patients] on hold and see if someone is available to speak to them, or tell them to call back somehow,” said Nancy Tardy, the director of the call center.
Because the call center serves as the main entry point of care for the Richmond, Virginia health center, these patients were at risk of not getting medical attention. They might not call back, or even hang up out of frustration.
A solution came in the form of an education session: the Medical Spanish session offered by the nonprofit group The MAVEN project. Through funding from Direct Relief, they provide educational services to physicians caring for underserved patients. This particular session was designed to help non-Spanish-speaking providers communicate clearly and effectively with Latino patients.
Providers learned key phrases and medical terms in Spanish, and culturally appropriate ways to provide care.
“They learned the basics on how to greet the patient, how to take the message and how to book the appointment,” said Tardy of her staff members who attended the session.
According to Tamara Ríos, who presented the Medical Spanish session, being bilingual in a patient’s language is not a requirement for providing culturally competent care. Instead, her education sessions focus on the basics.
“We certainly would never state that you will be fluent after taking any of our classes because that’s not realistic, but we do present concepts in a way that you can apply immediately in the medical setting, so it’s a correct, but simple Spanish,” she said. 
For example, Ríos teaches providers to use “key power verbs” which can be used to quickly give patients advice or recommendations. “So an example would be ‘necesita,’ [which means] ‘you need to,’ and then you can add on the infinitive,” she explained.
For Tardy’s staff, knowing this level of Spanish has made the difference between patients hanging up and patients getting care. “This class was like a blessing,” said Tardy. 
But providing culturally competent care is not just about language. Providers must also understand differences in communication styles, along with important cultural beliefs and practices. 
“There are different views of what causes disease and different views of what you can do when you are sick,” explained Dr. Gregory Juckett, a former professor at the West Virginia University School of Medicine and researcher specializing in culturally competent care for Latino populations. 
Some beliefs held by Latin American communities counter those held by standard Western physicians, Juckett said. For example, it is common for illnesses to be considered either hot or cold conditions.
Juckett gave the example of high blood pressure, which some think of as a hot condition that should be treated with a cooling remedy, such as lemon tea.  
At times, this view of disease can impede on the successful treatment of a patient, Juckett explained: “Basically you’re dealing with two different worldviews and sometimes these worldviews conflict with each other.” 
He has had mothers refuse vitamins for their children who have fever or illness “because vitamins are considered a hot therapy and therefore it wouldn’t make sense to use vitamins, something hot, to treat something that’s hot.”  
However, most of the time these traditional treatments can be used in tandem with Western medications or lifestyle changes, said Juckett. With some patients who have moderately high blood pressure, he will pair a culturally appropriate therapy with diet and exercise for a three-month period and monitor the patient’s condition.
If the patient improves, so much the better. If not, he negotiates: “We try to accomplish a compromise where we hopefully take some of both worlds and use them together.” 
This approach is common among many of the providers interviewed for this story, including Dr. Marianny De Aza from Health Brigade in Richmond, Virginia. De Aza is a Native Spanish speaker from the Dominican Republic and manager of the Health Brigade’s medical clinic. 
“The whole agency is bilingual because of the need of the bilingual staff to help with the Spanish-speaking patients,” who account for 80% of the clinic population, she said.
De Aza said she often encounters cultural beliefs that conflict with the treatment she has prescribed. “I have a lot of patients telling me ‘I’m not diabetic’…or ‘I don’t want to take Metformin,’” she said, referring to a treatment for diabetes. One of her patients used cold chocolate to manage her high blood pressure, rather than the medication she was prescribed. 
“I do not tell them [their therapies are] not going to help them. I just explain to them that there has been a lot of studies that have proven that if we help you with this type of medication, in the long term, the quality of life is going to be better,” said De Aza. 
As a Latina raised in the Dominican Republic, De Aza understands her patients’ perspective. “A lot of us have been raised by our abuelita giving us remedies and they cure us, they work,” she said.
This kind of understanding is key to developing trust with patients and helping them attain better health. In her sessions, Ríos encourages providers to ask questions that acknowledge traditional healers and therapies.
When asking about their health history, for example, providers can ask patients, ‘‘’Have you seen any other provider, yerbero, doctor, santero, curandero?’” she explained. “That way it signals to us, ‘Okay, everyone is on the same team.’” 
In addition, Ríos educates providers on differences in communication styles and expectations. It all begins with the introduction.
She explained that, while it’s typical in the U.S. for providers to skip over pleasantries and get right to the medicine, this can feel abrupt for patients accustomed to receiving care in Latin America. Instead, Ríos encourages providers to ask patients their names, ensure they are pronouncing them correctly, and always ask about their family. 
“Family is very much involved in the decision-making process of anything…particularly with the health of the patient,” said Ríos. This warm welcome adds a personal touch to the visit, or “a little version of ‘personalismo,’” that can ultimately determine the care a patient will accept and receive. 
At Health Brigade in Virginia, De Aza is working with her non-Spanish-speaking staff to help them better understand their patients. She’s been using the slides from the MAVEN Medical Project session to teach basic terms and phrases, such as “me duele” (“it hurts”) or “cabeza” (“head”), and add the personal touch Ríos describes.  
“Of course, they’re not going to be Spanish speaking or fluent, but at least they can connect with a patient,” said De Aza. With just a minimal level of Spanish, providers can understand what’s bothering the patient, what kind of care they need, and how to provide that care in a way that respects their culture and desire for treatment. 
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