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Kansas City, MO – Some major changes are coming to the U.S. health care system. For one, the health care overhaul passed by congress this year is supposed to expand coverage. But for immigrants trying to access health care in Kansas City and around the country, big obstacles remain.
Ocean-themed murals cover several walls at children's mercy's pediatric center in Kansas City. The place is also filled with bilingual signs. Nowadays, about one in three patient visits to the hospital involves families who primarily speak another language - most commonly it's Spanish.
Isela Cruz is here with her two year old son Esteban, who has an eye infection. Cruz says it can be scary going to a doctor who doesn't speak your language. That happened when she had some pregnancy complications. Cruz also says the U.S. system is totally different from where she came from.
"[translated from Spanish] Here, when you arrive at the doctor, they don't do tests right away, or analyze you on everything," says Cruz. "When you go to Mexico they do."
Dr. John Cowden meets with Cruz and her son this morning. Dr. Cowden is fluent in Spanish and has been working to make the hospital more accessible to immigrants, especially those who don't speak English very well. He says doctors need to be more aware of cultural differences for the safety of their patients.
"Just basic assumptions of quality, about understanding the medicine you're supposed to take and why, are things we take for granted as physicians when we tell the family, 'here's your medicine'...and that's dangerous."
Dr. Cowden's helped spearhead an expansion of the hospital's language services program. But he says just translating is not enough. He recalls a time when he was treating the child of an Iraqi family. He says their daughter was sick and needed a feeding tube placed in her stomach. The family wasn't interested. But Dr. Cowden says it wasn't because they didn't understand what he was saying.
"The idea of putting the tube into the body in the way we were talking about simply didn't fit in the family's understanding of the integrity of her body," says Dr. Cowden. "And once we were able to talk about that, we were able to break through and understand that on a larger scale, we could see the health of her in a different way than their assumptions and my assumptions held."
Just a few blocks east of the children's hospital, Truman Medical Center is dealing with similar issues. Gaby Flores is head of interpreter services. Along with coordinating about two dozen interpreters, she says she spends a lot of time training clinical staff about how the U.S. health care system can seem alien to someone not originally from here.
"In the United States, we've been taught from young age, to ask a lot of question," says Flores. "Informed consent is not a concept known throughout the world. It's very American. If I was that same patient in Guatemala, I would never challenge or ask questions to my physician. He's the doc, he should be telling me what I need to know, I shouldn't be asking questions."
Hospitals across the U.S. are increasingly recognizing the role that language and culture play in helping people get the care they need. The nation's main hospital accreditation agency, the Join Commission, recently issued new standards regarding language and culture that take effect this January.
Mara Youdelman is senior attorney with the national health law program. She says language services are becoming more available, but there are still a lot of gaps.
"There has been a growing awareness by health care providers to meet the need of an increasingly diverse patient population," says Youdelman. "But unfortunately, providing competent language services has been something that's a long time coming in many parts of the country."
Youdelman says a poorly qualified interpreter can jeopardize a patients' care. Federal law does require health care providers who accept tax dollars to provide competent language services, but the mandate has no funding.
Efforts are underway to develop a national certification system for interpreters. And, the federal health legislation that President Obama recently signed includes some new provisions to address language and cultural issues. It also requires the Department of Health and Human Services to collect data on race, ethnicity and language. Youdelman says that's a good thing.
"The importance of data collection is critical in helping providers identify which of their patients will need language services so they can appropriately plan and not wait until a patient walks through the door and scramble to find a way to communicate with that patient," says Youdelman.
The new law also includes language requiring that some insurance and public information documents be language-appropriate and 'culturally competent.' Youdelman says this is a good first step for immigrants, but how it plays out remains to be seen as officials implement the law over the coming months and years.
Funding for health care coverage on KCUR has been provided by the Health Care Foundation of Greater Kansas City.
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