California looks for a new generation of culturally sensitive health care workers
08/11/2013 12:00 AM
09/10/2013 8:31 AM
At 18, Tria Vue already has a world of experience in health care. For her Hmong parents, she's been translator, prescription drug dispenser, navigator, patient advocate and cultural broker.
After years of this, Vue has come to see the fallacy of Western medicine: the doctor-knows-best premise.
"When I heard about this new idea of patient-centered care, I got so excited," said Vue, a sophomore at California State University, Sacramento. "I was surprised to learn there's people in the health care field who care about patients."
Serving her family and community is key for Vue, one of two local students chosen for a scholarship to pursue a career in health care. The other area recipient of United Health Foundation's Diverse Scholars Initiative is Nancy Rivera, a UC Davis nutrition graduate who wants to become a doctor for the vast Latino population in the Central Valley.
This is the silver lining of the worsening doctor shortage – the opportunity to replace a wave of retiring physicians with a new generation of culturally attuned young professionals. In California, with its many underserved ethnic populations, the need for a multicultural health care workforce will be particularly great, as uninsured people sign up for health care coverage under the Affordable Care Act, experts say.
The surge of new patients will come as the California Academy of Family Physicians expects 30 percent of primary care doctors to retire in the next few years. The organization runs a program called Future Faces of Family Medicine, aiming to recruit low-income and ethnic minority youths into the medical profession.
Now is the time to amp up support and training of a diverse workforce to take the place of aging physicians, said Dr. Michael Rodriguez, a family physician and professor in UCLA's Department of Family Medicine.
"There's a particular need in the Central Valley, and we know that people who tend to be from those communities are most likely to return to them to serve. And they have the patients' perspectives, the patients' values in mind," Rodriguez said.
Vue, for one, knows how important it is to speak the language of patients – as well as be familiar with their cultural taboos. Some Hmong still hold onto traditional beliefs in a shaman's healing power.
Her father, like many Hmong, does not trust Western medicine. He had to be coaxed to a scheduled heart procedure with a "surprise doctor's appointment" arranged by Vue and a sister.
After the procedure, he was told to remove red meat from his diet, but the doctor's directive was not followed up with an explanation, she said.
"We're in an environment where the doctor is always right," Vue said. " 'You should do this,' they say. But they don't break down the information you need.
"When my father was told he shouldn't eat beef, he couldn't understand why. Why? What are the reasons? Are there other things we should ban after surgery so we don't upset our ancestors?"
Vue, who hopes to become a doctor, says she wants to hold onto and understand the Hmong culture as she comes to understand Western medicine. She will then serve as a bridge between both.
"I don't want to choose one culture over the other," she said. "By choosing the health field I'm choosing to be a mediator."
Gregory Mark, director of Asian American studies and professor of ethnic studies at Sacramento State, praised Vue. "She's so resourceful. She's such a very bright, hard worker that you can almost see that light bulb turning on in her brain.
"It's students like her that keep me going, that inspire me to teach."
Through a program Mark runs called the 65th Street Corridor Community Collaborative Project, Vue volunteers to tutor students in Oak Park – no matter their ethnicity. She also devotes her energies to helping build a Hmong American archive on the Sacramento State campus.
Mark said that when he took his students on a field trip to Oakland's Asian Health Services clinic, Vue spoke up to ask, "How can I do something like this for my community?"
According to the Association of American Medical Colleges, the number of multicultural health professionals is disproportionately low compared with the overall U.S. population.
Nationally, at least 15 percent of the population is Latino, yet only 5 percent of physicians and 4 percent of registered nurses are Latino. About 15 percent of the U.S. population is African American, compared with just 6 percent of doctors and 5 percent of registered nurses.
Federal research shows that when patients are seen by health professionals who share their background, they are apt to accept and adopt the medical treatment they receive.
"We know patients do best when they are treated by people who understand their language and culture," said Kate Rubin, president of United Health Foundation.
Rivera, the UC Davis graduate also granted a scholarship, is getting ready to apply for medical schools.
"As a bilingual and bicultural Latina, I look forward to connecting with my future patients and doing everything I can to help them live a better life," she said.
At 24, Rivera, too, has helped her parents access health care over the years. She's driven them to clinics to make sure they understand the outcomes of their appointments.
"I would say a language barrier and a cultural barrier definitely do exist," Rivera said. "There's definitely miscommunication there."
Rivera, whose hometown is Modesto, says her first choice as a future physician is to return to the Central Valley to serve the Latino population.
Her degree in nutrition science will be a plus, she hopes.
"I volunteered at clinics where a lot of our patients would come in with diabetes and high blood pressure," Rivera said. "I began to notice that the nutrition you follow really does dictate your health, especially in the Latino population with its culture of food."
Recruiting fresh talent such as Rivera is not just what the California Academy of Family Physicians wants – it's what the state of California desperately needs, said UCLA's Rodriguez.
"We know that there's a growing need for physicians in general," Rodriguez said. "And California, more than anywhere else in the nation, has such a disproportionate need for a health care workforce that more closely mirrors the population."
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