Columbia resident Benjamin Guillen, 51, is his parents’ caretaker.
When the medical clinics they go to don’t offer services in Spanish, Guillen said staff use a technology screen to translate.
Sometimes Guillen translates, even though he still struggles to understand some words in English himself.
“My mother, as a woman, would like to speak privately with the doctor,” Guillen said in Spanish. “For her, it’s complicated that her son has to listen to her problems to then be able to translate.”
Members of MU’s Latino Medical Student Association (LMSA) chapter are leading initiatives to bridge the gaps between medical professionals and Spanish-speaking patients.
According to the U.S. Census’ 2021 American Community Survey, 13.2% of the country’s population — over 41 million people — speaks Spanish at home. In Missouri, the number of native Spanish speakers drops to 2.6%. But, while the state’s Hispanic population remains small, it grew 42.6% over the previous decade. Boone County alone added 3,157 people to its Hispanic population count between 2010 and 2020.
Studies show Hispanics had the highest uninsured rate of any ethnic group in 2020. Lack of health insurance access shapes Hispanic health, along with lack of preventive care and language and cultural barriers, according to the U.S. Department of Health and Human Services Office of Minority Health.
Connor Diaz, co-president of MU’s LMSA chapter, said these barriers can create fear or mistrust when Spanish-speaking patients visit a clinic. He said he’s definitely felt the tension in the room with patients.
Then, he introduces himself: “Yo soy Connor Diaz. Yo soy un estudiante de medicina trabajando con su doctor. ¿Quieres hablar en Español?”
And the tension in the room eases, Diaz said.
‘We could do more’
LMSA members organized a community clinic that offered medical services free of cost and in Spanish on Monday at the Centro Latino de Salud.
The idea came about when Paola Orozco, who is Diaz’s co-president of LMSA, noticed the level of trust that opens up when she speaks to patients in Spanish.
“Right there, I began to feel like we could do more in Columbia’s Latino community to be able to reach these people whose first language is Spanish,” Orozco said.
Orozco reached out to the Centro Latino de Salud. Raquel Ortiz, secretary for LMSA, reached out to the MedZou Community Health Clinic, which provided influenza vaccines. MU School of Medicine students administered the shots, screened for diabetes and conducted blood pressure checks. Ortiz and Gabriela Garcia Delgado, LMSA community chair, coordinated the clinic on site.
Andres Bran, an infectious disease expert at MU, supervised the students’ on-site operations. More than anything, he said he would like to see more people get vaccinated.
“Most of all, it’s people who have risk factors, diabetes, uncontrolled blood pressure,” Bran said. “These are the people who things tend to go worse for if they get influenza. The best thing is prevention.”
Guillen got his flu shot at Monday’s clinic. He said he thinks one of the reasons for COVID-19 vaccine hesitancy in the Hispanic community is the lack of Spanish-language information about the shot.
“But when I see someone who looks like me and speaks the same language, I feel much more comfortable telling them, ‘Yes, you should give me the vaccine,’” Bran said. “Usually, people believe in those who look like them.”
Erika Hilario, a senior studying physics at MU, also got her flu shot Monday. She grew up translating at the doctor’s office for her father, who is from Mexico. Living in rural Sedalia, she said her father preferred to take care of his health in his own way, often self-diagnosing.
“I feel like he would be more comfortable going to something like this event,” Hilario said. “This is something that I wish would gain more community attraction because there are a lot of Latinos here who feel they do not have that attention and the kind of respect that they deserve.”
Guillen hopes there will be permanent Spanish-speaking medical care in the area. Orozco said more frequent service is the goal.
While there is no set date for the next clinic, Delgado said she hopes they will happen at least every few months. Conversations at local public schools to help young people understand health early on are a possibility. The students also want to add mental health and women’s health events in the future.
“We plan on taking this way further than it is right now and hopefully reaching way more Hispanic communities within Missouri,” Ortiz said.
Meeting patients in the community is an effort that is running alongside an initiative to train future doctors to better understand the Spanish-speaking communities they might one day serve.
Bringing down walls
Several of the students who volunteered at the community clinic are involved in an extracurricular course that teaches them how to conduct physical exams in Spanish. Diaz developed the course last year in collaboration with Celso Velazquez, a rheumatologist at MU.
Students who complete the Medical Spanish: Physical Exam course receive a certificate from LMSA and Students Interested in Global Health for Tomorrow. Diaz said that after a quick introduction on the uses of medical Spanish, students take six classes that cover interviewing patients and different aspects of a physical exam. Students work in pairs, using each other to practice the skill sets. The course improves their ability to communicate in Spanish, but Diaz said he does not expect them to be experts in Spanish after completing the course.
Diaz didn’t expect interest to blow up, but it did.
“The course is very basic, but many people are interested,” Bran said at Monday’s clinic. “And many of the students who are here volunteering are also helping other people learn Spanish.”
There are 500 students at the MU School of Medicine, public information officer Eric Maze confirmed. Diaz said 169 School of Medicine students expressed interest in the course last year. Of the 105 students who attended the course, 80 received a certificate of course completion.
“That demonstrates to you how important the students view this course,” Diaz said.
Now, the organizers are trying to figure out how they can best move it forward.
This year, they have opened the course up to pre-medical and nursing students, aiming to create mentorship and interdepartmental learning opportunities. In the future, they hope to have the course taught year-round and bring in community members to help students practice their Spanish with patients.
The process for becoming a medical Spanish interpreter can be lengthy and expensive. According to the National Board of Certification for Medical Interpreters, candidates must have completed an accredited, 40-hour medical interpreter training course or have a college transcript that shows three credit hours of medical interpreting coursework. They must also show oral proficiency in English and Spanish and pass a written and oral exam.
“I would like all of the students to be certified medical Spanish interpreters by the time they graduate,” Diaz said. “That means that we’ll probably have to design a more longitudinal course that’s going be taught through a third party. The problem that we’re going to come into is: How we are going to get that funding?’”
Michael Hosokawa, MU School of Medicine senior associate dean of Education and Faculty Development, wrote in an email that the School of Medicine supports the interests of its students. Hosokawa added that the dean’s office provides a lump sum to the Medical Student Affairs Council. LMSA could apply for some of the student-managed funds. Once qualified, the organization would submit a yearly budget request.
“If the students determined that medical Spanish should be a part of the medical student curriculum, they could submit a proposal/justification to the Curriculum Board for consideration,” Hosokawa wrote in the email. “Such a proposal would have to include a budget, objectives, evaluation and learning strategies, as well as how such a course fits into the mission of the School of Medicine.”
Another option, Hosokawa added, would be exploring online certificate courses with minimal registration fees or working with other LMSA chapters to develop a learning activity that involves synchronous learning via Zoom.
If the organizers are unable to get funding through the School of Medicine, Diaz said he will look for available grant opportunities. But after noticing at a recent LMSA House of Delegates meeting that MU has more students interested in medical Spanish than other universities, he thinks there is another opportunity there.
“They can be known as one of the best universities in the United States for producing Spanish-speaking physicians,” Diaz said.
It’s also about improving understanding of patients by speaking in their language.
“These walls that are there, they do fall down,” Diaz said. “You do feel that interaction. That’s very important because the intimacy of the physician-patient relationship should be there. You should feel feelings.”