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health care deliverers speak Spanish. This is especially true in communities in which the number of Spanish-speaking people is relatively small. Hispan- ics who live in these areas experience tremendous frustration because of the language barrier. Even in large cities, there are far too many occasions when a sick person has to rely on a young child to act not only as a translator but also as an interpreter. One way of sensitizing young nursing students to the pain of this situation is to ask them to present a health problem to a person who does not speak or understand a word of English. Needless to say, this is extremely difficult; it is also embarrassing. People who try this rapidly com- prehend and appreciate the feelings of patients who are unable to speak or understand English. (After this experience, 2 of my students decided to take a foreign-language elective.) Language will continue to be a problem until (1) there are more physicians, nurses, and social workers from the Spanish- speaking communities and (2) more of the present deliverers of health care learn to speak Spanish.
A second crucial barrier that Hispanic people encounter is poverty. The dis- eases of the poor—for example, tuberculosis, malnutrition, and lead poisoning— all have high incidences among Spanish-speaking populations.
A final barrier to adequate health care is the time orientation of His- panic Americans. To Hispanics, time is a relative phenomenon. Little atten- tion is given to the exact time of day. The frame of reference is wider, and the issue is whether it is day or night. The American health care system, on the other hand, places great emphasis on promptness. Health care providers demand that clients arrive at the exact time of the appointment—despite the fact that clients are often kept waiting. Health system workers stress the cli- ent’s promptness rather than their own. In fact, they tend to deny responsibil- ity for the waiting periods by blaming them on the “system.” Many facilities commonly schedule all appointments for 9:00 A.M. when it is clearly known and understood by the staff members that the doctor will not even arrive until 11:00 A.M. or later. The Hispanic person frequently responds to this practice by arriving late for appointments or failing to go at all. They prefer to attend walk-in clinics, where the waits are shorter. They also much prefer going to traditional healers.