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Old town, nuevos patients: Small-town doctors treating influx of Hispanic immigrants

New populations are changing the face of rural communities and changing the way physicians practice.

By Bob Cook, amednews staff. Oct. 1, 2001.

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Ligonier, Ind. -- Kim Waterfall, MD, is like a lot of small-town doctors. He sees patients with a wide variety of conditions. He's one of the few physicians in his area. And he struggles to communicate with his vast number of Spanish-speaking patients.

Dr. Waterfall, a Ligonier, Ind., family physician, and other small-town physicians nationwide are just beginning to absorb a massive wave of immigration, mostly from Mexico, that hit some of America's smallest towns over the last five years.

The lure, same as it ever was for America's immigrants, is jobs. Jobs in meatpacking, manufacturing, carpet-making. Jobs in areas with not nearly enough people to fill them, like Ligonier, with 4,357 residents and about 2,500 industrial jobs. And two physicians.

Dr. Waterfall likes that his Spanish-speaking patients tend to smoke less, listen to their doctor more and tend to be better about paying at the time of service than his other patients.

"I had preconceived notions of Mexican people, " Dr. Waterfall said. "I felt most weren't the kind of people I wanted as patients.

"I was expecting that if I said something wrong, they'd flip a switchblade out and be some sort of Pancho Villa-type. I didn't expect them to be as nice as they were. I grew up in Columbia City, Ind., and my exposure to Mexicans was next to nil."

But the language barrier, despite the hiring of a Spanish-speaking office helper to double as an interpreter, makes for long days. Not good when your hospital employer -- in Dr. Waterfall's case, Parkview Health System of Fort Wayne, Ind. -- is paying you in part based on productivity. [...]