FREE Take One | GRATIS Tome Una APR / JUN 2009
Samuel Gonçalves
When Access to Health Care
is Difficult Cuando el Acceso al Cuidado Médico es Difícil La historia de un inmigrante Eduardo A. de Oliveira EthnicNewz.org
y Familia Salud New England’s bilingual health magazine
Salud y Familia | 2
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Great Tasting Ways to Use Milk and Cheese Start at Breakfast t Add low fat milk to whole grain cereal with fresh fruit t Use low fat milk in place of water when making oatmeal t Make scrambled eggs with low fat milk and top with mozzarella cheese Creamy Banana Walnut Oatmeal *
Snack Smart
Perfect Fruit Smoothie *
t Prepare instant pudding mix with low fat or fat free milk and spoon over vanilla wafer cookies and sliced bananas t Mix low fat milk or yogurt with fruit ie in a blender to make a fruit smoothie t Enjoy a cup of steaming hot chocolate – mix fat free milk with chocolate syrup
Moving to lower fat milk? Take your time– Step one: switch between whole and 2% Step two: Stick with 2% if you like it, or switch between2% and 1% Step three: Stick with 1% if you like it, or switch between1% and fat free
Healthier Meals t Make soups and casseroles more by adding low fat milk t Sprinkle shredded mozzarella cheesee on top of broccoli, beans, whole grain rice or other family favorites
Cheesy Broccoli Soup*
*For these and other great tasting milk and . cheese recipes, visit
Sensitive to lactose? Try low fat and fat free lactose free milk!
www.3aday.org
© 2008 National Dairy Council®
APR / JUN 2009
Salud y Familia | 3
Nutrition IN THIS ISSUE… EN ESTA EDICIÓN... •
Nutrition / Nutrición
Be Heart Smart: Eat Right! Un Corazón Saludable P4-P5 ----------------------------------------• Oral Health / Salud Dental Healthy Nation, One Child at a Time Dientes Sanos, Un Niño a la Vez P7-P8 ----------------------------------------• Health Stories / Historias Saludables Immigrants and Health Care Los Inmigrantes y el Cuidado Médico P10-P13 ----------------------------------------• Life Style / Estilo de Vida No TV for Tots No Más Televisión P14-P15
EDITORIAL Editorial Coordinator Marcela García marcela@elplaneta.com Partners Neighborhood Health Plan BU Henry M. Goldman School of Dental Medicine Children’s Hospital Boston EthnicNewz.org Contributors Ricardo Herreras Álvarez Eduardo A. de Oliveira Graphic Design Jhosmer Hernández Health & Family is Published By El Planeta Publishing A Phoenix Media/ Communications Group Company Sales and Marketing Raúl Medina raulm@elplaneta.com (617) 937-5919 Subscriptions (617) 937-5900 EL PLANETA PUBLISHING 126 Brookline Avenue Boston, MA 02215 Phone: (617) 937-5900 Fax: (617) 933-7677 www.healthandfamilymagazine.com
Salud y Familia | 4
Be Heart Smart: Eat Right! Latinos have higher rates for heart disease, diabetes and high blood pressure; it’s time to “spring” into healthy eating * Neighborhood Health Plan March was National Nutrition Month, so when we moved the clocks ahead, it was also a time to “spring” into healthy eating. Heart disease and stroke are the number 1 and number 3 killers of all Americans. Latino Americans have higher rates of some risk factors for heart disease and stroke, such as diabetes and high blood pressure, than other ethnic groups. Risk factors include lifestyle choices, such as food. Good food and cultural celebrations go hand in hand. Yet, the traditional ways of frying foods and using fats for seasoning can increase your risk for clogged arteries and heart disease. Eating heart-healthy means making only a few changes to your menu, like choosing foods lower in saturated fat and cholesterol. These small changes can help to reduce your risk, while still holding on to traditions. FAT IN YOUR FOOD The two main types of fat found in food are saturated and unsaturated. Most foods have a mix of both. Together, the two are called total fat. Saturated fat raises blood cholesterol the most. Over time, this extra cholesterol can clog your arteries. You are then at risk for having a heart attack or stroke. Saturated fat is found mostly in foods that come from animals. These include: • fatty cuts of meat • beef • lamb • pork • poultry with skin • whole and 2% milk • butter • cheese • lard A high content of saturated fat can be found in some foods that come from plants such as: • palm kernel oil
The 2009 edition hardcover Best of Healthy Soul Food Recipes cookbook features 50 tasty and healthful recipes that follow the American Heart Association’s dietary recommendations. Easy-to-make favorites include Chicken Soup with Mustard Greens and Tomatoes, Carrot-Pineapple Salad with Golden Raisins, Spicy OvenFried Chicken and Rich and Creamy Mac and Cheese. HEALTHY SHOPPING TIPS: • Choose the chicken breast or drumstick instead of the wing and thigh. • Select skim milk or 1 percent instead of 2 percent or whole milk. • Buy lean cuts of meat such as round, sirloin and loin. • Buy more vegetables, fruits and grains. • Read nutrition labels on food packages. SEARCH YOUR HEART Join American Heart Association’s Search Your Heart Challenge which features nutrition tips, cooking demonstrations, fitness activities, health screenings, and expert speakers for local congregations and organizations. Participation is free. Sign up contacting Jenelle Holder Williams at Jenelle. Holder@heart.org or (508) 935-3994; or visit www.heart.org/bostonsyh.
• • •
palm oil coconut oil cocoa butter
LIMIT YOUR CHOLESTEROL Your body makes all the cholesterol you need. Eating foods high in saturated fat can raise your blood cholesterol levels. The higher your blood cholesterol, the greater your risk for heart disease. Too much cholesterol can lead to clogged arteries. You are then at risk for having a heart attack, a stroke or poor circulation. Cholesterol is found only in foods that come from animals. Foods very high in cholesterol include: • Egg yolks • Organ meats (Liver, kidney, and brains are especially high in cholesterol.) • There is no cholesterol in plant foods like fruits, vegetables, beans, and grains. If you are healthy, you should average no more than 300 milligrams of cholesterol per day. People who have high blood cholesterol or a heart problem may have to eat less. The yolk of one large egg provides
about 214 milligrams of cholesterol. Aim for no more than four egg yolks each week. This includes egg yolks in baked goods and processed foods. Egg whites contain no cholesterol. To cut back on saturated fat and cholesterol, try some of these new ways of cooking and shopping. NEW WAYS FOR FAVORITE RECIPES 1. For biscuits: Use vegetable oil instead of lard or butter and skim milk or 1 percent buttermilk instead of regular milk. 2. For macaroni and cheese: Use low-fat cheese and 1 percent or skim milk. 3. For greens: for example, use skinfree smoked turkey, liquid smoke, fat-free bacon bits or low-fat bacon instead of fatty meats. 4. For gravies or sauces: Skim the fat off pan drippings. For cream or white sauces, use skim milk and soft tub or liquid margarine. 5. For dressings or stuffing: Add broth or skimmed fat drippings instead of lard or butter. Use herbs and spices for added flavor. APR / JUN 2009
Nutrición
Un corazón saludable
Photos.com
6. For sweet potato pie: Mash sweet potato with orange juice concentrate, nutmeg, vanilla, cinnamon, and only one egg. Leave out the butter. 7. For cakes, cookies, quick breads, and pancakes: Use egg whites or egg substitute instead of whole eggs. Two egg whites can be substituted in many recipes for one whole egg. Use applesauce instead of some of the fat.
boil instead of frying. This helps remove fat. • Take off poultry skin before eating. • Use a nonstick pan with vegetable cooking oil spray or a small amount of liquid vegetable oil instead of lard, butter, shortening or other fats that are solid at room temperature. • Trim visible fat before you cook your meats. • Chill meat and poultry broth until fat becomes solid. Skim off fat before using the broth. Use skimmed broth to cook greens.
HEALTHY WAYS OF COOKING • Bake, steam, roast, broil, stew or
CENTRO DE INFORMACIÓN Y RECURSOS DE
MASSACHUSETTS
PIRC
Marzo fue el Mes Nacional de la Nutrición, y es la ocasión perfecta para empezar a comer alimentos sanos. Los latinos tenemos altas tasas de riesgo para ciertos factores que causan problemas cardíacos, como la diabetes y la hipertensión. En el terreno alimenticio, los factores de riesgo son las comidas con alta concentración de grasa, como la mantequilla, el queso o la carne de cerdo y cordero, y las que tienen mucho colesterol, como los huevos y las carnes de órganos animales. Los modos tradicionales de freír alimentos y usar determinadas grasas para su condimento pueden aumentar el riesgo de obstruir arterias y problemas cardíacos. Con sólo unos cambios en su modo de cocinar, se puede comer lo mismo, conservando el sabor tradicional.
RECETAS SALUDABLES • Para bizcochos: Usar aceite de verduras en vez de manteca de cerdo • Para macarrones con queso: Usar el queso de pocas calorías. • Para salsas: Para salsas blancas, usar la leche desnatada y margarina líquida. • Para tortas, galletas, panes, y hojuelas: Usar la clara del huevo en lugar del huevo entero. Se puede usar dos claras de huevo por uno entero. MANERAS SALUDABLES DE COCINAR • Cocer al horno, al vapor, asar, o guisar en vez de la freír. Esto ayuda quitar la grasa. • Usar un sartén antiadherente rociado con aceite de cocina de verduras o una pequeña cantidad de aceite líquido de verduras en vez de manteca de cerdo, mantequilla, u otras grasas sólidas.
Fundado en 1999 como Parents’ PLACE, nuestras metas son ayudar familias alrededor Massachusetts a aprender cómo tener un papel activo y efectivo en la educación de sus niños y ayudar a escuelas a convertirse en lugares donde la participación de las familias sea bienvenida y promovida.
Sabía usted que…
Podemos ayudar…
• Todos los niños tienen derecho a una educación de calidad sin importar donde vivan, que idioma hablen, o las necesidades especiales que tengan.
• TALLERES Y ENTRENAMIENTO para familias, educado-
res, y organizaciones comunitarias, sobre cómo puede participar la familia en la educación y las ventajas principales para los padres de la ley “No Child Left Behind Act”.
• PUBLICACIONES en inglés, español, y portugués
• Todos los padres tienen derecho a recibir información sobre la educación de sus niños en un idioma que puedan entender.
• Las familias tienen derecho a
participar en las decisiones que afecten a las escuelas a las que asisten sus niños.
Massachusetts PIRC es un lugar donde los padres pueden aprender sobre sus derechos y opciones disponibles bajo las leyes estatales y federales, para así tomar las mejores decisiones para sus niños. También trabajamos con escuelas y distritos alrededor del estado apoyándolos en sus esfuerzos para formar alianzas duraderas con familias que quieran lograr el avance académico de un estudiante. Un proyecto de la
APR / JUN 2009
sobre tópicos relacionados a la participación de la familia en la educación y desarrollo de sus niños.
• RECURSOS E INFORMACIÓN disponibles en Internet en nuestra página web en tres idiomas: www.masspirc.org
• ASISTENCIA INDIVIDUAL en inglés, español, y portu-
gués para familias, educadores, y organizaciones en la comunidad por medio de una línea de información gratuita: (877) 471-0980.
CREEMOS EN EL PODER QUE TIENEN LAS FAMILIAS, PADRES, ESCUELAS, Y COMUNIDADES CUANDO TRABAJAN JUNTOS PARA LOGRAR QUE LA EDUCACIÓN DE CALIDAD SEA UNA REALIDAD PARA TODOS NIÑOS.
Federación para Niños con Necesidades Especiales • Informando, Educando, Motivando Familias
Salud y Familia | 5
YMCA International Learning Center 316 Huntington Ave., Boston
El Dr. Bock es un médico reconocido con una clientela establecida, y puede ayudarle a tratar muchas enfermedades y problemas que afectan a su salud:
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781-286-3000 Dr. Randall S. Bock
372 Broadway Revere, MA 02151
Dr. Wanda Febo Cuello, PC
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Consulta Gratis / Free Consultations Salud y Familia | 6
APR / JUN 2009
Oral
Health
Healthy nation, one child at a time A program in Boston helps educate new mothers on their babies’ oral health * Boston University Henry M. Goldman School of Dental Medicine Elizabeth Johnson believes in planning ahead. She moved from her home in Jamaica to the United States in 1999 to get a better education and start a career. She worked towards an associate’s degree in medical assisting, hoping to secure her future. Then, a “miracle” changed her plan. Elizabeth, whom doctors told would not be able to have children, learned she was pregnant. “You can imagine my surprise!” Elizabeth says. “I thought it must be a miracle. But after the shock settled, fear set in. I had some health concerns that I thought could affect my unborn child. And most of all, I felt unprepared for parenthood and frightened by the enormous respon-
sibility. I wasn’t sure if I would be a good mother.” Looking for help, Elizabeth signed up for Boston Public Health Commission’s Healthy Baby /Healthy Child program (HBHC). Soon, nurse Marce Peters began visiting Elizabeth in her home to teach her how to have a healthy pregnancy. Marce monitored Elizabeth’s diabetes and hypertension, the conditions she worried might hurt her baby. “Finding this program gave me hope that my baby would be okay,” she says. What Elizabeth did not expect Marce to check was her oral health. Elizabeth laughs when she remembers that she rarely saw a dentist before she met Marce. Now, the
Desde el lanzamiento de Partnernship for Prescription Assistance en abril de 2005, más de 5 millones de estadounidenses han encontrado programas que les han ayudado a pagar sus medicinas. Y miles de personas más se siguen beneficiando día a día. Si usted no tiene cobertura para medicinas con receta y no las puede pagar, llame al 1-888-4PPA-NOW, o visite www.pparx.org. Cubrimos más de 2,500 medicamentos de marca y genéricos. Usted podría obtenerlos gratuitos o a muy bajo costo. Llame ya al 1-888-4PPA-NOW o visite www.pparx.org. Es confidencial, no cuesta nada y requiere solamente de unos minutos El programa Partnership for Prescription Assistance incorpora a las compañías farmacéuticas de Estados Unidos.
APR / JUN 2009
idea of ignoring her teeth seems so unbelievable, it’s humorous. “I used to think that if I’m brushing my teeth, I’m fine,” Elizabeth says. “But now I know if your teeth are not well that can affect your entire system.” Around the same time as Elizabeth, new mom Marisol Viera came to HBHC when she learned she was pregnant with her first daughter, Mayah. Unlike Elizabeth, Marisol saw a dentist nearby at Dorchester House. Marisol, however, was just as concerned as Elizabeth about how to care for a newborn’s mouth. “My nurse, Elsie, taught me what to look for because Mayah is my first child and I didn’t know much about oral hygiene,” Marisol says.
“I’ve learned to wash Mayah’s mouth after every feeding and what to look for when she starts teething.” At Elizabeth’s house, Marce begins her screenings of Elizabeth and now, son Matthew, with a check of Matthew’s gums. The little boy, well-dressed in powder blue outfit, does not make a sound. He smiles, seeming to thoroughly enjoy Marce’s check up. And why not? This exam is normal for Matthew. Mom, Elizabeth, and dad, Raymond, check Matthew’s gums and clean his mouth regularly. Marce and Elsie are able to care for both families’ oral health as the result of funding received in 2008 by the Boston University Goldman School of Dental Medicine (BUGS-
Beneficios de Seguro Social por Incapacidad y Accidentes de Automóvil Abogados: BAIN D. TESTA, Esq. D. LANCE TILLINGHAST, Esq.¹ ¹Abogado certificado por el National Board of Social Security Disability Advocacy* * Una organización privada cuyos niveles no son regulados por el estado de Massachusetts que certifica abogados.
Ayudamos a los clientes con el proceso de aplicación y también con el proceso de apelación para beneficios del Seguro Social.
Citas disponibles por teléfono.
Si no gana su caso, NO tiene que pagar. Llame gratis al 1-800-363-7186 Wyskiel, Boc, Tillinghast & Bolduc, P.A. Salud y Familia | 7
Salud
Dental
DM) Division of Community Health Programs (CHP) from the National Institutes of Health (NIH) to support the study, “Public Health Nurses as Oral Health Advocates.” CHP trains nurses like Marce and Elsie to give oral health education and checkups during their ongoing pre- and postnatal home visits. At a training led by BUGSDM Oral Health Promotion Coordinator Kathy Lituri and staff in fall 2008, nurses learned to provide risk assessment and screenings, check patients for common dental problems, and make referrals for care. Elizabeth and Marisol agree that so far, receiving oral health education from HBHC nurses works and even has one advantage over visiting the dentist’s office. “Marce makes me feel comfort-
able asking questions I might not feel comfortable asking a doctor,” Elizabeth says. “I know I can call Elsie between visits if I need to,” Marisol adds. “The long term goal of this study is to test how well we can prevent early childhood caries by visiting and educating patients in their homes,” says Dr. Michelle Henshaw, the study’s principal investigator. “Healthy Baby/Healthy Child is a sound investment,” Elizabeth says. “It builds a solid foundation for children like Matthew so they can go on to make a positive impact on society. Healthy children mean healthy communities, which will make for a healthier America.” Now that’s a plan we can all believe in.
Vernon Doucette / BU Photo Services
Matthew Johnson during one of his first dental exams
Dientes sanos, un niño a la vez Un programa en Boston ayuda a educar a las madres sobre la salud oral infantil Elizabeth Johnson llegó a los Estados Unidos como inmigrante proveniente de Jamaica en 1999 para conseguir una mejor educación y así comenzar una nueva vida. Entonces, un ‘milagro’ cambió su plan inicial. Elizabeth, una mujer a quien los doctores le habían dicho que no podía tener niños, quedó embarazada sorpresivamente. “Pensé realmente que era un milagro”, dice Elizabeth. “Pero después de la alegría inicial, me entró el miedo. Yo tenía algunos problemas de salud, que pensé que podrían afectar a mi niño. Y sobre todo, no me sentí preparada para la maternidad y me asusté por la enorme responsabilidad. No estaba segura de si iba a ser una buen madre o no”. Buscando ayuda, Elizabeth se inscribió en el programa Bebé Sano, Niño Sano (HBHC, por sus siglas en inglés), el cual es ofrecido por la Comisión de Salud Pública de Boston. La enfermera Marce Peters comenzó a visitar a Elizabeth en su casa para enseñarle cómo llevar un embarazo sano. Marce chequeaba los niveles de diabetes e hiperSalud y Familia | 8
tensión de Elizabeth, que eran las condiciones por las cuáles ella estaba preocupada. “El haber encontrado este programa me hizo sentir confiada de que mi bebé iba a nacer saludable”, explica la madre. Lo que Elizabeth no esperaba era que Marce revisara su salud bucal. Elizabeth ahora se ríe cuando ella recuerda que rara vez había visto a un dentista antes de que conociera a Marce. “Solía pensar que con cepillarse los dientes todos los días era suficiente, pero ahora sé que si los dientes no están bien cuidados y limpios, puede afectar al organismo entero y por consiguiente a mi hijo”, dice Elizabeth. Marisol Viera se inscribió en el programa HBHC al mismo tiempo que Elizabeth y cuando se dio cuenta que estaba esperando a su primera hija, Mayah. “Mi enfermera asignada, Elsie, me enseñó qué esperar y qué hacer cuando naciera mi bebé”, dice Marisol. “Como Mayah era mi primera hija, yo no sabía nada de higiene bucal en niños recién nacidos, pero
ahora sé cómo cuidar de su boca y sus pequeñas encías”. Durante sus visitas, las enfermeras del programa HBHC enseñan a madres de recién nacidos cómo cuidar de la salud oral de sus bebés, instruyéndolas sobre cómo lavarles la boca después de cada comida y qué esperar cuando a sus bebés empiecen a salirles dientes. En casa de Elizabeth, Marce ahora incluye en sus chequeos al bebé Matthew, a quien le revisa sus pequeñas encías. El bebé ya está acostumbrado, pues Elizabeth y su esposo, Ray, revisan y limpian la boca de Matthew regularmente. Gracias a un donativo del Instituto Nacional de Salud (NIH, por sus siglas en inglés) recibido el año pasado, la División de Programas de Salud Comunitarios de la Escuela de Medicina Oral Henry Goldman de Boston University (BUGSDM, por sus siglas en inglés) entrena a enfermeras como Marce y Elsie para participar en programas como HBHC y educar a madres sobre la importancia de la salud oral propia y de sus hijos, visitándolas antes y después de dar a luz.
Elizabeth y Marisol concuerdan en que sí funciona el recibir educación en casa sobre la salud bucal de enfermeras como Marce y Elsie, y que sus visitas les dan un nivel de confianza inesperado. “A Marce le tengo la suficiente confianza para preguntarle cosas que quizá yo no me atrevería a preguntarle a mi dentista en su consultorio”, señala Elizabeth. “Sé que puedo llamar a Elsie antes o después de una visita a mi dentista si tengo dudas o preguntas”, añade Marisol. Uno de los objetivos del programa HBHC es determinar qué tan efectivo es el educar y entrenar a los padres en sus propias casas para poder prevenir las caries infantiles tempranas. “El HBHC es una inversión sana”, finaliza Elizabeth. “Esto se traduce en que nuestros niños cuentan con una fundación y unas bases sólidas, por lo que ellos pueden así crear un impacto positivo en nuestra sociedad. El tener niños sanos implica que habrá comunidades saludables, y por consiguiente, un país más sano”. APR / JUN 2009
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Salud y Familia | 9
Healthy
Stories
Immigrants and access to health care Where do immigrants stand in the context of the Massachusetts Health Care Reform law? * Eduardo A. de Oliveira / EthnicNewz.org The Massachusetts Health Care Reform law is approaching its third year in April. While government officials celebrate the new coverage of 496,000 people, or about 98% of the state’s total population, questions linger for one group of residents: undocumented immigrants. Although Chapter 58, the Health Reform law, does not extend coverage to undocumented immigrants, its section 160 lays out provisions for an ongoing health disparities council. Even hospital rate increases, determines the reform’s section 25, “shall be made contingent upon hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care.”
But for “Pretinha,” a 64-year-old Brazilian housecleaner of Framingham, Mass., mother of two grown daughters, all that matters is whether or not she can get health insurance. Last year, the Brazilian immigrant sought the help of Esther Abreu Milagros, a Boston University doctor who created the Latino Health Insurance Program, a project that has helped hundreds of families enroll in a local health insurance. Pretinha, who’s been in the US for over 20 years, says she pay taxes, but couldn’t qualify for any program because she has no legal papers. But Dr. Milagros sent her for a check-up at Framingham’s Metrowest Medical Center. “She was diagnosed with heart rhythm distress and rushed to sur-
gery to receive a pacemaker,” said Dr. Milagros. Since Chapter 58 was passed in April of 2006, hundreds of undocumented families across Massachusetts are seeking care in the least expected places. Every Tuesday evening, from 6:30 to 8:30 p.m., Sudbury Congregation Beth El turns into the MetroWest Free Medical Program, a walkin clinic designed to treat underserved and uninsured populations. What started four years ago as a “band-aid” to care for about 20 low-income people has morphed into a reliable source of treatment for 40 patients per week. In 2007, about two-thirds of patients were Brazilian and 15% Hispanic. Alessandra Barbosa came to
treat a wart on her face. As several names are called, Barbosa know volunteers are doing their best and she is satisfied with the service. However, she sees it just as a temporary helping hand. “Having a health plan would be better, for sure,” she said. The services have been so well regarded that Beth El expended them to Framingham. Every Thursday evening the Unitarian Universalist Congregation replaces its prayer sessions with free doctor consultations. Elizabeth, a housecleaner (her last name is withheld), is one of 15 regular patients per week. She said that even in her own community, she doesn’t see the concern about people’s health status that she gets from the all-volunteer team.
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Salud y Familia | 10
APR / JUN 2009
Historias “They are all American volunteers providing such a caring service,” said Elizabeth, a Brazilian who cleans five homes per day, during her second visit to the clinic for women’s preventive care. LACK OF ACCESS AND REPRESENTATION The church is a clear example that at one side of the debate about health disparities is the lack of access to care. A study presented by Dr. Lenny Lopez, an associate at the Disparities Solutions Center at Massachusetts General Hospital, shows that in 2000 the access gap between white and Latino patients is 15.5%. Lack of citizenship is the top reason why that happens (19%), followed by other demographic factors (9%), and low level of education (8%). At the other side of the proverbial coin is the poor representation of ethnic minorities in the hospitals’ medical staff. Last year, minorities represented one-third of the US population, but are expected to become majority
However, in 2004, only 2.8% of the US physicians were LatiMA USA White, non-Hispanic: 79.7% 66% nos, and 3.3% were Black: 6.9% 12.8% African Americans. Asian: 4.8% 4.4% “The question Hispanic or Latino: 8.2% 15.1% remains: why does it Persons reporting 2 or more races: 1.3% 1.6% happen? Are we not American Indian and Alaskan Native: 0.3% 1% graduating minority Native Hawaiian and Pacific Islander: 0.1% 0.2% doctors at all?” Source: US Census Bureau asked Alice A. Tolbert Coombs, vicepresident of MasUninsured by race and ethnicity sachusetts Medical Percent of all Massachusetts residents, 2008 Society, at a Boston Total population: 2.6% University seminar White, non-Hispanic: 2.2% conducted in March Other race, non-Hispanic: 2.6% on the impact of Hispanic: 7.2% health care reform on minority populations. Source: State’s Division of Health Care Finance and Policy Now that the country is opening a new debate on at year 2042. The black population the topic of universal health care is projected to increase from 41.1 coverage nationwide, the question million, or 14% of the population, that lingers would be: for whom the to 65.7 million, or 15%, in 2050. Massachusetts method would be a And the Hispanic population is ex- model? For regular American citizens, pected to triple at the same period, or for those who don’t qualify to get from 46.7 million to 132.8 million. any coverage?
US and Massachusetts population by race/ethnicity:
Saludables
At a recent health care seminar at Regis College, a nursing student wanted to know who pays the bill for undocumented patients’ services. “Whether is undocumented or from Maine, we don’t discriminate, we care for the same way,” said Michael S. Jellinek, CEO of NewtonWellesley Hospital. However, Dr. Jellinek must rely of his hospital’s annual growth to balance his service, because when patients don’t pay their bills, he needs to ‘eat’ the debt, and when Medicaid reimbursement comes, he usually gets 55 cents for every dollar spent. “One of the indicators of the success of the state’s health reform is that the use of safety net resources has decreased,” said Mary Ann Hart, RN, assistant professor of Nursing at Regis College and consultant to Boston’s Public Policy Institute. Hart also added: “For critics who say that the health reform doesn’t go far enough, I’d reply that health insurance is a key component to access, and access is a key determinant of health.”
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Salud y Familia | 11
Healthy
Stories
Immigrants getting health care: a case study Brazilian teen with rare lung cancer beats all types of odds * Eduardo A. de Oliveira / EthnicNewz.org Think about a typical soccer aficionado, and you’ll picture Samuel Gonçalves. Born in Brazil in a family of three brothers, several first-league clubs in the soccer-loving country were interested in the young teen for a possible spot on their teams. But then a religious mission brought his father, Methodist pastor Juarez Gonçalves, to Saugus, Mass., to establish a Portuguese-speaking congregation. Sam first stepped into Logan International Airport at age 13, eager to keep his soccer dream alive. His family settled down in Medford, Mass., a city near Boston.
Sam was diagnosed with a rare cancer: only 20 known cases in the last 50 years At 18, and at the peak of his physical form, he had two options: follow the footsteps of an older brother, who was captain of the Univ. of Massachusetts Boston soccer team, or work for a while before embarking into college life. Sam chose the latter. He worked 80 hours per week, with a split schedule between a gig in the kitchen of a restaurant, and another as a garage attendant at the Lahey Clinic in Burlington, Mass. On top of the hectic routine, Sam was a frequent face at the gym, as he kept himself in shape for the soccer field. During that hectic period, Sam started to feel unexplainable chest pain, and one morning the chest pressure was unbearable. His primary care physician prescribed medicine for pneumonia. But it was the surprising results of a chest X-ray that brought Sam to Massachusetts General Hospital (MGH) in Boston. “I was filling a form and the first question [was]: ‘What is the reason for your visit today?’ The lobby attendant Salud y Familia | 12
nine months, at an additional cost of $560 per month. The insurance covered the full $180,000 cost of Sam’s emergency surgery. But other medical costs were covered for 80%, leaving Sam’s family to pay the remaining 20%, or $50,000, a medical debt that still haunts them two years later.
Samuel Gonçalves with a friend at the hospital had answered it for me,” said Sam. Her answer, “lung tumor,” shocked him. Sam was diagnosed with a lung tumor – known to his doctors as a teratoma with malign transformation to sarcoma – that was larger than a tennis ball. What followed added the Brazilian athlete to the annals of world medicine, with a type of cancer so rare that only 20 known cases of it worldwide have occurred in the last 50 years. Two days later, Sam started chemotherapy, which was painful and complex. The goal of the treatment was to reduce the tumor to prepare Sam for major surgery. He was scheduled for four cycles of chemotherapy over a period of more than two months, with each cycle consisting of one week of daily treatment followed by 15 chemo-free days. THE DILEMMA The first cycle of chemotherapy took a toll on Sam’s deteriorating health as he went through dramatic weight loss. The pain was so unbearable that the chemotherapy had to be stopped, and Sam rushed into surgery. The chemo caused the tumor to bleed and got inflated, pushing Sam’s heart toward the right in his chest cavity. As he was rushed into the operating room, Sam’s doctor warned him
that his chance of survival was 50%. But the 12-hour surgery successfully removed Sam’s entire left lung, according to Edwin Choy, Sam’s medical oncologist (cancer specialist) at MGH. Just as he was getting ready to receive seven weeks of daily radiotherapy after the surgery, Sam’s family was facing another dilemma: how to pay for Sam’s medical care. It was February of 2007, and the State Children Health Insurance Program (SCHIP) was no longer active. When the SCHIP federal law had been in effect, it enabled eligible kids to get healthcare coverage if their parents earned too much to qualify for Medicare, but too little to afford private insurance.
Sam and his family are still haunted by a medical debt of $50,000 Sam didn’t qualify for government-paid health treatment that required at least five years of being a green card holder. Sam was two years’ shy of the requirement. Sam’s father then added him to his health insurance coverage for
ONE LAST MIRACLE At the end of 2007, doctors found small traces of what they thought could be tiny tumors in his gall bladder. But Sam received medical approval anyway to take a trip to Brazil. A bittersweet moment, since his gall bladder surgery was scheduled for a month later in Boston. He was finally able to go to Brazil, and with good news. After four attempts at applying for MassHealth, a state-run health insurance that pays for the care of low- and mediumincome residents, his application was accepted. MassHealth covered his gall bladder surgery just as the nine-month extension on his father’s insurance was expiring. The surgery was complex, requiring the removal of a nodule that was difficult to reach. Juarez Gonçalves and his wife gathered some church members to endure the 8-hour wait. But within 45 minutes, a doctor came to the waiting room. Gonçalves’ heart pounded heavily. “The surgeon came to inform us that upon the first surgical cut, the tiny tumor jumped out… dry and dead. What a relief,” said Sam’s father. Today, although Samuel Gonçalves is looking forward to going to college, his aspirations of becoming an accomplished soccer player have completely evaporated. He pauses in search of a moment that occurred after the last surgery, when Dr. Choy told him he had only a 5% chance of survival. Sam breathes slowly – but decisively. APR / JUN 2009
y
Historias
Saludables
Los inmigrantes y su acceso al cuidado médico: un caso Joven brasileño con cáncer vence todo tipo de obstáculos Nacido en Brasil en una familia de tres hermanos, Samuel Gonçalves era el típico joven que quería convertirse en jugador de soccer por sobre todas las cosas. El trabajo de su padre Juarez Gonçalves, como pastor de una iglesia metodista trajo a la familia a Saugus, Massachusetts, para establecer una congregación de habla portuguesa, y se mudaron a una casa en Medford. Sam no dejo de entrenar en el gimnasio para mantenerse en forma en el campo de fútbol, y tomó dos empleos, trabajando 80 horas a la semana, antes de inscribirse en la universidad. Pero fue en ese tiempo cuando comenzó a sentir un inexplicable dolor en el pecho, hasta que una mañana el dolor fue insoportable. Su doctor le prescribió medicina para
neumonía. Sin embargo, fueron los resultados inesperados de sus rayos x lo que lo llevó al Hospital General de Massachusetts (MGH, por sus siglas en inglés) en Boston. “Estaba llenando la forma de ingreso al hospital y la primera pregunta era: ‘¿Cuál es la razón de su visita?’ La recepcionista ya la había contestado por mí”, dijo Sam. La respuesta, “tumor en el pulmón”, lo estremeció. Sam fue diagnosticado con un cáncer en el pulmón tan raro que solo se han conocido 20 casos en el mundo en los últimos 50 años. Dos días después Sam inició intensas y dolorosas sesiones de quimioterapia que duraron dos meses. Pero el joven llegó a sentir un dolor tan fuerte que tuvo que ser ingresado de emergencia para una cirugía y remover el tumor, que era
un poco más grande que una pelota de tenis. La quimioterapia había causado que el tumor se inflamara y sangrara, presionando el corazón de Sam contra su caja torácica. Su doctor les advirtió, mientras lo ingresaban a cirugía, que había un 50% de probabilidades de que sobreviviera. Sin embargo, el proceso de 12 horas resultó exitoso y a Sam le removieron el tumor junto con todo su pulmón izquierdo. Justo cuando se preparaba para recibir siete semanas de radioterapia postoperatoria, Sam y su familia enfrentaban otro obstáculo: las facturas del hospital. Esto ocurría en febrero de 2007, cuando el programa federal State Children Health Insurance (SCHIP) – que permitía a jóvenes y niños obtener cobertura médica si sus padres ganaban mucho para ser
elegibles para Medicare, pero muy poco para tener un seguro médico privado – ya no existía. Sam tampoco era elegible para ayuda subsidiada por el gobierno pues ésta requería que tuviera cinco años de tener su residencia (green card). Él tenía solo tres con ella. Su padre lo añadió entonces a su seguro médico a un costo adicional de $560 mensuales. El seguro cubrió los $180,000 de la cirugía. Pero otras cuentas quedaron pendientes, por $50,000, una deuda que todavía los agobia. Hoy, Samuel Gonçalves se prepara para inscribirse en la universidad, pero su sueño de ser jugador de soccer se ha desvanecido. Sin embargo, mientras recuerda cómo ha vencido todas sus adversidades médicas, respira lentamente, pero con determinación.
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APR / JUN 2009
Salud y Familia | 13
Life
Style
No TV for tots Watching TV before the age of two has no cognitive benefit, study finds * Children’s Hospital Boston A longitudinal study of infants from birth to age 3 showed TV viewing before the age of 2 does not improve a child’s language and visual motor skills, according to research conducted at Children’s Hospital Boston and Harvard Medical School. The findings, published in the March issue of Pediatrics, reaffirm current guidelines from the American Academy of Pediatrics (AAP) that recommend no television under the age of 2, and suggest that maternal, child, and household characteristics are more influential in a child’s cognitive development.
Contrary to common beliefs, watching TV does not improve a child’s language and visual motor skills “Contrary to marketing claims and some parents’ perception that television viewing is beneficial to children’s brain development, no evidence of such benefit was found,” says Marie Evans Schmidt, PhD, lead author of the study. The study analyzed data of 872 children from Project Viva, a prospective cohort study of mothers and their children. In-person visits with both mothers and infants were performed immediately after birth, at 6 months, and 3 years of age while mothers completed mail-in questionnaires regarding their child’s TV viewing habits when they were 1 and 2 years old. It was conducted by researchers in the Center on Media and Child Health at Children’s, and the Department of Ambulatory Care and Prevention at Harvard Medical School and Harvard Pilgrim Health Care. The study is the first to investigate the long term associations between infant TV viewing from birth Salud y Familia | 14
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to 2 years old and both language and visual-motor skill test scores at 3 years of age. These were calculated using the Peabody Picture Vocabulary Test III (PPVT III) and Wide-Range Assessment of Visual Motor Abilities (WRAVMA) test. The PPVT measures receptive vocabulary and is correlated with IQ, while WRAVMA tests for visual motor, visual spatial, and fine motor skills. The researchers controlled for socio-demographic and environmental factors that are known to contribute to an infants’ cognitive development, including mother’s age, education, household income, marital status, parity, and postpartum depression, and the child’s gender, race, birth weight, body mass index, and sleep habits. Using linear regression models, the researchers equalized the influences of each of these factors and calculated the independent effects of TV viewing on the cognitive development of infants. Once these influences were factored out, associations in the raw data between increased infant TV viewing and poorer cognitive
outcomes disappeared. “In this study, TV viewing in itself did not have measurable effects on cognition,” adds Elsie Taveras, MD, MPH, senior author of the study and pediatrician at Children’s. “TV viewing is perhaps best viewed as a marker for a host of other environmental and familial influences, which may themselves be detrimental to cognitive development.” While the study showed that increased infant TV exposure is of no benefit to cognitive development, it was also found to be of no detriment. The overall effects of increased TV viewing time were neutral. TV and video content was not measured, however, only the amount of time exposed. The researchers acknowledge follow-up studies need to be done, and they are quick to warn parents and pediatricians that the body of research evidence suggests TV viewing under the age of 2 does more harm than good. “TV exposure in infants has been associated with increased risk of obesity, attention problems, and decreased sleep quality,” adds Mi-
chael Rich, MD, MPH, the pediatrician who directs the Center on Media and Child Health and contributing author on this study and the current AAP Guidelines. “Parents need to understand that infants and toddlers do not learn or benefit in any way from viewing TV at an early age.” The Center on Media and Child Health, an affiliate of Children’s Hospital Boston, Harvard Medical School, and Harvard School of Public Health conducts and translates research about the effects of media on child’s health and development so that parents can make informed decisions about their children’s media use. Parents can access this information about research as well as tips at www.cmch.tv. Children’s Hospital Boston is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 500 scientists, including eight members of the National Academy of Sciences, 11 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children’s research community.
The study also found that the overall effects of increased TV viewing time were neutral Founded as a 20-bed hospital for children, Children’s Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children’s also is the primary pediatric teaching affiliate of Harvard Medical School. APR / JUN 2009
Estilo
de Vida
No más televisión Un estudio revela que ver TV antes de los dos años no tiene un beneficios cognitivos Un estudio longitudinal de los bebés, desde los recién nacidos hasta los de tres años de edad, demostró que el ver la televisión antes de la edad de dos años no mejora el lenguaje del niño ni la capacidad visual motriz, de acuerdo a una investigación realizada en el Hospital de Niños de Boston (Children’s Hospital Boston) y la Escuela de Medicina de Harvard. Los resultados, publicados en la edición de marzo de Pediatrics, reafirmó las pautas actuales de la Academia Americana de Pediatría (American Academy of Pediatrics) que recomienda no ver la televisión para niños menores de dos años y sugiere que el cuidado maternal y las características del hogar son más influyentes en el desarrollo cognitivo del niño. “No se encontró ninguna evidencia de que el ver la
televisión es beneficioso para el desarrollo del cerebro del niño lo cual es contrario a lo que dicen ciertas promociones comerciales y la percepción errónea de algunos padres de familia”, dijo la doctora Marie Evans Schmidt, autora principal del estudio. El estudio analizó datos de 872 niños del Proyecto Viva, un grupo de estudios de madres y sus hijos. Visitaron a las madres y los bebés inmediatamente después de su nacimiento, a los seis meses y a los tres años de edad mientras las madres llenaban unos cuestionarios y los enviaban por correo describiendo los hábitos o costumbres del niño de ver televisión cuando ellos tenían uno y dos años de edad. El estudio fue realizado por investigadores del Centro de Medios de Comunicación y la Salud del Niño
del Hospital de Niños de Boston y el Departamento de Prevención y Cuidado Ambulatorio de la Escuela de Medicina de Harvard y Harvard Pilgrim Health Care. “En este estudio, el ver la TV por sí solo no tuvo efectos medibles en la cognición”, dijo Elsie Taveras, MD, MPH, quien también fue autora del estudio y es pediatra en el Hospital de Niños de Boston. “La mejor manera de consi-derar esto es que ver la TV es como un marcador o indicador para muchas otras influencias familiares y ambientales, las cuales por si solas pueden ser perjudiciales para el desarrollo cognitivo”. Así como el estudio demostró que el aumentar la frecuencia de que un niño vea la TV no ocasiona un beneficio para su desarrollo cognitivo, también se descubrió que no era perjudicial. Los efectos generales
al aumentar el tiempo de ver la TV fueron neutrales. El contenido de la TV o los videos no fueron medidos, sin embargo, solo se midió el tiempo de estar expuesto a la TV. Los investigadores están de acuerdo que se necesitan hacer más estudios y que ellos prontamente quieren advertir a los padres y los pediatras que los resultados y evidencias de los estudios sugieren que el ver la televisión para los niños menores de 2 años les causa más daño que beneficio. “Los padres necesitan entender que los recién nacidos y los bebés no aprenden ni se benefician de ninguna manera al ver la televisión a una temprana edad., añadió Michael Rich, MD, MPH, el pediatra que dirige el Centro de los Medios de Comunicación y Salud Infantil y quien contribuyó al estudio y a las actuales pautas de la AAP.
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Salud y Familia | 15
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