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Melanie Cole (Host): The Hispanic community faces a variety of barriers to receiving healthcare services of high quality, and here to tell us about that today is my guest, Dr. Janeth Ceballos. She's a pediatrician with UK HealthCare. Dr. Ceballos, is there a disparity in the availability of physicians for Lexington's Hispanic community? And tell us a little bit about some of the challenges and special concerns of this population.

Dr. Janeth Ceballos Osorio, MD (Guest): Hi. Thank you for having me today, and yes, the Hispanic population in Fayette County and Lexington has been growing exponentially over the last fifteen years. But unfortunately, we don't see many services that are allotted to this growing population, there are many language barriers, and just availability of language services. So over the last fifteen years has doubled the size. Before in 2000 it was about 3% of the Hispanic population. In Lexington right now it's 7.2%. So we have about 7,000 children that are Hispanic enrolled in the public school system. So we have a large population that has a lot of- they're very vulnerable for poverty, they might have adverse developmental and behavioral outcomes. There are a lot of barriers including multiple social factors like language barriers, legal immigration issues, literacy levels, and definitely an insufficient culturally sensitive materials and problems that can erase all the Hispanic and ethnic community needs. So to that, we felt the need to work on that and try to help and improve our services here in Lexington around the Hispanic community.

Host: When we're speaking of health concerns, Doctor, what are some of the special health concerns that can afflict the Hispanic community when we look at cultural differences in food, or the way that we exercise, diabetes, high blood pressure, salt? What are some of the unique health concerns?

Dr. Ceballos Osorio: Well, you are right. So culturally the diet is going to be a little bit different, although there some petitions to more- some of them might have more Americanized diets, that we have differences in obesity and high levels of obesity and anti-sm. We might have low literacy levels in Hispanics too, so it's difficult to get health information and work and promotion prevention. We have- because also the language barriers, we might not have access to adequate - for example, allocation on development area, and we might see children who might need, for example, services in the community for development, and language development, and they might not get those services. But in general, we may see also risk factors for mental health associated with- especially now, legal and immigration issues. So we see children with anxiety and depression too that are very specific to this community and need to be addressed in a comprehensive manner.

Host: Isn't that a shame that children should have to be so stressed out and worried that they need extra services in the mental health department? Tell us about some of the barriers. You mentioned language, and what about access? Or even really awareness, Doctor, of some of those risk factors that contribute to mental health issues, or diabetes, or diet? Tell us about some of those barriers that you see, and what you think are some options to overcome them.

Dr. Ceballos Osorio: Well, there are some language barriers because most of the- some of the parents might not speak English. Most of the children that we see here in Fayette County and here in Kentucky, they are Hispanic but most of them are actually American citizens, and they have Medicaid. So they have access to services because they have American insurance, but their parents, when they go to the doctor, they might not understand what is going on with their children, and because of that they don't follow recommendations. In some places, like for example here at UK, we do have interpreters, but even with interpreters, we can see the difference when a patient is seen through the interpreter than when a patient is seen by a provider in a team that is bilingual and can speak in their own language.

So they can feel more- they can speak more freely and feel more connected to the provider if they have, for example, a native Spanish-speaking provider, a nurse, and they will be able to communicate better of what their needs are, and also kind of understand better what they can do with their children. So that's one of the added language barriers. It's not just the availability of interpreters, but also to have that personal connection with the provider which is easier when the provider is speaking in their own language and can understand his own culture. Also sometimes the insufficient culturally sensitive materials to provide them, sometimes they are materials that even are in English when they don't understand how to read it.

In some cases, the parents even don't speak Spanish as the first language. They might be from an indigenous community and Spanish is their second language, so even you need to go forward in that area to be able to communicate with them. But it's not just to have an interpreter, but also to understand the culture and have somebody who can translate that into how to take better care of their children.

Host: So what is Clinica Amiga? Tell us its purpose, and what are some of the services that you're offering the Hispanic community in Lexington?

Dr. Ceballos Osorio: So Clinica Amiga is a clinic that we want to form a Hispanic clinic for Lexington- for our Lexington community. We already have pediatric medical home for all societies, but currently here at Kentucky Clinic South and UK General Pediatrics, we have a bilingual team. So we have ladies- Spanish speaker nurse and provider, that is me, and we have a lactation consultant that is also bilingual. So we want to channel that team into seeing mostly our Hispanic community and develop all the materials and resources that the Hispanic community will need. Also, the Clinica Amiga isn't just providing the pediatric services and medical forms in pediatric care, but also developing programs to work the community to improve also the health of the Hispanic communities.

So for example, one of the community programs that we started with is Un Abrazo Amigo. It's a parent support group for families who have children with special healthcare needs, and the group is in Spanish. So we meet once a month at Cardinal Valley elementary school. We provide food and provide childcare, and families can go together with their children and have dinner, and after that we meet with the parents and do a support group, and we talk about different aspects. For example, we have taken a lawyer to talk about immigration issues, and what kinds of things they can do about it. We have financial planning, we have people from the Down Syndrome Association of Kentucky. Oral healthcare, autism. So depending on the parents' needs and what it seems that they would like to talk about, so we bring speakers to help them, and educate them, and help them to connect with resources that are in the community.

Host: So when you're developing community programs to address some of these barriers, Doctor, how is the community responding? Are they finding this a very valuable service? And do you feel that now this is going to by word of mouth help to raise awareness of some of the health risks that this community suffers from?

Dr. Ceballos Osorio: Yes, the community has responded well. They are engaged and they like to participate. They're always very thankful that they can get resources, and as you mentioned, they refer other families, other friends that they know that they might be helpful to go to the group. Also, here in my clinic when I see a family that can benefit from the group, I refer them to the group and then within the Department of Pediatrics also, they can be referred to the group. They're very thankful and appreciative of having this type of services and getting to know more resources, and getting educated and work on the health of their children.

Host: Such an important service that you're providing, Doctor. Wrap it up for us, what you would like the community to know about Clinica Amiga, its purpose, and how they can find out more about you.

Dr. Ceballos Osorio: Sure. So Clinica Amiga is an American home for the Hispanics and Latin community. We're happy to have all patients who want to come with us. We have a bilingual team, a bilingual native Spanish speaking pediatrician, and nurse, and a lactation consultant who is also bilingual. We provide the comprehensive pediatric medical care but also we have community programs and are working toward developing more community programs. One of them is Un Abrazo Amigo, which is a parent support group for families who have children with special healthcare needs, and to make an appointment with us, and to know a little bit more about Clinica Amiga, they can call to our Spanish phone line. We have interpreters in house and we have a Spanish phone line, and they can call to (859) 323-6211 and choose option five for the Spanish, and our interpreter on the line is going to get- connect them with the services.

Host: Thank you so much, Doctor, for joining us today and for explaining the healthcare needs and disparities for this underserved community, and thank you for all the great work that you're doing. This is UK HealthCast with the University of Kentucky Healthcare. For more information on Clinica Amiga, you can go to www.UKHealthcare.UKY.edu. That's www.UKHealthcare.UKY.edu. I'm Melanie Cole, thanks so much for tuning in.