Diversity & Equality in Health and Care Open Access

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From Puebla to East Harlem: healthcare for a rapidly emerging community

Mitchell H Rubin

In the winter of 1998, the first of many Mexican families arrived at one of New York City’s Health and Hospitals Corporation clinics in East Harlem. This paper traces the author’s 10-year experience of addressing and serving this unique community as director of this clinic. Finding a most willing ally in the New York City Mexican Consulate, which arranged visits to Mexican healthcare centres in California, Chicago and Mexico, he acquired the cultural competencies that allowed him to make appropriate adjustments to his clinic’s practice. At Oakland’s La Clinica de La Raza (‘the Clinic of the Race’ – that is, Mexican race), family structure and machismo were elucidated. In Chicago, the mental effects of emigration were depicted. However, it was not until the author visited Mexico that the full picture emerged. Socio-cultural values with regard to the experience and expression of illness, including gender roles and stoicism, were demonstrated. Systems and structures of healthcare networks, as well as patient expectations, were identified. Conditions that included obesity, diabetes, asthmaand mental illness were explored at Mexico’s referral centre, the National Institute of Health. First-hand knowledge was brought back and incorporated into the expanding family health centre. As Mexicans came to represent nearly onethirdof its patient population, the centre was rededicated and renamed La Clinica del Barrio (the clinic of the neighbourhood). It is now recognised by the State of New York Legislature as providing community-responsive healthcare for the people ofEast Harlem. The paper outlines one particular approach to the achievement of culturally competent healthcare, andcloses by linking this development to the broader aims of the Office of Minority Health.