During labor, she was attended by Bayview’s medical staff, her husband, Cesar, and a Bayview interpreter. Weighing 7 pounds, Daniel entered the world, howling and hungry.
Daniel joins the parade of 375 Hispanic babies born in FY 2005 at Bayview, where the surge in Latino patients has been particularly remarkable. Five years earlier, only 64 Hispanic babies were born at Bayview. By FY05, not only had that number increased nearly sixfold, but the number of adult patients had more than tripled to 2,452. (Patients are counted only once, no matter how many visits occur per year.)
It’s a phenomenon that’s taking place not just at Bayview. Hopkins Hospital and Howard County General Hospital also have seen a dramatic influx of Hispanic patients. A good many of these new immigrants are undocumented and uninsured, but by and large, stresses Steve Thompson, JHM senior vice president, “they are hard-working and earning money. They want to pay and are working out payment plans.”
Like other medical institutions across the country, Johns Hopkins bears a good part of the burden for those who cannot afford to pay. “But historically, we have a responsibility to care for people in our community,” Thompson says. “We recognize now that our neighborhoods are changing, and we are endeavoring to be equally responsive to all parts of our community.”
To serve this demographic, Hopkins Medicine is responding with a variety of initiatives—from classes, to interpreters, to community outreach. Few are more appreciative of these efforts than the patients themselves.
At Bayview, Carina had her own interpreter, Marlis Dipasquale. “It was very important for me to have Marlis’ support. Any concerns I had, I spoke to her. She was basic,” says Carina, speaking in Spanish. “The hospital’s staff treats you humanely, you’re not a number or just another patient.”
On this day, in Bayview’s Ob/Gyn clinic, Dipasquale is translating in one of the waiting rooms. “Sometimes patients are timid about asking questions,” she explains. “They feel more comfortable with the interpreters, and we function as a go-between, helping the patient and talking to the medical staff.”
From one part-time interpreter in 2001, Bayview now has eight Spanish translators providing 24/7 coverage. The greatest needs are in labor and delivery followed by pediatrics. From February to April 2005 alone, 2,061 documented Spanish translations took place.
Inspired to break through the language barrier, some Bayview staffers have been taking basic Spanish before or after work on campus. Meanwhile, a 14-week medical Spanish course was offered to JHM faculty, students and staff in East Baltimore. A week before the class was to begin in September, there already was a waiting list.
From 1990 to 2000, according to U.S. Census data, the numbers of Hispanics increased in the Baltimore region by 70 percent to about 50,000. In Baltimore City, the Hispanic population is officially put at 13,500, but according to Rafael Regales, liaison for the Mayor’s Office of Hispanic Affairs, estimates for 2004 put it at between 30,000 and 35,000. Accurate figures are hard to come by, he adds, because the population is transient, and many are undocumented.
JHM International is playing a significant role with local patients of Hispanic descent. Known for its hospitality services to international patients, it also offers Spanish interpreting 24/7 to local Latinos. Its 15 Spanish interpreters, the office’s largest group, handle about 320 requests for Spanish per month, about 55 percent of which are for locals. Requests for Spanish interpreters have nearly tripled since 2004.
“This increase is due to greater awareness among departments of what we offer, as well as continued growth of the Hispanic community,” said Raffaella Molteni, JHM International’s director of operations. The office produces materials in Spanish, such as bedside communication charts and educational information.
Neighborhoods near Hopkins’ three hospitals are the ones that have experienced some of the greatest growth in Hispanics. A bustling Latino business district flourishes on South Broadway in Fells Point, and high concentrations of Hispanics live in neighborhoods like Canton and Highlandtown near Bayview, as well as in areas of Howard County, near Howard County General Hospital.
HCGH’s self-identified Hispanic population (inpatient and emergency patients only) totaled 4,109 or 3.6 percent of the total patient population in FY05. The hospital uses JHM International’s in-person interpreters, and when they are occupied, accesses Language Line, a telephonic interpretation service. The highest number of interpreter hours are needed for the Spanish-speaking patients, particularly in obstetrics and emergency medicine.
Soon medical forms, a patient handbook and information about clinical procedures will be available in Spanish, thanks to a $10,000 grant from the Horizon Foundation, the fund created when HCGH became part of Hopkins Medicine.
Despite all the services the Health System offers the Hispanic community, the needs, says Earl Fox, director of the Johns Hopkins Urban Health Institute, “are greater than the resources. The population that has the largest percentage of uninsured are Latinos. If patients are illegal they don’t qualify for Medicare, Medicaid or Children’s Health Insurance and have to pay out of pocket.”
UHI runs a free clinic in East Baltimore (see sidebar below), but, says Fox, many undocumented Hispanics are afraid of going, even if it is free, for fear they will be identified and reported. Because many don’t receive primary and preventive care on a regular basis, those with chronic conditions have a poor outlook.
“There was such an overwhelming response to Katrina,” says Fox. “But we also need to take care of others in our own backyard.”
—Lydia Levis Bloch