Let us go forth, then, together

We held a "Latino Achievement Award Celebration" today to recognize the contributions and accomplishments of this large ethnic and cultural group in our community. The three people recognized were Ines de la Cruz, Dr. Leonor Fernandez, and Dr. Alvaro Pascual-Leone (seen here).

Each of the awardees gave a lovely talk to the audience, but I wanted to share Leonor's with you. She is a doctor in Healthcare Associates, our hospital-based primary care service. I include much of the text below, but I urge you also to watch the video below to get a better sense of the quiet power of her delivery.

I salute the true commitment to egalitarian quality health care at BIDMC evidenced in the many large and small decisions made daily by Russ, Paul, Jim, Tom, Mark, Louise, and many others here.

It is as a result of many of those decisions that I can spend a morning in HCA seeing, for example, a Columbian post-doc student with the flu; an elderly Iranian woman with heart failure; an intelligent Salvadoran woman with little formal education, who proudly tells me that her daughter is about to start college. I may see a wealthy middle aged Irish American man whose liver is failing due to hepatitis C, and a fit African American young lawyer with hypertension.

Without missing a beat, our team will triage them and treat them with equal respect and dignity. An interpreter will arrive on time to help us. If admitted, they will go to the same floors and be cared for by a dedicated and skilled group of nurses, hospitalists, social workers, techs, and food workers. They will be evaluated by a spectacular team of medical residents.

As one of my favorite poets, Jane Kenyon, has said, “It could be otherwise”.

Our ability to give intelligent, appropriate, and compassionate care will be tested, however. It will be tested by competing demands: by the complexity of therapy, by reimbursement structures, and by the pressures to do ever more in less time.

Our appreciation of cultural diversity and our commitment to egalitarian care is what will guide us. It must be our compass as we navigate the challenges of building systems and personnel that will enable each of us to give our best effort. Systems that support and ensure, for example, that we routinely speak to a patient –whether inpatient or outpatient—in a language they understand. Without continued attention to quality where the rubber meets the road, our best intentions run the risk of getting dropped, submerged into irrelevance by the more immediate pressures of our daily work.

I am proud to be a Latina, even if it is hard to define precisely what that means. Latin-America is a diverse continent, with a complex history flavored by the many cultures that emerged from sometimes violent collisions and from creative synergies. Cultures built on the legacy of Spanish Colonial times, the echoes of many ancient civilizations. Economies built on slavery and hard work, arrivals of newer immigrants, and the ever present influence of the powerful neighbour to the North. Latin American culture encompasses so many peoples, races and climates that it is as challenging to define it succinctly as it is to define a "U.S. culture".

And yet the word Latino retains meaning. I am honored and moved by the special affection and the warm words I feel and receive from Latinos in the cafeteria, from my patients, or from my colleagues here Alvaro and Ines. There is a recognition, an almost instant bond. It comes from a real love for the Spanish language, a sense of nostalgia or “saudade” (as the Brazilians would say) for a certain way of expressing affection, and perhaps from a shared sense of “otherness”—an implicit awareness of the daily struggle that so many face through language barriers, stereotype, or economic hardship. We may not each face all those barriers, but we bear witness to them, and we feel kinship.

The US is an incredibly inclusive and creative country. When I travel I find myself even more appreciative of the ability the U.S. has had to integrate so many peoples. But the US retains an ambivalence towards immigrants and towards other languages. These fears predictably raise their heads with every economic downturn—from Phoenix, Arizona, to Boston.

On the day after Sept 11, the French newspaper Le Monde published the headline, “We are all Americans”. The worldwide feeling of solidarity, of people standing with us, was palpable and deeply moving. That spirit of solidarity, that capacity to say, “I care about you--I respect you and stand by you,” is alive and well here at BIDMC. Through this award, we too say: “We are ALL Americans. We are all Latinos”.

Let us go forth, then, together.

If you can't see the video, click here.