Building Trust: Working with the Community
As early as grade school, Karina Luna was acting as a bridge between languages and cultures by interpreting from Spanish to English what her Mexican parents needed to communicate, and from English to Spanish what they wanted to understand.
“I think a lot of people in the Latino community can relate to that, and how it can be a huge burden to get information across as clear as it should be,” Ms. Luna said.
As the multicultural affairs executive officer at the Interprofessional Community Clinic (ICC), the second-year College of Pharmacy student continues to be that bridge, now on a broader scale, by leading a network of interpreters — both Rosalind Franklin University students and community members — who assist Spanish-speaking patients in their medical appointments. The process includes making sure every interaction provides the medical team a clear description of each patient’s concerns and outlines the specific instructions for their care.
The pandemic closed the ICC in March, since the clinic functioned with in-person consultation that didn’t align with social distancing, and students are not yet licensed professionals. Even before that time, Ms. Luna said, the work of interpreters was stretched thin.
Prior to the state’s stay-at-home order, much of her time was spent recruiting volunteers who could fill in the clinic’s time blocks, getting them trained and pairing their translating skills with the different types of appointments the clinic provides.
When the ICC shifted to telehealth, that work was cut off, as fewer appointments were scheduled. Ms. Luna said she and other Spanish speakers on the team were able to handle the shortened caseload, which was focused primarily on prescription refills and consultations.
But an additional challenge arose.
Of the many racial disparities highlighted by the pandemic, the unfamiliarity with and lack of access to technology are among the adverse barriers to good health. Education and digital socialization have been deployed at a time when the best prevention to the spread of COVID-19 has been physical distance from even our most loved ones.
To address that technology barrier and continue to provide care to patients in a digital manner, the ICC team members went into tech-support mode. They became familiar with the new platform in order to better instruct patients on the use of phone apps — since it was identified that many patients did not have access to computers or internet connections.
One of the first to test the new digital platform was medical student Lauren Gard’s mother.
Ms. Gard is president of the Interprofessional Clinic Initiative and worked with the student teams, initially, to reach all of the clinic’s patients and let them know of their cancelled appointments due to the clinic’s closure. Then came additional outreach to make patients aware of the switch to telehealth.
“How do you explain to someone who isn’t familiar with technology, and in their own language, how to get on the right browser?”
“She’s not the most computer-savvy person, so she was perfect for the pilot,” Ms. Gard said of her mom’s participation, which revealed during the first attempt that she didn’t have the right browser.
“So that was one thing we had to think of: How do you explain to someone who isn’t familiar with technology, and in their own language, how to get on the right browser?”
In order to make every appointment count, care coordinators were assigned to make initial contact. According to Ms. Gard, clinic managers called patients 15 minutes before their virtual appointment was set to start to help with any troubleshooting.
According to Ms. Gard, the telehealth platform has been so successful that another executive officer was brought in to team with Ms. Luna. The new position was demanded by the extra work needed before and after the digital health visits.
Danielle Wales, a second-year medical student at Chicago Medical School, oversees telehealth operations, including managing the clinic’s HIPAA-compliant telemedicine software; training new providers and student volunteers on telehealth processes and protocols; troubleshooting unanticipated concerns; and continually evaluating and improving the procedures and protocols.
Most of the patients seen at the ICC are from the Spanish-speaking community. Ms. Luna said that aside from the technological barriers telehealth has spotlighted, there are others that aren’t necessarily tied to language, but to differences in cultures.
“One of the main things we try to incorporate in our training for our interpreters is to be culturally sensitive,” Ms. Luna said. “For example, there are a lot of differences when it comes to the medication people use. Latinos tend to use more home remedies.
“Their elders are respected so much. If their mom tells them something, they will do it, even though it may contradict with what their doctor said.”
The natural herbal cures to many of life’s aches, pains and maladies that abuelas ("grandmothers" in Spanish) pass down are seen as nothing short of real medicine that can be trusted to alleviate the body, mind and soul.
The ICC team of interpreters is tasked with knowing how to listen to every single ingredient that a home remedy might have and then translating the components to English — however obscure the herb might be — so the medical team can determine what is safe or what might negatively interact with a prescribed medication.
With the amount of misinformation that has come out of the many unknowns of this novel coronavirus, it has never been more important for healthcare providers to dispel myths and understand what patients know and don’t know about how to stay safe.
“We’re being pretty active in the amount of information that goes out to our Latino community to try to help them in these times, because they are getting hit the hardest from COVID,” Ms. Luna said.
In June, the Centers for Disease Control and Prevention stated that “long-standing health and social inequities have resulted in increased risk for infection, severe illness, and death from COVID-19 among communities of color.”
According to data reported by the Lake County Health Department on the disparate impact of the novel coronavirus, numbers clearly show that inequity: When accounting for the differences in age between populations, for every white/non-Hispanic person contracting COVID-19 in Lake County, four African American/non-Hispanic and eight Hispanic residents were contracting the disease in late summer.
“Having access to different forms of information translates to a lot of different things, and health is one of them,” Ms. Luna said. “If you don’t know how to take care of yourself because you don’t have the access to the information of how to do that, that’s going to be a detriment to your health.”
Romelia Corrales is an example of someone who might be negatively impacted by an information gap, because she understands English better than she can speak it, she said. The North Chicago resident, who speaks Spanish, has been an ICC patient for about four years. She said it was there she was first diagnosed with prediabetes.
Telehealth was a bit of an intimidating thought when she first heard about it, Ms. Corrales added, but with the assistance of the ICC team guiding her every step of the way, her first virtual visit ended up not being at all difficult.
“We’ve done it twice now over the phone,” she said, “and in November, if the clinic is open for my next appointment, then I’ll go. But if it’s still closed, then it will be easy to do it on the phone again.”
Ms. Corrales added that she’s happy she can stay connected to her doctors, in whatever way she can, as she continues her attempt to lose weight with nutritional guides her healthcare team has provided for her.
But virtual medical appointments are going further than that, and are doing more for underserved patients who need to break through those extra barriers.
“They offered me help with other stuff, like connecting me to places that can offer jobs if I had job loss in my family,” Ms. Corrales said. Her husband did lose hours at work due to COVID restrictions, but she added, “Thanks to God he still has a job, so I didn’t need that type of help right now.”
Social inequities that are the drivers to overall poor health have to do with lack of access to transportation, food and housing insecurities, and more. Screening for social needs takes place during telehealth appointments. By connecting patients with resources available with a list of community organizations and county agencies that provide assistance to address those issues, Ms. Luna said screeners fill those gaps and lay a framework for patients’ understanding of their community.
“Reaching those who do not speak English is beneficial, because in a pandemic like the one we’re experiencing now, we all need to be aware of how to keep each other safe and keep each other accountable for each other’s safety,” Ms. Luna said. “Having everyone on the same playing field is beneficial, because we can all act as a unit to better the country and to better the state of everyone’s health.”
When the ICC is able to open its doors to patients again, officials expect the need for interpreters will increase, along with that of clinicians, mentors and other staff.
“We are in huge need of interpreters all the time, so once the clinic starts running in person, that need increases exponentially compared to telemedicine, and if we can have interpreters come in and take the time and help us out at least one hour or two, it shows a huge difference in our population,” Ms. Luna said, adding that patients are grateful to have someone there.
Yadira Sanchez Olson is a Lake County-based freelance writer who has written extensively about the Latino community.
Please note, any group photo that does not feature physical distancing or mask wearing was taken prior to the State of Illinois issuing such guidelines. RFU has policies in place that require these and many other safety measures.