

Reyes works as coordinator of the hospital's Latino Health Project, a job she's held for 10 years.

"The hospital created this position," Reyes said. "Various leaders got together and realized they needed someone to pay more attention to this population in a more structured way."

Most of the problems she encounters involve language, as English-speaking doctors, nurses and administrators struggle to communicate with Spanish-speaking patients and families.

But language problems spread beyond treatment issues.

"People receive a bill, and it's all in English," Reyes said. "How can we make sure our bills are bilingual, or how can we make sure they can access a bilingual person to help them? You can start feeling that a certain part of the population just doesn't want to pay their bills, and that's not accurate. They just don't understand the document that's been sent to them."

English-language prescription bottles are another potential problem. "We work with our pharmacists to use bilingual or visual instructions," she said.

And, language issues can crop up in the most unexpected places. "That's part of our work, constantly identifying where the gaps are," Reyes said. To get Spanish-speaking people to participate in clinical trials, for instance, you need Spanish-speaking people to explain what the trials are about and will involve, she said.

The other health barrier faced by Latinos at the hospital, Reyes said, is a lack of knowledge about how the health-care system works in the United States.

As an example, she cites Chile, where residents often go to a healer if they're sick. "Now you're here and you get sick, and you are wondering where you go," Reyes said.

Despite these issues, Reyes believes that many of the health disparities between the Latino community and white Americans derive from a social context, and are not solely due to failings of the health-care system.

"If we're going to look at obesity, why is it we don't have a grocery store in the inner city? Why do they only exist in the suburbs?" she asked. "Why are liquor ads all over the place in the inner city, but not in the suburbs? Isn't that interesting?"

Reyes also does outreach into the community, working with different agencies that help the Spanish-speaking and immigrant populations to promote better health. For example, if the Hispanic Center is holding a health fair, Reyes will try to find doctors, nurses or students to help staff it. It's difficult to do a lot of that, however, as Reyes is an office of one, and her hands are full.

"I work more with agencies that are doing this, to see how Duke Hospital can participate in these areas," she said.