Second Year PA Student Blog: Jose Carlo Esteban

Wednesday, April 24, 2019

Jose Carlo Esteban
Jose Carlo Esteban, PA-S

Navigating the Health Care System as a First Generation Immigrant

An elderly woman from China, who spoke little English, sat across from me and listened attentively to my counseling points of her new diagnosis of diabetes mellitus type 2. Her teenage grandson sat beside her and listened just as attentively.

He was writing down almost everything I said — which medications his grandmother would be on, how often she would need to check her blood sugars, what specialty visits she would routinely need to attend, what labs needed to be monitored, and what red flags to look out for that warranted urgent medical attention. It certainly was a frenzy of information, yet the grandson confidently spoke up with any questions that came to mind, and then translated anything his grandmother needed to address.

As I listened to the boy, his active yet mature engagement sparked memories of my own earliest footprint in health care. It was not too long ago that I, too, was wearing the same shoes as the patient’s grandson for my own grandmother.

As a first generation Filipino immigrant, I was given the role early in life as the voice for my lola (Tagalog for “grandmother”) during her medical appointments. It is common to witness immigrant children serve as the facilitators for their elders because they tend to learn, speak and read English better than their parents do. It was not only critical to serve as a translator, but also to be an expert on my culture and its expression of illness. It is common among the Asian social communities — particularly among Filipinos — for fear of health concerns to be publically exposed, even in the confidence of a health care provider. This is something I remained cognizant of throughout my experiences with my lola.

It was an instinct for me to take on this additional responsibility. While growing up, I shadowed my older siblings as they attended my lola’s appointments. I keenly observed how they communicated with providers and how they organized the medical information necessary for my lola to have a solid understanding of her health management. Reading and translating medical terminology became second nature. I also quickly grasped the necessity of a multidisciplinary team from the referrals to multiple specialists. By the time my siblings departed for college, the transition of duty to me was seamless.

Practicing the Art of Medicine and Bridging the Gaps of Health Care

The patient’s grandson and I both played pivotal roles in bridging our grandmothers to the quality care they deserved, though not everyone is fortunate enough to have someone there to help overcome a language or cultural barrier. My experience made a significant impact toward my endeavor as a future health care provider, and in my desire to take action in efforts to minimize health disparities due to the United States’ omnipresent health care barriers.

Culture and language differences represent but a small subset of challenges. It was during my didactic year at the Duke Physician Assistant Program when I learned about the mosaic of barriers from the course “Introduction to Prevention and Population Health.” In a team-based approach, we learned about social determinants of health and disease — transportation, lack of insurance coverage and limited language access, among others. The interactive approach allowed me to really appreciate just how vastly diverse my cohort is. We learned from each other, many times from sharing our own personal and professional experiences.

Now near the end of my clinical year and in the midst of rotations, I have felt quite astounded reflecting on the abundant and rich patient experiences I have encountered. Aside from continuing to practice the medicine that I spent countless hours studying in didactic year, I also continue to appreciate the many strategies providers use to overcome the health care barriers we learned about in class. I remind myself throughout these visits of the time with my lola and recall the vulnerability and challenges of being on the other end of these discussions. I wear my white uniform, one that conveys both trust and respect for others, applying all of these experiences in efforts to take another step toward my endeavor as a future PA.

It is a privilege and humbling experience to unfold the many opportunities available as a Duke PA student. With graduation approaching in a few months, I am confident that I will have acquired a strong foundation to treat a wide spectrum of patients and that I can make a positive impact on the health inequities of our nation — to be there for patients like my lola and all those struggling through health care barriers.

Jose Carlo Esteban is a second-year student with the Duke Physician Assistant Program. Email with questions.
Editor’s note: Duke Physician Assistant Program students blog twice a month. Blogs represent the opinion of the author, not the Duke Physician Assistant Program, the Department of Family Medicine and Community Health, or Duke University.