Hispanic health care difficult for patients, doctors

by JEFF DUNN

It’s a typical Monday afternoon at Dr. John H. Newton’s downtown orthodontist office. Patients are flipping through entertainment magazines, checking their voice mail or engaging in light conversation. In an adjoining room, Newton is tightening wires and applying fresh rubber bands. Of the nine people waiting in the cushioned chairs, four are Hispanic. And they all have different stories to tell.

Cassandra Avila, 16, attends night school at Horizonte High School to make room for her busy work schedule. The teenager works as a Subway sandwich artist five days a week. She’s required to work to help her single mother cover expenses, particularly health care. (Her parents are still married; however her father resides in Pachuca, Mexico, after giving his immigration papers to his brother 20 years ago.)

“I have a job so I’m helping,” she said, speaking of health care costs. “I hardly have time for myself. I have to make time to come to the dentist.”

Though she knew about the cost of orthodontia when she began the treatment program, Avila said she wanted braces to help correct her severely crooked teeth.

“My teeth were really messed up. I had a tooth up here,” she said, pointing to her upper gums near her left nostril.

Avila’s teeth are nearly straight now, and she happily reports her braces will be off in a few months. She should be happy. She’s worked harder than most 16-year-olds for her movie star smile.

Anna Cataxinos, 41, has also sacrificed for her health coverage. She actually worked for a time in medical records at a local hospital. While working there, the daughter of Chilean immigrants said she often got requests from different departments to translate for Spanish-speaking patients.

“A lot of people needed help understanding simple things like changing rooms,” she said. “Learning a new medical system is difficult and complicated for them.”

Despite being fluent in Spanish, Cataxinos said she struggled with different dialects and confusing medical terminology.

“It’s the terms that are hard,” she said. “It took me awhile. I didn’t trust myself to remember.”

Cataxinos said she knew the patients needed as much medical information as possible, so she made a list of all the terms she needed to know so she could make sure she got everything correct.

Avila agreed that translating complicated procedures for family members or friends can be extremely taxing. Her aunt, for example, doesn’t speak English and therefore doesn’t feel comfortable going to the doctor’s office alone.

“Every time she goes, she gets me or my cousin to go with her,” Avila said. “There are some big words they use, like doctor language that I don’t get. I speak both languages fluently, but it’s hard for me to understand.”

More importantly, it’s hard for her aunt to understand. Avila said it often requires repeated, simplified translations before her father’s sister-in-law can grasp what’s going on.

“I let her know until she gets it, and then she’ll go, ‘Oh, okay,'” Avila said.

Explaining the financial side of health care is even more challenging, according to Cataxinos. She said many Latin Americans she has worked with are used to different payment plans and protocols.

“The system is so different in South America,” she said. “Here things work so differently. They have to learn a whole new system.”

Dr. Newton, who has worked as an orthodontist for three decades, estimated he sees Spanish-speaking patients once or twice a month. He said many times the Hispanics people are required to have their children translate for them, which makes things difficult.

“There’s a lot lost in translation,” he said. “[The kids] frequently don’t understand the financial aspects, and 12-year-olds have a hard time explaining.”

Though working with child translators is strenuous and time consuming, he said he’s happy to do it. However, he said he knows several orthodontists who aren’t as willing.

“There’s that attitude that, ‘Hey, this is America. You have to learn English, because we’re not going to learn Spanish,'” he said.

Erik Storheim, 35, can relate. Storheim is a local dentist fluent in Spanish, thanks to a two-year mission to Santiago, Chile, for The Church of Jesus Christ of Latter-day Saints. He said explaining dental terminology in a foreign language is a constant struggle.

“Even though I speak Spanish, there’s definitely a communication barrier,” he said. “It’s hard to go in-depth and explain procedures. I didn’t learn dental terms on my mission.”

Storheim used periodontal disease prevention as an example of a difficult concept to describe to his Latino patients.

“It’s hard enough to explain to someone who is a native English speaker,” he said. “When I try to explain it with my limited Spanish ability, it’s even harder to convey the importance.”

But the complications don’t stop at the dentist chair. Because no one else on Storheim’s staff speaks Spanish, he is required to handle all the scheduling and financial arrangments for his Hispanic patients. Managing the receptionist’s duties often causes delayed appointments for other patients, he said.

Still, Storheim said it’s not the delays and complications that bother him the most, it’s the lack of care created by the language barrier.

“I get frustrated communicating sometimes,” he said. “I feel like I can’t communicate adequately and educate my patients like I want to. I feel like they don’t get the care they need sometimes.”

Storheim said he genuinely cares about his patients’ well-being and didn’t go through the rigors of dental school just to punch a time card.

“I’m not a dentist just to fill cavities and pull teeth,” he said. “I want my patients to come away more educated about their dental health. I don’t feel that I can provide that service all the time.”

Newton said he has been working with Hispanic clients since he attended orthodontist school at the University of Illinois in the early 1970s. During his last two years, Newton accepted a summer job in Alamosa, Colo., helping undocumented Hispanic workers get adequate health care.

“A lot of people think Colorado’s main source of income is skiing, tourism and John Denver,” he said. “I learned that that’s not true. The main source of revenue for Colorado is agriculture. And of course, they need field hands to work the crop and prepare the fields.”

Newton was one of around 20 upper-class medical students who worked to provide medical attention to needy migrant workers. He described his experience as eye-opening and disheartening.

“It was very hard,” he said. “Many were seriously ill, but they didn’t have any money or medical insurance.”

He also added the experience gave him a better understanding of some workers’ conception of health care.

“It was fascinating to see their folk remedies that didn’t exactly [jibe] with western, traditional medicine,” he said.

Although the team of students and doctors did all they could to help the workers, Newton said they simply didn’t have the resources to take care of everyone.

“It was like trying to hold back the ocean with a broom sometimes,” he said.

The orthodontist said he doesn’t think the situation has improved in the last 30 years.

“They’re outside the system,” he said. “No one’s interested in helping them, because there are no political benefits.”

No one except for dentists like Erik Storheim. Though he has his own financial issues stemming from buying his own practice in January, he said he still tries to help out when he can.

“Sometimes I give people a good deal,” he said. “I’ll say, ‘Listen, this is just for you.’ I don’t want word to get out that I do free dentistry.”

Storheim said assisting others is his way of showing gratitude for all he’s been blessed with.

“Everyone deserves a break once in a while,” he said. “You can always give back.”

An hour has passed, and the waiting room crowd is starting to thin out. The magazines are read, the voice mail checked and the light conversation complete. Dr. Newton appears, motioning in another patient. His tired eyes require no translation.

Neither do theirs.