Caring October 16, 2003 - Massachusetts General HospitalDispro-portionate access to care reminds many of us of a social history we hoped we had moved beyond. Now we see evi-dence of

Inside:Special Diversity IssueSpecial Diversity IssueSpecial Diversity IssueSpecial Diversity IssueSpecial Diversity Issue

Disparities in Health Care ...... 11111

Jeanette Ives Erickson ........... 22222The Changing Faceof America

New Bostonians CommunityDay ..................................... 33333

Health Disparities from a SocialWork Perspective ................ 44444

Health Disparities from aRehabilitation Perspective .. 55555

Cuba Revisited ....................... 66666

Foreign-Born Nurses .............. 77777

Disabilities and FalsePerceptions ......................... 88888

Health Care as a Civil Right ... 99999

Interpreter Services ..............1010101010

Fielding the Issues ...............1414141414Health Literacy

Educational Offerings ............1515151515

Resources ............................1616161616

CaringCaringOctober 16, 2003

H E A D L I N E S

Working toMGH P

W
minority, suffering from chronicillness, and dying young. Evi-dence suggests there is a corre-lation.
What are health disparities?The National Institutes of Health(NIH) describe health disparitiesas, “differences in the incidence, continued on page 11

Disparities in health care:the challenge for the new

millennium—by Deborah Washington, RN,

director of PCS Diversity

gether to shape the futureatient Care Services

hy do minority pop-ulations have shorterlifespans than the

majority population?Why do minorities

experience more chronic illnessthan the majority population?These are the core issues behindmany new initiatives striving toreduce and eliminate healthcaredisparities in thiscountry. Dispro-portionate accessto care remindsmany of us of asocial history wehoped we hadmoved beyond.Now we see evi-dence of racialand ethnic dispar-ities in the onearena that shouldbe a safe havenfor all people.Phrases like ‘dis-proportionateburden,’ ‘preva-lence rates,’ and‘access to qualitycare’ are becomingincreasingly fa-miliar as we seekto understand therelationship be-tween being a

prevalence, mortality, and bur-den of diseases and other ad-verse health conditions that existamong specific populations inthe United States.”

Health Resources and Ser-vices Administration (HRSA)says, “Health disparity is a pop-ulation-specific difference in the

Page 2

October 16, 2003October 16, 2003Jeanette Ives EricksonJeanette Ives Erickson

Jeanette Ives Erickson, RN, MSsenior vice president for Patient

Care and chief nurse

The face of America is changing:is health care keeping pace?

A

REMINDER!The Staff Perceptions of the ProfessionalPractice Environment Surveys must be

returned by October 24, 2003.

If you have not received a survey, pleasecall The Center for Clinical & Professional

Development at 726-3111.

All individual responses are confidential.Please complete and return your survey by

October 24th.

Your voice is important!

The Nursing Career Coaching ProgramMGH is introducing the Nursing Career Coaching Program

with a special information session

Monday, October 27, 200311:30am–12:30pm

Walcott Conference Room

The coaching program will provide information about careers innursing, scholarships, nursing schools, financial aid, and other

resources available to individuals considering a career in nursing.

The Nursing Career Coaching Program is a collaboration between thedepartment of Nursing and the Training and Workforce Development Office

within Human Resources. It is a pilot program funded by thestatewide Nursing Career Ladder Initiative to help

address the nursing shortage.

NOTE: Training and Workforce Development has movedto 100 Charles River Plaza, Suite 200

For more information, call: 6-6386

t the turn of the20th century,

only one in eightAmericans was non-

white. By 2001, Latinosaccounted for 12.5% ofthe population surpass-ing African-Americansas the largest minorityin the United States. By2050, an estimated onein three Americans willbe African-American,Latino, Native Americanor Asian/Pacific Islander.

Over the past sever-al decades there havebeen enormous advancesand improvements inhealth care. No one hasbenefited more fromthose advances thanAmericans. But all Am-ericans have not benefit-ted equally. Accordingto recent national healthstudies, ethnic and ra-cial minorities have notshared the same po-sitive health outcomesas the majority popu-lation. The fact that

disparities exist alongracial and ethnic lines isdisturbing and shouldbe a call to action for allcaregivers.

One way to approachthe problem is to lookat the factors contribut-ing to disparities. TheAmerican Hospital As-sociation (AHA) recent-ly published a reportentitled, “Unequal Treat-ment: Confronting Ra-cial and Ethnic Dispar-ities in Health Care.”The report suggeststhat racial and ethnicdisparities are causedby both patient-relatedand system-related fac-tors. Patient-relatedfactors include:

socioeconomic dif-ferenceshealth-educationdifferenceshealth-behavior dif-ferences

System-related factors:discriminationlanguage differences

workforce diversitydifferencescultural competencedifferencespayment/reimburse-ment differences fortreating Medicare,Medicaid and unin-sured patientsinsurance coveragedifferencesdata deficienciesThe AHA has an-

nounced its commit-ment to identify andeliminate healthcaredisparities in the UnitedStates. The PCS Diver-sity Steering Committeehas made health dispar-ities its new priority.And I ask each of youto participate in thisimportant work. Aswith all challenges, so-lutions begin with ideas.We need to be creativeand emphatic in oureffort to ensure thatpatients of every racial,ethnic, and cultural ori-gin receive the same

access to, and qualityof, care.

The face of Americais changing. It’s up tous to see that healthcare responds to thatchange in a way that isfair, proactive, and time-ly. Please summon yourcreativity and contact amember of the Diver-sity Steering Committeewith your ideas.

UpdatesI would like to take amoment to thank youall for your hard work,preparation, and per-formance during ourrecent JCAHO visit. Inevery interview andexchange I witnessed, Isaw MGH clinicians attheir best. I saw the

skill and spirit that makethis hospital the world-class institution it is.Thank-you.

I am pleased to an-nounce that Susan Finn,RN, has accepted theposition of clinical nursespecialist for the Blake2and Bigelow 12 CancerInfusion Units.

Kristen Jagodynski,BS, has accepted theposition of health educa-tor for the Patient &Family Learning Center.Kristen will develophealth-promotion pro-grams and patient-edu-cation materials andoversee the selectionand maintenance of con-sumer-health pamphletsand Internet links.

Page 3

October 16, 2003October 16, 2003

n Wednesday, Sep-tember 17, 2003,New Bostonians

Community Day wascelebrated at City Hall Plaza inBoston. It was the first timeI’d ever participated in such anevent, and I was impressed tosee the number of people whoattended. It was a groupunlike any other I’d everseen—so many differentnationalities and back-grounds. People stoppedat the many tables set upby various organizations.

The purpose of theday was to provide in-formation about how lo-cal government worksand facilitate access tocommunity resources forimmigrants new to Bos-ton’s rich multi-culturallandscape. In a collabo-ration between the PCSDiversity Committee andthe Partners InternationalProgram, MGH staffed abooth that provided freeblood-pressure screeningand MGH ID cards that

displayed each person’sname, preferred language,blood pressure, known aller-gies, and emergency contactinformation. It was great tosee so many people inter-ested in having their bloodpressure taken. I think a lot

New BostoniansCommunity Day 2003

—by Khalil El-Rayah,Arabic medical interpreter

Community OutreachCommunity Outreach

O

of people weren’t aware of thehealth services available in thecity. Hopefully, word of mouthwill carry this information toothers who may need it.

Visiting a new country canbe very stressful. Moving to a

new country can be even morechallenging. But being informedabout the services and resourcesavailable can make a real differ-ence in the immigration experi-ence for individuals new to ourcity.

Photographs clockwise from upper left: Photographs clockwise from upper left: Photographs clockwise from upper left: Photographs clockwise from upper left: Photographs clockwise from upper left: Staffing the MGH

table are (l-r) Reina Rico, Khalil El-Rayah, Beth Nolan, and

Cassandra Earley; nursing student, Meghan McDonald checks

blood pressure; June McMorrow, RN, checks blood pressure;

El-Rayah provides health information to visitors.

Page 4


Health disparities from asocial work perspective

—by Ellen Forman, LICSW, coordinator of theSocial Service Department’s Community Resource Center

Social ServicesSocial Services

(The following articleis a summary of

Forman’s presentationat the PCS Diversity

Committee’s Conferenceon Health Disparities)

Addressing health dis-parities is integral to thepractice of social work.Having access to medi-cal services is an obvi-ous contributor to goodhealth. But optimalhealth also requires asafe community, a safehome (lead-free, withheat and hot water, freeof violence), adequatefood and clothing, andaccess to quality mentalhealth services. Unfor-tunately, the impact ofour failure as a societyto fully address theseissues falls dispropor-tionately on commu-nities of color.

While the majorityof poor people in theUnited States are white,people of color and re-cent immigrants are dis-proportionately repre-sented (US Census) andare therefore more like-ly to rely on public ben-efit programs to meettheir basic needs. Whenthese programs originat-ed, they categorizedpeople as ‘worthy’ and‘unworthy,’ and thatsystem continues today.As a society, we dis-trust the poor and blamethem for their poverty,ignoring factors such asrace, language, disabi-lity, etc., which may be

significant contributingfactors.

These facts aboutfamilies receiving ‘wel-fare,’ or TemporaryAssistance for NeedyFamilies (TANF), maysurprise you:

There is no federalwelfare program thatprovides income toable-bodied adultswithout children.Of the 14 millionTANF recipients,only 4.9 million areadults, and of those90% are women.Half the children inwelfare families areunder age 6Sixty percent (60%)of all children onwelfare live withsomeone who workspart- or full-timeWhere full child-caresubsidies are avail-able, there is a drama-tic increase in laborforce participationamong the poorIt’s worth looking at

the federal Supplement-al Security Income (SSI)Program. SSI is a cash-assistance program for“aged, blind, and dis-abled individuals whohave little or no income.”For individuals livingalone, a blind personreceives up to $701 amonth, an elderly per-son up to $680 a month,and a disabled personup to $666 a month.These discrepanciesextend to all categories

of living arrangements.These ‘worthy’ poorpeople receive assist-ance that places thembelow the federal pover-ty level (which is cur-rently $749 a month,arguably an unrealisticestimate of what consti-tutes poverty).

Our treatment ofimmigrants is anotherexample of how we as asociety contribute tounfair access to assist-ance. The Welfare Re-form Law of 1996 creat-ed two groups of legalimmigrants: ‘qualified’and ‘unqualified’ (alsocalled, ‘special status’).The current state budgeteliminated MassHealthinsurance for ‘specialstatus’ aliens (who, bythe way, pay taxes).This includes immi-grants fleeing persecu-tion with pending appli-cations for asylum, im-migrants with permis-sion to live in the UnitedStates because condi-tions in their home coun-tries are unsafe, andcertain permanent legalresidents who won’t beeligible for federal bene-fits for five years fromtheir date of entry.

Massachusetts, likemany other states, hasprovided health cover-age for immigrants nolonger eligible for federalMedicaid since 1997. Atthat time, Speaker Fin-neran called the federalfailure to cover legal

immigrants, “a shamefuland cynical act.”

How do we decidewho’s living in this coun-try legally versus illegal-ly? Historically, therehave been caps placedon the number of en-trants allowed fromsome countries and pre-ferential treatment ex-tended to others based,to some extent, on race.Currently, Cuban refu-gees are allowed free-dom until their cases areheard, but under a poli-cy instituted last year,Haitians are held in fed-eral detention whileawaiting the results oftheir asylum applica-tions. America’s Schizo-phrenic ImmigrationPolicy: Race, Class,And Reason, by CharlesJ. Ogletree, Jr. says,“This oft-cited dispar-ity in the treatment ofHaitian as compared toCuban refugees is notan isolated situation,but rather an apt illus-tration of the factorsand considerations thatinform American immi-gration policy as awhole.”

Individuals who re-side in this country il-legally, or as ‘undocu-mented’ immigrants, areeligible for very littlepublic assistance, suchas emergency medicalcare. They are not eligi-ble for cash assistance.The short-sightednessof this policy can beseen in a recent caseright here at MGH. Pri-or to admission, a youngmale patient was healthy,employed, and self-suf-ficient. While hospital-ized, he experienced a

catastrophic accidentthat left him vent-de-pendent, quadriplegic,and requiring 24-hourcare. He couldn’t go toa nursing facility be-cause he wasn’t eligiblefor coverage due to hisimmigration status. Andthere are patients likethis at all of Boston’steaching hospitals atany given time. They’regetting great medicalcare, but not the socialstimulation and recrea-tion they would receivein a nursing facility. Isthis an appropriate useof resources for thesepatients? Is this in any-one’s best interest?

Racial disparitiesalso exist in the area ofmental health. In August2001, US Surgeon Gen-eral, David Satcher, re-leased a report, “MentalHealth: Culture, Race,and Ethnicity: a Sup-plement to MentalHealth.” It stated thatmental health dispari-ties represent, “a cri-tical public health con-cern.”

The report found“striking disparities incare,” with minorities:

having less access to,and availability of,mental health servicesoften receiving apoorer quality ofmental health carebeing underrepresent-ed in mental healthresearchThe barriers faced by

minorities, according tothe report, “are the sameas the barriers for allAmericans: cost, frag-mentation of services,lack of availability of

continued on page 12

Page 5


(The following articleis a summary of

Vega-Barachowitz’spresentation at the PCSDiversity Committee’sConference on Health

Disparities)In 1999, Congress re-quested a study of thedisparities that exist inthe quality of healthservices provided toracial and ethnic mi-norities; to explore fac-tors that may contri-bute to inequities ofcare; and recommendpolicies and practices toeliminate these inequi-ties. The study revealedevidence of unequaltreatment and servicesfor racial and ethnicminorities.

Though the studyfocused only on racialand ethnic disparities, acase can be made thatthere is also a connec-tion between disabilitiesand health disparities.One illustration of thisappears in an August 3,2003, Boston GlobeMagazine article. NeilSwidey published aninterview with Lisa Iez-zoni, a Harvard MedicalSchool professor whohas had multiple sclero-sis for 26 years anduses a battery-poweredscooter for mobility.Iezzoni is the author ofthe book, When Walk-ing Fails, and during theinterview she spokeabout some of the is-sues faced by individ-uals with mobility prob-

lems. She was surprisedto learn that women inwheelchairs are 40%less likely to get Papsmears and 30% lesslikely to get mammo-grams than the rest ofthe population. Herobservation was that,“People with disabili-ties are not getting thekind of care that otherpeople get.”

As healthcare pro-viders it is helpful forus to understand someof the barriers individ-uals with disabilitiesencounter when seekingcare.

The World HealthOrganization (WHO)frames human function-ality in two ways: thefirst has to do with func-tioning and disability.The second refers tocontextual factors.

Functioning and dis-ability includes:

body function andstructure: physiolo-gical or psychologicalfunctions of the body,and the anatomicalparts of the body andtheir components(such as the pharynxand larynx, whichhave a key role inswallowing).activity and participa-tion: the performanceof a task by an indivi-dual, and the individ-ual’s ability to partici-pate in a life situation.(such as eating out ina restaurant).

Contextual factorsinclude:

environmental factors:the physical, social,and attitudinal envi-ronment.personal factors: suchas age, race, gender,education, back-ground, and lifestyle.All of these factors

intertwine to facilitateor block normal func-tioning. An individualmay have a moderatedegree of hearing loss(body function andstructure). She has ahearing aid that allowsher to hear well in mostsituations (activity andparticipation), but en-vironmental factors im-pact the success of theamplification. If thisindividual visits theMGH cafeteria at 10:00in the morning, she isable to sit and have aquiet conversation withher husband. If she goesto the cafeteria at noon,she won’t be able tohear her husband be-cause of the significant-ly increased level ofenvironmental noise.Her disability impactsher activity and parti-cipation at certain timesof the day, under certainconditions.

What about a personwho is only able to am-bulate a short distance?This person may haveno difficulty if his phy-sician’s office is close towhere he’s dropped off

at the hospital. But whatif he has to go from oneend of the hospital tothe other? Surely hewill encounter difficul-ties and delays, andmay need a wheelchairto complete his trek.

The role of rehabili-tation healthcare provid-ers is to improve thequality of life for ourpatients by reducingimpairments of bodyfunction and structures,activity limitations,participation restric-tions, and environment-al barriers. To do so, weneed to identify contex-tual factors that serveas barriers to function.For instance:

Telephones: Mostoffices, includingmedical practices, relyon voice-mail systemsto schedule or cancelappointments, refillprescriptions, obtainreferrals, and reachspecific providers.Voice mail can bedifficult to use forelderly patients andpatients with cogni-tive and memorydisorders. Informationon voice-mail record-ings may be too longand complex forsomeone who hasdifficulty processingauditory information.Physical structure andbuilding environment:—Some buildingshave ramps for easieraccess for those withmobility problemsbut other impairmentsmay still impede theiraccess.—Patients withvisual-perceptiondifficulties may be

unable to read ahospital map to findtheir way around.—A patient with adegenerative diseasewho fatigues easilymay be unable totravel from one depart-ment to anotherwithout frequentpauses to rest andrecover.—Individuals inwheelchairs, elders,and individuals withdisability of the handor arm may not beable to open heavydoors.Navigating the referralsystem: Medical andinsurance systems inthis country arecomplex. Most insur-ance companies re-quire referrals andapprovals for patientsto see a specialist orreceive a specializedintervention. Indivi-duals with language,cultural, educational,or cognitive issuesmay be unable tounderstand the stepsnecessary to navigatethe system to receiveappropriate care (Anindividual with dys-lexia may not be ableto read informationregarding his insur-ance).Community agenciesand resources: Ambu-latory patients mayrequire services out-side the hospital set-ting. A shortage ofresources in theircommunity may be abarrier to achievingmaximum function.Services vary by com-munity and patients

Health Disparities froma Rehabilitation Perspective

—by Carmen Vega-Barachowitz, SLP,director, Speech-Language Pathology

RehabilitationRehabilitation

continued on page 12

Page 6


Cuba revisited: building bridgesto a broader community

—by Donna Perry, RN,professional development coordinatorn Wednesday,

September 24,2003, Donna

Perry, RN, pro-fessional developmentcoordinator; CarmenVega-Barachowitz, SLP,director of Speech-Lang-uage Pathology; OswaldMondejar, Human Re-sources manager; andspecial guest, SenatorJarrett Barrios, present-ed, “Cuba revisited:building bridges to a

broader community,” inO’Keeffe Auditorium.The presentation focus-ed on a recent visit toCuba that was part of ahumanitarian outreachprogram sponsored byACCESO (Americansand Cubans buildingCommunity throughExchange, Support, andOutreach). ACCESOwas created to providehumanitarian support to

the people of Cubathrough the donation ofmedicine, medical sup-plies and equipment,and reading materials.ACCESO sponsors anannual humanitarianmission that not onlydelivers material goodsbut helps build relation-ships between Ameri-cans and Cubans.

Mondejar and Bar-rios both have family in

Cuba. Barrios organizeda book drive severalyears ago after visitingCuba for the first time.He learned that despitea 95% literacy rate,books were in very shortsupply. He returned toCuba the following yearwith several thousandbooks donated by indi-viduals and organiza-tions for use in Cubanschools and libraries.

Mondejar, who is co-chair of the Governor’sCommission on Employ-ment of People withDisabilities, joined Bar-rios the following yearadding equipment forchildren with disabi-lities. And that’s howACCESO was born.

This past year, amedical component wasadded to the mission

International OutreachInternational Outreach

Ocontinued on page 13

Vega-Barachowitz (left) Mondejar (center) and Perry (right)with physician and nurse at Bejucal Polyclinic

School children in Havana

Young student reads thestory of José Marti, one of

Cuba’s national heroes.

Young girl at the Panama School for Children withPhysical Limitations

Page 7


Empowering foreign-bornnurses: preparing for the future

—by Kathleen M. Myers, RN,nurse managern reflecting

on what Iwanted to

write aboutfor this special

issue of Caring, I look-ed back through a num-ber of articles in myportfolio. One particu-lar article caught myeye. It began, “I havebeen doing this for 20years.” (That meant itwas seven years old.) Itdescribed a seminal timein my career. That year,there had been a numberof issues involving criesof racism, treating peo-ple differently, and staffwith chronic medicalproblems. It was a diffi-cult year that lead me toput my thoughts andfeelings down in writ-ing. It was also an im-portant year, because itmoved me forward on apath I’m still travelingtoday. It made me real-ize I wanted to be partof a change; I wanted tomake a difference inpromoting diversity atMGH.

As I re-read the ar-ticle, my words instruct-ed me to be proactive,not reactive, in lookingat ways I could be aleader who supported adiverse staff caring for adiverse patient popula-tion. I didn’t want towallow in the tribula-tions of a difficult year.It wasn’t a consciousdecision that led me tothis path, but it was agood decision, and one I

have never regretted.Two staff nurses on

my unit, Claribell Am-aya, RN, and IvonnyNiles, RN, have joinedin this endeavor. I havementored them over thepast two years and seenthem grow into nursesof exceptional wisdomand compassion. Theyare both seen as leadersin diversity initiativesby other staffon the unit andthroughout thehospital.

This sum-mer I had thepleasure of pre-senting a posterwith Claribelland Ivonny inPuerto Rico atthe NationalHispanic NursesAssociationConference. Iwas so proudof the way theyrepresented thehospital. Peo-ple came up tome just to tellme how clear,concise, andprofessionalthey were. Lead-ership of theassociationmust have shar-ed those viewsbecause wehave been ask-ed to comeback again nextyear.

If it’s truethat our popu-

lation is going to conti-nue to become more andmore diverse, then wemust be prepared. As Ilook back over all mydocuments, so many ofthem have to do withcommitment to diver-sity. Is it too much. Oris it not enough?

The answer remainsto be seen, but this yearI’ve been asked to chair

the Foreign Born NursesGroup, a committeethat seeks to make iteasier for nurses trainedin other countries toresume their nursingcareers here in America.I plan to involve Clari-bell and Ivonny in thiswork —who better toprecept one foreign-born nurse than anotherforeign-born nurse?

One of our first ef-forts will be teaming upwith Bunker Hill Com-munity College to de-velop a program to as-sist nurses in preparing

International SolutionsInternational Solutions

Ifor the licensing exam. Wehave heard from othernurses that this is a dif-ficult and confusing pro-cess. The two primaryconcerns for internationalnurse are competency-development and compe-tency-evaluation (whichdiffer according to pro-gram and country of or-igin).

Our first priority willbe to establish a relation-ship with an academicliaison to determine a listof prerequisites startingwith English proficiency,followed by the NCLEX

licensing exam orentry into an ac-credited nursingprogram. Mentorswill play a big partin the process. Ourhope is to havesomething in placeby the end of theyear.

A recent articlein Advance Nurse,spoke about for-eign-born nursesas the potentialsolution to thenursing shortage. Ifthis is true, weneed to be activeand vigilant in ourefforts to assistforeign-born nurses.As we move for-ward with this ini-tiative, we will eval-uate the program inhopes of refiningthe process.

I’m very excitedat the prospects forthe future, and Ihave the luxury ofbeing supported bytwo nurses whovalue this work asmuch as I do.

Myers (seated) with Claribell Amaya, RN (left),and Ivonny Niles, RN.

Page 8


vividly recallas a youngboy being told

by caregiversthat I wouldn’t

be able to do certainthings because of mydisability. This went onuntil I was in my earlyteens. “You won’t beable to tie your shoes,ride a bike, drive a caror button your shirtwithout a special deviceor procedure.” This wasa difficult message tohear because as a child,you always think pro-fessionals know best. Itwas particularly distres-sing because they hadno way of understand-ing my limitations. Theywere judging my abilitythrough their own ex-perience of having twoperfect hands.

As a young boy, Ididn’t question my el-ders out of respect. Butthere came a time whenI realized I could assertmyself, and I was nolonger made to feel in-ferior to, or ‘less’ than,others.

I am not chastising.From my own experi-ence, I know how im-portant it is for care-givers to make sure thatindividuals with physi-cal or mental disabilitiesfeel valued as whole.It’s helpful for all of usto examine our ownexperiences and assump-tions about those whoare physically differentbecause those assump-

tions can be more dis-abling than an actualdisability.

People think thatenvironmental obstaclessuch as stairways, re-volving doors, curbs,and inadequate signageare the biggest barriersto accessibility. I person-ally think that attitudi-nal barriers present thegreatest challenge. Wecan alter or adapt ourphysical environmentrelatively quickly; howlong does it take tochange someone’s wayof thinking? Certainly,raising awareness is thefirst step.

The Americans withDisabilities Act (ADA)has helped considerablyin raising our awarenessabout many issues re-lated to individuals withdisabilities. The ADA isa federal civil rights lawdesigned to preventdiscrimination and en-able individuals withdisabilities to partici-pate fully in all aspectsof society.

Requirements of theADA address:

Title I: EmploymentTitle II: Public Ser-vicesTitle III: Public Ac-commodationsTitle IV: Telecommu-nicationsTitle V: MiscellaneousProvisionsThe ADA does not

allow an employer toask questions about a

disability or requiremedical examinationsuntil after a conditionaljob offer is made.

The ADA requirespublic buildings to havereasonable accommoda-tions for individualswith disabilities. Reason-able accommodationsare adjustments or mod-ifications provided byan employer to enablepeople with disabilitiesto enjoy equal employ-ment opportunities.Accommodations varydepending upon theneeds of the individual.Not all people withdisabilities (or all peo-ple with the same dis-ability) require the sameaccommodations. Forexample:

A deaf person mayneed a sign-languageinterpreter during ajob interview.An employee withdiabetes may needregularly scheduledbreaks during thework day to eatproperly and monitorblood-sugar andinsulin levels.A blind person mayneed someone to readinformation posted ona bulletin board.An employee withcancer may needspecial leave to haveradiation or chemo-therapy treatments.As the population

ages, we will see an in-crease in the number of

individuals with disabi-lities, which will chal-lenge us to think of newways to accommodateour patients. Considerthese facts:

There are 54 millionAmericans withdisabilities.1 out of every 5Americans has adisabilityby 2020, 75 millionpeople will be overthe age of 55It has been my exper-

ience that most peopleare not trying to be in-sensitive. However,some of us are unin-formed. We all havefears about people whoare ‘different’ from us.The trick is not lettingthose fears distort howwe perceive or interactwith others, especiallyindividuals with physi-cal differences.

I have found that thefollowing tips can beuseful:

False perceptions can be moredisabling than disability

—by Oswald Mondejar,Human Resources manager

Equal AccessEqual Access

I

Use first-personlanguage wheneverpossible (for example:‘people with disabili-ties’ not, ‘the disabl-ed’)When offering assist-ance, always askbefore providingassistanceDirect your communi-cation to the indivi-dualRelax. Don’t be em-barrassed or afraid touse common phraseslike, “Can I walk youto the door,” (if theperson is in a wheel-chair) or “Did you seethe new Denzel Wash-ington movie?” (if theperson is blind.)As in most cases, if

you let common senseand consideration beyour guide, you and thedisabled individuals youcare for will do just fine.

For more informa-tion, please contact OzMondejar at 6-5741.

The Employee Assistance ProgramWork-Life Lunchtime Seminar Series

presents

“Successful Singlehood:Expanding your Social

Network”Presented by Henri Menco, LICSW

Being single and meeting new peoplecan be challenging. This is especially truewhen moving to a new city. Henri Menco

believes the number one thing preventingpeople from meeting new people is fear of

rejection. Menco will discuss ways of makingyourself visible, social networking, places to

meet people, positive self-talk, and just how tohave more fun in life

Thursday, November 13, 200312:00–1:00pm

Wellman Conference Room

For more information, please contact theEmployee Assistance Program (EAP) at 726-6976.

Page 9


communities where theair, soil, and water con-tain contaminants notfound in wealthy com-munities.

A study by Faberand Krieg of Northeast-ern University lookedat environmentally haz-ardous sites in Massa-chusetts and concludedthat hazardous sites aredisproportionately lo-cated in low-income andminority communities.The study found thatcommunities in whichpeople of color make up15% or more of the pop-ulation have four timesthe number of hazard-ous waste sites and fivetimes the amount ofchemical pollutants ascommunities where peo-

ple of color make upless than 5% of the pop-ulation. Communitieswith household incomeson average less than$30,000 per year havemore than four timesthe hazardous wastesites and seven timesthe chemical pollutantsas communities withincomes of more than$40,000.

When talking abouthealth disparities, saidBarrios, environmentalproblems must be partof the conversation.

One community thatdeals with a number ofenvironmental issues isChelsea. The Northeast-ern report identifiedChelsea as the thirdmost environmentally

Advocating for health careas a civil right

—by Donna Perry, RN,professional development coordinator

Civic ResponsibilityCivic Responsibility

A t the recentHealth Dis-

parities Confer-ence sponsored by

Patient Care Services,Senator Jarrett Barriosspoke about the societalissues that lead to poor-er health outcomes forlow-income and minori-ty families. He stressedthe need to addressthese issues at the local,state, and national level,and to seek understand-ing about why thesedisparities exist. Whileinstitutional changes areimportant, there is alsoa broader social context.

Barrios sited envi-ronmental issues as onekey factor impactinghealth disparities. Poor-er populations tend tolive in urban, industrial

overburdened city inMassachusetts. Recent-ly, citizens of Chelseaformed The ChelseaGreen Space and Recre-ation Committee to ad-dress environmentalissues and help protectand expand Chelsea’sparks and recreationalareas. In one urban area,residents have trans-formed a vacant lot intoa beautiful communitygarden. The ChelseaGreen Space and Recre-ation Committee has ayouth component calledThe Youth Environment-al Crew, a group ofteens who work on localenvironmental projects.

Barrios has introduc-ed a number of bills tohelp alleviate some ofthe burden caused byenvironmental factors,such as The Clean andHealthy CommunitiesAct, (to empower neigh-borhood communities to

promote environmentalsafety by providinggreater protection frompollution and hazardouswaste); An Act to Re-duce Disparities in Dis-ease Outcomes throughImproved Prevention,Detection and Treatmentfor Uninsured Massa-chusetts Residents (toimprove early diagnosisand treatment for all resi-dents).

Barrios advocates forchanges in policy andpractice that will ensurepreventative health careand effective diagnosticsystems for everyone.He points to the Massa-chusetts Interpreter Lawas a model for change.

Barrios recounted astory about a child in theBoston area who wasput on the wrong schoolbus because his skincolor led staff to assumehe was from a low-in-come neighborhood.Environmental equalityand health disparities arepart of the same prob-lem.

During a recent visitto Australia, Barrios wasstruck by the fact thatAustralia emulates theUnited States in almostevery area... except healthcare. American healthcarepractices are not emulat-ed because so many ofour citizens don’t haveaccess to care.

Access to qualitycare is a civil rights is-sue. America was found-ed on the promise ofliberty and justice for all.Changes need to be madein our healthcare systemin order to fulfill thatpromise.

Members of The Chelsea Youth Environmental Crewat the Chelsea Community Garden

Page 10


uage services, patient-education, and cultural-ly competent care. Insearching for benchmarkpractices in these areas,they identified MGHMedical InterpreterServices as a model forthe effective delivery oflanguage services.

I was invited by theBoltzmann Institute togo to Reggio Emilia,Italy, to present ourmodel of language ser-vices to hospital repre-sentatives from 11 Euro-pean countries. I heardabout the challengesthese countries are fac-ing. They are all at dif-ferent stages of imple-menting and improvingtheir interpreter ser-vices, but the challengethey’re facing is thesame: How do you de-liver effective interpret-

er services when thereare more than 5,000languages in the world?

We discussed manydifferent options. Themost common methodsfor delivering languageservices are face-to-faceand by telephone. Oneinnovative new optionis video-conferencing.But the preferred modeis face-to-face.

Obviously, it’s verydifficult to provide face-to-face interpreter ser-vices at all times, for alllanguage groups due tothe growing number ofrequests for service, thechanging demand forlanguages, and the dif-ficulty in finding compe-tent medical interpret-ers.

Interpreting over thephone is one way toprovide competent inter-

preter services across alarge geographic area.Many clinicians at MGHuse telephone interpret-ers and they report thatit is more convenientand effective than theythought it would be.Patients felt comfort-able and appreciated theadded level of privacythey got from using atelephone.

Interpreting by video-conferencing is still inits infancy, but it willbe available at MGH inthe coming months. Arecent study in Bostonconcluded that patientsprefer video-conferenc-ing because it gives themmore privacy.

The European rep-resentatives I met withwere impressed withthe resources we havein place at MGH: a cen-tralized interpreter sys-tem, a website to pro-mote our services, asystem to identify pa-tients’ preferred lang-uages, a scheduling sys-

tem that integrates lang-uage services, and theguidelines we developedfor clinicians on howbest to work with inter-preters.

I shared with themour practices of notallowing children under18 to serve as medicalinterpreters, and dis-couraging caregiversfrom asking family mem-bers to interpret fortheir loved ones.

As the manager ofMGH Medical Inter-preter Services, attend-ing the Migrant Friend-ly Hospital Forum inItaly was extremelysatisfying. It was bothrewarding and eye-open-ing.

I realized that thedelivery of competent,effective interpreterservices is a worldwidechallenge. But despitethe challenges, MGH,has been able to devel-op a multi-faceted sys-tem that other countriesrespect and emulate.

Interpreter ServicesInterpreter ServicesDelivering effective interpreterservices: a worldwide challenge

—by Lourdes Sanchez, manager,MGH Interpreter Servicesanguage bar-

riers are oneof the primary fac-

tors contrib-uting to health dis-

parities. When patientsenter the healthcare sys-tem, if they can’t com-municate, or locate ap-propriate resources tohelp them communicate,the chances that theywill receive adequatecare and treatment aregreatly diminished.

History shows anongoing influx of immi-grants from many coun-tries seeking residencein the United States.The growing immigrantpopulation presentschallenges to healthcareinstitutions strugglingto keep up with theneed for interpreter ser-vices.

Despite our relative-ly new understandingthat interpreter servicesis an integral part ofquality care, many statesand countries have beenunable to develop ef-fective programs to ade-quately meet the need.

The Ludwig Boltz-mann Institute for theSociology of Health andMedicine in Vienna, inconjunction with theWHO CollaboratingCenter for Health Pro-motions in Hospitalsand Health Care, initiat-ed a European effort topromote health andhealth literacy for mi-grants and ethnic mino-rities. The pilot programtargets three areas: lang-

L

Manager of MGH Medical Interpreter Services, Lourdes Sanchez (secondfrom left) addresses Migrant Friendly Hospital Forum in Reggio Emilia, Italy.

Page 11


presence of disease,health outcomes or ac-cess to care.”

The Center on HealthDisparities Research atJohns Hopkins Univer-sity School of Nursingdefines health dispari-ties as, “differences inaccess to care, process-es of care, or healthoutcomes.” They des-cribe underserved pop-ulations as those, “whohave less access to careeven though care maybe available; those whoreceive less or differentcare than the majorityof the general popula-tion; or those for whomtraditional models ofcare are inappropriatefor cultural or otherreasons.”

Health disparitieshas become a major con-cern among healthcare

Healthcare Disparitiescontinued from front cover

providers. The Depart-ment of Health and Hu-man Services has identi-fied six focus areas aspart of the nation’s

new health agenda:Healthy People 2010.These areas are: infantmortality, cancer screen-ing and management,cardiovascular disease,diabetes, HIV/AIDS,and immunizations.These areas were select-ed because they affectminority populations ata disproportionatelyhigher rate than whiteAmericans.

Infant mortality ratesare often used as anindicator of health sta-tus. In Massachusetts,four out of every 1,000white babies die versusalmost ten out of every1,000 African Americanbabies.

Medicare and Medi-caid report that the av-erage life expectancy inthe United States is76.8 years old. But notif you’re African Amer-ican. The life expectan-cy of an African Amer-ican is 70.3 years withonly 56 years anticipat-

ed as ‘healthy.’ It hasbeen reported that 30%of the 40 million benefi-ciaries of Medicare andMedicaid are blockeddue to cultural and ling-uistic barriers.

The question thatmust be answered is,

‘Why?’ Why do thesedisparities exist? TheOffice of Special Popu-lations within the Na-tional Institute of Men-tal Health is looking atinterpersonal, socio-cultural, and organiza-tional factors as it re-searches this issue.

The National Insti-tute of Nursing Researchand the National Centeron Minority Health andHealth Disparities havefunded a number of nurs-ing partnership centersto focus on health dis-parities. These academiccenters pair minority-serving institutions withmajority-serving insti-tutions to support nurs-ing research into healthdisparities. These cen-ters also help facilitatethe development of mi-nority researchers in thefield. Working directlywith affected communi-ties and cultivating re-searchers from diversebackgrounds are impor-tant steps toward eli-minating disparities inhealth care.

A great deal of atten-tion is focused on thisissue from many differ-ent venues. At the con-ference on Health Dis-parities sponsored bythe PCS Diversity Com-mittee recently, the com-plexities of the issuebecame abundantly clear.Health disparities is alegislative issue, a socialissue, a care-deliveryissue, a patient-drivenissue, and a healthcaresystems issue.

As we continue tograpple with the solu-tions to healthcare dis-parities, we must bal-ance our search for an-swers with the imme-diate needs of minoritypatient who are comingthrough our doors to-day. Our attention andcommitment to provid-ing equal, high-qualitycare to all patients can-not be put on hold.

100%

50%

Health Insurance Status by Race and Ethnicity(Total Non-Elderly Population)

0%

Uninsured Medicaid Private/Other

NativeAmerican

27%

19%

55%

Latino

36%

19%

45%

Asian/PacificIslander

22%

9%

69%

AfricanAmerican

23%

22%

54%

White(Non-Latino)

14%

8%

79%

(Source: KMCU, Medicaid Today: Profile of a Program and the People it Covers, 1999)

Page 12

A Social Work Perspectivecontinued from page 4

services, and societalstigma toward mentalillness. But additionalbarriers deter racial andethnic minorities: mis-trust and fear of treat-ment, racism and discri-mination, and differ-ences in language andcommunication.”

The report statedthat a lack of adequatetreatment leads to agreater disability burdenon minorities, whichgrows as the minoritypopulation grows. “Ra-cial and ethnic minori-ties in the US face asocial and economicenvironment of inequa-lity that includes greaterexposure to racism anddiscrimination, violence,and poverty, all of whichtake a toll on mentalhealth.”

Mental health prac-titioners need to be cul-turally competent in

caring for the commu-nities they serve. But itmay not be enough tounderstand someone’sculture or speak theirlanguage; we may needto develop new, com-munity-specific, inter-ventions.

Bonnie Zimmer,director of HAVEN, theMGH domestic-vio-lence intervention pro-gram, cites a useful ex-ample. The convention-al model of empoweringa survivor to break-offcontact with his/herabuser isn’t effective incommunities of colorwhere there is a highvalue on family andcommunity. One com-munity program pro-vides cutting-edge ser-vices teaching abusivemen how to renounceviolence while stayingconnected as fathers.They work with men to

take responsibility forthe violence, and helpthem talk with theirchildren about how tohelp stop the cycle ofviolence.

What is the socialwork field doing to

address disparities?The NASW Code ofEthics includes princi-ples and standards re-garding social justice,dignity and worth ofthe person, competence,and diversity. DetailedStandards For CulturalCompetence were ad-opted in June, 2001.

What is the MGHdepartment of Social

Services doing?The Social Services’Cultural CompetenceCommittee has beenworking to define issuesand goals for the depart-ment. The committeehas identified culturalcompetence and staffdiversity as our twoprimary goals. We areworking with an outside

consultant to analyzethe results of a depart-mental-needs assess-ment and together wewill identify and imple-ment appropriate initi-atives.

Another group isworking with Interpret-er Services to addressissues unique to socialwork. Many in our de-partment feel passion-ately about these is-sues and are findingcreative ways to addressthem in their practice.

What can we doas individuals?

Empowering clients toget involved in commu-nity organizations andpolitical actions can bean extremely useful cli-nical intervention. Weall know of parents whohave lost a child to vio-lence and used theirgrief to impact legisla-tion.

Patient advisorycouncils, such as the oneinitiated by the CancerCenter’s HOPES pro-

gram, are another wayto empower patientsand families.

Don’t underestimatethe importance of vot-ing and communicatingwith your legislators.Let your representa-tives know that youvalue safety-net pro-grams. Learn more aboutgroups like the Massa-chusetts Immigrant andRefugee Advocacy Co-alition (MIRA); Mass-Health Defense; and theMassachusetts HumanServices Coalition.

The NASW Code ofEthics strongly encour-ages political advocacyas part of our responsi-bility to our clients andour profession. Healthprofessionals are afford-ed a high level of trustand credibility by thepublic. We all have com-pelling stories to share.We are in a position toinfluence legislators andthe public. I urge you toput that influence togood use.


with similar disabi-lities may not haveaccess to the sametreatment (A childwith significant lang-uage delays may re-quire bi-weekly, one-on-one, speech-lang-uage therapy. Thechild attends a schoolthat has been impact-ed by budget cuts andis placed in a therapygroup with two otherchildren. The thera-pist does the best she

can under the circum-stances, but the childis at a significant dis-advantage comparedto a child attending aschool where resourcesand staff are not anissue.Through rehabilita-

tion, physical thera-pists, occupational ther-apists, and speech-lang-uage pathologists treatpatients who have dis-ease processes that li-mit their activity and

participation in society.Our goal is to improvetheir quality of life byreducing impairments ofbody function and struc-ture, activity limitationsand participation re-strictions. However,much can be done froma systems perspectiveto remove environmentalfactors that impede theprocess of rehabilitationand contribute to healthdisparities.

Addressing physical,social, and attitudinalfactors is everyone’sresponsibility. Becom-ing aware of these bar-

A Rehabilitation Perspectivecontinued from page 5

riers is the first step.Our goal must be tocreate a different kindof environment, an en-vironment that will al-

low us to hear, “Peoplewith disabilities are get-ting the same kind ofcare that other peopleget.”

The Employee Assistance ProgramWork-Life Lunchtime Seminar Series

presents

“Working and Breast-feeding”Presented by Germaine Lamberge, RN

This presentation will provide expectant and nursingparents basic information on breast-feeding, breast

pumps, problem-solving, and much more.

Thursday, November 4, 200312:00–1:00pm, VBK401

For more information, please contact theEmployee Assistance Program (EAP) at 726-6976.

October 16, 2003

Page 13

October 16, 2003

Next Publication Date:November 6, 2003

Published by:Caring Headlines is published twice eachmonth by the department of Patient Care

Services at Massachusetts General Hospital.

PublisherJeanette Ives Erickson RN, MS,

senior vice president for Patient Careand chief nurse

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy

Mary Martha Thiel

Development & Public Affairs LiaisonGeorgia Peirce

Editorial SupportMarianne Ditomassi, RN, MSN, MBAMary Ellin Smith, RN, MS

Materials ManagementEdward Raeke

Nutrition & Food ServicesPatrick BaldassaroMartha Lynch, MS, RD, CNSD

Office of Patient AdvocacySally Millar, RN, MBA

Orthotics & ProstheticsEileen Mullen

Patient Care Services, DiversityDeborah Washington, RN, MSN

Physical TherapyOccupational Therapy

Michael G. Sullivan, PT, MBA

Police & SecurityJoe Crowley

Reading Language DisordersCarolyn Horn, MEd

Respiratory CareEd Burns, RRT

Social ServicesEllen Forman, LICSW

Speech-Language PathologyCarmen Vega-Barachowitz, MS, SLP

Volunteer, Medical Interpreter, Ambassadorand LVC Retail Services

Pat Rowell

DistributionPlease contact Ursula Hoehl at 726-9057 for

all issues related to distribution

Submission of ArticlesWritten contributions should be

submitted directly to Susan Sabiaas far in advance as possible.

Caring Headlines cannot guarantee theinclusion of any article.

Articles/ideas should be submittedin writing by fax: 617-726-8594or e-mail: [email protected]

For more information, call: 617-724-1746.

Please recycle

when Mondejar was given thesupport of Jeanette Ives Erick-son, RN, senior vice presidentfor Patient Care, and Jeff Da-vis, senior vice president forHuman Resources. As a resultof this partnership, ACCESOhas received overwhelmingsupport from the MGH com-munity, including books donat-ed by staff and the TreadwellLibrary, and donations of med-ical supplies and equipment.Trish Gibbons, RN, associatechief for The Center for Clin-ical & Professional Develop-ment; Dr. Jean Elrick, seniorvice president for Administra-tion; Brian Griffin and EdRaeke of Materials Manage-ment; and the Chelsea and Ev-erett health centers have allbeen strong supporters of thiswork.

Donna Perry, RN, coordi-nator of the InternationalNurse Consultant Program,visited Cuba for the first timethis year as part of the AC-CESO delegation. Perry joinedthe humanitarian delegationwith the intent of giving butfound instead that she, “wasthe recipient of the bountifulgood will and love of the Cu-ban people.” In her presen-tation, Perry spoke about thework of Clara Barton, a nativeof Oxford, Massachusetts, andfounder of the American RedCross. Barton led a group ofnurses providing aid to Cubansduring the Spanish-Americanwar. The work of the RedCross nurses earned them therespect of the US Congressand led to the formation of theArmy Nurse Corps in 1901.

The Red Cross was found-ed on the principle that medi-cal care transcends politicalboundaries. Perry stressed the

Cuba Revisitedcontinued from page 6

importance of focusing on hu-man need. She quoted Barton,saying, “Think only of theneed and the impossible is ac-complished.” MGH and ACC-ESO are focusing on the need.

Despite the limitations ofthe Cuban healthcare system,Cuba has made remarkable pro-gress in medical care due to acomprehensive public healthpolicy. Vega-Barachowitz de-scribed the system of medicalcare in Cuba and shared herimpressions as a member ofthe ACCESO delegation. TheMinistry of Public Health isthe chief executive body of thenational system of health care.The Cuban healthcare systemis free to all citizens and avail-able at three levels. At the pri-mary level, the family doctorand nurse are the guardians ofhealth for each community. Atthe secondary level, polycli-nics are where patients go tobe treated for minor emergen-

cies and receive obstetrical andsurgical care. Polyclinics coor-dinate the activities of the com-munity doctors and nurses.Patients who require morecomplex care are referred toone of three tertiary hospitalsor one of the specialty hospi-tals in Havana. The Cubanhealthcare system is seen as amodel for public-health prac-tice and has led to the eradica-tion of several diseases includ-ing polio, measles, malaria,tetanus and diphtheria. Theinfant mortality rate, consid-ered a reliable indicator ofhealthcare quality, is an im-pressive 7.1 per 1,000 births.The average life-expectancy inCuba is 76 years.

Mondejar spoke about theimportant dialogues that occurduring these annual visits andthe progress that is being madeto reacquaint Cubans and Am-ericans after 40 years of es-trangement.

In recognition...Perry, Vega-Barachowitz, and Mondejar presented a spe-cial award to MGH president, Peter Slavin, MD; JeanetteIves Erickson, RN, senior vice president for Patient Care;and Jeff Davis, senior vice president for Human Resources,in recognition of the tremendous support MGH has givento the people of Cuba through ACCESO. The award wasaccompanied by a potted rose bush to be planted some-where on hospital grounds. Presenting the award, Perry readthis poem by Jose Marti, a national hero in Cuba:

Rosa Blanca (The White Rose)

I cultivate a white rose.In July as in January,For the sincere friend

Who gives me his hand frankly.

As for the cruel person,Who tears out the heart with which I live,

I cultivate neither nettles nor thorns:I cultivate a white rose.

Page 14


Health literacy: an importantfactor in disparities of care

The following questions and answers were drawn from a presentationgiven by Lori Pugsley, RN, co-chair of The Patient Education Committee, andTaryn Pittman, RN, patient education specialist, at a recent Women’s Health

Coordinating Council meeting.

Fielding the IssuesFielding the Issues

Infection Control WeekAwareness Fair

Sponsored by theMGH Infection Control Unit

October 21–23, 200311:30am–1:30pm.East dining room

The Infection Control Unit joinsThe Association for Professionals inInfection Control and Epidemiology

(APIC) in recognizing NationalInfection Control Week.

Please stop by our table to pick upthe latest information on disease

prevention.

The ProTech Program

The ProTech program is recruitingdepartments and staff to share their

job experience with small groupsof students from East Boston HighSchool. Visits will take place on the

morning of October 29, 2003.

Open your doors to a young personinterested in learning about health

careers.

For information, please [email protected] or call theProTech office at 617-724-8326.

The ProTech Program is offered throughthe MGH Community Benefit Office.

Women’s CancersAwareness Fair

Stop by the education booth in theMain Corridor to learn more about early

detection, prevention, and treatmentof the most common cancers

affecting women today

Friday, October 17, 20039:00am–2:00pm

in the Main Corridor

Question:What is healthliteracy?Answer: Health literacyrefers to a patient’s abi-lity to perform the basicreading and mathemati-cal skills necessary tofunction in the health-care environment.

Question:Is health liter-acy really a factor inhealthcare disparities?Answer: Almost half ofall adults in the UnitedStates have difficultyreading and understand-ing math. 21% of adultAmericans are function-ally illiterate (read be-low the 5th-grade level).Another 26% are onlymarginally literate (readat the 8th-grade level).That translates into aserious problem whentrying to ensure that allpatients have equal ac-cess to care.

Question:What can wedo to ensure that liter-acy doesn’t interferewith providing goodcare?Answer: Being aware ofthe problem is the firststep. Caregivers shouldassess a patient’s liter-acy level as part of theirinitial assessment. If aliteracy issue is identi-fied, the caregiver canthen tailor his/her com-munication to bettermeet the needs of thepatient.

Question: Shame is oftena factor in patients notrevealing poor literacyskills. How can we getpast those feelings toensure that patients getthe help they need?Answer: Many peoplewith limited literacyskills do feel ashamedor embarrassed. In fact,

they may try to hidethe problem from fam-ily, friends, and evencaregivers. It’s veryimportant to establish ashame-free environmentso patients of all liter-acy levels feel comfort-able and supported. Wesuggest:

reviewing all medica-tion instructions, dis-charge information,and follow-up ap-pointments before thepatient leaveshaving a family mem-ber or friend presentto hear relevant infor-mationusing simple languagewhen discussingprocedures, medica-tions, and treatmentmaking it policy toassist patients withpaperworkmaking follow-upphone calls to ensurepatients understandand are complyingwith medical instruc-tions.

Question:How can youensure understanding?Answer: To optimize apatient’s understandingit’s a good idea to:

read and review allinformation with thepatientuse the ‘teach back’method of having thepatient repeat theinstructions after youstate themuse the ‘chunks andchecks’ technique ofgiving two or threeconcepts at a time,then checking forunderstandingalways speak slowlyand clearlyavoid using highlytechnical medicaljargon

Question:Is there any-thing else we can do toovercome literacy is-sues?Answer: Much of ourpatient teaching is rein-forced with written edu-cational materials. Wecan apply the same prin-ciples to our writtencommunication as ourverbal communication.Keep it simple.

Here are some tips:Consider the age,gender, and culture ofyour target audiencewhen preparingwritten informationIt’s helpful to includepeople from yourtarget audience in theplanning of writtenmaterialsKeep the literacylevel of written mater-ials to a 6th-gradelevel.Use common words(such as ‘doctor’instead of ‘physician;’‘use’ instead of ‘uti-lize,’ etc.)Use short sentences,pictures, and diagramsto aid understandingMake sure yourwritten materials areeasy to read, consum-er-friendly, and read-er-focused.For more information,

visit these websites:www.plainlanguage.govww.hsph.harvard.edu/healthliteracywww.nces.ed.gov/naal(for results of the1992 National AdultLiteracy Survey)

2003

Page 15

2003

Educational OfferingsEducational Offerings October 16, 2003October 16, 2003

For detailed information about educational offerings, visit our web calendar at http://pcs.mgh.harvard.edu. To register, call (617)726-3111.For information about Risk Management Foundation programs, check the Internet at http://www.hrm.harvard.edu.

Contact HoursDescriptionWhen/WhereIntra-Aortic Balloon Pump WorkshopDay 1: New England Baptist Hospital. Day 2: (VBK607)

14.4for completing both days

October 27 and 287:30am–4:30pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK 401 (No BLS card given)

- - -October 278:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

Nursing Grand Rounds“An Overview of Case Management.” O’Keeffe Auditorium

1.2October 301:30–2:30pm

Wound Skin Care Update: 2003Shriners Hospital

TBAOctober 318:00am–4:30pm

Pre-ACLS CourseO’Keeffe Auditorium $100. (to register e-mail: [email protected])

- - -November 38:00–2:30pm

BLS Certification–HeartsaverVBK 601

- - -November 48:00am–12:00pm

Greater Boston ICU Consortium CORE ProgramVABHC

44.8for completing all six days

November 5, 12, 13, 17, 18, 197:30am–4:00pm

CPR—American Heart Association BLS Re-CertificationVBK 401

- - -November 67:30–11:00am/12:00–3:30pm

Nursing Grand Rounds“Communities of Color: Fact and Fiction.” O’Keeffe Auditorium

1.2November 61:30–2:30pm

Introduction to Culturally Competent Care: Understanding OurPatients, Ourselves and Each OtherTraining Department, Charles River Plaza

7.2November 78:00am–4:30pm

End-of-Life Nursing Education ProgramO’Keeffe Auditorium


New Graduate Nurse Development Seminar ITraining Department, Charles River Plaza

6.0(for mentors only)

November 128:00am–2:30pm

OA/PCA/USA Connections“Radiology: We All Play a Role.” Bigelow 4 Amphitheater

- - -November 121:30–2:30pm

Managing Pap Test Results in the Primary Care SettingO’Keeffe Auditorium


Workforce Dynamics: Skills for SuccessTraining Department, Charles River Plaza

TBANovember 138:00am–4:30pm

CPR—Age-Specific Mannequin Demonstration of BLS SkillsVBK 401 (No BLS card given)

- - -November 138:00am and 12:00pm (Adult)10:00am and 2:00pm (Pediatric)

The Joint Commission Satellite Network presents:“Hospital-Wide Competency Assessment.” Haber Conference Room

- - -November 131:00–2:30pm

CPR—American Heart Association BLS Re-CertificationVBK 401

- - -November 187:30–11:00am/12:00–3:30pm

Intermediate Respiratory CareRespiratory Care Conference Room, Ellison 401

TBANovember 188:00am–4:00pm

Natural Medicines: Helpful or Harmful?Clinics 262


Deb Wing Memorial LectureTopic TBA. Wellman Conference Room

TBANovember 54:00–6:00pm

Page 16


CaringCaringH E A D L I N E S

Send returns only to Bigelow 10Nursing Office, MGH

55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage Paid

Permit #57416Boston MA

Office of Civil Rights: TheHHS Office of Civil Rightsdrafted written policy guide-lines to assist healthcare pro-viders ensure that people withlimited English can effectivelyaccess critical health and socialservices. For more information,visit http://www.hhs.gov/ocr/lep/.

Healthfinder en Español: Thisis a Spanish-language websitethat helps consumers find re-liable information quickly andeasily on the Internet. Health-finder en Español presentshealth information on morethan 300 topics, including is-sues of greatest concern to theHispanic population. Visit:http://www.healthfinder.gov/espanol/.

MEDLINEplus: NIH’s Na-tional Library of Medicine(NLM) launched MEDLINE-plus, the Spanish-languagecounterpart to MEDLINE,which provides authoritative,full-text, medical resources. Goto: http://www.medlineplus.gov/esp.

Racial and Ethnic Adult Dis-parities in Immunization Ini-tiative (READII): HHS launch-ed READII, a new adult immu-nization initiative to reduceracial and ethnic disparities ininfluenza and pneumococcalvaccination coverage for adults65 years of age and older, fo-cusing on African-Americanand Hispanic communities. Forinformation, go to http://www.hhs.gov/news/press/2002pres/20020731a.html.

The Office of Minority Health(OMHRC) established a Re-source Center in 1987 to meetthe public’s need for reliable,accurate and timely health in-formation. Some of OMHRC’sservices include referrals, pub-lications, reference informa-tion, and access to minorityhealth professionals across thecountry. For information, goto: http://www.omhrc.gov.

Healthy People 2010: HealthyPeople 2010 is a comprehen-sive set of health objectives forthe nation, and includes twoover-arching goals: increasingquality and length of life, andeliminating racial and ethnicdisparities in health. Go tohttp://www.health.gov/healthypeople for more information.

Healthy People 2010 is theprevention agenda for the Na-tion. It is a statement of healthobjectives designed to identify

Health disparities:web-based resources

ResourcesResourcesthe most significant prevent-able threats to health and es-tablish national goals to reducethese threats. For information,visit: www.healthypeople.gov.

Research by the Agency forHealthcare Research and Qua-lity (AHRQ) has focused onidentifying and understandinghow inequities in health carecontribute to disparities, andhow disparities can be elimi-nated. For information, visit:www.ahrq.gov.

The Agency for HealthcareResearch and Quality (AHRQ)has awarded grants to nine“Excellence Centers To Elimi-nate Ethnic/Racial Disparities”(EXCEED). Each center isinvestigating a different themein an effort to identify andeliminate the causes of healthdisparities. For information,visit: http://www.ahrq.gov/research/exceed.htm.

Documents

Caring October 16, 2003 - Massachusetts General HospitalDispro-portionate access to care reminds many of us of a social history we hoped we had moved beyond. Now we see evi-dence of