health and family magazine 008 april 2009

Samuel Gonçalves When Access to Health Care

is Diffi cult

Cuando el Acceso al

Cuidado Médico es Difícil

La historia de un inmigrante

FREE Take One | GRATIS Tome Una

APR / JUN 2009

Salud FamiliayNew England’s bilingual health magazine

Eduardo A. de OliveiraEthnicNewz.org

Salud y Familia | 2 APR / JUN 2009

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APR / JUN 2009 Salud y Familia | 3

Nutrition

March was National Nutrition Month, so when we moved the clocks ahead, it was also a time to “spring” into healthy eating. Heart disease and stroke are the number 1 and number 3 killers of all Ameri-cans. Latino Americans have higher rates of some risk factors for heart disease and stroke, such as diabetes and high blood pressure, than other ethnic groups. Risk factors include lifestyle choices, such as food. Good food and cultural celebra-tions go hand in hand. Yet, the tradi-tional ways of frying foods and using fats for seasoning can increase your risk for clogged arteries and heart disease. Eating heart-healthy means making only a few changes to your menu, like choosing foods lower in saturated fat and cholesterol. These small changes can help to reduce your risk, while still holding on to traditions.

FAT IN YOUR FOODThe two main types of fat found in food are saturated and unsaturated. Most foods have a mix of both. To-gether, the two are called total fat. Saturated fat raises blood cho-lesterol the most. Over time, this extra cholesterol can clog your arter-ies. You are then at risk for having a heart attack or stroke. Saturated fat is found mostly in foods that come from animals. These include: • fatty cuts of meat • beef • lamb • pork • poultry with skin • whole and 2% milk • butter • cheese • lard

A high content of saturated fat can be found in some foods that come from plants such as:• palm kernel oil

• palm oil • coconut oil • cocoa butter

LIMIT YOUR CHOLESTEROLYour body makes all the cholesterol you need. Eating foods high in satu-rated fat can raise your blood cho-lesterol levels. The higher your blood cholesterol, the greater your risk for heart disease. Too much cholesterol can lead to clogged arteries. You are then at risk for having a heart attack, a stroke or poor circulation. Cholesterol is found only in foods that come from animals. Foods very high in cholesterol include: • Egg yolks • Organ meats (Liver, kidney, and brains are especially high in choles-terol.) • There is no cholesterol in plant foods like fruits, vegetables, beans, and grains. If you are healthy, you should average no more than 300 milli-grams of cholesterol per day. People who have high blood cholesterol or a heart problem may have to eat less. The yolk of one large egg provides

about 214 milligrams of cholesterol. Aim for no more than four egg yolks each week. This includes egg yolks in baked goods and processed foods. Egg whites contain no cholesterol. To cut back on saturated fat and cholesterol, try some of these new ways of cooking and shopping.

NEW WAYS FOR FAVORITE RECIPES1. For biscuits: Use vegetable oil in-stead of lard or butter and skim milk or 1 percent buttermilk instead of regular milk. 2. For macaroni and cheese: Use low-fat cheese and 1 percent or skim milk. 3. For greens: for example, use skin-free smoked turkey, liquid smoke, fat-free bacon bits or low-fat bacon instead of fatty meats. 4. For gravies or sauces: Skim the fat off pan drippings. For cream or white sauces, use skim milk and soft tub or liquid margarine. 5. For dressings or stuffi ng: Add broth or skimmed fat drippings instead of lard or butter. Use herbs and spices for added fl avor.

Be Heart Smart: Eat Right!Latinos have higher rates for heart disease, diabetes and high blood pressure; it’s time to “spring” into healthy eating* Neighborhood Health Plan


The 2009 edition hardcover Best of Healthy Soul Food Recipes cook-book features 50 tasty and healthful recipes that follow the American Heart Association’s dietary recommendations. Easy-to-make favorites include Chicken Soup with Mustard Greens and Tomatoes, Carrot-Pineapple Salad with Golden Raisins, Spicy Oven-Fried Chicken and Rich and Creamy Mac and Cheese.

HEALTHY SHOPPING TIPS:• Choose the chicken breast or drumstick instead of the wing and thigh. • Select skim milk or 1 percent instead of 2 percent or whole milk. • Buy lean cuts of meat such as round, sirloin and loin. • Buy more vegetables, fruits and grains. • Read nutrition labels on food packages.

SEARCH YOUR HEARTJoin American Heart Association’s Search Your Heart Challenge which features nutrition tips, cooking demonstrations, fi tness activities, health screenings, and expert speakers for local congregations and organizations. Participation is free. Sign up contacting Jenelle Holder Williams at [email protected] or (508) 935-3994; or visit www.heart.org/bostonsyh.

IN THIS ISSUE…EN ESTA EDICIÓN...

• Nutrition / Nutrición

Be Heart Smart: Eat Right!Un Corazón Saludable P4-P5 -----------------------------------------• Oral Health / Salud Dental

Healthy Nation, One Child at a TimeDientes Sanos, Un Niño a la Vez P7-P8 -----------------------------------------• Health Stories / Historias Saludables

Immigrants and Health CareLos Inmigrantes y el Cuidado Médico P10-P13 -----------------------------------------• Life Style / Estilo de Vida

No TV for Tots No Más Televisión P14-P15

EDITORIALEditorial CoordinatorMarcela García [email protected]

PartnersNeighborhood Health PlanBU Henry M. Goldman School of Dental MedicineChildren’s Hospital BostonEthnicNewz.org

ContributorsRicardo Herreras ÁlvarezEduardo A. de Oliveira

Graphic DesignJhosmer Hernández

Health & Family is Published ByEl Planeta PublishingA Phoenix Media/Communications Group Company

Sales and MarketingRaúl [email protected](617) 937-5919

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MASSACHUSETTS

CENTRO DE INFORMACIÓN Y RECURSOS DE PIRC

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Un proyecto de la Federación para Niños con Necesidades Especiales • Informando, Educando, Motivando Familias

Fundado en 1999 como Parents’ PLACE, nuestras metas son ayudar familias alrededor Massachusetts a aprender cómo tener un papel activo y efectivo en la educación de sus niños y ayudar a escuelas a convertirse en lugares donde la participación de las familias sea bienvenida y promovida.

Todos los niños tienen derecho a una educación de calidad sin importar donde vivan, que idioma hablen, o las necesidades especiales que tengan.

Todos los padres tienen derecho a recibir información sobre la educación de sus niños en un idioma que puedan entender.

Las familias tienen derecho a participar en las decisiones que afecten a las escuelas a las que asisten sus niños.

Massachusetts PIRC es un lugar donde los padres pueden aprender sobre sus derechos y opciones disponibles bajo las leyes estatales y federales, para así tomar las mejores decisiones para sus niños. También trabajamos con escuelas y distritos alrededor del estado apoyándolos en sus esfuerzos para formar alianzas duraderas con familias que quieran lograr el avance académico de un estudiante.

TALLERES Y ENTRENAMIENTO para familias, educado-res, y organizaciones comunitarias, sobre cómo puede participar la familia en la educación y las ventajas principales para los padres de la ley “No Child Left Behind Act”.

PUBLICACIONES en inglés, español, y portugués sobre tópicos relacionados a la participación de la familia en la educación y desarrollo de sus niños.

RECURSOS E INFORMACIÓN disponibles en Internet en nuestra página web en tres idiomas: www.masspirc.org

ASISTENCIA INDIVIDUAL en inglés, español, y portu-gués para familias, educadores, y organizaciones en la comunidad por medio de una línea de información gratuita: (877) 471-0980.

CREEMOS EN EL PODER QUE TIENEN LAS FAMILIAS, PADRES, ESCUELAS, Y COMUNIDADES CUANDO TRABAJAN JUNTOS PARA LOGRAR QUE LA EDUCACIÓN DE CALIDAD SEA UNA REALIDAD PARA TODOS NIÑOS.

Marzo fue el Mes Nacional de la Nutrición, y es la ocasión perfec-ta para empezar a comer alimen-tos sanos. Los latinos tenemos altas tasas de riesgo para ciertos factores que causan problemas cardíacos, como la diabetes y la hipertensión. En el terreno alimenticio, los factores de riesgo son las comidas con alta concentración de grasa, como la mantequilla, el queso o la carne de cerdo y cordero, y las que tienen mucho colesterol, como los huevos y las carnes de órganos animales. Los modos tradicionales de freír alimentos y usar determinadas grasas para su condimento pueden aumentar el riesgo de obstruir ar-terias y problemas cardíacos. Con sólo unos cambios en su modo de cocinar, se puede comer lo mismo, conservando el sabor tradicional.

RECETAS SALUDABLES• Para bizcochos: Usar aceite de ver-duras en vez de manteca de cerdo• Para macarrones con queso: Usar el queso de pocas calorías.• Para salsas: Para salsas blancas, usar la leche desnatada y margarina líquida. • Para tortas, galletas, panes, y ho-juelas: Usar la clara del huevo en lu-gar del huevo entero. Se puede usar dos claras de huevo por uno entero.

MANERAS SALUDABLES DE COCINAR• Cocer al horno, al vapor, asar, o guisar en vez de la freír. Esto ayuda quitar la grasa.• Usar un sartén antiadherente ro-ciado con aceite de cocina de ver-duras o una pequeña cantidad de aceite líquido de verduras en vez de manteca de cerdo, mantequilla, u otras grasas sólidas.

Un corazón saludablePhotos.com


Nutrición

6. For sweet potato pie: Mash sweet potato with orange juice concentrate, nutmeg, vanilla, cinnamon, and only one egg. Leave out the butter. 7. For cakes, cookies, quick breads, and pancakes: Use egg whites or egg substitute instead of whole eggs. Two egg whites can be substituted in many recipes for one whole egg. Use applesauce instead of some of the fat.

HEALTHY WAYS OF COOKING• Bake, steam, roast, broil, stew or

boil instead of frying. This helps re-move fat. • Take off poultry skin before eating. • Use a nonstick pan with vegetable cooking oil spray or a small amount of liquid vegetable oil instead of lard, butter, shortening or other fats that are solid at room temperature. • Trim visible fat before you cook your meats. • Chill meat and poultry broth until fat becomes solid. Skim off fat be-fore using the broth. Use skimmed broth to cook greens.

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Desde el lanzamiento de Partnernship for Prescription Assistance en abril de 2005, más de 5 millones de esta-dounidenses han encontrado progra-mas que les han ayudado a pagar sus medicinas. Y miles de personas más se siguen beneficiando día a día. Si usted no tiene cobertura para medicinas con receta y no las puede pagar, llame al 1-888-4PPA-NOW, o visite www.pparx.org. Cubrimos más de 2,500 medicamentos de marca y genéricos. Usted podría obtenerlos gratuitos o a muy bajo costo. Llame ya al 1-888-4PPA-NOW o visite www.pparx.org. Es confidencial, no cuesta nada y requiere solamente de unos minutos

El programa Partnership for Prescription Assistance incorpora a las compañías farmacéuticas de Estados Unidos.

Elizabeth Johnson believes in plan-ning ahead. She moved from her home in Jamaica to the United States in 1999 to get a better education and start a career. She worked towards an associate’s de-gree in medical assisting, hoping to secure her future. Then, a “miracle” changed her plan. Elizabeth, whom doctors told would not be able to have children, learned she was pregnant. “You can imagine my surprise!” Elizabeth says. “I thought it must be a miracle. But after the shock set-tled, fear set in. I had some health concerns that I thought could affect my unborn child. And most of all, I felt unprepared for parenthood and frightened by the enormous respon-

sibility. I wasn’t sure if I would be a good mother.” Looking for help, Elizabeth signed up for Boston Public Health Commission’s Healthy Baby /Healthy Child program (HBHC). Soon, nurse Marce Peters began visiting Eliza-beth in her home to teach her how to have a healthy pregnancy. Marce monitored Elizabeth’s diabetes and hypertension, the conditions she worried might hurt her baby. “Finding this program gave me hope that my baby would be okay,” she says. What Elizabeth did not expect Marce to check was her oral health. Elizabeth laughs when she remem-bers that she rarely saw a dentist before she met Marce. Now, the

idea of ignoring her teeth seems so unbelievable, it’s humorous. “I used to think that if I’m brushing my teeth, I’m fi ne,” Eliza-beth says. “But now I know if your teeth are not well that can affect your entire system.” Around the same time as Eliza-beth, new mom Marisol Viera came to HBHC when she learned she was pregnant with her fi rst daughter, Mayah. Unlike Elizabeth, Marisol saw a dentist nearby at Dorchester House. Marisol, however, was just as concerned as Elizabeth about how to care for a newborn’s mouth. “My nurse, Elsie, taught me what to look for because Mayah is my fi rst child and I didn’t know much about oral hygiene,” Marisol says.

“I’ve learned to wash Mayah’s mouth after every feeding and what to look for when she starts teething.” At Elizabeth’s house, Marce begins her screenings of Elizabeth and now, son Matthew, with a check of Matthew’s gums. The little boy, well-dressed in powder blue outfi t, does not make a sound. He smiles, seeming to thoroughly enjoy Marce’s check up. And why not? This exam is normal for Matthew. Mom, Elizabeth, and dad, Raymond, check Matthew’s gums and clean his mouth regularly. Marce and Elsie are able to care for both families’ oral health as the result of funding received in 2008 by the Boston University Goldman School of Dental Medicine (BUGS-

Oral Health


Healthy nation, one child at a timeA program in Boston helps educate new mothers on their babies’ oral health* Boston University Henry M. Goldman School of Dental Medicine

DM) Division of Community Health Programs (CHP) from the National Institutes of Health (NIH) to support the study, “Public Health Nurses as Oral Health Advocates.” CHP trains nurses like Marce and Elsie to give oral health educa-tion and checkups during their ongo-ing pre- and postnatal home visits. At a training led by BUGSDM Oral Health Promotion Coordinator Kathy Lituri and staff in fall 2008, nurses learned to provide risk as-sessment and screenings, check pa-tients for common dental problems, and make referrals for care. Elizabeth and Marisol agree that so far, receiving oral health education from HBHC nurses works and even has one advantage over visiting the dentist’s offi ce. “Marce makes me feel comfort-

able asking questions I might not feel comfortable asking a doctor,” Elizabeth says. “I know I can call Elsie between visits if I need to,” Marisol adds. “The long term goal of this study is to test how well we can prevent early childhood caries by visiting and educating patients in their homes,” says Dr. Michelle Henshaw, the study’s principal in-vestigator. “Healthy Baby/Healthy Child is a sound investment,” Elizabeth says. “It builds a solid foundation for chil-dren like Matthew so they can go on to make a positive impact on soci-ety. Healthy children mean healthy communities, which will make for a healthier America.” Now that’s a plan we can all believe in.


Salud Dental

Dientes sanos, un niño a la vez Un programa en Boston ayuda a educar a las madres sobre la salud oral infantil

Elizabeth Johnson llegó a los Esta-dos Unidos como inmigrante pro-veniente de Jamaica en 1999 para conseguir una mejor educación y así comenzar una nueva vida. Entonces, un ‘milagro’ cambió su plan inicial. Elizabeth, una mujer a quien los doctores le habían dicho que no podía tener niños, quedó embarazada sorpresivamente. “Pensé realmente que era un milagro”, dice Elizabeth. “Pero después de la alegría inicial, me entró el miedo. Yo tenía algunos problemas de salud, que pensé que podrían afectar a mi niño. Y sobre todo, no me sentí preparada para la maternidad y me asusté por la enorme responsabilidad. No estaba segura de si iba a ser una buen ma-dre o no”. Buscando ayuda, Elizabeth se inscribió en el programa Bebé Sano, Niño Sano (HBHC, por sus siglas en inglés), el cual es ofrecido por la Comisión de Salud Pública de Boston. La enfermera Marce Peters comenzó a visitar a Elizabeth en su casa para enseñarle cómo llevar un embarazo sano. Marce chequeaba los niveles de diabetes e hiper-

tensión de Elizabeth, que eran las condiciones por las cuáles ella es-taba preocupada. “El haber encontrado este pro-grama me hizo sentir confi ada de que mi bebé iba a nacer saludable”, explica la madre. Lo que Elizabeth no esperaba era que Marce revisara su salud bucal. Elizabeth ahora se ríe cuando ella recuerda que rara vez había visto a un dentista antes de que conociera a Marce. “Solía pensar que con cepi-llarse los dientes todos los días era sufi ciente, pero ahora sé que si los dientes no están bien cuidados y limpios, puede afectar al organismo entero y por consiguiente a mi hijo”, dice Elizabeth. Marisol Viera se inscribió en el programa HBHC al mismo ti-empo que Elizabeth y cuando se dio cuenta que estaba esperando a su primera hija, Mayah. “Mi enfermera asignada, Elsie, me enseñó qué esperar y qué hacer cuando naciera mi bebé”, dice Mari-sol. “Como Mayah era mi primera hija, yo no sabía nada de higiene bucal en niños recién nacidos, pero

ahora sé cómo cuidar de su boca y sus pequeñas encías”. Durante sus visitas, las en-fermeras del programa HBHC ense-ñan a madres de recién nacidos cómo cuidar de la salud oral de sus bebés, instruyéndolas sobre cómo lavarles la boca después de cada comida y qué esperar cuando a sus bebés empiecen a salirles dientes. En casa de Elizabeth, Marce ahora incluye en sus chequeos al bebé Matthew, a quien le revisa sus pequeñas encías. El bebé ya está acostumbrado, pues Elizabeth y su esposo, Ray, revisan y limpian la boca de Matthew regularmente. Gracias a un donativo del In-stituto Nacional de Salud (NIH, por sus siglas en inglés) recibido el año pasado, la División de Programas de Salud Comunitarios de la Escuela de Medicina Oral Henry Goldman de Boston University (BUGSDM, por sus siglas en inglés) entrena a enfermeras como Marce y Elsie para participar en programas como HBHC y educar a madres sobre la importancia de la salud oral propia y de sus hijos, visitándolas antes y después de dar a luz.

Elizabeth y Marisol concuerdan en que sí funciona el recibir edu-cación en casa sobre la salud bucal de enfermeras como Marce y Elsie, y que sus visitas les dan un nivel de confi anza inesperado. “A Marce le tengo la sufi ciente confi anza para preguntarle cosas que quizá yo no me atrevería a pre-guntarle a mi dentista en su consul-torio”, señala Elizabeth. “Sé que puedo llamar a Elsie antes o después de una visita a mi dentista si tengo dudas o pregun-tas”, añade Marisol. Uno de los objetivos del pro-grama HBHC es determinar qué tan efectivo es el educar y entrenar a los padres en sus propias casas para poder prevenir las caries infan-tiles tempranas. “El HBHC es una inversión sana”, fi naliza Elizabeth. “Esto se traduce en que nuestros niños cuen-tan con una fundación y unas bases sólidas, por lo que ellos pueden así crear un impacto positivo en nues-tra sociedad. El tener niños sanos implica que habrá comunidades saludables, y por consiguiente, un país más sano”.

Matthew Johnson during one of his fi rst dental exams

Vernon Doucette / BU Photo Services

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The Massachusetts Health Care Reform law is approaching its third year in April. While government of-fi cials celebrate the new coverage of 496,000 people, or about 98% of the state’s total population, questions linger for one group of residents: un-documented immigrants. Although Chapter 58, the Health Reform law, does not extend cover-age to undocumented immigrants, its section 160 lays out provisions for an ongoing health disparities council. Even hospital rate increases, determines the reform’s section 25, “shall be made contingent upon hos-pital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care.”

But for “Pretinha,” a 64-year-old Brazilian housecleaner of Framing-ham, Mass., mother of two grown daughters, all that matters is whether or not she can get health insurance. Last year, the Brazilian im-migrant sought the help of Esther Abreu Milagros, a Boston Univer-sity doctor who created the Latino Health Insurance Program, a project that has helped hundreds of families enroll in a local health insurance. Pretinha, who’s been in the US for over 20 years, says she pay taxes, but couldn’t qualify for any program because she has no legal papers. But Dr. Milagros sent her for a check-up at Framingham’s Metrowest Medical Center. “She was diagnosed with heart rhythm distress and rushed to sur-

gery to receive a pacemaker,” said Dr. Milagros. Since Chapter 58 was passed in April of 2006, hundreds of undocu-mented families across Massachu-setts are seeking care in the least expected places. Every Tuesday evening, from 6:30 to 8:30 p.m., Sudbury Congre-gation Beth El turns into the Metro-West Free Medical Program, a walk-in clinic designed to treat under-served and uninsured populations. What started four years ago as a “band-aid” to care for about 20 low-income people has morphed into a reliable source of treatment for 40 patients per week. In 2007, about two-thirds of patients were Brazilian and 15% Hispanic. Alessandra Barbosa came to

treat a wart on her face. As several names are called, Barbosa know vol-unteers are doing their best and she is satisfi ed with the service. How-ever, she sees it just as a temporary helping hand. “Having a health plan would be better, for sure,” she said. The services have been so well regarded that Beth El expended them to Framingham. Every Thursday evening the Unitarian Universalist Congregation replaces its prayer ses-sions with free doctor consultations. Elizabeth, a housecleaner (her last name is withheld), is one of 15 regular patients per week. She said that even in her own community, she doesn’t see the concern about people’s health status that she gets from the all-volunteer team.

Immigrants and access to health care Where do immigrants stand in the context of the Massachusetts Health Care Reform law?* Eduardo A. de Oliveira / EthnicNewz.org

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Historias Saludables “They are all American volun-teers providing such a caring ser-vice,” said Elizabeth, a Brazilian who cleans fi ve homes per day, during her second visit to the clinic for women’s preventive care.

LACK OF ACCESS AND REPRESENTATIONThe church is a clear example that at one side of the debate about health disparities is the lack of access to care. A study presented by Dr. Lenny Lopez, an associate at the Disparities Solutions Center at Massachusetts General Hospital, shows that in 2000 the access gap between white and Latino patients is 15.5%. Lack of citizenship is the top reason why that happens (19%), followed by other demographic factors (9%), and low level of education (8%). At the other side of the prover-bial coin is the poor representation of ethnic minorities in the hospitals’ medical staff. Last year, minorities represent-ed one-third of the US population, but are expected to become majority

at year 2042. The black population is projected to increase from 41.1 million, or 14% of the population, to 65.7 million, or 15%, in 2050. And the Hispanic population is ex-pected to triple at the same period, from 46.7 million to 132.8 million.

However, in 2004, only 2.8% of the US physicians were Lati-nos, and 3.3% were African Americans. “The question remains: why does it happen? Are we not graduating minoritydoctors at all?” asked Alice A. Tol-bert Coombs, vice-president of Mas-sachusetts Medical Society, at a Boston University seminar conducted in March on the impact of health care reform onminority populations. Now that the

country is opening a new debate on the topic of universal health care coverage nationwide, the question that lingers would be: for whom the Massachusetts method would be a model? For regular American citizens, or for those who don’t qualify to get any coverage?

At a recent health care seminar at Regis College, a nursing student wanted to know who pays the bill for undocumented patients’ services. “Whether is undocumented or from Maine, we don’t discriminate, we care for the same way,” said Michael S. Jellinek, CEO of Newton-Wellesley Hospital. However, Dr. Jellinek must rely of his hospital’s annual growth to bal-ance his service, because when pa-tients don’t pay their bills, he needs to ‘eat’ the debt, and when Medicaid reimbursement comes, he usually gets 55 cents for every dollar spent. “One of the indicators of the success of the state’s health reform is that the use of safety net resources has decreased,” said Mary Ann Hart, RN, assistant professor of Nursing at Regis College and consultant to Bos-ton’s Public Policy Institute. Hart also added: “For critics who say that the health reform doesn’t go far enough, I’d reply that health insurance is a key component to ac-cess, and access is a key determinant of health.”

US and Massachusetts population by race/ethnicity: MA USAWhite, non-Hispanic: 79.7% 66%Black: 6.9% 12.8% Asian: 4.8% 4.4%Hispanic or Latino: 8.2% 15.1%Persons reporting 2 or more races: 1.3% 1.6%American Indian and Alaskan Native: 0.3% 1%Native Hawaiian and Pacifi c Islander: 0.1% 0.2%

Source: US Census Bureau

Uninsured by race and ethnicityPercent of all Massachusetts residents, 2008

Total population: 2.6%White, non-Hispanic: 2.2%Other race, non-Hispanic: 2.6%Hispanic: 7.2%

Source: State’s Division of Health Care Finance and Policy

Samuel Gonçalves with a friend at the hospital

Think about a typical soccer afi cio-nado, and you’ll picture Samuel Gon-çalves. Born in Brazil in a family of three brothers, several fi rst-league clubs in the soccer-loving country were interested in the young teen for a possible spot on their teams. But then a religious mission brought his father, Methodist pastor Juarez Gonçalves, to Saugus, Mass., to establish a Portuguese-speaking congregation. Sam fi rst stepped into Logan International Airport at age 13, ea-ger to keep his soccer dream alive. His family settled down in Medford, Mass., a city near Boston.

At 18, and at the peak of his physical form, he had two options: follow the footsteps of an older brother, who was captain of the Univ. of Massa-chusetts Boston soccer team, or work for a while before embarking into college life. Sam chose the latter. He worked 80 hours per week, with a split schedule between a gig in the kitchen of a restaurant, and another as a garage attendant at the Lahey Clinic in Burlington, Mass. On top of the hectic routine, Sam was a frequent face at the gym, as he kept himself in shape for the soccer fi eld. During that hectic period, Sam started to feel unexplainable chest pain, and one morning the chest pres-sure was unbearable. His primary care physician prescribed medicine for pneumonia. But it was the surprising results of a chest X-ray that brought Sam to Massachusetts General Hos-pital (MGH) in Boston. “I was fi lling a form and the fi rst question [was]: ‘What is the reason for your visit today?’ The lobby attendant


had answered it for me,” said Sam. Her answer, “lung tumor,” shocked him. Sam was diagnosed with a lung tumor – known to his doctors as a teratoma with malign transforma-tion to sarcoma – that was larger than a tennis ball. What followed added the Brazilian athlete to the annals of world medicine, with a type of cancer so rare that only 20 known cases of it worldwide have occurred in the last 50 years. Two days later, Sam started che-motherapy, which was painful and complex. The goal of the treatment was to reduce the tumor to prepare Sam for major surgery. He was scheduled for four cycles of chemotherapy over a period of more than two months, with each cycle con-sisting of one week of daily treatment followed by 15 chemo-free days.

THE DILEMMAThe fi rst cycle of chemotherapy took a toll on Sam’s deteriorating health as he went through dramatic weight loss. The pain was so unbearable that the chemotherapy had to be stopped, and Sam rushed into surgery. The chemo caused the tumor to bleed and got infl ated, pushing Sam’s heart toward the right in his chest cav-ity. As he was rushed into the operat-ing room, Sam’s doctor warned him

that his chance of survival was 50%. But the 12-hour surgery suc-cessfully removed Sam’s entire left lung, according to Edwin Choy, Sam’s medical oncologist (cancer specialist) at MGH. Just as he was getting ready to receive seven weeks of daily radio-therapy after the surgery, Sam’s fam-ily was facing another dilemma: how to pay for Sam’s medical care. It was February of 2007, and the State Children Health Insurance Pro-gram (SCHIP) was no longer active. When the SCHIP federal law had been in effect, it enabled eligible kids to get healthcare coverage if their parents earned too much to qualify for Medicare, but too little to afford private insurance. Sam didn’t qualify for govern-ment-paid health treatment that required at least fi ve years of being a green card holder. Sam was two years’ shy of the requirement. Sam’s father then added him to his health insurance coverage for

nine months, at an additional cost of $560 per month. The insurance cov-ered the full $180,000 cost of Sam’s emergency surgery. But other medical costs were covered for 80%, leaving Sam’s family to pay the remaining 20%, or $50,000, a medical debt that still haunts them two years later.

ONE LAST MIRACLEAt the end of 2007, doctors found small traces of what they thought could be tiny tumors in his gall blad-der. But Sam received medical ap-proval anyway to take a trip to Brazil. A bittersweet moment, since his gall bladder surgery was scheduled for a month later in Boston. He was fi nally able to go to Bra-zil, and with good news. After four attempts at applying for MassHealth, a state-run health insurance that pays for the care of low- and medium-income residents, his application was accepted. MassHealth covered his gall bladder surgery just as the nine-month extension on his father’s insurance was expiring. The surgery was complex, requir-ing the removal of a nodule that was diffi cult to reach. Juarez Gonçalves and his wife gathered some church members to endure the 8-hour wait. But within 45 minutes, a doctor came to the waiting room. Gonçalves’ heart pounded heavily. “The surgeon came to inform us that upon the fi rst surgical cut, the tiny tumor jumped out… dry and dead. What a relief,” said Sam’s father. Today, although Samuel Gon-çalves is looking forward to going to college, his aspirations of becoming an accomplished soccer player have completely evaporated. He pauses in search of a moment that occurred after the last surgery, when Dr. Choy told him he had only a 5% chance of survival. Sam breathes slowly – but decisively.

Immigrants getting health care: a case studyBrazilian teen with rare lung cancer beats all types of odds* Eduardo A. de Oliveira / EthnicNewz.org

Healthy Stories

Sam and his family are still haunted by a medical debt of $50,000

Sam was diagnosed with a rare cancer: only 20 known cases in the last 50 years

Una nueva dimensión de cuidado, para una nueva perspectiva de la vida. 1,4 millones de personas en los Estados

Unidos sufren de la enfermedad de Crohn y colitis ulcerosa. En nuestro Centro para Desórdenes Digestivos, los especialistas

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para tratar enfermedades digestivas – y para cambiar las vidas de las personas. La atención más excepcional, sin excepción.

La mejor atención médica de la enfermedad de Crohn y colitis está en Boston.

Para más información visite BMC.org/exceptional o llame al 877-930-2288 (llamada gratuita).Boston Medical Center es el principal centro de enseñanza afiliado a la Escuela de Medicina de Boston University.


Historias Saludables

Los inmigrantes y su acceso al cuidado médico: un casoJoven brasileño con cáncer vence todo tipo de obstáculos

Nacido en Brasil en una familia de tres hermanos, Samuel Gonçalves era el típico joven que quería con-vertirse en jugador de soccer por sobre todas las cosas. El trabajo de su padre Juarez Gonçalves, como pastor de una iglesia metodista trajo a la familia a Saugus, Massachusetts, para es-tablecer una congregación de habla portuguesa, y se mudaron a una casa en Medford. Sam no dejo de entrenar en el gimnasio para mantenerse en forma en el campo de fútbol, y tomó dos empleos, trabajando 80 horas a la semana, antes de inscribirse en la universidad. Pero fue en ese tiempo cuando comenzó a sentir un inexplicable do-lor en el pecho, hasta que una ma-ñana el dolor fue insoportable. Su doctor le prescribió medicina para

neumonía. Sin embargo, fueron los resultados inesperados de sus rayos x lo que lo llevó al Hospital General de Massachusetts (MGH, por sus siglas en inglés) en Boston. “Estaba llenando la forma de ingreso al hospital y la primera pre-gunta era: ‘¿Cuál es la razón de su visita?’ La recepcionista ya la había contestado por mí”, dijo Sam. La respuesta, “tumor en el pulmón”, lo estremeció. Sam fue diagnosticado con un cáncer en el pulmón tan raro que solo se han conocido 20 casos en el mundo en los últimos 50 años. Dos días después Sam inició intensas y dolorosas sesiones de quimioterapia que duraron dos me-ses. Pero el joven llegó a sentir un dolor tan fuerte que tuvo que ser ingresado de emergencia para una cirugía y remover el tumor, que era

un poco más grande que una pelota de tenis. La quimioterapia había causado que el tumor se infl amara y sangrara, presionando el corazón de Sam contra su caja torácica. Su doctor les advirtió, mientras lo ingresaban a cirugía, que había un 50% de probabilidades de que sobreviviera. Sin embargo, el pro-ceso de 12 horas resultó exitoso y a Sam le removieron el tumor junto con todo su pulmón izquierdo. Justo cuando se preparaba para recibir siete semanas de ra-dioterapia postoperatoria, Sam y su familia enfrentaban otro obstáculo: las facturas del hospital. Esto ocurría en febrero de 2007, cuando el programa federal State Children Health Insurance (SCHIP) – que permitía a jóvenes y niños obtener cobertura médica si sus padres ganaban mucho para ser

elegibles para Medicare, pero muy poco para tener un seguro médico privado – ya no existía. Sam tampoco era elegible para ayuda subsidiada por el gobierno pues ésta requería que tuviera cinco años de tener su residencia (green card). Él tenía solo tres con ella. Su padre lo añadió entonces a su seguro médico a un costo adicio-nal de $560 mensuales. El seguro cubrió los $180,000 de la cirugía. Pero otras cuentas quedaron pendi-entes, por $50,000, una deuda que todavía los agobia. Hoy, Samuel Gonçalves se pre-para para inscribirse en la universi-dad, pero su sueño de ser jugador de soccer se ha desvanecido. Sin embargo, mientras recuerda cómo ha vencido todas sus adversidades médicas, respira lentamente, pero con determinación.

y

A longitudinal study of infants from birth to age 3 showed TV viewing before the age of 2 does not improve a child’s language and visual motor skills, according to research conduct-ed at Children’s Hospital Boston and Harvard Medical School. The fi ndings, published in the March issue of Pediatrics, reaffi rm current guidelines from the Ameri-can Academy of Pediatrics (AAP) that recommend no television under the age of 2, and suggest that mater-nal, child, and household character-istics are more infl uential in a child’s cognitive development. “Contrary to marketing claims and some parents’ perception that television viewing is benefi cial to children’s brain development, no evidence of such benefi t was found,” says Marie Evans Schmidt, PhD, lead author of the study. The study analyzed data of 872 children from Project Viva, a prospec-tive cohort study of mothers and their children. In-person visits with both mothers and infants were performed immediately after birth, at 6 months, and 3 years of age while mothers completed mail-in questionnaires regarding their child’s TV viewing habits when they were 1 and 2 years old. It was conducted by research-ers in the Center on Media and Child Health at Children’s, and the Depart-ment of Ambulatory Care and Preven-tion at Harvard Medical School and Harvard Pilgrim Health Care. The study is the fi rst to investi-gate the long term associations be-tween infant TV viewing from birth

to 2 years old and both language and visual-motor skill test scores at 3 years of age. These were calculated using the Peabody Picture Vocabulary Test III (PPVT III) and Wide-Range As-sessment of Visual Motor Abilities (WRAVMA) test. The PPVT measures receptive vocabulary and is correlat-ed with IQ, while WRAVMA tests for visual motor, visual spatial, and fi ne motor skills. The researchers controlled for socio-demographic and environ-mental factors that are known to contribute to an infants’ cognitive development, including mother’s age, education, household income, mari-tal status, parity, and postpartum depression, and the child’s gender, race, birth weight, body mass index, and sleep habits. Using linear regression models, the researchers equalized the infl u-ences of each of these factors and calculated the independent effects of TV viewing on the cognitive develop-ment of infants. Once these infl uenc-es were factored out, associations in the raw data between increased in-fant TV viewing and poorer cognitive

outcomes disappeared. “In this study, TV viewing in it-self did not have measurable effects on cognition,” adds Elsie Taveras, MD, MPH, senior author of the study and pediatrician at Children’s. “TV viewing is perhaps best viewed as a marker for a host of other environ-mental and familial infl uences, which may themselves be detrimental to cognitive development.” While the study showed that in-creased infant TV exposure is of no benefi t to cognitive development, it was also found to be of no detriment. The overall effects of increased TV viewing time were neutral. TV and video content was not measured, however, only the amount of time ex-posed. The researchers acknowledge follow-up studies need to be done, and they are quick to warn parents and pediatricians that the body of re-search evidence suggests TV viewing under the age of 2 does more harm than good. “TV exposure in infants has been associated with increased risk of obesity, attention problems, and decreased sleep quality,” adds Mi-

chael Rich, MD, MPH, the pediatri-cian who directs the Center on Me-dia and Child Health and contributing author on this study and the current AAP Guidelines. “Parents need to un-derstand that infants and toddlers do not learn or benefi t in any way from viewing TV at an early age.” The Center on Media and Child Health, an affi liate of Children’s Hospital Boston, Harvard Medical School, and Harvard School of Pub-lic Health conducts and translates research about the effects of media on child’s health and development so that parents can make informed de-cisions about their children’s media use. Parents can access this informa-tion about research as well as tips at www.cmch.tv. Children’s Hospital Boston is home to the world’s largest research enterprise based at a pediatric medi-cal center, where its discoveries have benefi ted both children and adults since 1869. More than 500 scientists, including eight members of the Na-tional Academy of Sciences, 11 mem-bers of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Children’s research community. Founded as a 20-bed hospital for children, Children’s Hospital Boston today is a 397-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Children’s also is the primary pediatric teaching affi liate of Harvard Medical School.

Life Style

No TV for totsWatching TV before the age of two has no cognitive benefi t, study fi nds* Children’s Hospital Boston

Contrary to common beliefs, watching TV does not improve a child’s language and visual motor skills

The study also found that the overall effects of increased TV viewing time were neutral


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No más televisiónUn estudio revela que ver TV antes de los dos años no tiene un benefi cios cognitivos

Un estudio longitudinal de los be-bés, desde los recién nacidos hasta los de tres años de edad, demostró que el ver la televisión antes de la edad de dos años no mejora el len-guaje del niño ni la capacidad visual motriz, de acuerdo a una investi-gación realizada en el Hospital de Niños de Boston (Children’s Hospi-tal Boston) y la Escuela de Medicina de Harvard. Los resultados, publicados en la edición de marzo de Pediatrics, reafi rmó las pautas actuales de la Academia Americana de Pediatría (American Academy of Pediatrics) que recomienda no ver la televisión para niños menores de dos años y sugiere que el cuidado maternal y las características del hogar son más infl uyentes en el desarrollo cognitivo del niño. “No se encontró ninguna evidencia de que el ver la

televisión es benefi cioso para el de-sarrollo del cerebro del niño lo cual es contrario a lo que dicen ciertas promociones comerciales y la per-cepción errónea de algunos padres de familia”, dijo la doctora Marie Evans Schmidt, autora principal del estudio. El estudio analizó datos de 872 niños del Proyecto Viva, un grupo de estudios de madres y sus hijos. Visitaron a las madres y los bebés inmediatamente después de su nacimiento, a los seis meses y a los tres años de edad mientras las madres llenaban unos cuestionarios y los enviaban por correo describi-endo los hábitos o costumbres del niño de ver televisión cuando ellos tenían uno y dos años de edad. El estudio fue realizado por investi-gadores del Centro de Medios de Comunicación y la Salud del Niño

del Hospital de Niños de Boston y el Departamento de Prevención y Cuidado Ambulatorio de la Escuela de Medicina de Harvard y Harvard Pilgrim Health Care. “En este estudio, el ver la TV por sí solo no tuvo efectos medibles en la cognición”, dijo Elsie Taveras, MD, MPH, quien también fue autora del estudio y es pediatra en el Hospital de Niños de Boston. “La mejor man-era de consi-derar esto es que ver la TV es como un marcador o indicador para muchas otras infl uencias famil-iares y ambientales, las cuales por si solas pueden ser perjudiciales para el desarrollo cognitivo”. Así como el estudio demostró que el aumentar la frecuencia de que un niño vea la TV no ocasiona un benefi cio para su desarrollo cog-nitivo, también se descubrió que no era perjudicial. Los efectos generales

al aumentar el tiempo de ver la TV fueron neutrales. El contenido de la TV o los videos no fueron medidos, sin embargo, solo se midió el tiempo de estar expuesto a la TV. Los inves-tigadores están de acuerdo que se necesitan hacer más estudios y que ellos prontamente quieren advertir a los padres y los pediatras que los resultados y evidencias de los estu-dios sugieren que el ver la televisión para los niños menores de 2 años les causa más daño que benefi cio. “Los padres necesitan entender que los recién nacidos y los bebés no aprenden ni se benefi cian de ninguna manera al ver la televisión a una temprana edad., añadió Mi-chael Rich, MD, MPH, el pediatra que dirige el Centro de los Medios de Comunicación y Salud Infantil y quien contribuyó al estudio y a las actuales pautas de la AAP.

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