By the time she visited UCI Family Health Center, the middle-aged Mexican immigrant was showing classic signs of untreated diabetes: exhaustion, blurred vision and chronic thirst. She’d already seen several doctors, but ignored their advice to begin insulin treatment. At the health center – UC Irvine’s neighborhood clinic in Santa Ana – Dr. Charles Vega and his medical student Marnie Granados, both fluent in Spanish, diagnosed her problem: She was afraid insulin would make her blind – a common misconception in some Latino communities. Cases like hers are precisely why UCI’s Program in Medical Education for the Latino Community (PRIME-LC) was developed.
PRIME-LC teaches young doctors to be sensitive and responsive to the special needs of Latino patients, while training them to be policy-level advocates, says Vega, clinical co-director of the program.
“The two kinds of problems – social and clinical – go hand in hand,” he says. “You can’t make a significant impact on one without understanding the other.”
Already a model
PRIME-LC was created as a dual-degree program in the UC Irvine School of Medicine, offering an M.D. and a master’s to its graduates. Its first students enrolled in 2004, and the program is now the thriving model for PRIME programs soon to be launched at the four other UC medical schools.
In the case of the diabetic patient, Vega and Granados used their mastery of Spanish and sensitivity to expectations and anxieties to persuade the patient that untreated diabetes, not insulin, could blind her. They convinced her, too, of the importance of modifying her diet and monitoring her blood-sugar level. On a larger scale, those same skills could bridge the divide separating millions of California’s Latino patients from access to good medical treatment.
“It can be difficult to find a good doctor in Santa Ana,” said the patient in Spanish as she thanked Vega, “let alone one who speaks Spanish, who understands me, who cares.”
According to the national Centers for Disease Control and Prevention, Mexican Americans, the largest Hispanic/Latino subgroup, are almost twice as likely to have diabetes as non-Hispanic whites. And they are five times as likely to suffer serious medical complications, such as kidney failure, from untreated diabetes.
As the state’s Latino population grows, so does the failure represented by its lack of access to good health care. This failure has many causes: linguistic and cultural barriers as well as economic, social and political issues. Nearly 30 percent of California’s Latinos are not covered by health insurance, compared to about 10 percent of whites. Many work at physically challenging jobs or earn very low wages and cannot take time off work to address medical problems before they become disabling. If they do seek help, they are often misunderstood by, or misunderstand, their doctors. PRIME-LC confronts these health care challenges.
The program adds a layer of coursework to standard medical school curriculum, requiring extraordinary talent and commitment from students, says Vega, also associate clinical professor of family medicine. They take classes in Latin American history, culture and geography.
“Doctors trained in Southern California often know more about Henry VIII than what happened 100 miles south of here,” says Dr. Alberto Manetta, senior associate dean of educational affairs in the UC Irvine School of Medicine and director of PRIME-LC. “If patients feel unknown or misunderstood by their doctors, they are unlikely to return for a second visit or comply with advice given at the first one.”
The summer before medical school, PRIME-LC students spend six weeks at the Universidad Internacional’s Center for Bilingual and Multicultural Studies in Cuernavaca, Mexico. They live with Mexican families and speak only Spanish, shadow Mexican doctors in hospitals and clinics, make home visits, and learn what it’s like for Mexicans to receive health care in their own country. When they return from Mexico at summer’s end – steeped in Spanish language and Mexican culture – they start med school with the rest of their class.
Although PRIME-LC participants come from a variety of backgrounds, they have one thing in common: a demonstrated commitment to helping underprivileged and underserved populations.
“I’ve always wanted to work with underserved communities,” says Granados, a member of PRIME’s inaugural class. “When I learned about the program, I knew it was for me.
“PRIME-LC students do the same things that the regular class does; they study the same material and take the same tests,” she adds. “But in addition to basic medical school curriculum, we have special classes and experiences.”
Their instruction is infused with a Latino perspective. While all medical students work with actors trained to present case histories, PRIME-LC students get Spanish-speaking actors who present typical Latino scenarios.
In the program’s second and third years, students take courses through UCI’s Department of Chicano/Latino Studies, including seminars on the epidemiology and biostatistics of diseases with high incidence in Latino communities.
“We learn everything from introduction to pre-Columbian health beliefs to current health policies affecting Latinos here in California,” Granados says.
After their third year, PRIME-LC students take a one-year leave from their medical studies to get master’s degrees in health-care related fields. Granados, for instance, will focus on health policy at UCLA’s School of Public Policy. Other students will get degrees in administration, public health, or Chicano and Latino studies.
“PRIME-LC has forced me to think about how I’m going to use my training as a doctor in Western medicine to reach out to my patients. What can I do besides wake up every morning, go to work, and make my rounds?” Granados says. “PRIME-LC has caused me to think about health policy and research, and how these things can improve access to health care for underserved Latinos.”
Treating with knowledge
John Rose Jr., who entered the program a year after Granados, says he was immediately “struck by the idea of a medical school program with the concept of social justice at its core. It is so central to health care, but so frequently neglected.”
Last summer, he and other PRIME-LC students spent a week in Nicaragua scouting sites for a cervical cancer program and seven weeks in Chiapas, Mexico, working with volunteers from a local public health organization. PRIME-LC is raising funds to send five students to Chiapas to continue the projects this summer.
This year, Rose and fellow students have helped the needy through Latino Health Access, a Santa Ana-based nonprofit organization that serves Orange County Latinos; Manetta is board chair. The students also have shared their experiences with faculty and other students at health conferences.
“The biggest problems with health care in our society are not problems of diagnosis or cure,” Rose says. “Most of the outbreaks of infectious disease and chronic diseases that hit poverty-stricken populations are rooted in the social fabric of our society. We’re trying to awaken in medical professionals an understanding of how social structure affects health. There are some things you just can’t cure with a pill.”
Right idea, right place, right time
Chancellor Michael Drake has been a leader in the University of California’s efforts to improve health care for underserved minority communities. He has been involved with PRIME-LC since its inception and served as principal investigator on the initial grant from The California Endowment.
“PRIME-LC is just what health care in California needs,” said Drake. “It educates talented students in cutting-edge medical procedures and builds a cultural understanding of our diverse communities. These students are committed to improving care for the underserved, and PRIME-LC provides them with the right tools to make a difference.”
Drake also saw the benefits of expanding the concept behind PRIME-LC to other underserved communities. He created “PRIME” programs at UC San Francisco for urban areas, at UC Davis for rural communities, and UC San Diego for populations with genetic health disparities.