Spanish as a Tool for Equity and Inclusion. Interview with Entrevista con Kristine M. Healy

Claudia Muñoz Cano
“With medical Spanish, we try to train students to live and work in a different world, to embrace the concepts of diversity, equity, and inclusion,” expresses Kristine M. Healy, professor emerita at Northwestern University Feinberg School of Medicine in Chicago, USA. Interviewed, she recounts her professional and personal experience with Spanish and details UNAM’s academic relevance in this project, in a city where almost 30% of the population consider themselves of Hispanic or Latinx origin, and where our language has become a fundamental tool for the development of specialties dedicated to service, especially in the medical field.

Claudia Muñoz Cano: How did you come into contact with the Spanish language?
Kristine M. Healy: Before I begin my story, it’s important to know that, in Chicago, the largest community within 30% of Latinos, considers itself Mexican or of Mexican-American descent. Providing future health professionals with language skills to care for this population is of vital importance. Collaborating with UNAM’s teachers and their connections to Mexico is certainly helpful. That is why I value today what I learned many years ago.

I studied Spanish for five years in the late 1960s. It was the time of the Chicano movement, mostly in California, and also of social justice movements, including agricultural workers’ rights movements. We were fortunate that community leaders from Texas or California whose first language was Spanish came from time to time.

Subsequently, I decided to apply as a physician assistant for a school. Since I was familiar with the United Farm Workers and their clinics, I volunteered at one located in Salinas, California. There I began interpreting for doctors who did not speak Spanish and for Spanish-speaking patients.

CMC: How was this first meeting with Spanish-speaking patients?
KMH: It was very difficult. My language skills, limited; my vocabulary, too. I surely didn’t know much about medicine. And I did not know what it was like to be a farmer, as my patients were. At the same time, this language immersion jump started my real learning in every way as I tried to communicate with people whose first or only language was Spanish. I was very lucky because the same farmers I worked for were very supportive.

Some people had work experiences that were unfamiliar to me, so understanding that language, just learning about people’s lives, was critical to their medical care. I tried to learn more about their symptoms, background, and family. That work at the Salinas clinic helped me become a more effective speaker and interpreter: someone who was able to understand some of the nuances of language.

After gaining some additional experience in clinics, I was accepted into a medical assistance school. I always wanted to work in community healthcare, especially in primary care in family medicine. I wanted to use my language skills to provide some service to people whose first language was Spanish, and I found a job in the Department of Family Medicine at Cook County Hospital here in Chicago. That was the only department at that time that had clinics in the communities. It was located in a neighborhood called Little Village or La Villita where almost everyone, except the doctors, came from the Mexican, Latino, or Mexican-American community. Spanish was the first language of everyone there. Staff members helped me understand some of the cultural aspects of medical care. Luckily, I was able to build my work on my own professional and cultural foundations, and I had excellent teachers, not only my colleagues but also my patients.

Eventually, I became a faculty member in the Physician Associate Program. I worked in different areas, always with Spanish-speaking patients, specifically at the Illinois Health Education Center which had funds to teach Spanish classes for health professionals.

We met with groups of medical students, residents, and Physician Associate Program students in a variety of settings. A special place in that regard was the Rudy Lozano Branch Library in Pilsen, Chicago. There we help people practice their Spanish, learn specific vocabulary, introduce themselves to patients, and, most importantly, know when to ask for an interpreter.

Besides language instruction, we also included what we called our cultural corner, visiting agricultural community organizations and other places to immerse them a bit in what we had at Pilsen.

CMC: Why is it important to know the culture and practices of your patients?
KMH: The literature calls it​​ patient-centered care, which means understanding who they are and what their beliefs are. If it were a person with traditional ideas about health, they might tell me that they use a particular herb or treatment that I am not familiar with. So I would have to ask: What is that, how do you use it, what effects do you expect it to have? Those are the kinds of questions we should ask all of our patients, even if they speak English because we would want to address their concerns and not just provide our impressions. That is why it is important to be able to talk with them in their language. Some of these principles are called​​ social determinants of health and involve understanding who people are, what is relevant to them, who is important to them, how they manage their lives, how they attend to their medical problems, and others, beyond the time they are in the clinic with me. I would like to better understand how certain issues affect them, and what they do to take care of themselves. This is very difficult to achieve without a good knowledge of the patient’s primary language. For a patient-centered physician, it clearly is best to have language skills that allow for a better understanding of the patient.

CMC: How did you transfer all this experience to the classroom?
KMH: Eleven years at the health center allowed me to develop my language skills. I even taught antenatal classes, basic life support, and other community activities, all in Spanish. These opened the door to many other ways of getting involved and helping to meet the needs of that community.

Before my current position, I was teaching in the Physician Associate Program in two other initiatives in the Chicago area that did not include Spanish courses. At the end of each one, I invited the students to the clinic to observe the interactions with the patients. I especially encouraged students who had some knowledge of Spanish but were not fluent. I like to think that this served as both an introduction and motivation to continue improving their language skills and knowledge, and that it is also a key to finding employment.

In Northwestern’s Physician Associate Program, medical Spanish was a required first-year course. One day I found that they were recruiting volunteers to perform as patients so that the students could practice their Spanish. I offered to participate and that is when we contacted UNAM. Since then we are very grateful to this great institution for their attention to our curriculum requirements, but most of all to the needs of our students.

CMC: What is your perception of the impact of the collaboration between the Northwestern University Physician Associate Program and UNAM on the Spanish proficiency of your students?
KMH: There are people with different levels of Spanish proficiency. So my expectation for students who have no experience with the language is that they will see the value in learning a tool that will benefit their patients.

We collect a lot of information from our second-year students. They keep a record of their patients that includes language-related questions such as: “How many of my patients speak Spanish? What was I able to do? Did I contact an interpreter or not?” When we review this data, we can see the impact of our course. 
If students ask me how to improve their language skills, I encourage them to develop interest and motivation and to seek out opportunities to speak and understand; to take additional classes, or learn it directly from their bilingual patients and colleagues.

Our course lasts approximately 14 weeks with two hours per week. UNAM colleagues evaluate students’ Spanish language skills before assigning them to a group. For many, our course is their first introduction to the language. The course levels focus on appropriate language and vocabulary to help them be prepared during interactions with Spanish-speaking patients. We help them develop cultural awareness. Even native and heritage Spanish speakers may not have been exposed to the medical vocabulary or the formality of language that the medical context requires. At each level, with the instruction of UNAM teachers, students can gradually build and develop their linguistic and cultural skills.

Because we have students with a variety of linguistic abilities, we also recognize that, especially for those who are more advanced or who may be native speakers themselves, it is important to expose them to Spanish speakers with other heritages, e. g., South American, Central American, or Caribbean.

Another advantage of working with UNAM has been that, as we have diversified our enrollment, our needs for levels of medical Spanish have increased. We now have advanced-level groups, which is very important to us because, in the last few years, we have recruited native Spanish speakers from different places, such as Guatemala and Colombia; people of Mexican-American descent from Chicago; and a student from Spain. UNAM has been a great help because of its experienced professors, who work with our students at these different levels.

CMC: Taking into account the forecast of the United States being in 2060 the country with the second-largest number of Spanish speakers in the world, how do you see the future of your profession?
KMH: We are preparing students from many heritages and experiences to be culturally and linguistically sensitive. We are wonderfully pleased with the number of students of Latino, Latinx and Hispanic heritage in our classrooms. What is really important is that people become members of professions that represent and care for the diversity that exists in the city of Chicago or the United States as a whole.
Kristine M. Healy is Assistant Professor Emerita of Medical Education in the Physician Assistant Program at Northwestern University Feinberg School of Medicine in Chicago, USA. 

Claudia Muñoz Cano is head of the Spanish Department at UNAM Chicago.
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