At Clinic, Tales and Health Concerns of Hispanics
By DENISE GRADY, NY TIMES, March 28, 2009
MINNEAPOLIS — As in many public hospitals across the country, the largest number of foreign-born patients at Hennepin County Medical Center are Hispanic immigrants. They are in the emergency room, the maternity ward, neighborhood clinics and in a part-time clinic in the main hospital set aside for Spanish-language patients.
The clinic, open three half-days a week, is so busy that it is hard to get an appointment. Dr. Carmen Divertie, an internist from Peru, founded it 15 years ago, modeling it after a clinic for Russians at the hospital.
Many of Dr. Divertie’s patients are recent immigrants from Mexico or Ecuador, and she assumes that virtually all are illegal, though she does not ask. The hospital has a policy of not considering immigration status in offering care, but the money spent on illegal immigrants accounts for a sizable part of the hospital’s unreimbursed tab of $45 million a year — a sore point for people upset about illegal immigration, even in this city with a long history of reaching out to immigrants.
Dr. Michael Belzer, the medical director at Hennepin, said wryly, “We’ve cornered the market on the uninsured.”
The hospital’s Spanish, Somali and Russian clinics all lose money because many insurers will not cover the cost of interpreters and because appointments take longer with everything being said twice, said Dr. Craig Garrett, who started the Russian clinic and oversees all three.
Even with Hennepin’s open-door policy, hospital officials say, getting health care is increasingly difficult for many illegal immigrants. Previously allowed to use Medicaid, people here illegally are no longer eligible, except for children, pregnant women or those with emergency cases. Some illegal immigrants are too afraid to approach a public hospital like Hennepin, fearful that any official interaction might tip off immigration agents.
The chatter in the hallways and waiting rooms indicates that Minneapolis — a full 1,150 miles from the Mexican border — is less a destination of convenience than necessity for illegal immigrants. Some went first to California, Chicago or New York, and then came here to get their children away from gangs or find affordable housing, jobs, good schools and health care.
“Some have already lost a child,” Dr. Divertie said of the gang violence in other cities.
One woman who arrived at the clinic last summer for a checkup said she had recently paid a coyote, or human smuggler, $3,000 to cross the heavily guarded border into Arizona. The crossing took just two hours.
“She must have had a good coyote,” Dr. Divertie said.
The patient, a widow in her 50s with five grown children, said the trip required running and jumping. A companion fell and broke her leg, and did not complete the trip. Dr. Divertie said some of her patients trained for crossing the border as they would for an athletic event.
Dr. Veronica Svetaz, an Argentine physician at a Hennepin neighborhood clinic, treated a 13-year-old girl who had been raped and made pregnant by a coyote. The girl was so ashamed that she did not tell her mother what had happened until she realized she was pregnant. The family wanted to end the pregnancy, but by the time the decision was made, a late-term abortion was needed, requiring a trip to Chicago. The family could not afford it. The girl had the baby, and kept it.
“It’s overwhelming,” Dr. Svetaz said.
Teenage pregnancy is a huge problem, she said, and sometimes it seems as if more girls, and younger ones, are showing up pregnant every day. Some were abused, some slipped up on birth control, and some decided that 15 was a good age to have a baby. But what saves Dr. Svetaz from despair is what she described as her relentless drive to push and inspire them to go back to school and to avoid a second teenage pregnancy.
Dr. Svetaz takes care of entire Latino families, and in adults and teenagers she sees a great deal of back pain, injuries, diabetes, high blood pressure, depression, anxiety and stress.
“Mental health is huge,” she said. “The levels of anxiety and depression are amazing.”
But her patients worry about being labeled crazy if they admit to emotional problems.
“Latinos tend to somatize more,” she said, meaning that their psychological troubles are expressed as things like back and neck pain.
“This is where cultural competence comes in,” she said. “I’ve seen an 18- or 19-year-old with chest pain and a headache, who had a panic attack, but was worked up in the emergency room for heart attack and given a head CT or M.R.I.”
Hennepin has a discount program with sliding-scale fees for the indigent. But even the discounted fees are more than some can afford, Dr. Divertie said, so many delay care until the need becomes urgent. Hoping bronchitis will go away, they wind up with pneumonia. Patients with heart failure wait until they cannot breathe. For lack of Pap tests, women develop advanced cervical cancer, a deadly disease that can be prevented. Breast cancers also tend to be found late, when the odds of survival are lower.
People with diabetes show up at Hennepin’s clinics with blood sugar so high that they are sent straight to the hospital. Some have severe diabetic complications, even gangrene. And it is hard to convince Mexicans to take insulin, no matter how badly they need it, Dr. Divertie said. Many have seen diabetic relatives die while using insulin, and they blame the medicine rather than the disease.
“Most of my patients are illiterate, the majority, and they’re ashamed of it,” Dr. Divertie said. “They don’t tell you.”
Many of Dr. Divertie’s patients take antidepressants. Often, they live in overcrowded housing to lower their rent and work more than one job to send money back to their home country. Some long for children left behind and worry that they are being abused by relatives who are supposed to be looking after them.
“They come in crying,” she said.
On top of the emotional troubles are cultural beliefs and habits that can make immigrants difficult to treat.
“Lots of my patients come in and they’ve already been taking antibiotics that didn’t work, and that’s why they come to me,” Dr. Divertie said. CLICK HERE FOR MORE
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