February 21, 2020
Cultural competence on the Texas border
By Susan M. Ogden, PA-C
In February 2016, I had the opportunity to travel to the U.S.-Mexico border for my capstone rotation. The month I spent in the Lower Rio Grande Valley provided me with firsthand knowledge of the importance of cultural competence. Although my journal is full of impressions and observations there are a few key components to my experiences that affect PAs.
In the Rio Grande Valley, farming and ranching are the mainstays of life. The workweek consists of six or seven long days for meager wages. The more family members who can work, the better it is for the family. Often, this means children leave school during their middle-school years to work, and their long-term educational goals are sacrificed for family need. Formal education may end at ages 12–14 for some young people here.
In South Texas, many of the residents only speak Spanish. I took French as my foreign language in high school because I grew up three hours from Canada. Not having a background in Spanish set up a considerable language barrier, and I found myself initially needing a translator for my history and physical exams during this rotation. But over the next four weeks, my outlook changed from dreading the next conversation to accepting the challenge of being an effective communicator in a new language.
There is also a literacy barrier; many residents are illiterate in both English and Spanish or have a basic reading level in Spanish only. We learned in the didactic year that providers need to assess literacy as part of the assessment of patients, and living here has given me new ideas on how to address this issue. Written instructions for medications can lead to a high rate of noncompliance; however, pictographs can be found for almost any medical condition and will yield better outcomes. Although it takes time to create or copy these in the clinic, I believe it is worth it.
While here, I have seen the importance of close family bonds in the Latino culture. Children are raised with a commitment to care for the matriarch and patriarch of the family until their last days. Decisions are made as a family unit. Now I understand why I have walked into very crowded hospital and exam rooms, at any time of day or night, to take a patient history.
The living conditions for most Rio Grande Valley residents are drastically different from those in San Antonio. Some colonias (neighborhoods) do not have indoor plumbing, public transportation or paved roads; other areas lack sidewalks and streetlights. Health challenges abound: lack of outdoor play and exercise, greater risk of disease and injuries, water contamination and inability to obtain basic services. Remember Maslow’s hierarchy of needs? A hungry family does not make choices about healthy food or preventive care—the immediate goal is to feed all the mouths around the table. In the same way, someone who has performed manual labor for the whole week may not have the energy to get medications refilled or make sure well-child exams are scheduled.
In summary, living in a different culture has motivated me to be a better provider. I will be examining each patient’s barriers to health and my own treatment plan more closely. Did I communicate so the patient could understand? Did I overcome language and literacy barriers? Have I educated family members? Have I taken the patient’s occupational, social and environmental histories accurately? Is what I am recommending to the patient feasible given their environment? I hope to be able to answer “yes” to all those questions in my PA career.
Susan M. Ogden, PA-C, was a second-year PA student at the University of Texas Health Science Center at San Antonio when this article was originally published in PA Professional in May 2016.