Cultural nuances can sometimes be lost in translation — a situation Graham Aufricht, a pediatric emergency medicine fellow training at Dell Children’s Medical Center, discovered firsthand when interacting with Spanish-speaking patients early on in his residency.
That recognition, along with an avid interest in global health, were catalysts for Aufricht to develop a three-week Spanish immersion elective for Dell Med residents in Puebla, Mexico. Carried out as part of Dell Med’s graduate medical education Advancing Care Transformation signature curriculum, the project aims to address health care disparities with Spanish-speaking patients and families.
Graham Aufricht, M.D.
Tell us about yourself. Describe your work and what brought you to this point.
My medical journey is positioned at the crossroads of pediatric emergency medicine and global health. Throughout my time at Dell Med, first as a pediatrics resident, and now as a pediatric emergency fellow, I’ve had the privilege of serving Austin’s vibrant and diverse Spanish-speaking patient population. This experience has exposed me to many of the unique challenges inherent in providing equitable care. Recognizing the critical role language and cultural understanding play in effective health care, I was motivated to establish a medical Spanish and cultural immersion elective in Puebla, Mexico, for our pediatric residents.
The program is fully funded by our department and offers residents an enriching, firsthand experience of Mexican culture. Participants live with a local host family and attend a highly regarded Spanish school, where they receive one-on-one instruction in general and medical Spanish. The elective also integrates culturally enlightening assignments and excursions designed to broaden the participants’ cultural knowledge. Once back in Texas, residents contribute to a longitudinal lecture series, sharing their experiences and acquired insights to stimulate discussions on health equity and cultivate cultural awareness within the department.
This past year, we piloted the program with the pediatric residency program, sending our first six residents to Puebla. We are excited to expand this opportunity to other Dell Med learners and trainees, including medical students and residents and fellows outside of pediatrics.
I firmly believe that this program is a critical stride toward delivering the highest standard of care to our Spanish-speaking patients and families in Austin, and I am proud of the positive impact we’re making.
Describe a singular memory (big or small, personal or professional) that has shaped how you approach your work.
During my early days as a pediatric intern at our residency clinic, I examined a young child whose mother was concerned that her daughter may have “mal de ojo.” Using a Spanish phone interpreter, this phrase was translated to me as “bad eyes.” After a thorough ophthalmologic examination, I assured the mother that her child’s eyes were healthy and there was no cause for concern.
It wasn’t until a year later, while attending classes in Mexico and learning about Mexican folk medicine, that I understood the depth of my misinterpretation. “Mal de ojo” is a prevalent belief across Latin America. It embodies the concept of a curse, believed to be initiated by an envious stare, which can result in illness arising from negative energies, predominantly affecting children. Its diagnosis and treatment extend beyond the scope of conventional Western medicine.
I realized that my limited understanding of my patient’s culture and language prevented me from fully addressing their concerns. The mother wasn’t concerned about her child’s eyes. This pivotal experience solidified my commitment to enhancing my cultural knowledge to ensure optimal care for all my patients.
What makes you uniquely positioned to do what you do?
My active involvement in UT’s global health work positions me uniquely in my role and helps me envision ways to bridge gaps between different cultures and health systems.
Dell Med is a critical component of the Academic Model Providing Access to Healthcare, or AMPATH, consortium. AMPATH is a network of academic health centers whose mission is to nurture long-term, equitable and cross-cultural partnerships with health centers and universities serving global populations with significant unmet needs. While UT has a long-standing involvement in AMPATH Kenya, we were recently chosen to spearhead a new collaboration: AMPATH México.
This partnership between Dell Med and BUAP medical school in Puebla, Mexico, aims to develop an interdisciplinary approach to creating high-quality health care, education and research collaborations. It serves the mutual interests of medical faculty, students and the local community in Puebla. One facet of this project is our language elective, an area where pediatrics is excited to lead.
What would readers be surprised to know about you or your work?
I am not fluent in Spanish. In fact, this initiative was born out of my own struggles with Spanish communication and the resulting frustration I experienced in failing to fully connect with my patients who primarily spoke Spanish. During my residency, I recognized that this linguistic barrier prevented me from fostering deeper connections with my patients. Consequently, I committed myself to learning Spanish.
For the remainder of my residency, I spent my vacation blocks traveling to different cities in central Mexico to learn the local culture and enroll in various Spanish schools. Word of my experiences gradually spread among my resident peers, triggering a common sentiment: “I’d love to do something like that.” But their enthusiasm was frequently offset by the time constraints or financial challenges associated with residency. While interest was present, significant hurdles existed. This realization catalyzed the development of our immersion program.
Fortunately, one of the distinguishing aspects of graduate medical education at Dell Med is its signature curriculum which places a strong emphasis on health systems science. As a participant in the Distinction in Care Transformation honors track, I was given the opportunity to design a project aimed at tackling a systemic challenge in health care. This provided me the extra time and resources I needed to design and launch the elective.
I would also like to express my gratitude to some key individuals who provided guidance and support in making this program possible, including Tim Ruttan, Becca Cook, Nalinda Charnsangavej and Leah Harris. Their contributions have been instrumental.
This news feature is part of Dell Med’s Voices, a series of profiles that highlight the people of Dell Med as they work to improve health with a unique focus on our community.
Graduate medical education, or GME, refers to the period of education in a particular specialty or subspecialty following completion of medical school. This continuation of training through residency and fellowship programs provides the clinical and educational experience needed for physicians to achieve autonomy, deliver high-quality patient care, and prepare for challenges in an evolving health care landscape.
Dell Med, in partnership with Ascension Seton, is home to 442 resident and fellow physicians and sponsors 48 residency and fellowship programs ranging from family medicine and neurology to pediatric emergency medicine and cardiovascular disease.