By Rick Flinders, MD

Don Felipe was one of the campesinos I got to know best during the two years I lived in South America. He was short and dark-eyed and was one of the wisest farmers among the new homesteaders on the Paraguayan subtropical frontier. 

One day as we were riding horseback to visit his parents in his native village, I made the mistake of saying I was hungry. He corrected me, saying that what I had was appetite, and that hunger was a term reserved only for those occasions when one had gone for two or three days without food. He said I had never been hungry. 

When we arrived in his parents’ village, we learned that little rain had fallen that spring and that the mandioca crop, his people’s staple food, had failed. His parents hadn’t eaten in six days. That, Felipe reminded me, was hunger. He made me promise that I wouldn’t forget the meaning of hunger when I returned to my own country.

If so much can ride on the meaning of a single word, what are we missing in the daily exchange of language with our patients from Asia, Africa, Europe, Central America and South America? And even if we understand the language, what meaning do those words convey in the context of cultural differences that can splinter the meaning of such basic concepts as illness, health, life and death? We can barely agree on these terms inside our own medical and cultural paradigms.

In this issue of Sonoma Medicine, we explore the reality and needs of cross-cultural medicine from a variety of experiences and perspectives. We begin with Dr. Nikola Lozanov, who gives us a unique view of the struggles of training and practicing in a medical system far removed from his native Bulgaria. 

Dr. Carlos Garcia—who grew up in a California Latino community, trained in our residency program and practices at Kaiser—has never forgotten his roots. He has practiced and taught among the Latino population in Sonoma County for more than a decade. He describes the values and belief systems that shape the doctor-patient relationship among Latino patients, and he shares the insights provided by the Consulado Latino de Kaiser. 

Dr. Ian Hoffman, a recent graduate of the residency program, reports on a meeting of the Medical Leadership Council on Cultural Proficiency, a broad-based group that works to improve language access, cultural proficiency and workforce diversity.

Dr. John Mihalik recounts the intense experience of providing care during regular visits to a remote rural clinic in the Dominican Republic, started and maintained by the Somos Amigos medical mission. Two of our own Family Medicine residents (Drs. Alana Benjamin and Veronica Jordan) recently completed elective rotations at the mission. They returned invigorated by the experience and have exuberantly shared with the rest of us the life-long medical lessons they learned.

Finally, our editor, Steve Osborn, analyzes a recent SCMA physician survey on the prevalence of non-English speaking patients, which produced both predictable and surprising results.

The rapid shifting of demographic trends in Sonoma County has focused attention on the linguistic and cultural dimensions of our local health care system. According to the SCMA survey, at least 10% of our patients speak little or no English. In our small survey alone (65 responses, comprising about 10% of our membership), physicians reported encountering more than two dozen languages from all over the world in their local offices. 

How do we cope with these linguistic barriers and still provide care that is medically appropriate and culturally sensitive? A surprising number of the physicians surveyed (74%) speak at least some Spanish, far and away the most prevalent non-English language among their patients. (Another recent survey found that Spanish is the primary language for almost half the children in Sonoma County.) 

Obviously, we cannot be fluent communicators to all our non-English-speaking patients. But we can become aware of the tools and resources available locally, to help us better serve our patients in a culturally sensitive context. It’s not only good relations; it’s good medicine.

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Dr. Flinders, a clinical professor of family and community medicine at UCSF, chairs the SCMA Editorial Board.