Resources strive to narrow minority health disparities

Music is medicine in Mexico, Claudia Aguilar said.

“They don’t think that they’re exercising. They’re just having fun,” the Mexican native said.

Aguilar regularly teaches dance and Zumba classes, which can include salsa and bachata, at the Jones Center in Springdale and at Tyson plants on employees’ lunch breaks. She occasionally leads classes at the University of Arkansas and Crystal Bridges Museum of American Art.

Angela Garza, 33, takes Aguilar’s Zumba class twice a week. Garza had a gym membership, but let it expire because the classes are more fun, she said.

Luisa Espinoza is a personal trainer at the Jones Center and regularly speaks to her clients in Spanish, she said. Espinoza, who is also from Mexico, said some of her clients have a difficult time understanding other instructors or knowing how to ask questions in English.

Local health leaders say Aguilar and Espinoza are part of a regional effort to close the cultural and language gaps contributing to health issues among racial and ethnic minorities.

“Minorities are disproportionately impacted for almost all chronic diseases,” said ShaRhonda Love, executive director at the Arkansas Minority Health Commission. Minority groups have higher rates of heart disease and cancer, for example, she said.

Increasing the diversity and cultural competence of the health care workers are recommendations of a study recently released by the commission. Cultural competence is an awareness of cultural differences and the ability to communicate with people with those differences.

The commission works to make sure all racial and ethnic minorities have access to health care; to find ways to educate the state’s minority residents; and to address, treat and prevent diseases and conditions prevalent among minority populations.

Cultural competence is important for health care workers, Love said. Patients of color may not feel comfortable asking doctors questions, and doctors sometimes don’t take into account cultural norms when talking with patients, she said.

Love gave an example of a patient whose doctor told him not to eat red meat. He thought he was following doctor’s orders by always cooking steak until it was well done.

Dr. Jordan Powers, a University of Arkansas for Medical Sciences internal medicine resident, said Marshallese patients would sometimes nod in agreement than say they don’t understand something or ask questions.

“It’s important to take the time to make sure they understand what you’re telling them to do and that they understand why you want them to do it,” she said.

Clinical help

UAMS has a free clinic at its Northwest campus on North Street in Fayetteville for Marshallese patients. The clinic mostly provides preventative care and helps patients manage chronic diseases, especially diabetes, Powers said.

The clinic averaged about 119 patient visits a month from September to June, according to data from UAMS Northwest.

The clinic staff focuses on education such as explaining foods such as rice or ramen, both common in a traditional Marshallese diet, aren’t helpful in preventing or managing diabetes. Between 40 and 50 percent of Marshallese adults in Northwest Arkansas has diabetes or are on the verge of developing diabetes, Bonnie Faitak of UAMS Northwest said.

The clinic also has visual representations showing what healthy portion sizes are and sometimes offers free diabetes screenings at Tyson plants and Marshallese churches, Powers said.

The Northwest campus is also home to the Center for Pacific Islander Health, a research program designed to decrease health disparities and develop culturally sensitive approaches to education and treatment.

Community Clinic, a nonprofit group, has also targeted Marshallese patients. Community Clinic has 13 clinics, including six clinics based at schools, in Northwest Arkansas and sees patients regardless of their ability to pay.

The clinic sees 37,500 patients a year, and more than half speak a language other than English, said Kathy Grisham, executive director of Community Clinic. Fifty-three percent of patients are Hispanic, 8% are Marshallese and 1% are black. The clinics have some providers and several staff members who are bilingual and can help interpret, said Amanda Echegoyen, chief operating officer at Community Clinic.

“We hire from the community that we serve,” she said.

Access

Areas where racial and ethnic minorities live, work and play also tend to have fewer safe places to walk outside and fewer grocery stores, Love said.

Black and Hispanic people in the United States make less money on average than non-Hispanic white people, according to the U.S. Census Bureau. Black residents’ median household incomes in 2017 were about 59% of white residents’ median household incomes, and Hispanic residents’ incomes were about 74% of white residents’ incomes.

“They may have access to health insurance, but if they don’t have a vehicle to drive, then having insurance doesn’t benefit them,” she said.

While 92-93% of non-Hispanic white people in the state had health insurance, 74% of Hispanic people did, according to the Minority Health Commission study.

Likewise, Echegoyen said some people without transportation or not enough money for nutritious food are more likely to walk to a nearby convenience store and buy junk food.

Grisham and Echegoyen said minority patients have higher rates of diabetes and hypertension because of a lack of access to healthy food and sometimes a lack of knowledge of good nutrition.

A traditional Hispanic diet, for example, includes lots of carbohydrates and meat. Echegoyen said the clinic once saw a patient who was told to cut tortillas out of her diet to manage her diabetes. Her health hadn’t improved after a few follow-up visits. The doctor found she replaced tortillas with rice, another carbohydrate.

People in the Marshall Islands don’t have access to a large supply of fresh vegetables. A traditional Marshallese diet isn’t heavy in vegetables, so a doctor telling a Marshallese patient to eat more vegetables isn’t enough, Echegoyen said. Medical professionals have to be careful to teach patients what to replace unhealthy options with and how to prepare healthy foods. Community Clinic has nutritionists on staff.

Bridging the gap

Hospitals in Northwest Arkansas have different ways of serving patients from different minority groups, officials said.

Taylor Kelamis, a nurse practitioner, recently stood in front of an iPad inside Mercy’s Springdale clinic. Within a minute of selecting “Spanish,” a woman appeared on the screen and said she would be her interpreter that day.

Mercy can access interpreters for 200 languages through this service, LanguageLine Solutions, so patients who don’t speak English can speak to their doctor or nurse. Kelamis also speaks Spanish, and the clinic has three native Spanish speakers.

One of those speakers, Larixa Gonzalez is originally from El Salvador and is a certified medical assistant. She said she finds herself interpreting for Spanish-speaking patients almost every day. Patients’ Spanish can vary depending on where they’re from and can differ from textbook Spanish. An interpreter can help patients effectively communicate their symptoms to their doctors and fully understand what their doctors are telling them, Gonzalez said.

Washington Regional Medical Center also offers interpreter services through CyraCom, which allows the medical staff, patient and interpreter to communicate via phone, said Cynthia Crowder, spokeswoman. Washington Regional’s HerHealth Clinic also provides appointments later in the day to accommodate more Marshallese women. Being punctual isno’t as important in Marshallese culture, and Marshallese patients often don’t want morning appointments, Crowder said. HerHealth also educates staff on best communication, including understanding family structure.

Northwest Health offers interpreters for patients who don’t speak English and has community outreach programs to target minority groups, said Beth Wright, spokeswoman. For example, the hospital has sponsored free diabetes screenings during November, Diabetes Awareness Month, and targeted black and Hispanic communities because they are at higher risk for diabetes.

Hospital leaders also regularly meet with Marshallese community leaders with a goal of improving health care, she said.

“Most recent initiatives have included discussion about a Marshallese-focused job fair as well as incorporating Marshallese culture education into new staff orientation and the annual orientation with current staff,” Wright said.

Arkansas Children’s Northwest hospital in Springdale employs Spanish and Marshallese interpreters and has several bilingual staff members, spokeswoman Christina Schell wrote in an email.

“We are planning to focus more efforts on the recruitment of minority/bilingual staff to better meet the needs of our minority patients,” she wrote.

Diverse workforce

A diverse health care workforce reflecting the population’s demographics can help mitigate disparities among underrepresented groups, a medical school official said.

The University of Arkansas for Medical Sciences has a Center for Diversity Affairs, which focuses on recruiting racial and ethnic minority students, among other tasks. Brian Gittens, vice chancellor for diversity, equity and inclusion, said UAMS wants to help create that diverse workforce.

The state’s medical school is based in Little Rock and has a Northwest campus in Fayetteville. Andrea Peel, UAMS spokeswoman, explained students begin medical school in Little Rock but may later transfer to the Northwest campus for some programs.

The school recruits from historically black colleges in the state, such as Shorter College, the University of Arkansas at Pine Bluff, Philander Smith College and Arkansas Baptist College, Gittens said.

The school also has several programs intended to get kids interested in health care targeting girls and underrepresented racial minority groups. The junior science, technology, engineering and mathematics academy is a two-week program for students in kindergarten through sixth-grade at the main UAMS campus in Little Rock. About 90% of applicants in 2018 were black.

Northwest Arkansas Community College has health profession programs including nursing, emergency medical services, radiologic imaging services, health information management, dental assistant, respiratory therapist, physical therapist assistant, certified nursing assistant and patient care assistant.

Each program may choose to give extra points on students’ applications to admit more students of underrepresented groups, which can include race and gender, said Mark Wallenmeyer, dean of health professions.

The University of Arkansas’ College of Education and Health Professions doesn’t specifically try to recruit minority students, but the college is included in the university’s overall effort to do so, said Shannon Magsam, spokeswoman for the college.

Suzanne McCray,, vice provost for enrollment and dean of admissions, said minority recruitment is a priority for the university.

“We are energetically investing in this area. In admissions, we have created a team to recruit in the Delta and to focus on diverse communities throughout Arkansas,” she wrote in an email.