This piece is to be published in the Fall edition of the North Carolina Pharmacist
“¿Se habla español?” asks a Hispanic woman with her 2 year-old son on her hip who is coughing as she approaches your pharmacy counter. Feeling frustrated, you reply “No.” She looks down and embarrassed that she doesn’t speak English and goes about her shopping. A short while later you notice her in the cough and cold aisle looking at medications presumably for her son.
In many pharmacies in North Carolina, this situation happens daily. By 2050 it is expected that nearly one in three U.S. residents will be Hispanic (an 86.1 million increase).1 Pharmacists face daily language and cultural challenges in providing the same level of care to these patients as we do for all other patients that enter our pharmacies. How are pharmacy students preparing for this challenge? I believe every pharmacy student should commit to making culturally appropriate care a priority. One place to begin is through our NCAP chapters by creating awareness of these challenges and creating solutions as suggested below.
Cultural competence is defined in Essentials of Cultural Competence in Pharmacy Practice as “the attitudes, knowledge, and skills that allow integration and translation of knowledge about various cultures into the practice of pharmacy.”2 The capability to apply this concept is a vital asset every pharmacist must possess in today’s multi-lingual and multi-cultural world. This does not mean that you have to speak Spanish.
The practice of pharmacy includes caring for our patients’ medical and subjective needs – beyond knowing the facts about medications. In my opinion, pharmacists act as guardians for their patient’s health. Over time, you build a trusting relationship with them through communication and their story begins to develop. This process of developing a trusting relationship is of particular importance when dealing with those from other countries and cultures. At the risk of over generalizing, once you gain rapport with a Hispanic patient, they will come to you for all their healthcare needs.
In order for pharmacists to act as culturally competent caregivers, we have to use our skills to help these patients find what they need so they can avoid aimless searches in aisles with English only labels as our example above showed. Skills and techniques you as a pharmacist can learn and employ include: creating an internal pharmacist and technician network making those who are bilingual or multilingual accessible to others; using hand gestures and simple vocabulary to help patients understand; use pre-printed Spanish-only cards to answer common questions; or using the patient’s children who are often bilingual to serve as an interpreter. The pharmacist in the scenario could have employed cards that tell the mother that there is not any medicine to treat her child’s cough due to his age and that she must take him to the doctor.
By committing to learn more about the cultures that shape the patient population in our practice settings and by interacting with them in culturally appropriate ways, we show them that we not only care, but build a foundation for strong patient-provider relationships. As the U.S. population continues its dramatic change over the next 40 years, the significance of these challenges will increase dramatically. Will our profession be equipped to meet all of our patient’s needs?
1 Hispanics to be 30 percent of U.S. population by 2050. http://www.hispanicbusiness.com/news/2008/8/15/hispanics_to_be_30_percent_of.htm Accessed 9/12/08.
2 Halbur, K.V. and Halbur, D.A. Essentials of Cultural Competence in Pharmacy Practice. Washington D.C.: APhA; 2008.
5 comments:
So it is very ironic that this topic come up as my wife and I just recently purchased Rosetta Stone software to begin learning spanish (Thanks a lot Michael Phelps!!!). I think it is easy to forget that this country was in the beginning and for many years, a mix of different cultures (who also spoke different languages!). Also, there are other major countries that are multilingual such as Canada (English/French). Regardless of how you feel about immigration policies, our generic job as healthcare professionals is to help people. I feel if that requires us to take a night class or a CE to learn how to counsel Hispanic patients on medications, then that is something we should do. So next time you see a Hispanic mother with a sick child staring blankly at the hundred different types of Tylenol products, think about how much help and assurance you could provide to her if you had taken that CE on Spanish for Pharmacists.
I recently visited another country where I did not speak the language. I tried to speak what little I knew of the language and the people there amazingly tried to help me with what little English they knew. This made me realize how often we choose not to help people in this country because they do not speak English. Because of the kindness that was given to me, I feel like we as professionals should try to help all patients, no matter what language they speak. If this must be done with pictographs or gestures, so be it. To ensure that the patient receives the best care, we simply must try.
I agree with Dr. Dixon that regardless of how we feel about the immigration policies we should provide equal care to all patients. I asked my friend that is a PY3 at UNC how much they have discussed Cultural Competency and I was surprised to hear that he didn’t even recognize the term. I was also surprised that they were not even required to take Medical Spanish. I know that when I graduate I want to know specific strategies on how to communicate better with patients from different cultures. I don’t want to be a pharmacist that just prints out the monograph in the patient’s language and sends them on their way. I’m thankful that we are talking about cultural competency in our classes now and that later we will be getting a primer in Medical Spanish.
In the past, I have worked at a community free clinic, where many of the patients were spanish speaking only. Luckily for me and the patients, the clinic had interpreters. You could actually see the relief on the persons face when they realized they did not have to struggle to understand or get you to understand what problem they or their family member were having. After discussing this topic in class it made me wonder, would we turn away a deaf person because they cannot hear...no, we would use pictograms or some other method. So, why would we turn away and hardly ackowledge a spanish speaking person because they cannot understand us? We obviously need to make more of an effort to help our patients regardless of cultural or any other barrier to the care that we should be providing for our patients.
One final comment:
The questions raised by the topic of cultural competency present pressing issues that need to be addressed by all members of the healthcare field. However, my feeling is that no matter how hard we try to bring this issue to the forefront of our attention and no matter how hard we try to resolve this issue, there is no solution to this national problem. Yes, learning Spanish is definitely a good practice and is beneficial in making a healthcare professional more proficient in their practice, but is there really time amidst the demands of a doctoral program for a minor in Spanish? I raise this question because taking 1 or 2 courses in a foreign language in no way prepares one for the challenges they will face when trying to relay a message to an individual whose first language is not English. I say this from personal experience and from having a minor in Spanish. 1 to 2 courses does not teach one enough about how to speak the language, but rather how to fumble through their thoughts and relay a few words and pieces of their message. And even if doctoral candidates were required to minor in Spanish, how would this help with all the other languages that are becoming prevalent throughout the United States? It now seems that as frequently as you encounter Spanish, you encounter Chinese, Japanese, Vietnamese, or Hmong. With the population of the world continuing to grow and the rate of immigration increasing, these languages will only appear more often in doctors’ offices and pharmacies all across the country. Being in a doctoral program, and knowing that others are just as demanding and maybe more demanding, we cannot spend the entire duration of the program attempting to learn multiple languages to address all of the cultural barriers we will be presented with throughout our careers. Thus, I refer back to my former statements and remind you that a minor in a foreign language would prove beneficial, but there is no way that all of the cultural barriers will ever be able to be resolved.
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