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Hispanic growth in rural towns creates health care challengesHANOVER, Pa. (AP)--Encouraging Hispanics to get flu shots in this rural community near the Maryland border proved a tough job for Gino Salazar. Whenever the part-time community health worker at Hanover Hospital told Hispanic residents about the hospital's vaccination clinics, they resisted, fearing the shots would make them sick. But when the hospital took the clinics to churches with predominantly Hispanic congregations--with Peru native Salazar making a pitch at Sunday services--they came in droves. "We thought if they saw one person going in (for a shot), then everybody will start coming in," Salazar said. "It became a mass vaccination." Salazar, who works full-time at an apple processing plant, serves as a bridge between Hanover's growing Hispanic population and community agencies providing health care or social services. He was hired in November as part of a broader effort by the hospital to improve services to Spanish-speaking residents. As more Hispanics move into America's rural communities, health care providers like Hanover Hospital are being forced to re-examine how they deliver services and consider new ways to help overcome language and cultural barriers. Hispanics are projected to become the largest rural minority by 2025, according to a U.S. Department of Agriculture analysis of census data. Their population nearly doubled from 1.4 million to 2.7 million in rural towns between 1980 and 2000, when the last census was held. In that period, Hispanic representation among rural residents rose from 3 percent to 5.5 percent. A major factor behind the growth of Hispanic residents is tighter border security--particularly after the Sept. 11 terrorist attacks--that makes traveling between the U.S. and Mexico more difficult for illegal immigrants. "They discover that crossing back and forth--no longer is easy and no longer is cheap. And they tend to bring their families with them," said William Kandel, an USDA sociologist. "There are a large number of children being born here." Some of the most acute problems caused by the Hispanic population boom are along the U.S.-Mexico border, where impoverished border towns lack basic services, said Amy Elizondo, vice president of program services for the National Rural Health Association. "You see a lot of overflow in emergency rooms" in the border communities, Elizondo said. "You're looking at Third-World country type problems." In rural communities that have adequate basic health care services, the challenge is in making Hispanics aware of what is available and how to get to hospitals, clinics and doctors' offices. Migrant workers present a special challenge because of their nomadic lifestyles, said Candace Kugel, a nurse practitioner in the town of State College, Pennsylvania, who is affiliated with the Migrant Clinicians Network, a national group of health professionals who serve migrants. "People who move because of their work are constantly being uprooted, and so if they are involved in care for a chronic illness or a pregnancy, for example, they are not necessarily going to have good continuity of care," Kugel said. Loretta Heuer of Migrant Health Services Inc. in Moorhead, Minnesota, tried to educate migrants in North Dakota, Minnesota and Texas about diabetes, under a program that paid certain migrants a small stipend to work as "lay educators" about the disease. The educators organized support groups or prevention screenings that typically took place at churches on Sunday. Participants were able to share their concerns with someone who spoke their language and could provide information and advice. "They were also able to talk about it with families and give them a better understanding of the disease," Heuer said. "Sometimes, if you have low blood sugar and you're irritable, your family members may just think you're being crabby." Bringing services to Hispanic residents can go a long way toward overcoming some health care obstacles, said Mark Holmes, vice president of the North Carolina Institute of Medicine, a nonprofit organization that analyzes health issues. "It really cuts down on transportation time and transportation may be a considerable barrier," Holmes said. "There's also a big issue of trust. When you have repeat visits and lay the groundwork for explaining who the health care providers are and what they do, that helps." In Hanover, the hospital and a counseling center jointly hired Spanish psychiatrist Dr. Carol Vidal to study the needs of the Hispanic community in 2005. The Hispanic population of the Hanover area was estimated at 5,600 last year, more than double the number counted by the 2000 census. Vidal found that language barriers, a lack of transportation, long work hours, perceived discrimination and deportation fears were among the obstacles blocking access to basic health care. "I was surprised by the amount of hours they were working, how they were trying to deal with family and work time," Vidal said. At Vidal's recommendation, the hospital hired two bilingual patient relations coordinators to assist emergency room patients last fall and hopes to hire two more. Earlier, it used a telephone translation service that patients felt didn't provide adequate help. "It was hard for Spanish speakers to engage with the health system," said Flavius Lilly, a hospital vice president. Luisa Wolfe, a Colombia native who is one of the hospital's new patient-relations coordinators, said Hispanics are "pleasantly shocked" to find someone speaking Spanish to answer their questions. "They say, 'We didn't know there was anyone here who could help us,' because there was no service before," said Wolfe. The hospital puts out a bilingual list of organizations serving Hispanics and a Spanish-language newsletter with information on health, education and job openings. It also is part of a coalition of community groups called Hanover Juntos, or Hanover Together, that promotes understanding between Hispanics and longtime residents, many of them descendants of German immigrants. "There are healthy ways and appropriate ways to bring the two communities together that the way they interact is mutually beneficial," Lilly said. "Part of our philosophy has been: if you alienate a group of people even more than they already are, you create social problems that didn't exist before." 12/17/07 Date: 12/7/07 Advertisement
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