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Speaking The Patient’s Language

Speaking The Patient’s LanguageIn efforts to more effectively serve the increasingly Hispanic clientele, University of Texas requires Spanish courses for health care students, but critics question responsibility of language barrier.By Lydia LumAs this country becomes increasingly Hispanic, a growing number of universities now offer — and sometimes require — Spanish courses geared to health care students. At public and private universities, medical and nursing students are clamoring for classes that better equip them to communicate with patients who speak little or no English. This is occurring even in areas that historically have been primarily White. Educators are responding with classes melding conversational Spanish with medical terms.
“We’re acutely aware of the multicultural world we now live in, and we want to be sensitive to that diverse world,” says Dr. Geraldine Bednash, executive director of the American Association of Colleges and Nursing. “We cannot provide the best medical care without communicating in other languages, especially Spanish.”
In a well-publicized move, the University of Texas at Austin became one of the latest to require its nursing students to enroll in a Spanish course especially designed for health care workers. The move affects this fall semester’s freshman class of 136 students, but they won’t enroll in that Spanish class until fall 2004 to coincide with upper-division clinical courses taught in English, says Dr. Joy Penticuff, UT professor of nursing and former assistant dean for undergraduate nursing programs. Meanwhile, seven upperclassmen chose to enroll in the new three-hour credit course this semester as an elective, she says.
By the end of the course, students should be able to prescribe medication in Spanish and guide patients through basic procedures like drawing blood. They also should be able to translate aloud body parts and basic body functions, Penticuff says. Less emphasis is placed on grammar and the many verb tenses taught in traditional Spanish courses. “We don’t have any delusions that our students will be proficient in discussing every medical procedure in Spanish,” she says. “On the other hand, you cannot give health care today without knowing that you, as a provider, have to reach out and do what’s necessary. It’s not the time to say, ‘I’m not going to speak to you in Spanish.’ ”
UT officials are making this such a high priority that they plan on requiring even bilingual nursing students to enroll. “We might eventually change the policy, but we also know that bilingual speakers don’t necessarily know specialized medical terms,” says Penticuff, a 27-year UT veteran. Mirroring the
Working World
Nationally, workplaces of all kinds are recognizing the need for employees to speak, read and write basic Spanish. Whether it’s in retail, government or corporate life, many working professionals are learning Spanish so they can more effectively serve the increasingly Hispanic clientele. Since 1990, the Hispanic population has swelled by at least 60 percent nationally. Consequently, enrollment in short, intensive Spanish courses has skyrocketed. From 1986 to 1998, enrollment in Spanish courses doubled at community colleges, reports say, where working professionals got doses of “occupational” Spanish. Those courses blended basic conversational skills with specialized vocabulary for a variety of industries, such as hotel and hospitality, law enforcement, construction and health care.
Among academia, many universities for years have required undergraduates to enroll in four semesters of a foreign language as a condition to graduate. Quite often, Spanish is a popular choice. But mirroring the working world, more professional schools are integrating occupational Spanish into the curriculum.
At the University of Miami’s law school, educators now teach several comparative law courses in Spanish each year that students can take as electives. Naturally, the instructors can revert briefly to English if confusion occurs, but “the idea is immersion,” says law dean Dennis O. Lynch. Teaching in Spanish better conveys aspects of indigenous topics such as Argentinian commercial law, Lynch says. In turn, such courses better prepare graduates for transactional work involving Latin and South America, he says.
And, some legal concepts don’t really translate to English anyway, but instead reflect the history and culture of Spanish-speaking countries so it’s more practical to learn them in Spanish. For instance, there’s no American counterpart to the “judge of instruction” of many Spanish-speaking countries, says Lynch, a nationally known Latin American law expert. A judge of instruction is a cross between an American judge and prosecutor.
“Not only can students capture substantive knowledge by learning in Spanish, but it lets them validate their ability to work while using that language,” Lynch says.
That’s what health care educators hope for. At Wake Forest University, medical school educators required graduating seniors this past spring to take a five-week intensive Spanish course right after they secured their residency matches. The three levels of the course accommodated first-time Spanish students as well as fluent speakers. After five weeks, all of them could, at the very least, ask in Spanish, “Where does it hurt?” and “Can you speak English?,” says Dr. Venita Morell, associate professor of family and community medicine. Wake Forest officials plan the same requirement for next year’s graduates. The Spanish requirement was added because students, accompanying doctors on their rounds at the nearby teaching hospital, became frustrated at not being able to work with patients with limited English. Even though North Carolina does not have nearly as high a Hispanic population as states such as California and Texas, it also has seen a sharp increase in Spanish-speaking migrant farm workers in recent years.
An Issue of Responsibility
Not everyone agrees that students should be required to learn foreign languages. Instead, students should simply be given the option of learning something besides English, says K.C. McAlpin, executive director of the ProEnglish nonprofit group. McAlpin also worked in South America, the Caribbean and Europe for 15 years.
“We should be about the teaching of English,” McAlpin says. “Is it the fault of the medical provider, or the fault of the individual if there’s a communication problem? There’s a real issue of responsibility here, and we as Americans are paying for the failure of immigrants to learn English.”
The American Medical Association has not taken any position about teaching specialized Spanish to health care students. However, some health care providers have complained about an order signed by President Clinton requiring entities receiving federal funds to provide bilingual services. That includes hospitals and clinics because of Medicare and Medicaid.
Consequently, some doctors contend they cannot afford their practices if they must accommodate translations for an array of patients whose primary languages vary from Spanish to Armenian, Farsi, Vietnamese and so forth. Doctors cannot get federal reimbursement for all translation services.
While the debate continues, some educators also wonder how fair it is to require Spanish, rather than another foreign language?
At the University of California at Los Angeles, officials “strongly recommend” health care-tailored Spanish for its nursing students. But as talks surface of making Spanish mandatory, educators remind each other of other fast-growing ethnic communities, says Kay Baker, the nursing school’s associate dean of student affairs. “The question of which language to require is just as difficult as the one of whether to require one,” Baker says.
But Baker and others still emphasize the critical shortage of Spanish-speaking health care professionals — and what happens due to the shortage. In one tragic accident, a Hispanic patient was hospitalized for overdosing on a prescription that should have been taken “once daily,” Baker says. However, the patient, reading “once” on the label, thought it meant 11 times because that’s what “once” (pronounced “ON-say”) in Spanish means. “No one had explained this to the patient — and apparently couldn’t,” Baker says.
And just as important as the language skills are cultural lessons in medical Spanish courses, says Dr. Paula Cifuentes Henderson, assistant professor of family medicine at UCLA’s medical school. In their courses, which are student electives, instructors teach future doctors how to navigate through the deeply family-oriented culture of many Hispanics.
“With many Spanish speakers, we want to tell them to take care of their health for the sake of their kids, their parents,” Henderson says. “If we tell them to do it for themselves, they won’t take it as seriously.” Students don’t have long before putting those lessons into play. Many do residencies at affiliated hospitals and clinics with Hispanic clienteles of 60 percent and higher.
It’s unclear how well prepared higher education institutions are to add greater numbers of health care and occupational Spanish courses. According to the Modern Languages Association, there are many more qualified foreign language teachers than there are full-time jobs. And recent surveys show foreign language faculty at universities earn about half what law professors earn. In fact, foreign language faculty languished at the bottom of the pay scale alongside those teaching music, English composition, communications and theater arts. In a series of interviews, college officials across the country say they tap instructors for health care Spanish courses from among a variety of sources: retired, bilingual physicians; community college faculty; and new lecturers who teach occupational Spanish in other industries and themselves must learn body parts and medical terms. At UCLA, which has offered medical Spanish for at least 10 years, the quality of instructors has run the gamut, Henderson says. “We have had great teachers, and we’ve had some so horrendous the students thought the course was a waste of time,” she says.
Olimpia Piccardo, head of the language education program at the University of Texas Medical Branch in Galveston, agrees that good medical Spanish resources are tough to find. When she first began teaching medical Spanish 20 years ago, she couldn’t find suitable textbooks, so she compiled her own. Over the years, medical schools across the country have tapped her book for their classrooms.
And clearly, demand for Spanish-speaking health care professionals isn’t abating. Even in nursing, recruiters prefer Spanish speakers, despite the current industry shortage that has one in 10 jobs vacant amid complaints of relatively poor pay and working conditions. Some analysts have suggested the overall nursing shortage has shortchanged patient care.
“The recruiters are all looking for bilingual nurse practitioners, no doubt about it,” says Dr. Jane Poss, director of the University of Texas at El Paso’s family nurse practitioner program, where master’s students are required to take medical Spanish. “Sometimes we’ll have students balk at taking the course, if they plan to move out of this area, but I always tell them they’re probably going to need Spanish anyway.” 

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