WASHINGTON - When Dr. Elmer Huerta was still practicing oncology in his native Peru, he was disturbed by seeing too many patients coming in too late for treatment of cancer that might have been prevented. Some people had put "yerba buena," or good herb, on the huge tumors that were deforming their bodies in the belief it would dissolve the cancer.
Since then, he has immigrated to the United States and in 1994 established a cancer "preventorium" at Washington Hospital Center for detection and prevention in seemingly healthy patients. Yet even here, he has been faced with similar problems: patients resorting to natural remedies like yerba buena and postponing care.
To counter that, Huerta employed someone who understood Hispanic culture to be a patient navigator, or guide. "A navigator helps a patient overcome barriers, navigating the people through the turbulent waters of the American medical system, which is extremely complicated," Huerta said.
Huerta's clinic is among the models for an act recently signed into law that is intended to make use of the nation's medical system less daunting for everyone. It may play an especially important role for non-English speakers, who were estimated to make up about 18 percent of the U.S. population as of 2003. In Maryland, the figure was about 13 percent, according to the Census Bureau.
Apart from not speaking the language, many are uninsured and afraid of being deported or walloped with medical costs. They can be reluctant to visit a doctor, and some cling to their birth country's traditions of using natural remedies, like some of Huerta's patients who believe in the healing power of yerba buena.
Advocates say the additional guidance from navigators will ensure people get the kind of care and education they need to prevent the development of chronic diseases or detect them early when they are easier to treat.
Local clinics face similar problems in trying to help the foreign-born more quickly replace old ways with new.
The Columbia Health Center sees a number of Hispanics at its women's health clinic. Esther Aponte, an interpreter at the clinic and a Puerto Rican native, has heard of potentially dangerous practices, such as a pregnant woman eating a certain kind of clay for its minerals. Instead, women in prenatal care are told to take vitamins to ensure health.
Lisette Osborne, director of the community and family health bureau of the Howard County Health Department, said that the job of the clinic's staff is to respect traditions while providing the best possible care.
"You don't want to rob people of their culture, but you want them to be healthy, and you have to strike a balance," she said.
One of Huerta's patients, Ruth Aloras, originally from Bolivia, says that, although she is not a believer in traditional remedies, she knows a large number of Hispanic people who try them. Many go so far as to ask family members in their native countries to send them familiar herbs and remedies.
"Because of Dr. Huerta, many people have realized, maybe the herb helps, but you always have to go to a doctor," she said.
Aloras, 42, of Germantown, says she feels more comfortable in Huerta's clinic than in typical North American health care settings. "He is Bolivia-style," she said, referring to the Peruvian native.
Huerta's navigator, Diana Garcia, was helpful to her when she came to the clinic, said Aloras. Among other things, Garcia helps patients arrange appointments and screenings for high cholesterol or blood pressure.
Dr. Harold Freeman, director of the Ralph Lauren Center for Cancer Care and Prevention in New York, created the first patient navigator program in 1990 during his previous post at New York's Harlem Hospital. It is another model for the Patient Navigator, Outreach and Chronic Disease Prevention Act.
The patients he sees in New York, who are predominantly African-American or Hispanic, can hold incorrect notions about certain diseases that hinder their treatment. Some patients refuse a surgery because they believe exposing tumors to air will make them worse.
"My belief is some of that distrust can be abated if someone is in the system that talks like them, looks like them, and cares about them; someone they can relate to," said Freeman.
Under the new federal act, health clinics would apply for funds to employ navigators. The government expects to spend $25 million over the next five years.
The patient guidance would be in addition to the services of social workers and others that some medical centers already offer. For example, the University of Maryland Medical System supplied not only an interpreter but a social worker to Anna Rodionova, 72, of Columbia. The Russian immigrant said the social worker, Lindsey Levis, helped her to arrange transportation and to apply for financial aid to pay for treatment of pre-leukemia. "I would have died without her," said Rodionova, a native of Siberia.
Licy Do Canto, assistant director for federal affairs at the National Association of Community Health Centers, said navigators with close ties to the groups they would likely be most successful, calling the bond an "enduring connection to the community."
In Baltimore, such a connection has been pivotal for Pedro Diaz, Spanish interpreter at Highlandtown Community Health Center, which serves non-English-speaking patients from various Latin American and African countries. "We are immigrants in this country," said Diaz, originally from Peru. "That's where you actually relate to them. You don't just see a patient. You see a friend or a mother, because a lot of us here have family away."
As a native of Ecuador, interpreter Blanca Peralta knows what her Highlandtown patients mean when they tell her their child has "mal de ojo." They are referring to "evil eye," a belief that adults who stare intently at a child could make the child ill. Actually, the child probably has a fever, she said.
The Highlandtown clinic, which is funded by federal and private grants, has another clientele whose life experiences have made U.S. assimilation even more challenging. People from refugee camps in Africa come to a nearby resettlement center after receiving only minimal health care in the past.
Abdalla Siyaad, the clinic's Somali interpreter, has worked with refugee patients who do not know how to use an elevator. "Everything is new to them: the system, the medication, the hospital, the doctors," he said.
Casa de Maryland, a nonprofit organization that helps Hispanics with various problems such as health care, takes a proactive approach to educating people whose backgrounds often provide limited medical knowledge.
Christy Swanson, director of services, said one woman who had late-stage cancer only understood that she had "dirty blood."
Casa sends workers door-to-door and attempts to make people reflect about health in their own lives by staging humorous skits at health fairs.
The idea is to teach people what they need to know sooner rather than later, when information might come with the diagnosis of a serious disease.
"They don't want health to be something terrible to discover," Swanson said.