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New Law Takes a Step Toward Culturally Competent Health Care

City Heights refugees have spoken out in recent years about the need for better interpretation at doctors offices. They haven’t gotten it yet, but a new law written by a City Heights woman could push lawmakers over to their side.

Gov. Jerry Brown has signed a bill co-written by a City Heights woman that will help the state identify diversity gaps in the health care workforce.

Nearly a quarter of those who gained health coverage under the Affordable Care Act’s Medi-Cal expansion do not speak English as their primary language. Womens Policy Institute fellow Ramla Sahid co-wrote the bill and said it will help the state serve a diversifying patient population under the Affordable Care Act.

“Patients are more likely to seek care if providers understand the cultural and linguistic needs of the communities they serve,” said Sahid. “So it will help us in understanding what the needs are. For example, are we seeing in San Diego that we don’t have any Somali speakers or that we don’t have enough Latino nurses?”

The law requires the state boards for nurses, physicians assistants and other health care providers to report to the legislature the ethnicity, language and other demographics of their workforce. The data could guide lawmakers and schools in directing resources to diverse communities for training in health care fields, resulting in nurses and assistants who speak multiple languages and understand cultural needs.

In San Diego, East African and Asian refugees have spoken out in recent years about medical mishaps and wrong diagnoses due to poor language access and culturally incompetent care at local hospitals and doctors offices. One described a giving birth in a San Diego delivery room without an interpreter:

“They were asking me, ‘What’s wrong? What’s wrong with you? The baby isn’t coming out because everything is sewed,’” Nor said.

Like a lot of East African women who came to the United States in the 1990s, Nor was circumcised. The cultural practice removes parts of the genitals. Stitches and scar tissue narrow the birth canal. For a circumcised woman to give birth vaginally, the doctor would have to make incisions to re-establish the birth canal.

Nor’s doctor had never seen a circumcised female patient.

Nor didn’t speak English at the time, so she said she tried to describe the procedure she needed by pantomiming through the pain and chaos of labor. It didn’t work. The baby came before the cuts were made, causing Nor a lot of pain and, eventually, permanent numbness.

Sahro Nor and other women on the City Heights-based United Women’s East African Support Team have been working with a statewide coalition to pass another bill, AB 2325, that would create a medical interpreters registry and reimburse interpreter services through Medi-Cal. The current iteration of the bill is on the governor’s desk, but he’s vetoed it twice before.

Sahid said her bill, which was sponsored by the California Pan-Ethnic Health Network and the Latino Coalition for a Healthy California, could help make the case for passing the interpreter bill in the future if the governor denies it again.

“We don’t have good information, we don’t have good data. So part of this is collecting evidence and making sure we understand what the picture looks like,” Sahid said. “Hopefully it sets a precedent where that bill can pass one day, or universities change their recruiting practices in communities, or new pipelines develop where we’re strengthening the workforce.”

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