QUESTIONS AND ANSWERS

2005 Champions of Health Professions Diversity Award Honorees

Elia V. Gallardo, Esq.

Q: How do community clinics provide effective care for underserved populations?

A: Community clinics grew out of the civil rights movement in the 1960s to address the lack of equity in the health care system between those who had money and access to health care, and those who were poor and did not. The ability to pay often fell along ethnic and racial lines. Community clinics provide health care at a very grassroots level. They are the first to respond to the changing demographics of a community by providing new immigrants access to health care. Increasing access is more than language translation. For example, at one of our clinics, “cultural mediators” are included as part of the medical team. The mediators give input when diagnoses are being discussed, and help negotiate differences in cultural norms—helping patients with something as simple as being on time for an appointment to the more complicated process of filling out the forms.

Q: What are some of the rewards of your work?

A: Before I came to work at California Primary Care Association, I was privileged to work with some amazing women at the Organización en California de Líderes Campesinas to help them become promotores (health care promoters). These women had been on the front lines of the farmworker movement and worked side by side with Cesar Chavez. As the daughter of farmworkers, collaborating with these “adelitas” gave me a great sense of pride. Since coming to CPCA, a personal highlight was meeting a doctor at the first graduating class of the loan repayment program for culturally and linguistically competent physicians and dentists working in underserved areas, who without this program would not have been able to return to practice at a community clinic.

Q: In your opinion, which communities are hit the hardest by linguistic isolation and lack of diversity in the health workplace?

A: There are many new immigrants and refugees that have recently come to the United States who face enormous challenges. Immigrants from the indigenous cultures of the Mixtec and Zapotec of southern Mexico often do not speak English or Spanish, and because they are new communities, they have just begun to establish roots here. Often it is their child who has graduated from high school or college that becomes the new immigrants’ bridge to health care. I was that bridge for my parents, who were immigrants from Mexico and monolingual Spanish speakers.

Q: What keeps you motivated?

A: Health care access is a human right, and the fact that so many are uninsured is just wrong. Community clinics offer open access to anybody, regardless of ability to pay or immigration status. It’s truly easy to stay motivated when the vision and mission of the work I do are so in line with my own beliefs.

Sherry M. Hirota

Q: How did you realize linguistic and cultural competency were essential to providing quality health care?

A: When Asian Health Services started, there was a survey of the 40-block area surrounding Chinatown, which noted that language access and lack of insurance or affordability were key barriers to care. We heard almost-daily horror stories from our patients who went to the county hospital. We took these experiences and crafted an advocacy agenda to increase language access in the broader health care system and promote policies that would ensure language access rights were enforced and established.

Q: You have been a pioneer in creating a staff that reflects the face of the community. Was this intentional?

A: I'm really proud that early on, we recognized that, although we were principally dealing with a Chinese and Filipino population, the diversity of the population was growing. Korean, Vietnamese, and other Southeast-Asian populations were emerging, and there were no trained professionals (much less para-professionals) to serve them. Nobody's dispensable when it comes to health care, so we hired people from the community and trained them. Over time, we developed the community-help work-model program based on these para-professionals who had strong cultural competency and bilingual language skills. We couldn’t hire doctors in every language for every community we served, but we ensured that we had at least two full-time staff people in each language as liaisons to that community.

Q: What challenges have you faced in your efforts to promote workplace diversity?

A: There isn’t a ready pool of minority candidates, not just based on race and ethnicity, but on who comes from the underserved communities and whether they can really embrace and identify with the experiences of our typical patient. Another challenge has been trying to create career ladders for people we’ve taken in from the community. I’ve worked on developing a community health academy to get universities to recognize our work as an “on the job” program to give our community health workers academic credit, but it’s been tough.

Q: What can be done to incorporate more community health workers into the health system?

A: Community health workers have a really positive effect on health outcomes, which has been demonstrated by many studies showing that the doctor-patient encounter is unsatisfactory for most minority populations. If we recognize these workers as the liaisons who make our health system effective for the underserved, we need to acknowledge that with health care dollars. On the language access side, we don't recieve reimbursement for interpreter time. We need to recognize that without community health workers, health providers and the health system cannot be competent. A diverse California needs to really deal with this challenge.

Martin Waukazoo

Q: How did you first become involved in the community health movement?

A: I really got involved in the community health movement after spending some time with the problem of alcoholism. When I went into recovery, I came to the clinic. When I met the receptionist, it was the first time in my life that somebody treated me with respect. I applied for a job at the clinic and became the assistant director. When the executive director resigned abruptly, Dr. Gerald Hill, a young Indian physician, asked me if I would take the job. I said, no, because at that time, financially the organization was in bad shape. Dr. Hill and I sat down and I said, well, I’ll give it a shot, but I want you to help me. He said sure. I planned to only take it for six months. It’s been 24 years.

Q: What role do community health centers play?

A: A clinic is not just a health facility, it’s also a community center. If someone comes from Arizona, New Mexico or South Dakota, and they pull into the Greyhound bus station, the first question they’re going to ask is, where’s the clinic? The clinic is the heart of the community.

Q: Why do we need to have more Native American health professionals?

A: There’s more to health care than just physical healing. Having an RN who is educated in Western medicine and practices his or her traditions, increases the chances of a person getting well. And when that person get well, their family gets well, and then the community gets well. Healing doesn’t take place within individuals, it takes place within communities.

Q: What barriers or obstacles do you feel need to be overcome to increase the number of Native Americans in the health professions?

A: I think our barrier is probably ourselves. Within the community, we need to build role models. If we have a doctor and an RN who are Native American, children can look up to them and say: “I want to be a doctor” or “I want to be an RN.” Having said that, we’ve made substantial progress overcoming that barrier already.

Q: What would you say to young people looking to enter the health care field?

A: Young people have an enormous responsibility and an opportunity to change people’s lives. Don’t learn just about your culture, be thirsty about learning other cultures too. When you learn more about someone else, you connect with them. Make sure that every day that you walk on the street, you’re aware that you’ve got your niece or your nephew looking up to you or your little brother or your little sister. Make your parents and your grandparents proud. Make your people proud of you.