WATERLOO -- How do you brush a white person's hair?

The question drew a laugh when Yolanda Davis, who is black, asked it in her nursing class at Hawkeye Community College. It's a simple and silly question on the surface, but illustrates many of the cultural and ethnic challenges Iowa nurses face in a rapidly diversifying state, and the importance of employing health professionals from all walks of life.

"(It's important) just being able to talk through those things, because there are differences in our two types of hairs," Davis said.

It's also important because Iowa and the entire country continue to diversify. Census figures released Friday showed minorities are fueling Iowa's population growth, while the white population inches along at a near stagnant rate. The two biggest minority groups in the state, Hispanics and blacks, increased by 32 and 14 percent, respectively, since the 2000 Census. The white population increased by .16 percent.

By 2050, America's minorities will be a majority, making up at least 50 percent of the population, according to government estimates. However, minorities only represent 9 percent of nurses. The percentage is even lower for doctors and dentists.

The number of nursing students at local nursing colleges are consistent with the low national numbers.

Of the 42 students in Davis' program, only two were minorities -- both black females. The school doesn't keep track of the numbers of minorities enrolled, but nursing department chairwoman Barb Krieg said there are not a "significant number" of minorities enrolled.

At Allen College, a nursing school, only 2 percent of its 400 students are minorities, though the school is still enrolling and admitting students.

"There's this huge gap demographically between the need for minority health professionals and the reality in the field," said Michelle Yehieli, director of Iowa EXPORT Center of Excellence on Health Disparities at the University of Northern Iowa.

Minority nurses needed

Minority health workers bring several unique skill sets and have the ability to connect with minority patients in ways that their white counterparts can't, Yehieli said. For example, minority health professionals tend to be received better received by minority patients and can reduce language and cultural barriers. This helps improve health care in populations that typically don't get enough attention.

Davis said most of the time she doesn't notice a difference in the way minority patients react to her, but any exceptions usually come from older black people. She said older generations, many of whom migrated from the segregated South, never got in the habit of seeing a doctor. Sometimes they rely on home remedies, such as eating Karo syrup for a stomachache or placing warm drops of oil in the ear for earaches rather than following the doctor's advice. But, as Davis found out, they won't admit those practices to just anybody.

"The families sometimes seemed more willing to be more open and frank (with me), because maybe they do some things at home that the doctor said they shouldn't do," Davis said.

The open communication and trust can help increase the chances that the patient will comply with a doctor's recommendation.

Language barriers, especially with the local Bosnian and Latino population, also can hinder effective health care. Krieg, Hawkeye's nursing chairwoman, said she was once in a doctor's office when a Bosnian woman jumped up and gave her a big hug after Krieg told a colleague that she had the plane tickets to Boston.

"She thought I said Bosnian," she explained. "It was this comfort level of 'Finally somebody who can help me.' I was a hero for about 30 seconds."

Minority health professionals also tend to be more willing to work less prestigious and lower paying jobs in underserved communities. Allen College student Susan McConnell, an American Indian who is part Creek and Cherokee, said she would like to eventually return home to Oklahoma and serve her people there. She said there's a huge need for improved health care among American Indians.

"When you look at hypertension, diabetes, tuberculosis, obesity, alcoholism, it's just more extreme among Native American people no matter where they are," she said. "In the southern part of our country, obesity and diabetes is much extreme among the Navajo people and in the Arizona area."

Increasing enrollment

Allen College's dean of academic affairs, Susan Dawson, took over the post this summer after several years in the St. Louis area. One of the first things she noticed, despite being located in one of the most diverse communities in the state, was a lack of diversity at the school. She acknowledged part of the barrier is the cost, $12,300 tuition for the upcoming academic year. She believes the money barrier can be broken because it is mostly a perceived one: Nearly all the students come from working class backgrounds and manage the cost with scholarships or financial aid.

She said one of her goals is to change the image of the college to make it seem more accessible in the eyes of students, especially minorities.

"People see this as a rich people's school, and that isn't the case," she said. "(Allen) needs a welcome mat, to tell people how to prepare. To me it's not always a matter of people not being able, but they see barriers as too big."

UNI's health disparities center produced a statewide strategic plan last year to identify those barriers and overcome them, in order to increase minorities in the health professions. This summer it rolled out a statewide mentoring network called Iowa Minority REACH Network, with the intention of recruiting and mentoring young Iowans.

The center also recommended increasing minority presence in every position from top-level management to nurses aides, and diversity and cultural education.

Hawkeye Community College recently implemented culturally specific recruitment and marketing, one of the center's recommendations. Though the ratio of students by race more or less mirrors that of the area, the college still wants to attract more people of color.

Quentin Hart, associate director of multicultural affairs at Hawkeye, said traditional forms of reaching students -- home mailings, newspapers, high school visits and college fairs -- are often inefficient with minorities. Instead, the college has been heading out to local churches, which play an important role in many black communities, neighborhood organizations and community centers.

The college also is hoping to build partnerships with K-12 schools and local hospitals to build a student pipeline. It already works with the UNI Center for Urban Education by exposing young students to different career paths and areas of study available at the college.

"Our community is one of the most diverse communities within the state, if not the most diverse," he said. "The biggest thing is not to sit in our institution and wait for the students to come to us, but to get out in the community get out in the neighborhood groups to show that we want those people to participate."

Contact Jens Manuel Krogstad at (319) 291-1580 or jens.krogstad@wcfcourier.com.