Immigration, language barriers influence veterinary care

Clinics increase language skills, more Hispanic students enter veterinary colleges
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Dr. Del G. Miles works with feedyards in seven states, and most have workers who speak only Spanish.

The veterinarian from Greeley, Colo., does not speak Spanish, but he and the feedyard employees find ways to work together, whether by relying on someone who is bilingual or by drawing in the dirt.

The few feedyard employees who have some veterinary training are a tremendous asset, Dr. Miles said. Although not all speak English, they have some skills and understanding of what he and other veterinarians are trying to accomplish.

"It's easier to communicate with them and get them to execute the tasks we're trying to accomplish, because they understand some of the basics," Dr. Miles said. He thinks it is a missed opportunity not to encourage those workers to continue their education in the United States.

Dr. Miles said it appears some immigrant workers' children are expressing interest in veterinary medicine.

"The first generation that comes here—a lot of them insist that their kids get an education," Dr. Miles said. "And I think we'll see some very qualified individuals in time come out of that pool."

Lisa M. Greenhill, associate executive director for diversity for the Association of American Veterinary Medical Colleges, noted that the nation's Hispanic population is one of the fastest-growing in the country.

Figures from the U.S. Census Bureau from 2006 indicate more than 44 million people in the U.S. identify themselves as Hispanic, about 40 percent of them are foreign-born, and Hispanics accounted for half the nation's growth between 2000 and 2006. The nation's Hispanic population increased by nearly one quarter during that time, while the overall population grew by 6 percent.

Greenhill said it is unclear what impact immigration from Latin American countries has had on the U.S. veterinary profession.

Statistics from the AAVMC show that for the 28 U.S. veterinary colleges, 82 of the 2,485 veterinary students in the class of 2008—or 3.3 percent of the total—identified themselves as Hispanic. The number of students identifying themselves as Hispanic increased in each of the next three classes admitted. Students expected to graduate in 2011 include 106 who identify themselves as Hispanic. They represent 3.9 percent of veterinary students in that class.

"We know that (Hispanic-Americans) own pets," Greenhill said. "What we know about how they conceptualize pet ownership is a bit lacking."

She said some immigrants from Latin American countries may have limited contact with veterinarians because of economic issues, misperceptions regarding the value of veterinary services, or language barriers.

"Can you as a clinician really get informed consent if you're trying to explain something to an individual whose primary language is not English?" Greenhill asked. "Do they really understand, and if they do understand and if you give them a prescription, how do you ensure compliance?"

Adding bilingual or multilingual staff members helps, she said, and those staff members should ideally be native Spanish speakers who can translate and interpret.

"It will help people feel more comfortable bringing in their animal, and it will help them increase the value that these populations assign to that service," Greenhill said.

Madai Rivera, the coordinator of academic services and diversity in Kansas State University's College of Human Ecology and the university's admissions coordinator of Hispanic recruitment, spoke in September 2009 with a class full of veterinary students about communicating with Hispanic pet owners.

Students expressed concern over who is responsible when communication errors occur, particularly when a client's child is acting as a translator during a conversation about health problems in a family pet. While growing up, Rivera herself and her siblings helped translate for their parents when they needed to communicate with bank tellers and doctors.

Some of the students also indicated they did not know how to discourage use of home remedies without offending clients, Rivera said. She recommended that the students focus on client education but exercise care with their tone and the pace at which they talk, maintaining a balance that allows clients to understand without offending them with overly slow pronunciation.

Rivera also suggested avoiding assumptions about people's perceived value of veterinary care.

Dr. Karen L. Jacobsen, a veterinarian in Athens, Ga., said immigration has had a noticeable impact on the dairy industry. As part of her dairy consulting business, she teaches veterinarians, farm owners, and dairy employees how to communicate in English and Spanish, and she has authored a book and CD set titled "Easy Dairy Spanish."

"Certainly in bovine veterinary medicine there's been a lot of interest in veterinarians learning Spanish," Dr. Jacobsen said.

During her 22 years as a professor and a large animal clinician, Dr. Jacobsen was often asked to provide labor training and translation on farms. The demand led her to develop the classes and educational materials that are now used by veterinarians, dairy farmers, and farm employees.

One of Dr. Jacobsen's clients owns and milks 600 cows and speaks only English, but his herdsman speaks only a small amount of English. She works with the herdsman and serves as a liaison between him and the owner.

"Being able to talk to the people in the parlor and explain to them what you want done—I think there's a lot of interest among bovine veterinarians," Dr. Jacobsen said.

Greenhill is seeing veterinary students initiate programs to work with clients across cultures or institute language education for them.

Hispanic students surveyed in the past two years at career fairs hosted by the AAVMC have shown almost equal interest in small animal and production animal medicine, Greenhill said.

Data from the U.S. Census Bureau indicate about 1,300 of the 60,000 veterinarians who responded for the 2000 census identified themselves as Hispanic, and they represented about 2 percent of practitioners. About 5 percent of physicians and surgeons, 4 percent of dentists, and 3 percent of pharmacists identified themselves as Hispanic.

Since January 2000, just more than 200 veterinarians from 15 Latin American countries have become certified through the AVMA Educational Commission for Foreign Veterinary Graduates program to meet the educational prerequisite for licensure eligibility to work in the United States. Those countries are Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay, and Venezuela.

Overall, about 360 veterinarians from those countries have become certified through the ECFVG since the commission was formed in the early 1970s, including about 125 who graduated from veterinary colleges in Mexico. More than 4,400 veterinarians have become certified through the ECFVG in the past 40 years.

An increase in Hispanic veterinarians could increase trust and access among some populations and reduce potential disparities in care sought for their pets, Greenhill said. She suspects that increased diversity in veterinary medicine will improve the health of animals in minority and immigrant communities.