I have been at JMH for the past two years and I speak spanish fluently. I would say that I spend the majority of the time speaking spanish. There is also another small percentage of patients that speak Creole. Most of the patient population consists of indigent Hispanic/Black/Haitian people. About 30-40% of the patients are white and speak English. I have noticed it is very frustrating for those who do not speak spanish but most people seem to pick up the key words needed to take a history, consent a patient, and explain treatment. There are translators available all the time and they usually arrive within 5 minutes of your page. Whatever your background is, you will end up finishing your residency with a decent knowledge of spanish. Its the nature of the beast here so I guess my advice is to be willing to have an open mind towards a different culture or go to a hospital where everyone is American.