By Sylvia Moreno
Washington Post Staff Writer
Tuesday, May 13, 2008
Emilia Uriarte and Mariluz Garcia are just the types of patients that Elmer Huerta loves to see. The first hasn't been to a doctor in 10 years; the second has been a faithful patient of the cancer prevention specialist for the past seven.
With Uriarte, he patiently explains in Spanish the value of a yearly Pap test as an early detection tool for cervical cancer and the importance of an annual mammogram and monthly breast self-exam -- especially now that she is three months past her 40th birthday. Huerta uses one of his favorite analogies to drive home the point that she needs to make this a yearly visit: You maintain your car to keep it running, don't you?
"So why not take ourselves in for our own tuneup?" says Uriarte, repeating the lesson that Huerta just imparted.
Garcia, meanwhile, can recite Huerta's advice by heart: The most important visit to the doctor is the one when you are well.
"I'm not sick. I just want to do prevention because you never know," says Garcia, 49.
Uriarte, of Frederick, and Garcia, of Rockville, are both patients of the Cancer Preventorium, a one-of-a-kind clinic that is part of the cancer institute at Washington Hospital Center. It is aimed at drawing in low-income Latino women, not for treatment but for prevention.
Huerta, the president this year of the American Cancer Society, used to be an oncologist in his native Peru. But he changed his focus in the late 1980s after seeing women with cancerous tumors bulging out of their breasts. "They didn't know anything about health," he said, "because they were ashamed to show anyone what was wrong and because they thought the absence of pain is the absence of anything wrong."
Many of these patients, however, knew the latest celebrity gossip, the subplots of every TV soap opera and the scores of every big soccer match. If radio and television were that powerful, Huerta recalls thinking, "would it be possible to sell health to the public through the media?"
In 1986, he began producing and then starring in a health education TV show in Lima; he discontinued the show in 1987 when he moved to the United States to complete a fellowship at the Johns Hopkins Oncology Center. He began a medical residency program in Baltimore and started recording five-minute health-care spots on a Spanish-language radio station in Laurel. In 1994, the same year the Cancer Preventorium opened, Huerta created a live weekly television program on health promotion and disease prevention.
Today, Huerta's radio spots, called "Cuidando Su Salud" ("Taking Care of Your Health"), air daily on more than 120 stations in the United States and more than 350 in Latin America. His television program, "Hablemos de Salud" ("Let's Talk About Health"), is distributed nationally.
Three months ago, Huerta's local call-in program expanded to two hours after being syndicated nationally. Now called "Cita Con el Doctor" ("Appointment With the Doctor"), it reaches Latinos in 14 states five days a week.
Broadcasting from his cramped office at the Washington Cancer Institute one recent afternoon, "el doctor" fielded almost 20 inquiries, ranging from vertigo to cancer metastasis, from callers nationwide.
Isabel of Maryland cried as she described the diagnosis of juvenile diabetes her 4-year-old daughter had just received. She wanted to know what caused this disease. And two callers, including Socorro in California, were awarded rousing "applause," a sound effect that Huerta plays on a digital sound board. Socorro said she is 39, has a 12-year-old child and is ready to have her intrauterine device removed so she can have a second child next year. "¿Doctor," she asked, "qué debo de hacer para preparar" for pregnancy? ("Doctor, what do I need to do to prepare?")
"¡Aplausos, aplausos para Socorro y su excelente pregunta!" Huerta said. ("Applause, applause for Socorro and her excellent question!") His advice: See an obstetrician as soon as possible; eat a healthful diet that includes lots of fruit and vegetables; walk or exercise at least 30 minutes a day; and take 400 micrograms of folic acid daily.
"Y ahora necesitas insistir que tu esposo se ponga a trabajar bien duro," he said with a laugh, as if he were speaking with a friend or relative. ("And now you need to insist that your husband work very hard.")Broadcasting Prevention
Huerta, 55, doesn't diagnose over the air, but he advises, reassures and comforts. Most important, he promotes good health practices in simple language: Don't smoke. Try to get a job that offers health insurance. Get a primary care doctor. Cancer in its earliest stage is silent, so get an annual checkup. Don't be afraid to ask questions. Most folkloric remedies are fine, but don't forsake traditional medicine.
"He explains things in a way that really gets to people," said Eduardo Armenta, a College Park pediatrician, "especially those not well educated in the medical field."
Armenta, who listens to "Cita Con el Doctor" three or four times a week, calls Huerta's media campaign "one of the best things" that has happened in terms of preventive medicine in the Latino immigrant community. "He urges people to see doctors ahead of time, before disease gets to the point of no return," Armenta said.
Since 1994, the Cancer Preventorium has seen almost 15,400 women and 6,000 men, and a recent survey of patients showed that 70 percent found the clinic after hearing Huerta on either radio or television, said Washington Hospital Center spokeswoman So Young Pak.
Lawrence Lessin, former medical director of the cancer institute, said Huerta's proposal to promote cancer prevention among the area's growing Spanish-speaking community met stiff opposition in 1994 from some Washington Hospital Center administrators. Nonetheless, Lessin hired him to open the clinic.
"There was a concern about getting a lot of uninsured people to the hospital and then diagnosing a cancer and being obligated to take care of it," Lessin said. "But that's never really been the case, because Elmer developed relationships with other physicians who were willing to take care of these patients every time he detected cancer or other disease."
Huerta's two requisites for taking patients are that they have no apparent symptoms and that they pay upfront. In 1994, the fee for an initial exam was $55. Today it costs $120 for a physical, blood work, consultation and a Pap test for women or a prostate-specific antigen (PSA) test for men. If patients have health insurance (only about 30 percent do), they file their own claims.
Huerta's female patients outnumber males by three to one, and the women remain his priority. American Cancer Society data show that breast cancer is the most commonly diagnosed cancer among Latino women. The five-year survival rate of Latinas is only 83 percent , compared with 87.5 percent for white women.
"Why?" Huerta asks. "They tend to have no insurance, they're fatalistic, they're poorer, they're linguistically isolated and there are few centers that are culturally sensitive."
The preventorium also has a Spanish-speaking nurse and a "patient navigator," Diana P. Garcia, who guides patients to clinics that provide screening mammograms for free or very low cost. Garcia refers patients who need follow-up care to physicians who take low-income, uninsured patients. If needed, she tries to get them enrolled in cancer treatment trials at the National Institutes of Health or into cancer clinics or hospitals that readily accept low-income patients. (To date, the clinic has discovered 71 cancers, almost half of them breast cancer.) Garcia also guides patients to health coverage they may be able to receive, and Huerta helps connect them to primary care physicians.
"But the main thing is to teach them about prevention, because as a culture we don't think we need to see a doctor until we're sick," Garcia said.Vote of Confidence
Mariluz Garcia said she was drawn to the Cancer Preventorium seven years ago after visiting a Silver Spring clinic because she was concerned about abnormal menstrual cycles; she was given a blood test. She said she had to initiate the follow-up and was told only that her bloodwork was normal. A month later, she heard Huerta's radio show and the next year went to see him. It took her two or three weeks to get an appointment then; now there is a four-month waiting list, but she keeps returning for her annual checkup.
Garcia, who is from Colombia, has no health insurance and pays her $120 out of pocket. Is it worth the money? "Oh, yes!" she said. "Thank God, nothing has happened to me -- yet."
Emilia Uriarte arrived at the Cancer Preventorium at the insistence of a friend, who made an appointment for her as a 40th birthday present. Her friend is a fan of Huerta's shows and is a patient herself.
"I came, but I didn't think it was necessary for me because I never feel bad," said Uriarte, who is from Honduras. As is customary in her country, she admitted, she thought that "older people" like her 60-year-old mother are candidates for doctor visits. Besides, in her country, most people depend on a pharmacist to recommend medicine or on grandparents or other elders to prescribe folkloric remedies.
When Uriarte left Honduras at the age of 27, she said, she had never seen a doctor. Here, she saw one 10 years ago, when she gave birth to her daughter.
Now that she has seen Huerta, she understands "that every April I need to get checked," Uriarte said. "The doctor was very nice . . . and I liked the way he educated me."