Claudia Rojas

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Claudia Rojas is the program director for the Center for Latin American Health, or CELAH, at the University of North Carolina. In her position Claudia coordinates the many operations of CELAH. Her team goes to specific clinics to help Spanish-speaking clients navigate the healthcare system. This may include following up to make sure that clients are satisfied with their care and verifying that they know where to locate pharmacies and that their overall needs are being met. The main issue discussed involved the overall lack of preventative healthcare measures due to uninsured patients not being aware of the charity care provisions and free clinics that are available. Rojas is originally from Colombia and has lived in the United States for sixteen years.



[ 00:0:00] Claudia and Adriann are discussing dance styles, such as Merengue and Salsa. Claudia tells how she grew up dancing Merengue because it is more popular close to the Venezuelan border, where she is from.

[00:01:54] Claudia tells us that she is from Cúcuta, Colombia. She tells us that she came here 16 years ago with her husband and two kids because her husband, who is a physician, desired better job opportunities here in the United States due to the state of health care in Colombia. She has been working with CELAH, the Center for Latino Health for eight years, since its inception in 2008. She has been working at UNC for 12 years, however.

[00: 3:10] AB: So what do you do with CELAH?

[00:3:14] CR: I am the program director and we started from scratch. So Dr. Douglas Morgan, who is the founder of this program, he got a grant that he was fighting for since three years before. He finally got the grant, he gave me the good news, and he invited me to be the program director. So he gave me the grant, and I started reading the grant and I started everything from scratch. And we hired a nurse practitioner and we hired an administrative assistant, the person who sits in the front desk and she is in charge of check ins, check out’s. So, we started the three of us, a few clinics with GI, because Dr. Morgan was a GI doctor. And internal medicine, because two of them Dr. Marco Alemán and Dr. Roland1 330, they participated in the grant with Dr. Morgan. So we started with two clinics. And then we started introducing more, and more and more. And right now we have only nine, but we are doing so much for those specific patients. And we are not just serving in the clinics with specific bilingual providers and their Latino patients. We are doing patient education with every single one. We are doing patient navigation. So if the patient needs to go to the lab, to radiology, to the financial counselor, or if they nee to go the pharmacy, we walk the patient to that specific place, if they do not know where it is located. SO, the beauty of this program is the experience of these patients from door-to-door is in Spanish. I’m having between 20and 30 undergrads, bilingual ones, every semester. So they help me a lot with patient navigation, so they walk everywhere. And because we became a formal program at UNC health care three years later, we introduced formal rotations for med students, fourth year med students. So the program is growing, it is strong enough. It is not a baby anymore. And we have pharmacy students and nursing students and nurse practitioner students. And we have social workers. From UNC, the social work school, we cannot get a student because we do not have our own social worker. That is the problem…that is the only way to get a UNC social work student. We are travelling between different buildings. ACC for example, is a place we see our patients from internal medicine. So we go there every Monday and Friday we are there, seeing specific providers, Latino patients. On Tuesdays, we are in surgery, oncology and mammogram. On another Tuesday, we are in nephrology in the cancer hospital. On Wednesdays we are off campus most of the times. We are in Carolina point, on NC-54, working with rheumatology, OB-GYN, and geriatrics. On Thursdays we are in the office on admin days. Every single patient we see and everything we run, we go to Excel and we are doing data. We are collecting data since 2008, to see when they came, why they came and what kind of medication they prescribed, the referrals…if they needed to be referred to another clinic. They contact us for anything: to cancel, to reschedule, to know about medication side affects, to leave a message for a doctor or another doctor that we have referred to. So, the snowball is growing. It is a train that is never going to stop. But we are committed. We have proven that the three of us are still not struggling with the amount of patients. We are working hard everyday.

[00:9:08] AB: As director, could you tell me about why there’s a need for CELAH in the community, to provide access to primary care practitioners?

[00:9:23] CR: since 2011. No first, we got the grant through the School of Medicine in 2008 and from the Investment for the Future, that’s the name of the grant. So they saw, they identified the need. That’s the reason Dr. Morgan got this huge grant. So in 2011, we got approved from UNC Health Care system for us to become a formal program. So, the need is there since the Hispanic or Latino community is growing. The difference between CELAH and interpreters is because interpreters are not doing the work that we’re doing before and after the encounter with the patient. The beauty of this program is not only the experience of the Latino patients from door to door is in Spanish. The beauty of this program is that we become the primary contact. So, there is always a need for a Latino voice, a Spanish voice, on the other line.

[00:10:45] AB: And how far do patients come from your patients come for your services?

[00:11:00] From everywhere. From Wilmington, from Siler City… when they realize we are giving this good service. We have situations like this…”my husband is a PHS patient from Siler City, but when I was in need to find a doctor, and I saw that his doctor was not really committed and didn’t answer my phone calls… I realized my friend’s doctor is better from UNC, from CELAH. She’s never complained. She is happy.” So, it is a mouth spreading. They realize it is better with us, no matter if they have to travel. Some come from outer banks, they have to take a boat first.

[00:12:12] CR: At the end of the day it is worth it because they appreciate you. They kiss us, or they hug us because they are happy with us. It is a way to show appreciation. So that’s worth it.

[00:12:30] AB: In what capacity does CELAH provide services to women who are pregnant?

[00:12:40] CR: when Dr. Morgan wrote the grant it was only to serve adult volunteers and patients and non-pregnant. But until a month ago we were running an OB GYN clinic for eight years in a row. But now they moved to Hillsborough and we are not going to follow them. And we made that decision because it’s not really convenient for CELAH to travel. But for prenatal, I have a little bit of experience with that through the Women’s Hospital, the patient education room that is on the ground floor. To admitting and registration. They offer at several low classes, classes at low, low costs, maybe $5, or support classes for pregnant woman. And they give tours of the hospital, if they decide to give birth here and they have so many beautiful classes for prenatals. So if I found out a patient is pregnant, I really advice for them to go there.

[00:14:33] AB: do you have to have insurance for those classes?

[00:14:33] CR: No you do not need to have insurance. Even to have the baby. I heard that it is almost 50% are born here Latinos. It just shows the population is growing. It’s not a secret.

[00:15:11] AB: in your experience what prenatal care is available to immigrant women in this area that don’t have health insurance.

[00:15:20] CR: The only one I know is UNC because we are e a state hospital, we don’t reject anyone. We don’t ask, “So what is your immigration status?”. We just serve them. We go through ER and they have the Medicare thing, so they cover their expenses and the baby for the first 3 months. The services here are incredible for pregnant women. But, I really doubt that in the private hospital s they are doing this. Because UNC has the way to…

[00:16:20] AB: Do you all offer any family planning services in the OB-GY clinic?

[00:16:28] Claudia describes that they always offer it in the Hillsborough OB GYN clinic: “if the income is so low, or they have a big family…that’s part of the responsibility”.

[00:17:05] AB: How often do women without health insurance come to the OB GYN clinic?

[00:17:13] CR: I can tell that more than 50% are Latinas. We know. They are having a huge problem now; in the sense that Hillsborough is not taking charity care patients. In most of these patients have charity care. I don’t know what it going to happen. I already talked to the Hillsborough director and some financial counselors here to let them know what is happening. Probably was miscommunication. I really doubt that this will continue, because if UNC gives you charity care you can use that charity care in any UNC, Hillsborough, Raleigh or Chapel Hill. So you can go anywhere and get the services that you request. There are some tings that have to be fixed still in Hillsborough, in the hospital that they just built. I encourage patient to call Patients Relations. I encourage patients when they see unfair situations to go to Patient Relations, they speaks Spanish. So that is my obligation, my responsibility. To let them know where they have to go, where they have to talk. Their rights. Even if you don’t have insurance you have patient rights. So you have to call this person at this number

[0019:11] AB: in your professional experience have you ever encountered patients who have had bad experience with the healthcare system?

[00:19:19] CR: yea but not at UNC. Maybe a couple things, minor things. But in another areas. They complain because of lack of commitment of doctors. “This doctor has been treating me since a year ago and I don’t see any improvement, I don’t see that something is changing.” They don’t want to authorize a surgery that I need. This kind of complaint. With UNC just minor things, more with the front desk personnel than doctors, especially ones that don’t speak Spanish. They are not friendly with Latinos because maybe they don’t have insurance or they didn’t apply to charity care so they get mad with these patients because they are not straight in the system. That kind of complaints.

[00:20:44] AB: I seen it provides interpreting. In your experience how do language barriers impact care for pregnant women or just immigrants in general?

[00:20:54] CR: I really don’t provide interpreter services becausee we are bilingual so there is no sense in providing an interpreter. Because we speak Spanish they assume that we are interpreters, but we have to let the system know that we are not interpreters. For example, they want me to read the papers to the patients, to sign some release and some kind of things. So I have to let them know, I am not certified; I am not allowed to, so I cannot do this, you have to call an interpreter. So I can help you with the triage, with what’s going on with the changes in the breasts. But we don’t discuss anything going on with the procedure.

[00:22:19] AB: in your experience do pregnant women there on my face worse birth experiences, who don’t have charity care, or who aren’t going to UNC…?

[00:22:51] CR: I think it’s our problem with that the Latino community is having about… they don’t know what is prevention. They wait until they are having symptoms and they feel terrible and they use the ER. That is a big deal for the health system, for UNC or for Duke. They are using the ER as a place for some pain they are having 6 months ago. So I go to different health fairs to promote prevention. So when you feel like you are super healthy person to still go to a primary care physician. That’s my goal. To let them know how important is prevention. How much money we are saving to the system. We explain through education when is the good time to go to the ER (2430).

[00:24:31] AB: wouldn’t it be hard to go to a primary care physician if you don’t have health insurance?

[00:25:01] CR: I tell them you don’t have to go to UNC. You can go to a health department. I promote health departments. I promote some things my doctors have found that are just $10. I share with them those telephone numbers. The most important part is that at the end. The ER is so expensive…

Claudia tells about her own experiences with her family and the cost of the ER.

[00:27:35] AB: for someone who work in your field, why do you think the policymakers and lawmakers have ignored the healthcare needs of pregnant women and people who just don’t have health insurance

[00:27:56] CR : lawmakers had to be more close to the public; they have to be more friendly they have to work United. Because everything you do with the Latinos and not just Latinos but any minority can be a huge public health problem and the lawmakers he probably didn’t think about that. They have to have a person or work pretty close with that because they have to be more proactive, to integrate different people on the team who have different points of views, so they can really find…

[00:29:38] Claudia describes how she doesn't really have a lawyer on her team but occasionally lawyers to approach her asking if any of her patients need a lawyer she also has a Spanish speaking Korean friend who is a lawyer and advocate for the Latino community.

[00:30:30] AB: maybe in 10 years SELA can have a lot team who can go to Raleigh to push for more healthcare coverage for everyone.

{00:30:38] CR: that is the hope. The youth and community may only have a little bit but they willing to pay… it depends on what kind of services they’re having. And they are willing! Sometimes they say oh I want to send you the bill in the mail and I say no she’s willing to pay, will you please receive her payment. Sometimes you just see laziness with people collecting money but I want to show to the system that Latinos I want to pay whatever. For example, most Latinos don’t ask for charity care. Some Latinos there income is not too high not to low, but they always ask for monthly payments for some help. But that is the beauty of my Latinos; they don’t want to be homeless. We cannot destroy that willingness. My experience is that we are not going to be committed to the treatment if it is free. We cannot destroy that.

[00:33:12] AB: how do you think that people who are not in the Latino community react to about the kind of things that CELAH does in the community? Or about the shift of polices about health care coverage in North Carolina?

[00:33:53] CR: they are concerned about the changes. Especially last year when talked about the ACA 3400 . It was a lot of drama last year, plus we got a new system here at UNC. So 2014 was a drama year. There were some concerns about that, “what is going to happen with me? “What is going to happen with my charity care?” There were a lot of concerns. But the good thing is a lot of our financial counselors; they are ACA certified, so we, CELAH had to find interviews with financial counselors to talk about Obamacare or the ACA. So they were relaxed about it. This year, it is not the topic. Nobody is mentioning the ACA. So it was last yar, the big concern. Now everyone is relaxed, just waiting. Several people qualified for the ACA

[00:35:11] AB: I did the a little research and DACA grantees are not granted coverage under the ACA. With being in kind of limbo about their status, how do you think that affects their health care?

[00:35:35} CR: I don’t think so, there’s is always money to help those that don’t classify. But like a colander… but then there are other ones who don’t qualify who can still get charity care. I don’t see a bad future for the ones that don’t qualify

[00:36:10] AB: and going back to CELAH’s average week, what is an average day like a non-administrative day?

[00:36:37] CR: it depends on the clinic. Internal medicine is in high demand. I love our role in internal medicine because it is the main door in UN health care. It is really committed. It has over 150 providers. It has same day, like a mini ER that needs to be seen the next day because they are not feeling well that day and the doctor is not in. The have the anti-coagulation team, the diabetes team. They have the retina camera, a special exam for patients with diabetes. They have so many good teams in there. So they have the patient tam, so our role when we are in internal medicine is pretty, is sort of hard, but good hard. But, good hard in the sense that we have to do a lot of stuff for the patients. As soon as we start the clinic, we have to do check-in and my staff, we are walking patients in to who they have to see and they have to go the nurse, to do the nurse triage. And I am sort of coordinating the efforts at the same time. If someone is not there that specific day, then I fill in the gaps. Sometimes doctors will ask me to help the patients, like for example, how to collect the stool, FOBT. “Claudia could you do this? Could you read this? Could you make sure the patient reads this exercise?” Whatever is necessary we are doing. In between that we are doing check-in and check-outs at the same time and scheduling the following appointment in cardiology or whatever they need to do.. Undergrads are walking the patients to the lab and they need someone to walk them to the pharmacy, sort of like interpreter. We are like a butterfly, doing whatever the patients ask. It’s a pretty fast paced especially in some specific clinics…it depends, I try to keep myself moving. I see and identify what the needs are. So, whatever they need in the clinic we are willing to do it. It is not like “I am the clinic manager, the program director, so I don’t do it.” I am so hand on. I can’t imagine myself being hands-off, because it is the three of us. So if I am hands-off, then my nurse practitioner can be the best, my AA2 can be the best person in the front desk. But excuse me we have to be more into the pace, so if they need something specific…[For example] “Do you need research into Latinas?...I can talk to my patients.” I can explain how important it Is to walk.” Like with camino con gusto3 like 285 patients last summer. Between the Mexican consulate, the clinics and my church, St. Thomas Moore4, we are encouraging people to participate. So whatever the doctor needs and the system needs, we participate. We are willing to help. That is the beauty of CCEAH. We are proactive in the community and at UNC hospital. Because eight years pass like eight months.

[00:41:43] AB: I know its busy. What make it all worth it? What are some momentos lindo que tu tienes5?

[00:41:50} AB: I guess the hugs and this kisses that we get from the patients an the big hello and big goodbyes. And the look in their eyes that they trust us, that is the worth it thing. They trust and they listen. They listen… they appreciate what we are doing to help them to understand to do by themselves. Like calls to the pharmacy; “but I don’t speak English” “I know, but let me put my cell phone in the speaker and I will teach you how”. With this medication, this is the Rx number, this is the doctor, this means that you have to refill after one, and so lets do that” so then I am writing down the prompts, so they can try next month. So when they come back to the appointment they are so happy because “I did it for myself and I did it for my husband as well!”. That’s the worth it part, they are like little kids If you teach them the right way, then you are going to see later on the results. That’s worth it. That’s like the best feeling ever. Yea.

[00:43:25] AB: and what do you wish that health professionals knew about the Latino community in the area, providing services or things like that?

[00:43:40] CR: so let me start from the beginning. My UNC undergrad volunteers wish I to be strong in Spanish. They are the future of doctors, nurses and pharmacist, All of them, in the last 8 years, my undergrads, they are in the med school, pharmacy school or nursing school, or they have graduated. So they know already. We are educating the CELAH experience. They are seeing pretty close the Latino community. They understand more. I talk about this or that...” in the middle of the treatment if we are feeling better we can stop” “nothing is going to happen.” So, to talk about these Latino good or bad habits, how we think how we act and we see them in the Latino clinics, as a med student or nursing student. So that’s the beauty. So we are creating a new generation of health professionals with a good sense of how is the Latino community. So that is beautiful . And the providers we work with already have a good sense e of what is the Latino community. So they have mentors or researchers to their groups, in that sense, we are good.

[00:45:38] AB: You should be very proud!

[00:45:38] CR: We are very proud. And for example f we don’t work in the (), I kow already who in () speaks Spanish, so I can refer a patient to that specific doctor. So we identify in the system who speaks Spanish. “Who do you know who in your division who speaks Spanish? I have no idea.” Then months later he became my cardiologist. “How do you find out that Dr. Coleman, Mitch Coleman speaks Spanish?” …”I just was digging, digging, digging! So from now on, we are going to schedule our Latinos with him. So it is important to find out what languages our doctors speak, not just Spanish, but Arabic, French or whatever. We need this data because that saves money and time. And we don’t need an interpreter if the doctor speaks French. That’s something that we have to work a little bit more harder. We are proud to identify these kind of things, in order for the Latino community to ha e a great experience and good service, and that reflect in the patient satisfaction surveys. And that is something that we are trying to work on , because it is not in the culture to answer surveys. We don’t answer surveys. So…

[00:47:15] AB: and why is that so?

[00:47:17] CR: it is not apart of the culture. In Latin American countries, we don’t have these kind of things, asking “how do you feel in the hospital, how was your experience with the nurse”, we don’t do these kind of things.

[00:47:40] AB: But con pago6, with payment?

[00:47:45} CR: Not in Colombia. I really doubt in Mexico it is the same thing. The company doesn’t spend this kind of money just on paper. So I try to ask every single patient how was the experience, how was the doctor, how was the lady who did lab work with you, was she gentle with you? I got a pretty bad feedback like three years ago. She was so afraid to come back, because the doctor ordered more labs three months later. [She said] “I don’t want more labs”… [I say] “But it is good for you. You have changes because you are taking this medication. So he has to take your blood to find out”. [The patient said] “But I don’t want it, I don’t want”. And then, she starts crying, so we go in another room to find out what’s going in. She says “she grabs my arm like I am a criminal, she digs that needle with all her strength. She is mistreating me and I got a big bruise for a whole month.” [I say] “Why you never tell us? Now you have to grab that telephone and call patient relations right now.” [The patient says] “But I don’t want to cause any problems, I have charity care”. They are so scared that because they don’t have insurance, they charity care. And I tell them that right now you have to call patient relations or write a letter in Spanish, you need to report it right now. So that person, was I don’t know if they were fired or not. I don’t keep up with that. But it was so bad, I was so sad. But you cannot control it. Sometimes people are haters and you cannot control it. You cannot control employees. It’s hard sometimes to find feedback that is scary.

[00:50:08] AB: its good that’s the minority of the feedback.

[00:50:10] That why it so, so good to ask, so we can improve, so we can stop doing certain things. You care not the first person to say that. You know what Myra7, we care going o stop calling the patients 2-3 days in advance because they are cancelling their appointment in the machine because it is English. Because when they call, it takes too say long to say “in Spanish press …..”, so they hang on sometimes press something wrong and you see it in the system when they come in and it shows that you don’t have an appointment. They say” no, yes I do have an appointment”. [We say]: no you cancelled your appointment. [They say] “Oh yea in the machine I pushed the wrong buttons”. From now on we call the patients 2-3 days in advance. So anything that I find out, I correct it. This is something that we do. It is a train we cannot stop.

[00:51:25] AB: things are changing!

[ 00:51:27] CR: Some things are always the same. Persistence is the key for success, for any department. To be consistent. This week, we are going to call patients, this week we relax. No, no, we have to be consistent. We are handworkers, we don’t complain too much. We don’t have time to complain. We just keep going, keep going. And, when we have the hugs and kisses from the patients. When you see little kids, they are growing. [We ask]: “do you need help, do you want one of the volunteers to go with you to the lab?” [They say]: “ no, no I know where it is!”. So they are grown ups. They become independent. That’s the idea; don’t hold their hands for too long. To teach, to see that they do good, and teach the next one.

[00:52:59] Adriann thanks Claudia for her time.