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Turning Cultural Barriers into Bridges
Surgeon General, Symposium Kick Off Hispanic Heritage Month Salute

By Carla Garnett

Photos by Ernie Branson

On the Front Page...

NIDCR director Dr. Lawrence Tabak recalls that in his early days of treating patients in New York City, his rudimentary Spanish language skills sometimes weren't enough to get the message across to the Latinos he encountered in the Columbia University neighborhood. At such times, he would call on a colleague — who happened to be Chinese and spoke Spanish fluently — for help. As the U.S. population becomes increasingly diverse, Tabak said the medical community must do whatever it takes to serve everyone.

Continued...

That sentiment also could have served as the take-home message from "Salud! To Your Health!" — NIH's annual Hispanic Heritage Month observance.

"There's no question that a month like this is an opportunity for everyone to reflect on where we are as a society and where all the components of our society contribute," said NIH director Dr. Elias Zerhouni, in opening remarks. "We want — all of us in our multicultural, diverse society — to contribute to the maximum extent possible to all activities of the country. Research is no exception. Public service is no exception. Public health is no exception. The National Institutes of Health would like also to promote all minorities to positions where they can be effective and able to effect change."

Citing census information that identifies Hispanics as the fastest growing population in the U.S., Zerhouni said predictions indicate that one in four Americans will be of Hispanic descent by 2050.

"So, are we [at NIH] doing well?" he asked. "Is the Hispanic minority represented well? The data is not as good as the growth. [Hispanics] are the most severely underrepresented minority group in the federal government. Hispanics comprise only 6.7 percent of the total federal workforce, compared with 11.8 percent of the civilian workforce — a difference we need to address. They account for only 21/2 percent of Senior Executive Service employees. I'm really concerned about the Hispanic representation at NIH. Out of a total workforce of approximately 18,000, only 538 are Hispanic. So clearly we have work to do and I'm going to count on you to help me do it."

NIH director Dr. Elias Zerhouni is greeted with a warm smile by his friend U.S. Surgeon General Richard Carmona.

Zerhouni said improving diversity is important to him not only as the NIH director, but also as a direct beneficiary.

"I come from an institution that embraced diversity, embraced people from different walks of life," he explained. "I am an immigrant. I was embraced and given chances. This is our job. Our job is to give the opportunities. I would like you to help me identify the best and brightest Hispanic scientists, Hispanic administrators, the best leaders. Identify them and be our best agents. Sell NIH to them."

There is a limit to what brochures and programs can accomplish, Zerhouni said. "At the end of the day, it's the one-to-one relationships that make the difference. It's not the programs, it's not speeches by the director of NIH. It's who you know and how you can convey to them the outstanding nature of NIH, the incredible morale that we have here, the spirit of excellence and the spirit of being special."

Stressing the importance of the issue, Zerhouni told the audience of his determination to attend the program, despite a previous engagement. "I told Larry [Self, director of NIH's Office of Equal Opportunity and Diversity Management] that I need to be here, so that they will know that under my tenure, openness and opportunity will be the operating words."

In a heartfelt testament to the value of opportunity, Dr. Richard Carmona, newly appointed U.S. Surgeon General, offered an inspiring account of his journey to "an incredible career he never imagined having." (See sidebar, p. 10)

Institute directors Dr. Lawrence Tabak of NIDCR and Kenneth Olden of NIEHS offer remarks on celebrating Hispanic Heritage Month at NIH.

Themed "Language and Access to Care," the kickoff also featured remarks by two institute directors. NIDCR's Tabak discussed the need to eliminate gaps in health, particularly in oral health. Citing a 2000 Surgeon General's report, Tabak stressed one of the document's key messages: "Oral health is essential to the general health of all Americans and can be achieved. However, all Americans are not able to take that to heart."

He said data from the report show "profound and consequential oral health disparities in our population." For example, he continued, poor people — regardless of racial or ethnic background — have a higher percentage of untreated decay in their primary teeth.

Tabak said research can address the needs of the nation's changing demographics on several fronts: Increasing the research capacity by finding, training and empowering young Hispanic investigators to pursue careers in dentistry; accumulating more data on the widely heterogeneous Latino population; and stepping up health promotion and disease prevention efforts in affected communities.

NIH HEO president Dr. Marta Leon-Monzon, who emceed the program, gathers participants (from l) Tabak, Carmona and Zerhouni.

"The best way to predict the future is to invent it," Tabak concluded, quoting computer science visionary Alan Kay. "What I would ask each of you to do is to help us invent a far better future."

In his remarks, NIEHS director Dr. Kenneth Olden, too, sought help in moving from what has been to what will be. "Occasions such as Hispanic Heritage Month are important because they provide us an opportunity to recall and celebrate successes of the past," he acknowledged, "but these events also give us an opportunity to anticipate the future. I want to look forward."

Addressing what he called "the unfinished business of building a biomedical research and healthcare enterprise that is more representative of the diversity of our society," Olden said closing health gaps will require innovative ways to involve everyone in the country. "We as leaders have to step out of our comfort zones and try some new approaches."

As examples, Olden described a few of NIEHS's success stories, including community-based priority setting that uses town hall meetings to brainstorm with local citizens on ways to tackle difficult health issues, and ARCH (Advanced Research Cooperation in Environmental Health), which establishes partnerships between research-intensive universities and minority-serving institutions.

The program's three scientific presentations focused on "How to Handle Two Languages with One Brain: A Neuroscience Perspective" by Dr. Thomas Münte of Otto von Guericke University Magdeburg in Germany, "Language and Culture: Bridges or Barriers?" by Dr. Nilda Peragallo of the University of Maryland-Baltimore and "Pilot Hispanic Research Initiative in Mood Disorder Patients," by Dr. Carlos Zarate of NIMH.

The program offered three scientific presentations by Dr. Thomas Münte (l) of Otto von Guericke University Magdeburg in Germany, Dr. Nilda Peragallo of the University of Maryland-Baltimore and Dr. Carlos Zarate of NIMH.

According to recent data, about half the world's population is at least somewhat bilingual. In the U.S., approximately 32 people million speak a language other than English at home. Bilingualism includes two extremes — knowledge of some words, perfect command of primary and secondary languages — and everything in between. "Most of us are somewhere in between," Münte said. He described three types of bilingualism: dominant, in which a person is good at one language and "really miserable at the other"; additive, in which the person is proficient at both; and subtractive, in which a person isn't very good at either language.

His research uses temporal and spatial neuroimaging to examine how the brain stores multiple languages, whether and to what extent multiple languages interfere with each other in the brain during processing, and whether all bilinguals process languages the same way.

NIH's Hispanic Employee Organization recognized Dr. Robert Desimone (third from l), director of NIMH's Division of Intramural Research Program, and Dr. Susan Koester (second from l), associate director for science in that division, for successfully implementing a pilot Hispanic Research Initiative on mood disorders. Offering congratulations are (from l) Leon-Monzon, NIH deputy director Dr. Ruth Kirschstein, Tabak and NIEHS director Dr. Kenneth Olden.

Peragallo, in her first public appearance as president of the National Association of Hispanic Nurses, provided a snapshot of the multifaceted obstacles faced by patients as well as caregivers who do not speak the same language. She said the impact of these barriers must be addressed when developing a healthcare agenda that serves all of the nation's residents.

A native of Chile, Peragallo recalled living in Germany for 2 years as a nurse anesthetist. She said it took 6 months before she would attempt to speak German, but that she never had too much difficulty using gestures and other non-verbal signals to communicate with her patients.

"That was pretty easy because they were all going to sleep," she quipped. "All I had to say was, 'Schlafen sie gutes' [sleep well]. But my point is that there are ways and ways to communicate and language is only one of them."

Finally, Zarate described a successful Hispanic Research Initiative, which garnered kudos for its developers from the NIH Hispanic Employees Organization. Noting that the Hispanic patient population at the Clinical Center has grown steadily in each of the past 3 years, Zarate said, "There is an increased need for resources to be able to treat and evaluate these patients for research."

Zarate briefly addressed several valuable insights gained from developing the initiative: Race and ethnicity should not be overlooked in any psychiatric research; such demographics of potential subjects as education level and unemployment status must be considered; the language and cultural sensitivity of the study's staff is crucial; participants' adherence to the study may depend on any combination of these considerations.

Lastly, Zarate said conclusions regarding participation should encourage other investigators to plan studies in Latino populations.

"The Hispanic community is very receptive to and motivated for research as a whole," he concluded. "When asked why they agreed to take part, over and over we heard from patients: 'Because my participation will help other people.'"

A videocast of the program is archived at http://videocast.nih.gov/ram/hispanic091902.ram. A reception and exhibit followed the program in the Visitor Information Center.

NINR director Dr. Patricia Grady (c) and NINR deputy director Dr. Mary Leveck (l) chat with Peragallo, president of the National Association of Hispanic Nurses.

Recognized by the HEO, Desimone offers brief remarks about the pilot research initiative he and Koester established in his NIMH division.

NICHD deputy director Dr. Yvonne Maddox talks with IC directors Tabak (l) and Olden before the program begins.

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