Latinos and health care:
beyond the mainstream
The eyes of the SPH global health faculty travel around the world as they conduct research and seek to improve people’s health. But sometimes their perspective zeroes in on the world contained right here in the local community. Take neighboring San Bernardino, for example—a diverse city with a large Latino community.
Juan Carlos Belliard, PhD, MPH, assistant professor of global health, became aware of traditional Latino medical folklore during his childhood and youth in Ecuador and around migrant communities here in the United States.
When he was a child in Washington state, he would visit migrant camps with his mother, a Bible worker. One day, the young Dr. Belliard ate some hot chili peppers with his hands and then rubbed his eye. Stinging pain resulted. One of the migrant women came to his rescue: she rubbed her long hair on his eye.
"It really helped—it soothed the burning," he remembers. "I look back and see so much wisdom and tradition in the community I grew up in."
Now as an adult and public health professional, Dr. Belliard perceives a gap between mainstream health care and the belief systems and needs of the communities it seeks to serve. His research in the School of Public Health works on bridging that gap.
Currently, Dr. Belliard is involved in four projects that address the health beliefs, practices, and needs of San Bernardino’s Latinos, many of whom have backgrounds from Mexico and Central America.
The first study addresses the use of herbal remedies among Latinos—what they take, and whether they share this with their professional health care providers.
Full disclosure about herbal use is key, because when patients utilize herbal remedies alongside prescription drugs—and their health care providers don’t know it—medical complications can ensue.
"The big question is what are the potential interactions between herbs and prescription drugs," says Dr. Belliard, who also serves as associate director of diversity for Loma Linda University.
Unfortunately, according to Dr. Belliard’s research, many Latino patients who use herbs don’t communicate this fact to their health care providers.
Traditional, alternative medicine—such as the use of medicinal herbs—and mainstream biomedical health care are often considered two separate realms, as far as professional health care practitioners are concerned. The same does not always hold true for patients. "The Latino community navigates in and out of both systems with a lot of ease and comfort," Dr. Belliard says. "We call this phenomenon medical pluralism."
Working with public health students including Adriana Arzate and Melissa Preciado, Dr. Belliard has collected 214 surveys about the use of herbal remedies among Latino patients culled mainly from LLU’s Social Action Community Health System clinics in San Bernardino.
The results revealed that 98.6 percent of the patients surveyed have used herbal products medicinally.
The four herbs most commonly reported were chamomile (for stomach and digestive ailments), aloe vera (for skin conditions such as burns, acne, and hair loss), the flesh of prickly pear cacti (for diabetes), and mint (for stomach ailments and relaxation).
Slightly more than 75 percent of those surveyed take prescription medications—and 65.4 percent reported that they never tell their health care provider about their herbal use.
Why is that? Many health care providers never think to ask, and patients hesitate to bring it up because they fear a negative or skeptical reaction.
Dr. Belliard and the students have been working for about a year on this project. They are now in the analysis stage; developing educational materials for health care providers comes next.
"Providers need to know their patients better through this data—what they’re using and why they are not communicating this," Dr. Belliard says.
This project, sponsored by LLU’s Center for Health Disparities and Molecular Medicine, is also being done in partnership with the Loma Linda University School of Pharmacy, including Kathryn Knecht, PhD, associate professor of pharmacology.
Future pharmaceutical research resulting from this survey could focus on the interactions between commonly used prescription drugs and commonly used herbs.
Understanding botanicas
The second project also explores the relationship of the local Latino community to the world of alternative medicine.
It involves creating an ethnographic photojournal of the role botanicas play in local health care delivery.
Botanicas are shops that sell a blend of herbal and traditional remedy products alongside religious paraphernalia representing an eclectic mix of faith traditions. Candles and religious statuary may be found next to eucalyptus or sage leaves. Sometimes, healing ceremonies are performed at botanicas.
About half a dozen botanicas exist in San Bernardino. The project seeks to gain an understanding of who uses these stores, as well as to tease out the health belief systems held by botanica owners and their clients.
SPH alumna and skilled photographer Stephanie Skillman, MPH, started the project when she was a student, under the guidance of Dr. Belliard. MPH student Rebecca Medina, along with Dr. Belliard, is taking the project to completion. Fellow student Olga Shuhatovich is helping with additional photography.
The work has involved spending time at three local San Bernardino botanicas, interviewing owners and clientele. Photography of the shops plays the biggest role in the project, serving as a visual illustration of cultural data.
The final outcome will be a comprehensive report containing descriptive analysis and photographs of various botanicas and the artifacts inside. This report will be made available to community clinics, the San Bernardino County Health department, and botanica owners.
"Again, if providers don’t know what their patients are using or what they believe in, they cannot provide optimum care, and that contributes to health disparities. Raising awareness and understanding is crucial," Dr. Belliard says.
Latino health maps
The third project is called "Bridging the Gap: An Inventory of Latino Health Resources." This project, funded by the SPH Center for Health Research, has used geographic information systems (GIS) to map commercially licensed establishments in San Bernardino that provide folk health care to the Latino population. Such establishments include botanicas and Latino grocery stores that sell health products. Also included in the map are hospitals and clinics that Latinos rely on.
"We wanted to see which clinics attract the Latino population—and why," explains Dr. Belliard.
The maps and accompanying explanatory data will be used to raise awareness in the professional health sector of what resources patients are turning to.
Furthermore, these maps could be used to assist in developing health policies and effectively allocating health care resources.
Empowerment
The fourth project is in the pipeline and will be what is called an empowerment evaluation of Latino health in San Bernardino County.
The project will mobilize the community to diagnose its own health problems. Then, the community members will create their own solutions. According to Dr. Belliard, this method—also called the community action model—is not often utilized.
"The people closest to the problem are rarely involved in solving the problem—which causes more problems," he says.
The process will lead to pilot intervention programs and, at the end of one year, this area’s first-ever Latino health summit.
This project will be an activity of the Center for Health Disparities and Molecular Medicine, in partnership with the Latino Health Collaborative. The Latino Health Collaborative is a local organization dedicated to addressing health concerns, as well as issues such as workforce diversity, nonprofit capacity building, and advocacy in California’s Inland Empire. Dr. Belliard serves on the board of the collaborative.
Working on projects such as these is the reason Dr. Belliard enjoys being at Loma Linda University.
"My passion comes from building bridges, be that between the patient and providers, or between the University and the community," he says. "I also like to see the excitement that students get out of learning directly from community experiences—things that you can never reproduce in the classroom."
