The Hispanic population in Nebraska, currently at 12-13% across the state, is set to represent more than 20% of the population by 2040, making it the largest minority population in Nebraska. And while many health centers throughout the state have access to live or phone interpreters to serve this population, the need for health care professionals who can speak Spanish remains high.
While UNMC continues to attempt to recruit a cadre of Hispanic health care providers to address this need, it also is working to provide opportunities for training to increase the ability to understand and speak Spanish.
For more than 20 years, the Office of Global Engagement (OGE) has offered a robust intensive Spanish language elective to fourth-year medical students. Under the guidance of Sara Pirtle and in partnership with language centers, one-on-one instruction in Spanish-speaking countries was made available — first in 2000-2007 in Guatemala, then from 2009-2018 in Nicaragua.
Although she said a four-week immersion Spanish program does not make a student fluent, Pirtle noted that many of the former students who have gone through the OGE’s program have gone on to explore further learning opportunities on their own.
Most recently, thanks to the help of Armando De Alba, MD, assistant dean of DEI student programs, a new partnership with the University of Anáhuac, in Xalapa in the state of Veracruz, Mexico began in 2019.
The program has always offered one-on-one instruction for three weeks, six hours a day, five days a week — a total of 90 hours classroom time, supplemented by two lectures per week on health care-related topics related topics, followed by a one-week in-country volunteer experience.
"The nature of the experience depends on the student’s level of clinical experience and the level of Spanish," Pirtle said.
"The combination of three weeks of very intensive Spanish instruction, followed by a week of a more practical application was a winning combination, enhanced by the home stay with a local family and two week-end field trips," Pirtle said. The course has traditionally been popular — averaging about 11 students per course.
When COVID-19 restrictions made the travel aspect of the course impossible, Pirtle grappled with a way to enhance the value of the new version of the course, which still featured one-on-one language instruction (now virtual) but lacked the in-country immersive experience.
Enter Shirley Delair, MD, and the UNMC College of Medicine’s Office of Diversity, Equity and Inclusion (ODEI).
As the course moved to a four-week virtual class, "Dr. Delair designed a unique social determinant of health-related fourth week," Pirtle said.
Dr. Delair, recognizing the need for more Spanish instruction as a valuable tool to address health barriers and disparities in the Spanish-speaking population, had long wanted to offer an option for students who could not afford to travel or had other obligations that precluded them from traveling outside of Omaha.
"Prior to the pandemic, it had been difficult to find local instructors with the flexibility to provide quality individualized immersive Spanish in Omaha. COVID-19 changed that, and we were able to leverage our partnership with the University of Veracruz to provide a university level, tailored immersion Spanish experience for our students," Dr. Delair said.
"The ability to speak Spanish is important as providers explore avenues for reducing health disparities among the Latinx population," she said. "But cultural and social context also are important."
Collaborating with Melanie Menning, MD, Dr. Delair shifted the program to allow medical students to virtually attend social work visits and telehealth visits with OneWorld’s Spanish-speaking clients, allowing the students an eye-opening glimpse at the dynamics and needs of the families being served. (Dr. Menning is an assistant professor of family medicine at UNMC and assistant medical director of the Family Medicine Residency Clinic at OneWorld Community Health Centers. She served as the co-director for the spring course.)
The students also held reading group discussions featuring articles on health disparities and attended lectures discussing social determinants of health and care of Hispanic and migrant populations.
Pirtle credited Dr. Delair and Rocío Ríos Rojas, the immersion program lead at the University of Anáhuac, for their innovative and cooperative collaboration.
"Undoubtedly, in terms of intensive language immersion, the gold standard would include travel to a Spanish-speaking country," Dr. Delair said. "But when grappling with the effects of the COVID-19 pandemic, and still committing to provide a valuable intensive Spanish elective experience, OGE and ODEI combined to create something that has value of its own and will continue on as an in Omaha alternative for students."
Pirtle said the program is exploring opening up the immersive Spanish elective to the wider student body, although she cautioned that the time commitment and one-on-one instruction means that there would be logistical challenges to overcome — not just at UNMC, but at the University of Anáhuac, as well.
Dr. Delair and Pirtle hope to explore other Spanish-language education and immersion opportunities for UNMC medical students and other UNMC students.
"Our goal is to help our students improve their communication with the underserved Latinx community.," Pirtle said. "As this innovative program shows, there are various avenues to explore in pursuit of this goal."