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Hispanic Patients: The Communication Challenge
By Miki Fairley  You're a new amputee, about to be
fitted for your first prosthesis. You're a bit nervous and
apprehensive, even though some of your family has accompanied you
to the prosthetic facility. Spanish is your first language, and the
English you know seems to be rapidly deserting your mind as you
face this somewhat intimidating experience. The prosthetist comes
through the door--and speaks to you in fluent Spanish. How
reassuring! At once, you're relaxed and much more
confident.
This is the experience of many Spanish-speaking patients as
prosthetic and orthotic providers, who are mostly non-Hispanic,
increase their efforts to serve this growing segment of the US
population.
The nation's Hispanic population has been growing much faster
than the population as a whole, increasing from 35.3 million on
April 1, 2000, to 38.8 million on July 1, 2002, according to US
Census Bureau estimates. "The official population estimates now
indicate that the Hispanic community is the nation's largest
minority community," said Census Bureau Director Louis Kincannon in
an address to the League of United Latin American Citizens (LULAC)
convention in Lake Buena Vista, Florida, in June. "This is an
important event in this country--an event that we know is the
result of the growth of a vibrant and diverse population that is
vital to America's future."
New Census Bureau population estimates show that the Hispanic
population grew 9.8 percent between April 1, 2000, and July 1,
2002. The rate of growth of the population as a whole was 2.5
percent.
Cultural Immersion Helps Texan
Caring for a Spanish-speaking patient population has come easily
to John W. Fain II, CPO, chief executive officer,
Medical Center Brace & Limb Inc., Houston, Texas. Fain has had
almost a lifelong passion for Spanish culture and the Spanish
language. "I even dream in Spanish," he says. Fain studied Spanish
in junior high and high school, including several years at an East
Coast prep school, and throughout his four years at Southern
Methodist University (SMU), Dallas. Two of Fain's sisters had lived
with a non-English-speaking family in Spain for awhile, and Fain,
the youngest of eight children, later did likewise. Immersing
himself in the language that way helped make it second nature for
him. One of his college majors was Ibero-American studies, which
deepened his understanding and appreciation for Hispanic peoples
and culture.
In his work, "I use my Spanish every day," Fain says. He
frequently is asked to translate for physicians and therapists.
"I'm a 6'4" blond gringo," he continues, "and when I walk in and
surprise people by speaking Spanish, I'm usually met with smiles
and warm expressions of thanks." Patients and families relax and
"open up" when they hear their own language, he notes. Sometimes he
doesn't reveal immediately that he understands Spanish, so when a
patient or family member makes comments, such as "He won't have the
leg ready in time," or "He's really tall," he elicits surprise and
giggles when he suddenly chimes into the conversation in Spanish.
Spanish-speaking friends often call him "Juanito" or "Rubio"
("Blond").
Houston has a large Spanish-speaking population, and the staff
at Fain's company all speak Spanish at some level; several are
fluent. Printed informational materials are available in both
Spanish and English. Fain also treats patients at the renowned TIRR
rehabilitation hospital and a prison population in two state
clinics and a large federal prison in the Houston area, and has
found that his language skills are useful in these settings
too.
As far as cultural differences, Fain sees more differences in
"haves" and "have-nots," such as low-income families in the Houston
area and wealthy Latin Americans who fly to the States for medical
care--money no object--than between various countries of
origin.
Shriners Hospitals
The Orthotics and Prosthetics Department at Shriners Hospital in
St. Louis, Missouri, also sees many children from Spanish-speaking
families, according to Eddy Leopoldo Fuentes, CPO.
The hospital covers areas of Missouri, Illinois, Kentucky,
Tennessee, Arkansas, Iowa, Kansas, and Oklahoma. The number of
Spanish-speaking patients has been increasing, especially from
Kansas, Fuentes says.
Although many of the children speak English well, most of the
consent forms must be signed by the parents, Fuentes notes.
"Explanations of surgical procedures, post-op care, orthotics,
prosthetics, and other relevant information have to be given to the
person who is responsible for the child," Fuentes explains. "And
many of them speak very little English, or none at all."
Fuentes, who is bilingual, assists the medical staff and other
coworkers with translations when needed. Also, non-English-speaking
patients are encouraged to bring a translator with them, he notes.
"If they cannot provide one, the hospital, through the Family
Services department, makes arrangements to help." A 12-week course,
"Medical Spanish for Healthcare Providers," is also offered. The
course, which involves two hours a week, is an intermediate-level
course requiring students to have taken Spanish classes in high
school or college. Instructional documents and forms for patients
are available in Spanish.
Steve Baxter, CO, LO, director, Orthotics
Department, Shriners Hospital, Houston, finds the language barrier
more formidable. Originally from Cleveland, Ohio, Baxter, like many
others, took two years of Spanish in high school--25 years ago.
"That apparently did not help me when I came here five and a half
years ago," he says. Rescue has come in the form of a bilingual
Hispanic office manager who "over the years has tried to teach
myself and two other practitioners enough Spanish to be able to
communicate somewhat with our patients. Mostly she will
translate--but with three practitioners, the phone, and handling
our reception desk, she can't be everywhere--so we've had to learn
some Spanish!"
More help arrived when an orthotist, who is originally from
Mexico but received his orthotic training in Minnesota, joined the
staff. "He has been a great asset in battling the language
barrier," says Baxter.
Spanish fluency has been vital to the Shriners Orthotics
Department, since a large percentage of the hospital's child
patients are Hispanic. They come from the Houston area, other parts
of Texas, plus northern and central Mexico. An outreach clinic is
held several times a year in La Feria, Texas, about four miles from
the Mexican border. "Very few of these 250 patients speak any
English," Baxter says.
Practitioners Share Experience, Insight
"Our staff was primarily Spanish-speaking because our patient
base was also primarily Spanish," says Robert A "Bob"
Bangham, CO, LO, who was working at Park Prosthetics &
Orthotics Inc., Corpus Christi, Texas, at the time this article was
researched. "Our city's Spanish population is the majority; we
Anglos' are the minority."
Bangham started a new program for the company, "Diabetic Shoes,"
since he learned that the south Texas population has twice the rate
of diabetes as the rest of the US. "We were experiencing so many
diabetic patients that we could hardly begin to keep up with them,"
Bangham says. Since the majority were Hispanic and many did not
speak English, Bangham was training a Spanish-speaking pedorthic
staff to help handle the volume of work.
Ellie Boomer, an orthotic resident at Mary Free
Bed Rehabilitation Center Orthotics and Prosthetics, Grand Rapids,
Michigan, at the time this article was being researched (she's now
staff orthotist), found to her surprise that the facility sees
quite a few Hispanic patients. "I am always thankful for my four
years of high-school Spanish that I suffered through," she says.
Another aid is a small English-to-Spanish electronic translator
that she bought at a local store.
"I have seen an increase in the number of Hispanic patients
here, primarily due to our location in southwest Florida," says
Steven Fries, CPO, Cardinal Prosthetics &
Orthotics, Fort Myers. "There are a lot of migrant workers and
immigrants employed in unskilled labor positions who have proven
themselves to be quite dependable and industrious."
The two biggest challenges his firm faces in caring for Hispanic
patients, according to Fries, are 1) most are uninsured, and 2)
many speak little or no English. Fries has found a new tool:
"Franklin makes an electronic English-Spanish dictionary-translator
which actually speaks," he notes. "These are available at most
Radio Shacks at a very reasonable cost and serve well in
communicating with Hispanic patients who no habla Inglés.'"
Fries also comments on a helpful website, AltaVista's Babel Fish,
which converts words, phrases, and more extensive material into
other languages (www.world.altavista.com). When this reporter
tested it, longer translations can be somewhat garbled--but the
general meaning is usually clear.
There is a strong need in the O&P field for an
English/Spanish lexicon with prosthetic, orthotic, and other
rehabilitation/medical terminology included, several practitioners
have noted. An online lexicon/dictionary is now available on the
Canada member society of the International Society for Prosthetics
& Orthotics (ISPO) website (www.ispo.ca/lexicon). A Spanish addition to the
lexicon/dictionary is underway, according to Wieland Kaphingst,
Dipl-Ing, BMT, CPO, one of the authors. In some areas, continuing
education courses in Spanish are available.
Josh Ryder, CO, Island Coast Orthopedics, Cape
Coral, Florida, does not speak much Spanish, he says, although he
learned to read and converse a little when he lived in Miami
several years ago. One way Ryder has adapted his practice to the
needs of his Hispanic patients is to have a translator on staff:
his office manager is fluent in both Spanish and English. "You
should see the joy they have," says Ryder, when he thus meets their
communication needs and "shows their culture respect."
Lane Ferrin, CP, Northwest Orthotics
Prosthetics Inc., Provo, Utah, says, "I speak Portuguese and grew
up in a Latino neighborhood of Phoenix, so my Spanish is coming
along." His language skills have helped him in his practice, since
he says he has seen a great increase in the Hispanic population in
the last two-three years, "being a general trend in our area."
Eric Schwelke, CPO, has treated patients of
many nationalities in his 19 years of practicing in the New York
City area. Since quite a few have been Spanish-speaking, Schwelke
says he wishes he had studied Spanish in high school and college.
"Out of necessity, I have picked up a rudimentary vocabulary to
help communication." His company supplies manuals and patient
instructions in Spanish: "This has helped tremendously in educating
them about their new devices we provide."
Another help has been a bilingual employee to assist with
translations when needed. "It has been a challenge trying to make
appointments and such when not one of the family members speaks
English," Schwelke says. "I have often thought of taking a Spanish
course, but finding the time is hard."
Marita Dorsch-Carozza, CP, FAAOP, now of Klemmt
Orthopaedic Services, Vestal, New York, notes that in her former
Manhattan practice, Dorsch Prosthetics & Orthotics,
Spanish-speaking patients were the largest non-English-speaking
population in her practice, followed by Italian, Russian, and
Chinese-speaking clients. Dorsch-Carozza, who studied four years of
Castilian Spanish in school, says, "I speak enough Spanish to work
with patients." At hospitals, a social worker often helps with
translations when needed, but "pain is easy to pick up," she says,
as patients point to areas of pressure and pain.
Forms, instructions, and other printed materials in Spanish have
helped in communicating with patients, plus Dorsch-Carozza had
Spanish-speaking office staff for over 28 years. She also had
Spanish questionnaires that the non-Spanish-speaking staff could
use in order to communicate properly with her patients. "It is
imperative for patients to be able to express their prosthetic or
orthotic issues clearly to their practitioner," she says. "One can
never underestimate the comfort level of speaking with someone in
your native tongue."
Communication among Staff Members
Of course, not all communication difficulties and linguistic
barriers involve patients. Many patient-care centers and other
O&P-related companies have staff members whose first language
may not be English. How do business owners meet this challenge?
A problem can arise when many staff members speak the same
language, but not all. The ones not speaking the language may feel
like excluded outsiders. They may even feel that they are being
spoken about in a derogatory way--and this could actually be
happening. A recent newspaper article described a situation in a
fast-food restaurant in which workers who could speak a Native
American language were insulting workers who did not speak the
language "behind their back," as well as the English-speaking-only
owners of the business. A legal case arose.
One business in another industry solves the problem by requiring
all workers present in an area to speak a language--not necessarily
English--that everyone present understands. In other words, if the
majority speaks a non-English language and everyone understands it,
they may use it, but if someone comes in who doesn't understand the
language, they must speak in a language that person understands
also.
Hersco Orthotic Labs, Long Island City, New York, a pedorthic
central fabrication facility, has ten employees, mostly of Hispanic
and Eastern bloc origin. "We're diverse--just like New York City,"
says Séamus Kennedy, CPed, who with his
brother Cathal, bought the 65-year-old business a few years ago.
"Out of the 12 people who work here, including my brother and
myself, only two were born in America." The Kennedy brothers came
to the States from Ireland.
"I've learned a little bit of Spanish and Russian," says
Kennedy, "and it helps a feeling of goodwill and reaching out when
I try to speak it with our staff." The Kennedys make it plain to
the staff that, although communication can be a problem, "there is
no room for confusion or animosity," Séamus says. "If anyone
has a problem, they are to bring it to my brother or myself, and we
can clear it up."
Culture per se has never been a problem, Kennedy notes. "People
generally come to New York to get ahead, and they understand that
the rules' may be different here." Hersco Labs keeps rules clear
and simple: "no smoking, no drinking on the job, no fighting." The
drinking issue came up because some cultures accept it and also
some US companies accept it. "Some of our guys came from another
shoe manufacturer, who allowed them to drink on the job," Kennedy
says. "However, they understand that here it is different."
Kennedy also lets the staff know that if they fit in and do
well, they can have a secure future with the company. He points to
two staff members of Puerto Rican origin, who have been employed
for over 35 years.
Ways To Overcome Linguistic Barriers
So, how have non-Hispanic O&P practitioners been meeting the
challenge of communicating with Hispanic patients? Here are some
ways:
1) learning Spanish;
2) employing bilingual office and clinical/technical staff;
3) using bilingual or Spanish patient instructions, manuals,
brochures, and other forms;
4) using electronic translators, the Internet, or printed
translation guides to help; and
5) having a sincere respect for their language and culture, an
attitude which comes through to Hispanic patients.
Meet the Challenge: Learn the Language!
And, of course, if you are not a fluent Spanish speaker, or
fluent in another language widely used in your area, there's always
the challenge and adventure of learning a new language. Even though
adults do not usually learn a language as fast as children, and
research shows that adults actually use a different part of their
brain in learning a language than children do, it's certainly
possible. Sometimes adults, unlike most children, are
self-conscious about their grammar and pronunciation.
But go ahead--go for it! Many who have tried to learn and use
another language have found that native speakers appreciate their
efforts.
Note: The federal government treats Hispanic origin
and race as separate and distinct concepts; thus Hispanics (who
reported themselves as Hispanic, Latino, or Spanish to the Census
Bureau) can be of any race. Specific Spanish, Hispanic, or Latino
categories listed on the Census 2000 questionnaire included
Mexican, Mexican Am., Chicano, Puerto Rican, or Cuban, as well
those who indicated there are other Spanish/Hispanic/Latino.
Persons in the other category include those whose origins are from
Spain, the Spanish-speaking countries of Central and South America,
and the Dominican Republic, as well as people generally identifying
themselves as Spanish, Spanish-American, Hispanic, Hispano,
etc. 
Table Of Contents - January 2004
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