Big Sur Health Center: a matter of understanding

Although it has a post office, a library, and a local grocer, most would agree that Big Sur is not a town. For the many who live there, it is a legend, a lifestyle, a haven, and a home, flanking a stretch of highway and disappearing into the canyons and mountains of a relentlessly beautiful landscape.

The refuge from an urban existence is a welcome choice by those who make it, except when someone gets sick. The closest healthcare facility, Community Hospital of the Monterey Peninsula, is an uneasy drive of 30 minutes to two hours, depending on how far south or remote one’s Big Sur residence.

In Sept. 1979, in response to a recognized need for local healthcare, citizens opened the Big Sur Health Center in the kitchen of the old Grange Hall. Originally staffed just one day a week by medical director Saul Kunitz, MD, the demonstrated need warranted an expansion of service to two half days and then three. By 1996, doors were opened fi ve full days a week.

Thanks to a couple of trailers donated by Community Hospital, the Health Center eventually moved to its present location on property owned by All Saints Episcopal Church.

Due to a large Hispanic work force in the hospitality sector of Big Sur, some 30 percent of the population is Hispanic. Neither a transient nor a seasonal community, these residents live in Big Sur all year.

But what kind of medical care can they expect from providers who don’t speak their language and don’t understand their culture? For many patients, it’s simply been easier not to come. Until now.

Physician assistant Sharen Carey, who was the primary healthcare provider and, since the mid-’90s, has served as administrator of the center, recognized both the problem and the solution to offering effective healthcare to the Hispanic population. Rather than teaching them all English, she would improve her Spanish.

“My language background was four years of high school Spanish,” says Carey. “When I went to medical school in 1981, I took a refresher course at USC, but it wasn’t enough to do anything but speak very basic Spanish. This allowed me to do a basic physical assessment of a Hispanic patient but not go into depth. I could not address the psychosocial or socioeconomic issues behind chronic illnesses. I couldn’t ask about the lifestyle issues that would help me understand why they got sick.”

For some 15 years, it had been Carey’s dream to go to Mexico to improve her Spanish. But to do that would mean finding someone to cover for her at the clinic while she went into a nine-week Spanish immersion program.

In walked Aida Hasbun, MD, who had worked at the center during the mid-’90s. During a casual conversation, Carey spontaneously asked Hasbun if she would be willing to cover for her while she went to Mexico. Hasbun said yes.

One month later, Carey was on her way to Guadalajara to study Spanish, thanks to a multicultural health program grant funded in part by Community Hospital.

“I immediately started researching the best place for me to study,” says Carey. “It became obvious, based on the background of our community, that I should go to Guadalajara. On the internet, I found the medical school there and saw they had, ‘Medicina en la Comunidad,’ a program for people like me in the medical field.”

“I could not address the psychosocial or socioeconomic issues behind chronic illnesses. I couldn’t ask about the lifestyle issues that would help me understand why they got sick.”
— Sharen Carey, physician assistant at the Big Sur Health Center

Carey, who lived with a local family in Guadalajara, began her studies with two hours of grammar in the morning, followed by two hours of group medical conversation supported by a private tutor. As is the tradition in Mexico, everyone went home for lunch with their families.

“I lived with a lovely family who didn’t speak a word of English,” says Carey. “But that was good for me. After the main afternoon meal, I returned to school and was taken to La Clínica de Santa Margarita, where I participated with students from the medical school and saw patients for four hours. At 8 p.m., I drove back to have dinner with the family, a bowl of cereal and fruit, before taking my shower and settling down to two hours of homework. I would get to bed around midnight, and then rise the next day at 7 a.m. to begin again. I thrived on it.”

Carey plans to return to the program in February to refine her Spanish. For now, she is implementing what she learned.

“As I was planning my first trip,” says Carey, “I recognized that we needed to so something more organized with this opportunity. We needed to take this further than just my learning the language. So I met with well respected members of the Hispanic community — including Carlos Vasquez — to brainstorm what we could do to improve communication and understand traditions and beliefs. I had no other agenda than to find out what we could do to improve their ability to be self-empowered when it came to their own health and well-being.”

The result is ¡Salud! — a bilingual newsletter designed to involve the greater community in healthcare topics.

“Even within the same culture,” says Carey, “we all have, depending on our family traditions, different approaches to healthcare. Consider what happens when people are not from the same country. We use a different vocabulary and foster different beliefs and take different approaches to our health. All these cultural ideas are very important and worth sharing and understanding.”