Published: April 19, 2024
In 1995 I arrived in Louisville with my wife and two teenagers. I had $400 dollars to my name and a debt of $4,000 to a family member in Miami, Florida. I did not know the city at all. No relatives and no friends had ever lived in Kentucky. I was the only one able to communicate in English. We were sponsored by the Kentucky Refugee Ministries.
Working in Burundi, in Africa, for two years opened my eyes and showed another way of living as a professional. It showed me that I could have a better life, like my African colleagues. I worked together with physicians from different countries. I saw their houses, their cars and how wealthy they were. I also saw that I could work outside my hometown and outside of my native country of Cuba.
Passing the medical boards was not easy. When I was in medical school in Cuba, we never studied DNA replication. The hepatitis virus was not well known like today. So, after 20 years in obstetrics and gynecology, I had to quickly review all those subjects, many of them absolutely forgotten. Thanks to Moises Dreszer, M.D., and Leonardo Clavijo, M.D., and Ms. Nayris Bracey, all mentors of mine along the way, I started to study with books and a dictionary. I had no money for a Kaplan course. I was forced by my circumstances to work full time during the day and study from 6 p.m. to midnight.
The internal medicine residency program was my choice. It was an internship, at 43 years old, on call every three days and dealing with tons of abbreviations and slang that I had never heard in my entire life. I was like a sponge, absorbing everything, trying to understand everyone in daily rounds. I had to guess the meaning of JVD, STD, CHF and DNR. Words that were very well known for native medical students and staff were absolutely new for me. My only help was a medical textbook, my old Washington Manual. For three years I prayed to the Lord 24/7, asking for the help of St. Jude.
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In those days, I promised that I would serve the growing Hispanic community and that I would remain in Louisville, Kentucky, after graduation, if I could graduate. I knew that I would not be a brilliant resident but a disciplined one. I was never late, never complaining and always ready to go the extra mile. Kathy J. Thomas, M.D., (now an internal medicine physician with Norton Hospitalists) gave me a distinguished award. I also received an award for my attendance to ground rounds. Those were my personal goals.
Norton Healthcare helped me to open a solo practice in downtown Louisville. I began with six patients a day, but after a few months, I had 100 patients a week. I received people from all over the world: Mexico, Honduras, Dominican Republic, Costa Rica, Guatemala and Cuba. Also, Kentucky Refugee Ministries and Catholic Charities began to send me all the immigrants from Bosnia, Russia and Somalia, among others. Churchill Downs asked me to see their Hispanic workers as well. I had to learn Spanish words and phrases from different countries. There were multiple Spanish terms that I did not know. One example: A Cuban says that they have “punzada” to express sharp pain. A Mexican says “piquete.” There were multiple examples of words, phrases and ways to describe symptoms absolutely unknown by me. I did not know that there were Hispanics from Central America who do not speak Spanish, but instead a dialect. I learned to use a family member to interpret to me in Spanish, and then I could write the note in the chart in English.
The advantage of talking to providers in their own language, without a translator is tremendous. The original message is directly received by the provider without interpretation and bias. Several complaints cannot be shared with a third person though a tablet. Intimacy and privacy are violated when an interpreter is necessary. Several phrases are not easy to translate even for experienced professionals. Personal interpretations may be subjective, incomplete or even erroneous. An office visit for something like a sore throat takes double the time if an interpreter is needed.
Several bilingual advanced practice providers joined me in the journey and helped me to enlarge the practice. I had the pleasure to receive students and residents interested in practice with the Hispanic population.
After 20 years, however, I began to feel the burden of administration. I made a decision to join Norton Medical Group and dedicate my time to just see patients. Judith Maxwell, system vice president, Norton Medical Group, helped me in the process, and now I am proud to be part of a new experiment in Norton Community Medial Associates – La Clínica Preston. It is a group of nine health care workers ranging from providers to medical assistants and X-ray technologists with a strong interest in the underserved Hispanic community. We started in November 2021. After 18 months we came to the conclusion that we need a larger office to accommodate at least four providers. Louisville now has a significant Hispanic population, growing more and more. We have two providers and see 50 patients daily. We are receiving seven to 10 new patients every day.
If our city continues growing and receiving immigrants, we have to prepare for that. More international students must be evaluated in our residency programs. We need to become a multilingual health care community.
Juan G. Polo, M.D., is an internal medicine physician at Norton Community Medical Associates – La Clínica Preston.
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