Cultural Competency – Key to Health Services for California’s Immigrant Communities
 any U.S. immigrants face serious obstacles in accessing quality health care. Throughout the immigration and acculturation process, they encounter linguistic, economic and social barriers such as limited English proficiency, a lack of financial resources and a shortage of culturally competent providers.
 “Through the experiences of our grantees, we see numerous examples that demonstrate the critical need for cultural understanding in order to grasp the particular health promotion and disease prevention needs of diverse immigrant communities,” said Gary L. Yates, president and CEO of The California Wellness Foundation (TCWF). “One emerging strategy to increase access to health care for these populations is providing grants to organizations that provide culturally and linguistically appropriate health and human services that incorporate the traditions and values held by these groups.”
TCWF has provided core operating support grants to many organizations that address the health needs of traditionally underserved populations. The following are several examples of agencies that are providing culturally competent health and human services to diverse immigrant communities throughout Southern California.
The Cambodian Family
The Minnie Street neighborhood of Santa Ana became the new home to several thousand Cambodian refugees in the early 1980s. The densely populated neighborhood suffers from high rates of crime, poverty and unemployment.
In 1990, The Cambodian Family established an after-school youth program in response to an increasing Cambodian and Latino gang presence in the area. TCWF awarded the organization a three-year, $150,000 grant in March 2004 for its after-school program serving at-risk Cambodian and Latino youth.
According to Sundaram Rama, The Cambodian Family youth program coordinator, the “Plan Ahead” youth program has been an effective vehicle for bridging the Cambodian and Latino communities. Program staff has found that both of these communities face many of the same challenges, including lack of education, limited English-language skills and a poor understanding of educational and career opportunities.
“Our program gives our neighborhood youth a safe place to go after school, where our bilingual staff tutor and mentor them, teach them new skills, help them build dreams for the future, and support them in achieving their potential,” Rama said. “Without our help, encouragement and support, their risk factors would increase, contributing to increased rates of high school dropout, teen pregnancy, teen marriages, gang violence, substance abuse and teen runaways.”
The grant has also helped The Cambodian Family sustain the operation of its academic, leadership and career exploration activities. Academic programming includes tutoring, homework assistance, study skills and a computer lab with Internet access, while the leadership institute offers life skills classes, Cambodian traditional dance, karate, arts and crafts, community service activities and a youth leadership club. Additionally, career advancement opportunities are offered in areas such as writing a résumé, getting a part-time job and applying for college, financial aid and scholarships. Other activities include career workshops and field trips to local colleges.
TCWF’s funding has also helped the program encourage parental involvement. They schedule monthly parent meetings that offer health education, job counseling and help for non-English-speaking parents to talk with personnel at their children’s schools. Other parent-focused services include assistance with parenting skills such as discipline and communication with youth. Counseling and referrals are also available.
“Organizations like The Cambodian Family address the multifaceted needs of immigrant communities,” said Nicole J. Jones, TCWF program director. “By developing youth capacity to avoid negative influences and empowering parents to make good choices for their children while honoring and celebrating their culture and traditions, healthier and safer neighborhoods are ensured for all residents.”
Thai Community Development Center
Thai immigrants in Los Angeles represent a rapidly growing community with unmet needs. Unlike many Cambodian families who came to the United States fleeing war at home, few Thai immigrants are considered refugees by the U.S. government. A large segment of Thais without legal status do not qualify for public benefits or services. Often living on the margins, many are part of the underground economic workforce, vulnerable to abuse and exploitation.
For the past 11 years, the Thai Community Development Center (Thai CDC) has been working on behalf of low-income Thai immigrants in Los Angeles County. In December 2002, TCWF awarded Thai CDC a three-year, $155,000 grant to sustain health education, prevention awareness and provision of affordable health care in this community.
“Our initial data, observations and experience from working with poor Thai immigrants have shown the unsettling fact that they are at great medical risk because they cannot access health care due to language and cultural barriers, religious beliefs and practices, lack of health insurance, cost of medications, and poor and unsafe working conditions,” said Chanchanit Martorell, Thai CDC executive director.
 In April 2004, Thai CDC produced a comprehensive study on the health status of this population titled “Healthcare on the Margins.” Its findings showed that nearly 50 percent of Thais use an interpreter during their doctor visits. It also found that 40 percent of Thai immigrants do not have a regular source of health care, compared with 19 percent of the general county population.
The report and its findings have helped Thai CDC develop strategies for improving access to care and promoting responsible health behavior to immigrants, including tailored health education programs that incorporate occupational safety and health training.
Thai CDC also operates a community health leadership program. It has fostered hundreds of participants to become health advocates by developing their technical health knowledge and leadership skills to educate family members, friends, co-workers and community members about disease prevention, chronic illnesses, access to care and other critical health issues.
Given the limited pool of qualified and trained Thai candidates for jobs in the health sector, this leadership program will emphasize opportunities for community leaders to assume careers in health professions in the near future.
Additionally, Thai CDC’s annual health fairs have become a signature event in the East Hollywood community. For the past five years, they have offered health screenings, referrals and other services from more than 40 different health providers and exhibitors.
“Organizations like Thai CDC help close the gap in access to health care for medically indigent populations,” said Sandra Martínez, TCWF program director. “By providing culturally appropriate health services to an underserved population, they are making enormous strides to improve the health of an often overlooked immigrant community.”
Clinica Monsignor Oscar A. Romero
 Clinica Monsignor Oscar A. Romero (Clinica Romero) began providing services in 1983 when a coalition of Salvadoran refugees and volunteer physicians established a free clinic to address the lack of health services available to immigrants in Los Angeles.
“Too often, immigrant populations become invisible. They don’t see dentists or visit doctors for regular physicals,” said David A. Román, development associate at Clinica Romero. “Our patients perceive health care professionals as belonging to different socio- economic strata, and therefore, seeking services places them outside of their comfort zone. This is especially true when the health care professionals or their support staff are from different cultures.”
In December 2002, TCWF awarded Clinica Romero a three-year, $150,000 grant to provide preventive health services to the low-income immigrant communities in the Pico-Union/Westlake areas of Los Angeles.
According to Román, most of the clinic’s patients are first-generation immigrants who speak a language other than English and are employed in low-wage service industries that do not offer health insurance benefits.
In addition to serving Spanish-speaking immigrants, Clinica Romero also serves a small but growing number of Korean and Mayan populations in the community. It is only one of two community clinics in California that provides culturally appropriate services to the approximately 80,000 indigenous Mayans residing in Los Angeles.
With a staff that speaks the same languages and shares the same customs as their patients, Clinica Romero provides medical, dental, mental health and health education services to approximately 1,000 patients a week. Many of its employees were former patients, bringing a tacit knowledge of the immigrant experience to the workplace.
“Clinica Romero provides a crucial health service to immigrant communities in Los Angeles,” said TCWF’s Martínez. “Thousands of individuals and families — many with no alternative source of health insurance due to poverty or legal status — consider this clinic their medical home.”
TCWF’s grant has been used to strengthen Clinica Romero’s administrative infrastructure. Román said that securing funding for key administrative positions has brought greater stability to the organization and has enabled staff to better concentrate on their job functions.
In addition to opening a full-time site in East Los Angeles last year, Clinica Romero has recently expanded operations at its Alvarado site to improve efficiency of patient flow. These renovations include four new examination rooms, three new mental health counseling rooms, a health education station, a designated room for administering immunizations, a soon-to-be-completed prenatal waiting room and the addition of a dispensary, a staff pharmacist and pharmacy clerks.
Information about the organizations in this article can be found at:
The Cambodian Family
(714) 571-1966
Thai Community Development Center
www.thaicdc.org
Clinica Monsignor Oscar A. Romero
www.clinicaromero.com |
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