The television commercial shows two children and their parents perspiring fiercely under a hot sun, their faces creased with worry.
A narrator says living in a country without a Spanish-speaking doctor is like being alone in the middle of the desert. He offers a toll-free number that spells "my health" in Spanish, saying callers will be referred to Spanish-speaking doctors near their home or work.
The commercial is part of an agressive advertising campaign launched by Charter Suburban Hospital in Paramount that targets middle-class Latinos. The advertisement is one of three similar spots aired by the hospital on Spanish-language television and radio in Southern California.
The hospital, part of a nationwide chain, said its approach is based on marketing surveys that show Latinos are its best source of revenue. Targetting that market, hospital officials said, is one way of getting their share of the increasingly competitive $360-billion national health care industry.
Charter Suburban officials say their marketing campaign is backed by a complete bilingual-bicultural program--from Spanish-speaking doctors and a policy that requires future employees to be bilingual, to waiting rooms big enough to accommodate the traditionally large Latino families.
Other area hospitals are turning to similar strategies, ranging from merely advertising to establishing broader programs that include plans for a satellite clinic in predominantly Latino Huntington Park.
Although Latino health care advocates acknowledge that badly needed bilingual/bicultural services would be welcome and that some medical agencies have done a good job providing such services, some are skeptical of health care that is marketed the way beer, cigarettes and soft drinks are sold.
Ruth Rivera, a project director for the East Los Angeles Health Task Force, a nonprofit agency that provides free or low-cost health care for Latinos, said such advertising exploits the culture and that the added bicultural services "should have been part of any hospital's plan all along."
Hospital officials said the targetting of the Latino community is no different than what hospitals do when catering to a variety of conditions ranging from alcoholism to childbirth, from athletic injuries to eating disorders. Charter also has programs aimed at smokers, diabetics and the elderly.
Charter Suburban officials maintain that they are providing quality care that is sensitive to the Latino culture. The service, they said, also eliminates dangers they have encountered when doctors and patients don't speak the same language.
"We realized that we had to be more responsible to the community," Elliot A. Sainer, executive director of the hospital, said. "We're trying to reach the greatest number of people and hook them to people who speak their language and understand their culture. It's good for the patients, the hospital and the company."
Like Charter, St. Francis Hospital in Lynwood and Beverly Hospital in Montebello are targeting their Latino populations.
Beverly Hospital, for example, plans to run ads in Spanish-language newspapers while St. Francis will advertise on Spanish-speaking radio, television or through the mail next year, spokesmen for the hospitals said.
In addition to the advertising, St. Francis is recruiting bilingual doctors, nurses and emergency room staffs and will open a walk-in clinic in Huntington Park next year. It is also offering birthing classes in Spanish, said Ricardo M. Terrones, director of the hospital's ambulatory care service.
A telephone survey of hospitals in Bellflower, Compton, Long Beach, Whittier, Huntington Park, Lynwood and Montebello indicated bilingual/bicultural services are limited, with some hospitals posting signs and offering appointment cards and medical literature in two languages, providing physician referral and asking employees who speak another language to serve as translators.
Charter Suburban, formerly known as Paramount General, was built in 1971 by 11 doctors, some Latino, who wanted to serve that area. In 1980, the hospital was leased to the Charter Medical Corp., based in Macon, Ga., which operates 64 hospitals nationwide, including six in Los Angeles County.
In April, Charter Suburban decided to go fully bilingual and bicultural when an extensive marketing survey showed there are sufficient Latinos with public or private insurance to keep the hospital profitable through the turn of the century.
In April it began a 13-week ad campaign aimed at middle-class Latinos, appealing to values that give priority to the family and its security and health. Some of the advertising depicts well-dressed Latinos in attractive homes, and is placed on billboards, in Spanish-language newspapers and featured in 30,000 direct mail brochures.
The campaign, hospital officials said, is working.
The toll-free number that refers people to doctors in their area, for example, has resulted in about 250 calls a week. Of that number, from 75% to 80% are keeping appointments, said Laura Schuck, assistant director of program development for the hospital. She said the campaign and the free physician referral service will, in the long-run, increase admissions for the hospital through favorable publicity.
The hospital pinpointed its target after conducting a yearlong study of the 10-mile radius it serves, including Paramount, Artesia, Bellflower, Cerritos, Downey, Compton, Hawaiian Gardens, Lakewood, Lynwood, Norwalk, La Mirada, North Long Beach and Cypress, Schuck said.
The hospital's marketing study found that Latinos in its area tend to be two-parent households with at least one person working, yielding "financially solid" patients with insurance, Schuck said. In both Los Angeles and Orange counties, the median income of Latino families is $15,000 to $20,000 and "that's a pretty good draw for the hospital," she said.
According to the marketing study, Latinos make up nearly 25%--2.7 million--of the 11.3 million residents in the county. By 1990 they will exceed 3.5 million.
At Charter Suburban, about 40% of the 4,500 patients admitted each year are Latino, said Becky Barney-Villano, hospital public relations director. She said 30 of the hospital's 200 doctors and 12 of its 100 nurses are bilingual, many of whom have been on the staff since the hospital was founded.
As part of its new program, the hospital is requiring new employees to be bilingual, has printed its forms and medical literature in English and Spanish and plans to offer Spanish language classes for problems such as alcoholism, smoking or drug abuse.
The hospital has also posted hospital signs in the two languages, even labeling the linen hampers.
Schuck said the hospital wanted to provide "facilities and physicians who spoke the language so that Hispanic patients could talk to them without a translator and feel comfortable and wanted."
Spanish-speaking doctors are in such demand that people surveyed said they were traveling as far as Tijuana to find a doctor who speaks their language, she said.
Studies compiled by the UCLA Spanish Speaking Mental Health Research Center from 1971 to 1983 bear out Charter's conclusions.
The studies call for bilingual/bicultural services in the county and nationwide, saying medical institutions have historically neglected Latino communities. The studies stress the importance of removing language barriers so patients can accurately describe ailments and medical histories, and doctors can correctly explain illnesses and prescribe treatment.
They also recommend bilingual staffs, awareness of cultural values, ethnic menus and trained translators, as well as going to the root of the problem by making greater efforts to place minorities at medical schools and other training institutions.
During a recent visit to Charter Suburban, patients appeared to be happy with the program.
To Maria Rodriguez, 23, and Martin O'Neill, 52, who are under the care of Dr. Camilo Jorge at Charter Suburban, a Spanish-speaking doctor meant they could feel at ease.
"I can tell him how I feel and he can tell me what's wrong and what needs to be done," said Rodriguez, who was told she had a thyroid tumor during a recent hospital stay.
But the doctor calmed her, gently explaining in Spanish that her tumor wasn't cancerous and could be treated.
O'Neill, who is Puerto Rican, is suffering from a pancreatic illness. He said that though he speaks English he would rather have a Spanish-speaking doctor because communication "seems better" and "there are American doctors who don't understand our ways."
Jorge, a staff physician, cited several problems he has encountered because English-speaking doctors could not communicate with their Spanish-speaking patients:
- Women on birth control pills who did not know they must stop taking the pill at intervals for menstruation to occur. When they don't stop taking the pill and as a result don't menstruate, they think they are pregnant.
- Others on the pill who also misunderstand the directions, but the error for them resulted in pregnancy.
- Mothers who fed suppositories to their babies or did not give medicine in the correct dose or at the the appropriate time.
- Patients who have gone to three or four doctors trying to explain what's wrong with them but were never understood.
The UCLA studies and other physicians interviewed confirm that using translators can be a poor alternative to a fully bilingual staff because translators often hamper the relationship between a patient and his doctor or nurse.
Untrained translators such as receptionists, janitors or cooks working at the hospital may be ineffective because they speak different Spanish dialects or do not know medical terms, said Dr. Robert Lange, an internist and medical director for La Clinica Familiar del Barrio, a private, nonprofit agency offering low-cost care in East Los Angeles.
He said the more Spanish he learned, "the clearer it became that there was a great deal lost in the translation."
Other problems occur because cultural values are not understood.
Some doctors prescribe chemotherapy treatment without first discussing the cost and often, Latino patients will accept only what they can pay for. When they run out of money, they discontinue the treatments, risking their lives, said Susana Arellano, interim director of the East Los Angeles Task Force.
The East Los Angeles Task Force and La Clinica Familiar del Barrio in East Los Angeles are nonprofit agencies that provide free or low-cost care and were established in that predominantly Latino community in 1969 because medical institutions were ignoring the population, said Castulo de la Rocha, executive director of La Clinica Familiar del Barrio.
Now, clinics and hospitals are reaching out to Latinos, de la Rocha said, "not out of the goodness of their hearts, but because it's part of that $360-billion health care industry." Appealing to Latinos "worked with the grocery chains. They took dollars out of the community, but what will they put back in?" said Arellano, asking whether the hospital would use some of its profits to pay for indigent care, transportation to the hospital, free inoculations or other services.
De la Rocha and Arellano are among several Latino health care critics who question the sincerity of advertising aimed at Latinos and warn patients to consider the quality of care and the medical institution's reputation above any other factor.
The Latino health care directors say they have seen other health care facilities, particularly clinics, fall short of their bilingual/bicultural promises and fear that hospitals jumping into the Latino health care market may fall into the same pattern.
Chuck Martinez, director of family planning and development at La Clinica Familiar, echoed de la Rocha, saying patients have complained that bilingual services offered by some clinics merely consisted of care from nurse practitioners and assistants.
The advocates also worry that poor people, attracted by the advertising but who do not have insurance or cannot pay for care, will not be served.
Private hospitals are increasingly dumping more poor patients to other clinics or county hospitals to avoid bearing the financial losses and are accepting fewer of those who have Medi-Cal or Medicare, said Carol Emmott, executive director of the California Assn. of Public Hospitals.
Charter Suburban serves Medi-Cal and Medicare patients and refers poor people to county hospitals, but it still loses a "substantial" amount treating indigents, said Lenore Cullman, associate administrator for patient care services.
In its bid for Latino patients, Charter Suburban said it is offering some services that aren't available from other hospitals in the area.
In addition to the physician referral service, it is offering free transportation to callers, picking them up and taking them to doctors in their areas, and has hired Paramount activist Catherine Sena as its community relations director to recruit bilingual hospital volunteers.
Charter's services, Sena said, means "Hispanics will now be able to communicate in their own language and be able to see familiar brown faces at a hospital in their own neighborhood."
In turn, she said, the hospital has tapped a valuable market.