OU Medical Student Uses the Power of Language to Serve Tulsa’s Spanish-speaking Community

In 2001, Oklahoma occupied a low rung on the ladder of national health metrics. The financial fallout throughout the post-9/11 world was severe, and the city of Tulsa found itself ranked second among cities in the United States in unemployment due to lost jobs per capita. The consequent rise in numbers of uninsured residents spurred action and inspired an innovative partnership to create the Bedlam Clinic.

Sponsored by the OU-TU School of Community Medicine at OU-Tulsa, and supported by generous private donors in the community, Tulsa’s Bedlam Clinic keeps the vision and mission alive, still serving underserved and uninsured patients across the Tulsa metro today.

Auston Stiefer, medical student at OU-TU School of Community Medicine and an Albert Schweitzer Fellow, is grateful for the enhanced educational opportunities the clinic makes possible.

“As students, we have almost the same experience as first-year residents, learning to care for patients who have chronic and acute care needs,” Stiefer said.

He explained that third- and fourth-year medical students and students pursuing physician associate degrees at the School of Community Medicine regularly provide patient care. Their clinical activities are supervised by the same attending physicians and faculty members who oversee residents in family, internal and emergency medicine disciplines. It’s a level of exposure and experience not routinely offered by medical schools across the country.

As valuable as this additional layer of educational experience is, Stiefer’s passion for marginalized patients inspires his work today, and is a key driver as he considers his own future practice. With an undergraduate background in Spanish literature and public health, Stiefer had previous experience as a medical interpreter, and had completed accredited course work. It’s a skill he’s determined to sharpen as his residency begins, and he plans to sit for a national board exam before graduation.

He explained that students who work at Bedlam have their own panel of patients, seen weekly, as well as participation in the evening clinic. The patient population seeking care at the evening clinic has gradually evolved and is now largely made up of non-English-speaking patients, many of whom speak only Spanish.

Stiefer began his second year, going to Bedlam as he was able, to provide Spanish/English translation.

“Many patients went to the evening clinic for primary care services,” he said. “Then, the pandemic happened, and the acute care clinic was essentially shut down. That means a lot of people went 10 months without care.”

When the clinic reopened, Stiefer was just beginning his third-year rotations.

“My priority was to get back to Bedlam to work with patients, many I had met a year ago and had been seeing almost weekly. As third-year students, we would reinvest, going twice a week on Tuesday and Thursday nights,” he said.

Stiefer had applied for the Schweitzer Fellowship as a way to formalize the project he already had in mind for more than a year – what he described as “a glorified quality improvement project.” He knew the Schweitzer Fellowship would offer a better support network with national leadership and mentors with shared objectives.

His project, specifically aimed at boosting coronavirus education and vaccination among Spanish-speaking patients at the Bedlam Clinic, was ultimately selected.

While continuing their graduate studies, Schweitzer Fellows must design, implement, evaluate and plan for sustainable, community-based prevention and intervention projects that address social determinants of health. Chapters are strategically established in cities and regions with large academic centers, and with a history of profound and severe health disparity.

Tulsa is a more recently added chapter, selected for many of the same reasons that the School of Community Medicine developed a four-year curriculum, Stiefer said.

“In Tulsa, we see disparity between north and south Tulsa, with variable health outcomes based on where you live. It’s an interesting climate in which to learn and practice medicine,” he said.

“The local infrastructure – how we access info and make sense of the world around us – looks different from place to place. Tulsa was unique, given its recent history as the site of a United States Immigration and Customs Enforcement detention center, and it’s large, racially diverse, Spanish-speaking population,” Stiefer said. “Fascinatingly complex social issues impact the patients we see. What do you do about it if you don’t even speak the same language?”

Although services are available, they are unfortunately underutilized, Stiefer said, attributing this fact to the fears of a vulnerable population.

“As the pandemic arrived, we had the perfect storm of hesitation, political implications and historically marginalized populations enduring severe illness,” he said. “To give the project context, I have been a medical interpreter as our patients waited to be seen. I’ve come to know them, perhaps at a shallow level, but I talk and listen, assessing basic health literacy, to see what their needs are, how we can better serve them.”

Citing the literature and trends, Stiefer said only 30% of Spanish-only speakers were vaccinated for influenza in 2019.

“That was pre-COVID. Now it’s much more disparate. Moving into the pandemic, new restrictions added to the existing Public Charge Rule in 2020 had the effect of limiting services to certain immigrants,” Stiefer said. “In other words, what you were deemed to contribute to society during the immigration process might weigh on your ability to receive services.”

Stiefer uses two validated surveys in his health literacy assessment process. The first assesses basic, functional health literacy – a list of 18 most commonly used terms in a medical encounter. Essentially, it is a paired word-association technique to determine how well these terms are understood. The second survey seeks information about behaviors, related to health themes.

“I track our sources of information. I introduce questions and create a space in which they can express other questions or concerns,” he said.

In the midst of the pandemic, Stiefer faced a familiar challenge – keeping up with the research, seeking ways to make the information more accessible and digestible, and explaining what the Centers for Disease Control and Prevention and Federal Drug Administration are, and what they do.

“These organizations have created marginally understandable material, and I tried to follow up with patients on subsequent visits or over phone visits,” he said. “It’s a constant process of assessing and reassessing and providing information. These are part of our typical clinical interactions, in or out of Bedlam. But it can be more confusing when you add in the aspect of another language.”

Early in the project, Stiefer expected curiosity, but also resistance. He remembers a particular patient who was very willing to listen to everything he had to say about his passions, including vaccine technology.

“She just said, ‘If you think I should get the shot, I’m happy to do that. Whatever you recommend I will totally do.’ What was a little disturbing about that, is that no one had ever mentioned, suggested or recommended vaccination to her,” Stiefer said.

Stiefer made the point that Spanish isn’t just Spanish, but a language with regional variations and dialects. Patients may speak Mexican-Spanish, Venezuelan, Honduran, Cuban, Puerto Rican and others with Central American origins.

“Linguistically, they sound a little different, and asking more questions helps clarify language and cultural characteristics,” he said. “We have incredible patients who are kind and patient with our efforts.”

Stiefer said he’s deeply grateful for the support of two, very different yet very equal advisors/mentors. One is Janelle Whitt, D.O., medical director for Bedlam, who was also faculty physician for his panel of patients.

“She’s the go-to person who can make things happen very quickly at Bedlam,” he said. “It was really fun working with her closely for a year, pitching this idea and her saying ‘OK, let’s figure out a way to make it happen. I’ll absolutely support you throughout.’”

In addition, Stiefer described Brianna Reyes, APRN, FNP, as “the mastermind of linking patients to assistance programs that ensure they get their medications. She helps us learn the logistics of patient safety.”

Reyes also is fluent in Spanish and is well-acquainted with work among patients throughout the state who speak only Spanish.

“I’m relatively well-versed, but some things – cultural contexts – are less-easily learned. She’s been a tremendous mentor for me with this specific population I care about,” Stiefer said.

Stiefer said he’s learned much about the nature of trust in this community and gained a deep sense of appreciation as a result. He has a firm grasp on the power of language to establish common ground and build bridges, citing the words of Nelson Mandela: “If you talk to a man in a language he understands – that goes to his head. If you talk to him in his language – that goes to his heart.”

The Bedlam Evening Clinic provides acute and limited specialty care and is open 48 weeks of the year. School of Community Medicine students gain direct experience. The clinical experience develops not only strong patient care skills, but also deeper insight into barriers to access and challenges faced by the uninsured.

To learn more about the Bedlam Clinic, click here.

This article was originally published in OU Medicine Magazine.

Article Published:  Wednesday, May 18, 2022

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