Editorial Publications Archive

by Nora Esteban-Cruciani, MD, MS; JNHMA Editorial Board

November 2024

This fourth issue of the Journal of the National Hispanic Medical Association reflects the collective effort of “unsung heroes” nationwide, working to empower Hispanic individuals and populations to take control of their health and well-being through community involvement and culturally relevant approaches.

As a pediatrician leading a perinatal newborn section, I witness daily—beyond just the statistics—how rapidly the Hispanic population is growing, making it increasingly urgent for all of us to advocate for and address the unique public health challenges they face. This collection of articles highlights crucial areas of focus—voting rights, social media engagement, health fairs, unique case discussions, cancer treatment adherence, and representation in medical education—all of which intersect to empower the Hispanic communities and improve overall population health.

The importance of civic engagement, particularly voting, is underscored in Alvarez's article, which emphasizes the barriers Latino medical professionals encounter. These obstacles not only affect their civic participation but also hinder efforts to advocate for policies that promote health equity. By providing tangible solutions to reduce these barriers, we can enhance the collective voice of healthcare professionals dedicated to serving Hispanic populations.

In an age where misinformation can rapidly spread, Gonzalez-Arias advocates for leveraging social media to combat health disparities related to diabetes and obesity among Latinos. Culturally sensitive health promotion through these platforms can empower individuals to make informed choices, but it is essential to address access disparities. Collaboration among healthcare providers and public health officials is vital to ensuring these efforts are effective and equitable.

Khurana's study on health fairs reveals the power of community-driven initiatives in understanding and addressing the barriers faced by the Hispanic population in Metro Detroit. The high prevalence of chronic conditions and the significant barriers to care—such as lack of insurance and language challenges—highlight the necessity for targeted interventions. Health fairs not only provide critical health services but also foster community engagement and empowerment, serving as a model for similar initiatives nationwide.

The experiences of Hispanic breast cancer survivors, as explored by Granda-Cameron, underscore the complexities surrounding treatment adherence. The qualitative insights reveal significant gaps in patient education and communication, particularly for Spanish-speaking patients. Culturally competent care, characterized by trust and understanding, is crucial for improving adherence to endocrine blocking therapy and ultimately enhancing survival rates in this vulnerable population.

Moreover, the representation of Hispanic faculty in medical schools, as reported by Romero, raises concerns about the disparities in academic medicine. Despite a growing Hispanic population, faculty representation has increased only marginally over the past 50 years.

This underrepresentation perpetuates a cycle of inequity, limiting mentorship opportunities and affecting the cultural competence of future physicians.Finally, Solano's exploration of artificial intelligence in clinical practice highlights the potential for technology to improve patient care, especially within Spanish-speaking populations. While AI tools can alleviate some administrative burdens, careful consideration of their implementation is necessary to ensure they meet the needs of diverse patient populations.

Together, these articles illuminate a pathway toward a more equitable public health landscape for Hispanic communities. By overcoming barriers to voting, harnessing the power of social media, fostering community engagement, ensuring culturally competent care, and promoting diversity in medical education, we can create a more responsive and empowered healthcare system. The goal is clear: to enhance the health and well-being of Hispanic populations, decrease disparities, and promote health equity for all.

by Roberto "Bert" Johansson, MD, PhD, FAAP; JNHMA Editorial Board

April 2024

This special third issue of the JNHMA focuses on the ongoing migration crisis at the US-Mexico border from a variety of informed perspectives, including additional theorization and original research centered on clinical means in which language and cultural issues influence patient care.

Migration across the US-Mexico Border is not new. For millennia, indigenous people have used natural passages, riverbeds, and arroyos to traverse the harsh environment of the Chihuahua and Sonoran deserts in search of water, arable land, game, and to escape social unrest. After colonization by Europeans, and the subsequent establishment of new geopolitical borders, migration patterns changed, and many were prohibited. But the establishment of Nuevas Fronteras did not deter people in search of work or a better life in the Milagro del Norte. For many decades, this was the case for many Mexican workers who travelled north to the United States, many under the auspices of the Bracero Program, a US government program welcoming migrants to enter the US legally as temporary workers. Agricultural farm workers were able to migrate to work on both sides of the border. Although the Bracero Program ended in 1964, the northbound migration has continued. In the early 1980’s, political unrest, civil wars, economic oppression, and climate change forced people from beyond Mexico—Central America (e.g., El Salvador, Honduras, Nicaragua), South America (e.g., Venezuela, Colombia), and the Caribbean (e.g., Haiti, Cuba)—to look North.

Once in the US, a person is “in custody” and can seek asylum, not refugee status. Refugee status is an application that takes place outside of the US and provides specific legal protections. Asylum seekers do not have these protections and will often, ultimately, be seeking refugee status. Although we speak of a migrant crisis, being a migrant implies choice in leaving one’s country. For many, the compelling reasons outlined above have taken away their choice. We may instead be confronting a refugee crisis.

In custody, medical exams are conducted. With varying medical needs, these exams are often woefully less than many migrants need. Unfortunately, critically ill children and adults have died because of illness while in custody. After their long journey through the Darien Gap and Chihuahuan Desert, many have nutritional deficiencies (e.g., iron deficient anemia, micro and macrocytic anemias) secondary to protein and calorie deficient diets. They have also endured physical and psychological abuse and trauma. Compounding matters, tropical diseases are common—Chagas Disease, Leishmaniosis, intestinal parasites, and other illnesses not often seen and cared for by healthcare professionals in the US. Chronic illness such as Type 1 and Type 2 diabetes, COPD, and newly diagnosed illness such as adenocarcinoma of the lung, leukemia, and lymphoma may also afflict new migrants. Contrary to the misinformation from anti-migrant news sources, the overwhelming majority of new migrants do not have the resources to access medical care. We, as a society, must ask ourselves, “How can we help these new arrivals to our country?” How can we reverse hostile anti-migrant sentiment?

Migrants may be deported or may be accepted for an asylum hearing and live in the US while they await their court date. Some may stay in US border communities such as El Paso, TX, this writer’s current hometown. In El Paso, religious organizations like Annunciation House (currently under investigation by the Texas Attorney General for violating state immigration law) and Sacred Heart Catholic Church—both under the auspices of the Archdiocese of El Paso; and nongovernmental organizations, such as, Hope Border Institute, Las Americas, and others, provide medical care and assist migrants to reach their destinations within the US. Groups such as the Migrant Clinicians Network help and support migrants along their journey. When migrants arrive to their destination cities, some by politically motived anti-sanctuary city stunts, a variety of challenges greet them. With few exceptions, migrants currently crossing the US-Mexican Border 2 Journal of the National Hispanic Medical Association, Volume 2, Issue 1, 2024 are limited English speakers with those from Central and South America speaking Spanish or native languages such as K’iche and Lenca. They may find themselves in harsh agricultural, poultry, or meat processing working environments, with scarce medical resources and limited language or social support. Some may find themselves in large metropolitan areas, such as Los Angeles, Chicago, or New York City, but even in these cities the “systems” are overwhelmed.

We hope that this edition of the Journal of the National Hispanic Medical Association presents facts and thoughtful perspectives on the impact of current immigration issues on health. We invite an open dialogue on problems and potential solutions. Articles in this Journal include contributions from the Migrant Clinicians Network, a network of concerned, compassionate, and committed healthcare workers who support migrants from the time they cross the Border to the time they are settled safely in the US. Additionally, we have a contribution from Unsettled, a group of physicians from across the US who care for the health needs of new migrants. Unsettled was founded and organized by Dr. Judith Flores, ChairEmeritus, National Hispanic Medical Association Board. Collectively, these articles present a multi-faceted and informed view of what it means to provide medical, social, and psychological care to new arrivals to our country, a country of migrants.

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by Ana Maria Lopez, MD, MPH, MACP, FRCP (London); JNHMA Editorial Board

November 2023

This second issue of the Journal of the National Hispanic Medical Association includes several articles important to our community. The manuscripts range from language access to mental health, diabetes, colon cancer, mentorship, and climate change.

As an oncologist, my attention was drawn to the paper on The Impact of the COVID-19 Pandemic on the Presentation of Colorectal Cancer in the Puerto Rican Population. From an oncology perspective, a diagnosis of colon cancer is a failure of screening efforts. Screening identifies disease early before symptoms are apparent. The carcinogenic process for colorectal cancer has been well-delineated and is estimated to be in the range of ten to fifteen years. Colorectal cancer screening with a colonoscopy provides an opportunity for early detection of a malignancy and for treatment of a premalignant lesion. If a colonoscopy is not feasible, stool-based tests are also available.

The recently updated recommendations by the U. S. Preventive Services Task Force (UAPSTF) take into consideration cancer risk across the lifespan. As younger people are being diagnosed, the age for screening onset has dropped to 45 years of age for persons at average risk. Persons with a family history or a genetic mutation should speak with their doctor regarding when to start screening. As people are living longer and living well longer, screening can continue to age 85 based on clinical judgment and shared decision making. Individual factors that can be taken into consideration include the person’s overall health, prior screening results, and life expectancy.

According to the Centers for Disease Control and Prevention (CDC), in 2020, just over two-thirds of eligible adults were up to date on colorectal screening. According to the CDC, a 10% increase in screening, would result in a 20% drop in colorectal cancer diagnoses, a 30% drop in deaths, and a drop in health care costs.

Despite these benefits, less than half of Latinos/Hispanics eligible for colorectal screening have been screened with only a third of diagnoses being in an early stage. With the shift to younger age of diagnosis, Latinos/Hispanics experienced the greatest increase in colorectal cancer incidence in those 20 to 29 years of age (Montminy). Co-morbidities such as diabetes and being overweight appear to increase risk along with hereditary and lifestyle factors (sedentary lifestyle, limited fruits and vegetables, processed meats, and increased psychosocial stress).

The article by Martínez-Valcárcel reminds us that barriers to screening, such as the COVID-19 pandemic, delay diagnoses and result in advanced disease. We work with our communities to increase colorectal cancer screening and other cancer screenings because screening and vaccinations save lives.

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by the JNHMA Editorial Board

April 2023

Medicine in the 21st Century is complex. Our patients and our communities are facing multiple barriers to health. Our job as health professionals requires collaboration, compassion, and a commitment to betterment for our patients and for ourselves. That was the seed that gave birth to the Journal and the words that you are reading today.

NHMA members work to improve the health and well-being of Hispanic populations locally, regionally, and nationally through mentorship, education, healthcare delivery, and advocacy. As health professionals who care for Hispanic patients, we are committed to improving Hispanic health. If these words resonate with you, welcome! The Journal of the National Hispanic Medical Association (JNHMA) is for you. The JNHMA will provide a forum for idea sharing, research findings, and advocacy for our diverse Hispanic communities.

As a virtual link where members can engage to share unique perspectives and best practices, the JNHMA seeks to publish peer-reviewed articles that impact Hispanic health and looks forward to reviewing your contributions. JNHMA is an open-access journal published online to support universal access. Articles are reviewed and published on an ongoing basis. The articles may focus on clinical, educational, research, or community aspects of Hispanic health. It is our goal that the articles published within these virtual pages will advance knowledge to improve Hispanic health. We are intentionally not specialty specific. We acknowledge the importance of interprofessional teams in optimizing care for our patient population. We are committed to intergenerational growth and mentorship, as an investment in our children’s future.

We welcome studies across the full spectrum of clinical experience from health to illness and back. We encourage an understanding of translational research from bench to bedside and bedside to bench. We welcome insights from our communities that give real, on-the-ground perspectives to scientific knowledge gained. We consider health and illness to include multiple factors, including but not limited to, biological, emotional, social, cultural, and economic. The work presented in the Journal is expansive. The focus is narrow: Hispanic health.

During this year’s NHMA Conference 2023, we welcome the Journal; we welcome you, the reader; and we welcome you, the writer. Together, let’s make a difference!

Sincerely,

The JNHMA Editorial Board

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