The use of home remedies like chamomile and star anise teas is common in many Hispanic cultures but it can cause life-threatening complications for a young infant. A pediatrician who isn’t savvy to Hispanic traditions would never think to ask whether a parent were dosing a crying baby with tea and the parent might not mention such a routine practice.
This single example illustrates the need for culturally sensitive health care for Louisville’s Hispanic community—now 3 percent of Kentucky’s population—according to University of Louisville Children & Youth Project pediatrician Fernanda Nota, MD. Nota has made that goal her personal mission and has worked to achieve it since beginning her pediatric residency at UofL in 2003.
“I was moved by the needs of my Hispanic patients who don’t know our medicines or understand our pharmacy and health care systems and often don’t have insurance. It seemed language barriers and lack of cultural awareness kept them from getting optimal care,” said Nota, a native of Argentina.
Nota recently received a competitive one-year fellowship that she hopes will prepare her to advance her goal. The National Hispanic Medical Association Leadership Fellowship provides seasoned Hispanic physicians the skills necessary to take a leadership role at local, state and national levels in health policy development and advocacy related to the health of the Hispanic community.
“I want to receive the education and knowledge I need to lead and implement programs that will benefit our Hispanics in Louisville as well as network with other Hispanic physicians in the country so I can learn how to get federal or state support needed to organize and create a culturally sensitive medical home for this underserved population,” she said.
Nota believes any federal or state dollars would pay off universally, improving patient care, reducing long-term complications and minimizing patients’ need to access more expensive emergency and specialty services that could be avoided with preventive care.
She already has thought through many of the details and envisions a medical practice specifically for Hispanic families that offers primary care for adults and children and possibly obstetrical and gynecology services, as well. Nota knows from experience that Hispanic families expect to spend more time with their doctors so she would like to handle scheduling differently than it is in traditional primary care offices. She also wants interpretive services available, as well as bilingual health care providers, nurses and front desk personnel.
“If patients feel the doctor understands and respects their perspective, beliefs and culture, they will be more likely to follow their medical advice,” she noted.
A study done in collaboration with UofL’s J.B. Speed School of Engineering has shown that the optimal location for the clinic is near the Gene Snyder Freeway, which provides easy access to Churchill Downs and Shelbyville, Ky., where many Hispanic families have settled.
Nota also sees this as an opportunity to expose students and doctors-in-training to Hispanic culture, which will someday make them better able to serve their own patients with Latin heritage.
“Many of our medical students are aware of this increasing need. Frequently I get emails from students asking for opportunities to practice and improve their Spanish language skills in a direct patient encounter setting” she said.
UofL Department of Pediatrics Chairman Gerard Rabalais, MD, MHA, thinks Nota’s concept is a wise one.
“Dr. Nota’s plan puts patients’ needs first, which must be our first concern. In this instance, serving the patients’ needs also serves the community at large by helping to reduce health care costs,” he said. “We’re lucky to have Dr. Nota to lead us on this journey, especially since our Hispanic population continues to grow.”
Nota’s experience as a pediatric resident, Children & Youth Project physician, and member of Louisville’s Hispanic community, has informed her vision. She has taken charge of overseeing the care of C&Y’s Hispanic patients, who make up 13 percent of the total patient population. When she was a pediatric resident, the total was just 5 percent.
She consulted a University of Arkansas pediatrician who created a successful Latino pediatric clinic and a medical home for Hispanic children with special needs in Little Rock. She visited free-clinics in Utah and Indiana. In 2011, she helped open a Family Community Clinic in Louisville’s Butchertown neighborhood that’s modeled on those clinics. Located in the basement of St. Joseph Catholic Church, the free-clinic provides intermediate health care services to adults and children without insurance. In its first year, the Saturday morning clinic served 360 patients, of whom 58 percent were Hispanic.
“I like to think of the Family Community Clinic as a pilot for my larger vision,” Nota said. “I look forward to learning the leadership skills necessary to pursue this dream.”
As a part of the one-year fellowship, Nota will spend a week at New York University studying federal and state policy development strategy. She will attend the Congressional Hispanic Caucus Institute in Washington, D.C., and meet with leaders of the executive branch, the White House and national organizations with interest in health policy.