As a little girl, growing up in a household filled with family from various parts of Latin America, food was a major part of our lives. Celebrations, anniversaries, major events, all involved food.

Later, as a graduate student studying to be a speech-language pathologist, part of my training in my hospital internship involved administering tests to assess that patients could chew and swallow safely. Those evaluations involved having patients swallow a small amount of various food and drink consistencies. I knew how important the ability to taste and swallow food was, and appreciated the opportunity to be a part of the team that could help navigate their way back to eating and drinking safely. 

I was doing fine in conducting these assessments until I had an 82-year-old Chinese patient who refused to drink the small amount of cold water I provided. I tried to explain the importance of the evaluation and yet she continued to refuse. I was stumped until a colleague shared that in Chinese culture, it is viewed as harmful to drink cold beverages when you are sick. I was asking that patient to ingest cold food and beverages, which violated her understanding of medicine and healing. That experience with the Chinese patient highlighted how a lack of cultural awareness can impact the most basic of needs; swallowing. 

If you grew up in a Chinese home (or many other nationalities), you likely rolled your eyes when you read the words “cold water.” You have knowledge that exists simply by growing up in your home environment. I have that same knowledge for my community. I am named after my great-grandmother; a curandera (healer) in the mountains of El Salvador, who only had a formal education up to first grade. For her whole adult life, people travel from surrounding villages to be healed by la niña Marcela. I grew up using herbs that have no English names, and having my mother and aunts use everyday herbs like garlic for multiple healing purposes. I have also been a practicing speech-language pathologist (SLP) for 17 years, and have taught future SLPs for more than 11 years. 

As a minority in my field (92% white), my upbringing has provided an awareness that a majority of my colleagues lack. 

The American Academy of Family Physicians has highlighted health outcomes that are improved when people have similar racial, ethnic, and linguistic backgrounds, and that medical professionals from underrepresented backgrounds are more likely to serve their own communities. Conversely, multiple studies have shown that lack of diversity in these fields has caused harm to underrepresented communities. In June, the White House put out a document outlining the maternal mortality crisis, highlighting that Black women were three times more likely to die from pregnancy related complications. Using U.S. Centers for Disease Control data, the White House also reported a concerning increase in Latina maternal mortality. They noted that while mortality rates increased across the board in 2020, Latinas saw an increase that was over six and a half times that of their white counterparts.  They cite an “exceptional lack of diversity” in the medical profession as a contributor to this crisis. 

From the Coronavirus pandemic to maternal mortality rates, how long you live and your chances of dying are directly tied to your race. A clear example exists in the Cambodian community experience in my hometown of San Jose, California. 

NPR recently released an episode from their Invisibilia series called “Therapy Ghostbusters.” That episode revealed the alarming statistic that in one community clinic, 90% of Cambodian clients were taking anti-psychotic medication. As explained in their podcast, although the Cambodian genocide killed an estimated 1.7 million people in the 1970’s, the doctors treating the patients were not aware of this community trauma. Their western medical practices, or, “allopathic care” combined with a lack of cultural awareness meant that when doctors heard their patients speaking of “ghosts,” or “spirits,” they chalked it up to psychosis and prescribed medicine as opposed to treating these families for the real problem, post-traumatic stress disorder (PTSD). As highlighted in the podcast, those medications exacerbate pre-existing medical conditions and did not address the underlying trauma that generations had experienced. 

While the symptom in the case of Cambodian patients was the wrong medication prescription, the cause was lack of knowledge, and lack of diversity. Doctors, therapists, and other medical professionals shape who we are and how we live in the world. When these professionals view the world through a single lens, especially a majority-framed lens, they marginalize other people. The concept of culturally and linguistically concordant care, which focuses on providers coming from the same cultural, racial, or linguistic background, is beginning to emerge as a necessity in the field of medicine. The Health Resource and Services Administration highlighted the need to provide racially concordant care while recognizing that medical fields are not graduating sufficient medical practitioners of color. At the same time, the Supreme Court is sending signals that it will eliminate the practice of considering race in college admissions. This practice would likely decrease diversity in health care professions, especially among Black, Latinx, and Indigenous people. While increasing diversity in these settings is not the only cure, it will have a major impact in the experiences of people and communities. 

To be sure, increasing racial and linguistic diversity alone is not a panacea. In order to close the myriad gaps in health outcomes, we have to address social inequalities, geographical access to high quality healthcare, and increase the number of providers in general. But, health care systems  and the universities that feed into them should recognize the resources that diverse providers bring; in language, personal experience, and culture. I continue to work with a multicultural and multilingual community, but my strength lies in my ability to connect with my Spanish-speaking families, and our connection can’t be replicated by mere training. 

Opening doors to more people from various communities will help decrease poor health outcomes, and increase trust between patients and doctors, leading to better results. Until these changes happen, people will continue to be misdiagnosed, and patients will continue to be harmed, leading to shorter lifespans and poor quality of life. We all deserve the ability to celebrate with our families, and live our best lives. Increasing diversity within healthcare professions will help us live longer, and celebrate more years with people, music, and food.

Marcella Cardoza McCollum is a bilingual speech-language pathologist, and assistant professor at San José State University. Her research interests focus on access of underrepresented student populations...