UCI May Have Prescription for Improving Latino Healthcare

The University of California has expanded medical school enrollment for the first time in about 25 years to accommodate a new UC Irvine program to improve Latino healthcare.

The Program in Medical Education for the Latino Community, launched over the summer with eight students, is believed by university officials and numerous medical associations to be the first of its kind in the country. The program is steeped in the premise that Latino patients will receive better medical care if the physicians treating them speak Spanish and understand the history, geography and cultures of Latin America.

In addition to receiving instruction in those areas, the students will be taught to develop leadership skills so they can press for healthcare reform. Besides the usual four years of medical school, the students will spend a year studying for master’s degrees in business administration or public health.

Graduates are expected to spend their careers working with Latino patients.

“If one of the students ends up being a cosmetic surgeon in Beverly Hills, I’d say we are failing there,” said Dr. Alberto Manetta, senior associate dean for educational affairs at UCI’s medical school and director of the initiative.

UC officials are considering the Irvine program as a model for the system’s four other medical schools to target other underserved populations.

Dr. Michael Drake, UC’s vice president of health affairs, acknowledged that immigrants and the poor have received short shrift in healthcare. “The problems are all of ours, and all of us ought to have the opportunity to find a solution.”

The need for such a program is clear. According to the 2000 census, Latinos make up about 12% of the national population, but only 5% of doctors are Latino, said Dr. Elena Rios, president of the National Hispanic Medical Assn.

Health experts say communication between doctor and patient can be difficult even when both speak English, so it is magnified when neither is fluent in the other’s language, or if a patient’s young child is translating.

Cultural differences add another barrier. How should a doctor deal with patients who believe illness is God’s will, or with grandmothers who insist on bringing six relatives to their appointments, or with people who rely on folk remedies?

Medical schools have tried to improve healthcare by training more minority doctors through affirmative-action programs. But since the passage of Proposition 209 in 1996, California state universities have been prohibited from considering applicants’ race in admission decisions.

The new program is focusing on how to better serve the Latino population rather than recruiting more Latino medical students. Three of the eight students are not Latino.

The program was funded with about $500,000 over two years from the California Endowment, a foundation that promotes healthcare for the underserved. Students attend school tuition-free. Manetta said that in several years the program might fold unless the state funded it.

Before they can enter the Latino program, students must be admitted to the medical school, not an easy task considering that 3,500 people apply for the annual 100 slots. Besides the two interviews that most medical applicants undergo, those hoping to get into the Latino program are grilled a third time, in Spanish.

Manetta said incoming students must have worked with the poor “because nothing will better predict the behavior of physicians than what they have done in the past. We’re not talking about going to Tibet for three weeks as a volunteer. We’re talking a significant effort on the applicant’s part that shows dedication to caring for the underserved.”

One student, Parker Duncan, worked for about seven years as a mental health counselor at a community clinic in San Francisco and spent two summers working in rural clinics in Ecuador.

Duncan, 36, said that when he read about the new UCI program, “my jaw jumped open, because this was what I wanted do anyway. I’ll have the support of the entire university rather than charting my own path.”

Another, Sarah Lopez, 25, had volunteered in the labor and delivery room at St. Joseph Hospital in Orange for a year, translating between medical workers and mothers. Lopez, who grew up in Santa Ana and received her bachelor’s degree at UCI, said she could empathize with the poor: Her grandmother treated her with folk remedies because medical care was too expensive.

Students begin the program the summer before medical school starts by attending six weeks of school in Cuernavaca, about an hour’s drive south of Mexico City, to improve their Spanish and study Latin America. They spend mornings following a Mexican doctor or community health worker.

Back at UCI, their training is nearly the same as that of their classmates, with some courses modified to emphasize Latino care. For instance, when UCI medical students practice on people who are trained to act as patients, the medical students in the Latino program will be assigned many more Latino “patients” than other students.

When third-year students start seeing real patients, the Latino health group will spend more time in hospitals that treat a larger number of Latino patients and also work in a border town hospital. The students also will spend more time studying diseases that occur more often among Latinos, such as diabetes. Special lectures will address nonmedical factors they may encounter, such as the legal rights of relatives of undocumented workers.

“I would dare to say 99.9% of physicians in California don’t understand that,” said Manetta, who immigrated from Argentina.

Other UC medical schools are considering similar programs to help medical students better treat blacks, agricultural workers and the homeless, Manetta and Drake said.

“It’s very obvious to me that any type of healthcare goals the state or nation could have cannot be achieved if you leave behind a very large section of the population,” Manetta said.