Bridging a Cultural Divide: Questions for Dr. Charles Vega

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Among the more vexing problems facing the medical profession as it works to serve diverse communities is the sometimes wide cultural divide between doctors and their patients. Language barriers, cultural traditions and just plain suspicion can make it difficult for doctors and other health professionals to effectively treat people from underrepresented communities.

Some help is on the way. Among the newly minted doctors who graduated from the UC Irvine School of Medicine this spring were eleven with special training in Latino health issues. They were trained through the school’s PRIME-LC program. And by the end of this month, a new class of UCI medical students will enter PRIME-LC and train in Latin America and Santa Ana.

We spoke with Dr. Charles Vega, the director of PRIME-LC, about the program and its goal of training doctors to better serve the underserved.

What’s the next step for this year’s graduates?

The next step is going to be residency training. … There are two obstetricians, one general surgeon, a couple family doctors, a couple pediatricians and one ER [emergency room] physician, among others.

What’s the new class like?

We should be at 10 next year. The new cohort reflects the rest of PRIME-LC. The majority of students are from underrepresented minority groups with at least competent skills in speaking Spanish — not your typical medical student class.

How do students’ life experiences influence their work in the program?

Many come from backgrounds where they know what it’s like to not always have insurance, and many have personal experiences, translating for parents. I’m talking about going in with your mom to her [gynecologist] appointment and you’re seven years old. It’s tough stuff.

In addition to medicine, what do students learn in PRIME-LC?

When they’re here we give them root causes of health disparities. Obviously a critical pillar is seeing patients, but it is also augmented by classes in Latino studies, history and culture of Latin America that stretch back to pre-Columbian days. That background helps patients dealing with diabetes where a patient’s sugar is out of control or a woman with a lump in her breast who has waited way too long to come and see a doctor.

Where do they get their practical training?

At the UCI Family Health Center in Santa Ana [in addition to standard medical school rotations]. We’re one of the only federally qualified health centers in the country. Twenty percent of safety-net care in Orange County flows through here.

What’s an example of a cultural difference that might be important to understand in treating underserved Latino patients?

Patients may use alternative providers — complementary sources of health care. That can be valuable. … It’s not a contradiction to go to a curandero [healer]; that’s just one example. The other big example is understanding how to get things done with limited access to insurance.

What medical issues receive special attention at PRIME-LC?

We know that Latinos, compared with non-Hispanic white populations, have higher rates of diabetes, higher rates of heart disease. Those are the top things we treat at the clinic: diabetes, hypertension and cholesterol.

How important is language?

All students have to have competent Spanish when they enter the program. … Part of the summer starting from day one is working with health promoters and in clinics. They need to have good skills, [but] we don’t require fluency.

Where will students study in Latin America?

We used to go to Mexico, but because of the State Department warning, we’re now looking for a different option, a one-month immersion experience somewhere in Latin America as part of their training.

Is PRIME-LC unique?

Prime was such a strong idea, it has spread to the other UC campuses. San Francisco does urban underserved communities, and Davis does rural underserved. We’re the original, oldest one. … Activism, understanding the whole patient — we really believe in that.

— Interview by AMY DePAUL

 

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