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Fri May 2, 2014
Bilingual Pediatric Neurology Clinic Helps Crack Tricky Diagnoses
There’s been a significant uptick in the number of children being diagnosed with Autism and related disorders. Nationwide, recent federal numbers report one in 68 children have what are called "autism spectrum disorders," which come with all sorts of symptoms related to behavior and communication. One thing that’s important is helping children with these problems early. But researchers say for many Latino children, that’s not happening. And part of the problem is language.
At a new clinic at Boston Medical Center, neurologists are working to overcome the language barriers that can get in the way of good medical care for kids.
It wasn’t until Claudia Lopez’s 6-year-old son returned from a trip to El Salvador that she noticed his strange blinking.
"He looks so bad on nighttime when we put him on bed, he looks really scary, his eyes are blinking, his head is starting to shake," she said.
So Lopez took her son, Jonathan, to his primary care doctor, who speaks English, but only a little bit of Spanish.
"It’s really hard sometimes for people to go to the clinic or go see a doctor and when they don’t speak your same language, its really hard for us," she said.
It’s hard because communicating important health information is a challenge even when there is no language barrier.
"When a family does not speak English as their primary language, or does not speak English at all, then there are disparities in care," said Karl Kuban chief of the Division of Child Neurology at Boston Medical Center. When he and other doctors talk about "disparities in care" they mean some people don’t get the diagnosis or the medical treatments that they should or could. For example, a recent study published in the journal Pediatrics found that Latino children are diagnosed with Autism on average 2.5 years later than white children.
"That is perhaps the most flagrant example that we know of so far," Kuban said. "But we have indications that the same sorts of disparities occur in children who have epilepsy and children who have intellectual disabilities."
The study found multiple reasons for disparities in autism diagnosis, including a lack of access to primary and specialist care, and the perception among providers that the Latino population is not well educated about autism. That worries pediatric neurologist Alcy Torres. He’s the director of International and Hispanic Services at Boston Medical Center. Torres says the study also found that only one in 10 pediatricians perform recommended screenings for autism in Spanish.
"All of these things interfere with the ability to provide adequate medical care," he said.
Originally from Ecuador, Torres worked with Kuban to develop what they say is the only bilingual pediatric neurology clinic in Massachusetts. The majority of patients at Boston Medical Center are not native English speakers, so Kuban says, having doctors fluent in multiple languages is one way to increase the quality of care.
The service opened in August, and includes clinics in East Boston, Fitchburg and North Andover. Kuban says there is up to a two-month waiting list for some of the clinics. One of Torres' patients is Jonathan, the 6-year-old boy with the strange blinking.
"Jonathan is a little boy who has a seizure disorder," Torres said. "When I met him he had the diagnosis of [Attention Defecit Hyperactive Disorder] and tics."
But Torres suspected misdiagnosis. He didn’t think the eye blinking was the result of tics, so he ordered a test that confirmed Jonathan had seizures. After some trial and error with medicine, Jonathan is now seizure free.
Torres says being able to take a history of the patient in Spanish made a huge difference in properly diagnosing Jonathan.
"I had in the history heard that there was some other episodes at night in which he was woke up and was a little bit confused and I said, hmm, I think we need to look for these in another way," Torres said.
But Torres says addressing disparities in medical care requires more than just knowing a person’s language. It entails making sure the patient understands what the doctor is saying so they can follow through with treatment.
"There are patients that are not familiar with the medical terms or the medical vocabulary and they might confuse medications," he said. "And the stickers on the bottles, for example, are not bilingual and the pharmacy might not be bilingual and so there are many pieces."
For Torres, providing adequate medical care means being accessible to his patients. He says he’s almost always on call. Jonathan’s mother, Claudia Lopez, appreciates this. She says it’s this type of access to a doctor that keeps her and her husband from moving back to Arkansas, where her parents and siblings live.
"We are really happy to work with Dr. Torres because he is really nice doctor, he speaks English and Spanish," she said. "That is a really good thing for us, for Latin people, you know?"
Having a bilingual doctor is a really good thing. It’s one effective way to cure a language barrier.
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