cambio de colores (change of colors)
latinos in missouri: neighbors in urban and rural communities

march 12-14, 2003
university of missouri-kansas city

Health Care Panel

By Rebecca Rivas
A report contributed by

Moderator:
William Chignoli, Ph.D., Director, La Clínica

From the finest hospitals to the rural clinics, problems in Missouri�s health care share the same color of gray. In Kansas City, the city with the most established Latino population, the medical field struggles with same issues of translations and cultural competency that Milan and Sedalia medics do with their new Latino populations.

In the Health Care panel discussion on Wednesday, March 12, the six panelists offered information from their areas of expertise to answer many of the shared questions of caring for the Latino population.�

Joy Williams, chief of the state Minority Health Department:

Preparing health care systems for Latino populations requires more than a notion, she said. Currently we have small staffs to deal with large populations. Lack of access to publicly funded care stretches across ethnic barriers. However, cultural competency makes a difference. On average, an interpreter makes 31 mistakes at a patient visit.

The emergency rooms are feeling the pressure of Hispanics lack of primary care. �Hospitals are saying, �Ouch, we can�t afford to do it this way.��
The health department started taking care of pregnant women first because �those babies are ours,� she said.

Harold Kirby, Rural Health and Primary Care, department of Health and Senior Services:

The community health center program is designed to intervene with primary care. The state has 17 centers and 70 delivery sites in the state. The two newest centers are in Pinewood and Milan. Because of their large Latino populations, they are both now federally funded, which is the hope for every center.

Kay Libbus, Professor at University of Missouri � Columbia, Sinclair School of Nursing:

About 66 percent of Latinos have some insurance, compared to 84 percent of African Americans and 86 percent of Anglos. Latinos have the highest risk of diabetes, obesity, and undiagnosed tuberculosis. They also have the highest rate of child and adolescent depression. In prenatal health care, the women have the lowest number of C-sections, lowest usage of smoking, low incidence of low weight birth and prematurity, and the highest birth rates.

With these statistics, Libbus said, we need to think globally and act locally. We need to ask the women what they need and recognize health practices that more traditional or cultural so as not to alienate them.

Manuel Navarro, of Boone Hospital Center, Assessment of Federal and State Law: Regulations and Practices:

Navarro focused on how BooneHospitalCenter in Columbia implements the regulations of the Limited English Proficiency (LEP) and 1964 Civil Rights Act Title VI. It wasn�t until 2000 that the government revisited the civil rights act to ensure that all federally funded agencies provide translation to non-English speakers. Now there are guidelines to push this mandate. There are some reasonable steps that we can take to provide meaningful access to translation:

1)     Assessment of language needs

2)      Written policy on language access � oral and written

3)      Method for notifying LEP individuals about their rights

The guidelines for compliance are as follows: If either 10 percent of the population or 3,000 people who visit a federally funded hospital or medical center is non-English speaking, the agency must provide translated most materials including all vital documents. If it�s 5 percent or 1,000 people, the agency must translate vital documents and the other documents can be orally translated. If there are fewer than 100 people, the agency does not have to provide written translated materials and can have notification of translator for materials.

Vital documents include applications, consent forms, letters containing eligibility information, notices of reduction or denial of care, and enrollment handbooks. Oral interpreters must be competent but no certification is required. No use of friends, family without the consent of the patient. It should be a written consent to show the patient denied interpreters� services. Minor children cannot be used at any time.

Navarro stressed the importance of educating health care providers on the logistics. Currently in legislation is SB0023, which establishes �Missouri Universal Health Assurance Program� to provide health care benefits to all Missouri citizens.

David Moskowitz, MD FACP Medicine

There is a possible prevention technique that involves looking at the genetic code of patients with diabetes. Latinos get diabetes on average one decade before African Americans. By studying the genetics, Moskowitz believes doctors can detect diabetes before it gets too detrimental. His in-depth, scientific presentation is posted on the Cambio De Colores website.�