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For N.H.'s Brazilian immigrants, healthcare can be a challenge. Some are trying to fix that.

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New Hampshire is home to a growing Brazilian population, but some local advocates and medical providers say miscommunication and cultural misunderstandings can make it difficult for people in this community to access healthcare.

A recent training hosted by Ascentria Care Alliance, an organization supporting local immigrants and refugees, sought to help New Hampshire medical providers better meet the needs of their Brazilian patients.

The virtual webinar brought together Brazilian health professionals to answer questions and offer advice about improving patient-doctor interactions: addressing language barriers, taking more time to get to know their patients during medical appointments, and better understanding the hurdles that might make it challenging to access healthcare.

According to the New Hampshire Brazilian Council, most of the state's Brazilian community is concentrated in Nashua. All three of the presenters for this training were also based in that city.

"Many Brazilians fear the doctors won't understand them," said Silvia Petuck, a community health worker with Nashua Public Health & Community Services. "We need interpreters from Brazil who understand the language and cultural background."

Watila Burpee, a Brazilian therapist at the Greater Nashua Mental Health Center, said medical personnel often assume Brazilians speak Spanish — when, in fact, they speak Portuguese.

"It makes a big difference when trying to communicate with your provider," Burpee said." But Brazilians don't say anything because they don't want to bother; we feel bad to correct somebody."

But language is only one of the factors creating discomfort for local Brazilian patients, Burpee said. Immigration can be traumatic, she explained, leading to loneliness and depression. And it can be hard to get medical providers to understand this experience.

The professionals at the training said Brazilians might look for someone to talk to about their feelings, but doctors usually rush and don't take the time to chat with them about daily life – something that can make a big difference when earning their trust.

"That [behavior] decreases their self-esteem and increases isolation," Burpee said.

The stigma around mental health can also be challenging, Burpee said, "especially the male population." She noted that many Brazilians might not want to let anybody know they have a mental health problem because they are afraid they will not be invited to social events anymore.

As the providers explained during this training, socializing and being surrounded by family and friends is a high priority for many Brazilians. So is showing affection: Some Brazilians might hug and kiss others, including their doctors, as a greeting.

Burpee said providers can if needed, explain that they're not comfortable with this kind of greeting but should also be mindful about how they reject this interaction, since it could make their patients feel inadequate.

But for many local Brazilians, the biggest challenge is getting medical care in the first place. According to the local advocates, many struggle to pay for health insurance, and high medical costs prevent them from returning to appointments.

"We need affordable care, more services for low-income people," said Bruno D'Britto, founder of the New Hampshire Brazilian Council."

D'Britto is a lawyer, not a medical provider, but he said his experience working with the local Brazilian community has shown him how navigating immigration issues, for example, can affect someone's mental health.

"Being unable to get a driver's license when undocumented or a professional license when they just arrive affects them," he said. "They can feel overwhelmed."

Petuck, the community health worker, said many Brazilians living in New Hampshire previously worked as lawyers, psychologists, or engineers but cannot find work locally in those fields. Instead, she said, some of them work cleaning houses or in jobs other than what they've trained for. That disconnect can also contribute to depression, she said.

The panelists concluded that more clinical outreach — such as medical campaigns in other languages, interpreter services and training — are still in needed in New Hampshire. Cultural training, they said, is the key to better understanding rapidly growing immigrant populations and better serving people who might otherwise feel marginalized.

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