In many African countries, almost nothing related to healthcare is free. That’s why an offer of free medical tests and treatment upon an immigrant’s arrival in Spain can be met with skepticism. Recipients might wonder: will my fluids end up on the black market? Why do they need so much blood? When a doctor and a patient speak different languages, everything from explaining the reason for a pain to discrediting blood-trafficking rumors is a challenge.
Salud Entre Culturas is a pioneering healthcare program that was born in 2006 within the Tropical Diseases unit of the Madrid-based Ramón y Cajal Hospital. Its mission is to provide healthcare to people who don’t speak Spanish, and who have limited English and French skills. These are mainly sub-Saharan young men, but the program is open to all nationalities. The focus is on breaking the language barrier while getting past cultural differences. “Many do not know what hepatitis is. You talk about malaria and some think it spreads by water, or that AIDS doesn’t exist. Explaining dormant tuberculosis, diagnosing a chronic disease or telling them they need blood tests every six months is a hurdle,” says director Rogelio López-Vélez, MD.
López-Vélez leads a team of five regular professionals and several assistants. Translators participate in consultations with migrants who know only certain African languages. In this facility, up to 30 African languages have been spoken, as well as Romanian, Russian and Arabic. The immigrants’ most common countries of origin include Cameroon, Côte d'Ivoire, Guinea Conakry, Ukraine and most recently, Syria.
Suleiman, age 25, attended his first doctor’s appointment in Spain with two friends. “We were concerned about whether they would understand us and be able to come up with a diagnosis,” he says. “Now that we’ve been through this, we really appreciate the interpreting service. Translators are of tremendous help. Without them this would be extremely difficult and unreliable.” All three of them come from Guinea Conakry and say that learning Spanish is their top priority.
The program appeared at the same time as the cayuco boat crisis, when 39,180 people landed in small “patera” boats on the coast of the Canary Islands. Since then, healthcare professionals have treated more than 5,700 migrants and have created specialized workshops for nearly 10,000 people, raising awareness about issues such as TB, HIV-AIDS and sex education. In 2017, Madrid’s Health Council made the program official, recognizing the importance of cultural mediation and interpreting services.
Alongside López-Vélez, psychologist Anne Guionet, interpreter Bárbara Navaza and Doctor Miriam Navarro bolstered the initiative. Navarro, who no longer practices day-to-day medical care, still remembers their first steps: “From the very beginning, we realized the unease it caused for these people to have a heap of tests done with no one able to explain them in their own language, and all the misconceptions such a situation entailed.”
Migrants normally come for their first medical appointments thanks to the workshops they regularly attend, organized by members of Salud Entre Culturas at NGOs, shared flats or even local bars. The project started with sub-Saharan Africans and progressively opened up to other nationalities. “In these meetings we run quick HIV tests and organize themed talks based on the needs of our respective organizations,” Peña says. The team has started analyzing the impact of these workshops. Based on data collected by Navarro, at first only 47 percent of attendees acknowledged the existence of AIDS — a figure that rose to 95 percent at the end of the workshop.
Over the years, the project has received financing from public sources such as the National AIDS Plan and European funds, as well as from private investors and donors.
From university and jumping the fence
In 2008, Entre Culturas trained a group of Africans to become health and cultural mediators. This year, they were able to train four more. Serigne Fall of Senegal was part of the first group; the second one included Serge Hoys, a Cameroonian who joined in June. Their stories have a rather different starting point but converged in this unit. While Fall came to Spain from France, where he studied French philology, Hoys literally jumped over the fence at Melilla. They both ended up working for the organization.
“In Cameroon, there are over 187 official dialects,” Hoys says. “Imagine what it’s like to talk to people who only speak these languages. This is not just any job; the conditions in which the sub-Saharan Africans arrive here are tough. Some of them have never been to a medical practice, nor have they been admitted to a hospital or had a flu shot. This is what we need to be aware of,” he stresses. “We’re pushing for interpreters to become part of the public health system. A doctor shouldn’t have to draw a picture for a patient.”
Now the service’s greatest challenge is to follow up on treatments. “It’s a very unstable demographic,” López-Vélez says, “because they can only stay in foster homes in Madrid for 90 days at most…and many of them leave afterwards. It is important to adapt protocols.” For the time being, at least, the program has managed to remove linguistic barriers, and to convince patients that their blood is in good hands.