WASHINGTON Simple yet targeted efforts to improve minority patients' access to health care are growing in communities across the nation.
Often, language is the first component that needs to be addressed.
The first step in Expecting Success, a national project to reduce disparities supported by the Robert Wood Johnson Foundation, was to query patients on ethnicity and language on admission to 10 hospitals serving a large number of cardiac patients.
The results were somewhat startling: One hospital that had no interpreters, found that they were admitting 500 Spanish-speaking patients a month.
"Until you ask the question, you will not know. At that institution, they are now investing in interpreters, in translated materials, they started taking this seriously," said Dr. Bruce Siegel, director of Expecting Success and a professor of health policy at George Washington University.
In suburban Washington, Adventist Healthcare system was similarly surprised by the diversity of community it found that it serves.
"Within Washington Adventist Hospital, just one of our hospitals, we have 68 different languages spoken by our staff, serving a community with about 140 languages spoken," said Adventist Healthcare President William Robertson at a meeting that was sponsored by the Alliance of Minority Medical Associations, the National Association for Equal Opportunity in Higher Education, and the U.S. Health and Human Services department.
Even within an ethnic group, there is a wide diversity of cultures, said Maria Lemus, executive director of Vision y Compromiso, a California-based advocacy group that aims to educate the Hispanic community about quality of care issues.
"A Cuban is a very different Latino from a Mexican, from a Guatemalan. In terms of cultural competency and trying to adapt to your community, it is important to recognize those differences," Ms. Lemus commented.
Although understanding the ethnic make-up of a population is important before moving forward, successful strategies ultimately rely on the strengths of local communities, she noted.
One of the group's programs, the Community Health Worker/Promotoras Network, comprises respected members of the Hispanic community who provide education and outreach to their peers.
Ms. Lemus described promotoras as people who "are always concerned about other people …. They are people with a heart to serve."
The promotoras concept has been around for more 50 years, having been implemented in Europe, China, Africa, Europe, and Latin America. It was adopted in California a little more than 25 years ago, she said.
Promotora is an apt term for Jerry Barnes of Columbus, Ga., who gave up a successful nursing career to work toward a healthier community. As a city council member, he was the driving force behind an effort to reduce the city's relatively high diabetes rates.
"I had a 'eureka' moment one afternoon and thought, there are fire stations throughout the entire city. Why not make it accessible for people to stop in and have their blood sugar tested?" Mr. Barnes said.
Now thanks to the impetus of Mr. Barnes and the efforts of Columbus' mayor and fire chief, any resident can stop by one of the fire houses and have their blood sugar checked between 9:00 a.m and 9:00 p.m.
Officials in San Antonio took similar steps to ensure that widely needed services are readily available when they set up a twice-weekly immunization clinic at Goodwill Stores. The program was so successful that immunizations are now available 5 days a week.
Though home-grown, these strategies can be adapted to other communities as well, according to Ms. Lemus.