My role as a care coordinator for a local mobile health clinic — the mobile outreach clinic (MOC) — comes with responsibilities seldomly awarded to an undergraduate, 20-year old, volunteer student. MOC is unique in that it not only provides free, low-barrier, patient-centered primary care, but it also assigns patients to volunteer care coordinators. Care coordinators have a daunting task: to identify our assigned patients’ socioeconomic barriers to health and give patients the resources and support they need to overcome them. We develop long-standing relationships with our patients, learn from them regarding barriers to health and wellness, and empower them to set and achieve health goals.
There are common barriers that most of our patients face: lack of reliable transportation, lack of access to healthy foods, no health insurance, and underemployment. Our local community has a robust safety net with non-profit organizations and community groups who offer myriad resources to help patients overcome these barriers. However, sometimes even the act of accessing these resources is a challenge. For example, I recently helped connect a patient to an organization that has a resume building workshop every week at 5 p.m. While my patient was able to call the organization and confirm a slot in the following week’s workshop, she ended up working late and was unable to attend. It took several attempts to help her reconnect with the organization, but she was eventually successful.
When I checked in with her the following week, she thanked me and said she was already on the job hunt with her new resume.
While there are successes to celebrate in care coordination, there are also many times care coordination alone does not suffice. As a Spanish-speaking volunteer, all of my 14 assigned patients are native Spanish speakers with limited English proficiency. Some of them have additional barriers related to immigration status. It is far too common to work to connect them to local resources, only to see an unmet need remain because of insufficient language access services.
Just a few weeks ago, I called a woman I have been in contact with for a few months. She does not speak English, is without health insurance, and has limited income in her work as an at-home caregiver for an elderly man. During our call, her priority was worsening dental pain and a need to see a dentist. I provided contact information for a local resource that provides low-cost dental care; we made a plan that she would reach out to this agency, and I would follow up with her the following week.
I left the call feeling grateful that such resources are available in our community. During our next call, she relayed to me the frustration she felt when she called the dental office, only to realize that no one was available on the other end to communicate with her in Spanish. The person on the other line, being unable to understand what my patient was saying in Spanish, eventually hung up the phone. For patients like her, care coordinators must go above and beyond to connect patients with the community; simply passing on a resource is not enough.
That day, I offered to spend my shift on a three-way conference call so that I could interpret for her in real-time and get answers to her questions, book the appointment, and provide all the necessary information she would need to successfully receive dental care.
We are failing Spanish-speaking members of our community when we refer them to outside programs and organizations and assure that we can help, without knowing if those programs are equipped to provide appropriate language and cultural care. My role as a care coordinator is valuable. And being able to address a patient’s social determinants of health as part of their plan of care is crucial to achieving health equity. However, the added barriers our Spanish-speaking patients face means it must be a priority for community partners to provide interpretation services in-house and brochures and websites in Spanish.
Of course, this is much easier said than done. Community organizations, often already working on a tight budget, may not be able to devote increased financial and human resources towards translating a wealth of printed and electronic materials into other languages, as well as hiring interpreters or paying for a telephonic language interpretation service. A more affordable solution is to seek and train bilingual volunteers or better yet, to engage the limited English proficiency patients who utilize the services to weigh in on the ways that access, communication, and equity can be improved.
Laura V. Robles-Torres is a care coordinator.
Image credit: Shutterstock.com
