Dr. Julie Ramos sees her work in the Bronx, where many of her patients are women with heart disease, as the best way to thank the family, friends and neighbors who believed in her potential as a girl.
“Growing up, people saw me getting this education, and they always said, ‘Don’t forget where you come from,'” Ramos told Women’s eNews in a phone interview.
As the director of outreach cardiology at Montefiore Medical Center in the Bronx, New York, Ramos treats women – mostly Spanish speaking – who remind her of her own mother.
“My mom did not have a job other than as a cleaning lady,” Ramos said, recalling that her mother’s education and fluency in English were “very limited. I was the translator. I know the culture. We spoke only Spanish at home.”
On average, Latinas are likely to develop heart disease 10 years earlier than non-Hispanic women, according to the American Heart Association. Heart disease is the No. 1 killer of Latinas, but only 1-in-3 is aware of this.
Ramos was born and raised in Plainfield, New Jersey, a community that she describes as “very similar” to the Bronx. About 60 percent of Montefiore’s patients are Latinos and Latinas, 39 percent are African Americans, 50 percent are obese and 30 percent live at the poverty level, Ramos said. All of those factors put these patients at high risk for heart disease.
“I grew up lower income, but we were culturally rich,” she said.
Ramos was in private practice in Phoenix when she got the call to interview for a position with Montefiore Medical Center, which she joined in 2011.
“I told Dr. (Mario) Garcia it was my ideal job,” she said, remembering her interview with Montefiore’s chief of cardiology. He is also the co-director of the Montefiore Einstein Center for Heart and Vascular Care.
In 2013, she became Montefiore’s medical director of outreach cardiology. In addition to treating patients, she will oversee the new WomenHeart peer-support group for women with heart disease.
“A lot of these ladies I serve are home health aides and cleaning ladies,” Ramos said. “As a physician, it’s a calling – to go above and beyond and help them navigate the barriers. We try to be very sensitive to who works with these patients.”
That empathy comes naturally to Ramos. She can’t forget the family and friends who rooted for her as she earned her bachelor’s degree at Rutgers University, a master’s degree in nutrition at Tufts University and her M.D. from the University of Medicine and Dentistry of New Jersey (now known as the Rutgers School of Biomedical and Health Sciences) – and then went on for an internal medicine residency in New York and a cardiology fellowship in Atlanta.
Barriers to Care
The language barrier is a hurdle for most of her Latina patients with heart disease, Ramos said.
“Ninety-five percent can’t navigate a conversation in English,” she said, noting that they have difficulty with reading labels on pill bottles. “‘One tablet by mouth once a day.’ That seems simple enough” if English is your language.
The doctor often explains the directions in the office. “If the patient doesn’t understand the instructions, she won’t take the medicine.”
Living on a low income also makes it difficult for many of her patients to get access to medical care, Ramos said, adding that “about 90 percent are on Medicaid. With health-care reform, it’s much more open. But Medicaid patients have limitations. We deal with a lot of patients who are in this marginalized population.”
Getting to and from a medical appointment can be a challenge, too, for women who are living on a fixed income or working long hours for low pay. “Many have to take the bus or the train to go see the doctor. That’s a $5 round-trip. That could be their breakfast money. It’s a reality for a lot of these ladies,” Ramos said.
A peer-support group for women with heart disease sponsored by WomenHeart, a nonprofit advocacy group based in Washington, D.C., is “a first for Montefiore,” Ramos said. The group, led by Coral Robinson and Roxanne Watson, two women who are living with heart disease, will extend the work that Ramos does to educate and empower individual patients. It will help patients, Ramos added, to learn how to speak up during their doctor appointments so they get better care.
“It teaches them to ask questions. Have the woman say: ‘Doctor, if you don’t mind, I have a difficult time (with English).’ Have the instructions in Spanish. A lot of pharmacies will give the instructions in Spanish,” she said. “So it’s teaching women what to ask for – how to navigate the system and remind their providers there are issues.”