2013-2014 REPORT

University of Kansas Medical Center

Department of Preventive Medicine and Public Health

November 2014

Notes from the Director In 2011, JUNTOS Center for Advancing Latino Health came into existence at the University of Kansas Medical Cen-

ter to join forces with outstanding organizations with the overarching task of addressing health disparities faced by

Latinos in the state of Kansas. At JUNTOS we have an important role to play in strengthening our Latino communi-

ty – a task that cannot be accomplished alone. We strongly believe that we would not exist without the essential

support of our friends, partnering organizations, donors, and funders. Moreover, we would not be successful with-

out the commitment and support from staff, departments, and centers at our University of Kansas Medical Center.

Our gratitude to the research collaboration with Drs. Ellerbeck, Engelman, Choi, Collins, and Cox among others. We

continue to hold strong implementing our four core objectives: Objective 1: Develop a sustained program in community-based participatory research to advance Latino health

in rural and urban areas of Kansas

Objective 2: Reduce cancer-related disparities among Latinos by advancing research on cancer screening, smoking cessation trials and disseminating cancer prevention messages among Latinos in Kansas.

Objective 3: Promote educational programs of existing and future health care providers in Kansas to master cultural competency and provide high quality care to Latinos..

Objective 4: Develop coordinated bilateral efforts between KUMC and Latin American countries (primarily Mexi-co) to pursue research, teaching and clinical excellence in the field of Latino health.

During this year, we have achieved our objectives by solidified important partnerships including our work with the

Mexican Consulate, Ventanilla de Salud, Universidad Autonoma del Estado de Morelos, Universidad Autonoma del

Estado de Hidalgo, Riverview Health Services, Inc, Enroll Wyandotte, ACS/NFL Promotores de Salud, Latino Health

for All, Duchene Clinic, Samuel U Rodgers Health Center, KUMC Healthy Living Kansas, KUMC Office of Cultural

Enhancement and Diversity, KUMC Office of International Programs, k-12 KUMC pipeline, and Children Mercy Hos-

pital - Offices of Equity and Diversity and Adolescent Medicine.

A special acknowledgement goes to every single organization or individual

that interacted with JUNTOS in the previous year. In special we must ap-

plaud our team Liliana Abdualla, Johana Bravo, Mariana Ramirez, Arturo

Ponce, Ramiro Diaz, Brenda Cartujano, Alejandro Gutierrez, Victor Mar-

tinez, Andrea D’Achiardi, Stefany Paredes, Sophy Paulino, Fabiola Hernan-

dez, and Luis Barboza. Thanks to our amazing interns for all the energy

and support they bring Idaima Calderon, Abril Negrete, Andros Garcia,

Ruth Pedraza, Montserrat Jimenez, and Jehieli Arteta. Finally, to Joanne

McNair, Marilyn Painter, and Glenn James for their incredible support as

a part of our Department of Preventive Medicine and Public Health.

Thanks to your support, collaborative work and friendship we received the

Community Engagement faculty Award for excellence in Developing En-

gaged Scholarship Initiatives in 2014. It is an honor to work with and

learn from each one of you. I strongly believe JUNTOS is just in the begin-

ning steps of much more to come. Looking forward to 2015!

Sincerely,

Paula Cupertino

Affordable Care Act Counselors at Juntos

Enroll Wyandotte is an effort led by the Community

Health Council of Wyandotte County to provide in-

formation and resources, and ultimately promote

enrollment in the new health insurance market-

place created under the Affordable Care Act. Jun-

tos joined Enroll Wyandotte efforts to increase en-

rollment among Latino Kansas residents. A total of

8 bilingual staff members received training to be-

come ACA counselors and assisted in the educa-

tion and enrollment efforts. Throughout the

months of October 2013 to March 2014, Juntos

counselors assisted a total of 50 Latino Kansas

residents and provided education to many others.

In March 2014, Juntos co-sponsored the ‘ACA To-

day” Health Fair. The health event took place at

the Memorial Hall in Kansas City, KS were many

health care services and free health screenings

were available to participants, in addition to assis-

tance to enrollment in the health marketplace.

Extensive planning took place to provide all coun-

selors with personalized computers for enrollment.

A total of 25 stations were setup, and the event

was very successful with a total of 200 partici-

pants attending

the event.

KUMC post bac-

calaureate stu-

dents Carlos

Pacheco and

Scott Ogan

worked together

with Arturo Ponce

to assess aware-

ness, knowledge,

and intention to

enroll among Lati-

nos in rural and

urban areas.

Juntos will continue to collaborate with Enroll Wyandotte during

the enrollment session for 2015. Contact us for enrollment

events and referrals at (913) 945-7874.

ACA KNOWLEDGE AND INTENTION TO ENROLL AMONG LATINOS (N=107)

Among Latino urban and rural resi-

dents less than 50% believe the

ACA will increase the quality and ac-cess to health care

Less than 20% knew that Kansas

has not expanded Medicaid.

Even though 77% of Latinos are

aware of the penalty fine for not ob-

taining health insurance, only 50% reported intention to enroll in the ACA.

Overall, Latinos are fairly familiar with most aspects of the new health care law, but rural residents are less likely to enroll compared to urban residents.

VENTANILLA DE SALUD

Improving the health of Mexican immigrants in the US

Kansas Latino Population

‘Average age of US Latino immigrants: 27 years old’ - Hispanic Pew Research

31% At high risk of

diabetes

82% Overweight or

obese

26% Hypertension

10% Diabetic

The Ventanilla de Salud (VDS) program was designed to

improve the physical and mental health of Mexicans living

in the US and to increase access to primary and preventive

health resources. We continue our efforts in Southwest

Kansas and counties of high concentration of Latinos. We

provide free access to basic health needs, and culturally

sensitive information on specific health topics such as;

healthy lifestyles, breast cancer, skin cancer, STDs, smok-

ing cessation, diabetes, and hypertension. In 2013-2014,

Juntos organized 11 events reaching a total of 1,504 Lati-

nos. Our local partners, promotores, and research staff con-

tinue to assess health, educate on healthy lifestyles, and

their risk for developing chronic diseases. Participants at

high risk of developing any chronic disease are referred to

UMMAM, the local bilingual safety net clinic.

We continue to better understand the health needs of the

Latino community across Kansas to better served them,

and provide the necessary resources to build a healthier

community.

Demographics of Participants Frequency

Percentage

Average age (SD) 39 years old (11.3)

Female 899 (60.5%)

Mexican 1,425 (95.0%)

Recent immigrants < 10 years in the US 360 (27%)

Less than high school education 979 (65%)

Have health insurance 436 (29%)

Findings (N=1504)

10% are current smokers

50% have unhealthy lifestyles, overweight

and/or not physically active.

51% have not heard about HPV

Only 12% have been vaccinated for HPV.

59% don’t know if they’ve received a colon-

oscopy or FOBT in the past.

Only 31% of women over the age of 40

have performed a mammogram in the past

2 years.

Wichita

Garden City

Great Bend

Wyandotte

Kansas Latino Population

Second Generation—VDS para Niños The University of Kansas Medical Center, Children’s Mer-

cy Hospital, and the Mexican Consulate in Kansas City,

MO joined together to develop Ventanilla de Salud para

Niños in August 2013. Dr. John Cowden, pediatrician

from Children’s Mercy, Co-PI of the project has joined with

Juntos research staff to implement the specialized and

culturally relevant program for Latino families with chil-

dren in rural Kansas. Two medical students from Mexico,

Alejandro Gutierrez and Victor Martinez, helped pilot test

and evaluate the program. Research Intern Idaima Calde-

ron has also been collaborating on this project, focusing

on obesity in Latino children in rural Kansas.

This multidisciplinary team of researchers developed and

implemented the evidence--based community-based par-

ticipatory research program focused on five pediatric

health themes: vaccination, obesity/nutrition, dental

health, reproductive/sexual health, and behavioral/

mental health.

In February 2014, Dr. Romina Barral from Children’s Mer-

cy joined the team as an expert in adolescent health. She

will be conducting research on teen pregnancy prevention

among Latino adolescents.

Since the start of the pilot program, the team has as-

sessed the health needs of 177children from over 100

Latino families in rural Kansas, providing direct health

services and information on the program’s five health

themes. As the program continues to grow, the team will

be adding to the preliminary data shown to the right.

Wyandotte

In an effort to eliminate disparities in breast cancer among Lati-

na women, Juntos and Viva Saludable en Kansas launched the

A.M.I.G.A. program in January 2014; funded by the American

Cancer Society and the National Football League. The program

aims to decrease the incidence of breast cancer among Latina

women by providing information about breast cancer (particularly

breast physiology, screening, risk factors and prevention) and to

encourage women to utilize free and/or low-cost breast cancer

screening services available in the community.

The Promotoras de Salud that are participating in this effort are

Catalina Reyes, Lucia Martinez, Norma Paredes, and Gloria Cor-

tes. They are based at two safety net clinics serving a large pro-

portion of Spanish-speaking Latinas in the Kansas City metro

area, Duchesne Clinic and Cabot Westside Health Center. As

Latina patients wait for their appointments, Promotoras reach

out to them in a linguistically and culturally appropriate way.

From palpable breast models to bright breast anatomy illustra-

tions, Promotoras use different tools to explain the importance of

breast cancer screening for early detection in one-on-one ses-

sions where women feel comfortable to share thoughts and ask

questions. Promotoras encourage women to talk to their provid-

ers about their breast health, discuss their risk factors, and the

best screening tests for them. Overall, they work to empower

women to take control of their own wellbeing.

After their first contact, Promotoras follow up with every age-

eligible women they contact via telephone to make sure they are

able to complete their screening. When necessary, they navigate

women in scheduling appointments with their clinics or referring

them to other services and resources as needed such as Early

Detection Works which is part of the National Breast and Cervical

Cancer Early Detection Program. “Yo le voy a dar seguimiento, yo

no la voy a dejar” (I will follow up with you, I won’t leave you

alone) is the commitment they make with every women they talk

to.

Mariana Ramírez, MSW

Project Manager. Originally

from Mexico City, she coor-

dinates the activities for

education, outreach and

research under the

A.M.I.G.A. program.

Fabiola Hernandez, Stu-

dent Research Assis-

tant, is in charge of da-

tabase management for

the program.

A.M.I.G.A.

Program

A special thank you to the American Cancer Society and

National Football League for their support funding the

A.M.I.G.A. program.

INCREASING MAMMOGRAM SCREENINGS

FOR LATINO WOMEN IN KANSAS

The Promotoras de Salud are actively involved in their

community and conduct outreach in different health

fair events and at the Mexican Consulate every week.

They also partner with several organizations to host

breast cancer workshops where they share information

on healthy lifestyles to prevent breast cancer, explain

key concepts about cancer and refer women for free or

low cost mammograms. Some of the community part-

ners they have worked with include Westside CAN Cen-

ter, Parents as Teachers program, Guadalupe Center,

Iglesia El Sagrado Corazon de Guadalupe, and YMCA

Wyandotte.

Besides tracking all their activities, planning events,

and having weekly coaching meetings, Promotoras par-

ticipate in monthly training sessions about different

health topics in the Latino community. These sessions

are also conducted in collaboration with KUMC and

community partners such as Enroll Wyandotte, Alzhei-

mer’s Association, KanCare, and Kansas Family Part-

nership.

The Promotoras are extremely passionate and dedicat-

ed in the work that they do. They have surpassed pro-

gram outcomes, the following table shows how many

women have been contacted so far this year:

A TOTAL OF 157 WOMEN HAVE RECEIVED A FREE

MAMMOGRAM IN THE 10 MONTHS OF THE PROGRAM.

Thanks to the information that Promotoras collect, we

have been able to obtain a baseline with information on

the number of women current with their screenings, the

time it takes them to make an appointment and the

rate of completed mammograms. This information has

enabled the program to share with health care provid-

ers the lessons learned to improve screening rates and

address barriers to early detection in Latinas. Another

aspect of the A.M.I.G.A. breast cancer program is con-

ducting a study assessing effectiveness of the Promo-

tora model and its impact in Promotora skills such as

self-efficacy and health literacy.

Location Number of

women contacted

Health fairs and commu-

nity settings

694

Clinics 288

Total 982

Meet our A.M.I.G.A. Promotoras

Lucia Martinez, original-

ly from Chihuahua, Mex-

ico. Came to the US 8

years ago and is study-

ing to become a Nurse.

She is already CNA cer-

tified.

Norma Paredes, origi-

nally from Quito, Ecua-

dor . She recently

moved to Kansas and

is excited to work and

educate the Latina

women.

Gloria Cortes originally

from Mexico. She’s

been in Kansas for 11

years. She has being a

Promotora de Salud

since January and has

started her own clean-

ing business.

Catalina Reyes, from

Veracruz, Mexico. She

has being in Kansas

since 2006 and has

been a Promotora de

Salud for 6 years.

TRAINING FUTURE

HEALTHCARE PROVIDERS

Latino Medical Student Association

(LMSA)

LMSA at the University of Kansas School of Medi-

cine (KUSOM) serves the Kansas City community

and medical students interested in health care for

Kansas City's growing Hispanic population, as well

as other medically and socially underserved popu-

lations. LMSA is also committed to increasing en-

rollment and success of medical students from

diverse backgrounds within KUSOM. LMSA has

seen the support of the Office of Cultural En-

hancement and Diversity (OCED) and Juntos

throughout the entirety of their events. Members

of LMSA are highly involved in a variety of commu-

nity service activities and health fairs. Many have

an interest in learning Spanish and gaining valua-

ble experiences within the Latino community. Jun-

tos has helped us host one of the best programs

implemented by LMSA “60 Minutos” an inter-

professional medical Spanish workshop. Around

175 students have benefited from those work-

shops. "60 Minutos” was recently awarded the

Outstanding Campus Program of 2014. Juntos is

therefore, supporting future healthcare providers

and bridging the gap between Latino populations

and culturally competent health care providers.

by Stefany Paredes—LMSA secretary

Web-based comprehensive Medical Span-

ish Curriculum at KuSoM

While the number of Spanish-speaking patients in

Kansas continues to grow, Spanish speaking physi-

cians is scarce, and where existing, lacks rigor. Lan-

guage barriers are associated with decreased access

to services, lower patient satisfaction, limited adher-

ence to treatment and worse health outcomes. The

National Standards for Culturally and Linguistically

Appropriate Services (CLAS) mandate health care or-

ganizations to provide care to patients in their pre-

ferred language and in a manner compatible to their

cultural beliefs. Nevertheless, healthcare providers,

particularly those in states with large rural areas such

as Kansas, struggle to provide for Limited English Pro-

ficiency (LEP) patients due to workforce shortages

and rising costs. The need for healthcare providers

who are linguistically and culturally equipped to work

with an increasingly diverse patient population is a

public health priority.

Over the last two years, the University of Kansas

School of Medicine (KUSoM) experienced an expo-

nential increase in student demand for Medical Span-

ish as an elective course with 165 students enrolling

the past year. Unfortunately, Medical Spanish curricu-

la in healthcare programs tend to focus on mastering

lists of decontextualized vocabulary rather than on

communicative competence. Therefore, the Office of

Cultural Enhancement and Diversity (OCED) got fund-

ed to develop a comprehensive Medical Spanish pro-

gram rooted on second-language acquisition research

principles and focused on oral, aural, and cultural pro-

ficiency. Juntos bilingual research staff has been

providing support in the development of this signifi-

cant and important project to increase the number of

culturally competent providers for the underserved

Latino community of Kansas.

Binational Medical Exchange Programs

RUTH PEDRAZA, a second year

medical student at KUMC from Michoacan,

Mexico, wanted to go back to her country

to better understand the health care system

and get more clinical experience with a cul-

turally sensitive prospective. The summer

between the first and second year of medi-

cal school, students take the opportunity to

get involved in research or have an interna-

tional clinical experience. Ms. Pedraza, cur-

rent LMSA president, knew about the op-

portunities for a 6-week medical rotation in

Mexico with the different partnerships es-

tablished between KUMC, Juntos, the Uni-

versity of Morelos, and the University of

Hidalgo. She shadowed residents on high

risk pregnancy consults, and regular rou-

tine visits, assisted in cesareans, and deliv-

eries, and obtained colonoscopy training.

Ruth wants to become an OBGYN physi-

cian serving Latinos, and other under-

served communities in the US.

One of Juntos goals is to develop coordinated bilateral ef-

forts between KUMC and Mexican governmental and aca-

demic entities to conduct research, teaching, and infor-

mation exchange in the field of Latino health. In the past

three years, Juntos Director Dr. Cupertino has developed

important partnerships with the Universidad Autónoma del

Estado de Morelos (UAEM) and the Universidad Autónoma

del Estado de Hidalgo (UAEH) to mentor and lead Mexican

medical students at KUMC during their last year of commu-

nity service. In August 2014, we welcomed the fourth 6th

year medical students from UAEM, for a 1-year community

service program. Medical students from Mexico are im-

mersed in our community-based programs to increase

their understanding of public health initiatives for Mexican

immigrants in Kansas, develop skills and knowledge on

binational health initiatives, and conduct clinical shadow-

ing experience to enhance their understanding of the US

health care system.

In the summer of 2014, we connected a KUMC 1st year

medical student with Mexico. Ruth Pedraza was part of a

6-week medical rotation to better understand the public

health system of Mexico, and to get clinical experience in

OBGYN from the two medical universities (UAEM and

UAEH). In addition, Juntos is working with the international

office at KUMC to send 4 medical students in the 2014-

2015 winter break to complete their international clinical

rotation. Students will be matched with their specialties of

preference and receive one-on-one mentoring from spe-

cialized physicians in the respective hospitals.

Exchange programs with Mexican medical universi-

ties are available for medical students, MPH stu-

dents, KUMC residents, and faculty. The exchange

program agreements are for clinical rotation, basic

science research, trainings, and public health pro-

grams. If you are interested in taking part of an ex-

change program contact Liliana Abdualla at:

labdualla-martinez@kumc.edu or (913)945-7065.

THANK TO ALL OUR PARTNERS AND SPONSORS

Upcoming events

November 2014. For more information, please contact Lilliana Abdualla at labdualla-martinez@kumc.edu or (913)945-7065.

Juntos Center for Advancing Latino Health

University of Kansas School of Medicine Department of Preventive Medicine

and Public Health 4125 Rainbow Boulevard MS 1056

Kansas City, KS 66160

Liberal, KS Ventanilla de Salud Health Fair

Saturday November 22nd and Sunday November 23rd from

9:00AM to 4:00PM. Health fair providing educational material,

basic health screenings and doctors available on-site.

Kansas City, KS Affordable Care Act Enrollment Fair

Saturday December 5th from 8:00AM to 5:00PM at Memorial

Hall (600 N 7th Street Trafficway). Bilingual certified counse-

lors will be available for ACA enrollment. Additionally, educa-

tional material, and basic health screenings available on-site.

Garden City, KS Ventanilla de Salud Health Fair

Saturday December 13th and Sunday December 14th from

9:00AM to 4:00PM. Health fair providing educational material,

basic health screenings and doctors available on-site.