Editor’s Note: We began this series looking at simplicity as the key to better healthcare access. The pandemic highlighted how one of the most basic communications tools, the telephone, could break down barriers. And although remote and phone-based care helped many people in Louisiana, for Spanish speakers, it only made things more complicated. This story looks at how advocates in the New Orleans area cleared hurdle after hurdle to connect the Spanish-speaking population with healthcare when it mattered most. As our sources point out, it’s important to note similar obstacles exist for all non-English speakers, but for this piece, we have focused on the Hispanic community.
Xiomara Tejada, 35, moved to New Orleans from Honduras seven years ago. When she was three months pregnant, her doctor delivered a diagnosis that would change her life — her baby had a rare birth defect called omphalocele. At best, the condition meant her little boy would be born with internal organs outside of his body; at worst, he wouldn’t survive.
Tejada says she and her husband faced the option to terminate her pregnancy, but instead decided to “see what God wants.” That’s when she was transferred to Ochsner Baptist.
In the past, the Spanish translation services she received at a women’s clinic were over a phone. Ochsner, however, provided her with an in-person translator to guide her through every doctor’s visit. And there have been many. Her son, now 2 years old, needed two crucial surgeries after delivery, one on his intestine and one on his trachea, that left him hospitalized for almost five months. Now he’s learned to walk and breathe on his own, but he is still on a ventilator for about eight hours a day. He regularly sees a pulmonologist, cardiologist and gastrointestinal specialist, all at Ochsner.
When the COVID-19 pandemic hit, Tejada canceled most of her son’s appointments. She wasn’t sure what else to do. Then, an Ochsner interpreter reached out to explain Tejada’s telemedicine options. She helped her reschedule the appointments remotely and walked her through the process of receiving telemedicine translation over the phone.
“It was just like having someone there with me,” says Tejada of the telemedicine experience, via a translator. “I felt very comfortable.”
Dr. Claudia Medina, who has master’s degrees in healthcare administration and public health, is the director of International and Language Services at Ochsner Health. She immigrated to the United States from Bogota, Colombia, 25 years ago and serves as the vice-chair for the Gulf Coast Chapter of the National Hispanic Medical Association. She says the pandemic exacerbated the social and logistical barriers the Hispanic community faces when it comes to healthcare access.
Ochsner locked down on March 16, in response to the COVID-19 outbreak. Medina knew at the onset the system needed to act fast to continue language operations remotely, or those baseline barriers would become insurmountable for Spanish speakers panicked by a novel and uncharted disease. But first, she had to figure out a way to get people in the door.
“I said, ‘listen guys, we can get the interpreters. If you can get them on Zoom, at least we can talk to the patients through the process at the door,’” she recalls.
The next day, the system’s hospitals opened with temperature checks at their entrances. Medina brought in remote interpreter services at the checkpoints using the Zoom app.
Solving the telehealth issue proved a little more complicated. The no-visitor policy meant interpreters were not allowed in the doctors’ clinics within the hospital. Ochsner’s electronic medical records system, while optimized for telehealth, did not have out-of-the-box integration for interpreters. Medina quickly worked with the hospital’s technology team to link Zoom to Ochsner’s EMS. But the patient-facing side of that system is all in English, and the people who needed language services didn’t know how to log into the portal, much less how to navigate it. Plus, it initially put the responsibility on the doctors to manually invite interpreters to the patient meetings. Medina decided it made much more sense to put the interpreters in the driver’s seat.
Now, interpreters coordinate telemedicine appointments with doctors and patients. She says before each appointment, an interpreter will check in with patients, as they did for Tejada and her son, to make sure they know what to expect and how to access Zoom and Ochsner’s patient portal.
“We knew the patients didn’t know what was going on,” says Medina. “We hold them by the hand. We call them and explain what is going to happen, and we guide them.”
Dr. Margarita Tillman, an anesthesiologist from Honduras, is currently working as a health coach and outreach representative at Access Health Louisiana. Access Health operates 32 affordable care clinics and school-based health centers throughout Southeast Louisiana. Based in Kenner, Tillman provides health education and outreach to the Hispanic community.
During the pandemic, like most healthcare providers, Access Health made a hard shift to telehealth. Almost 80% of its patients from March to September were seen through telehealth. That includes 75% of patients who identified Spanish as their primary language.
Tillman says many of the providers and most of the medical assistants at Access Health’s Kenner and Norco locations speak Spanish. So, it wasn’t difficult to get the right people in the virtual room for Spanish-speaking patients. Because these providers are the same people they see in the office, the faces and voices were familiar. Like Medina, Tillman found the bigger problem was helping the patients to figure out the technology.
“They aren’t used to using the technology of the video conferences,” says Tillman. “It’s new for all of us. Maybe they are at home with a bunch of other people around. We found that to be more successful if they didn’t have video on.”
Tillman says Access Health is working on adding an automated Spanish-language captioning functionality to its telehealth portal, so patients can also read what the provider is saying. This focus on language access, in addition to the clinics’ sliding fee scale, free transportation services and affordable prescription drug plan, helps to erase many of the Hispanic community’s most common pain points in the healthcare system.
Although there were providers, like Ochsner and Access Health, prioritizing outreach and language access, the pandemic revealed the gaps in the region’s public health infrastructure. In late May, as COVID-19 cases surged in New Orleans, data showed Hispanics who had gotten tested made up more than 20% of positive cases. All of a sudden, the public health disparity faced by the New Orleans Hispanic community was making national news.
“What the pandemic has done and what emergency situations will do is show what is going well and what is not in the current system, because everything is under a pressure cooker,” says Adam Bradley, executive director at Luke’s House Clinic in Central City New Orleans. Bradley, who has a master’s degree in public health, also serves on the board of the National Association of Free and Charitable Clinics.
As an intern in 2014, Bradley helped to work on a comprehensive survey of Latino health issues in New Orleans. According to the survey, the top barriers when trying to access healthcare were “cost,” “don’t know where to go,” and “legal status.” He says not much has changed since then.
Luke’s House offers a free medical clinic two days a week, and Bradley estimates about 90% of its patients are Spanish speakers. He says in addition to clinic services, he and his staff help patients navigate the health system, making appointments for them and sometimes attending office visits to provide in-person translation services for offices that use virtual translator phones, known as “blue phones.”
During the pandemic, Luke’s House made use of its phone database to send out personalized text messages in Spanish with health resources and practical advice about hand washing methods and the importance of social distancing. But, he says, it’s a drop in the bucket in a city and state where public health has continually been undercut and underfunded.
“We’re reaching 1,000 people when 60,000 people need that resource,” says Bradley. “We have the resources to make effective decisions, but we need to make sure that the people who are most impacted have a say. You don’t see people asking them, ‘What can we do?’ There’s a lot of hand wringing. It doesn’t have to be that hard.”
It’s not hard to identify what needs to be done, but as advocates attest, actually doing the work requires dedicated financial and personnel resources. Lindsey Navarro, founder and executive director of the financial literacy nonprofit El Centro, has spent her career advocating for the Hispanic community and has experienced what it’s like to be the only bilingual person at the table.
“Burnout is real,” Navarro says. “By being that one person, everything came to me. You take a really great job at the city’s office to do the translating for the mayor, next thing you know, you’re getting roped into every conversation.”
She says during the pandemic, time and again she saw a failure by government leaders to understand the importance of the social and cultural diversity of the Latino population.
“I don’t think speaking to someone directly in Spanish is going to solve the issue or cause the community to directly trust that person,” says Navarro. “It takes more time and investment in understanding what are the needs of the community.”
She says while churches, community organizations and Spanish-language media are all crucial forms of outreach, nothing is more powerful than word of mouth.
“In the Latino community, one person has a good experience, they tell five more,” says Navarro. “One bad experience burns everything you’ve worked for to the ground.”
Navarro says awareness of roadblocks, such as requiring social security numbers, state IDs and not having forms properly translated, can all be prevented if you have someone at the table who understands why these barriers erode trust and discourage immigrants from seeking help. Navarro offers up reliance on single-language phone lines as a clear example.
“Calling usually means … ’if you’d like to speak to a representative in Spanish, click two,’ then you’re clicking and clicking and next thing you know you’re waiting three hours for the one bilingual person to answer the call,” says Navarro.
She says the organizations that have been successful in reaching the Hispanic population have done so because they have prioritized listening to community members’ needs and have hired employees whose backgrounds reflect the communities they serve.
Daniela Bello was born in Miami, but lived in Nicaragua from the time she was old enough to speak. Aside from a brief return to Nicaragua to study communications, Bello has spent the last decade putting down roots in Jefferson Parish. In January, newly elected Jefferson Parish President Cynthia Lee Sheng appointed Bello to her administration, as the parish’s first cross cultural coordinator.
In the early days of the pandemic, Bello gave a Spanish briefing after every press conference and used her media connections, as a former Telemundo reporter, to broadcast COVID-19 updates from the parish president across Spanish-language radio, television and social media. When the company administering the parish’s free tests required Louisiana IDs, she advocated for them to accept passports as well. But after visiting the first few testing sites, she knew she had more work to do on the ground.
“We were seeing 300 patients per day … and a lot of Hispanic people,” says Bello. “I realized I needed to go, because most people were lost. Nobody knew what to do. I started talking to people in Spanish while they waited in line. I explained about the test, and how they would get results.”
Her personal conviction to visit testing sites only increased after she tested positive for COVID-19 on Memorial Day. Although she didn’t experience any severe symptoms, it took a month in quarantine before she tested negative. The isolation took a toll on her mental health and helped her empathize with the struggle fellow Latinos were facing.
“I realized people needed more information about what was going on,” says Bello. “That experience made me more confident speaking to people about what they could expect. I decided to go to every testing site in Jefferson Parish to talk about my experience.”
Bello says at testing sites people asked her health-related questions, but also financial ones, like how much it would cost at the hospital if they tested positive and needed care. She’s taken the initiative to seek out information on low-cost clinics so she can share that information with people at the testing sites, where she is often the only available interpreter.
Bello also used her face time in the testing lines to sign people up for a new Spanish text alert system for Jefferson Parish, JPNOTICIAS, to notify residents about food distribution and testing. She says the parish will use this for emergency alerts and outreach going forward. So far, 450 people have subscribed. A 2015 community survey from the U.S. Census Bureau reports more than 43,000 people in Jefferson Parish speak Spanish at home — roughly half of those report speaking English “less than very well.” Bello, who also spent her time in testing lines helping people filling out the census, believes that number is much higher.
As the Spanish-speaking population continues to grow in Louisiana, there are more people like Tejada, paralyzed when they approach a healthcare system that doesn’t speak their language. It’s no surprise most fell through the cracks, but coronavirus showed just how big those cracks are and what it’s going to take to mend them.
Oschner’s Medina emphasizes that providing healthcare in someone’s preferred language is not only legally required, but critical to establishing trust. In the pandemic, that trust proved more critical than ever.
“The language barrier is one of many,” Medina says. “We have to understand, when we talk about Hispanics who are low-income, who are immigrants without papers, they fear healthcare.”
This is the last installment of Lifeline. Check out the full series by starting here.
Lifeline: COVID is made possible with help from founding sponsor LHC Group, supporting sponsor Oschner Lafayette General and Solutions Journalism Network.