The Immigrant Health ExperienceAs the 7 train rumbles by just outside, about 30 patients sit in a light green carpeted room, waiting to see their local doctor. As in waiting rooms throughout the city, some slouch, some cough, but in this office all share the same faint and defeated stare in their eyes.
It’s the cheap cost of needed health care, about 20 dollars a visit, that has brought them all the way up the 19 steps from the bustling Roosevelt Avenue below. They’ve come to visit Dr. Guido E. Reinoso, an older man, with a thick mustache and a soft smile.
On a typical Sunday, Dr. Reinoso will treat more than 50 patients, most are undocumented immigrants. He examines his patients in the small back room of his second floor Queens office. Patients wait a couple of hours to receive about 10 minutes of his care. After their session, some leave the doctor’s office clasping onto brown paper bags containing treatments.
The framed credentials on Dr. Reinoso’s wall aren’t those you’d expect most doctors to display. Although he says he’s a licensed doctor in his native country of Ecuador, here Dr. Reinoso serves the community as a natural health practitioner. He treats his patients, mostly Ecuadorians who live in the community, with herbs and dietary supplements. “It’s part of our culture,” said Dr. Reinoso. In Ecuador, doctors often treat patients with teas and vitamins.
The patients here can afford Dr. Reinoso’s low fee, and some he’ll even treat for free. “They don’t have health insurance and clinics are too expensive for them,” he said.
Adam Yuguilema, 40, is a patient of Dr. Reinoso. Rather than visit a clinic or emergency room, he waits till his day off for a visit. “The doctor will treat me faster and cheaper,” he says. Mr. Yuguilema is an undocumented immigrant from Ecuador. He’s been living in the U.S. for the past 11 years.
Mr. Yuguilema visits Dr. Reinoso’s office mostly to treat his allergies. He learned of the doctor through word-of-mouth. During his visit, Mr. Yuguilema received a shot and enough pills for two weeks. When asked, the doctor denied giving any medicine. Mr. Yuguilema is completely unsure of what the shot or pills were exactly, “I trust that the doctor is giving me medicine to cure me, not kill me.”
For decades the United States has been viewed as a refuge for immigrants from all over the world. Little do they know, that basic needs, such as health care, is third-rate for them. Some find alternative doctors, such as Mr. Reinoso, who aren’t licensed to practice in the United States. Many spend hours inside emergency waiting rooms or community health centers. Even then, they receive only minutes with a doctor or nurse. They are then sent off with referrals they can’t use and prescriptions they can’t afford to fill.
Affordable health care is a nationwide problem. From waiting room to waiting room, faces all show despair over the lack of affordable options. The latest census report states that 50.7 million people currently have no health insurance. 13 million are foreign-born. The Department of Homeland Security estimates that there are10.8 million are unauthorized immigrants. The national health policy is undergoing much awaited changes for citizens lacking medical insurance. Whether immigrants should or shouldn’t have any benefits, particularly the undocumented, has been a contentious issue. But everywhere, from Arizona, to Georgia, to the streets of New York, immigrants need reliable health services and they will continue to.
In 1996 Congress restricted federal benefits to immigrants and required a five-year minimum for green card holders before they can qualify for public health benefits. But emergency care is usually available to anyone. Federal and state tax dollars fund emergency care.
In New York, a visit to the emergency room doesn’t require disclosure of any immigration status, in compliance with Bloomberg’s Executive Order 41. During intake, billing information is simply directed to the patient’s address. However the bill usually amounts to many times more than it would (or should) through a normal doctor’s visit.
Mr. Felix Acevedo, 44, was charged over 700 hundred dollars for a couple of stitches when he was treated in Elmhurst Hospital in Queens. He’d been working on a paint job in someone’s backyard as a day laborer for 50 dollars. At some point a neighbor’s dog became loose and ran over to Mr. Acevedo. His left wrist was soon clutched in the mouth of the pit-bull and he began to bleed profusely. The police came to the scene. They advised Mr. Acevedo to go to the hospital and check the possibility of a rabies infection. An ambulance was called and drove Mr. Acevedo less than two miles to the emergency room.
“I waited almost all day,” said Mr. Acevedo. He became anxious in the waiting room and changed his own dressing. Later he was asked to sign a paper in English. He was told it was a release to receive treatment but he couldn’t read it. The medical staff gave him an injection, some cream and a prescription. He was then sent home.
Mr. Acevedo never filled that prescription. He couldn’t afford it. He had lost almost a full day’s work. Instead, he applied Aloe Vera and carefully changed the dressing everyday.
Almost a month later his cut healed. He received an envelope from the hospital. It was a bill for $777.70. “I was in shock,” said Mr. Acevedo. “All they did was give me a shot and some cream. I could’ve just gone home and cleaned it up myself.”
A few weeks later Mr. Acevedo received another bill, $529, for the ambulance service. “I could’ve walked! Or even taken a cab,” he said. It was after all only a short walk to the hospital.
The bill was entirely unaffordable for his sporadic income. Mr. Acevedo says he would have been more than willing to pay for the care he received. “But this charge is unreasonable,” he said. He sought help from NICE (New Immigrant Community Empowerment), an immigrant advocacy group, who referred him to a social worker from another organization to get the emergency charges waived. He will still be responsible for the ambulance bill.
“We have a lot of members with this problem,” said Valeria Treves, the executive director for NICE. During a meeting with some of her members she asked about their experiences at the local emergency room. A young man declared, “that’s not a hospital, it’s a morgue.” The others in the small meeting room chuckled.
In this community there is an urban myth about emergency visits. Names are not attributed. “The brother of a friend walked in with a stomach pain, a day later he died.” The story goes on to describe the experience that the friend had when trying to inquire about the cause of his brother’s death. Since there are no documents to prove kinship, the person was denied all patient information. The death remains a mystery all the way back to their home country.
Even Mr. Yuguilema has avoided emergency rooms due to this myth. “Many people have told me not to go there when I get sick, because instead of healing you they kill you.”
Despite this questionable popular reputation, many people do enter the double sliding doors. In 2010, the Elmhurst Hospital emergency room treated 134, 582 patients. About forty percent of these patients were self-pay visits that later get adjusted according to income, paid with a monthly plan, or absorbed by Medicaid emergency funds as in Mr. Acevedo’s case. Immigration status isn’t tracked by the hospital.
Over four billion tax dollars are already spent annually on providing health care for the undocumented according to the Center for Immigrant Studies. However the Congressional Budget Office says that extending immigrants a public health option would be more expensive when compared with emergency room costs. So for now, nothing is changing.
Currently immigrants struggle to survive on the edges of American communities. Many are adamant about staying out of the public health sphere. They are left on their own to navigate the underground networks of sympathetic health practitioners, pharmacists and acquaintances. They seek so-and-so’s daughter who is studying medicine; she may be able to diagnose the problem. A friend or relative is traveling to their home country; maybe they will bring back some medicine. A neighbor, the one whose close friend is a pharmacist, maybe he can help to attain a prescribed drug.
In Queens there are several pharmacies that will sell a couple of loose pills though it’s not easy to get. Instead of needing a doctor’s prescription, you have to be referred by someone who is trusted. It’s a dubious but accessible way of treating an illness.
Community health centers offer a small solution. Carmelo Chavez, 39, an undocumented immigrant from Mexico, was referred to his clinic, The Ryan Center, by his citizen fiancé. This center is just steps away from his home, on the upper west side. He pays $32 a visit, adjusted according to the income he reported during registration, $150 weekly.
“The waiting room is completely saturated,” said Mr. Chavez. “It’s really frustrating.” Inside the first-floor waiting area, Mr. Chavez waits with about 35 other seated people and more standing against the walls. Screaming children and people in bad moods make the room feel much smaller.
Later Mr. Chavez is directed down the hallway to another waiting room. “It shouldn’t be like this,” he said referring to the shuffling from one doctor’s waiting room to the next. Finally when Mr. Chavez is in the exam room, his temperature, blood pressure and weight are hastily taken and recorded in his file. In a few short minutes, Mr. Chavez’s face time with the doctor ends and his main concerns are overlooked. His ailments eventually fade.
Most health centers throughout the US don’t verify resident status. Some critics say that there should be some sort of verification procedure in order to deter unauthorized immigrants from using public services, such as the Systematic Alien Verification for Entitlements programs also known as SAVE. It’s equivalent to the E-Verify system that employers use to verify immigration status of employees.
Mr. Ira Mehlman, from the Federation for American Immigration Reform (FAIR) organization, is an advocate of the SAVE system. He says preventing access to medical care is part of the solution to illegal immigration. “If you remove the reason why they came here in the first place, many of them, if not most, will make the rational decision that it is not worth sticking around.”
The number of Federal, state, and local agencies that participate in the SAVE program has been increasing in recent years. The cost of implementing the system is very high. Results from the program show that nearly no immigrant has been found trying to apply. “When the highway patrol wants to enforce the speed limit, they put lots of patrol cars out on the highway, your not surprised to find not too many people [anymore] speeding out there,” said Mr. Mehlman who is confident that the program is indeed keeping the away the undocumented.
Some legislators say it makes sense to offer immigrants a public health option. “The undocumented community is to the point where even their citizen children are suffering” said Congressman Luis V. Gutierrez (D) from Illinois “their children play with our children.” It’s a public health concern. “People tend to think that immigrants live in an isolated community, they don’t,” said Congressman Gutierrez. Immigrants are often employed in kitchens, making our beds and picking our fruit. “They are part of our everyday life and denying them appropriate healthcare or accessibility puts all of us at risk.”
As the outbreak of the H1N1 flu showed us, public health affects everyone.
A recent federal statute requires all individuals to obtain health insurance by 2014. Federal subsidies will be available for those who meet the standard. But for unauthorized immigrants, which mostly live on hand-to-mouth incomes, this can push them further into the health care abyss.
Mr. Yuguilema doesn’t know how long he will live out these circumstances. He’s thought about leaving many times. “If something serious occurred, I don’t know what would happen. I practically live alone. I don‘t know what I’d do,” said Mr. Yuguilema. He has been paying taxes for almost six years hoping that immigration reform might legitimize him. Reform that may or may not, come soon. For now alternative medicine and homemade soup is his most affordable option.