No One Is Free From Harm: Healthcare poses perils when you don't speak English
I've worked in public sector managed care for the last 30 years and consider myself pretty knowledgeable about the healthcare system.
But I've found from helping my mother, father and one of my brothers that it's very difficult to navigate the system when you are low-income, have multiple medical necessities and face a language barrier.
Growing up in Puerto Rico, my family received healthcare through Medicaid. I moved to the States 33 years ago for college, and stayed here and got married. I later brought my parents and my brother to live near me in Virginia Beach, Va. They continue to receive Medicaid and Medicare.
My parents, Gloria and Herminio, don't speak English, while my brother Jeffrey understands English but can't communicate well. The system is not equipped in geographic areas like Virginia Beach that aren't heavily Hispanic to serve Spanish-speaking people and explain treatments and benefits.
So I am the one who goes on appointments and tries to do coordination for the entire family.
On the hospital side, they do offer Spanish translation services. But here in Virginia Beach, I haven't been able to find a doctor for my mother's special needs who speaks Spanish. My mother is 72 and has fibromyalgia, high blood pressure, gum disease and depression.
I have to be available for everything. Because of my job and my work travel, it is truly a struggle to be on top of all her appointments, case reviews and other medical issues.
When the doctor prescribes an extra medication for her, if I don't pay attention, she'll be doing double doses on everything. She doesn't understand that two drugs with different names can be the same.
A year ago, the doctor prescribed a generic version of the brand-name blood pressure medication she was taking. For about a month she was taking both prescriptions. I was able to cut it off before she suffered any harm.
When that happened, she was seeing doctors in different provider networks. The lesson I learned was to make sure the specialists and primary-care doctors she sees are all in the same network so they all have access to my mother's medical records and avoid duplication of prescriptions.
My father, who's divorced from my mother, suffers from chronic depression. He couldn't find a local mental health provider who spoke Spanish, and he didn't want to talk about such private issues through a translator. We found a doctor in the Washington, D.C., area who spoke Spanish and could treat him. For two years I drove him there once a month. It was a 4½-hour round trip.
After a couple of years of doing that, I relocated because of my job, and my father couldn't see driving himself to the appointments. So six years ago, he moved back to Puerto Rico because of the lack of access to a Spanish-speaking mental health provider.
My brother, who's 47 and has had two strokes, can understand what the doctors say but it's hard for them to understand him. Whenever he has an appointment, he tells me what he's going through and I write it down for him to give to the doctors in case there is no translator.
Think about all the multiple languages spoken in the U.S. and all the people who have problems with care coordination and quality of life just because they don't have access to healthcare in their own language.
I think the system has improved from 20 years ago. Virginia recently rolled out a special needs plan for people like my mother and brother who are dually eligible for Medicare and Medicaid. Now one health plan coordinates the benefits and care, and I don't have to get on the phone to make sure the provider accepts both Medicare and Medicaid. That was a godsend.
While they were growing up, my children saw the needs of low-income people who come from a different culture and speak a different language. Maritza is a social worker at a center serving predominantly Hispanic children. One of my sons, Oscar, is a third-year medical student who wants to be able to use the Spanish language to serve his patients.
There definitely needs to be an acceleration in progress. How can we get the right information to family caregivers so they know how to navigate the system in the language they understand? It is a very complex system.
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