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My parents spent more than 40 years in this country; they never felt compelled to learn English. Sometimes I feel that my parents had children in order to have translation services. I should be grateful to the monolingual staff at the DMV who would roll her eyes at my father’s gasping attempts at broken English – otherwise I would not be here today. The other reason why I am grateful is because I had a holiday any time my parents had a doctor’s appointment.

I was far too truthful, in the sense that I would not cover for my parents. In the eyes of America, my parents had no explanation as to why their cholesterol levels were higher than the Gross National Product. In reality, my mother used so much lard that it would eclipse what the food she was cooking was originally supposed to taste like. My father was told that he needed to watch his weight, so naturally he switched over to Bud Light. He had me tell the doctor that he never touched a drop of alcohol — unless it was a social event. (For the record, asking me what Dodger score was on a Friday night totally counted as a social event.)

Consequently, my sister became the official family translator from childhood to adulthood. She would drive my parents to their medical appointments, and sorted through their medical prescriptions. One time, my sister did not want to tell my father he needed a prostate exam. She knew that he was not going to cooperate, so she helped him change into his hospital gown, started holding his hand and did not let go. Then he felt a discomfort he was unfamiliar with. My father always recalled the story with all the anger and remorse of a man who had bitten off more than he could chew. He would never forgive my sister, as if she put the doctor up to it.

My father was a wooden man who worked so hard he could give a donkey an inferiority complex. He never got to enjoy his retirement, because as soon as he stopped working he was diagnosed with renal failure, which in turn became dialysis treatments three times a week. My sister was there with him as he argued with doctors and rejected their advice. He would eventually follow their advice, but I think it made him feel better to send them to hell. It was disheartening to watch the downward spiral, as hospital stays grew longer and longer and came in shorter intervals.

It was inspiring in a kind of way you know you should not be inspiring, but it fills your heart with courage. Throughout the grimace-inducing pain, memory lapses and countless needles, my father still had the time and energy to comment about the nurse’s physical attributes. The nurses always wanted to know what he was saying, but that was something we kept to ourselves, because the meaning was bound to get lost in translation.

[Image Courtesy Stethoscopes]

By Christine Granados

Six years ago, my ob-gyn found two millimeters of cancerous cells on my cervix and told me that my uterus should be removed as a precaution. I steeled my nerves and decided I would not have the procedure. I was 38 years old. I wanted to keep my uterus, keep my body whole, keep all of my spirit. I’m not sure where this idea came from. I’d never considered myself a deeply spiritual or religious person. (Perhaps agnostic theist is the best term to describe my beliefs.)

As I pondered my response, I recalled my interview, years earlier, with Dr. David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the University of California at Los Angeles. He told me that the Latino population’s medical needs were different from the Anglo population’s, citing attitudes toward heart transplants as an example.

“Hispanics believe, as did the pre-Columbian Nahua Indians, that the soul resides in the heart, and wonder whether a heart transplant recipient could become a different person after the operation,” he said.

I found it ridiculous at the time. But my experience with cancer—I was diagnosed with Stage 1A micro-invasive cervical cancer in 2005—has changed my mind. Today, with good reason, health care providers and researchers talk about the importance of cultural competency, the concept that the prevention and treatment of diseases are affected by the culture, gender, race and ethnicity of patients. In short, belief systems affect people’s attitudes toward disease and treatment, and to be effective, health care professionals have to understand these differences.

I have prided myself on being an atypical Mexican-American, defying the statistics. I’m not Catholic, I am educated, and I get annual health screenings. Yet I decided that if the heart holds the soul, then my uterus held the magic of life—and as a woman I wouldn’t be whole without it.

But there was more to my feelings than wanting to be “whole.” Cervical cancer is caused by the human papillomavirus (HPV), which is transmitted through sexual activity. It’s the most common sexually transmitted infection in the country, and, with regular screening and early treatment, the most preventable female cancer.

I imagined facing the judgment of my family and friends for my condition, like Hester Prynne in The Scarlet Letter, and it scared me, though there was no basis for my fear. I had grown up in El Paso on the border with Mexico, but unlike many of my Catholic friends’ mothers, my mother encouraged me to leave home and live with a man before I committed to marriage. She talked to me about sex and introduced me to birth control in my early teens. Still, after my diagnosis I recalled my five relationships, chastising myself for being sexually active before marriage. I didn’t want my husband or father to think poorly of me. Perhaps a subconscious reason for wanting to keep my uterus was to punish myself by holding the disease inside me.

The embarrassment and difficulty in talking about sexuality and reproductive health are part of the reason Latinas are not getting these life-saving screenings, according to studies by the Centers for Disease Control and Prevention (CDC) and other health organizations. Lack of health insurance remains the major barrier to receiving early cancer diagnosis and treatment for many women. I was not a member of the uninsured, but I was part of a cultural statistic. Like many Latinas, I was ashamed to share sexual information with health care workers.

This mindset, coupled with the lack of health insurance, keeps cervical cancer and mortality rates among Latinas in Texas and the U.S. higher than those for Anglo women, according to the CDC. Three of every 100,000 Latinas diagnosed with cervical cancer in the U.S. die from the disease, compared to two of every 100,000 Anglo women. The highest mortality rate is for black women, at 4.3 per 100,000 women, even though black women have high rates of screening for the disease. Eighty-one percent of black women are screened for cervical cancer, compared to 82 percent of white women and 76 percent of Latinas, according to Usha R. Ranji, Associate Director of Women’s Health Policy at the Kaiser Family Foundation.

In communities along the U.S. side of the border with Mexico, cervical cancer mortality rates for Mexican-American women are almost identical to national rates among black women. A study by Dr. Theresa Byrd, co-authored with Drs. Katherine Wilson and Rafaelita Chavez in the journal Ethnicity & Disease in 2007, found the mortality rate from cervical cancer in El Paso County was 4.2 per 100,000 Latinas. According to the study, “Hispanic women have a lower rate of participation in cervical cancer screening programs than other women.”

The same can be said of breast cancer screenings, the most common cancer diagnosis and the second-leading cause of death among Latinas. Heart disease is the No. 1 killer. Colorectal and lung cancer are the second and third most common cancer diagnoses, while cervical cancer ranks seventh. Though cervical cancer is not the leading cause of death among Latinas, health officials say it is the most frustrating because, as with colorectal cancer, “you can find early changes before they are cancer,” Byrd said.

“So there are cancers where screening can be either for early detection or for prevention.”

Byrd’s study was used to develop educational information targeting Mexican-American women along the U.S. border. The result was the AMIGAS project, created in 2004 to help reduce cervical cancer rates among Latinas. The program has since expanded to El Paso, Houston and Washington state’s Yakima valley. Community health workers called Promotoras de Salud (Promoters of Health) fan out in neighborhoods with a DVD, flip charts, and games. The program is part of a broader effort by the CDC to increase cervical cancer screenings for all women to 93 percent by 2020.

The program helps women put themselves first by stressing their importance to their families. “We stress in the video that we don’t [get Pap tests, which detect the presence of cancerous cells] for us, but for our family, because what would our family do without us,” Byrd said, explaining the program’s approach.

How health care providers get the word out is one of the most important factors in reaching a community, said Dr. Wilson. A large part of educating Mexican-Americans, the largest Latino population in the country, lies in who delivers the message. “The community health worker programs have been alive since the 1960s,” said Dr. Wilson. “The health worker acts as a bridge [between the patient and doctor].”

The promotoras have lists of low-cost and free resources for cancer screening and early-detection programs. The video opens with two young women from El Paso talking in Spanish about the dates they are about to go on. The conversation progresses to birth control. One of the young women, Alyssa, invites her mother, who is a promotora, to explain why a Pap test is important. Alyssa’s grandmother overhears the conversation and joins the intergenerational discussion. The video also highlights issues that CDC researchers found were barriers to screening, such as lack of insurance and misinformation.

The program also addresses embarrassment about going to the doctor. “For all women, Pap tests are embarrassing and unpleasant,” Byrd said. “Hispanic women, especially young women, have the added problem of not wanting everyone to think they’re having sex.”

Not wanting to talk about my sexual history initially led me to reject having a hysterectomy. But I changed my mind, stunned back to reality by the fact that Latinas have a rate of invasive cervical cancer that is twice as high as that of Anglo women.

I consented to having my uterus removed. But I toyed with the idea of keeping it after surgery, as I continued to grapple with what it meant to me.

I settled on merely seeing it. Looking at it in the hospital pathology lab a few hours after my surgery, I realized that it didn’t define me. I was still whole. I had learned something about myself through my experience with cervical cancer. My belief system was not so different from that of the border community where I was raised, and the thousands of Latinas I hope the AMIGAS program can save.

Christine Granados is a mother, wife and writer, although not always in that order. Her writings have appeared in anthologies, journals, magazines and newspapers. She teaches at the University of Houston-Victoria.

[Photo By Doug McIntosh]

[Editor's Note: The following comes courtesy SEIU.]

By Dr. L. Toni Lewis

Medicaid covers one of every two Latino children across this country, and one of every four adults. It is the lifeline that ensures both the youngest and eldest members of Latino communities are able to see a doctor, instead of being forced to rely on emergency room care.

Sadly, secure, quality healthcare coverage has long been out of reach for many Latino families who work hard but simply cannot afford the skyrocketing cost of healthcare. A new report released by the National Council of La Raza and Families USA underscores what physicians, nurses and healthcare workers have witnessed with growing concern:

If Republican plans to gut Medicaid and take away the benefits of the Affordable Care Act become reality, millions of Americans will be harmed — but the harm to Latino communities would be exponentially greater.

By Marlen Castañeda, Pharmacy Technician in McKinney, Texas

I am a certified, registered pharmacy technician. A pharmacy tech works alongside a pharmacist and assists in typing and filling prescriptions. We can do almost everything a pharmacist does — except counsel patients. Counseling is very important in the pharmacy because it covers so much information in such little time.

When a patient arrives at a pharmacy they are greeted by me, a tech. I am usually the one to type the labels on their prescriptions. Being that I am bilingual, I sometimes type the instructions in Spanish at the patient’s and doctor’s request. The problem with this, though, is that sometimes the tech who is typing the script doesn’t speak, read or write Spanish, so the directions are written incorrectly.

The pharmacist is required to verify everything the tech does with a prescription before it leaves the pharmacy so that he/she can catch any mistakes, such as dosage, strength, etc. These common mistakes are usually corrected at this point wjem filling a prescription.

However, when a prescription is being translated from English to Spanish, it is difficult if a pharmacist isn’t bilingual, because he/she is unable to catch simple mistakes. So, even if a pharmacist does their job in verifying a prescription, errors can slip by unnoticed.  We can’t always rely on the computers to auto-translate because that’s when mistakes occur.

The most important and simplest way to avoid any dangerous mistakes and to verify that the patient knows how to take the medicine as prescribed by their doctor is by allowing the pharmacist to counsel you. Most patients decline the counsel and walk away confident they know what to take and how — and that’s not always the case. Usually a doctor explains to the patient how to take their medications. Then, when the patient leaves the pharmacy, they walk away feeling confident in what they are taking and how.

A pharmacist counseling a patient not only repeats those instructions, but goes into further detail, also advising against allergies, side effects, interactions etc. In other words, things that the doctor may not have gone over with the patient. So I advise that all patients accept pharmacy counsel, request someone to translate for them, and ask questions. Especially for those patients receiving new prescriptions and those who speak English as a second language.

It takes 2 minutes of their time and may save their life and prevent any life-threatening mistakes. Not all patients have the luxury of having their adult children check medications for them. Not all patients have a doctor who carefully monitors their medications —  at least not as closely as their pharmacist typically would.

I also recommend that patients fill all their medications at one single pharmacy — always. This allows the pharmacist to know all the medications one patient takes at any given time. Allowing him/her to monitor for interactions and other potential problems. When patients fill at several pharmacies, it is difficult for one pharmacist to know what medications patients are taking. Even the over-the-counter (OTC) medications that seem harmless might present a risk, which brings me to my next point, never hesitate to ask your pharmacist about those medications that are OTC. They can always provide valuable information that your doctor may overlook.

People today are too casual towards prescriptions, and that’s always a dangerous attitude. Medications can save and and help make our lives more fulfilling, but with this casual attitude, they can also be deadly.

[Photo By e-MagineArt]