Philip Ramírez
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Abstract
Philip Ramirez, a first-year medical student at the University of North Carolina at Chapel Hill (UNC), shares the range of personal and professional experiences that fostered his interests in the health disparities that many Latinos face. As president of UNC’s chapter of the Latino Medical Student Association (LMSA), Ramirez discusses one of the major contributors to this health disparity: underrepresentation of Latinos in the health care professions. Through his moral standpoint on healthcare, his experience as an Army medic, and his desire to both become a physician and pursue a Masters in Business Administration, he provides a unique perspective into some ways to improve disparities in access to healthcare for Latinos.R0712_Audio.mp3
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Transcript
Radha Patel: Okay so, good afternoon. My name is Radha Patel. I’m the interviewer for today. I’m interviewing Philip Ramirez. We are in the Health Sciences Library in—on the University of North Carolina at Chapel Hill campus. It is April 15, 2014. Yea, that’s about it. So could you give me a brief background about yourself and your interests in health care for the Latino population?
Philip Ramirez: Alright, so my history starts, I guess, with my parents. My mother is from southern California and my dad was born in Mexico. He came across when he was a child with his—his parents. And they had five children and raised us all on the salary of an enlisted Air Force—I want to call him a soldier because I was in the military, but—airman, there you go, and my mother was a day care teacher. So growing up, it was just kind of living with my brothers and my parents. And I had a really good family friend of ours named Uncle Dan. We call him “uncle” because he was such a close friend. He was in the military as an F-17 fighter pilot and he would fly around places and come back and visit us and show us like the money that he had and show us pictures and stuff that he had collected. And when he was done flying F-17s, he decided he wanted to be a doctor. So that was pretty much my first influence with becoming a physician. Not sure if that completely answers your question.
RP: No, that’s totally fine—that’s great. Yea, so that’s great. So you mentioned that you’re the president of LMSA, which is the Latino Medical Student Association. Could you tell me a little bit more about that, like what the goals of the organization are and things like that?
PR: Now I remember the latter part of your first question, about why I’m interested in health care and particular disparities. I guess that comes from a little bit of the moral indoctrination from my upbringing—my family is a strong Catholic family and so we kind of believe in taking care of the poor and kind of like the saying in the bible: “The poor have an easier time gettin’ into heaven than a rich person would be gettin’ through the eyehole of a needle.” So I probably said that wrong (laughter), but similar…similar. So just kind of like, you know, take care of the less fortunate kind of thing, so health disparities—health care in general I believe if very conducive to that…that lifestyle. So, when I got into medicine, it was with the help of the Office of Special Programs. They had a Medical Education Development (MED) program that I did that is for socioeconomically underprivileged people, like minorities or just people who are poor in general. And through that, I really learned of some fabulous stories. Some people—like there was a lost boy from Sudan that was in our class, you know the boy soldiers, so he was thirteen when he was a soldier. And then a single mother, who at sixteen was paying her way through college…now she’s in the honors society and things like that. So it’s just really—these people really are great people who could be in the medical field only—if only they were given an opportunity and often times, their position in life doesn’t afford them that opportunity. So programs like the MED program really opened my eyes to say “wow” you know? These are the people that are gonna go back and take care of the people from where they came from—the poor people or the underprivileged people that nobody else really wants to take care of because there’s no money in that. So how do we address the problem of growing health disparities in the country? What you do is you elevate the people who are fully capable of performing medical services from the communities that are underprivileged and have the largest health disparities because its been shown – I don’t know the research statistics and I don't know the research paper—but I know it's been shown repeatedly that people from underprivileged areas are more likely to give back to underprivileged areas. So, the Latino Medical Student Association kind of arose out of chance. I was walking out a meeting—out of Medicine and Society—the class is about the cultural… like the whole…it’s really complicated to explain ‘cause it’s a really complicated class. It’s too—it’s really so that you can appreciate the complexity that an individual brings to you in your office. So if you’re interviewing this person trying to get their—their history. And the way that they report the illnesses and diseases and then the background they came from, the access to health care that they’ve had in the past, the barriers to them trusting you—it just really teases out all those little cultural nuances that affect how you gather information and treat somebody. So I was walking out of this class and someone was—it was the beginning of the year, first year medical student, and at the beginning of the year, everybody’s trying to recruit you for their organization. There was a lady who was a TA (Teacher’s Assistant) for me in the Medical Education Development Program that I did over the summer walking into the classroom. She’s Hispanic, real big on Latino health disparity issues, and she’s like, “I’m having an interest meeting for a brand new group called Latino Medical Student Association, and you’re Latino so you should stay.” And I was like, “You know what? You’re right, I’ll stay and check it out.” So I stuck around and she was like going around asking people questions and what they wanted to do and… just after that, she started passing out positions, like “Anybody can have any position they want, really, kind of to pad your resume. We just want to get this group started and get some interest going.” So I was like “I’ll be whatever you need.” And she was like “How about secretary?” and I said “How about vice president?” (laughter). She said, “Sure, sure, sure.” So I was vice president, and then it turns out she couldn’t be the president of the organization because she’s a—she’s a wonderful, wonderful woman, her name is Pamela Della Valle…Della Valle, and she has two kids, and she’s married, and she’s a third year medical student, and she’s co-president for student government for Whitehead Medical Society, which is the student body for the medical school. And so she had to take a little bit of time off because she just had a child and she wasn’t a full time student, and by student policy regulations for the—to be a student group, you have to be a full time student, so she’s like, “Could you be the president?” so I was like, “Only if I can have a co-president!” because I, you know, I wanted someone to bounce ideas off of. So I asked my buddy Alonso Saldana and we get together and we found an advisor, and the advisor’s name is Marco Aleman, and he is someone that you probably definitely want to interview if he has the time. And, you know, he’s very busy. He—I’m sure if he had the time he would definitely give it to you. But, he told us what we should focus on is creating a pipeline for Latino students from middle school all the way to a medical career, and that's where ¡El Camino Hacia el Exito! Came from. So, Alonso named it—he was like “Let’s give it a name! It’ll make it something that people can hold on to.” We call it ¡Exito! for short, which sounds great. And then Pamela had an idea called the Family Unit. In the Family Unit, you know, it’s a physician, resident, medical student, undergrad, high school, middle school, and so that’s the pipeline—the virtual pipeline for education. So right now, LMSA’s main goal is to create the educational pipeline to increase the number of Latinos in the health care field so that they are more likely to give back to Latino communities, just to kind of bring a full circle for you.
RP: Awesome, cool! So, it’s a really new thing—it started this year?
PR: So there’s an LMSA national group. It’s 503c (non-profit), started in 2009, and the history of that is that there were a bunch of different groups…so there was a definite need for Latino organizations in medical school and there was a…(sigh), don’t get me saying the names—I’ll be lying if I knew, but there were different, different sorts of Latino groups all over the country and they were all finding out about each other and they were like, “You know, we should just unite under one banner.” And so they did in 2009, they made LMSA, so it’s a relatively young organization and they’re doing really, really well—I mean, we are doing really, really well.
RP: Are they all doing the same pipeline sort of thing or are they all—
PR: No, that’s been our focus. I’m not extremely familiar if that’s their focus. I know that they all have the intentions of lifting up the Latino population. Some might do so by going out and educating about—about the disparities, you know, because disparity is not just due to socioeconomics, but it’s also due to education, cultural barriers, trust for you physicians or your system. So they go out and provide health fairs or something like that. They have different, different ways of doing things. So I think it’s coming together so that people are eventually going to have mentorship programs, but I think the family unit might be fairly unique to UNC.
RP: Okay, cool. So this is a little bit off topic but how many—how big is the medical school here? How many students are there and of those, what percentage or how many are Latino?
PR: So, my class in 180 students and there are, I believe, there are only six Latino students in my class. And I’m only half but they count me as a whole. And you know, honestly, I love UNC. They’re great and they have, you know, nothing else to go by except numbers. I mean, they want to look good to recruit people and they want to recruit Latinos—it’s just, there’s other barriers besides the school letting them in. You know, the school has standards, they have to keep their standards, keep it a great school. But, that’s where ¡Exito! is gonna come in—help increase the caliber of the Latino applicant for UNC’s medical school.
RP: Cool, that's awesome! Have you had a lot of experience working with patients—I know you’re a first-year—I’m not sure how that works.
PR: I am actually twenty-nine years old. I took the scenic route to college. I was—I joined the military immediately upon graduating from high school in 2002. I was a medic in the Army, so yes; I’ve had plenty of experience with patients.
RP: Okay, with Latino patients?
PR: With Latino patients, no.
RP: Okay, never mind then.
PR: I mean, not Latino patients in particular.
RP: Yea, okay cool. So I’m in a medical anthropology class right now and we’ve been talking a little bit about rationing and triage and things like that—and how we think about that a lot in terms of other nations and—well, you’re from the military—on the field and stuff like that, but I guess the main topic of our class discussion has been that we ration medicine in the U.S. even, just based on socioeconomic things like that. So in terms or finances, what do you—what do you think about our health care system and…
PR: I think I’m severely under qualified to completely—I can give you my two cents, but I mean, anything I say is not expert opinion at all.
RP: Yea, that’s fine.
PR: I think that there’s a lot of greed in the system for sure, and I think that that’s kind of the way capitalism works, you know. I’m not saying it’s bad because capitalism clearly got the United States to the point where it’s at, but I mean, there has to be some things in place to make sure that the baseline that people are living at is something that you’d be okay with living that yourself. If you’re at the top, you know, you can't just say, “I don’t care about them because they’re not doing their thing,” so I mean, what happens if you ended up there? You know, would you want to not be able to take your kids to the hospital because you can’t afford it? I’m not sure—the current climate going on is so complicated. The justifications and rationale—it’s, you know, it’s all hidden behind rhetoric like what does somebody really want from this bill that they’re passing or this goal that they’re doing and how that…I don’t know, but I know that doctors for the most part want to give back and help. I do know, I mean, some want money, of course there’s a whole spectrum there. And money attracts power, unfortunately, so you’ve got to be careful with cutting pay. I don’t necessarily think that physician salary is the problem. I think it might be insurance companies and companies that build equipment for certain surgeries or, you know. I’m not sure what they’re called…the medical companies… I don’t want to name any in particular…
RP: Oh, that’s okay.
PR: I don’t want to get in trouble, but—the medical device companies.
RP: So they—the medical device companies charge way more than they should be? Is that—is that kind of the gist of it?
PR: I mean, I’m not sure it’s more than they should be, but I know the amount of money that they charge for things is astronomical.
RP: Yea, it sounds like it.
PR: I also know that insurance plans will only accept—will make deals with pharmaceutical companies and deals with medical device companies, so that if carry their insurance, you can’t even offer the patient that other medicine. It's a gag clause. Right? Like you can’t even tell them that they won’t cover it—you just can’t tell them about it. That seems a little off, right?
RP: Yea, that does seem a little off.
PR: Yea, these are the things we learn about in Medicine and Society class and honestly, I’m still wrapping my head around all of it. I think that practice will show me the ins and outs of the perversion and the correct ways of conducting business in the medical field. I plan on getting my MBA (Masters in Business Administration) in my third year, too, to help understand that aspect of medicine as well. So I’m not sure if I answered your question—
RP: No, no, that was really, very helpful.
PR: But I just think it’s a very complex, convoluted, political, policy-making sphere that surrounds health care, you know, that kind of distracts from the end goal of health care for most physicians, which is to give care to patients that need it.
RP: So I guess leading off of that, there—I know there are some sorts of free clinics, things like that. Do you know how those work? Do you know if the government sponsors them or if doctors are volunteering their time—I know that, I’m sure it’s a mix of both?
PR: You’re exactly right, it is a mix of both. So there’s the Student Health Action Coalition, also known as SHAC. It’s run by students and they get doctors to volunteer their time. There’s also a cardiology clinic that’s run on the third Thursday of every month and there’s a cardiologist—I think I know his name but I don’t want to say the wrong name, but he definitely deserves credit because he is donating his time for four hours every third Thursday to take on these patients that have no other access to care.
RP: Is that—do you know if that’s a lot of the farmworker population or something like that?
PR: So, they have CAMPOS (Comprehensive Advanced Medical Program of Spanish). CAMPOS is a student run organization at UNC, kind of like LMSA. That’s why we have to differentiate our goal as the pipeline—because CAMPOS goes out and helps out the migrant workers. They go to farms and kids get to—“kids,” I’m sorry (laughter)—medical students get to practice their medical Spanish as well they get to go out and give back. So they go out with physicians and higher up medical students, like MS4s or MS3s, and they interview patients and, you know, try to identify problems and educate them on things. I’m not sure if they hand out medications or not if the physician’s there with them. I doubt that they do, but yea, they have—CAMPOS does that. There’s different organization that are fueled by student interest that give back to the community and the Latino community.
RP: Okay, great. Do you think that often times, organizations like this have trouble finding people who are willing to volunteer their time or…? I know you said and I’m sure a lot of doctors like to give back, but…?
PR: I think UNC- Chapel Hill is pretty diverse, pretty mixed, and they have a—I mean, the admissions process, the same things holding a lot of students back is also what makes UNC great. It’s a great filtering process to get students who really care about health care, and if you care about health care, I think you’re gonna care about disparities, and if you care about health disparities, you’re gonna care about the Latino population because we’re the fastest growing and largest minority population, so, kind of roundabout way. Repeat the question one more time.
RP: Oh, if people have trouble finding—
PR: So at UNC, there hasn’t been a whole lot of trouble with recruiting for LMSA, but I know at ECU (East Carolina University)—and I guess that’s backhanded—but (laughter), ECU is having trouble building an LMSA group because they don’t have very many Latinos who are interested. And they—I don't know how they’re gonna generate interest, but I think that they should pull at the same strings that we have in LMSA, which is health disparity, not necessarily just Latinos.
RP: I thought Brody (ECU’s medical school) was sort of focused on health disparities in North Carolina, like in rural places, but not specifically Latino populations?
PR: They are, they are. I just know that they’re having trouble with recruiting people because people think the group is only for Latinos, whereas it’s for addressing Latino-specific disparities. I think it’s easier to attack and identify and attack the cultural nuances of one culture at a time. I mean, some of the situation are gonna be similar to the African American population or the Indian population, but you might have to change it just a little bit, like the diets. Just educating on the diet is a little different, or you know, things of the sort.
RP: Yea, definitely. Okay yea, so I guess aside from the financial factors, you mentioned cultural factors a couple times. Could you maybe give me some examples of different cultural factors that—that are barriers to accessing healthcare or…?
PR: I usually talk about the overarching theme of, you know, people feel more in concert with the person who is of the same cultural background. They’re more likely to go see someone who they feel speaks the same language as them or whom they feel knows their struggle a little better. And they’re also more likely to listen to them, so you have more use of the healthcare system and better outcomes. So I guess the cultural barriers there might be lack of trust for things that you don’t know, you know? You don't know—you don’t know about their culture as much so you don’t know how to act, you know, that little apprehension, little bit of hesitation, and then you just put it off. Or like, “they don’t care about me,” of sometimes they don’t care about you, you know. You go in and they don’t want to hear what you’re saying because they think you’re stupid—they think that because you’re dirty, because you worked all day, because that’s the life that you’re forced to live—you come in that you’re below education status, so they don’t really listen to your complaints as well. They think they know what it is and eventually you’re jaded by the system and that gets passed down to the people that you know. Other cultural problems… I mean, maybe the diets. Genetics also, like diabetes runs rampant in the Latino population. That could be due to diet, also partly due to genetics. I mean also, the one that everybody knows about is socioeconomics that tie in with cultures, you know? We all know who’s in power these days and who’s been in power forever, and there’s always gonna be that protection of the power that is in place. I mean there’s just this innate desire to take care of people that are closer to you, and so people may not see the other cultures as someone that they might put as a priority to take care of. And there’s also differences about how people view health. This is way off topic, but I’m sure that being in medical anthropology, you can definitely understand what I’m saying. In some cultures, when someone is crazy, they think that maybe they’re a mystic or something, right? But you know, in our culture, if someone’s crazy, they go to the hospital and get medications or speak to somebody. That’s a real big extreme, but some people will deal with an illness in a different way, so they wont’ go to the healthcare system, they won’t see it as a problem. Or some people will just tough it out due to lack of money until it becomes a huge problem.
RP: I guess in terms of ways of approaching medicine, do you see—do you think that people use traditional medicines from their home countries, things like that… or, I don't know?
PR: I am not sure. I—well actually, I heard a story about how warm tortillas on your stomach will help with a stomachache. So I guess that’s kind of what you’re talking about. Yea, I’m sure there are a lot always home remedies that ride the cultural wave.
RP: I wonder if people turn to those because financially, they can't, I don’t know…I was just curious.
PR: Yea, maybe it’s because they don’t have anything else, so it works. I can see a correlation there. Why go to the doctor for some pain meds when you can just put warm tortillas on your stomach (laughter).
RP: I want warm tortillas on my stomach! (Laughter).
PR: I want them in my stomach (laughter).
RP: Yea, even better! Do you know anything about the Affordable Care act and how that’s impacting, I guess specifically the Latino population and underprivileged populations in general?
PR: So, if you stratify the United States into three groups, which is pretty simplistic, but upper class, middle, class, and lower class. So the Affordable Care Act is gonna help the lower class, especially in North Carolina where North Carolina won’t accept the increased Medicare help from the federal government. So that’s optional—so they offered—so there’s a swath of people in the middle that are gonna have to pay more money for health insurance, right, and that’s what people are complaining about. There’s also a swath of people who are gonna remain uncovered and would fall under Medicaid, right? And so the federal government offered to pay more money to help out with the Medicaid costs, but North Carolina said, “No, we don’t want that” for various reasons—I won’t get into those. So they’re gonna leave a bunch of people uncovered, but below that is where the Latinos usually fall. So the Latinos fall in the— I mean most Latinos fall in the lower class, which the Affordable Care Act is definitely helping out. So I think the Affordable Care Act has been really good for the Latino populations. And there I actually a lady… I think her name is Veronica Ramirez… I may be getting the first name wrong… last name is definitely Ramirez because that’s my last name (laughter) and I remember it. She’s with Families USA and she actually loves the Affordable Care Act because it helps the Latino population, and she was saying that it gives more access.
RP: It’s interesting that you say that because somebody else that I interviewed, she—her work is more with undocumented Latino immigrants and for them, it’s sort of like the opposite because you have to be a citizen to qualify. And so since the lower class population that you were talking about, since they are getting more access to health care, the federal government that sponsors clinics, things like that—those are getting—starting to decrease or something. Or it’s predicted to start decreasing, so it sort of leaves the undocumented population more vulnerable.
PR: She said that the community health centers – the federally qualified community health centers – were gonna diminish?
RP: Yea, because since everyone is gonna—or, since more people are gonna have access to—
PR: To hospitals, they’d rather go to the hospitals. That’s what everybody keeps saying, but I don't necessarily believe that because there’s still a problem with transportation. And also, the community health centers, I feel like they would do better because—I had this discussion with somebody else too—Dr. Bright, who is the head of the Office of Special Programs, who is also the president of the National Medical Association, and he’s the director for the MED program, the Medical Education Development program—and he told me the same thing. He was like, “Why do you want to work for a community health center? The Affordable Care Act’s gonna ruin them.” And I said, “Well, don’t they usually see uninsured and underinsured patients? And won’t they now see more insured patients and have more money for themselves?” But he was like, “Why would you go to a community health center when you can go to a hospital?” So I guess we’re gonna have to see where the chips fall with that one. As far as what to do about undocumented immigrants, I can’t tell you (shaking head). People won’t talk about it—they won’t talk about it. Our higher ups won’t talk about it—they refuse to talk about it, so. Yea, it’s interesting that you brought that up ‘cause I’ve been thinking about the Affordable Care Act and it’s effect on community health centers for a while.
RP: Do you know if—so you said a little bit earlier that North Carolina is a little bit different because they’re not accepting that federal care—what would it be like if they did accept?
PR: Well, see, okay. I guess you want to tease out the reasons why they’re not accepting it. So there’s a couple other states that weren’t accepting either. Ohio was one of them that didn’t initially accept it, but they ended up—the lady ended up—the governor… I don’t know her name. I should know her name ‘cause she’s awesome. She’s actually a republican—I’m not necessarily republican, but she went around her legislature to get Medicaid accepted for her people so that she should get more people health insurance. But other states like, I think Texas is one of them, North Carolina is one of them—there’s a bunch of states that haven’t accepted the Medicaid boost. It’s because the federal government offered to pay 100% of the Medicaid boost, and eventually, they would back off to 90%. But what it did—it takes control away from the state to control how much Medicaid that they use so that they’re—and they’re also afraid that maybe the federal government will back down on their promise through changes in legislature and not pay 90% and they’ll be stuck paying that whole bill now. So it gives them less control over their finances—gives the federal government more power than their legislatures and policy-making ideas, which states don’t necessarily abide by. States want to have, maintain their control. A lot of—the word I’m looking for I can’t find right now…it’s been a couple times that I’ve looked for it but, it’s the staunch opposition to federal imposition of rules on state regulation. It’s—that’s a big, bit thing. They also don’t want the federal government running insurance. That’s another thing. That’s why a lot of doctors are opposed to the Affordable Care Act as well, ‘cause they don’t want insurance—I mean they already think medical companies meddle too much in the finances of a physician. They don't want the physician to be affected at all with the relationship on the patient with money; they don’t want that to happen at all. And slowly but surely, it’s becoming a problem. I mean, I think it might have been inevitable, especially with the rising cost of health care. To be financially sustainable, to be sustainable—that’s just the world we live in.
RP: Yea, sounds good. Do you think that the public perception of Latinos plays a role—plays a significant role in the way that politicians make policies? Like do you think that, you know, if people were way more accepting, especially in North Carolina, if people were more accepting of Latino populations and understood, rather than making harsh judgment. Do you think that policies would actually change if that happened, or…?
PR: Well I don't—what do you mean by—how are they currently holding them down?
RP: I don’t know, I feel like…
PR: Just by not caring about them?
RP: Yea.
PR: Not paying attention because it’s not in their face? (Sigh). It’s kind of like those commercials you see on TV where it’s like, “A quarter a day can feed this child.” So you—you can make people care but they can just change the channel because they’re so distanced from it. So you’re talking about bringing the problems of the Latino community to the forefront of peoples’ attention and how can you focus on them so that when certain legislation comes through, they could be behind it or against it? I would like to say yes, that that would have an affect. But I think people, if they were forced to give up something for somebody else, that they would start to become really selfish and you’d see that—that innate desire I was talking about to care about the people closest to you. There’s a lot of people, especially around Chapel Hill and Carrboro area that would be willing to give up, but it’s a lot more liberal of a town. If you go to some of the more rural areas where people are actually competing with jobs of immigrants, they totally would be against helping the Latino population. It's the natural, natural struggle, I mean. The thing often times if fuel by political lines and ignorance in the media, like pulling strings on people.
RP: Yea, definitely. Okay, so we talked about—a little bit about this earlier, but so I know that there are a lot of health education programs out there. Do you think that that—the way—or I guess the ratio of health education to actual medicine access for folks, like maybe migrant farm workers, things like that—do you think that the ratio is okay? Because I know that there is a lot of health education, but does that—I guess, does that make up for the lack of access or…?
PR: No, I wouldn’t say it makes up for the lack of access ‘cause I think with access comes education. Because a good physician will education will educate the patient. So I think access is key, but education will—so there’s education in many senses. There’s education on how to take care of yourself. There’s also education on problems that plague your area, or why these problems plague your area and where they come from—maybe it’s that dirty sewage plant upstream that’s polluting your water that’s causing an increase of this problem in the population. There’s all kinds of different sorts of education and ultimately, I think the more educated someone is, the better their health is going to be, up to a point. Some people just don’t care—they’d rather just eat the food they want to eat or smoke some the cigarettes they want to smoke. But as far as a balance, like which one’s more important, you mean?
RP: I mean, I guess so, yea.
PR: So which one’s more important? I would say access. No, I’m not sure. They go hand in hand. I want to say access because it kind of includes education, but without the education you don’t really know when to get to the hospital or not, you know, or what the best methods are for going through the hospital. But I guess you could learn that through trial and error, so access I still would say is more important. As far as feasibility in the current climate, education is probably the most effective, especially for undocumented people—education is probably the most—like education on how to take care of yourself, how to take care of your family, where the free clinics are, what kind of support are you gonna get from your local government, you know, ways to go around the access issue.
RP: Okay, cool. What—what are some things that regular people like me, what are something that we can do to help, I guess, increase access and things like that?
PR: First, I don't think you’re a regular person because you’re at UNC- Chapel Hill.
RP: Oh yea (laughter), okay.
PR: You had to have gone through quite the filter process to get to where you are now. So how could you increase access to health? By doing what you’re doing. I mean, everybody’s kind of got a place. Right now, you’re kind of uncovering the—the reasons, based highly on opinion especially with me, for disparities, health disparities. Really educating people, like you said, do you think that if people were educated, that they would be more likely to give back—I don’t think everybody would, but I think there are some people who are eventually gonna help unite more people on the same cause, social justice. As far as concrete things that you can do, get a health degree of some sort, give back via your profession, you know. Show people in your career, this is that I’m doing, you know, I have time, I can sacrifice a half of a day to go—once a month to give care to these people or educate people, so yea.
RP: So I’m jumping back a little bit, but do you think the quality of treatment in clinics like we were talking about earlier, like free clinics, things like that—do you think it’s the same as the other health care systems? Like the quality of a hospital versus a health clinic?
PR: Well they don’t have to them, so I think that what they do provide, the quality is probably pretty good, pretty comparable. But as far as the things that they provide, there’s no comparison.
RP: So what would happen—do you know what would happen if a patient came to a health clinic and then the health clinic was able to help—I guess they had a sliding scale system or something so they could pay based on their income, but then what the patient had was a little bit more serious and they didn’t have the means to treat it, do you think—do you know what would happen in a situation like that? Would they go to a hospital and have to find a way to pay or…?
PR: I’m not—I don’t know.
RP: Okay. Sorry, that was a really broad question.
PR: No, that’s okay, that’s a good question. I wish I knew the answer to that. I—I don’t know. I don't know if they would send them to the ER (emergency room) and try to get them charity care, I’m not sure. Not sure.
RP: Okay, and then—we talked about this a little bit before but could you maybe expand on what you said about how the quality of health care given to certain populations may be different—not necessarily based on—like just based on perceptions, of the power dynamics between the doctor and the patient, things like that? You said sometimes, you know, there’s that desire to give back to your own community, so do you think that since there isn’t such a high representation of Latino folks in health care professions, do you think that—
PR: —it affects how much people give back to the Latino population?
RP: How much and I guess just the quality of regular health care in general.
PR: Well there’s a big—yea, I know what you’re saying. There’s a big push for cultural competency, which I think is a nebulas term—I think it’s kind of a fiction. I don’t think its possible to be culturally competent. I think you can be from a culture and understand the culture, but you don’t know how—you can’t just read a book or take a class and learn how to be culturally competent. So, that fallacy right there is something that needs to be addressed and the real way to become culturally competent is by having the same cultures represented in the same percentage in the—in the providing service, the service that’s providing care. So that was a really, really difficult way to say that—I didn’t really word this before I thought about it, but the health care industry, or doctors are five percent Latino, right? And the population is sixteen percent. You can try to make another eleven percent of the doctors culturally competent or everybody culturally competent, which I think is kind of a fallacy, right? Or you can get eleven percent more Latinos to represent. So now the field is culturally competent, you know what I mean?
RP: That makes sense.
PR: But I mean, I think that the practicality of assigning Latinos to Latino doctors is kind of not there, but I also think that they will be able to help spread the culturally competed aspect of the medical field to their colleagues. People will see them, respect them, and see that they’re smart—they’re not just, they’re not just migrant workers, you know?
RP: Yea. Maybe the media will in turn also take that into consideration and not portray all minorities as like gangsters.
PR: Yea.
RP: Okay. Well that’s all the questions that I have. Do you have anything that you would like to share or anything I may have missed out on? Or any questions?
PR: No, I think you did a really good job of asking questions. I hope I did a reasonably good job at answering your questions—I get a little tongue-tied sometimes.
RP: Oh, thank you. No, you did fantastic! Okay well thank you.
PR: You’re welcome.
Philip Ramirez: Alright, so my history starts, I guess, with my parents. My mother is from southern California and my dad was born in Mexico. He came across when he was a child with his—his parents. And they had five children and raised us all on the salary of an enlisted Air Force—I want to call him a soldier because I was in the military, but—airman, there you go, and my mother was a day care teacher. So growing up, it was just kind of living with my brothers and my parents. And I had a really good family friend of ours named Uncle Dan. We call him “uncle” because he was such a close friend. He was in the military as an F-17 fighter pilot and he would fly around places and come back and visit us and show us like the money that he had and show us pictures and stuff that he had collected. And when he was done flying F-17s, he decided he wanted to be a doctor. So that was pretty much my first influence with becoming a physician. Not sure if that completely answers your question.
RP: No, that’s totally fine—that’s great. Yea, so that’s great. So you mentioned that you’re the president of LMSA, which is the Latino Medical Student Association. Could you tell me a little bit more about that, like what the goals of the organization are and things like that?
PR: Now I remember the latter part of your first question, about why I’m interested in health care and particular disparities. I guess that comes from a little bit of the moral indoctrination from my upbringing—my family is a strong Catholic family and so we kind of believe in taking care of the poor and kind of like the saying in the bible: “The poor have an easier time gettin’ into heaven than a rich person would be gettin’ through the eyehole of a needle.” So I probably said that wrong (laughter), but similar…similar. So just kind of like, you know, take care of the less fortunate kind of thing, so health disparities—health care in general I believe if very conducive to that…that lifestyle. So, when I got into medicine, it was with the help of the Office of Special Programs. They had a Medical Education Development (MED) program that I did that is for socioeconomically underprivileged people, like minorities or just people who are poor in general. And through that, I really learned of some fabulous stories. Some people—like there was a lost boy from Sudan that was in our class, you know the boy soldiers, so he was thirteen when he was a soldier. And then a single mother, who at sixteen was paying her way through college…now she’s in the honors society and things like that. So it’s just really—these people really are great people who could be in the medical field only—if only they were given an opportunity and often times, their position in life doesn’t afford them that opportunity. So programs like the MED program really opened my eyes to say “wow” you know? These are the people that are gonna go back and take care of the people from where they came from—the poor people or the underprivileged people that nobody else really wants to take care of because there’s no money in that. So how do we address the problem of growing health disparities in the country? What you do is you elevate the people who are fully capable of performing medical services from the communities that are underprivileged and have the largest health disparities because its been shown – I don’t know the research statistics and I don't know the research paper—but I know it's been shown repeatedly that people from underprivileged areas are more likely to give back to underprivileged areas. So, the Latino Medical Student Association kind of arose out of chance. I was walking out a meeting—out of Medicine and Society—the class is about the cultural… like the whole…it’s really complicated to explain ‘cause it’s a really complicated class. It’s too—it’s really so that you can appreciate the complexity that an individual brings to you in your office. So if you’re interviewing this person trying to get their—their history. And the way that they report the illnesses and diseases and then the background they came from, the access to health care that they’ve had in the past, the barriers to them trusting you—it just really teases out all those little cultural nuances that affect how you gather information and treat somebody. So I was walking out of this class and someone was—it was the beginning of the year, first year medical student, and at the beginning of the year, everybody’s trying to recruit you for their organization. There was a lady who was a TA (Teacher’s Assistant) for me in the Medical Education Development Program that I did over the summer walking into the classroom. She’s Hispanic, real big on Latino health disparity issues, and she’s like, “I’m having an interest meeting for a brand new group called Latino Medical Student Association, and you’re Latino so you should stay.” And I was like, “You know what? You’re right, I’ll stay and check it out.” So I stuck around and she was like going around asking people questions and what they wanted to do and… just after that, she started passing out positions, like “Anybody can have any position they want, really, kind of to pad your resume. We just want to get this group started and get some interest going.” So I was like “I’ll be whatever you need.” And she was like “How about secretary?” and I said “How about vice president?” (laughter). She said, “Sure, sure, sure.” So I was vice president, and then it turns out she couldn’t be the president of the organization because she’s a—she’s a wonderful, wonderful woman, her name is Pamela Della Valle…Della Valle, and she has two kids, and she’s married, and she’s a third year medical student, and she’s co-president for student government for Whitehead Medical Society, which is the student body for the medical school. And so she had to take a little bit of time off because she just had a child and she wasn’t a full time student, and by student policy regulations for the—to be a student group, you have to be a full time student, so she’s like, “Could you be the president?” so I was like, “Only if I can have a co-president!” because I, you know, I wanted someone to bounce ideas off of. So I asked my buddy Alonso Saldana and we get together and we found an advisor, and the advisor’s name is Marco Aleman, and he is someone that you probably definitely want to interview if he has the time. And, you know, he’s very busy. He—I’m sure if he had the time he would definitely give it to you. But, he told us what we should focus on is creating a pipeline for Latino students from middle school all the way to a medical career, and that's where ¡El Camino Hacia el Exito! Came from. So, Alonso named it—he was like “Let’s give it a name! It’ll make it something that people can hold on to.” We call it ¡Exito! for short, which sounds great. And then Pamela had an idea called the Family Unit. In the Family Unit, you know, it’s a physician, resident, medical student, undergrad, high school, middle school, and so that’s the pipeline—the virtual pipeline for education. So right now, LMSA’s main goal is to create the educational pipeline to increase the number of Latinos in the health care field so that they are more likely to give back to Latino communities, just to kind of bring a full circle for you.
RP: Awesome, cool! So, it’s a really new thing—it started this year?
PR: So there’s an LMSA national group. It’s 503c (non-profit), started in 2009, and the history of that is that there were a bunch of different groups…so there was a definite need for Latino organizations in medical school and there was a…(sigh), don’t get me saying the names—I’ll be lying if I knew, but there were different, different sorts of Latino groups all over the country and they were all finding out about each other and they were like, “You know, we should just unite under one banner.” And so they did in 2009, they made LMSA, so it’s a relatively young organization and they’re doing really, really well—I mean, we are doing really, really well.
RP: Are they all doing the same pipeline sort of thing or are they all—
PR: No, that’s been our focus. I’m not extremely familiar if that’s their focus. I know that they all have the intentions of lifting up the Latino population. Some might do so by going out and educating about—about the disparities, you know, because disparity is not just due to socioeconomics, but it’s also due to education, cultural barriers, trust for you physicians or your system. So they go out and provide health fairs or something like that. They have different, different ways of doing things. So I think it’s coming together so that people are eventually going to have mentorship programs, but I think the family unit might be fairly unique to UNC.
RP: Okay, cool. So this is a little bit off topic but how many—how big is the medical school here? How many students are there and of those, what percentage or how many are Latino?
PR: So, my class in 180 students and there are, I believe, there are only six Latino students in my class. And I’m only half but they count me as a whole. And you know, honestly, I love UNC. They’re great and they have, you know, nothing else to go by except numbers. I mean, they want to look good to recruit people and they want to recruit Latinos—it’s just, there’s other barriers besides the school letting them in. You know, the school has standards, they have to keep their standards, keep it a great school. But, that’s where ¡Exito! is gonna come in—help increase the caliber of the Latino applicant for UNC’s medical school.
RP: Cool, that's awesome! Have you had a lot of experience working with patients—I know you’re a first-year—I’m not sure how that works.
PR: I am actually twenty-nine years old. I took the scenic route to college. I was—I joined the military immediately upon graduating from high school in 2002. I was a medic in the Army, so yes; I’ve had plenty of experience with patients.
RP: Okay, with Latino patients?
PR: With Latino patients, no.
RP: Okay, never mind then.
PR: I mean, not Latino patients in particular.
RP: Yea, okay cool. So I’m in a medical anthropology class right now and we’ve been talking a little bit about rationing and triage and things like that—and how we think about that a lot in terms of other nations and—well, you’re from the military—on the field and stuff like that, but I guess the main topic of our class discussion has been that we ration medicine in the U.S. even, just based on socioeconomic things like that. So in terms or finances, what do you—what do you think about our health care system and…
PR: I think I’m severely under qualified to completely—I can give you my two cents, but I mean, anything I say is not expert opinion at all.
RP: Yea, that’s fine.
PR: I think that there’s a lot of greed in the system for sure, and I think that that’s kind of the way capitalism works, you know. I’m not saying it’s bad because capitalism clearly got the United States to the point where it’s at, but I mean, there has to be some things in place to make sure that the baseline that people are living at is something that you’d be okay with living that yourself. If you’re at the top, you know, you can't just say, “I don’t care about them because they’re not doing their thing,” so I mean, what happens if you ended up there? You know, would you want to not be able to take your kids to the hospital because you can’t afford it? I’m not sure—the current climate going on is so complicated. The justifications and rationale—it’s, you know, it’s all hidden behind rhetoric like what does somebody really want from this bill that they’re passing or this goal that they’re doing and how that…I don’t know, but I know that doctors for the most part want to give back and help. I do know, I mean, some want money, of course there’s a whole spectrum there. And money attracts power, unfortunately, so you’ve got to be careful with cutting pay. I don’t necessarily think that physician salary is the problem. I think it might be insurance companies and companies that build equipment for certain surgeries or, you know. I’m not sure what they’re called…the medical companies… I don’t want to name any in particular…
RP: Oh, that’s okay.
PR: I don’t want to get in trouble, but—the medical device companies.
RP: So they—the medical device companies charge way more than they should be? Is that—is that kind of the gist of it?
PR: I mean, I’m not sure it’s more than they should be, but I know the amount of money that they charge for things is astronomical.
RP: Yea, it sounds like it.
PR: I also know that insurance plans will only accept—will make deals with pharmaceutical companies and deals with medical device companies, so that if carry their insurance, you can’t even offer the patient that other medicine. It's a gag clause. Right? Like you can’t even tell them that they won’t cover it—you just can’t tell them about it. That seems a little off, right?
RP: Yea, that does seem a little off.
PR: Yea, these are the things we learn about in Medicine and Society class and honestly, I’m still wrapping my head around all of it. I think that practice will show me the ins and outs of the perversion and the correct ways of conducting business in the medical field. I plan on getting my MBA (Masters in Business Administration) in my third year, too, to help understand that aspect of medicine as well. So I’m not sure if I answered your question—
RP: No, no, that was really, very helpful.
PR: But I just think it’s a very complex, convoluted, political, policy-making sphere that surrounds health care, you know, that kind of distracts from the end goal of health care for most physicians, which is to give care to patients that need it.
RP: So I guess leading off of that, there—I know there are some sorts of free clinics, things like that. Do you know how those work? Do you know if the government sponsors them or if doctors are volunteering their time—I know that, I’m sure it’s a mix of both?
PR: You’re exactly right, it is a mix of both. So there’s the Student Health Action Coalition, also known as SHAC. It’s run by students and they get doctors to volunteer their time. There’s also a cardiology clinic that’s run on the third Thursday of every month and there’s a cardiologist—I think I know his name but I don’t want to say the wrong name, but he definitely deserves credit because he is donating his time for four hours every third Thursday to take on these patients that have no other access to care.
RP: Is that—do you know if that’s a lot of the farmworker population or something like that?
PR: So, they have CAMPOS (Comprehensive Advanced Medical Program of Spanish). CAMPOS is a student run organization at UNC, kind of like LMSA. That’s why we have to differentiate our goal as the pipeline—because CAMPOS goes out and helps out the migrant workers. They go to farms and kids get to—“kids,” I’m sorry (laughter)—medical students get to practice their medical Spanish as well they get to go out and give back. So they go out with physicians and higher up medical students, like MS4s or MS3s, and they interview patients and, you know, try to identify problems and educate them on things. I’m not sure if they hand out medications or not if the physician’s there with them. I doubt that they do, but yea, they have—CAMPOS does that. There’s different organization that are fueled by student interest that give back to the community and the Latino community.
RP: Okay, great. Do you think that often times, organizations like this have trouble finding people who are willing to volunteer their time or…? I know you said and I’m sure a lot of doctors like to give back, but…?
PR: I think UNC- Chapel Hill is pretty diverse, pretty mixed, and they have a—I mean, the admissions process, the same things holding a lot of students back is also what makes UNC great. It’s a great filtering process to get students who really care about health care, and if you care about health care, I think you’re gonna care about disparities, and if you care about health disparities, you’re gonna care about the Latino population because we’re the fastest growing and largest minority population, so, kind of roundabout way. Repeat the question one more time.
RP: Oh, if people have trouble finding—
PR: So at UNC, there hasn’t been a whole lot of trouble with recruiting for LMSA, but I know at ECU (East Carolina University)—and I guess that’s backhanded—but (laughter), ECU is having trouble building an LMSA group because they don’t have very many Latinos who are interested. And they—I don't know how they’re gonna generate interest, but I think that they should pull at the same strings that we have in LMSA, which is health disparity, not necessarily just Latinos.
RP: I thought Brody (ECU’s medical school) was sort of focused on health disparities in North Carolina, like in rural places, but not specifically Latino populations?
PR: They are, they are. I just know that they’re having trouble with recruiting people because people think the group is only for Latinos, whereas it’s for addressing Latino-specific disparities. I think it’s easier to attack and identify and attack the cultural nuances of one culture at a time. I mean, some of the situation are gonna be similar to the African American population or the Indian population, but you might have to change it just a little bit, like the diets. Just educating on the diet is a little different, or you know, things of the sort.
RP: Yea, definitely. Okay yea, so I guess aside from the financial factors, you mentioned cultural factors a couple times. Could you maybe give me some examples of different cultural factors that—that are barriers to accessing healthcare or…?
PR: I usually talk about the overarching theme of, you know, people feel more in concert with the person who is of the same cultural background. They’re more likely to go see someone who they feel speaks the same language as them or whom they feel knows their struggle a little better. And they’re also more likely to listen to them, so you have more use of the healthcare system and better outcomes. So I guess the cultural barriers there might be lack of trust for things that you don’t know, you know? You don't know—you don’t know about their culture as much so you don’t know how to act, you know, that little apprehension, little bit of hesitation, and then you just put it off. Or like, “they don’t care about me,” of sometimes they don’t care about you, you know. You go in and they don’t want to hear what you’re saying because they think you’re stupid—they think that because you’re dirty, because you worked all day, because that’s the life that you’re forced to live—you come in that you’re below education status, so they don’t really listen to your complaints as well. They think they know what it is and eventually you’re jaded by the system and that gets passed down to the people that you know. Other cultural problems… I mean, maybe the diets. Genetics also, like diabetes runs rampant in the Latino population. That could be due to diet, also partly due to genetics. I mean also, the one that everybody knows about is socioeconomics that tie in with cultures, you know? We all know who’s in power these days and who’s been in power forever, and there’s always gonna be that protection of the power that is in place. I mean there’s just this innate desire to take care of people that are closer to you, and so people may not see the other cultures as someone that they might put as a priority to take care of. And there’s also differences about how people view health. This is way off topic, but I’m sure that being in medical anthropology, you can definitely understand what I’m saying. In some cultures, when someone is crazy, they think that maybe they’re a mystic or something, right? But you know, in our culture, if someone’s crazy, they go to the hospital and get medications or speak to somebody. That’s a real big extreme, but some people will deal with an illness in a different way, so they wont’ go to the healthcare system, they won’t see it as a problem. Or some people will just tough it out due to lack of money until it becomes a huge problem.
RP: I guess in terms of ways of approaching medicine, do you see—do you think that people use traditional medicines from their home countries, things like that… or, I don't know?
PR: I am not sure. I—well actually, I heard a story about how warm tortillas on your stomach will help with a stomachache. So I guess that’s kind of what you’re talking about. Yea, I’m sure there are a lot always home remedies that ride the cultural wave.
RP: I wonder if people turn to those because financially, they can't, I don’t know…I was just curious.
PR: Yea, maybe it’s because they don’t have anything else, so it works. I can see a correlation there. Why go to the doctor for some pain meds when you can just put warm tortillas on your stomach (laughter).
RP: I want warm tortillas on my stomach! (Laughter).
PR: I want them in my stomach (laughter).
RP: Yea, even better! Do you know anything about the Affordable Care act and how that’s impacting, I guess specifically the Latino population and underprivileged populations in general?
PR: So, if you stratify the United States into three groups, which is pretty simplistic, but upper class, middle, class, and lower class. So the Affordable Care Act is gonna help the lower class, especially in North Carolina where North Carolina won’t accept the increased Medicare help from the federal government. So that’s optional—so they offered—so there’s a swath of people in the middle that are gonna have to pay more money for health insurance, right, and that’s what people are complaining about. There’s also a swath of people who are gonna remain uncovered and would fall under Medicaid, right? And so the federal government offered to pay more money to help out with the Medicaid costs, but North Carolina said, “No, we don’t want that” for various reasons—I won’t get into those. So they’re gonna leave a bunch of people uncovered, but below that is where the Latinos usually fall. So the Latinos fall in the— I mean most Latinos fall in the lower class, which the Affordable Care Act is definitely helping out. So I think the Affordable Care Act has been really good for the Latino populations. And there I actually a lady… I think her name is Veronica Ramirez… I may be getting the first name wrong… last name is definitely Ramirez because that’s my last name (laughter) and I remember it. She’s with Families USA and she actually loves the Affordable Care Act because it helps the Latino population, and she was saying that it gives more access.
RP: It’s interesting that you say that because somebody else that I interviewed, she—her work is more with undocumented Latino immigrants and for them, it’s sort of like the opposite because you have to be a citizen to qualify. And so since the lower class population that you were talking about, since they are getting more access to health care, the federal government that sponsors clinics, things like that—those are getting—starting to decrease or something. Or it’s predicted to start decreasing, so it sort of leaves the undocumented population more vulnerable.
PR: She said that the community health centers – the federally qualified community health centers – were gonna diminish?
RP: Yea, because since everyone is gonna—or, since more people are gonna have access to—
PR: To hospitals, they’d rather go to the hospitals. That’s what everybody keeps saying, but I don't necessarily believe that because there’s still a problem with transportation. And also, the community health centers, I feel like they would do better because—I had this discussion with somebody else too—Dr. Bright, who is the head of the Office of Special Programs, who is also the president of the National Medical Association, and he’s the director for the MED program, the Medical Education Development program—and he told me the same thing. He was like, “Why do you want to work for a community health center? The Affordable Care Act’s gonna ruin them.” And I said, “Well, don’t they usually see uninsured and underinsured patients? And won’t they now see more insured patients and have more money for themselves?” But he was like, “Why would you go to a community health center when you can go to a hospital?” So I guess we’re gonna have to see where the chips fall with that one. As far as what to do about undocumented immigrants, I can’t tell you (shaking head). People won’t talk about it—they won’t talk about it. Our higher ups won’t talk about it—they refuse to talk about it, so. Yea, it’s interesting that you brought that up ‘cause I’ve been thinking about the Affordable Care Act and it’s effect on community health centers for a while.
RP: Do you know if—so you said a little bit earlier that North Carolina is a little bit different because they’re not accepting that federal care—what would it be like if they did accept?
PR: Well, see, okay. I guess you want to tease out the reasons why they’re not accepting it. So there’s a couple other states that weren’t accepting either. Ohio was one of them that didn’t initially accept it, but they ended up—the lady ended up—the governor… I don’t know her name. I should know her name ‘cause she’s awesome. She’s actually a republican—I’m not necessarily republican, but she went around her legislature to get Medicaid accepted for her people so that she should get more people health insurance. But other states like, I think Texas is one of them, North Carolina is one of them—there’s a bunch of states that haven’t accepted the Medicaid boost. It’s because the federal government offered to pay 100% of the Medicaid boost, and eventually, they would back off to 90%. But what it did—it takes control away from the state to control how much Medicaid that they use so that they’re—and they’re also afraid that maybe the federal government will back down on their promise through changes in legislature and not pay 90% and they’ll be stuck paying that whole bill now. So it gives them less control over their finances—gives the federal government more power than their legislatures and policy-making ideas, which states don’t necessarily abide by. States want to have, maintain their control. A lot of—the word I’m looking for I can’t find right now…it’s been a couple times that I’ve looked for it but, it’s the staunch opposition to federal imposition of rules on state regulation. It’s—that’s a big, bit thing. They also don’t want the federal government running insurance. That’s another thing. That’s why a lot of doctors are opposed to the Affordable Care Act as well, ‘cause they don’t want insurance—I mean they already think medical companies meddle too much in the finances of a physician. They don't want the physician to be affected at all with the relationship on the patient with money; they don’t want that to happen at all. And slowly but surely, it’s becoming a problem. I mean, I think it might have been inevitable, especially with the rising cost of health care. To be financially sustainable, to be sustainable—that’s just the world we live in.
RP: Yea, sounds good. Do you think that the public perception of Latinos plays a role—plays a significant role in the way that politicians make policies? Like do you think that, you know, if people were way more accepting, especially in North Carolina, if people were more accepting of Latino populations and understood, rather than making harsh judgment. Do you think that policies would actually change if that happened, or…?
PR: Well I don't—what do you mean by—how are they currently holding them down?
RP: I don’t know, I feel like…
PR: Just by not caring about them?
RP: Yea.
PR: Not paying attention because it’s not in their face? (Sigh). It’s kind of like those commercials you see on TV where it’s like, “A quarter a day can feed this child.” So you—you can make people care but they can just change the channel because they’re so distanced from it. So you’re talking about bringing the problems of the Latino community to the forefront of peoples’ attention and how can you focus on them so that when certain legislation comes through, they could be behind it or against it? I would like to say yes, that that would have an affect. But I think people, if they were forced to give up something for somebody else, that they would start to become really selfish and you’d see that—that innate desire I was talking about to care about the people closest to you. There’s a lot of people, especially around Chapel Hill and Carrboro area that would be willing to give up, but it’s a lot more liberal of a town. If you go to some of the more rural areas where people are actually competing with jobs of immigrants, they totally would be against helping the Latino population. It's the natural, natural struggle, I mean. The thing often times if fuel by political lines and ignorance in the media, like pulling strings on people.
RP: Yea, definitely. Okay, so we talked about—a little bit about this earlier, but so I know that there are a lot of health education programs out there. Do you think that that—the way—or I guess the ratio of health education to actual medicine access for folks, like maybe migrant farm workers, things like that—do you think that the ratio is okay? Because I know that there is a lot of health education, but does that—I guess, does that make up for the lack of access or…?
PR: No, I wouldn’t say it makes up for the lack of access ‘cause I think with access comes education. Because a good physician will education will educate the patient. So I think access is key, but education will—so there’s education in many senses. There’s education on how to take care of yourself. There’s also education on problems that plague your area, or why these problems plague your area and where they come from—maybe it’s that dirty sewage plant upstream that’s polluting your water that’s causing an increase of this problem in the population. There’s all kinds of different sorts of education and ultimately, I think the more educated someone is, the better their health is going to be, up to a point. Some people just don’t care—they’d rather just eat the food they want to eat or smoke some the cigarettes they want to smoke. But as far as a balance, like which one’s more important, you mean?
RP: I mean, I guess so, yea.
PR: So which one’s more important? I would say access. No, I’m not sure. They go hand in hand. I want to say access because it kind of includes education, but without the education you don’t really know when to get to the hospital or not, you know, or what the best methods are for going through the hospital. But I guess you could learn that through trial and error, so access I still would say is more important. As far as feasibility in the current climate, education is probably the most effective, especially for undocumented people—education is probably the most—like education on how to take care of yourself, how to take care of your family, where the free clinics are, what kind of support are you gonna get from your local government, you know, ways to go around the access issue.
RP: Okay, cool. What—what are some things that regular people like me, what are something that we can do to help, I guess, increase access and things like that?
PR: First, I don't think you’re a regular person because you’re at UNC- Chapel Hill.
RP: Oh yea (laughter), okay.
PR: You had to have gone through quite the filter process to get to where you are now. So how could you increase access to health? By doing what you’re doing. I mean, everybody’s kind of got a place. Right now, you’re kind of uncovering the—the reasons, based highly on opinion especially with me, for disparities, health disparities. Really educating people, like you said, do you think that if people were educated, that they would be more likely to give back—I don’t think everybody would, but I think there are some people who are eventually gonna help unite more people on the same cause, social justice. As far as concrete things that you can do, get a health degree of some sort, give back via your profession, you know. Show people in your career, this is that I’m doing, you know, I have time, I can sacrifice a half of a day to go—once a month to give care to these people or educate people, so yea.
RP: So I’m jumping back a little bit, but do you think the quality of treatment in clinics like we were talking about earlier, like free clinics, things like that—do you think it’s the same as the other health care systems? Like the quality of a hospital versus a health clinic?
PR: Well they don’t have to them, so I think that what they do provide, the quality is probably pretty good, pretty comparable. But as far as the things that they provide, there’s no comparison.
RP: So what would happen—do you know what would happen if a patient came to a health clinic and then the health clinic was able to help—I guess they had a sliding scale system or something so they could pay based on their income, but then what the patient had was a little bit more serious and they didn’t have the means to treat it, do you think—do you know what would happen in a situation like that? Would they go to a hospital and have to find a way to pay or…?
PR: I’m not—I don’t know.
RP: Okay. Sorry, that was a really broad question.
PR: No, that’s okay, that’s a good question. I wish I knew the answer to that. I—I don’t know. I don't know if they would send them to the ER (emergency room) and try to get them charity care, I’m not sure. Not sure.
RP: Okay, and then—we talked about this a little bit before but could you maybe expand on what you said about how the quality of health care given to certain populations may be different—not necessarily based on—like just based on perceptions, of the power dynamics between the doctor and the patient, things like that? You said sometimes, you know, there’s that desire to give back to your own community, so do you think that since there isn’t such a high representation of Latino folks in health care professions, do you think that—
PR: —it affects how much people give back to the Latino population?
RP: How much and I guess just the quality of regular health care in general.
PR: Well there’s a big—yea, I know what you’re saying. There’s a big push for cultural competency, which I think is a nebulas term—I think it’s kind of a fiction. I don’t think its possible to be culturally competent. I think you can be from a culture and understand the culture, but you don’t know how—you can’t just read a book or take a class and learn how to be culturally competent. So, that fallacy right there is something that needs to be addressed and the real way to become culturally competent is by having the same cultures represented in the same percentage in the—in the providing service, the service that’s providing care. So that was a really, really difficult way to say that—I didn’t really word this before I thought about it, but the health care industry, or doctors are five percent Latino, right? And the population is sixteen percent. You can try to make another eleven percent of the doctors culturally competent or everybody culturally competent, which I think is kind of a fallacy, right? Or you can get eleven percent more Latinos to represent. So now the field is culturally competent, you know what I mean?
RP: That makes sense.
PR: But I mean, I think that the practicality of assigning Latinos to Latino doctors is kind of not there, but I also think that they will be able to help spread the culturally competed aspect of the medical field to their colleagues. People will see them, respect them, and see that they’re smart—they’re not just, they’re not just migrant workers, you know?
RP: Yea. Maybe the media will in turn also take that into consideration and not portray all minorities as like gangsters.
PR: Yea.
RP: Okay. Well that’s all the questions that I have. Do you have anything that you would like to share or anything I may have missed out on? Or any questions?
PR: No, I think you did a really good job of asking questions. I hope I did a reasonably good job at answering your questions—I get a little tongue-tied sometimes.
RP: Oh, thank you. No, you did fantastic! Okay well thank you.
PR: You’re welcome.
