Hispanic-Centered Healthcare: Creating a Bilingual, Culturally Competent Pharmacy Workforce

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According to a 2013 Pew Research Center survey, approximately 48 percent of the 38.7 million Hispanic adults living in the United States have limited English proficiency (LEP). Yet many pharmacies lack the bilingual staff and resources necessary to properly serve Spanish speakers.

Not surprisingly, this type of language barrier can have dire consequences for patients. Misinterpretations between pharmacy staff and LEP clients have led to documented cases of misdiagnoses, improper drug use, and serious harm to some patients — as well as malpractice suits against the pharmacists involved.

Despite these dangers, many schools of pharmacy appear to be doing little to create a more robust bilingual workforce: A 2016 study by Wingate University found that only 22 out of 61 schools surveyed offered courses in medical Spanish — with many reporting difficulty hiring qualified instructors and finding room in the curriculum to offer such classes. However, some institutions have committed the necessary resources for creating unique and innovative pharmacy programs focused on Spanish language and culture, effectively preparing future pharmacists to serve America’s largest minority population.

[Above: Students in BU College of Pharmacy and Health Sciences’ Medical Spanish program participate in the 2015-2016 cultural immersion trip to Costa Rica.]

Butler University College of Pharmacy and Health Sciences
In 2003, the Indiana State Department of Health announced a new objective to “promote a culturally and linguistically competent system of healthcare” in order to reduce health disparities for the state’s growing Hispanic population. In response, Butler University (BU) College of Pharmacy and Health Sciences in Indianapolis initially added an introductory medical Spanish course to its PharmD curriculum.

Gala Kennedy
Gala Kennedy

“The idea was to introduce students to medical and health terminology in Spanish, … but the class became so popular that we added an advanced course, and the program just progressed from there,” says Gala Kennedy, a Spanish professor at the school. Today, the college offers electives in introductory and advanced medical Spanish as well as a service-learning course in Hispanic healthcare. PharmD students now have the option to specialize in this area through the Medical Spanish emphasis, which includes rotations in Spanish-speaking clinics and an overseas immersion trip in addition to three core classes.

“The Medical Spanish program is designed to help students broaden their knowledge of Hispanic culture while advancing their fluency and grammar,” says Kennedy, adding that students entering the program must have previous coursework in Spanish. “All the students need to be able to speak the language — not perfectly, but enough so that they can communicate with the class.”

Students on the Medical Spanish track are taught an extensive Spanish vocabulary. “We start with very introductory topics like anatomy and then [cover] all the terminology for filling prescriptions and explaining dosages,” Kennedy explains. “They also learn how to talk about nutrition, diabetes, blood work — all of the different material they’ll be talking about with clients.”

In addition, they learn about conditions and diseases that are particularly common in local Latino communities, such as diabetes and cardiovascular disease. The curriculum emphasizes the importance of discussing nutrition with patients in order to combat these problems, Kennedy says. Furthermore, they discover how Hispanic culture can influence individuals’ behaviors when it comes to seeking healthcare — for example, how religious beliefs might affect one’s views on prescription birth control.

In the service-learning course, students spend 25 hours per semester in a clinic with Spanish-speaking patients, in addition to two days in the classroom each week. This experience, along with the PharmD clinical rotations, allows students to shadow doctors and pharmacists before interacting with LEP patients one on one.

“The clinics allow them to observe everything [doctors and pharmacists] do with patients,” Kennedy says. “Then they get to actually practice what they’ve learned by speaking with patients directly, interviewing them about their health conditions and needs, and making recommendations.”

The program also encourages enrollment in regular Spanish courses at BU, and students must pass fluency exams before progressing on to the next level. Prior to participating in the overseas component of the program, for instance, students must take an exam to determine the level of coursework they are able to complete at a host university abroad.

The trip occurs annually during BU’s winter break. Typically, Kennedy, a pharmacy professor, and up to 35 students attend each year. Host institutions introduce them to their country’s healthcare system, and students participate in cultural immersion experiences that include visiting museums and city markets as well as volunteering at orphanages and facilities for individuals with disabilities. In the past, these trips have taken students to Mexico and Costa Rica; the 2017-2018 trip will be to Guatemala.

“While the students go on the trip to study and do activities, they are also living with host families that usually only speak Spanish,” Kennedy says. “The feedback from students is always wonderful, and they say they feel they are really learning through these experiences.”

She hopes the college can demonstrate to other schools that preparing students to be experts in delivering linguistically and culturally competent healthcare to Hispanic populations is not only critical but also feasible with the right commitment and the proper resources. “Not many universities are doing what we’re doing to prepare students to go into the workforce and treat the Hispanic community,” says Kennedy. “We want to show the pharmacy community that it’s possible to do something like this and that it can be very successful.”

A pharmacy student at UH observes faculty member Katherine Smith as she takes a patient’s medical history in Spanish.
A pharmacy student at UH observes faculty member Katherine Smith as she takes a patient’s medical history in Spanish.
A UH pharmacy student translates for a Spanish-speaking patient during an on-campus health fair.
A UH pharmacy student translates for a Spanish-speaking patient during an on-campus health fair.

University of Houston College of Pharmacy
At the University of Houston (UH) College of Pharmacy, interested doctoral students can gain expertise serving Latino patients through the Hispanic Healthcare Certificate Program. By completing 18 credit hours of advanced coursework in medical Spanish and Hispanic studies as well as participating in immersive experiences within Hispanic communities, students acquire the language skills and cultural knowledge necessary to effectively treat this underserved population, says Dean of UH College of Pharmacy Lamar Pritchard, PhD.

Lamar Pritchard
Lamar Pritchard

“Many students [who enroll in the program] have had previous Spanish language coursework, but the certificate is more immersive and is geared specifically toward health professions,” says Pritchard, who is also a professor. “These classes [focus on] medical terminology, dealing with patients, understanding folk medicine, and other factors you may not find in traditional Spanish courses.”

Folk medicine, as defined by the U.S. Department of Health and Human Services, includes traditional healthcare beliefs and practices that may rely on spiritual or natural methods of healing, such as special prayers or herbal remedies.

First-year pharmacy students who choose to pursue the certificate take healthcare-oriented courses, such as medical Spanish, that are offered through UH’s Spanish and Hispanic Studies departments. They are also required to participate in service-learning activities, including health fairs and on-site visits to nursing homes, community centers, and other facilities that serve primarily low-income LEP individuals.

“We work with [facilities] where many patients don’t have a lot of healthcare options because, for these clients, some simple pharmaceutical care services can have a tremendous impact,” Pritchard says. “Our students love being able to make a difference, and they really prefer these face-to-face interactions with patients instead of simulations.”

He believes personal interactions are the best way to learn about Latino cultures — which, he says, can vary widely by country of origin — and how beliefs and customs influence a person’s health. For example, first-year students may perform on-site visits to nursing homes on holidays such as Día de los Muertos, or Day of the Dead. In addition to using their Spanish language skills to provide health screenings and other services, they get to learn about Day of the Dead traditions from nursing home residents who observe the holiday.

Similar experiences continue into the second year of the program, when students complete clinical rotations in health centers that serve a large number of LEP individuals. Experienced UH faculty members work alongside them and assist with communicating with patients.

“If there is a patient in his 60s from Guatemala who speaks no English and suffers from diabetes, a faculty member will want to learn about his folk medicine or if he has changed his diet,” Pritchard explains. “Maybe in his culture, there is a lot of food made with animal fat around the holidays, so [they’ll want to] talk about converting to healthier alternatives that are still within the Hispanic recipe spectrum.”

The certificate’s requirements align with that of the college’s 10-semester PharmD program so that students can gain these skills without having to prolong their time in graduate school — something that Pritchard believes keeps other pharmacy schools from offering similar programs. “Many schools are opting to do accelerated [PharmD] programs, and offering these types of electives is more difficult in that limited amount of time than it is with a traditional program like ours,” he says. “Plus, many students may not understand how valuable a certificate like this is, especially if they aren’t in a location like ours where there is such a large Hispanic population.”

Surveys have shown that LEP patients prefer interacting with pharmacists with whom they can more easily communicate and who understand their culture. Furthermore, Hispanic individuals are more likely to visit pharmacies for basic medical advice and services than the average consumer — a fact attributed to cost, convenience, and the position of trust and authority that pharmacists hold in many Latino countries, according to a 2014 report by PricewaterhouseCoopers’ Health Research Institute. The report also calls on medical programs and pharmaceutical companies to do more to create a culturally competent workforce if U.S. pharmacies are to meet the needs of their growing Latino clientele.

“Here in Texas, in my opinion, this is something all graduates need,” Pritchard says. “It’s a matter of making time and room in your curriculum and realizing this is important in order to be able to care for your patients.”

Mariah Bohanon is a senior staff writer for INSIGHT Into Diversity. This article was published in our January/February 2018 issue.