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How we can build trust in healthcare among underrepresented communities

Oscar Delgado
Oscar Delgado

When I think about ways we can improve health outcomes in underrepresented communities across Nevada, I often think about my mom. She helped support our family by working as a housekeeper in the maternity ward of Reno’s Renown Medical Center — known back in those days as Washoe Medical Center.

As one of the handful of bilingual employees available, she occasionally would be called to translate between English-speaking medical professionals and Spanish-speaking patients. And then, sometimes years later, she would encounter those patients in the community. They’d thank her. They’d proudly introduce her to the growing children she had first met when they were newborns. 

Often, these proud parents no longer remembered the names or even the faces of the doctors or the nurses who had assisted with childbirth. But they remembered my mom. They trusted her during emotional, sometimes scary moments. They knew that she spoke their language. She understood their culture and their community, and she mirrored their worldview.

Creating trust must remain a priority for healthcare organizations that serve underrepresented communities, especially given the persistent disparities in health outcomes underlined by the COVID-19 pandemic.  Trust between health providers and patients is difficult to measure by formal metrics, but it provides the bedrock upon which we build successful systems.

So how do we build trust in and among underrepresented communities?

We start, of course, through the employment of healthcare providers and other staff members who speak the languages of their patients and share their cultural backgrounds. From the reception desk to the examination room, shared language and shared experience establish a common ground for patients and providers to communicate effectively. In fact, we know that patients often are unwilling to seek care at all if they’re intimidated by language and cultural issues — and patients who delay care almost certainly will need more expensive care down the road. 

Whether having a doctor that grew up on the same block as the patients they now serve, or a nurse that speaks Tagalog, or a medical assistant that goes to the same church, we have to build a health profession that reflects all of Nevada in its wide and growing diversity. 

An important initiative at UNR recognizes the need to enlarge the pipeline of bilingual workers in healthcare as well as other scientific and technical fields. The program, known as Community of Bilingual English-Spanish Speakers Exploring Issues in Science and Health (CBESS), selects 32 bilingual high school juniors annually to participate in a three-week session in which they conduct research on a community health issue, tour research and health facilities and polish their academic and communication skills. Then they’re matched with a bilingual undergraduate student from the university who provides monthly mentoring as participants head toward high school graduation. Another 64 bilingual high school students participate in a less-intensive version of CBESS.  

The goal is straightforward: Build a bilingual healthcare workforce from the ground up.

Another approach is underway at Community Health Alliance, where I head a team of nearly 300 medical and administrative professionals. Approximately 70 percent of our staff is bilingual.

More than a dozen staff members in our call center and front office have begun training to become medical assistants. From their front-line experience, they understand the importance of compassionate, culturally sensitive relationships with patients. They already know the language and the culture, which are difficult to teach. Now we’re providing them a chance to get the additional knowledge they need to put their bilingual, multicultural skills to new use.  

We’re also working with the state’s Office of Workforce Innovation to create this career ladder for healthcare workers, and we hope to extend our current program to provide scholarships for nursing education as well. Programs such as these to create multicultural trust in healthcare are important for Nevada. 

Together, we can find the innovative answers that ensure all our communities can build productive relationships with our healthcare professionals.

Oscar Delgado is chief executive officer of Community Health Alliance and a member of the Reno City Council. He is also the chair of the Washoe County Health District.


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