This Doctor Breaks Down Language And Cultural Barriers To Health Care


 
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By Kimbriell Kelly

It was the early 1960s, and 9-year-old Eliseo Perez-Stable was at home in Miami with the chickenpox, dreading his return to the third grade.

Nearly a year had passed since his parents in Cuba — fearful of the communists’ rise to power — had sent him out of that country with his grandparents, and he still couldn’t grasp English. At school, his teacher had resorted to yelling at him in Spanish.

The boy panicked. Scabs were forming over his blisters, but if they didn’t heal, he rationalized, perhaps he could stay home. One by one, he began to pick at them. It was a month before he was forced to return to class.

His experiences as a young immigrant proved pivotal for Perez-Stable, who grew up to become a physician and scientist, whose research has documented the impact of language barriers and other issues on the health of Latinos. At 64, he leads the National Institutes of Health’s division for funding and guiding minority health research.

“From this stage, I can see the opportunity to shape the field and promote the development of the next generation in minority health and health disparities,” he said last week as he marked his first year as director of the National Institute on Minority Health and Health Disparities.

Some of his motivation dates to childhood. At that first school, he never learned English but excelled in math because numbers were their own familiar language. He moved to Pittsburgh once his parents arrived, where he was called racist nicknames, asked if he knew about refrigerators and teased about his favorite baseball player, Roberto Clemente.

“I think my experiences as an immigrant child, my efforts at assimilation and the experiences of the external world in the late 1960s shaped my perspective on society,” he said. Yet his homeland continues to shape him. He has returned to Cuba nearly 10 times in the past few decades to recapture his language and “connect to the Latino American reality.” His most recent visit was in March.

Perez-Stable began doing research in the 1980s, when he was a professor of medicine at the University of California at San Francisco. The city’s racial and ethnic disparities were clear to him; certainly, there was no empowered Latino community as he had known growing up in Miami and attending college and medical school there.

“You’d walk into UCSF, and the only people of color you would see would be behind the desk or the custodians,” he said. “There were very few physicians who were minority.”

He studied tobacco use among Latinos and the effectiveness of smoking-cessation policies, the impact of informal translators on Latino health, minority aging and cancer prevention among Latinos.

“At the time, people were saying you quit smoking for your own health," he said. “And what we discovered in working with Latinos ... was that the big motivator was going to be not just for their own health, but also for [their family and] others around them.”

His research on interpreters found that communication barriers made it difficult to understand a patient’s symptoms and therefore treat their diseases. Errors were made, and ad-hoc interpreters, such as family members or office assistants who happened to speak the language, were being used instead of professional interpreters.

“Documenting empirically that it was better to not do that, I think, was an important step to provide evidence for policy changes,” Perez-Stable said.

Perez-Stable had been in the Bay Area for 37 years, treating patients and conducting research, when he received a call for applicants to head the National Institutes of Health’s lead organization on minority health. The outgoing director, John Ruffin, was retiring after nearly a quarter-century at NIH.

As part of the hiring process, leaders there asked about Perez-Stable’s vision. He wanted to bring the social sciences more under the umbrella of the medical sciences, he told them, to better study health disparities. He envisioned research to show how people’s socioeconomic status and everyday lives affect their health. He wanted to know whether being a victim of abuse, for example, or struggling with food insecurity, poverty or family tension, has a biological impact on long-term health.

“Being stressed-out as a baby for whatever reason, or having bad events happen to you as a young child, may trigger changes in biology that may lead to disease when you’re 40 or 50,” Pérez-Stable explained recently, sitting in his sunlight-flooded office in Bethesda, about 15 minutes from NIH’s main campus. A map of Cuba decorates the wall behind his desk.

“We’re now beginning to see that that’s not just theoretically possible, but it’s actually a plausible biological mechanism of what happens with chronic disease,” he said. Even if such a mechanism doesn’t always matter, “we should always be asking that question.”

Perez-Stable started his new job last September. Created in 2010, his institute is the newest at NIH, and its second-smallest, with a $281 million budget for research, training and public education. Some of the grant money is set aside in a program to target under-resourced institutions. For example, in 2014 the institute funded a $15.5 million grant to Morehouse School of Medicine in Atlanta to expand its capacity to conduct research on minority health and health disparities.

Similarly, in 2016, a $9.5 million grant was awarded to Florida International University to conduct community-based research to reduce high rates of HIV.

Perez-Stable is planting roots in Washington. In August, he and his wife, Claudia Husni, purchased a home in Columbia Heights, a neighborhood that he describes as having some of the “grit” of the Bay Area.

In his role at NIH, he’s intent on providing grants toward causes he has long supported.

“I would like to ... establish a greater depth and credibility and acceptance of the science of minority health and health disparities,” he said. “So that people say, yeah, this is important to know what happens in the human behavior, human biology; to understand what the factors of race, ethnicity and socioeconomic status are on how the brain functions, or how childhood experiences affect adult health.”

 
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