Monday, April 27, 2009
Cultural Health Literacy
Our gardener is from Honduras but he speaks excellent English as a second language and has lived in the U.S. for many years. Despite this, his understanding of medical issues is quite limited, both by language and education. Today we were talking about the Swine Flu outbreak in Mexico and I was giving him what I thought was simple education. The conversation switched to immunizations and that is where I realized even simple explanations didn't work.
Raul believes he had a vaccination for Tuberculosis at a local community clinic before he recently returned to Honduras for a visit. He also had another vaccine that he has no idea what it was. I explained the TB skin test to him and the fact that there are no vaccinations for TB. (Actually in some foreign countries they do vaccinate with a drug called BCG but it is not used in the U.S.) He insisted that he tested negative for TB but was given 8 months of pills to take as a vaccine.
I am clear what happened. Tuberculosis exposure is treated with INH (Isoniazid) pills daily for 6-8 months. He probably had a positive TB skin test and because he travels back and forth to a TB endemic area he was given INH for "latent" TB and to prevent active infection.
This is not what we know of as a vaccine. Even more worrisome is the other vaccine that he received for unknown reasons. It could have been tetanus, polio, yellow fever or measles. And we have no idea what preventive immunizations he is missing.
Very few patients, no matter where they are from, remember when and where they were vaccinated. As a comprehensive Internist, I keep a record on my patients but fewer and fewer patients have a continuity physician. Patients who are seen at various emergency rooms, urgent care, travel clinics or other community clinics have no real records to fall back on.
At the very least, patients should be given a laminated card to carry in their wallets that list immunizations and dates. This should be standardized across the U.S., much like a drivers license. Is that so hard to do?
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