A graduate student breaks down cultural barriers, uniting patients and health care providers in common cause.
Jimmy Reyes traces his drive to foster communication and community to his grandmother’s influence.
“She taught me the importance of knowing your place in the world and what good you can do in it,” says Reyes, today a doctoral student in the University of Iowa College of Nursing. That service ethic inspires his focus on helping health care transcend differences in language and culture.
Reyes was born in Lima, Peru, the eldest of three. Fleeing violence and political turmoil, his family sent him to Chile and the care of his grandmother, Violeta.
A nurse by training, Violeta shared stories from her work with the nuns at a local church, how they would visit underserved areas and provide what care they could. For a young Reyes, social responsibility and community action were never far from mind.
“I remember when my grandmother showed me how to make a noisemaker from a can and some rocks,” he says. “At the time there were a lot of protests going on and I used to sit on her back porch and rattle that thing as a way of participating.”
After completing high school in Chile, Reyes joined his parents in Florida. He moved to Iowa to continue his education, starting at Kirkwood Community College in 2000, then transferring to the University for a BS in nursing.
While volunteering as a nursing assistant in a surgical cancer unit, he noticed that bilingual staff were fairly uncommon, and that patients’ family members weren’t always available to translate. Many patients spoke only Spanish—the intimidation that any patient might feel in the clinical environment was compounded for them.
The unfamiliar setting and communication barrier complicated pain management, especially when other cultural factors intervened. “I understood that some patients wouldn’t readily share their discomfort with someone,” Reyes says. “They know that they should tough it out for their family’s sake—the idea of machismo.”
Reyes responded to the problem creatively. He sought help from a friend in the Spanish department and after studying treatment options and pain assessment tools in both English and Spanish, developed a system of six cards with phonetically spelled terms and illustrations to help nurses characterize patients’ pain.
Nurses used the cards to ask patients about their pain levels, locations, and factors that made the pain better or worse. From there, they could provide proper treatment.
“It was pretty exciting when the nurses and patients responded to it,” Reyes says. The success prompted him to develop Spanish-language binders that offered patients information on treatment options and what they might expect in the unit.
The experience made it clear to Reyes that the best results come from a collaborative effort between patients and caregivers. “It’s not about raising cultural competence, but about establishing cultural congruency,” he says, noting the latter term’s focus on shared responsibility.
After graduating in 2004, Reyes returned to the University for a nurse practitioner license, teaching a small class at the College of Nursing and working with Proteus, a Des Moines-based nonprofit agency. Proteus worked with Iowa farmers who provided room and board for migrant workers coming up from Mexico.
The workers detasseled corn twelve hours a day. Reyes helped provide them with basic health care a few evenings a week.
“The workers faced different allergens, problems from heat and other ailments,” Reyes says. “Often they wouldn’t ask for a glass of water if they needed it. It’s part of the culture to put your head down and work hard.”
In time, Reyes gained the workers’ trust. With help from various institutional donors in Iowa City, he raised enough money to establish a temporary migrant health clinic. Later, he brought his students out to get some experience.
“They would be the primary caregivers, and I just hung out and helped as a interpreter if they needed me,” Reyes says. “It was professional work, but offered a social networking aspect that I think was very beneficial to all of them.”
Iowa’s supportive community encouraged Reyes to stay on for the dual PhD/DNP program he’s pursuing today. “The mentoring, the diversity, these are all things I’ve really taking something away from. This place works with all students and really promotes opportunities, and I try to give back in the same way to my students now,” he says.
While much of his work has focused on minority communities, Reyes emphasizes that effective communication and cooperation are essential principles that should guide care for everyone. “There needs to be ongoing dialogue between communities and health care institutions, caregivers and researchers,” he says. “In doing these things we hope to achieve more individualized care.”
Story by Steve Cain; Photo by Tim Schoon
November 9, 2009