El doctor lo vera ahora (The doctor will see you now)

By Michaela Gibson Morris

Daily Journal

It's hard enough being sick. Imagine not being able to communicate well with the doctor, not understanding how to fill out basic forms or how the bill will get paid.

For newly arrived Latinos who are still trying to learn English and Northeast Mississippi culture, navigating the health care system can be an extremely frustrating exercise.

“It's frightening to be sick in another country É you feel bad and you don't know how to access the system,” said Penny Sisson, an Oxford Spanish teacher and deacon in charge of the Hispanic health ministry at St. Peter's Episcopal Church.

Clinics around Northeast Mississippi reported they are seeing big increases in the number of Latino patients, but not as many as they would expect to see given the growth in the area.

“We're seeing the tip of the iceberg,” said Dr. Erik Dukes, a Booneville family physician, who speaks some Spanish.

Health care providers around Northeast Mississippi are working to address the needs of the rapidly expanding Latino community, who primarily hail from Mexico, but also come from other Central and South American countries such as Guatemala, San Salvador and Honduras.

Forms and brochures have been translated into Spanish. Many hospitals and clinics have invested in resources – people and technology – so translators are available in person or by phone. They have used their own resources and those of area community colleges to expose nurses and office workers to Spanish, too.

“It's actually changed the way we deliver services,” said Charlotte West, director of North Mississippi Medical Center's Work Link, which offers on-site health services to area companies.

All the difference

Having a doctor that speaks Spanish makes all the difference in the world, said Chris Fonseca, who with his wife Nidia moved to New Albany from Mexico about four years ago.

“For me it was wonderful,” Fonseca said. “I understand English pretty well, but my wife doesn't understand as well. (Because family physician Dr. Jason Dees speaks Spanish) she can understand and ask questions.”

Otherwise, she has to rely on him to translate, Fonseca said.

Information overload

A visit to the doctor can be so information heavy that health care providers worry about native English speakers grasping all the instructions.

When English is a second language, it can be especially difficult for doctors and patients to communicate, said Cuqui Hopson, who translates for patients at North Mississippi Medical Center and private clinics.

“They think they understand, but it's hard for them to comprehend everything,” said Hopson, a native of Puerto Rico who has lived in Tupelo and Memphis for nearly 40 years.

Communication is an essential part of making a good diagnosis, Dukes said.

“I'm not great (at speaking Spanish), but it makes a big difference,” Dukes said. “It improves their comfort level. They're more likely to tell me the whole story.”

Once they connect with a Spanish-speaking doctor, the patients tend to spread the word among friends and family, doctors said.

Dr. Mirko Villanueva, a Calhoun City physician, has patients driving from Vardaman, Bruce and Houston.

“I think they'd rather drive an extra 10 minutes to see someone who understands them better,” said Villanueva, a native of Peru. “I know I would.”

Cultural cues

While language is a central hurdle, it isn't the only bridge health care providers are trying to build to reach the growing Latino community.

Some barriers are cultural. Seemingly simple things like making and keeping a doctor's appointment, navigating over-the-counter drugs and the basics of health insurance have to be learned.

“Deductibles to them is French,” Hopson said.

Depending on where newly arrived Latinos come from, their expectations of what the health care system should provide can vary widely.

In Mexico, there are state-run hospitals and clinics, where there are long waits, but care is available, Hopson said.

In Ecuador, many rural villages have no access to health care at all, Dees said. Except for missions and state-run hospitals, health care providers don't have to take patients who can't pay, even if it is an emergency.

Some health care providers are also concerned that worries over immigration status are keeping some people away from health care.

“They fear any kind of contact with (hospitals) because it might link them to the government,” Dees said. “That's not the case; we just want to take care of the patient.”

In other ways, longtime Mississippians and newly arrived Latinos share similar problems when it comes to their health and access to care.

Many don't seek health care until they feel sick; preventive care takes a back seat, and they worry about how they are going to pay for health care.

Preventive care

Studies have show that Latinos are not focused on preventive care, Villanueva said. His personal experience in Calhoun City backs that up.

“Most of the time, the first contact is in the ER,” he said.

Fortunately, once they connect with a physician that can speak Spanish, they will usually spread the word among family and friends about the clinic, which is a less expensive, more efficient way to treat acute and chronic illnesses.

“It's like a snowball effect,” Villanueva said.

Northeast Mississippi doctors say most of their Latino patients come in with acute conditions – usually on-the-job injuries or acute illnesses like sore throats and childhood diseases.

Part of the effect can be attributed to the relative youth and health of Mississippi's Latino population, doctors said.

Until Nidia and Chris Fonseca of New Albany were anticipating the arrival of now 10-month-old Lizbeth, neither of the young, healthy Fonsecas had seen a doctor.

Preventive care, however, can be vitally important, especially as people age.

Just like Mississippians, Latinos are at high risk for developing high blood pressure, diabetes and high cholesterol, which can contribute to a number of life-threatening health problems.

“They're not that much different from the population they're in as far as health risks,” Dukes said.

But routine health screening is especially important for picking up those chronic conditions.

“Most of the time, they don't have any symptoms,” Villanueva said.

Where's the money

High costs complicate access for both acute and preventive health care for many Latinos, as well as native Mississippians.

“Most of the time, they are self-pay. A lot of them don't have insurance,” Villanueva said. “That makes it difficult.”

Tupelo dentist Dr. Harry Rayburn, whose mother immigrated from Mexico in 1969, said he sees a lot of patients weighing their own health care needs against the needs of their family at home.

“They send as much money home as they can,” Rayburn said. “If it costs $100 to get a tooth pulled, that's money they can't send.”

Common ground

Although it's very important for Latinos to learn English so they can fully join the Northeast Mississippi community, it is equally important, especially for health care providers, to meet them where they are, doctors say.

“We both need to find some common ground,” said Dees, who practices in New Albany. “In the rest of the world, (the ability to speak)) two languages is almost expected.”

A willingness to speak Spanish, even if it's not perfect, can go a long way and help Latinos feel more comfortable using their budding English skills.

“Often people with limited English are embarrassed or scared to use it because they are worried they will say something wrong,” Dees said.

Reaching out

Connecting the Latino community with resources and health care education has proven difficult.

“We've got to do a better job of communicating with the Hispanic community,” Dees said.

Because many Latinos have limited English skills, the traditional forms of communicating with the public – newspapers, radio, television – aren't necessarily effective. Word of mouth seems to be the primary mode of mass communication.

“We have to find new ways of communicating,” Dees said.

Dees took Spanish-language flyers out to local plants and met with plant managers to talk about referrals for their Latino workers.

The problem won't get any easier to solve.

“It will be easier to reach those people now, while the population is still small,” Villanueva said.