Study Looks at Hispanic Health Care

By Brad Branan

Arkansas Democrat-Gazette

SPRINGDALE -- Mario Vega worries that his reluctance to get medical checkups will haunt him someday.  He hasn’t visited a doctor in years even though he’s insured through his wifes health insurance plan.

Vega said his medical resistance is rooted in his native country. He relied on teas and herbs from his grandmother when he was sick in Mexico.  “I was raised like that,” said Vega, co-owner of the Lasting Impressions car shop in Springdale. “We didn't get sick very often, and we didn't worry about it.”

Vega’s avoidance of medical care isn’t unusual for Hispanics in Northwest Arkansas, a recent survey shows. State health officials have long suspected Hispanics avoid health-care providers in Arkansas.

The study, by Tulane University School of Public Health student Mary Ramey, found 64 percent of Hispanics didn’t visit a doctor in the past year. Of the 1,200 people Ramey surveyed, 70 percent had never received a physical checkup.

Ramey’s survey, which was done as a master's degree requirement, is the first systematic study of how many Hispanics in Northwest Arkansas miss out on medical care, officials with the state Department of Health said.

Ramey’s report tries to explains why Hispanics dismiss American health care. Most Hispanics --78 percent -- said it’s because they don’t have health insurance. Hispanics often skip out on insurance and doctor visits because they come from countries with attitudes about health care that are different from beliefs in the U.S., Ramey said.

“They think doctors and hospitals are for rich people,” she said. “They come from a culture that doesn't recognize the importance of insurance. They also come from places where illness is viewed as a result of sin, or an act of God.”

Doctors’ offices intimidate Hispanics, Ramey and health-care providers said. Physicians and nurses rarely speak Spanish, and they sometimes fail to understand important cultural differences, they said.

By avoiding doctors, Hispanics put themselves at risk for complications from diseases such as diabetes and other serious illnesses, they said. Medical screenings could prevent or alleviate the illness.

Cultural Differences

Area health-care providers advised Ramey what questions to ask in her survey. Ramey interviewed about 400 Hispanics in focus groups and had another 800 complete surveys at places such as Wal-Mart stores and poultry processing plants. The survey was supervised by Tulane professors and University of Arkansas professors.

Ramey recently presented her findings to the Northwest Arkansas Hometown Health Improvement Project, a group of health-care providers organized by the state Health Department. She plans to hold a seminar in October in an effort to get more medical care for Hispanics and to help physicians understand the needs of Hispanics.

Hispanics continue to rely on the health-care methods learned in their homelands, Ramey said. They turn to folk healers, who conduct ceremonies to rid them of illness. Folk healers believe illnesses can come from fright or loss of soul, and use eggs, lemons and herb branches as ceremonial tools, Ramey said.

Hispanics often turn to herbs, teas and vitamins. Some of them consider penicillin to be a vitamin, and many of them get the drug from relatives in Mexico where a prescription isn’t required. The survey showed 72 percent of respondents took the medication every day. That finding troubled many Arkansas health-care providers who heard Ramey’s report. Continual use of penicillin can render it ineffective when someone really needs it, they said.

Almost 90 percent of the survey respondents said they trusted the use of herbs and other folk medicine. Among the people who avoided doctors or clinics, every respondent listed a lack of sympathy or understanding from doctors as one of the reasons.

Alicia Rodriguez is among Northwest Arkansas Hispanics who are insured. She receives health insurance through Springdale's Rockline Industries, her employer.

Rodriguez said she recognized the need for insurance because she understands English, the language Rockline officials used to explain the health insurance program.

“Sometimes people don't get it because nobody explains it to them in Spanish,” Rodriguez said. “If they don't ask for it, they don't get it.”

Employers often fail to explain health insurance in Spanish or explain the importance of insurance, Ramey said.

That’s not the case at Tyson Foods Inc., where there are 1,750 Hispanic employees at plants in Benton and Washington counties, spokesman Ed Nicholson said. The company automatically enrolls new employees in health insurance programs, which are also available to family members. The benefits are explained in Spanish-language newsletters given to employees.

Still, some Hispanics don’t use the insurance they have. Rodriguez hasn’t visited a doctor since she joined the Rockline health program two years ago. Instead, she calls her grandmother in Texas when she gets sick.

“She buys me medicine in Mexico,” Rodriguez said. “I don't know why, but it works better.”

Health Risks

Hispanics are particularly at risk for diabetes and hypertension caused by pregnancy, administrators at the University of Arkansas for Medical Sciences, Fayetteville branch, said.

Complications from diseases such as diabetes are more likely to be avoided if they are caught early, UAMS officials said.

Hispanics consider pregnancy a sign of good health and a blessing. To Hispanics, the idea of prenatal care doesn't make sense, Ramey and UAMS officials said.

“The idea of preventative care is alien to them,” said Carla Mills, an interpreter at The Family Health Center, the UAMS facility in Fayetteville. The center has about 1,000 active Hispanic patients.

The center has taken steps to better serve Hispanics. It received a grant from the Community Care Foundation to provide prenatal care and hired two full-time translators to educate doctors on the Spanish language and culture.

Physicians and nurses need to understand Ramey’s findings to serve Northwest Arkansas’ growing Hispanic population, county health officials said 

“There’s a recognition that cultural sensitivity is something that's lacking,” said Loy Bailey, head of the Benton County Health Department.  Rick Johnson of the Washington County Health Department agreed.  “It’s pretty evident that Hispanics have different ideas about medicine,” he said.

Johnson’s ideas echo those of Fay Boozman, director of the state Health Department. Poverty and distrust keep Hispanics out of doctors’ offices, Boozman said at a conference last year in Fayetteville.

“For many, the modern medical system and its administration are intimating,” Boozman said at the conference on Hispanic health.

Northwest Arkansas doctors only a decade ago had less of a need to understand Hispanics or the Spanish language. The Census Bureau counted 1,769 Hispanics in Washington and Benton counties in 1990. The counties’ Hispanic population was counted at 26,401 in the 2000 Census.

“It’s critical that we understand these issues,” said Lynn Sallings, an administrator at the family practice residency program at UAMS. “I don't see how we can provide effective care without understanding them.”

She said she has doubts that private practice doctors will make the effort.  “It's economics,” Sallings said. “They have to see a certain amount of patients to get by. It takes twice as long to serve a patient who needs a translator.”

This article was published on Sunday, February 24, 2002