Dr. Liliana Ramirez Gomez is a neurologist at the MDU clinic. She sees Spanish-speaking patients and has come to believe that the cultural understanding that the staff in the MDU Spanish Clinic offers is a very important aspect of the care that is provided.
“Many Hispanics come to the USA in midlife or older, and have difficulties with acculturation which is the cultural and psychological change resulting from intercultural contact and exposure to the language and traditions of a new environment,” Dr. Ramirez Gomez said. “This includes changes in customs, language, economic status, political life, social behavior, attitudes toward the acculturation process, and cultural identity.”
“Some individuals with low level of acculturation to the American mainstream due to not having learned English or other factors could remain relatively socially isolated, without developing a network of outside friends in their new country and relying on close family support without a larger network of social interactions,” Dr. Ramirez Gomez said. “This could potentially lead to delays in difficulties recognizing symptoms of cognitive decline earlier, because sometimes family and/or healthcare providers could potentially misinterpret or attribute early signs of cognitive decline to depression leading to delays in appropriate diagnosis and treatment.”
Dr. Ramirez Gomez believes that “it is important to have doctors who can communicate in Spanish, have an understanding of the culture and can establish a relationship with the patients and their families. It makes for a more complete assessment and fuller understanding of the situation.”
Dr. Ramirez Gomez also spoke about the importance of training residents to be able to provide care to an immigrant population that in the near future will be in the majority.
“There are not a lot of multicultural programs in the U.S that provide specialized evaluation and care for patients with cognitive disorders.” Dr. Ramirez Gomez said. “Dementia is rising. In the U.S. there currently is a grand mix of cultures and we need to effectively serve people from all backgrounds. We need to focus on training and teaching people to have cultural sensitivity and awareness, and incorporate that into the care they provide for their patients.”
MAPP hosts the MGH Multicultural Neuropsychology Program (MUNDOS), based at the Psychology Assessment Center. This program is Co-Directed by Dr Janet Sherman and Dr. Yakeel Quiroz. MUNDOS directly targets the Latino population in the area by offering culturally sensitive neuropsychological assessments and psychoeducation, available in Spanish and English. MUNDOS provides these evaluations for a variety of disorders that impact brain and cognitive functioning including dementia, epilepsy, brain tumors, and learning disabilities, among others.
The evaluations consist of: a clinical interview with the patient and/or the patient’s family members, the administration of a battery of tests designed to evaluate different aspects of cognitive functioning, and the solving of tasks that require the patient to give either verbal responses or non-verbal responses.
MUNDOS also offers memory workshops for older individuals to help them develop and maintain strategies for optimal memory function. They also offer cognitive rehabilitation to help patients re-learn cognitive skills that have been lost or altered as a result of a brain disease and to learn new skills to compensate for lost cognitive functions.
Latinos in Massachusetts and in the USA face many challenges when it comes to receiving quality health care. Not only do language barriers deter Latino patients from seeking help, but cultural differences, such as the norm of not wanting to bother people with their problems, can make it challenging to communicate their needs to their physicians and may delay treatment. Barriers to healthcare access are higher for Latinos compared to non-Hispanic black and white adults in Massachusetts. Challenges regularly faced by Hispanic elders include limited access to or resistance to seeking medical care, language barriers, and other factors contributing to delay in diagnosis and treatment.
The Memory Disorders Unit at the Department of Neurology provides comprehensive evaluation, diagnostic and treatment services for adult patients that present with memory complaints, disturbances in language or changes in behavior. Common disorders treated in this clinic include Alzheimer’s disease and other types of dementia such as frontotemporal degeneration and Lewy Body dementia. Several specialized outpatient clinics such as the Memory Disorders Unit (MDU), the Frontotemporal Disorders Unit (FTD), the Normal Pressure Hydrocephalus clinic, and the Lewy body Dementia clinic are all encompassed under the Memory Disorders Division. The MDU has a clinic in Spanish that focuses on evaluating patients who only speak Spanish or have Spanish listed as preferred language.
The MDU Spanish clinic is staffed by bilingual board-certified neurologists, geriatric psychiatrists, nurses and social work resource specialists that work to ensure Latino patients feel comfortable and receive quality care.
There is an important benefit to patients when they can interact with bilingual medical personnel directly instead of having interpreters, be they family or medical interpreters who work in the hospital. It’s believed that interpreters may add another layer of perception of a patient’s disorders and can affect the assessment and diagnosis. While having interpreters is necessary when the provider does not speak Spanish, having medical personnel who can speak Spanish directly to the patient and their family, sympathize and relate culturally with their patients is incredibly important.