Diabetes is a growing epidemic in the U.S.; about 13% of all adults have the disease. But for certain people, like those in the Latinx community, it creates a particularly heavy burden. They are more likely to get diabetes at a younger age and to die from complications than white patients. At the same time, many in the Latinx community face barriers in accessing healthcare.
“Diabetes is a huge problem in the Latinx community,” says Lorena Alarcon-Casas Wright, MD, a UW associate professor of metabolism, endocrinology and nutrition. “We need to pay more attention to this population to address the disparities in care.”
To better serve the community, Wright has established a new Latinx diabetes clinic at UW Medicine. In addition to offering care for Spanish-speaking patients, she hopes the clinic will serve as a community outreach point and a hub for culturally appropriate medical education.
A SHARED CULTURE
Wright, who is originally from Mexico, has always known the value of sharing her patients’ language and culture.
“Especially for a chronic disease like diabetes, having a good relationship with your patients is very important, and language can be a huge barrier,” she says.
Although Wright has cared for Spanish-speaking patients for years, she dreamed of reaching more people with a clinic for Washington’s Latinx community — the second largest demographic group in the state. Latinx people represent 13% of Washington’s population, but only 3.4% of its doctors, creating a significant shortage in bilingual and culturally appropriate care.
In November 2020, Wright’s dream came true with the clinic’s grand opening. Held weekly on Tuesday afternoons, the clinic is located in the Diabetes Institute at UW Medicine’s South Lake Union campus. Patients can self-refer or seek a referral from their healthcare provider.
Staff members include physicians, a diabetes educator/nutritionist, a clinic manager and three patient-care specialists. All are bilingual, so everything from appointment scheduling to patient education to specialist referrals is in Spanish.
With financial support from the community, says Wright, they could add two much-needed positions: a social worker and a cultural navigator. Social workers connect patients to social support, nutrition and financial counseling services. Cultural navigators help patients fill out forms, arrange transportation and schedule appointments. They can also serve as translators between English-speaking providers and Latinx patients.
In addition, the clinic will give medical students and residents opportunities to learn about caring for Latinx patients and how cultural differences affect healthcare. Understanding a patient’s background, says Wright, is key to helping them manage their health.
“For example, Latinx patients use a lot of herbal products or natural remedies, but if they don’t feel comfortable with their providers, they won’t mention it — and that might make a difference,” says Wright. “Knowing what kind of foods Latinx people prefer, and having realistic expectations and sustainable goals, is all part of cultural care.”
IMPROVING HEALTHCARE EQUITY
Social determinants of health are a major factor in healthcare disparities — and a global pandemic has only made the inequity worse. Patients with diabetes, or complications from diabetes, are at much greater risk of having a severe case of COVID-19. Yet many Latinx people are essential workers who can’t work from home. And large, multi-generational households increase the risk of exposure and make quarantines and social distancing difficult.
To help more Latinx people access care, the clinic will also do community outreach. Efforts have already begun at Harborview Medical Center and will soon expand to rural communities in eastern Washington. They plan to work with church and community leaders as well. “When people hear a leader in the community giving recommendations, they will be more likely to take those recommendations seriously,” she says.
The clinic will also help connect Latinx patients to clinical trials. “Many clinical trials have underrepresented Latinx populations,” says Wright. “Having a big population of Latinx patients is an opportunity to have more participation, which is really needed.”
With Spanish-language services, cultural care and community outreach, the clinic is working hard to build strong, trusting relationships with Washington’s Latinx community. And philanthropic support can play a vital role in helping Latinx people access diabetes care more easily.
“We want our patients to feel that when they come to our clinic, we are going to help them, regardless of their background,” says Wright.