In honor of the upcoming World Day for Cultural Diversity for Dialogue and Development on May 21, we join in celebrating the many cultures of our world and community.
As we’re all part of different cultures, we’re also all unique. In hospice care, we embrace every single person as an individual. At Suncoast Hospice, a member of Empath Health, our teams provide understanding, respect, compassion and every effort to meet our patients’ specific needs and to support their families.
In this Q&A, Suncoast Hospice physicians Jasmin Jerez-Marte, MD, medical director of two of our south county care teams, and Juan Escobales, MD, serving at our mid-Pinellas care center, discuss culturally-competent care, their care experiences with different cultures and the ways our teams enhance quality of life for everyone in our care.
1. What’s your background?
Dr. Jerez-Marte: I’m an internist. I graduated from residency in 2005. I’ve practiced in primary care, hospitals, offices and nursing homes. I moved to Florida two years ago and did primary care in Bradenton.
In primary care, I had patients under my wing and remained in their journeys almost until the very end, educating them about getting into hospice early rather than too late or managing their hospice needs. I let them know it was a transition to a different approach to care and we weren’t abandoning them. They had great satisfaction. I joined Suncoast Hospice in October 2015. It has been a great fit.
Dr. Escobales: I did private practice in family medicine for 38 years. I also served in the Air Force for a couple of years as a Captain, Major and first assistant in surgery.
In family medicine, I delivered babies, helped in surgery and helped people of all ages get better with their illness. My mission then was to keep them functioning, healthy and away from dying. After I finished my practice, I didn’t want to stop. It just happened accidentally that I came to hospice. Otherwise, had I known better, I would have started in hospice from the beginning.
2. How can physicians and teams provide culturally-competent care?
Dr. Jerez-Marte: There are some trainings in medical schools and language classes. You have to see a patient as a patient. There’s no difference in meeting a patient’s basic needs. We must make that effort to connect with our patients. They’re coming to us for care and advice and we can’t assume anything. We must be kind, sensitive and gentle in our approach.
Dr. Escobales: Across the nation and worldwide everybody’s working on it. When I was in private practice we were asked to take courses. The world is getting so small. There’s a need for it.
We need to respect our patients and families. When you address the Hispanic population, you address a person by title and family name to give “respecto.” With the Asian population, you bow to them to show respect. In other cultures, you have to pay attention to eye contact, tone of voice and names. If they are a minority culture, particularly if they are black, Asian or Hispanic, they may feel more left out from society and that people might not follow through and deliver. But if you make an effort, they feel you’ve earned their trust. With any population you have to be friendly and warm with them and show genuine interest in their situation.
With regard to Latinos, you also have to factor our unique sense of time; it’s more global and indefinite. In hospice, it’s important to address the spiritual side of the physical problems. Healthcare providers in general tend to discount the supernatural of culture and that doesn’t work. We have to ask them what they need and show compassion.
3. What are some beliefs and barriers of hospice with diverse communities and how can you help bring understanding?
Dr. Jerez-Marte: The word hospice means different things to different cultures. It’s called “hospicio” in Spanish, and it can mean nursing home or orphanage. Understanding what hospice is can be the first barrier to overcome. A lot of times with African-American families, they think when they call for hospice it’s the “death squad.” Family members may be close to death but they don’t want to be taken out of the home. We must talk with families and understand their backgrounds and cultures so we can take care of the patients’ needs.
Hospice is such a harsh word and hard to accept for many people. We talk about our mission and find out about our patients’ life, goals, needs and expectations. We let them know we can help them through the process in comfort. We’re there to celebrate their life and support them in their dreams and wishes. It’s about how they want to take control, what they want to do and how we can help make it happen. We do some amazing things. When people come to hospice, we provide emotional support and relief. They can relax, let go and enter that last phase in dignity.
Dr. Escobales: In the end we’re all the same. That’s how I approach minority populations when they have difficulty accepting the end of life. I tell them we’re all going, but at least they know when and have the time to say goodbye to their loved ones.
4. How do you discuss advance care planning with your patients and families?
Dr. Jerez-Marte: I want to think people come to us with their plans in hand, but surprisingly many don’t. A lot of times my visits are just for that purpose. Many times with Hispanic families, the moms are the matriarchs calling the shots, the dads ask for support and the kids are making those decisions. Parents will think the kids just know what they want. Our discussions must be patient and family-centered. Our role is not to be pushy. It’s on their own terms at their own time.
Dr. Escobales: We had one black patient who was dying with cancer at our care center. She didn’t have a DNR and she expressed to her family that she wanted to be treated until the end. She went to the hospital and died there. That was her wish. Sometimes, we try to do what we think is best, but then you’re going against people’s wishes and they will lose trust in you and the system. You have to listen.
5. What are the most important responsibilities of your job as a hospice physician?
Dr. Jerez-Marte: Helping our teams to make the right recommendations in order to guide their treatment; creating a culture of compassion and competency; and being a resource, guidance and channel for them to be able to communicate with each other so they can have rapid response to the patients’ needs. It’s a relief to our patients to be taken care of immediately and for our nurses to have what’s available to take care of our patients.
6. What qualities should hospice team members possess?
Dr. Jerez-Marte: I always put compassion at the top. You shouldn’t do this job if compassion isn’t driving you. You must have patience, competency in the field and a desire to learn, bring ideas to the table and apply your knowledge to care. You also need to be a team player; you can’t do it all yourself.
Dr. Escobales: Mainly to be empathetic, compassionate and a good listener. And to define what a person needs and wants, more than what you think is best for that person.
7. How do your teams comfort and support patients and families?
Dr. Jerez-Marte: I have great teams. Our social workers follow our patients and families and help us meet their needs. Our chaplains each have their own style in helping with spiritual needs; one sat down and sang with a patient who recently passed away and one nurtures, listens and provides spiritual guidance. Our nurses are so amazing and available and that’s a comfort to our patients and families. They give such hard work and selflessness putting our patients first.
8. What are the most valuable lessons you’ve learned in your job?
Dr. Jerez-Marte: I’ve had a great learning experience. I’ve learned resiliency, acceptance and the meaning of quality of life from our patients and nurses. People are still grateful despite these difficult situations. It was meant for me to be here.
It is time for hospice?
We’re here to talk with you. Give us a call at (727) 467-7423 or go online to request services.