December 13, 2006
Dr. May Farnsworth

Dr. May Farnsworth

A wardrobe truck sits at the entrance of the Ambulatory Care Center at UNC Hospitals. In the second-floor lobby, a makeup artist puts the finishing touches on an actor’s face; up in the thirdfloor pharmacy, movie lights and cameras move into position, people in headsets focus intently on their script binders, and a voice calls for silence. On this summer Saturday, the patient care facility has been transformed into a film set — all to help health professionals provide better care to their Spanish-speaking patients.

¡A su salud! (“To your health!”) is an innovative, multimedia Spanish language program built around authentic health situations. The intermediate course is offered as an elective to residential and distance education students at the UNC School of Public Health as well as the other UNC health science schools, the School of Social Work, and to undergraduates in the UNC College of Arts and Sciences’ Department of Romance Languages. The Office of Continuing Education at UNC’s School of Public Health and the UNC William and Ida Friday Center for Continuing Education also offer the intermediate course via a distance learning format to those outside the university. And, the curriculum’s publisher –Yale University Press — offers a free guide for those who wish to use the intermediate course materials for self-study available through their website at

Now the Salud team — an interdisciplinary group of health professionals and Spanish-language educators from across the Carolina campus — is hard at work on an introductory-level program. A professional film company is shooting its centerpiece, a broadcast-quality Spanish soap opera or telenovela, and they’re underlining its realism by doing some of the filming at the UNC Ambulatory Care Center.

Claire Lorch, Salud project director and a clinical instructor in the Public Health Leadership Program (PHLP) at the UNC School of Public Health, says that preparing health professionals to communicate more effectively with their Latino patients can help improve health outcomes. “Latinos in need of medical care often face enormous challenges,” she says. “Few health care professionals speak Spanish or really understand Latino immigrant culture. As a result, Latinos rarely receive adequate preventive care, and they are less likely to follow treatment guidelines. Latinos tend to enter the system only when they urgently need services, and that puts a strain on their health and on the health care system.” Nationwide, she notes, fifty percent of Latino immigrants are unable to speak English sufficiently well to communicate with their health care providers.

“If a provider can communicate directly with patients, there’s a greater bond there, a greater chance the provider will have the full picture, get the context,” says another member of the Salud team, Christina A. Harlan, a research assistant professor in the PHLP and a public health nurse who also teaches in the UNC School of Nursing. “If you don’t have the language or if you bring in an interpreter, it totally changes the dynamic.”

Harlan’s philosophy is that good health requires a team approach. “It’s something we do together,” she says. “In order to have that cooperation, that networking, that collaboration and partnering, having the language and working effectively across cultures is tremendously important.”

By design, ¡A su salud! episodes portray Hispanics as a diverse group of people and expose participants to a wide range of accents. The program also emphasizes cultural learning. “We feel our mission is language and culture, and the culture is not secondary to the language,” says Dr. Elizabeth Tolman, visiting assistant professor of Romance Languages at UNC and a language consultant on the Salud project. Cultural misunderstandings can interfere with provider-patient understanding, she points out. “In some cultures from Latin America, instead of making eye contact, patients might look down to show respect. You might think they’re shy or they don’t understand or they are disrespectful, but they are showing great respect.”

The introductory telenovela focuses on two immigrant families, a family that recently arrived in a Southern town and a well-established family that has been in the community for many years. “We wanted to introduce some of the perspective of Latino immigrants,” says Dr. Deborah Bender, a fourth member of the team and a clinical professor of health policy and administration in the UNC School of Public Health. “We felt it would be really important for beginning students in particular to understand in a more global way where these folks are coming from.” Tolman reports that health professionals who took part in a pilot program at the introductory level said they had more positive interactions as a result of taking the class. “They were more relaxed, and their patients were more relaxed,” she says.

The drama includes real-world situations that health practitioners are likely to encounter: for example, a social worker talks with an adolescent to assess whether she has a drug or alcohol problem; a physician tries to tell a teenager that she has a sexually transmitted infection; and a physical therapist instructs a patient on how to use crutches. Course materials also will feature a series of reflections in English by practicing professionals who have encountered language and cultural barriers.

At the UNC Ambulatory Care Center, Meredith Greene, an outpatient pharmacist at UNC Hospitals, is taping one of those reflections. “It’s important to know Spanish in my job,” she says. “I need to tell patients what the medicine is for, how to take the medicine, what the side effects are and how to get in touch with the doctor if they need to.” In her experience, she says, a patient getting a prescription filled will often come in with a child. “You’ll speak with the kid, and they’ll translate,” she says. “Since I know Spanish, I know they don’t always translate all the information. They don’t translate every word you say, just what they understand. In other words, there is some information that gets lost.”

The intermediate level ¡A su salud! course was funded by the Office of the Provost at UNC and by a grant from the U.S. Department of Education’s Fund for the Improvement of Postsecondary Education (FIPSE). The Office of the President of UNC, the North Carolina GlaxoSmithKline Foundation, Blue Cross and Blue Shield of North Carolina and The Aetna Foundation are funding the introductory program. ¡A su salud! is a project of the Office of Distance Education and E-Learning Policy at the William and Ida Friday Center for Continuing Education. The introductory ¡A su salud! will be offered at UNC and partner institutions by spring 2008 and distributed nationally soon after. For more information on the project, contact Claire Lorch at or (919) 962-4011.

— by Kathleen Kearns

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Carolina Public Health is a publication of the University of North Carolina at Chapel Hill School of Public Health. To subscribe to Carolina Public Health or to view the entire Fall 2007 issue in PDF, visit



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