WEST SACRAMENTO, Calif. _ On any given day at the Salud Clinic, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it's rarely in English. Sometimes it's Hindi. Or Dari. Or Hmong. Or Russian.
Maas is fluent in English and Spanish, but that gets her only so far. She often has to hop on the phone with a medical interpreter, who relays her questions to the patient and then translates the patient's answers. "It just takes a little more time," the nurse practitioner said.
The future of American health care looks a lot more like the Salud clinic than Norman Rockwell's iconic small-town doctor's office. The country is on course to lose its white majority around 2050. That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home.
Sacramento-area hospitals, community health centers and doctor's offices have had to adapt. They've hired more multilingual, bicultural staff. They've contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds.
When a diabetic pregnant Afghan woman wanted to fast during Ramadan, the Salud Clinic's nutritionist recalculated the best time of day to measure her blood sugar. If Mexican mothers say they're rubbing gentian violet on their baby's umbilical cord area to keep it clean _ a harmless natural remedy _ doctors encourage them to keep doing so.
Similar stories are playing out across California, which became majority minority in 2000. Health systems are using new data tools to get a better handle on just who they're serving _ and where the trend lines are pointing. County health departments, nonprofits and clinics have invested in recruiting and training bilingual community health workers.
Insurance doesn't always pay for the extra costs of services like translation. Patient visits take extra time, straining schedules for doctors and nurses. "You can't really help somebody if you don't understand how they value health, and how they understand health and the health care system," says Robin Affrime, CEO of CommuniCare Health Centers, the nonprofit that operates the Salud Clinic.
