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Reaching the Underserved Through the Media


 

NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls.

In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.

But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.

“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.

Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care.

Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages.

“The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.

The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next.

So, “I thought, why can't we sell health like we sell shoes—through the media?”

In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention.

The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.

In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears.

During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter. “How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.

Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month.

Each day, he broadcasts clear, easy to understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.

Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center.

The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis, he said.

You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.

Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.

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