Language Barriers Hazardous to Health

Clinics consider outreach to bridge communication gap

By Alexis Martin

Alfonso Lazaro is used to coming home with an aching back and sore limbs from 10-hour days working the fields in the Salinas Valley. But on a recent evening, in the home he shares with two families, another health concern surfaced.

As one of 30 indigenous Mexicans participating in a health screening, Lazaro learned that his blood-sugar level is higher than it should be and the 31-year-old is at risk for developing diabetes.

The in-home screening was part of a growing effort by Clinica de Salud, one of three Greenfield health clinics, to reach out to Mixtec and Triqui farm workers who have emigrated in the last decade from the poor Mexican state of Oaxaca to find work. The population suffers acutely from diabetes and the chronic pains associated with field work.

Yet formidable language and cultural barriers block their access to health care. Neither clinics in Greenfield, including Clinica de Salud, nor the nearby Mee Memorial Hospital in King City provide indigenous-language translators for medical appointments.

“Health problems are worse with people that are marginalized,” said Seth Holmes, doctoral candidate in medicine and anthropology at the University of California at Berkeley and UC-San Francisco.

Pesticide and weather exposure, depression and alcoholism are other problems among the indigenous Oaxacan community, Holmes said.

Only 5 percent of all migrant farm workers have health insurance and 27 percent have never received a physical, according to Holmes. Clinic visits are expensive (at least $40), health-care information is not available in indigenous languages, and many indigenous farm workers expect doctors to be ineffectual or abusive, he added.

“The doctors don’t treat me the way I should be treated,” said Vicente Suarez, a Triqui who suffers from asthma. “I believe they don’t treat me that well because we don’t have papers or much money.”

Seventy-five to 80 percent of the patients who visit Clinica de Salud do not speak Spanish or English, according to manager Eva Chavez. At Mee Memorial Outpatient Clinic in Greenfield, non-Spanish-speaking patients are required to bring their own translators.

Mee Memorial Hospital in King City tracks down bilingual Oaxacans from the community to translate, but only in life threatening emergencies. A year ago, it took half an hour to find an interpreter for a family whose child had a 112-degree temperature, according to Virgie Ponce, the hospital’s staff development director.

Indigenous Oaxacans rely on bilingual family members, friends, or strangers to translate for them in doctors’ appointments. That can be humiliating when a husband or other man has to translate a woman’s gynecological issues, or dangerous when a child translating for parents cannot accurately relate medical information, Chavez said.

Managers at Mee Memorial Clinic and Mee Memorial Hospital discussed hiring indigenous-language translators, but they have yet to, Ponce said. Hospital officials also discussed developing an outreach program to encourage indigenous farm workers to access services before a developing health problem becomes an emergency, Ponce said.

Only Clinica de Salud is doing such outreach now. The clinic works with Spanish-speaking Mixtec and Triqui women who support the indigenous community by passing along health advice, arranging doctors’ appointments and translating health workshops such as the one in Lazaro’s living room.

Like everyone in the room, Luisa Santiago works in the fields. She is a quiet Mixtec woman, barely 5 feet tall and heavy around her waist. She moves slowly through her chronic back and joint pain as she ushers small children into the kitchen, where packs of Top Ramen and Doritos are stacked on the refrigerator. Outside, a hen struts a square-foot area of patio lined with dried chili peppers and hundreds of empty soda cans.

She remains in the kitchen and out of earshot when medical assistant Eduardo Garcia talks about the importance of a healthy diet, pointing to pictures of fruits and vegetables on a laminated page.

“Having a poor diet accelerates the development of diabetes,” Garcia says in Spanish. A Mixtec translator relays the message as a Triqui outreach worker hands out bananas, oranges and water bottles.

Here, there isn’t time or money for the naturally grown meals the immigrants ate in Oaxaca, said Rosario Aguirre, the Clinica de Salud outreach coordinator supervising the workshop.

“Here I eat because I have to eat - I don’t know where the food comes from,” said Evaristo Lazaro, a 50-year-old field worker unrelated to the family. “In Mexico I know where the food comes from. I know the beans are good, natural beans.”

Despite her pain and her decision to host the outreach workers, Santiago has never visited a clinic and doesn’t plan to.

“They won’t take care of me,” Santiago said through a Mixtec translator. “I’d feel more comfortable going to the clinic if I spoke Spanish.”