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“Knowing that an important number of Latinx are not yet fully vaccinated and understanding the health care gaps and social disparities that affect this group, it is reasonable to assume that the Latinx community will be disproportionately affected by the pain and sorrow of the new wave of the COVID-19 pandemic. More efforts and resources need to be designated to continue educating and empowering the Latinx community to comply with vaccination and other well-proven preventive measures that will protect them from COVID-19 and its devastating consequences now and in the future. In addition, medical schools, societies, and other related health care institutions need to become more socially and culturally aware and advocate for a diverse, inclusive health care system that promotes equity and reduces disparities.”
Miriam Zylberglait Lisigurski is an internal medicine physician. Ricardo Correa is an endocrinologist.
They share their stories and discuss the KevinMD article, “COVID-19 vaccination: the Latinx experience.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.
Today on the show, we have Miriam Zylberglait and Ricardo Correa. Miriam we’ve had on the show several times. She’s an internal medicine physician. Ricardo is an endocrinologist, and together they wrote the article “COVID-19 vaccination: the Latinx experience.” Miriam and Ricardo, welcome to the show.
Miriam Zylberglait Lisigurski: Thank you.
Ricardo Correa: Thank you.
Kevin Pho: We’ll get into that article in a little bit, but I’m going to ask each of you just to share your stories and journeys to where you are today. Miriam, why don’t you go first?
Miriam Zylberglait Lisigurski: As you well know, I am an international. I am Latina, even if my last name doesn’t sound like that. I emigrated, originally, from Peru, where I practiced medicine for 10 years. I am very into wellness, and I don’t see myself separating wellness from inclusion and diversity. So even though this topic doesn’t target my number one interest, which is wellness, clearly we really need to focus on inclusion and what happened with minorities to really offer wellness to all the community.
Kevin Pho: Miriam, tell me about your background as a Latinx. How does that influence your profession as a physician?
Miriam Zylberglait Lisigurski: I always say that I practice medicine in the Latin way. During my career in Peru and my training, we were close to patients, almost part of the family. The doctor is well respected and appreciated. We treat our patients as family. So I have been trying to practice that type of medicine here, forgetting a little about the times and metrics, which are very important and which we need to fulfill, but focusing on the patient as a human being and treating them as my family.
Kevin Pho: Ricardo, can you just briefly share your story and journey to where you are today?
Ricardo Correa: Yes. First, thank you for having us. I’m an endocrinologist by training. I’m originally from Panama, so I did medical school there, and then for postgraduate medical education, like Miriam, I traveled to the U.S. I was on the East Coast, first in Miami as a resident and then in Maryland as a fellow. I moved to Rhode Island, very close to you, so I was in New England for a while, and then I moved to the West Coast, to Phoenix, where I’m practicing right now. I’m in the academic setting, so I’m the program director for the endocrine fellowship.
During this time in Phoenix, I realized something that I always tell people: I felt more like a minority when I arrived in Phoenix than when I was in Rhode Island, where everybody would think the opposite, meaning Arizona is 30 percent Latinx community, and Phoenix is 40 percent. So I started getting a lot more involved in the diversity, equity, and inclusion movement, and I was able to get involved in university studies and become the director for diversity in graduate medical education.
Then, with the pandemic, a lot of the things that I was seeing just locally were definitely flourishing nationally, in the disparities that were happening. That gave me the opportunity to explode and say, “Hey, this is nothing new. This is something that is happening constantly, and now you’re realizing it, but it’s nothing new.” Then I had the opportunity to interact more with the community and to expose this to the public, using the Spanish TV here, Telemundo and Univision, and using other media, and having that impact has been very helpful. I think that we always see the bad side of things, and there are definitely so many bad things that the pandemic brought, but the positive is that people started realizing that this was happening, and now they want to make some changes, and there is a commitment.
In that journey, I met Miriam, who has a similar interest, and I thought that pairing together to tell the story, our story and the story of our community, to the physician community was important. We have been telling this to the public, yes, but telling the physician community what is happening was important.
Kevin Pho: All right, so let’s talk about that article that both of you wrote. It’s titled “COVID-19 vaccination: the Latinx experience.” Miriam, I’m going to ask you to summarize that article and share the reasons why you and Ricardo decided to write it.
Miriam Zylberglait Lisigurski: The article is a review of many other articles that were published during the last couple of years. We tried to bring, first, a little of the idea of how big the Latin community is in this country and how many differences there are between the care that they receive and the care that other communities are receiving. This is beyond health care per se; it is also focusing on the attention that they receive, right? When we talk about other minorities that deserve to be considered and that need extra help, the Latin community has always been very silent when reviewing the statistics, not only about vaccination, which was kind of at the end of the process, but about morbidity, mortality, complications, and understanding of the rules that we were supposed to follow in order to protect ourselves and our families.
What we found in this review of articles was that the Latin community really was dealing with a serious problem. The mortality was very high, beyond even the African American community. Morbidity was also in the higher rank. And there was the lack of education, or of the possibilities, and especially the fear. That is something that, for me, was the most dramatic part of this review: people fearing to ask for help or to go to the hospital because they were afraid of being moved back to their countries or being penalized for being immigrants.
So what we are trying to do with this article is to create awareness and to explain the specific characteristics of the Latin population and the specific needs, including these types of fears, that we need to consider. We are physicians. We are not here to judge. We are here to support and to care, and also to explain that if we don’t take the time to understand the social aspects, the emotional aspects, and the cultural aspects of the patients that we are taking care of, we are not practicing good medicine. That’s actually the reason why we did this. We wanted to create awareness and help our communities.
Kevin Pho: Ricardo, can you tell us a story or a case study of a patient or group of patients that you’ve seen that really illustrates what Miriam has been talking about regarding the obstacles to care that the Latinx community faces?
Ricardo Correa: Yes. Something very important that Miriam mentioned was seeing the Latinx community as what it is. It’s a different culture, and it’s multiracial, so we don’t have one race in it. It’s multiracial. And what I have seen a lot of times is, “I speak Spanish, and that’s enough.” So it’s not just understanding, or having the translation, or having a translator; it’s understanding the culture.
One of the things that happened here at the beginning of the pandemic was that, yes, people were saying, “You need to get tested if you have these kinds of symptoms,” and then they established centers in Arizona. The stadium was a center for testing, and there were other big centers. So people needed to go in a car to get tested, because you had to go to this place that was certainly far, far away from the Latinx community. We know there is a lower socioeconomic status, more so in border states, where, most likely, they are undocumented immigrants. Second, they went there, and what they were seeing was police and ICE. Why was ICE in the surroundings of a testing center during a public health emergency? Why was ICE there? That created more reluctance and more fear. They already had fear, but this was more fear to go to the health care system and ask for help. And then, of course, they started getting infected, and these were the people who, by certain predispositions, and not everything has to be genetic, but certain predispositions in genetics, include more diabetic and more obese patients. And then they finally got to the end point of the disease, which was dying from it. So that was one part.
The other part of the population was afraid of going, because if they were diagnosed, then they would not be able to go to work. These were the population that didn’t have opportunities for telework. There were many people who, yes, had the opportunity. In medicine, we have telemedicine, and then telework. But these are the janitors, the maintenance people, the people who have to go to the farms. These are the front lines, to a certain point, and they were unable to get sick days that were paid. And this is our other big topic: Why in the U.S. don’t we have paid sick days? So these were the people who didn’t want to get tested, didn’t want to, because they had to go to work. But their work was the one on the front line that more likely would get COVID. So this was a population that also suffered the most.
Other cases were patients who, as I mentioned, didn’t want to go to the hospital, because the other thing was that, at the beginning of the pandemic, and then it was stopped, but in the middle of the pandemic, we had the public charge rule. This is a rule that says that if you use federal funding for something in your process of legalization, then you will get hit by that, and you will not finally get your permanent status. So they were worried about using these systems, because then they would get penalized, as Miriam mentioned, and not just worried about getting sent back to their country, but worried that they could not get official status in the U.S.
So that was the beginning. It was stopped. We moved to the vaccines. Yes, OK, perfect, we saw that issue, and there were many things that were done, a lot of education to the community. But then the vaccine came, and it was another problem. There was no translation into Spanish of much of the documentation. Just in Arizona, for example, vaccinations started in December of 2020, and by February, the end of February of 2021, is when the Arizona Department of Health was publishing something in Spanish. So for two and a half, or two, months, there was a lack of documentation, and that was also affecting the community. We needed the vaccine. We needed to end a public health problem. It was not a problem of different race or ethnicity; it was a public health problem. But we didn’t provide resources to them, and this shows the problem perfectly.
I think that something we can get from this, and I have talked to Miriam about this, is that as a community caring for different races and ethnicities, it was in understanding this culture. In this case, we had the experience of helping in an underserved clinic and then making that clinic the center for the community, where they feel that there is trust in that clinic, and the people who are telling them the news are people that they trust. I always make the comparison: Yes, Dr. Fauci is a great source of information for us, for scientists, for medicine, but for their community, Dr. Fauci doesn’t represent anything. The ones that they will believe will be the doctors that see them every day.
It was making that happen, empowering community health care workers to go out. We did door-to-door knowledge. We did radio. Even I was very surprised, because we are in the world of social media, but there are older Latinx populations that use radio. They still use radio, and the radio is very important for them. So if you don’t understand the culture, you will never understand to use those things to promote the scientific evidence and then get them more vaccinated. And we saw this: At the beginning, they were the race and ethnicity with the most reluctance, and that decreased a lot. They fell to the third or fourth place in reluctance, just because a lot of the Latinx scientists and medical providers were doing this effort in their own communities and becoming the center of knowledge for that community.
Kevin Pho: Miriam, take us into the exam room. When you talk to a Latinx family and they express some of these concerns or have some obstacles to care, take us into the exam room. Tell us some of the conversations that you have to help alleviate those concerns.
Miriam Zylberglait Lisigurski: I will say that the first thing that I will do is speak in Spanish, even if they speak English perfectly, and that’s something that creates a very interesting connection. When they know that I am Hispanic, I don’t know, their faces change tremendously. So that has been a very interesting process. I talk to them really as family and friends, and I start like that. It’s like, “I will tell you what I am doing with my family.” That’s exactly what I say. “I will share the story of my parents, who are elderly. I will tell you about my kids and what I am doing with them. I will give you the pros and cons.”
Normally, I am very transparent, and I express my own fears. I remember telling them that I was in the car for 30 minutes thinking about it, right, and being afraid of what would happen if something happened, and why I made the decision. So I become part of them and their family. I use transparent information, and I admit what I know and what I don’t know.
But again, I believe that what Ricardo was saying is so important: to allow them to feel that they belong, that they are not different, that they are accepted, and for us to feel also that we belong to them, so we can create a real connection. That’s really my trick. It’s not very sophisticated. It’s just being transparent and respectful.
Kevin Pho: We’re talking to Miriam Zylberglait and Ricardo Correa. Miriam is an internal medicine physician. Ricardo is an endocrinologist, and together they wrote the KevinMD article “COVID-19 vaccination: the Latinx experience.” Ricardo, for those clinicians who don’t have that shared cultural background, and you mentioned there are a lot of misconceptions and misunderstandings about the Latinx cultural background, what are some pieces of advice that you could share with those non-Latinx clinicians to help connect with this population?
Ricardo Correa: Yes, and this is a great question, because we don’t have to have the background. We don’t expect that every physician has the background of being Latinx to understand the Latinx community. I think that it’s just that connection that you put in as a physician to understand who the patients are that you are seeing, and reading a little bit about how the structural and social determinants of health play a role in those populations. Sometimes it’s going to resources like the National Hispanic Medical Association, which has a good program on understanding the Latinx community. Other times, it’s just going to some other resources or asking your colleagues who probably have more experience or have been dealing with the population, because that way, you understand certain things that are not usual in other cultures.
One is that in the Latinx community, the role, or the owner, of the health of the family is the female. Sometimes it will be the grandma; other times it will be the mother. You have to understand that, because whenever you give a recommendation to a male, they will relay that to the female of the family, and then a lot of the things will come from them. Something that we have is a movement called Latina Strong, empowering those females so that, besides being responsible for taking care of all the family, they do other things. So understanding that is important.
Another thing, for example, in COVID, we realized that there were a lot of recommendations coming from the grandmas, the grandparents, that were really applicable in this condition, and a lot of the patients were coming in saying, “Hey, yes, I took a hot tea to kill the virus in my mouth.” And I said, “Who told you?” “Oh, my abuelita told me that.” And then you have to deal with that. You cannot say, “Do not believe your abuelita,” because they will never do it. This is the culture. So you have to say, “Hey, you know, at this time, probably your grandparents are not aware. This is totally new,” and try to understand that kind of culture.
So for resources, I think that there are a lot out there. The Latinx community represents 18.6 percent of the entire U.S. population. Probably it will be one-third, more than one-third, so it will not be a minority anymore. So what we need is to educate ourselves about the population that we’re seeing, in this case focusing on the Latinx: What are the things that the culture has that I can use as a physician or as a health care worker to potentiate my message and to make them understand where I’m coming from, so that they don’t feel that I’m just against everything, but that I’m just trying to understand and then pairing with them? I always believe that health is a co-work. The patient is one part, the health care worker is another part, and with that, I think that will solve a lot of the problems, and more so in dealing with the Latinx community.
What I’m focusing on a lot is probably the older generation, or the middle to older age. The new age group has more understanding. They have been in this country for several years, and they have a little bit of understanding, so we can utilize that. But the older generations are still in that phase where a lot of their background culture, a lot of the herbal things, a lot of the over-the-counter things, still work for them.
Another thing that I faced a lot was how to deal with the religious beliefs. A lot of them in the Latinx community are Christian, Catholic. They were coming in saying, “Yes, God will protect me from this.” How do you deal with that? You have to understand that also. I will tell them, “Yes, God gave the power of science to the humans, and that’s what we are utilizing here.” But if you say, “Ah, do not believe in God,” then boom, you break that empathy you established with that population.
Kevin Pho: I’m going to ask each of you one final question, and it’s really your take-home messages to the KevinMD audience. Miriam, why don’t we start with you?
Miriam Zylberglait Lisigurski: I want to say that even though we are talking about COVID vaccination right now, this goes beyond COVID, beyond vaccination. This is something that applies to any other condition: cancer screening, diabetes, diet, cardiovascular disease, etc. So we can learn from what happened during COVID, create the awareness, make ourselves aware, create social awareness, identify those gaps, and try to fill them.
You were asking what we can do at some point to change what is happening right now, and I believe that number one is to educate any future health care worker on diversity and inclusion, because it’s something that really changes the outcomes of patient care tremendously. The second is to reinforce empathy and respect, which are a big part of what we need to embrace as physicians, and as human beings too. Also, educate the community, right? We need to educate the health care workers, but we also need to educate the community. This is something that needs to happen at the level of the schools, or high school and college: collaboration, and making sure that this community, which is growing to the point that it will be a third of the U.S. in the next few years, receives the care that they need for themselves and the care that we need as a country.
Because if we have a community that is sicker, it is a community that is also using more resources, and it’s a community that also has more risk of disability and will not be able to work, and again, we will need more help and support from the rest of the community. So even if we don’t think about them as a group or as human beings, even in a business concept, it is a good investment to take care of them and to help them, so all of us have a good future in the health care system.
Kevin Pho: Ricardo, what are some of your take-home messages?
Ricardo Correa: Yes, I totally agree with everything Miriam said. An extra thing would be increasing underrepresented minorities in medicine. In this case, as Miriam mentioned, whenever she sees a patient, she connects with the patient because she starts speaking Spanish and she understands the culture. So we need more people in medicine who understand different cultures. It will be different from state to state. I always say, “I don’t expect that North Dakota has the same number of Latinx physicians as Arizona.” But that’s something important, and the only way to start doing that is, as Miriam mentioned, from middle school, from elementary school, trying to tell them that they can make it. These are people, these are populations that are suffering because of toxic stress and systemic discrimination. So you have to make them believe that they can be in any part of the health care workforce, and then just try to make that bigger. With that, we will see a difference, probably not in our upcoming years, but in the next generation, we will see something totally different.
And the final thing from this is that, really, all these disparities that we were talking about were there before COVID. COVID just made them flourish. I think that it is a responsibility for all of us who are working in health care to understand the social determinants of health of the patient and to put that together into our visits. Sometimes I see, “Yes, just go outside and walk 15 minutes to decrease obesity,” and the patient cannot do it because they live in a zone where there is a lot of criminality, or there are a lot of neighborhoods where they cannot go out and walk. So understanding that is very important. It should be an integral part. I think that medical schools, at least, are doing a very good movement of putting this together in the curriculum, but there’s a lot more work to do.
So this is not the end. This is just probably the beginning of a national movement. As I mentioned, the good thing of the bad was that at least people started caring about this. In the past, it was a small group of us just caring about this. Now it’s a bigger group, and we need everybody to care about this.
Kevin Pho: Well, thank you both for sharing your time and insight, and thanks again for being on the show.
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