Latinxs are one of the fastest growing demographics of people in the United States. As this diverse population grows, the gap in disparities in healthcare continues to widen almost as quickly. The Latinx community was impacted by COVID-19 at higher rates than other cultural demographics in the United States. Latinxs are at greater risk for stroke, diabetes, and other underlying conditions that cause disorders that are treated by Speech-Language Pathologists. Many factors contribute to Latinxs’ access to healthcare including language barriers, fear of seeking healthcare due to immigration status, and socioeconomic status. Further contributing to inequities in healthcare for members of the Latinx community is the fact that approximately 1 in 6 Latinxs are uninsured. As SLPs, we may not have all of the solutions for these complex problems. However, we can play an important role in improving equity for Latinx patients by providing culturally responsive care.
As we strive to provide improved communication, cognitive, and swallowing services to our Latinxs patients, we should first attempt to learn more about the unique cultures of our Latinx patients. Latin America spans over 30 countries with a wide variety of ethnic, racial, and cultural groups. Latinxs is an ethnicity, not a race. As such, Latinxs can be any race and may have varying experiences with racial identity and racism. You cannot tell whether a patient is Latinx based on their physical appearance, last name, or accent. Contrary to popular belief, Spanish is not the only language spoken in Latin America. Other commonly spoken languages include Portuguese, Haitian Creole, French, Quechua, Mam, and other Indigenous languages. Some Latinxs are monolingual English speakers. Dialects of Spanish drastically differ within regions of each Latin American country as well as from country to country. The differences in Spanish dialects can be as drastic as the difference between U.S. English, Australian English, and Jamaican English. Due to a variety of factors, the cultural diet of Latin Americans drastically differs by country. It’s important to not make assumptions about the linguistic background or cultural diet of your Latinx patients. Check your bias at the door.
For our non-English speaking Latinxs, the most important thing that we can do as SLPs is utilize interpreters in our therapy sessions. ASHA mandates use of interpreters by SLPs in their document Collaborating with Interpreters, Transliterators, and Translators. Federal laws, such as Title VI of the Civil Rights Act of 1964, protect the rights of our non-English speaking patients to receive healthcare services in the language in which they communicate most effectively. Additionally, many private insurance companies always have rules mandating reimbursable services to be provided with the use of an interpreter. When you choose not to use an interpreter, you not only violate the ASHA Code of Ethics (Principle I Rules A & B, Principle II), but you also may be violating federal law or committing insurance fraud. Even if the patient is bilingual, Aphasia and cognitive impairment do not always present equally in both languages of bilingual speakers. By assessing in English only, you are not assessing the total picture in bilingual speakers. When your facility places non-English speaking or bilingual patients on your caseload without providing interpreter services, put your foot down and refuse to complete an unethical evaluation.
In the same vein, it is unethical to use translated Spanish materials that you have found on the internet when you do not speak Spanish. Because vocabulary and syntax drastically vary from one culture to another, you have no way to determine whether the language in the Spanish material is appropriate for your patient. Consider that acceptable words in one dialect of Spanish may be considered inappropriate or even pejorative in other dialects. For example, in the area of dysphagia, one commonly used word for “swallow” in many dialects has a highly offensive meaning in another dialect of Spanish. I often hear non-Spanish speaking SLPs use this term and cringe to think of how many patients they have likely offended. Collaborate with an interpreter to create handouts/activities in the Spanish dialect that your patient speaks. When you create an activity in your patient’s dialect, it’s going to be meaningful and functional. You will probably see better buy in to your therapy. Also, don’t support monolingual English SLPs who create products in other languages. If you are a bilingual SLP who creates products in Spanish, add a disclaimer to your products that identifies the dialect of Spanish that the product is intended for.
In the area of swallowing, SLPs are leaps and bounds behind in providing culturally appropriate diet recommendations for our Latinx patients. Food is at the forefront of so many Latinx holidays and celebrations. Our cultures and traditions are passed down over meals and through meal preparation with our family members. When we justify our services for dysphagia therapy, we often write things such as “without skilled ST intervention, patient is at risk of social isolation.” Our diet recommendations, although well intentioned, may inadvertently lead to social and cultural isolation as our patients may not be able to participate in customs surrounding food. We have all given a handout to our patients with a list of IDDSI diet levels and recommended foods. However, it’s important to consider that these diet recommendations are created with an American palate in mind. Then we wonder why our patients are non-compliant with our diet recommendations.
Even though I am Latina, I often work with Latinx patients that come from Latinx cultures that are different from mine. There is a learning curve when it comes to making appropriate recommendations as I work to familiarize myself with the culture. I typically start with asking my patient to come up with a list of foods that they eat on a typical day. If I am unfamiliar with the patient’s preferred foods, I whip out my phone for a quick google search. Then we come up with a list of appropriate foods and/or diet modifications to safely enjoy the foods that the patient prefers. The end goal is to always have a list of 3-4 items that the patient can have for each meal of the day. Please be cautious of the food items that you tell a patient to avoid. For example, rice is a staple in many Latin American diets. It’s also a food that we frequently tell patients with dysphagia to avoid. Instead of simply telling a patient to avoid rice (or any food), think critically about the modifications that could potentially be made before eliminating it from a patient’s diet. During an instrumental, what compensatory strategies could be trialed with bites of rice? How could the rice be prepared differently to improve swallow efficiency? Would cooking it to be stickier eliminate the symptoms of dysphagia? What about serving it in sauce? Does following a bite of rice with a liquid wash or double swallow improve the deficit?
What can we do for our long term care residents with dysphagia and/or cognitive problems that may be losing weight because they are not being served their cultural diet? Collaborate with your dietary staff to serve more items that are culturally appropriate for the patient. For example, if a large percentage of the residents are Mexican, why not incorporate Mexican dishes during the week? Keeping in mind other dietary restrictions (e.g., such as salt, carbohydrates, and renal), would it be appropriate for your patient to add culturally appropriate seasonings to their food? For example, I once worked with a Caribbean Latinx patient whose family member would bring salt free Sazon seasoning and add it to the patient's dinner. Bringing a familiar flavor or food may encourage oral intake for our patients who are at risk of weight loss.
In summary, it is not up to Latinx SLPs to provide equitable care for our Latinx patients. It’s also not solely the responsibility of bilingual Spanish speaking SLPs to provide equitable care for our Spanish speaking Latinx SLPs. As a profession, all SLPs need to recognize our roles and contribute to improving the barriers that Latinxs face in healthcare.
Article by Guest Blogger: Jackie Rodriguez, M.S., CCC-SLP
Jackie Rodriguez is a travel Speech-Language Pathologist from Augusta, Georgia. She has experience working in skilled nursing facilities, memory care, assisted living, independent living, programs for all inclusive care of the elderly, and continuing care residential communities. She is passionate about dementia care and providing functional therapy. Her African American and Puerto Rican cultural background has influenced her passion for cultural and linguistic diversity across the lifespan. In her spare time, Jackie enjoys taking road trips, hiking, and reading.
Instagram: @unlearnwithme.theslp
Website: pico.link/unlearnwithmetheslp
Email: Bilingualslpatl@gmail.com
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