Claudia Lopez’s 7-year-old son had one eye that would not stop blinking, rapidly, like some kind of misplaced hummingbird’s wing. Lopez’s pediatrician thought it was a facial tic, caused by a neurological condition like Tourette syndrome, and recommended she take her son to Boston Medical Center.
There was a specific reason why. It has a new bilingual pediatric neurology practice, the first such program in Boston, and, it appears, in the state.
Lopez made the half-hour trip from her home in Lynn to BMC, where she met Dr. Alcy Torres, who speaks Spanish fluently. As Torres took a medical history from Lopez, she shared with him that her son had been waking up in the middle of the night, confused. He wasn’t having nightmares, she told him, or night terrors.
This was a possible sign of nocturnal epileptic seizures. Coupled with the facial tic being in just one eye, Torres thought the boy had been misdiagnosed. It turned out he was suffering from repeated small epileptic seizures.
The misdiagnosis, Torres says, “just shows how language can throw very good physicians off track.” Without his ability to communicate in Spanish with Lopez, it would have been harder for Torres to gather the clues he needed to make his own diagnosis.
Patients like Lopez’s son had prompted Torres to leave Boston Children’s Hospital to start his bilingual clinic at BMC. Torres grew up in Ecuador, in a family of doctors, and they instilled in him from a young age the message that doctors need to help people. As a medical student in Ecuador, he did research with his father, who he says was the country’s first pediatric neurologist.
After medical school, Torres went to do a residency at Miami Children’s Hospital. While there, he was assigned to work on a project with some doctors from Boston Children’s Hospital, and they later recommended him for a job at the hospital.
Torres liked it at Children’s, but over the 12 years he was there, he felt the need to help his people, the kind of people he would have been treating had he stayed in Ecuador.
The Ecuadoran community in Boston is close, and Torres had seen over the years that the patient population he saw at Children’s Hospital did not reflect the number of Hispanics in the Boston area who need care.
He notes that 10 percent of Massachusetts’ populace speaks Spanish, 20 percent in Boston overall, and in East Boston, 40 percent of residents speak Spanish.
So when Karl Kuban, BMC’s chief of pediatric neurology, approached with the idea of a bilingual practice, Torres jumped at the chance. He also holds office hours at a BMC-affiliated clinic in East Boston and in separate clinics in North Andover and Fitchburg. His assistants speak Spanish, and he’s looking to hire a bilingual nurse. All the documents he gives to patients are in both Spanish and English, and he’s training two Spanish-speaking medical students.
Kuban says he had been thinking about the need for a bilingual practice in pediatric neurology for years. Conditions like epilepsy, attention deficit disorder, or learning disabilities “require a special sophistication of communications,” he says.
He had also begun to see research showing that for nonnative English speakers, a condition like autism might be diagnosed three or four years later than for English speakers. About 31 percent of BMC’s patients consider English their second language, and about 75 percent don’t have insurance or are on Medicaid or Medicare, making it the most logical of Boston’s hospitals to want to develop a bilingual practice.
A patient like Lopez would ordinarily need an interpreter to interact with medical staff (BMC’s staff of interpreters covers 15 languages). She says she has been happy to talk with a Spanish-speaking doctor about her son. How helpful is it? “Oh, mucho!” she says. “A lot.” She adds, through an interpreter, that “having to explain things in English is very difficult, because just a little detail can make the whole situation change.”
How helpful is it for a patient like Claudia Lopez to have a bilingual doctor? “Oh, mucho!” she says. “A lot.”
Once her son was diagnosed with epilepsy, it took time to figure out the right medication; one gave him a rash, Stevens-Johnson syndrome. But once such issues were resolved, it’s been a year and a half since he last had a seizure.
Another patient Torres saw came in because she’d been having bad headaches. When he took her history, he found that she’d also been having episodes of paralysis along her left side.
Since migraines don’t cause paralysis, he scheduled an MRI and found that she’d had a stroke related to an undiagnosed heart defect. Torres referred her to a surgeon who closed the hole in her heart.
Another patient he saw was having spasms, where she would be doing something like brushing her teeth and her hand would flick the brush backward. Her doctor was unable to diagnose the source of the spasms, and sent her to Torres. Torres took her history and realized that she had juvenile myoclonic epilepsy. “For a pediatric neurologist working in English, this is a classic case,” he said. “One hundred percent of pediatric neurologists would say this is JME, but in a different language, it was missed.”
Torres is the only doctor in his center, though he hopes to hire his residents when they finish. If they choose to leave, he says he will find others to help him by expanding his practice to meet demand. He says he’s seeing more patients in a year than he saw at Children’s Hospital, and more than a doctor who didn’t speak Spanish would be able to see. Not needing an interpreter saves time for Torres and his patients, and reduces BMC’s costs.
He says he sees some immigrants who are fluent in English, but want to get a second opinion in their native language. He thinks some of that is cultural, because Americans tend to be much more blunt than Latinos.
Torres says he’s BMC’s bilingual “Indian Rabbit,” the phrase in Ecuador that corresponds to being a guinea pig. He expects, given his demand, that the hospital will add more bilingual programs. The hospital will assess results when his program hits its two-year mark in September.
Kuban says he already considers Torres a huge success, and that the next physician hired in his department will be bilingual, to help fill the overwhelming demand for Torres.
As for himself, Torres says simply: “I’m completely, fully, what is the word? Realizados!” That means satisfied.Michael Fitzgerald is a frequent Globe contributor. E-mail him at firstname.lastname@example.org.