Veronica is shy and a bit nervous.
She doesn't want to discuss the specific reason she is here at the Clinica Medicos office on 23d Street — it is too private, she said through an interpreter — but she had a child recently and, for the first time, doctors helped with her delivery.
Medical care during pregnancy is not common in her native Guatemala, she said. Most women give birth in their homes with a family member or local unofficial midwife helping out.
"They don't go to a hospital," she said, "that is not an option."
A mother would always be expected to teach her daughter how to give birth, Veronica said, just as she would teach her daughter how to cook.
But the lessons a mother might teach in Guatemala may no longer be the best way to deliver healthy babies here in the U.S.
Changing those centuries-old habits is just one of the challenges doctors at Clinica Medicos and health officials elsewhere say they face to provide good health care to Chattanooga's burgeoning Latino population.
"We have women who come here 30 weeks pregnant who have never seen a doctor, and in their countries, that is completely normal," said Dr. Kelly Rodney Arnold, the founder of Clinica Medicos.
"In most communities, young women go to their elders about what to do to their children. But now medicine is saying something different," said Rae Bond, executive director of the Hamilton County Medical Society. The society helps run Project Access, a program to provide free care to those who cannot afford it, including a large number of area Latinos. "And if there is a conflict between what grandmother says and what the medical community says, the tendency is to listen to grandma."
The need for health care aimed at the metro area's Latino population has grown as that community has ballooned in recent years. There were only 5,500 Hispanics in Chattanooga as of the 2000 census, but that number almost tripled to 15,000 by the 2010 census, and it is projected to be at 40,000, or about 15 percent of the population, in Hamilton County by 2020. Hispanic enrollment in Hamilton County schools shows a parallel increase, rising more than 40 percent in only four years, from 3,249 in 2012-2013 to 4,647 in 2015-16, according to Sheryl Rogers with the Hamilton County Department of Education.
That population is majority Mexican and includes representatives of virtually every country in Central or South America, but the local Guatemalan community is unexpectedly large, an estimated 22 percent of all local Latinos. That compares to about 2.3 percent nationally, according to Stacy Johnson, a Cleveland, Tenn., native who heads La Paz, the leading Latino advocacy group locally.
As at Clinica Medicos, the majority of the Latinos La Paz serves are from Guatemala. "These tend to be the people who need more services, more help," Johnson said.
Language is the major impediment for local Hispanics in finding jobs or health care, according to a survey completed this spring by La Paz. That can be particularly difficult for Guatemalans because while Spanish is the official language, many of them are from rural areas where they might speak their indigenous Mayan dialects such as K'iche or Q'eqchi.
"To work with someone from Guatemala, we have had an interpreter who knows the dialect, and they are translating into Spanish and then we have had to have an interpreter from Spanish to English," said Diana Kreider, director of case management services with the Chattanooga-Hamilton County Health Department.
Besides hiring translators, the health department and other organizations dealing with the Latino community use translation services such as Language Line, according to Tammy Burke, director of clinical services at the health department. A health care worker can call a phone number, type in a payment code, and a translator located elsewhere in the U.S. will join a conference call to handle the translation.
But after language barriers, cultural issues are often not far behind.
Changing how mothers raise their babies is a good example.
"What we know today is best for babies is different from what we thought when I had my babies," Bond said. Parents were told to let babies sleep on their stomachs and cover them with a blanket. But now, "doctors say keep them always on their back, don't cover them up, and put them in clothing so they can't cover their faces our whole knowledge has changed," she said.
"You realize that people have had traditions and even when medical science has solid evidence to the contrary, we are still working on how to convey that strong medical evidence to folks in ways that make it easy to understand and are respectful and help them understand how we've learned this new information," Bond said.
Much of the primary care for area Latinos, including health education, is handled at clinics run by the health department, Erlanger and CHI Memorial hospitals, and other groups such as LifeSpring Community Health, Volunteers in Medicine, or Clinica San Jose (St. Joseph's Clinic, in English).
The health department, for example, offered a program to challenge Latino residents to find ways to address chronic health problems such as diabetes or obesity.
"Most of those who come to the program are women and they cook for the family," said Carleena Angwin, who ran the program for the health department. "They're introducing water [in place of sugary drinks], vegetables, walking — they make up their own action plans, not us."
More serious issues or those requiring specialization are often referred to Project Access, a program coordinated by the Medical Society, and the Medical Foundation of Chattanooga, but including almost every major health care organization in town. More than 900 doctors have donated charity care valued at over $140 million since the project launched in 2004, Bond said.
There is also an auspicious newcomer providing health care to the Latino community.
Clinica Medicos was launched a little over a year ago by Arnold with a total staff of five. In 12 months, the staff has grown to 17 and the clinic, on 23rd Street, near the intersection with Holtzclaw, has seen more than 1,000 patients.
Arnold sees her clinic as much more of a mission than a career. She is a fourth-generation physician whose father taught her about "the beauty and honor of treating the underdog," she said.
She grew up in Los Angeles and traveled widely in Latin America, falling in love with the people and culture. But she earned her undergraduate degree in Spanish from University of Tennessee at Knoxville and followed that with a medical degree from the UT Health Science Center in Memphis before doing her residency here in Chattanooga.
"When we opened this, all my mind's eye could see was an underserved Latino community that I thought needed a voice, and needed logical solutions at an affordable price, steeped in compassion," she said.
The clinic is a converted warehouse, but its walls are decorated with bright-colored folk art Arnold has collected from around Latin America.
"We can provide 90 percent of our patients' health needs, and can do it under one roof here for one-tenth of the cost," she said. All of the clinic's staffers are bilingual, and several are themselves immigrants.
Arnold is particularly proud the clinic is open seven days a week.
"Somehow we have arbitrarily created a Monday-through-Friday, 9-to-5 model of medicine as if that's the only time people get sick or need a physician who knows them and they trust," she said.
Workers are already hammering away on an addition in the rear of the building that will almost double the clinic's space. If sufficient funding is available from the foundations and other organizations that help support Clinica Medicos, she would like to add a dental suite or perhaps provide mental health services.
Another key role Clinica Medicos plays — as does La Paz — is to guide Latinos who are often unaware of the services available to them or wary of approaching government offices.
"Especially for people with language or cultural problems, having the door opened first by La Paz or Clinica Medicos is an important link," the Medical Society's Bond said.
That is especially true of those Latinos who are here illegally. Immigration status is something local health care providers do not ask about.
"Our programs don't require that we ask that question," Burke said.
Arnold is even more blunt: "I hope the message is loud and clear to any patient who walks in, in that situation, that you are safe," she said. "It's a complicated topic. I don't have all of the answers, but I do know how to take care of humans and take care of them well."