People have been coming to America since they crossed the land bridge from northeastern Asia over 10,000 years ago.
This leads to something that public health experts—salubristas, in Spanish—bear in mind: We are a nation of immigrants.
Salubristas don’t just look at an individual organ they have to fix. They ask: What is happening across populations? The answers, which form the foundation of preventive care, can lead to surprising collaborations.
At the nexus of the salubrista and the biomedical is where Dr. Jorge Gomez finds his passion.
|NCI’s Dr. Jorge Gomez
“Elite cancer centers want to solve everything with a web site,” says Gomez, senior project officer for NCI’s Center for Global Health, where he directs the United States-Latin America Cancer Research Network in partnership with the Fogarty International Center. “We need to be more proactive in inviting the public to participate in clinical trials.”
He recalls his “Aha!” moment.
“Here I was at the top of this particular program, answering questions from Congress and patient advocates, and I realized we had a problem. It’s very important to explain research in Spanish, but we don’t have a spot on a national TV network unless we’re called. We don’t volunteer our own experts.”
Communicating about health, research and clinical trials is not just an information blast, but creating a relationship.
“NIH has sponsored all the major scientific breakthroughs, either directly or indirectly,” says Gomez. “Yet NIH becomes small print at the end of the story, or not at all. We need to reach out to the Hispanic community and explain all the good work being done. And be sure they take part in clinical trials.”
Although Hispanics number around 17 percent of the total U.S. population, and 23 percent of all children under 18, only 2 percent of Hispanics have participated in cancer research trials.
“Accrual is better in Latin America,” says Gomez. “It’s 15 percent, because countries are paying for standard treatment down there.”
One problem here is lack of information. When Hispanics in the U.S. seek medical attention, they tend to go to a bilingual doctor unfamiliar with clinical trials, or to a community hospital, not a cancer center.
Gomez is bridging the gap. In his 15 years at NCI, he has participated in many communications for Spanish-speaking audiences.
"I have definitely changed careers,” he says.
He does this on the strength of his medical degree, two doctorates (immunology, pharmacology) and two postdocs, the latter one at NIH “where I had the good fortune to be involved in what used to be—before NCATS—the largest translational research program at NIH, the Specialized Programs of Research Excellence.”
How do you culturally understand an audience of over half a billion spread across 20 sovereign nations?
“People from El Salvador are different than people from Mexico and Miami. If you’re too elevated, they get lost. If you’re too regional, they get lost. You have to find a common denominator and then they have to identify you as part of their culture.”
Originally from Mexico, Gomez was educated both there and in the U.S. You can catch his health messages on Univision, the largest U.S. Spanish-language TV network, or on the Hispanic Information and Telecommunications Network, its non-commercial cousin. Other interviews and PSAs have appeared on the Hispanic Radio Network, North American Networks, Radio Nueva Vida and ConCiencia, the first Spanish-language science and health news service in the U.S.
He also volunteers for the National Hispanic Medical Association and the NIH Hispanic employment committee. And he finds time to mentor M.P.H. and Ph.D. students.
Hispanics in the U.S. are underrepresented socially, economically and politically, Gomez says, and at NIH, there are few who understand research, medical issues and how to communicate them. A student visiting from Texas reported how her parents had warned her: “You won’t find any Hispanics there.” But once she got here, she said,
“I’m very proud to be here. Now I can tell my friends about it.”
“That’s how you build relationships,” he says. “A little at a time.”
Cultural competence serves him well as the project officer for the U.S.–Latin America Cancer Research Network. Over 500 women with stage II or III breast cancer in 5 Latin American countries are enrolled in a breast cancer study, with over 70 joining each month. The molecular epidemiology trial will involve more than 20 hospitals and research facilities in Argentina, Brazil, Chile, Mexico and Uruguay.
In the U.S., cancer incidence and death rates are lower among Hispanics compared to non-Hispanic whites. Yet cancer death rates among Hispanics are 22 percent higher among the U.S.-born compared with the foreign-born.
“We now have opportunities to find out whether these groups have different mutations,” says Gomez. “What are their familial or environmental risks? Tobacco, alcohol, obesity, the age of women having kids, the number of kids. These may influence the development of breast cancer.”
The study will not only help us better understand how to categorize and treat breast cancer, a disease with many subtypes, it will also help build research infrastructure.
Understanding cancer patterns in Latin American countries can accelerate progress against cancer in all the Americas.
So this is Gomez’s way forward: “How can I contribute to society? To the United States? I want to give something back,” he says. “Working at NIH has meaning.”