Claudia Rojas

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Madhu Vulimiri: Interview with Claudia Rojas, Clinic Manager for UNC Center for Latino Health for Global Studies 390: Latin American Migration, on the morning of Friday, April 5, 2013, in the Health Sciences Library at UNC-Chapel Hill, on the topic of her experience working to improve Latino patients’ access to healthcare through the Center for Latino Health; the interviewer is Madhu Vulimiri. Great, so, Claudia, could you just start by telling me about yourself, where you're from? Anything you'd like to tell me.
Claudia Rojas: So my name is Claudia Rojas and I came to this country fifteen years ago from Colombia, South America. I came with my husband and my two kids. At that time they were three and five years old. So, this is our home since fifteen years ago in Chapel Hill. We live in the last fifteen years in the same neighborhood. We have the same schools, same neighbors, same everything. So, we fit pretty well in that community and we were pretty welcomed in the community. We feel sort of Chapel Hillian now. [laughter]
MV: Yeah. And so, what brought you to the Triangle area in particular?
CR: Okay. My husband is a doctor. He's a surgeon. At that time, fifteen years ago, my brother-in-law--he's a pediatrician/neonatologist--he was working here at UNC in the Children's Hospital. He invite us to come and check. Said, "Will be interested, Mauricio if you can come to Chapel Hill and check. It's a very nice place to live. Great opportunities for you as well. So why you don't come to the States and take some days off with us, na na na." So we came in 1997 and we fall in love. Say, "This is a great town to grow a small family, with small kids." So we fall in love and we bought a month later a condominium by drawing. So a year later--
MV: A lottery?
CR: No, in drawing.
MV: Blueprint?
CR: Mm...we make a reservation. They were not built yet. It was a project that is going to be finished in a year. We bought in advance, that condominium. It was in Southern Village. At that time, Southern Village was sort of growing and they were putting electriz and everything. They built Morris Grove elementary. They built more houses around the elementary school. We bought one of that houses, close to the school. So a year later, we moved to Chapel Hill. My husband, he started working at Duke as a researcher. Now he's in cardiology here in ( ) Lab, doing research at UNC. So, but yeah, we came and we are happy since 1998, living in Chapel Hill.
MV: So you had family here originally?
CR: Yeah, my mother-in-law, my sister-in-law at that time.
MV: They were all close by.
CR: Yeah, yeah, yeah. They were related with UNC.
MV: Yeah. Okay, great. So, how did you get interested in or involved in healthcare?
CR: I was working in healthcare in Colombia with a company sort of similar to Blue Cross Blue Shield, an insurance company. So at that time, the company's name is Colpatria. At that time, I became so interested to work in health and I have to visit the inpatient in the different hospitals that related with the company. I have to do a lot of customer service and make sure that everything was working. Interview doctors, visit them in their offices, do evaluations. So I have to a do lot stuff. It was like a multi-tasker. And I fall in love with health and then I met my husband. [laughter]
MV: In Colombia?
CR: Yeah, in Colombia in a surgery room. I was a patient, he was the doctor. [laughter] Yeah, it was sort of crazy.
MV: You were having a surgery?
CR: Yes, eye surgery. But he was one of the doctors who finished the surgery for a patient and I was waiting for my surgeon, so we were introduced in that surgery room by the anesthesiologist that is my friend, a mutual friend. So it was pretty cool. I was a lot nervous because my surgeon was running late, and so the anesthesiologist asked my future husband, at the time, "Could you come down? Claudia is not, you know, feeling pretty good. She's nervous and Dr. Borges is running late." I was like, "Oh my god, where is the IV?" and everything. So, it was pretty cool, yeah. So but, since, I guess 2000--no, no, no, 1987, I was working in health. But I studied hospitality.
MV: The hotel industry?
CR: Yeah. So I switched from hotel to hospitals. Now the tourists are the patients. Now I realize they are pretty similar. So, customer service is one of my goals and my main thing. So I say, Hmm, I can do pretty good in this. Yeah, that's the goal I had. So, yeah.
MV: Can you tell me more about Center for Latino Health?
CR: Mm-hmm. So in 2007, finally Dr. Douglas Morgan, the founder of this program--he got the grant through the School of Medicine Investment for the Future. And he got a four years grant. Big, good money for this, to start this beautiful project. At that time, we were together in GI, because I was working four years before at UNC since 2004. So when he met me in 2007, he said, "Claudia, I am doing a project, waiting for something big, and I would like to count on you." I said, "Yeah, sure, Dr. Morgan, of course." But I didn't know at that time what he was talking about. So finally when he got the grant in 2007, he asked me to join the group as the program manager. He hired a nurse practitioner. He hired a PVA, a person that is in the front desk, doing the check-ins and check-outs. So he choose his team. I started the program from scratch, because--. So I have to read the grant and everything, and I start putting the pieces together. Buy a telephone line and buy a fax, and you know--do the whole thing from the beginning, from scratch. It was pretty good.
MV: What does it do exactly?
CR: Okay, so, the program is--. We started with the main clinics, the clinic that has more demand. Latino patients demand, like internal medicine, GI, geriatrics, like nephrology, like breast clinic, oncology. We have gastroenterology. We are doing diabetes teaching classes in Spanish. We started with main clinics--OB GYN.
MV: Where there were more Latino patients?
CR: Exactly. Cardiology. We were so lucky--and we're still lucky. Because we have in every single division, in every single clinic, we have between two and four bilingual providers. So we--they joined the program, so that we were doing since day number one is manipulate our templates. They choose one day per week or one day per month or two half days per month or two days per week. They choose their schedule and what we're doing is manipulating that template and schedule their Latino patients. So we're working with UNC Latino patients, their patients. The new ones are coming from different areas from North Carolina. Most of them are referred by PHS, Piedmont Health Services. They are working together with UNC. We started with these main clinics. We are introducing more bilingual providers to that clinic right now. Right now we are full capacity, so now we need to hire another nurse practitioner, duplicate the program. Another PVA, so we can be in two places at the same time.
MV: So where is the location right now?
CR: The location of the Latino clinic is where the doctor normally sees their patient.
MV: So, not a separate building.
CR: No. We are a traveling clinic. On Monday mornings, we can be in the ACC Building seeing Dr. Aleman's or Dr. Roland's patients or Dr. Bustamantes Padillas Borjas', or Pratas' patients. On Tuesdays, we can be--some Tuesdays, we are in the ACC as well, but in another floor seeing the nephrology patients. On Wednesdays, sometimes we are off-campus or in the women's hospital. So every week of the month is different, we're scheduling. Every day is so different. So it's pretty--sounds pretty complicated. But it's so easy. We memorize already. So we know that the thirty days of the month, we know exactly where we're going to be.
MV: So essentially you are using existing doctors--you're not bringing anybody new in. You're just taking advantage of the resources that are already there and putting them together.
CR: Exactly. So, that's what we're doing. And we take care, very well, of these patients when they are in the clinic. So we take advantage when they are in the clinic to do a lot of patient education, safety, and navigation. I have a beautiful number of volunteers, undergrad, every semester. Between thirty and thirty-five people every semester. Undergrads that speak Spanish. They are our extra hands, extra eyes. So it's so easy to work with that amount of people. It's not only Elizabeth Prata, the nurse practitioner, or Myra McCarthy the PVA, or Claudia Rojas the program manager. It's the provider, it's the financial counselor that is bilingual. The volunteers--the undergrad volunteers; the intern from the School of Nursing or Pharmacy; student of the School of Medicine that is doing a month rotation with us. It's a lot of people at the end that joins the group in that specific clinic.
So it's pretty good, you know. Every day it's something different. It's hi and bye, hi and bye. We are in between ACC Building, Memorial Hospital, Women's Hospital, Cancer Hospital, off-campus, Carolina Point. We run geriatrics, rheumatology, and oncology clinic--breast clinic over there. And cardiology, unfortunately our cardiology has moved to another state. So we don't have Meadowmont clinic now. But yeah, we're waiting for a bilingual cardiologist. But it's pretty intense. But it's worth it. Because you can do so many things for the patient.
MV: When you say you do patient education, do you do that while the patient is in the waiting room?
CR: Mm-hmm. As soon as they arrive, we make sure that the demographics--most of the time, their names are wrong spelled. So we make sure that the spelling--because I am Latina, I know. Is that Zapata with a Z or with S? "No, it's with Z!" Okay, I see here that it is with S. I'm going to correct that. Is it Olibia or Berlinda with V as victor? "No, no, no, it's B as boy." Oh yeah, I knew it, I don't know any Belinda with V. I made that corrections, or PVA made sure about that. We made sure that every single information that is in GE, in the system, is correct.
We are telephone number collectors, because most of the Latino patients, when we are going to try to contact them for reason--telephone disconnected, no longer in service. So, they travel a lot with the telephone numbers. So I ask for your sisters', brothers'--"No, but they don't live here in North Carolina." No, it doesn't matter. Just give me the number, so I can leave a message or something, in case we need you or something is wrong with the labs or something. We can reach the patient. So we are doing safety too, at that moment.
Primary and secondary contact. I am so obsessive collecting that, primary and secondary contact in case of emergency, but we use the telephone to leave messages, generic messages of "Okay, we need you," reminder appointments, whatever. So, so...we're doing a lot in that moment. After we are finished this registration, this check-in, we share with them a list of questions that they have to read in the waiting area. Questions about their health, about medications, about history or family history, whatever. To remind them that they have to ask. We encourage them to ask, to participate more. "It hurts here." No, but here, why, when it started. Talk more about that. Something happened in car crash. What happened? Tell more details about that pain. So we try to push them to participate more because they are like a shy people. Not because they act shy, but because of the social, cultural level, they don't go ahead. They are here, and that's it. So you have to take down all the information, so we encourage them to ask questions.
MV: Do you think that shyness is a cultural thing or is it maybe being more or less educated?
CR: Both. Yeah. So, in our Latino countries, we see the doctors like that, on a pedestal. Or it's like, "Okay, whatever you say, mm-hmm." So, they feel a lot respect for the doctors, their level. It's intimidating.
MV: Do you think they feel the same level of respect here? Do you think the patients feel the same level of respect here, the Latino patients?
CR: In my program, yes, because they--at the end of the appointment, when they are brand new--says, "I feel like home." So that say a lot to me. I felt at home, not only because they could speak Spanish with the doctor, but because we treat so well. We treat with respect, with "Mrs.," "Mr.", "How are you?" You know, very warm, hello.
MV: Makes a big difference.
CR: They see that we take the extra mile. Suppose every single clinic at UNC Health Care have to do the same thing. But you know, I try to put that Latino spice in the Latino clinic and be a little bit more warm. More eye contact, more smile, physical contact--touching their shoulder. How are you. How's everything doing. That opens a lot of doors. They are more confident. So, that's--that's one of the advice that I am giving to my undergrads that are now in the School of Medicine. If you make a little bit of physical contact with them--you don't have to touch their whole arm--just touch a little bit of the shoulder. It can break a lot of ice. You can get a lot of information from that patient. We are physical. We kiss. It's part of the culture. So, sometimes, they kiss us. It's because it's Latina. "Thank you very much! You're so great! Thank you, you took care very well of me, so na na na. The doctor, you, Myra, everybody is so nice." I say, "Yeah, okay, I'm glad. This is our work. Suppose we have to do this." Say, "No, no, no, you are so warm." "Okay, I'm glad, I'm glad. So call us if you need something."
So the beauty of this program is not only that. It's that we become the primary care contact so they don't have to struggle any more, calling another number, trying to speak a little bit of English asking for refill or try to explain the side effects of X or Y medication. They--
MV: They call you--?
CR: And leave a message in the voicemail. The voicemail is working 24/7 because we are traveling. So, we don't have--. Sometimes I have some volunteers in the office so they can answer. And they take messages and they email us. Say, look, "This is Maria Morena calling, she says that she needs refills. The medication name, Nexium na na na, and the pharmacy na na na. And I do some prompts and I leave in the office so they can take information from the patient and they can email us. So it's pretty-- I can retrieve my voicemail from everywhere, but I give my students the chance to practice. Because phone is the most difficult one. So this is a program that there is not only clinic. We are like a--this clinic, research, and education. I am sort of in the middle, trying to--you know, coordinate this effort. And worth it. Worth the matter.
MV: It makes a difference.
CR: Made me feel happy every day since five years ago. It's something that I really feel great. Yeah, I feel like I am helpful.
MV: Do you feel like you're connects you back to the community?
CR: Yeah, yeah. And because I am latina, I understand very well the culture. I can do so easily the extra mile without trying. It's natural. [laughter]
MV: It's who you are.
CR: Exactly. That's nice. It made me feel better. Because I understand them, I can be the voice in the UNC Health Care. Along the last five years I am doing certain things that helps my coworkers to understand the culture.
MV: What kind of things are those?
CR: Like, I share with them a document--maybe I can share with you too--how to understand the Latino names. The origin. That simple. Okay? People Latino have two last names. IF you see four names in one line, the last one is the mother's. Don't grab that one! That's not the real last name, that's mothers'. Take the one immediately before. That one is the last name. Through examples, I explain how they can understand this. If a Latina marries an American; if an American marries a Latina; if two Latinos marry, what's going on with the kids' last names. So it's through examples, helping my coworkers to understand more. So why I'm doing this?
I volunteer for doing that because when I have a Latino patient in front of me or in the telephone, says, "Could you do me a favor? Could you make an appointment for me?" Yeah, sure, what is your name? "Maria Serrano." [pretends to type] Okay, Maria Serrano. I see four Maria Serranos. Same date of birth, four medical records. And I said, you are Serrano what? Serrano-Garcia. Oh yeah, one medical record she is Maria Serrano and another is Maria Garcia and another one is Maria Serrano Garcia. And another one is Garcia Serrano. They thought Garcia is the first name. So I say, Oh, same date of birth. Do you live in this mailing address? "Yeah, but that was a year ago." Okay, so she's the same person. So, I tried to--. Then I have to call medical records and ask for--they can merge all these medical records. So every day I found these things.
MV: Has it helped reduce the number of records that they create?
CR: Some years ago, I shared this document form--this information--with Mrs. Karen McColl, she's the vice president of the hospital. I said, "Look, this is pretty important. The trainers for the new employees know they can share these with the new employees that come in. So they can understand more about this when they are going to register that mistake. So, always when I have the chance I share with everybody. It's like part of my best ... and you know, through this I'm doing a lot stuff that is sort of helping to understand more the Latino culture. Always when I meet people. So at the end I am not Latino clinic or CELAH. I am a UNC employee. It doesn't matter if it's our patient our not. What's important is that it's a Latino who needs help. Cannot understand, cannot speak a single word in English. I can help--we can help. That's our goal. Help any Latino phone call that comes to our line.
MV: So, do you know if any other hospitals in the area have a program like this?
CR: No, not really.
MV: It is a unique program to UNC...?
CR: But, Dr. Morgan said that this is not a rocket science program.
MV: No, it's not.
CR: Probably, it exists, but I don't know where. Yes.
MV: Well, it's not rocket science, but it's amazing to think about how many places don't do things like that would make it so much easier for patients.
CR: It would be a great difference if different clinics were more conscious about this and at least hired one or two bilingual. They don't have to pay more for that. It's not difficult to find bilingual people. At least a nurse and a person in the front desk. That would be ideal. At least two people in every single clinic. But we are UNC Health Care, but every clinic has their own personality, their own way, their own rules. That's another thing that we are doing pretty good with the clinics, because we blend. If we are in cardiology, we blend with the cardiology staff, we follow the rules, we place the paper where they place the paper, [] maker, and every single clinic is different. It's totally different. We are UNC, but every single clinic has their personality.
MV: I’m really interested in understanding how CELAH came about? Could you share that history or background with me? Whose idea was it to create it? And how did it come about?
CR: I heard from Dr. Douglas Morgan, the medical director and founder of this program that he was one of the interpreters. He's a gastroenterologist. He became an interpreter in his own division. His coworkers, his colleagues says, "Oh, Douglas, can you help me? I have a Latino patient in the room and the interpreter is not here yet, it's taking a little bit long, so could you please help me?" He's so--they need. He, because he is bilingual--he's bilingual, so I guess at that moment it triggered in him. He said, "Okay, we need something to make a difference here. And besides, he was--he lives in Honduras for almost five years. He belonged to the Peace Corps. Probably he saw the need of the people. He work at that time, engineer. When he came back to the United States, he became doctor, then he did gastroenterology, he went to public health school. He's a pretty smart guy. Probably he fall in love with the Latino culture. Now he has several research programs in different countries: Honduras, Nicaragua, Colombia. So, he love research, he love Latinos. He advocate for the Latinos.
MV: Is he Latino himself?
CR: No, he's American--American guy. His wife is a pediatrician. His kids have the same age as mine. They are bilingual too. It's incredible how close he is to the Latino culture. And he's not the only one. Most of our bilingual providers are not Latino. They love the Latino culture. They understand and they really understand the Latino program because they joined this program. They really know that the Latino population needs more attention and more personalized attention. So, it's pretty cool.
MV: What aspect of Latino culture is it that these providers or these folks really connect to?
CR: They are pretty naive. Not educated. They are uninsured. They are a minority.
MV: So more like seeing the need for helping these folks.
CR: Yes. In their home countries, they don't really take care of them. That's another reason, because a lot of Latinos are trying to find another place to live. Because their own governments are not taking care of them at all. They don't care.
MV: Obviously immigration plays a big role in Latinos coming here. Their process of integrating into our Chapel Hill or trying to get access to health care -- what do you think are your colleagues views on immigration?
CR: [pauses] I guess, it's similar to the answer I gave you some minutes ago. They are just--you know, the doctors are here to serve. They want to learn a lot from the Latino community. Most of them are doing research as well. Trying to understand more the culture. Not all of the treatments work as well for the Latinos as for the Americans or the Afro-Americans. So, they are pretty interested to know more the Latinos and how they can react to certain treatments. I guess, pretty scientific interest too.
MV: How does the clinic--does it do any outreach to Latinos other than--I know you're at capacity, so I don't know if you have the time or resources to actually reach out to the community. Or do you just take people?
CR: No, since five years ago we're working with the Latino community. We are participating in different, different health fairs in the last five years. We go and we are doing just patient education. We don't advertise at ALL Latino clinic, because we don't want to disappoint the Latino community. Forty or fifty patients today. We cannot do [that] so we don't mention the Latino clinic.
MV: I noticed that, because I googled it and I couldn't find it anywhere. Only through some news article but there was no website, and I was curious about that.
CR: We don't advertise at all because of that. We don't want to disappoint the Latino community. But we are doing in every single Saturday a health fair in the spring and fall. It's just patient education. I love--I really love to talk with the community when I am in the health fairs. When a guy comes to my table and says, "Hi how are you? Hi how are you, what are you doing here?" I brought some information in Spanish on diabetes. It is about cholesterol, it is about this and that and that. How old are you? "I'm fifty-six." Oh, okay great. And do you have family here? "Yeah, my wife and my four kids." Say, Oh, okay. "I'm the only one that is working at home. My wife is with the kids at home, na na na." And who's your doctor? Do you have a PCP, a primary care physician? "No, no, no, I'm pretty healthy." Good for you, I'm so glad! So I said, Okay, and do you live--your parents are here in the United States? "No, no, no, they pass away. My mom had pretty bad diabetes and my dad had pretty bad problem with high blood pressure so he had a heart attack." Oh my gosh, okay. Okay. "I am pretty healthy. Sometimes I cannot see very well--blurry." Oh my gosh, maybe diabetes. I am not a nurse or a doctor, but I started guessing. Oh my god, maybe he has something. So I said, Okay, do you know about prevention? Here in the United States, the Americans are doing a lot of prevention. They go to the doctor even when they are not sick. He says, "No, why I have to go to the doctor if I don't feel sick? Why? I don't want to spend a day and half a salary that day going to Chapel Hill or whatever and find a doctor. No, no, no, I cannot do that, I am the only one working at home so I cannot do that," he said. That's the main reason, because you have to do that. You have to adapt a PCP. And find out if you have something. Everything on time has a solution. But what if you go to ER because you're feeling so sick. And then you're going to need a surgery. And then you're going to need a week or two weeks after the surgery you have to be at home. Who is going to provide in your house? Who's going to buy the groceries? Say, no no no, I can't--. Do you see how important it is to a doc, a PCP in make your annual check, your blood pressures, your blood, your sugar. The main things. So I try to teach how important it is to do prevention.
In Latinos, we don't deal with prevention. When we are sick, we go to the hospital, to ER. In our home countries we go to ER. A doctor is waiting over there for people to do a normal office visit and prescribe you or whatever. "But, why I have to go to hospital or see a doctor if I don't feel sick? What is the sense of that?" They don't understand.
MV: That's a big cultural barrier you have to work against all the time.
CR: But I love to do that because when they realize, "Yeah, you're right." You know what, I don't want to scare you, but if your mom pass away from pretty bad diabetes, maybe you have diabetes. Maybe you have some silence--silent illness that just at the end, you're probably, you're going to die with that because of that. I alert the community talking about that. By asking questions, so they can really understand. Said, "Yeah, you're right." It's a day that they can spend instead of one two weeks maybe, usually if I have something bad.
MV: Do you think you're able to convey that message pretty well and then you see the lightbulb go off, and they're like, "Oh!"
CR: Something I do in every single health fair. I love to do that. I love to do that. Especially with the guys! Because they are the only provider at home. Even better! That's the perfect example. So I would like to make a campaign sometimes. Make a poster and everywhere. This poster is only for guys. Big guys. Fathers. The providers. Tricky questions.
MV: I would guess that the guys are harder to convince at first.
CR: My female patients they bring sometimes. Could you make an appointment for my husband? He never saw a doctor before and I am concerned and he's not doing anything. This lady bring their husbands with force, with a leash. I said, "She brought me. I don't know what's going on, but she's insisting. [whispers] I don't need this appointment." "We'll see, we'll see, the doctor's going to say if you need this or not."
So, it's pretty cool to work with Latinos. So many things you can do for them. So many things. And if you spend two, three, four minutes--not more than that--with one patient, and you teach something important to them, he or she is going to spread that in their family. He is going to be the educator in that group. It's just that simple. You know.
MV: Can you tell me more about if--do you have any undocumented patients coming through the clinic and what kind of challenges do they face, and you all face?
CR: When I am doing the registration, one of the questions that we have to ask is if you have social security. He says, "I don't have one." Okay. So that's the only question that we really ask about that. We don't--that's not part of the registration so we don't deal with that.
MV: So technically is it a free clinic? Do people have to pay at all?
CR: Yeah, if they are uninsured, they have to be interviewed the same day by the financial counselor. They can make payment arrangements with the financial counselor, or the financial counselor--UNC has different programs: charity programs, or different kind of programs they can offer, a specific program.
MV: But it's not a free clinic.
CR: No, it's not. Unfortunately, it's not free.
MV: What percent of people--patients coming through--would you say are undocumented?
CR: I don't know--we don't--we don't know.
MV: Okay, that's alright. So, I guess, what have you learned from--what are some lessons you've taken away from working at the UNC Health Care System over the years? What has it shown you about the healthcare system?
CR: First of all, that we really need to hire more bilingual people because bilingual employees are so important in different clinics. At least one nurse and one PVA in the front desk. At least two people per clinic would be absolutely great and would be improve the quality of the care--quality of the services that we're giving regularly to the Latino patients. [pause] The hospital is doing pretty well--he has a pretty good number of interpreters--they are serving in different clinics where the patient cannot communicate very well. They cannot speak a single word in English. They can request an interpreter. It's going to take longer because there are only twenty-five, I guess, in total in the hospital--interpreters. But, anyway, they can--it's part of the service. So, that will be great to have more interpreters or duplicate or triplicate our program, the UNC CELAH. So, would be absolutely ideal to cover more clinics. So, yeah, when we are working in a specific clinic, we are not just doing that Latino patient, we are giving support to the staff, support to the nurse. We're giving support--for example, when we are working in internal medicine, there is a pretty good example. In Internal Medicine there is pain clinic, coumadin clinic, they have nutrition clinic, they have diabetes team care, they have the depression team care. They have different teams inside the clinic, like sub-clinics, and we are giving support to all of them. Five years ago, when we started this program, I found out--more than 8 years ago, since I am working at UNC--that in internal medicine they have diabetes teaching classes in English, for our class. So I said, It would be great if you have these classes in Spanish. "No wa, can't bring an interpreter. Four hours class could be six or seven hours class. So it's not really convenient. This is only for English-speakers, patients." I say, Huh, could you change the PowerPoints? I could translate into Spanish. And do the same thing that you're doing but on other days. They said, "Are you willing to do that?" I said, "Yeah, it's going to take me a few days, but yeah, I can do that. Large four hours program--PowerPoint. So I did that--took me like two or three months. [laughter] Because I was doing another things, but it was great because, as soon as the PowerPoint was ready, at that time I got a very nice volunteer, a medical--a doctor from Honduras that is not a doctor in the United States. He's an MD, a real MD. He works in one of the churches here in North Carolina. He's one of the pastors. He said, "I can be your volunteer. I can give the diabetes teaching class." I said, Really? So, Dr. Aguilera became my educator. Plus, my nurse practitioner, Liz, are both doing the class. The diabetes teaching classes. I said, Look, we've got the PowerPoint, the volunteers since five years ago (we have the same volunteer) and the nurse practitioner is doing the stress management and nutrition part. The last part of the PowerPoint. We are giving education and teaching the people about diabetes in Spanish. We encourage them to bring their family members, involve the family, because the Latinos are so family-oriented. It would be great to involve the family. Because sometimes the patient is not the person who cooks or buys the groceries. So bring your wife, bring your mother, whatever. So, it's very nice. It's just--you have to decide to do something. It's so easy to do everything. But you have to--
MV: Want to do it.
CR: Exactly. Only, that's the key.
MV: How would you compare the U.S. system with the Colombian one, or the system that you know most Mexican immigrants are coming from? What are the biggest differences between them that, maybe, add to the challenges we see now?
CR: Well, difficult question. [pause] I can say that the health system works much better than, for example, in my home country, Colombia. We are having lot of problems lately in the last fifteen years in Colombia in one of the--several Latino countries. The s ystem, the health system is--most of the health system is private. So, the companies like Blue Cross Blue Shield--different companies, we call EPS in Colombia. They hire doctors and they pay a salary to these doctors to see forty, sixty, one hundred people per day. So every five, every seven minutes you have to see a patient. You cannot spend more than that. So the system is pushing these doctors to see more patients in less time. So, that's pretty bad, bad, bad. That's one of the main reasons because my husband moved to the United States. "What if I do a mistake, malpractice, or whatever? Who is going to pay the consequences?" They are not going to put their faces and say, "Oh, I'm so sorry, we pushed you so hard." [He said] "No, I cannot see a patient in ten minutes, or fifteen." So, health care in the United States is still perfect. In my program, it's better than great. So if I compare my healthcare system with this one, here it's much better. Hundred times better.
MV: Okay. Then, I guess, I have one more question for you. I guess, going back to the idea of immigration. How has immigration impacted your life and your profession?
CR: When I moved to this country in 20--1998, one of the problems was--at that time--I have to--. My husband was a permanent resident. So I have to wait seven years for my visa. I cannot live in seven years this country. So I have no permission to work for seven years. So, I spent seven years going every day to the school of my kids and I became room mother, chaperone in every single field trip. Parent that--I ate lunch with my kids every day. I became a 24/7 volunteer in that school. That's the place that I got the English that I have right now. That is pretty broken now, because since five years I speak more Spanish than English. So my English is, meh. My husband says, "Oh my gosh, your English is incredible bad." I say, "Thank you." Because I speak 24/7 in my work, in my house, Spanish. So I lose that. But anyway, I'm happy.
MV: I can understand you.
CR: I'm happy doing what I'm doing, so that's okay. It's worth it. But, so that's--every immigrant has to pay the price. I paid that price: seven years without--living in this country. This is my home country without work. Thank god at that time with one salary we can live. Probably at this time, no. With that salary, no. Yeah, we paid that price. So now I'm an American citizen and everything. Proud American and-. But every immigrant, if they come swimming in the river or walking--I can understand how hard it is for every single person to come to this country. So, if I complain because I came in an airplane and I came to a brand new house and my kids were in a brand new school. We got brand new church--St. Thomas More was built at that time--and if I--. Suppose, I suffered, but I say, "No. Why I was feeling so bad? Look these guys. They come in pretty bad shape, with zero dollars. No papers.
MV: In debt.
CR: In debt! Exactly. So. Every day I feel more grateful. I say, Oh my gosh. I have to be more than special with these people, because they really deserve, at least in this clinic, to be treated with respect. So, and now I don't feel Colombian any more. Fifteen years, I felt so Colombian, my (inaudible), my team. Now, I feel Latina. I don't feel Colombian any more. When I am talking with Peruvians, I can feel that I can be Peruvian. Yeah, when I am talking with Mexicans, I feel I can be Mexican. I can eat their food--you know, we talk the same language, with different accents, but yeah, I don't feel Colombian any more. I feel Latina. So, it's pretty good feeling. This program made me grow. This country made me grow. A better person. MY goal is be a better person every day, a little bit more and more. So, I have a lot of good things about this country to say, and experiences I am having now through this program and at UNC. So I feel pretty blessed and lucky. So I'm now--it's time to pay that and give good treatment and quality and advice to people and share my experiences so they don't have to do the same mistakes. You know, you can be good, better person when you see people in need.
MV: Well, thank you so much. You gave me a lot of really wonderful information.
CR: I forgot to mention something important.
MV: What is it?
CR: We are pretty involved with foundations, like American Cancer Society and we are doing a program for Latinas with cancer. So we are doing beauty sessions, two hour sessions and we talk about skin care. We facilitate them the wigs, we play with bandanas, how to cover their heads. We play with makeup. We have different donors and they give us makeup for free, from different beautiful brands. So, we're doing this two hours beauty sessions in Spanish as well. We're working with different places: Orange County Health Department, we're doing a lot in the community, working as members.
MV: You have a lot of partnerships.
CR: Yeah, a lot. We are pretty good at doing partnerships.
MV: That's how you reach out to people.
CR: Yes, exactly. And we're doing the health fair every year in St. Thomas More. So, we serve around three hundred, four hundred people every year, doing a lot of for free. It's pretty cool. It's a lot to do, but--
MV: Keeps you busy.
CR: Yeah. It's worth it.
MV: Do you have anything else to add?
CR: Oh no, we just got three awards. The Latino Diamante award, the Ohtli, the Mexican consulate. We're partners with the Mexican consulate. Another one, internal to UNC, so we always try to be active and now we are having our recognizement?
MV: Recognition.
CR: Recognition. So, it's good. Feels good when you get a pat on the shoulders. Okay.
MV: Well you deserve it.
CR: Yeah, and we got the good news two years ago, 2011 in summer that we are not grant anymore. We are a formal program at UNC Health Care System. We are now hospital employees and so it's because we're pretty committed for caring.
MV: Congratulations.
CR: Thank you, Madhu. Yeah, we'll keep working hard. That's the idea.
MV: Thank you so much. I really appreciate it. I learned a lot about--not only what your organization does, but how you’re able to help Latinos in this area. Thank you so much.