Losing 2 Languages: How Stroke, and Awareness, Impact Hispanic Americans Differently

Noelia Gutierrez could never have prepared herself for what happened to her eight days after she gave birth to her daughter, Chenoah.

The 29-year-old mother of three was standing at her kitchen counter on a video call with her brother, when she was gripped by a sudden headache and an unfamiliar warmth flushed through her body. She handed her infant to her mother, telling her in Spanish that something was not right.

Then the seizures began.

Gutierrez’s fingers curled around the edge of the countertop, her hands involuntarily gripping the surface.

“My mom said, ‘You have to go to the couch,’ but I couldn’t tell my body to move. It’s like it just grabbed on and stuck there,” Gutierrez remembers.

Her 70-year-old mother dragged her to the couch, where Gutierrez sat and used the emergency function on her cellphone to call an ambulance. “I had a moment of clarity there,” she says.

From there, Gutierrez says that her memory is blurry, but she was able to piece things together with the help of her family. Although she believed she was speaking clearly to the dispatcher, the person on the other line immediately recognized her incoherent slurs as reason to send an ambulance to the gated community near Miami where Gutierrez and her family lived.

When she arrived at the hospital, Gutierrez was deteriorating quickly. Much of her care team was confused about what was happening since Gutierrez was so young, but her doctor finally recognized the symptoms.

“No more testing, I know what she has,” the doctor said, and rushed Gutierrez into surgery to remove the blood clot in her brain.

Before she had even turned 30 years old, Gutierrez, who grew up in New York and the Dominican Republic, had experienced a stroke.

Stroke Among Latino Americans Expected to Rise

While stroke risk among Latino Americans is relatively low, the American Heart Association (AHA) projects the biggest rise in strokes over the next decade — nearly 30 percent — will be among white Hispanic men. And, according to the AHA, strokes in young people like Gutierrez are on the rise, increasing 40 percent in the past few decades.

According to a study published in the AHA journal Stroke that included health data from almost 25,000 adults in the United States, 1 in 3 young people do not know how to recognize stroke signs.

In an effort to expand stroke knowledge among all age groups in the United States, the American Stroke Association, a division of the AHA, are popularizing a Spanish language version of their popular FAST acronym.

The initiative was in response to a Centers for Disease Control and Prevention (CDC) survey from 2017 that showed that just 58 percent of Hispanic adults in the United States could recognize telltale stroke symptoms, compared with 64 percent of Black Americans and 71 percent of white Americans.

“There are gaps that have been observed for many years in stroke care for Latino Americans,” says José Biller, MD a professor and chair of Neurology at Loyola University Chicago’s Stritch School of Medicine, and an American Stroke Association volunteer expert who helped develop RÁPIDO, the new acronym aimed at expanding knowledge of stroke warning signs among Spanish speakers.

Stroke is the fifth leading cause of death in the United States, but the fourth for Hispanic men and third for Hispanic women, CDC data shows.

“Knowledge is power, and in order to provide that additional power to this population, the ASA and the AHA are adapting a culturally relevant acronym,” Dr. Biller says.

Recognizing Signs, Acting RÁPIDO

RÁPIDO was originally designed by experts at The University of Texas System. The AHA’s FAST acronym stands for:

• Face drooping
• Arm weakness
• Speech difficulty
• Time to call 911

The RÁPIDO acronym includes the same warning signs and action prompts:

• Rostro caído
• Alteración del equilibrio
• Pérdida de fuerza
• Impedimento visual
• Dificultad para hablar
• Obtenga ayuda rápido

“We are going to close some of the gaps because stroke is a time-sensitive urgency that is treatable, that is preventable, and that should be recognized by the vast majority of the population,” Biller says.

More than 12 percent of all households in the United States are Spanish-speaking, census data shows. It’s the only language spoken by many immigrants, including Gutierrez’s mother.

“I grew up bilingual,” Gutierrez says. “My first job was helping my mom translate her mail.”

Being Bilingual Came With Complex Challenges for Stroke Recovery

Gutierrez's stroke occurred in March 2017, and the following months were dedicated to relearning the things she once took for granted — putting one foot in front of the other and taking a step, gipping a toothbrush, and communicating with her mother in Spanish.

English and Spanish, the two languages Gutierrez once spoke fluently, were affected in different ways. Her English was slurred, but parts of her Spanish seemed to have disappeared. “It was very weird for me,” Gutierrez says.

On top of intensive stroke recovery, including regaining her speech in two languages, Gutierrez was doing her best to care for her new baby. The experience threw her into a spiral of anxiety and depression.

Around one-quarter of people will experience anxiety within five years of having a stroke, according to the Stroke Association. Gutierrez, who is now 35, credits her husband, Chris, with helping her through the experience.

“I had two babies before this and had never had postpartum depression. My anxiety was at the point where, if I had an appointment at noon, I would be in the car by 7 a.m.,” she remembers. “Once I arrived, I couldn’t sit still in the waiting room. I’d go up to the front desk and ask why we were not in yet.”

But even in the midst of depression, to work on regaining her ability to speak Spanish, Gutierrez turned to quality time with her daughters and mother. “I watched little lullabies in Spanish with my girls, and watched TV shows in Spanish with my mom,” she says.

By May, Gutierrez estimates she was about 80 percent recovered — more than enough to attend a Mother’s Day event for her oldest daughter, Destiny, who was 9 years old at the time.

“Getting ready for the Mothers Day event, I was speechless. So many things were going through my head — you could have missed this, you could have been in another world by now. Would you have been able to see in spirit what she would have felt?” says Gutierrez.

She knows it was her quick action and ability to recognize her symptoms as both abnormal and serious that allowed her to be present at every Mother’s Day since then.

“We have to listen to our bodies — that was the difference in my case. I paid attention to it and knew it wasn’t normal and I didn’t just take an Advil and see how it was tomorrow,” she says.

Education and Awareness in the Spanish Community is Key

But Gutierrez worries that other people in her community, especially those of her mother’s generation, who are at higher risk for stroke because of their age, may not have the same impulse, or resources, if they were experiencing the same symptoms.

“As an immigrant child, our families teach us how to work hard, how to have a family that is together, and how to provide for our families, but we really don’t have those sit downs to talk about health,” she says. “Sometimes it’s because there isn’t time because we’re working so much, sometimes it’s because we don’t have a job that has health benefits and it costs too much out of pocket. It’s a problem. It's a huge problem.”

Adding to the disparity is the fact that so much more information on stroke in the United States exists in English than Spanish, she adds: “Having that in Spanish so people can understand and identify the signs is great.”

Gutierrez says she’s grateful to be part of the team that’s expanding access to information on stroke to communities that were previously cut out of it due to language barriers.

“It feels lucky in an unlucky way,” she says. “If this was the purpose of what happened to me, to be able to save other people, I’m all in for it.”