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Reach him at jraff@kqed.org","avatar":"https://secure.gravatar.com/avatar/1444299e18b67b815fbbdc87a85e7dff?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]}],"headData":{"title":"Jeremy Raff | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/1444299e18b67b815fbbdc87a85e7dff?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/1444299e18b67b815fbbdc87a85e7dff?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/jeremyraff"},"lisaaliferis":{"type":"authors","id":"240","meta":{"index":"authors_1591205172","id":"240","found":true},"name":"Lisa Aliferis","firstName":"Lisa","lastName":"Aliferis","slug":"lisaaliferis","email":"laliferis@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":"Lisa Aliferis is the founding editor of KQED's \u003cem>State of Health\u003c/em> blog. Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including\u003cem> Dateline NBC\u003c/em> and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a \u003ca title=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\">handy guide to the Affordable Care Act\u003c/a>, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for \"Best Topical Reporting\" from the Online News Association. You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of Health","lastName":null,"slug":"state-of-health","email":"stateofhealth@kqed.org","display_author_email":false,"staff_mastheads":[],"title":null,"bio":null,"avatar":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twitter":null,"facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"stateofhealth","roles":["editor"]}],"headData":{"title":"State of Health | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/66de4bf6d331fa7402bba1ffe8135e17?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/state-of-health"},"fjhabvala":{"type":"authors","id":"8659","meta":{"index":"authors_1591205172","id":"8659","found":true},"name":"Farida Jhabvala Romero","firstName":"Farida","lastName":"Jhabvala Romero","slug":"fjhabvala","email":"fjhabvala@kqed.org","display_author_email":true,"staff_mastheads":["news"],"title":"KQED Contributor","bio":"\u003cspan style=\"font-weight: 400;\">Farida Jhabvala Romero is a Labor Correspondent for KQED. She previously covered immigration. Farida was \u003ca href=\"https://www.ccnma.org/2022-most-influential-latina-journalists\">named\u003c/a> one of the 10 Most Influential Latina Journalists in California in 2022 by the California Chicano News Media Association. Her work has won awards from the Society of Professional Journalists (Northern California), as well as a national and regional Edward M. Murrow Award for the collaborative reporting projects “Dangerous Air” and “Graying California.” \u003c/span>\u003cspan style=\"font-weight: 400;\">Before joining KQED, Farida worked as a producer at Radio Bilingüe, a national public radio network. Farida earned her master’s degree in journalism from Stanford University.\u003c/span>","avatar":"https://secure.gravatar.com/avatar/c3ab27c5554b67b478f80971e515aa02?s=600&d=blank&r=g","twitter":"FaridaJhabvala","facebook":null,"instagram":null,"linkedin":"https://www.linkedin.com/in/faridajhabvala/","sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["author"]}],"headData":{"title":"Farida Jhabvala Romero | KQED","description":"KQED Contributor","ogImgSrc":"https://secure.gravatar.com/avatar/c3ab27c5554b67b478f80971e515aa02?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/c3ab27c5554b67b478f80971e515aa02?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/fjhabvala"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_117914":{"type":"posts","id":"stateofhealth_117914","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"117914","score":null,"sort":[1449680350000]},"guestAuthors":[],"slug":"hayward-promotoras-make-house-calls-neighbors-health","title":"Hayward 'Promotoras' Make House Calls, Connect Neighbors to Health Care","publishDate":1449680350,"format":"standard","headTitle":"Vital Signs | State of Health | KQED News","labelTerm":{"term":2363,"site":"stateofhealth"},"content":"\u003cp>Carolina Arroyo-Solveson and Guadalupe Perez are community health workers, but the bulk of their work is done outside a clinic or hospital setting. Instead, they share health information right in people's homes.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/237124405\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>The two women are \u003cem>\u003ca href=\"http://www.cdc.gov/minorityhealth/promotores.html\" target=\"_blank\">promotoras de \u003c/a>\u003cspan style=\"color: #24890d\">salud\u003c/span>, \u003c/em>Spanish-speaking lay health educators. Promotoras have a long history in California, and Arroyo-Solveson and Perez are working today in Hayward as part of \u003ca href=\"http://www.haywardpromise.org/\" target=\"_blank\">Hayward Promise Neighborhood\u003c/a>, a federally-funded initiative that is honing in on the Jackson Triangle neighborhood, a lower-income, ethnically diverse area of the city.\u003c/p>\n\u003cp>The women go door to door, connecting residents to community clinics and other health services.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know that we are part of the community. We have our kids in the same schools. We go to the same stores.'\u003cbr>\n\u003ccite>Guadalupe Perez, a promotora in Hayward\u003c/cite>\u003c/aside>\n\u003cp>Arroyo-Solveson says there is nothing like face-to-face interaction to reach parents and others who may feel isolated or distrustful of government programs for which they would qualify.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Often when you have cultural barriers, language barriers, economic barriers, it’s very hard to feel empowered,\" Arroyo-Solveson says. \"We are trying to bridge these services for them so they can get empowered and engaged with the community.\"\u003c/p>\n\u003cp>Arroyo-Solveson is originally from Chile and says her own immigrant experience helps her relate to the families she works with.\u003c/p>\n\u003cp>Today, Arroyo-Solveson and Perez will meet with Liliana Salas, a stay-at-home mother with two children. Salas has invited the promotoras to her home, which is a welcome change from days past.\u003c/p>\n\u003cp>“When we started this work, nobody would tell us, 'Can you please come to our home?' They would slam the door or take a long time to answer,\" Arroyo-Solveson says with a chuckle. \"Now people hear about us and invite us to their home, which is wonderful.\"\u003c/p>\n\u003cp>Perez says that part of the success of promotoras in reaching residents is their familiarity with the neighborhood.\u003c/p>\n\u003cp>\"They know that we are part of the community. We have our kids in the same schools. We go to the same stores,\" says Perez.\u003c/p>\n\u003cp>After everyone is settled in Salas' living room, Arroyo-Solveson and Perez try to assess the family's needs. Do they have health insurance? They do. Has Salas heard of CalFresh, the state's food stamps program? She hasn’t, but wants to know more.\u003c/p>\n\u003cfigure id=\"attachment_117943\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\">\u003cimg class=\"wp-image-117943 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liliana Salas (R), a stay-at-home mom, listens to Perez explain CalFresh, the state's Supplemental Nutrition Assistance Program, formerly known as food stamps. Perez and Arroyo-Solveson visited Salas at her home as part of the Hayward Promise Neighborhood initiative. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Salas listens attentively and asks questions as the promotoras explain how to apply for CalFresh. They also describe neighborhood events nearby -- the local library is offering kids help with their homework, and a community center is soon holding a drum circle.\u003c/p>\n\u003cp>“It’s a great event that helps to relieve stress,” explains Perez in Spanish. “And you can bring your kids to participate.\"\u003c/p>\n\u003cp>As the women close their visit, Salas promises to review the information, including a subsidized training course to become a medical assistant.\u003c/p>\n\u003cp>“I’ll try to find the programs that are the most relevant to me and my family,” says Salas, holding a stack of papers and phone numbers for local resources.\u003c/p>\n\u003cfigure id=\"attachment_117947\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut.jpg\">\u003cimg class=\"wp-image-117947 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carolina Arroyo-Solveson (L) and Guadalupe Perez prepare to visit immigrant families in Hayward's Jackson Triangle neighborhood. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says it's interactions like these that give her role meaning. And she is committed. She volunteers as a promotora; her work is generally unpaid. During her four years as a promotora for the \u003ca href=\"http://www.tvhc.org/\" target=\"_blank\">Tiburcio Vasquez Health Center\u003c/a>, Perez says she has witnessed positive changes in people’s mindsets -– and consequently, their lives.\u003c/p>\n\u003cp>One example she cites is clients who are initially resigned to getting chronic diseases like diabetes if their relatives also suffer from it.\u003c/p>\n\u003cp>“We'll tell them, ‘No. Don’t think like this! You can break the pattern.’ How? By exercising, changing your diet and being more relaxed,” says Perez, adding that many of the parents she meets with work more than one job and face high levels of stress.\u003c/p>\n\u003cp>Nationwide, Latinos are \u003ca href=\"http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63\" target=\"_blank\">40 percent\u003c/a> more likely to die from diabetes than non-Hispanic whites, according to federal statistics.\u003c/p>\n\u003cp>Perez, a mother of three who cleans homes for a living, says that her own family has benefited from the knowledge she’s gained as a promotora. Her kids are more aware of nutritional labels as they browse aisles at the supermarket –- and appreciate the dangers of too much sugar and salt in their diets. Her husband reduced his daily soda intake from three or more cans daily to just one.\u003c/p>\n\u003cfigure id=\"attachment_117944\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut.jpg\">\u003cimg class=\"wp-image-117944 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Perez shares information about a support group for parents to a resident she visited at her home. Most of the immigrant families Perez works with in Hayward's Jackson Triangle are low income. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says being a promotora has also boosted her confidence and sense of purpose.\u003c/p>\n\u003cp>\"The training of promotora completely changed my life,\" says Perez, who is originally from Mexico.\u003c/p>\n\u003cp>She’s lost weight by adding vegetables to her diet and exercising more. It’s an approach she preaches to her clients: make the time for small beneficial changes that you can keep.\u003c/p>\n\u003cp>“I don’t have the time to go to the gym and also I don’t have money to go to the gym, so I do my exercise at home,” she said. “I have some zumba videos, so I'll play them and dance at home with my kids.\"\u003c/p>\n\u003cp>Another benefit she says, is how much more connected she feels with her community. Before, she would try to ignore problems -- like drug users at the park or gang-related violence. Now, she's taking an active role in improving her neighborhood.\u003c/p>\n\u003cp>\"Health is about everything -- good schools, access to good foods, and feeling safe in your neighborhood,\" says Perez, who earlier this year received a volunteer award from the city of Hayward.\u003c/p>\n\u003cp>Arroyo-Solveson says promotoras are an agent of change with tangible impacts.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"When I see that children get vaccinated because we have provided [parents with] resources on where to do that, they get health insurance because the promotoras came with all the information. It’s just a wonderful thing to see the transformation,\" says Arroyo-Solvenson. \"We are transforming a community with information, with care, because we care for them.\"\u003c/p>\n\n","blocks":[],"excerpt":"Spanish-speaking lay health workers go door to door in the Jackson Triangle neighborhood, a low-income area of Hayward.","status":"publish","parent":0,"modified":1449859439,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":1170},"headData":{"title":"Hayward 'Promotoras' Make House Calls, Connect Neighbors to Health Care | KQED","description":"Spanish-speaking lay health workers go door to door in the Jackson Triangle neighborhood, a low-income area of Hayward.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"117914 http://ww2.kqed.org/stateofhealth/?p=117914","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/09/hayward-promotoras-make-house-calls-neighbors-health/","disqusTitle":"Hayward 'Promotoras' Make House Calls, Connect Neighbors to Health Care","path":"/stateofhealth/117914/hayward-promotoras-make-house-calls-neighbors-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Carolina Arroyo-Solveson and Guadalupe Perez are community health workers, but the bulk of their work is done outside a clinic or hospital setting. Instead, they share health information right in people's homes.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/237124405&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/237124405'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The two women are \u003cem>\u003ca href=\"http://www.cdc.gov/minorityhealth/promotores.html\" target=\"_blank\">promotoras de \u003c/a>\u003cspan style=\"color: #24890d\">salud\u003c/span>, \u003c/em>Spanish-speaking lay health educators. Promotoras have a long history in California, and Arroyo-Solveson and Perez are working today in Hayward as part of \u003ca href=\"http://www.haywardpromise.org/\" target=\"_blank\">Hayward Promise Neighborhood\u003c/a>, a federally-funded initiative that is honing in on the Jackson Triangle neighborhood, a lower-income, ethnically diverse area of the city.\u003c/p>\n\u003cp>The women go door to door, connecting residents to community clinics and other health services.\u003c/p>\n\u003caside class=\"pullquote alignright\">'They know that we are part of the community. We have our kids in the same schools. We go to the same stores.'\u003cbr>\n\u003ccite>Guadalupe Perez, a promotora in Hayward\u003c/cite>\u003c/aside>\n\u003cp>Arroyo-Solveson says there is nothing like face-to-face interaction to reach parents and others who may feel isolated or distrustful of government programs for which they would qualify.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Often when you have cultural barriers, language barriers, economic barriers, it’s very hard to feel empowered,\" Arroyo-Solveson says. \"We are trying to bridge these services for them so they can get empowered and engaged with the community.\"\u003c/p>\n\u003cp>Arroyo-Solveson is originally from Chile and says her own immigrant experience helps her relate to the families she works with.\u003c/p>\n\u003cp>Today, Arroyo-Solveson and Perez will meet with Liliana Salas, a stay-at-home mother with two children. Salas has invited the promotoras to her home, which is a welcome change from days past.\u003c/p>\n\u003cp>“When we started this work, nobody would tell us, 'Can you please come to our home?' They would slam the door or take a long time to answer,\" Arroyo-Solveson says with a chuckle. \"Now people hear about us and invite us to their home, which is wonderful.\"\u003c/p>\n\u003cp>Perez says that part of the success of promotoras in reaching residents is their familiarity with the neighborhood.\u003c/p>\n\u003cp>\"They know that we are part of the community. We have our kids in the same schools. We go to the same stores,\" says Perez.\u003c/p>\n\u003cp>After everyone is settled in Salas' living room, Arroyo-Solveson and Perez try to assess the family's needs. Do they have health insurance? They do. Has Salas heard of CalFresh, the state's food stamps program? She hasn’t, but wants to know more.\u003c/p>\n\u003cfigure id=\"attachment_117943\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\">\u003cimg class=\"wp-image-117943 size-full\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17562_Promotoras_with_Liliana.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Liliana Salas (R), a stay-at-home mom, listens to Perez explain CalFresh, the state's Supplemental Nutrition Assistance Program, formerly known as food stamps. Perez and Arroyo-Solveson visited Salas at her home as part of the Hayward Promise Neighborhood initiative. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Salas listens attentively and asks questions as the promotoras explain how to apply for CalFresh. They also describe neighborhood events nearby -- the local library is offering kids help with their homework, and a community center is soon holding a drum circle.\u003c/p>\n\u003cp>“It’s a great event that helps to relieve stress,” explains Perez in Spanish. “And you can bring your kids to participate.\"\u003c/p>\n\u003cp>As the women close their visit, Salas promises to review the information, including a subsidized training course to become a medical assistant.\u003c/p>\n\u003cp>“I’ll try to find the programs that are the most relevant to me and my family,” says Salas, holding a stack of papers and phone numbers for local resources.\u003c/p>\n\u003cfigure id=\"attachment_117947\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut.jpg\">\u003cimg class=\"wp-image-117947 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17559_IMG_9794.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Carolina Arroyo-Solveson (L) and Guadalupe Perez prepare to visit immigrant families in Hayward's Jackson Triangle neighborhood. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says it's interactions like these that give her role meaning. And she is committed. She volunteers as a promotora; her work is generally unpaid. During her four years as a promotora for the \u003ca href=\"http://www.tvhc.org/\" target=\"_blank\">Tiburcio Vasquez Health Center\u003c/a>, Perez says she has witnessed positive changes in people’s mindsets -– and consequently, their lives.\u003c/p>\n\u003cp>One example she cites is clients who are initially resigned to getting chronic diseases like diabetes if their relatives also suffer from it.\u003c/p>\n\u003cp>“We'll tell them, ‘No. Don’t think like this! You can break the pattern.’ How? By exercising, changing your diet and being more relaxed,” says Perez, adding that many of the parents she meets with work more than one job and face high levels of stress.\u003c/p>\n\u003cp>Nationwide, Latinos are \u003ca href=\"http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=63\" target=\"_blank\">40 percent\u003c/a> more likely to die from diabetes than non-Hispanic whites, according to federal statistics.\u003c/p>\n\u003cp>Perez, a mother of three who cleans homes for a living, says that her own family has benefited from the knowledge she’s gained as a promotora. Her kids are more aware of nutritional labels as they browse aisles at the supermarket –- and appreciate the dangers of too much sugar and salt in their diets. Her husband reduced his daily soda intake from three or more cans daily to just one.\u003c/p>\n\u003cfigure id=\"attachment_117944\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut.jpg\">\u003cimg class=\"wp-image-117944 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg\" alt=\"\" width=\"400\" height=\"267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/12/RS17560_IMG_9809.JPG-qut-960x640.jpg 960w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Perez shares information about a support group for parents to a resident she visited at her home. Most of the immigrant families Perez works with in Hayward's Jackson Triangle are low income. \u003ccite>(Farida Jhabvala Romero/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Perez says being a promotora has also boosted her confidence and sense of purpose.\u003c/p>\n\u003cp>\"The training of promotora completely changed my life,\" says Perez, who is originally from Mexico.\u003c/p>\n\u003cp>She’s lost weight by adding vegetables to her diet and exercising more. It’s an approach she preaches to her clients: make the time for small beneficial changes that you can keep.\u003c/p>\n\u003cp>“I don’t have the time to go to the gym and also I don’t have money to go to the gym, so I do my exercise at home,” she said. “I have some zumba videos, so I'll play them and dance at home with my kids.\"\u003c/p>\n\u003cp>Another benefit she says, is how much more connected she feels with her community. Before, she would try to ignore problems -- like drug users at the park or gang-related violence. Now, she's taking an active role in improving her neighborhood.\u003c/p>\n\u003cp>\"Health is about everything -- good schools, access to good foods, and feeling safe in your neighborhood,\" says Perez, who earlier this year received a volunteer award from the city of Hayward.\u003c/p>\n\u003cp>Arroyo-Solveson says promotoras are an agent of change with tangible impacts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"When I see that children get vaccinated because we have provided [parents with] resources on where to do that, they get health insurance because the promotoras came with all the information. It’s just a wonderful thing to see the transformation,\" says Arroyo-Solvenson. \"We are transforming a community with information, with care, because we care for them.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/117914/hayward-promotoras-make-house-calls-neighbors-health","authors":["8659"],"series":["stateofhealth_2363"],"categories":["stateofhealth_11"],"tags":["stateofhealth_407","stateofhealth_2519"],"featImg":"stateofhealth_117945","label":"stateofhealth_2363"},"stateofhealth_90763":{"type":"posts","id":"stateofhealth_90763","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"90763","score":null,"sort":[1444412754000]},"guestAuthors":[],"slug":"no-one-explained-before-surgery-video","title":"'No One Explained' Before Surgery (Video)","publishDate":1444412754,"format":"video","headTitle":"Vital Signs | State of Health | KQED News","labelTerm":{"term":2363,"site":"stateofhealth"},"content":"\u003cp>Fully one-third of California farmworkers speak a language indigenous to Mexico. They likely do not understand Spanish. And when they need to see a doctor, there's usually no one to translate for them.\u003c/p>\n\u003cp>In an emergency, it can be downright frightening. Angelina Diaz-Ramirez, 50, suffered a heart attack while working in a green bean field near Salinas. She is from southern Mexico and speaks Triqui.\u003c/p>\n\u003cp>Diaz-Ramirez was taken by ambulance, and she says no one explained anything to her before she underwent a surgery. \"I was scared, but I didn't have a choice,\" she says.\u003c/p>\n\u003cp>As part of our ongoing series Vital Signs, photojournalist Jeremy Raff produced the video about Diaz-Ramirez. Read his \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/\" target=\"_blank\">full story \u003c/a>on the dire need for medical interpreters for indigenous Mexicans who have immigrated to California.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"\"When I woke up, I just felt pain where they did the surgery. I cried because I didn't understand.\"","status":"publish","parent":0,"modified":1444493359,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":6,"wordCount":139},"headData":{"title":"'No One Explained' Before Surgery (Video) | KQED","description":""When I woke up, I just felt pain where they did the surgery. I cried because I didn't understand."","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"90763 http://ww2.kqed.org/stateofhealth/?p=90763","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/09/no-one-explained-before-surgery-video/","disqusTitle":"'No One Explained' Before Surgery (Video)","videoEmbed":"https://vimeo.com/140479930","path":"/stateofhealth/90763/no-one-explained-before-surgery-video","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Fully one-third of California farmworkers speak a language indigenous to Mexico. They likely do not understand Spanish. And when they need to see a doctor, there's usually no one to translate for them.\u003c/p>\n\u003cp>In an emergency, it can be downright frightening. Angelina Diaz-Ramirez, 50, suffered a heart attack while working in a green bean field near Salinas. She is from southern Mexico and speaks Triqui.\u003c/p>\n\u003cp>Diaz-Ramirez was taken by ambulance, and she says no one explained anything to her before she underwent a surgery. \"I was scared, but I didn't have a choice,\" she says.\u003c/p>\n\u003cp>As part of our ongoing series Vital Signs, photojournalist Jeremy Raff produced the video about Diaz-Ramirez. Read his \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/\" target=\"_blank\">full story \u003c/a>on the dire need for medical interpreters for indigenous Mexicans who have immigrated to California.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/90763/no-one-explained-before-surgery-video","authors":["8344"],"series":["stateofhealth_2363"],"categories":["stateofhealth_11"],"tags":["stateofhealth_249","stateofhealth_407","stateofhealth_2519"],"featImg":"stateofhealth_91176","label":"stateofhealth_2363"},"stateofhealth_83818":{"type":"posts","id":"stateofhealth_83818","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"83818","score":null,"sort":[1443451543000]},"guestAuthors":[],"slug":"need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","publishDate":1443451543,"format":"image","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\n\u003cp>https://vimeo.com/140479930\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>[contextly_sidebar id=\"2KQd30QKKYZZL3bwvUkl6icTu31wfvST\"]\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/225965640\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n","blocks":[],"excerpt":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","status":"publish","parent":0,"modified":1443477793,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":67,"wordCount":1896},"headData":{"title":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters | KQED","description":"One in three California farmworkers speaks an indigenous language and barely understands Spanish. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"83818 http://ww2.kqed.org/stateofhealth/?p=83818","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/28/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields/","disqusTitle":"Mexican Indigenous Immigrants' Dire Need for Medical Interpreters","path":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Imagine you are rushed to the hospital as pain radiates through your chest. Doctors whirl around you, but you don’t know what's happening because everyone is speaking a foreign language.\u003c/p>\n\u003cp>That’s what happened to farmworker Angelina Diaz-Ramirez, 50, after she had a heart attack in a Monterey County green bean field in 2012.\u003c/p>\n\u003cp>The foreman of her work crew took her to the main road and put her in an ambulance, alone. Diaz-Ramirez is an immigrant from Mexico, and while there were Spanish-speaking staff, she was still isolated by a language barrier.\u003c/p>\n\u003cp>That's because Diaz-Ramirez, like a third of California farmworkers, speaks a language indigenous to southern Mexico. She doesn’t understand Spanish. Her language, Triqui, is as different from Spanish as Navajo is from English.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"vimeoLink","attributes":{"named":{"vimeoId":"140479930"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>At the hospital, without a Triqui interpreter, “no one explained anything to me,” said Diaz-Ramirez.\u003c/p>\n\u003cp>“I was scared, but I didn’t have a choice,\" she said.\u003c/p>\n\u003cp>As anesthesia blotted out the operating room, Diaz-Ramirez had no idea a surgeon was about to cut open her chest to implant a pacemaker.\u003c/p>\n\u003cp>\u003cstrong>Medical Interpreters Are Key\u003c/strong>\u003c/p>\n\u003cp>Diaz-Ramirez’s case highlights the importance of trained medical interpreters, researchers say.\u003c/p>\n\u003caside class=\"pullquote alignright\">'No one explained anything to me. I was scared but I didn't have a choice.'\u003ccite>Angelina Diaz-Ramirez, Triqui farmworker who had heart surgery without an interpreter\u003c/cite>\u003c/aside>\n\u003cp>Interpreters are “absolutely necessary,” said Alicia Fernandez, a medical interpretation expert at UC San Francisco, because quality health care and basic informed consent are nearly impossible without one.\u003c/p>\n\u003cp>Interpreters “enormously increase patient understanding and satisfaction,” said Fernandez. She adds that interpreters also “increase physician satisfaction with the care they deliver.”\u003c/p>\n\u003cp>Medicine, she said, is not an antiseptic, scientific process. Doctors can’t just scan, medicate and operate. Clear communication is essential for accurate diagnosis and effective treatment.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s why using improvised sign language, or asking a child to interpret -- just \"getting by\" -- is simply not good enough, said Fernandez.\u003c/p>\n\u003cp>“Getting by leads to mistakes,” she said. “And mistakes can be tragic, for both the patient and the physician.”\u003c/p>\n\u003cp>\u003cstrong>Indigenous Farmworkers Without Interpreters\u003c/strong>\u003c/p>\n\u003cp>Erica Gastelum, a pediatrician in Fresno, regrets that she rarely has access to an interpreter for her Mixteco-speaking patients. She says without one, “You're not able to provide equal care to all comers.”\u003c/p>\n\u003cfigure id=\"attachment_83923\" class=\"wp-caption alignleft\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map.png\">\u003cimg class=\"wp-image-83923 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Lagnuage-map-400x225.png\" alt=\"This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in southwest of the country (Jeremy Raff/KQED). \" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">This map shows where Mexican indigenous languages originate. Triqui and Mixteco belong to the oto-mangue family, in the southwest of the country. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>She remembers a 1-year-old boy with fatal congenital heart disease. Doctors had exhausted every option, and the family was gathered in the intensive care unit.\u003c/p>\n\u003cp>“This is it, this is the moment where we’re going to disconnect the tubes,” said Gastelum. “It seemed like they understood. But in such a crucial moment like that, it would have been so much better to have a culturally sensitive, in-person interpreter.”\u003c/p>\n\u003cp>Most hospitals, including Gastelum’s, have telephone services that should let doctors call up an interpreter for any language. In practice, though, the system doesn’t always work for more unusual languages.\u003c/p>\n\u003cp>“When you try to use the phone interpreter line to get the indigenous speaker, you’ll be on hold for like two hours,” said Jasmine Walker, also a pediatrician in Fresno. “Then when you get them, they don't actually speak the language that you need.”\u003c/p>\n\u003cp>Seth Holmes is a physician who lived and worked alongside Triqui migrant farmworkers for 10 years and wrote about his experiences in the book \"\u003ca href=\"http://www.ucpress.edu/book.php?isbn=9780520275140\" target=\"_blank\">Fresh Fruit, Broken Bodies\u003c/a>.\" As the migrants followed crops up and down the West Coast, they often asked Holmes to accompany them to health clinics.\u003c/p>\n\u003cp>In dozens of clinics throughout California, Washington and Oregon, he said, “I have never seen any Triqui person get a medical interpreter.”\u003c/p>\n\u003cp>Hospitals may underestimate how many indigenous patients they have -- and how many interpreters they need -- because many providers assume all Mexicans speak Spanish. Some indigenous people may be afraid to call attention to themselves by asking for an interpreter because they are undocumented.\u003c/p>\n\u003cp>“They don't know that they’re entitled to someone who speaks their language,” said Leoncio Vasquez, who has been training interpreters for 15 years.\u003c/p>\n\u003cp>Any health care facility receiving public money has a legal obligation under both state and federal law to provide an interpreter to every patient who needs one. But only a few health care providers have made\u003ca href=\"http://www.indigenousfarmworkers.org/\" target=\"_blank\"> California’s 120,000 indigenous farmworkers\u003c/a> an explicit priority.\u003c/p>\n\u003cp>\u003cstrong>Interpreting a Big Opportunity for Some Farmworkers\u003c/strong>\u003c/p>\n\u003cp>Brigida Gonzalez, wearing a big \"Qualified Interpreter\" badge, hustles around Natividad Medical Center in Salinas. It's a big building and she’s needed all over.\u003c/p>\n\u003cp>Today she’s a professional employee at a big hospital. A year ago, she was picking strawberries nearby.\u003c/p>\n\u003cfigure id=\"attachment_83917\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-e1443272915487.png\">\u003cimg class=\"wp-image-83917 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Brigida-Patient3-400x225.png\" alt=\"Interpreter Brigida Gonzalez\" width=\"400\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Before interpreter training, Brigida Gonzalez (R) worked in the strawberry fields nearby. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In the fields one day, another picker noticed Gonzalez spoke English -- a rarity in agriculture -- and suggested she look into Natividad’s training program.\u003c/p>\n\u003cp>Staff at Natividad were thrilled to hear from Gonzalez, “because it was so hard to find someone who spoke English, Spanish and an indigenous language like Mixteco and Triqui,” she said.\u003c/p>\n\u003cp>Gonzalez completed Natividad's six-month training program for indigenous interpreters, the first of its kind, and now works there part time.\u003c/p>\n\u003cp>\u003cstrong>Not Just Hospitals\u003c/strong>\u003c/p>\n\u003cp>The need for trilingual interpreters like Gonzalez is growing, and it's not just hospitals.\u003c/p>\n\u003cp>Four hours down the coast in Oxnard, all three school districts have hired Mixteco interpreters, and the police have one on contract.\u003c/p>\n\u003cp>Altogether, there are about 20 Mixteco speakers making a good living with their language skills in Ventura County.\u003c/p>\n\u003cp>These opportunities are one reason why Argelia Zarate, the Oxnard school district’s first full-time Mixteco interpreter, encourages students to practice their Mixteco so they don’t lose it.\u003c/p>\n\u003cfigure id=\"attachment_83919\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\">\u003cimg class=\"size-full wp-image-83919\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-1-of-1-e1443466270661.jpg\" alt=\"Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages.\" width=\"1920\" height=\"1280\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Argelia Zarate, a Mixteco interpreter at the Oxnard School District, encourages students to practice their native languages. \u003ccite>(Jeremy Raff/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I didn't go to college, yet I have this job,” said Zarate, “because the community is growing so big that they don't need bilinguals-- they need trilinguals.”\u003c/p>\n\u003cp>The U.S. Bureau of Labor Statistics expects employment of interpreters and translators to grow by\u003ca href=\"http://www.bls.gov/ooh/media-and-communication/interpreters-and-translators.htm\" target=\"_blank\"> 46 percent between 2012 and 2022.\u003c/a> Driving that demand is the \u003ca href=\"http://www.census.gov/content/dam/Census/library/publications/2013/acs/acs-22.pdf\" target=\"_blank\">158 percent increase since 1980 \u003c/a>in the number of people who speak a language other than English at home.\u003c/p>\n\u003cp>Nationally, the median hourly wage for interpreters is $25, compared with $9.09 for farm work.\u003c/p>\n\u003cp>Zarate says the better pay, stable hours and a chance to serve her community all make interpreting a big step up from field work.\u003c/p>\n\u003cp>“Here everybody is nice to you: they talk to you, appreciate what you do,” Zarate said at the elementary school where she works. “In the fields, they treat you like you’re nothing, a slave working for a little bit of money.”\u003c/p>\n\u003cp>The Mixteco/Indigena Community Organizing Project has trained dozens of interpreters in Ventura County and has pressured public agencies to make use of them.\u003c/p>\n\u003cfigure id=\"attachment_83920\" class=\"wp-caption alignright\" style=\"max-width: 5010px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\">\u003cimg class=\"size-full wp-image-83920\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/09/Argelia-2-of-2.jpg\" alt=\"Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco (Jeremy Raff/KQED).\" width=\"5010\" height=\"3340\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2.jpg 5010w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/09/Argelia-2-of-2-960x640.jpg 960w\" sizes=\"(max-width: 5010px) 100vw, 5010px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Maria, 6, arrived in Oxnard, CA, from the Mexican state of Oaxaca recently and speaks only Mixteco. (Jeremy Raff/KQED).\u003c/figcaption>\u003c/figure>\n\u003cp>Today, “Ventura County has invested in having better language access than most parts of California, and honestly most parts of Oaxaca,” said Margaret Sawyer, the group’s development director, referring to the Mexican state that many Mixteco migrants are from.\u003c/p>\n\u003cp>\u003cstrong>Barriers Remain\u003c/strong>\u003c/p>\n\u003cp>Not everyone trilingual can make the switch from farm work, though, because there are only a few full-time jobs.\u003c/p>\n\u003cp>Instead, most hospitals rely on freelance part-time interpreters, who have a hard time making a living.\u003c/p>\n\u003cp>“They will have you for two or three hours, then you’re done for the whole day,” said Israel Vasquez, a trilingual interpreter. “You can’t really live off that.” He eventually quit because he couldn’t get enough hours.\u003c/p>\n\u003cp>“Making a living specifically in health care interpreting right now is not really going to happen,” said Don Schinske, executive director of the California Healthcare Interpreting Association.\u003c/p>\n\u003cp>Part of the problem, Schinske said, is that even though federal law requires hospitals to provide interpreters, there is not a direct federal funding stream to pay for those services.\u003c/p>\n\u003cp>“You get a lot of this sentiment from hospitals: ‘Look, we’re trying to get people services in their language, but it is a nicety, not a necessity,’ ” said Schinske.\u003c/p>\n\u003cp>The indigenous interpretation programs at Natividad Medical Center are funded by private donations from agricultural businesses in the area, who have contributed $1.7 million since 2010.\u003c/p>\n\u003cp>Meanwhile, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB635\" target=\"_blank\">a bill \u003c/a>that would make it easier for hospitals to get federal money for medical interpreters has stalled in the California Legislature.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='100%' height='166'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/225965640&visual=true&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false'\n title='https://api.soundcloud.com/tracks/225965640'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Wasted Resource\u003c/strong>\u003c/p>\n\u003cp>Farmworker Angelina Diaz-Ramirez returned home after her surgery with a new pacemaker ticking in her chest -- and a stack of printed instructions that she couldn’t read.\u003c/p>\n\u003cp>“I didn’t know what to do,\" she said, through an interpreter. \"I had strong pain. Should I call them back?”\u003c/p>\n\u003cp>Diaz-Ramirez didn’t know who her cardiologist was, how to get an appointment or which medications to take. It's just the kind of confusion that a trained medical interpreter can prevent.\u003c/p>\n\u003cp>\"I just felt very sad,\" she said.\u003c/p>\n\u003cp>Every week, indigenous people with these same questions visit Leoncio Vasquez, the interpreter trainer in Fresno.\u003c/p>\n\u003cp>He looks through their paperwork, pieces together a backstory, and helps them figure out what to do next -- something that should have happened at the hospital or clinic, with one of the dozens of interpreters Vasquez has already trained.\u003c/p>\n\u003cp>But those interpreters “can’t find jobs related to interpreting,” said Vasquez. What do they do instead? “Some go back to the fields to do farm work.”\u003c/p>\n\u003cp>To Vasquez, it's a waste. He says that until more hospitals recognize these immigrants’ valuable language skills, trained interpreters will stay in the fields, picking strawberries.\u003c/p>\n\u003cp>\u003cem>This piece was produced with support from the Institute for Justice and Journalism.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ci>California has the seventh-largest economy in the world, and immigrants have a long history in building that prosperity. Today one out of every three working people in California is an immigrant — a share that has grown in recent decades. Our state is shaped by these workers and entrepreneurs — 6 million people who’ve found a job in the Golden State. In our series “\u003ca href=\"http://ww2.kqed.org/news/series/california-immigrants-at-work\">Immigrant Shift\u003c/a>,” KQED and The California Report explore the impact they have, the challenges they face and the policies that affect them.\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/83818/need-a-medical-interpreter-try-looking-in-californias-strawberry-fields","authors":["230"],"categories":["stateofhealth_11"],"tags":["stateofhealth_280","stateofhealth_249","stateofhealth_407","stateofhealth_325","stateofhealth_53","stateofhealth_2519","stateofhealth_251"],"featImg":"stateofhealth_83922","label":"stateofhealth"},"stateofhealth_22652":{"type":"posts","id":"stateofhealth_22652","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22652","score":null,"sort":[1416547176000]},"guestAuthors":[],"slug":"newly-protected-immigrants-will-be-eligible-for-medi-cal-advocates-say","title":"Newly Protected Immigrants Will Be Eligible for Medi-Cal, Advocates Say","publishDate":1416547176,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22655\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/RS13171_459316502-qut.jpg\">\u003cimg class=\"size-large wp-image-22655\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/RS13171_459316502-qut-640x427.jpg\" alt=\"President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California undocumented immigrants who are eligible for deferred deportation under President Obama's \u003ca title=\"http://www.whitehouse.gov/issues/immigration/immigration-action\" href=\"http://www.whitehouse.gov/issues/immigration/immigration-action\" target=\"_blank\">executive action\u003c/a> are expected to be eligible for Medi-Cal, as long as they meet income guidelines, advocates said Thursday.\u003c/p>\n\u003cp>Medi-Cal is the state's health insurance program for people who are low income.\u003c/p>\n\u003cp>Under federal law, these immigrants are not eligible for other benefits of the Affordable Care Act, including subsidies on the Covered California exchange.\u003c!--more-->\u003c/p>\n\u003cp>Gabrielle Lessard is a health policy attorney with the Los Angeles office of the National Immigration Law Center. \"They’ll be in the same situation as DACA,\" she said, in reference to Deferred Action for Childhood Arrivals, Obama's 2012 policy for young undocumented immigrants who had come to the United States as children.\u003c/p>\n\u003cp>While most states do not extend Medicaid benefits to DACA immigrants, California does.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"'Deferred action' means those individuals who are approved are considered lawfully present,\" said Ronald Coleman, government affairs manager for the California Immigrant Policy Center. \"California has historically covered broad populations of immigrants who reside in the state.\"\u003c/p>\n\u003cp>Both Lessard and Coleman insisted no legislative action was necessary, that existing state law extends Medi-Cal benefits to immigrants who qualify under Obama's action.\u003c/p>\n\u003cp>Coleman said the immigrants benefitting from Obama's action will be \"work eligible and, as lawfully present immigrants, they will be eligible for the state Medi-Cal program ... if they are income eligible.\"\u003c/p>\n\u003cp>But Tony Cava, spokesman for the state's Department of Health Care Services said that since the agency has not received any details about the president's action, \"we are unable to assess any impact it might have on Medi-Cal services.\"\u003c/p>\n\u003cp>Cava added that federal Medicaid law requires all states to provide emergency services to undocumented people and that any information that undocumented individuals provide to determine whether they qualify for Medi-Cal may not be used \"for any type of civil immigration enforcement action under U.S. Immigration and Customs Enforcement law.\"\u003c/p>\n\u003cp>Even though that information is not supposed to be used, the fear lingers. There are\u003ca title=\"http://www.latimes.com/business/la-fi-obamacare-latinos-20141110-story.html#page=1\" href=\"http://www.latimes.com/business/la-fi-obamacare-latinos-20141110-story.html#page=1\" target=\"_blank\"> reports\u003c/a> of lawfully-present immigrants hesitant to sign up for health insurance, if they must answer questions about undocumented family members. They worry about exposing undocumented relatives to enforcement scrutiny.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Coleman estimates that of the 5 million people affected nationally by Obama's action, about 1 million of them live in California. But not all of them will be eligible for Medi-Cal, he said. Roughly 40 percent of undocumented immigrants receive employer-based insurance; others will make too much money to qualify for Medi-Cal.\u003c/p>\n\n","blocks":[],"excerpt":"The advocates say that California covers more groups of immigrants than other states.","status":"publish","parent":0,"modified":1416592670,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":454},"headData":{"title":"Newly Protected Immigrants Will Be Eligible for Medi-Cal, Advocates Say | KQED","description":"The advocates say that California covers more groups of immigrants than other states.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"22652 http://blogs.kqed.org/stateofhealth/?p=22652","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/20/newly-protected-immigrants-will-be-eligible-for-medi-cal-advocates-say/","disqusTitle":"Newly Protected Immigrants Will Be Eligible for Medi-Cal, Advocates Say","path":"/stateofhealth/22652/newly-protected-immigrants-will-be-eligible-for-medi-cal-advocates-say","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22655\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/RS13171_459316502-qut.jpg\">\u003cimg class=\"size-large wp-image-22655\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/RS13171_459316502-qut-640x427.jpg\" alt=\"President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">President Barack Obama announces executive actions on U.S. immigration policy Thursday. ( Jim Bourg-Pool/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>California undocumented immigrants who are eligible for deferred deportation under President Obama's \u003ca title=\"http://www.whitehouse.gov/issues/immigration/immigration-action\" href=\"http://www.whitehouse.gov/issues/immigration/immigration-action\" target=\"_blank\">executive action\u003c/a> are expected to be eligible for Medi-Cal, as long as they meet income guidelines, advocates said Thursday.\u003c/p>\n\u003cp>Medi-Cal is the state's health insurance program for people who are low income.\u003c/p>\n\u003cp>Under federal law, these immigrants are not eligible for other benefits of the Affordable Care Act, including subsidies on the Covered California exchange.\u003c!--more-->\u003c/p>\n\u003cp>Gabrielle Lessard is a health policy attorney with the Los Angeles office of the National Immigration Law Center. \"They’ll be in the same situation as DACA,\" she said, in reference to Deferred Action for Childhood Arrivals, Obama's 2012 policy for young undocumented immigrants who had come to the United States as children.\u003c/p>\n\u003cp>While most states do not extend Medicaid benefits to DACA immigrants, California does.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"'Deferred action' means those individuals who are approved are considered lawfully present,\" said Ronald Coleman, government affairs manager for the California Immigrant Policy Center. \"California has historically covered broad populations of immigrants who reside in the state.\"\u003c/p>\n\u003cp>Both Lessard and Coleman insisted no legislative action was necessary, that existing state law extends Medi-Cal benefits to immigrants who qualify under Obama's action.\u003c/p>\n\u003cp>Coleman said the immigrants benefitting from Obama's action will be \"work eligible and, as lawfully present immigrants, they will be eligible for the state Medi-Cal program ... if they are income eligible.\"\u003c/p>\n\u003cp>But Tony Cava, spokesman for the state's Department of Health Care Services said that since the agency has not received any details about the president's action, \"we are unable to assess any impact it might have on Medi-Cal services.\"\u003c/p>\n\u003cp>Cava added that federal Medicaid law requires all states to provide emergency services to undocumented people and that any information that undocumented individuals provide to determine whether they qualify for Medi-Cal may not be used \"for any type of civil immigration enforcement action under U.S. Immigration and Customs Enforcement law.\"\u003c/p>\n\u003cp>Even though that information is not supposed to be used, the fear lingers. There are\u003ca title=\"http://www.latimes.com/business/la-fi-obamacare-latinos-20141110-story.html#page=1\" href=\"http://www.latimes.com/business/la-fi-obamacare-latinos-20141110-story.html#page=1\" target=\"_blank\"> reports\u003c/a> of lawfully-present immigrants hesitant to sign up for health insurance, if they must answer questions about undocumented family members. They worry about exposing undocumented relatives to enforcement scrutiny.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Coleman estimates that of the 5 million people affected nationally by Obama's action, about 1 million of them live in California. But not all of them will be eligible for Medi-Cal, he said. Roughly 40 percent of undocumented immigrants receive employer-based insurance; others will make too much money to qualify for Medi-Cal.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22652/newly-protected-immigrants-will-be-eligible-for-medi-cal-advocates-say","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_407","stateofhealth_99","stateofhealth_489"],"featImg":"stateofhealth_22655","label":"stateofhealth"},"stateofhealth_22315":{"type":"posts","id":"stateofhealth_22315","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22315","score":null,"sort":[1415039004000]},"guestAuthors":[],"slug":"for-families-with-mixed-immigration-status-some-insured-some-not","title":"For Families with Mixed-Immigration Status: Some Insured, Some Not","publishDate":1415039004,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22318\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravo-1-e1415038250334.jpg\">\u003cimg class=\"size-large wp-image-22318\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravo-1-640x427.jpg\" alt=\"Jessica Bravo, 19, of Costa Mesa was granted DACA (Deferred Action for Childhood Arrivals) status, but didn’t know she could also qualify for Medi-Cal. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Bravo, 19, of Costa Mesa was granted DACA (Deferred Action for Childhood Arrivals) status, but didn’t know she could also qualify for Medi-Cal. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Heidi de Marco\u003c/strong>, \u003ca title=\"http://kaiserhealthnews.org/news/for-families-with-mixed-immigration-status-health-insurance-can-be-puzzling/\" href=\"http://kaiserhealthnews.org/news/for-families-with-mixed-immigration-status-health-insurance-can-be-puzzling/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jessica Bravo walks house-to-house in the piercing Southern California heat. Over and over, at doorsteps around Orange County, she asks the same question: “Are you insured?”\u003c/p>\n\u003cp>Getting an answer isn’t always easy. Doors slam in her face. She gets shooed from porches. And sometimes people cut her off mid-spiel.\u003c/p>\n\u003cp>Bravo is a paid health outreach worker for the Orange County Congregation Community Organization, a faith-based nonprofit. Her job is to inform people about getting health insurance under the nation’s landmark health law, the Affordable Care Act.\u003c/p>\n\u003cp>“A lot of people don’t know about this new law … this opportunity for health insurance,” said Bravo, a 19-year old Costa Mesa resident.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Until a few months ago, Bravo didn’t actually know coverage was an opportunity for her, as well.\u003c/p>\n\u003cp>She is an undocumented immigrant from Mexico. Most people without papers can’t get health insurance under the ACA. But last year, Bravo and her 21-year-old brother Daniel qualified for the Deferred Action for Childhood Arrivals (DACA) program -– a 2012 initiative that grants temporary legal status to certain undocumented immigrants who were brought to the United States as children.\u003c/p>\n\u003cp>The law applies to people who came to the U.S. before turning 16, are in school or a high school graduate and are now under the age of 33.\u003c/p>\n\u003cp>They can obtain a work permit, a driver’s license, a Social Security number, a two-year reprieve from deportation and — as Bravo now realizes — the opportunity to get health insurance through Medi-Cal, California’s insurance program for poor and disabled people. Only a few other states offer similar options.\u003c/p>\n\u003cp>Now studying politics and ethnic studies full time at Golden West College in Huntington Beach, Bravo can’t work as much as she used to. Her monthly income of $960 likely would make her eligible for Medi-Cal.\u003c/p>\n\u003cp>Figuring out her options under the law was especially difficult for Bravo, whose family is of “mixed status.” That is, some have federal authorization to be in this country and others don’t. While anyone can buy insurance privately, people without legal status are not allowed to buy insurance on the exchange or participate in most government program such as Medicare, non-emergency Medicaid or the Children’s Health Insurance Program.\u003c/p>\n\u003cp>Her parents are in the country without permission, as is her older brother Luis, 22, who did not qualify for DACA. Her other brother Daniel, 21, was granted DACA status and qualifies for the same benefits she does. And her brother Alex, 11, is a U.S.-born citizen, covered through California Kids –- a nonprofit health insurance plan.\u003c/p>\n\u003cp>\u003cstrong>‘Stuck In The Middle’\u003c/strong>\u003c/p>\n\u003cp>The family’s history is complicated. After several failed visa attempts, her father Enrique Bravo crossed the border illegally in 1996. His wife, Virginia, tried to cross by hiding in a car but was caught by border patrol agents. Desperate to join her husband, she tried again and made it across six months later. Three-year-old Jessica and her older brothers later crossed with legal-resident relatives in a car.\u003c/p>\n\u003cp>“I’m 100 percent Mexican…but all my memories growing up are from the United States,” said Jessica. “It’s like I’m stuck in the middle…I’m neither from here or there.”\u003c/p>\n\u003cfigure id=\"attachment_22319\" class=\"wp-caption alignright\" style=\"max-width: 380px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg\">\u003cimg class=\"size-full wp-image-22319\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg\" alt=\"Photos of the Bravo family, Enrique, his wife, Virginia, and their children Jessica, Daniel and Luis, taken in 2001, five years after arriving in the United States (Photos Courtesy of the Bravo Family).\" width=\"380\" height=\"777\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg 380w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/Bravos-e1415038674805-320x654.jpg 320w\" sizes=\"(max-width: 380px) 100vw, 380px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Photos of the Bravo family, Enrique, his wife, Virginia, and their children Jessica, Daniel and Luis, taken in 2001, five years after arriving in the United States (Photos Courtesy of the Bravo Family).\u003c/figcaption>\u003c/figure>\n\u003cp>As the older children grew up, getting health care proved dicey. The family tried to stay below the radar. This meant visiting the doctor only when absolutely necessary -- and always paying cash.\u003c/p>\n\u003cp>They were, like many immigrants, fearful of exposing the family’s unauthorized status and risking deportation, for themselves and their children.\u003c/p>\n\u003cp>Eventually Enrique, an electrician, found a job that offered health insurance, and for several years the family was insured. But he got laid off in 2006. From then on, they were forced to rely on local community clinics that provide care on a sliding pay scale.\u003c/p>\n\u003cp>“I remember my parents telling me that I was no longer going to be insured under their plan,” said Jessica. “I just tried to eat healthy.”\u003c/p>\n\u003cp>Her biggest concern now, she says, is that one of the others will get sick and the family won’t be able to pay for care.\u003c/p>\n\u003cp>“Even though that fear is gone for me, it’s still very real for my family,” said Bravo, who is in the process of renewing her DACA status for another two years.\u003c/p>\n\u003cp>“It’s difficult to grasp that I have this privilege, yet my parents who worked twice as hard, don’t have anything.”\u003c/p>\n\u003cp>Recent events have compounded the family’s worries.\u003c/p>\n\u003cp>Jessica’s brother Luis was recently detained by agents from Immigration and Customs Enforcement as a result of a tip arising from a prior conviction for driving under the influence. It’s unclear what will happen until the immigration court hears his case and decides whether he can remain in the U.S.\u003c/p>\n\u003cp>“It all seems like a dream…it happened so fast,” said Jessica. “We’re doing everything we can to stop his deportation.”\u003c/p>\n\u003cp>\u003cstrong>One Fall Can Change Everything\u003c/strong>\u003c/p>\n\u003cp>Weeks ago, Jessica’s mother Virginia stumbled and fell to the ground in front of their Costa Mesa apartment, spilling the milk she’d just bought. The 48-year-old former hairstylist hurt her arm, but despite feeling a sharp pain she won’t be visiting the emergency room.\u003c/p>\n\u003cp>“We can’t afford it,” Virginia Bravo said. The mother of four has been unemployed for over a year and is more concerned about stocking the empty refrigerator than seeking treatment.\u003c/p>\n\u003cp>She knows all too well that without insurance an unexpected injury could leave them bankrupt.\u003c/p>\n\u003cp>Last year, Enrique had to be rushed to the emergency room. He woke up in the middle of the night with extreme paranoia, unable to catch his breath, and feeling numb.\u003c/p>\n\u003cp>He was having a panic attack. The bill for the two-hour hospital stay was about $6,000. Already struggling financially, the family had to find a way to pay cash.\u003c/p>\n\u003cp>“At first I refused to go to the hospital,” he said. “I knew it would be expensive.”\u003c/p>\n\u003cp>The 44-year-old says he struggles to earn at least $2,250 each month as a self-employed electrician –- the exact amount he needs to pay rent.\u003c/p>\n\u003cp>Any extra money is used to buy food and pay bills. Saving for an emergency is impossible, the family members said.\u003c/p>\n\u003cp>“We’re poor, but rich in health and family unity,” Virginia Bravo said.\u003c/p>\n\u003cp>Living in a mixed-status family has been challenging, but it has also brought them closer, she said. The whole family has been involved in campaigning for immigration reform and hopes the ACA will eventually include coverage for undocumented immigrants.\u003c/p>\n\u003cp>“People don’t know what we had to go through to get here,” said Virginia. “We made it across … we’re the lucky ones.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We don’t want anything for free,” she said. “If we had an opportunity to buy health insurance, we would find a way to pay for it.”\u003c/p>\n\n","blocks":[],"excerpt":"Three of four siblings qualify for health insurance benefits, but their parents and an older brother do not.","status":"publish","parent":0,"modified":1415039004,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":40,"wordCount":1332},"headData":{"title":"For Families with Mixed-Immigration Status: Some Insured, Some Not | KQED","description":"Three of four siblings qualify for health insurance benefits, but their parents and an older brother do not.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"22315 http://blogs.kqed.org/stateofhealth/?p=22315","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/11/03/for-families-with-mixed-immigration-status-some-insured-some-not/","disqusTitle":"For Families with Mixed-Immigration Status: Some Insured, Some Not","path":"/stateofhealth/22315/for-families-with-mixed-immigration-status-some-insured-some-not","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22318\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravo-1-e1415038250334.jpg\">\u003cimg class=\"size-large wp-image-22318\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravo-1-640x427.jpg\" alt=\"Jessica Bravo, 19, of Costa Mesa was granted DACA (Deferred Action for Childhood Arrivals) status, but didn’t know she could also qualify for Medi-Cal. (Heidi de Marco/Kaiser Health News).\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jessica Bravo, 19, of Costa Mesa was granted DACA (Deferred Action for Childhood Arrivals) status, but didn’t know she could also qualify for Medi-Cal. (Heidi de Marco/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Heidi de Marco\u003c/strong>, \u003ca title=\"http://kaiserhealthnews.org/news/for-families-with-mixed-immigration-status-health-insurance-can-be-puzzling/\" href=\"http://kaiserhealthnews.org/news/for-families-with-mixed-immigration-status-health-insurance-can-be-puzzling/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jessica Bravo walks house-to-house in the piercing Southern California heat. Over and over, at doorsteps around Orange County, she asks the same question: “Are you insured?”\u003c/p>\n\u003cp>Getting an answer isn’t always easy. Doors slam in her face. She gets shooed from porches. And sometimes people cut her off mid-spiel.\u003c/p>\n\u003cp>Bravo is a paid health outreach worker for the Orange County Congregation Community Organization, a faith-based nonprofit. Her job is to inform people about getting health insurance under the nation’s landmark health law, the Affordable Care Act.\u003c/p>\n\u003cp>“A lot of people don’t know about this new law … this opportunity for health insurance,” said Bravo, a 19-year old Costa Mesa resident.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Until a few months ago, Bravo didn’t actually know coverage was an opportunity for her, as well.\u003c/p>\n\u003cp>She is an undocumented immigrant from Mexico. Most people without papers can’t get health insurance under the ACA. But last year, Bravo and her 21-year-old brother Daniel qualified for the Deferred Action for Childhood Arrivals (DACA) program -– a 2012 initiative that grants temporary legal status to certain undocumented immigrants who were brought to the United States as children.\u003c/p>\n\u003cp>The law applies to people who came to the U.S. before turning 16, are in school or a high school graduate and are now under the age of 33.\u003c/p>\n\u003cp>They can obtain a work permit, a driver’s license, a Social Security number, a two-year reprieve from deportation and — as Bravo now realizes — the opportunity to get health insurance through Medi-Cal, California’s insurance program for poor and disabled people. Only a few other states offer similar options.\u003c/p>\n\u003cp>Now studying politics and ethnic studies full time at Golden West College in Huntington Beach, Bravo can’t work as much as she used to. Her monthly income of $960 likely would make her eligible for Medi-Cal.\u003c/p>\n\u003cp>Figuring out her options under the law was especially difficult for Bravo, whose family is of “mixed status.” That is, some have federal authorization to be in this country and others don’t. While anyone can buy insurance privately, people without legal status are not allowed to buy insurance on the exchange or participate in most government program such as Medicare, non-emergency Medicaid or the Children’s Health Insurance Program.\u003c/p>\n\u003cp>Her parents are in the country without permission, as is her older brother Luis, 22, who did not qualify for DACA. Her other brother Daniel, 21, was granted DACA status and qualifies for the same benefits she does. And her brother Alex, 11, is a U.S.-born citizen, covered through California Kids –- a nonprofit health insurance plan.\u003c/p>\n\u003cp>\u003cstrong>‘Stuck In The Middle’\u003c/strong>\u003c/p>\n\u003cp>The family’s history is complicated. After several failed visa attempts, her father Enrique Bravo crossed the border illegally in 1996. His wife, Virginia, tried to cross by hiding in a car but was caught by border patrol agents. Desperate to join her husband, she tried again and made it across six months later. Three-year-old Jessica and her older brothers later crossed with legal-resident relatives in a car.\u003c/p>\n\u003cp>“I’m 100 percent Mexican…but all my memories growing up are from the United States,” said Jessica. “It’s like I’m stuck in the middle…I’m neither from here or there.”\u003c/p>\n\u003cfigure id=\"attachment_22319\" class=\"wp-caption alignright\" style=\"max-width: 380px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg\">\u003cimg class=\"size-full wp-image-22319\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg\" alt=\"Photos of the Bravo family, Enrique, his wife, Virginia, and their children Jessica, Daniel and Luis, taken in 2001, five years after arriving in the United States (Photos Courtesy of the Bravo Family).\" width=\"380\" height=\"777\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/11/Bravos-e1415038674805.jpg 380w, https://ww2.kqed.org/app/uploads/sites/27/2014/11/Bravos-e1415038674805-320x654.jpg 320w\" sizes=\"(max-width: 380px) 100vw, 380px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Photos of the Bravo family, Enrique, his wife, Virginia, and their children Jessica, Daniel and Luis, taken in 2001, five years after arriving in the United States (Photos Courtesy of the Bravo Family).\u003c/figcaption>\u003c/figure>\n\u003cp>As the older children grew up, getting health care proved dicey. The family tried to stay below the radar. This meant visiting the doctor only when absolutely necessary -- and always paying cash.\u003c/p>\n\u003cp>They were, like many immigrants, fearful of exposing the family’s unauthorized status and risking deportation, for themselves and their children.\u003c/p>\n\u003cp>Eventually Enrique, an electrician, found a job that offered health insurance, and for several years the family was insured. But he got laid off in 2006. From then on, they were forced to rely on local community clinics that provide care on a sliding pay scale.\u003c/p>\n\u003cp>“I remember my parents telling me that I was no longer going to be insured under their plan,” said Jessica. “I just tried to eat healthy.”\u003c/p>\n\u003cp>Her biggest concern now, she says, is that one of the others will get sick and the family won’t be able to pay for care.\u003c/p>\n\u003cp>“Even though that fear is gone for me, it’s still very real for my family,” said Bravo, who is in the process of renewing her DACA status for another two years.\u003c/p>\n\u003cp>“It’s difficult to grasp that I have this privilege, yet my parents who worked twice as hard, don’t have anything.”\u003c/p>\n\u003cp>Recent events have compounded the family’s worries.\u003c/p>\n\u003cp>Jessica’s brother Luis was recently detained by agents from Immigration and Customs Enforcement as a result of a tip arising from a prior conviction for driving under the influence. It’s unclear what will happen until the immigration court hears his case and decides whether he can remain in the U.S.\u003c/p>\n\u003cp>“It all seems like a dream…it happened so fast,” said Jessica. “We’re doing everything we can to stop his deportation.”\u003c/p>\n\u003cp>\u003cstrong>One Fall Can Change Everything\u003c/strong>\u003c/p>\n\u003cp>Weeks ago, Jessica’s mother Virginia stumbled and fell to the ground in front of their Costa Mesa apartment, spilling the milk she’d just bought. The 48-year-old former hairstylist hurt her arm, but despite feeling a sharp pain she won’t be visiting the emergency room.\u003c/p>\n\u003cp>“We can’t afford it,” Virginia Bravo said. The mother of four has been unemployed for over a year and is more concerned about stocking the empty refrigerator than seeking treatment.\u003c/p>\n\u003cp>She knows all too well that without insurance an unexpected injury could leave them bankrupt.\u003c/p>\n\u003cp>Last year, Enrique had to be rushed to the emergency room. He woke up in the middle of the night with extreme paranoia, unable to catch his breath, and feeling numb.\u003c/p>\n\u003cp>He was having a panic attack. The bill for the two-hour hospital stay was about $6,000. Already struggling financially, the family had to find a way to pay cash.\u003c/p>\n\u003cp>“At first I refused to go to the hospital,” he said. “I knew it would be expensive.”\u003c/p>\n\u003cp>The 44-year-old says he struggles to earn at least $2,250 each month as a self-employed electrician –- the exact amount he needs to pay rent.\u003c/p>\n\u003cp>Any extra money is used to buy food and pay bills. Saving for an emergency is impossible, the family members said.\u003c/p>\n\u003cp>“We’re poor, but rich in health and family unity,” Virginia Bravo said.\u003c/p>\n\u003cp>Living in a mixed-status family has been challenging, but it has also brought them closer, she said. The whole family has been involved in campaigning for immigration reform and hopes the ACA will eventually include coverage for undocumented immigrants.\u003c/p>\n\u003cp>“People don’t know what we had to go through to get here,” said Virginia. “We made it across … we’re the lucky ones.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We don’t want anything for free,” she said. “If we had an opportunity to buy health insurance, we would find a way to pay for it.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22315/for-families-with-mixed-immigration-status-some-insured-some-not","authors":["8344"],"categories":["stateofhealth_11","stateofhealth_15"],"tags":["stateofhealth_407"],"label":"stateofhealth"},"stateofhealth_19025":{"type":"posts","id":"stateofhealth_19025","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19025","score":null,"sort":[1399327368000]},"guestAuthors":[],"slug":"even-with-obamacare-many-latinos-still-seek-medical-care-in-mexico","title":"Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico","publishDate":1399327368,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19033\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-e1399327135736.jpg\">\u003cimg class=\"size-large wp-image-19033\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-640x508.jpg\" alt=\"Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\" width=\"640\" height=\"508\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/05/south-of-the-border-health-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">\"To be honest, I like to come here better even if I have insurance.\"\u003c/aside>\n\u003c/p>\u003cp>But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can't use her insurance for care outside California but it's still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp style=\"color: #000000\">\"She listens to me,\" said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. \"I come here feeling really bad, and three days later I am better.\"\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities like Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos.\u003c/p>\n\u003cp style=\"color: #000000\">Naturalized citizens and legal residents are expected to continue traveling for check-ups, minor surgeries and dental care, drawn to treatment that is less expensive and a medical culture that is less hurried. Doctors speak their language and patients often can get appointments without long waits.\u003c/p>\n\u003cp style=\"color: #000000\">In fact, it's possible even more U.S. residents may seek care with Mexican doctors, said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the UCLA School of Medicine. Many Latinos in the United States live in areas with a huge undersupply of providers, and as new coverage increases the demand for care, waits for appointments could grow longer and more frustrating, he said.\u003c/p>\n\u003cp style=\"color: #000000\">\"If you don't have access to care, going to Tijuana may seem like a reasonable alternative,\" he said.\u003c/p>\n\u003cp style=\"color: #000000\">Some of these patients now going to Mexico remain uninsured, or work for employers in the U.S. offering insurance plans that pay for medical care in Mexico. Others have signed up for Obamacare to cover emergencies or avoid a fine – but face high deductibles and out-of-pocket expenses.\u003c/p>\n\u003cp style=\"color: #000000\">\"Even with insurance, it can sometimes be cheaper in Mexico,\" said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Long Drive \"But Worth It\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">The majority of these patients are Mexican immigrants with green cards or U.S. citizenship who can travel freely across the border. One 2009 study by Wallace found that nearly half a million Mexican immigrants living in California receive medical, dental or prescription services every year south of the border.\u003c/p>\n\u003cp style=\"color: #000000\">Lorena Villanueva, who cleans houses in Riverside County, Calif., came to Tijuana on a recent day because of a flare up of allergies that gave her a sore throat and a rash on both arms. Villanueva bought a plan through Covered California for about $150 a month. Joining a plan that her husband has through his work as a car salesman was too expensive.\u003c/p>\n\u003cp style=\"color: #000000\">\"To be honest, I like to come here better even if I have insurance,\" she said. \"Over there it's wasting money and wasting time.\"\u003c/p>\n\u003cp style=\"color: #000000\">The Obamacare plan, she said, is just for emergencies. For most everything else, Villanueva said she will continue driving the 70 miles to Tijuana. \"It's a long drive … but for me, it's worth it,\" she said.\u003c/p>\n\u003cp style=\"color: #000000\">The\u003cstrong> \u003c/strong>medical office where she sees her doctor is in an eight-story, modern building just steps from the border and across the street from a bus station. Two flags – one American and one Mexican – fly above the building owned by SIMNSA, a cross-border health plan.\u003c/p>\n\u003cp style=\"color: #000000\">Just outside, security guards monitor who enters and a line of taxis waits to give patients rides. Inside, the clinic is bustling with people seeking to get their eyes checked, lab results read, cavities filled, hearts examined, allergies treated and children immunized.\u003c/p>\n\u003cp style=\"color: #000000\">Licensed in California and overseen by the state's Department of Managed Health Care, SIMNSA offers health insurance to employees of American companies in San Diego and Imperial counties. The employer plan offers the essential benefits required under the ACA, administrators said.\u003c/p>\n\u003cp style=\"color: #000000\">Patients not on the SIMNSA employer plan can walk in to the clinic and pay out-of-pocket. Or, like Montalvo, they can pay a small membership fee allowing them to see an internist for $15 and a specialist for $25.\u003c/p>\n\u003cp style=\"color: #000000\">SIMNSA provides primary and specialty care, physical therapy, spa services and a pharmacy.\u003cstrong> \"\u003c/strong>It's a one-stop shop,\" said Christina Suggett, chief operating officer.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>\"Quality and Warmth\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Suggett said appointments typically last 30 minutes or more and the doctors don't rely heavily on nurses or medical assistants – a contrast to often more rushed encounters in the United States. Physicians develop long-term relationships with their patients, who return again and again, often bringing family members along.\u003c/p>\n\u003cp style=\"color: #000000\">Ophthalmologist Josue Delgado has been seeing Alberto Luna, 49, for several years. Luna lives just over the border in National City and has a SIMNSA policy through his job at a hotel in San Diego. Luna said he never has to wait to see Delgado and that the doctor treats him like a friend.\u003c/p>\n\u003cp style=\"color: #000000\">\"We know each other by first name,\" Delgado said of Luna.\u003c/p>\n\u003cp style=\"color: #000000\">On this day, Luna was seeking follow-up treatment for a complication of his diabetes -- bleeding in his eye. Delgado explained it was causing blurry vision and wasn't healing. The doctor gave Luna a note for his boss so he could spend a few more weeks at home before returning to work. \"Make sure you rest,\" Delgado told his patient, shaking his hand\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Xochitl Castaneda, director of the health initiative of the Americas at U.C. Berkeley's School of Public Health, said Mexican clinics offer something not always found in the U.S. \"In Spanish, we say \u003cem>calidad\u003c/em> and \u003cem>calidez\u003c/em>, quality and warmth,\" she said. \"When you are sick, you need medical support. You also need emotional support. That is something that Mexican physicians give.\"\u003c/p>\n\u003cp style=\"color: #000000\">The question of quality is not settled. Experts say that some hospitals, doctors and clinics are comparable to the U.S. but that quality varies widely. Some studies find that patient satisfaction with Mexican providers is generally good while others find the care needs improvement.\u003c/p>\n\u003cp style=\"color: #000000\">It is that warmth that brings Montalvo back to Tijuana, despite her new Covered California plan. After checking Montalvo's rash, Espinoza told her to continue the medication and come back in a few weeks. She also told her to call – night or day – if she had any questions.\u003c/p>\n\u003cp style=\"color: #000000\">\"You are responding perfectly\" to the medication, Espinoza told Montalvo. \"I'm happy.\"\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo smiled at her doctor before heading down to the pharmacy. \"\u003cem>Que dios le bendiga,\" \u003c/em>Montalvo told her. \"May God bless you.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"Uf8uyBE4OtjyA0nIu5NrIodNwMz5d52c\"]\u003c/p>\n\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1399485784,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":5,"wordCount":1295},"headData":{"title":"Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico | KQED","description":"By Anna Gorman, Kaiser Health News TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years. "To be honest, I like to come here better even if I have insurance." But when she needed treatment for","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"19025 http://blogs.kqed.org/stateofhealth/?p=19025","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/05/05/even-with-obamacare-many-latinos-still-seek-medical-care-in-mexico/","disqusTitle":"Even With Obamacare, Many Latinos Still Seek Medical Care in Mexico","path":"/stateofhealth/19025/even-with-obamacare-many-latinos-still-seek-medical-care-in-mexico","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19033\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-e1399327135736.jpg\">\u003cimg class=\"size-large wp-image-19033\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/simnsa-2_rev-640x508.jpg\" alt=\"Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\" width=\"640\" height=\"508\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Cecilia Espinoza meets with her patient Irma Montalvo. Montalvo, a U.S. citizen, prefers to travel to Mexico for health care, even though she signed up for a health plan through Covered California (Heidi de Marco/KHN).\u003c/figcaption>\u003c/figure>\n\u003cp style=\"color: #000000\">\u003cstrong>By Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/May/05/south-of-the-border-health-care.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp style=\"color: #000000\">TIJUANA, Mexico – Irma Montalvo signed up for a health plan through Covered California, the state's insurance marketplace, last month, getting coverage for the first time in eight years.\u003c/p>\n\u003cp style=\"color: #000000\">\n\u003caside class=\"pullquote alignleft\">\"To be honest, I like to come here better even if I have insurance.\"\u003c/aside>\n\u003c/p>\u003cp>But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, diagnosed her with shingles and prescribed medication to relieve pain and head off complications.\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo, 64, said she comes to Tijuana in part because it costs just $15 to see the doctor. She can't use her insurance for care outside California but it's still cheaper because she doesn’t have to worry about a deductible. More important, she said, is that she feels comfortable with Espinoza.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp style=\"color: #000000\">\"She listens to me,\" said Montalvo, a U.S. citizen who was born in Mexico, said in Spanish. \"I come here feeling really bad, and three days later I am better.\"\u003c!--more-->\u003c/p>\n\u003cp style=\"color: #000000\">Mexican immigrants living in California, Arizona, Texas and New Mexico have long sought health care in border cities like Tijuana, Mexicali and Nogales. The Affordable Care Act won't change that, experts said, even though it has expanded coverage to millions of people, including many Latinos.\u003c/p>\n\u003cp style=\"color: #000000\">Naturalized citizens and legal residents are expected to continue traveling for check-ups, minor surgeries and dental care, drawn to treatment that is less expensive and a medical culture that is less hurried. Doctors speak their language and patients often can get appointments without long waits.\u003c/p>\n\u003cp style=\"color: #000000\">In fact, it's possible even more U.S. residents may seek care with Mexican doctors, said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the UCLA School of Medicine. Many Latinos in the United States live in areas with a huge undersupply of providers, and as new coverage increases the demand for care, waits for appointments could grow longer and more frustrating, he said.\u003c/p>\n\u003cp style=\"color: #000000\">\"If you don't have access to care, going to Tijuana may seem like a reasonable alternative,\" he said.\u003c/p>\n\u003cp style=\"color: #000000\">Some of these patients now going to Mexico remain uninsured, or work for employers in the U.S. offering insurance plans that pay for medical care in Mexico. Others have signed up for Obamacare to cover emergencies or avoid a fine – but face high deductibles and out-of-pocket expenses.\u003c/p>\n\u003cp style=\"color: #000000\">\"Even with insurance, it can sometimes be cheaper in Mexico,\" said Steven Wallace, who is associate director the UCLA center and has studied why Mexican immigrants seek care in Mexico.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>Long Drive \"But Worth It\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">The majority of these patients are Mexican immigrants with green cards or U.S. citizenship who can travel freely across the border. One 2009 study by Wallace found that nearly half a million Mexican immigrants living in California receive medical, dental or prescription services every year south of the border.\u003c/p>\n\u003cp style=\"color: #000000\">Lorena Villanueva, who cleans houses in Riverside County, Calif., came to Tijuana on a recent day because of a flare up of allergies that gave her a sore throat and a rash on both arms. Villanueva bought a plan through Covered California for about $150 a month. Joining a plan that her husband has through his work as a car salesman was too expensive.\u003c/p>\n\u003cp style=\"color: #000000\">\"To be honest, I like to come here better even if I have insurance,\" she said. \"Over there it's wasting money and wasting time.\"\u003c/p>\n\u003cp style=\"color: #000000\">The Obamacare plan, she said, is just for emergencies. For most everything else, Villanueva said she will continue driving the 70 miles to Tijuana. \"It's a long drive … but for me, it's worth it,\" she said.\u003c/p>\n\u003cp style=\"color: #000000\">The\u003cstrong> \u003c/strong>medical office where she sees her doctor is in an eight-story, modern building just steps from the border and across the street from a bus station. Two flags – one American and one Mexican – fly above the building owned by SIMNSA, a cross-border health plan.\u003c/p>\n\u003cp style=\"color: #000000\">Just outside, security guards monitor who enters and a line of taxis waits to give patients rides. Inside, the clinic is bustling with people seeking to get their eyes checked, lab results read, cavities filled, hearts examined, allergies treated and children immunized.\u003c/p>\n\u003cp style=\"color: #000000\">Licensed in California and overseen by the state's Department of Managed Health Care, SIMNSA offers health insurance to employees of American companies in San Diego and Imperial counties. The employer plan offers the essential benefits required under the ACA, administrators said.\u003c/p>\n\u003cp style=\"color: #000000\">Patients not on the SIMNSA employer plan can walk in to the clinic and pay out-of-pocket. Or, like Montalvo, they can pay a small membership fee allowing them to see an internist for $15 and a specialist for $25.\u003c/p>\n\u003cp style=\"color: #000000\">SIMNSA provides primary and specialty care, physical therapy, spa services and a pharmacy.\u003cstrong> \"\u003c/strong>It's a one-stop shop,\" said Christina Suggett, chief operating officer.\u003c/p>\n\u003cp style=\"color: #000000\">\u003cstrong>\"Quality and Warmth\"\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Suggett said appointments typically last 30 minutes or more and the doctors don't rely heavily on nurses or medical assistants – a contrast to often more rushed encounters in the United States. Physicians develop long-term relationships with their patients, who return again and again, often bringing family members along.\u003c/p>\n\u003cp style=\"color: #000000\">Ophthalmologist Josue Delgado has been seeing Alberto Luna, 49, for several years. Luna lives just over the border in National City and has a SIMNSA policy through his job at a hotel in San Diego. Luna said he never has to wait to see Delgado and that the doctor treats him like a friend.\u003c/p>\n\u003cp style=\"color: #000000\">\"We know each other by first name,\" Delgado said of Luna.\u003c/p>\n\u003cp style=\"color: #000000\">On this day, Luna was seeking follow-up treatment for a complication of his diabetes -- bleeding in his eye. Delgado explained it was causing blurry vision and wasn't healing. The doctor gave Luna a note for his boss so he could spend a few more weeks at home before returning to work. \"Make sure you rest,\" Delgado told his patient, shaking his hand\u003cstrong>.\u003c/strong>\u003c/p>\n\u003cp style=\"color: #000000\">Xochitl Castaneda, director of the health initiative of the Americas at U.C. Berkeley's School of Public Health, said Mexican clinics offer something not always found in the U.S. \"In Spanish, we say \u003cem>calidad\u003c/em> and \u003cem>calidez\u003c/em>, quality and warmth,\" she said. \"When you are sick, you need medical support. You also need emotional support. That is something that Mexican physicians give.\"\u003c/p>\n\u003cp style=\"color: #000000\">The question of quality is not settled. Experts say that some hospitals, doctors and clinics are comparable to the U.S. but that quality varies widely. Some studies find that patient satisfaction with Mexican providers is generally good while others find the care needs improvement.\u003c/p>\n\u003cp style=\"color: #000000\">It is that warmth that brings Montalvo back to Tijuana, despite her new Covered California plan. After checking Montalvo's rash, Espinoza told her to continue the medication and come back in a few weeks. She also told her to call – night or day – if she had any questions.\u003c/p>\n\u003cp style=\"color: #000000\">\"You are responding perfectly\" to the medication, Espinoza told Montalvo. \"I'm happy.\"\u003c/p>\n\u003cp style=\"color: #000000\">Montalvo smiled at her doctor before heading down to the pharmacy. \"\u003cem>Que dios le bendiga,\" \u003c/em>Montalvo told her. \"May God bless you.\"\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"Uf8uyBE4OtjyA0nIu5NrIodNwMz5d52c\"]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19025/even-with-obamacare-many-latinos-still-seek-medical-care-in-mexico","authors":["8344"],"categories":["stateofhealth_15"],"tags":["stateofhealth_368","stateofhealth_407"],"featImg":"stateofhealth_19033","label":"stateofhealth"},"stateofhealth_12005":{"type":"posts","id":"stateofhealth_12005","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"12005","score":null,"sort":[1365458112000]},"guestAuthors":[],"slug":"immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","title":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage","publishDate":1365458112,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\r\n\r\nBut unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards.\r\n","status":"publish","parent":0,"modified":1365627038,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":866},"headData":{"title":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage | KQED","description":"When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\r\n\r\nBut unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs and at night he studied for the boards.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"12005 http://blogs.kqed.org/stateofhealth/?p=12005","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/","disqusTitle":"Immigrant Doctors Help Ease California's Primary Care Doctor Shortage","path":"/stateofhealth/12005/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By \u003ca href=\"http://www.kaiserhealthnews.org/Reporters/GoldJ.aspx\">Jenny Gold\u003c/a>, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/April/04/california-doctors-primary-care-latin-america.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cdiv>\n\u003cfigure id=\"attachment_12010\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/04/08/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage/immigrant-doc-300_jennygold_khn/\" rel=\"attachment wp-att-12010\">\u003cimg class=\"size-full wp-image-12010\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/04/immigrant-doc-300_JennyGold_KHN.jpg\" alt=\"Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jose Chavez Gonzalez examines Graciela Jauregui at Riverside County Regional Medical Center (Jenny Gold/Kaiser Health News).\u003c/figcaption>\u003c/figure>\n\u003cp>It's a familiar story in California.\u003c/p>\n\u003cp>When Jose Chavez Gonzalez moved to the United States from El Salvador, he took any job he could get -- stocking warehouses, construction, cleaning houses and working in a meat processing plant.\u003c/p>\n\u003cp>But unlike most of the other immigrants he worked alongside, Chavez, 38, was a doctor with eight years of medical training. He came to the U.S. in the mid-1990’s to be with his family, but like all doctors from other countries, he still had to pass the U.S. medical boards and go through at least three years of residency in order to practice here. The process can be both expensive and time consuming, so during the day he worked various menial jobs. At night he studied for the boards.\u003c/p>\n\u003caside class=\"pullquote alignright\">Hundreds, maybe thousands, of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. That’s a wasted resource.\u003c/aside>\n\u003cp>“I had to do it. And I wouldn’t complain,” says Chavez. “It was OK to me. I mean, of course medicine is my passion, but since I didn’t have a license here, I couldn’t practice it.”\u003c/p>\n\u003cp>A quarter of U.S. doctors are foreign-born, mostly from countries like India that focus on training medical students to work in the U.S. Many other immigrant physicians never become American doctors, particularly those who come from Latin American countries like Chavez.\u003c/p>\n\u003cp>But a program at the University of California is seeking to change that, while at the same time helping to address \u003ca href=\"http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care\" target=\"_blank\">the shortage of primary care doctors\u003c/a> in the state. The UCLA \u003ca href=\"http://fm.mednet.ucla.edu/IMG/img_program.asp\" target=\"_blank\">International Medical Graduate Program\u003c/a> offers Latino doctors a stipend along with board preparation classes, mentorship and references to help them find a good residency slot in primary care. In return, the doctors pledge to work in an underserved area of California for two or three years.\u003c!--more-->\u003c/p>\n\u003cp>The program at UCLA was founded by Dr. Patrick Dowling and Dr. Michelle Bholat to help address the shortage of primary care doctors in the state, and a particular shortage of doctors of Latin American heritage. Though more than one-third of California’s population is Hispanic, only 5 percent of its doctors are.\u003c/p>\n\u003cp>In addition, nearly half of the estimated \u003ca href=\"http://www.healthexchange.ca.gov/BoardMeetings/Documents/November%2014_2012/IX_HBEX_CoveredCaBoardLevel2-Blueprint11-14-2012_Final.pdf\">5 million Californians\u003c/a> expected to be newly eligible for health insurance under the Affordable Care Act are Latino, and Dowling says it’s key that patients see a doctor who understands their language and culture.\u003c/p>\n\u003cp>“You can either do total body cat scans on everybody or you can sit down and try to understand what the patient is saying and why and what’s going on in their life,” says Dowling.\u003c/p>\n\u003cp>The program is small. But slowly, it’s making a dent. Chavez was able to pass his medical exams in two years. Today, he’s hard at work as a first-year resident at the Riverside County Regional Medical Center. Most of his patients are Hispanic, and many are immigrants like him.\u003c/p>\n\u003cp>Graciela Jauregui came to the clinic with severe pain in her knee. She was born in Mexico but has lived in the U.S. for 17 years, working as a housekeeper. She’s 62 and doesn’t speak English. She says she always prefers to see a doctor who can actually understand her.\u003c/p>\n\u003cp>Speaking through an interpreter, Jauregui says, “All doctors are good people, but when they speak Spanish it’s better.”\u003c/p>\n\u003cp>Chavez’s fluency in Spanish is prized by his boss, Riverside’s chief of family medicine Dr. Geoffrey Leung. Leung says the clinic employs translators, but they are often in short supply. And even \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2009/April/21/Medical-Interpreters.aspx\" target=\"_blank\">with a translator\u003c/a>, important details can be lost.\u003c/p>\n\u003cp>“No matter how good of a translator you have, your concern is that you may lose some part of the integrity of the message,” Leung says.\u003c/p>\n\u003cp>So far, the UCLA program has placed 54 Hispanic doctors into family medicine training programs –- Dowling says that’s almost as many as came from all 10 California medical schools put together.\u003c/p>\n\u003cp>Dowling says hundreds and maybe thousands of immigrant doctors from Latin America could be practicing, but are instead working other –- often menial –- jobs. And that’s a wasted resource.\u003c/p>\n\u003cp>“I was just reviewing an applicant this morning who’s currently working in McDonalds,” Dowling says. “And I thought of the irony: She’s serving people Big Macs right now and what she could be doing is explaining to people that isn’t what you want you want to be eating.”\u003c/p>\n\u003cp>Chavez, for his part, is happy to be treating patients again: “[It] gave me the opportunity to stop working and focus full-time on studying. Without the program, I would still be working on construction.”\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/12005/immigrant-doctors-help-ease-californias-primary-care-doctor-shortage","authors":["240"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_415","stateofhealth_407","stateofhealth_37"],"featImg":"stateofhealth_12010","label":"stateofhealth"},"stateofhealth_9942":{"type":"posts","id":"stateofhealth_9942","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"9942","score":null,"sort":[1358187272000]},"guestAuthors":[],"slug":"as-%e2%80%98bodega-clinicas%e2%80%99-fill-void-officials-torn-on-embracing-them","title":"As ‘Bodega Clinicas’ Fill Void, Officials Torn on Embracing Them","publishDate":1358187272,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By Sarah Varney, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/January/13/Varney-Clinicas.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9953\" class=\"wp-caption alignleft\" style=\"max-width: 320px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/photo-2.jpg\">\u003cimg class=\"size-full wp-image-9953\" title=\"photo-2\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/photo-2.jpg\" alt=\"\" width=\"320\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Sarah Varney/Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.\u003c/p>\n\u003cp>County health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide. Staffed with Spanish speaking medical providers, few of these low-rent clinics accept private insurance or participate in Medicaid managed care plans.\u003c/p>\n\u003cp>“Someone has to figure out if there’s a basic level of competence,” said Dr. Patrick Dowling, professor and chair of the department of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.\u003c/p>\n\u003cp>Not that researchers haven’t tried. Dr. Dowling, for one, has canvassed the local clinicas for years as part of his research for the state to document physician shortages. What he and others have found, however, is that clinca owners were reluctant to answer their questions.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>What is certain, though, is that despite their name, many of these clinicas are actually private doctor’s offices, not licensed clinics which are required to report regularly to federal and state oversight bodies. It is a distinction that deeply concerns Kimberly Wyard, chief executive of Northeast Valley Health Corporation, a non-profit group which runs 13 accredited health clinics for low-income Southern Californians. “They are off the radar screen,” said Wyard of the clinicas, “and it’s unclear what they’re doing.”\u003c/p>\n\u003cp>But driven by fast-approaching deadlines set by the Affordable Care Act, health officials in Los Angeles are vexed over whether to embrace bodega clinicas and bring them –- selectively and gingerly –- into the network of tightly regulated public and non-profit health centers that are driven more by mission than by profit to serve the uninsured.\u003c/p>\n\u003cp>Health officials see in the clinicas the tantalizing opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to 2 million currently uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care. And the clinicas, public health officials note, are already well established in the county’s poorest neighborhoods where they are meeting the needs of Spanish-speaking residents. The clinicas also could continue to serve a market that the Affordable Care Act does not touch: undocumented immigrants who are prohibited from getting health insurance under the law.\u003c/p>\n\u003cp>Dr. Mark Ghaly, deputy director for Community Health at the Los Angeles County Department of Health Services, said bodega clinicas, a term he seems to have coined, that agree to some scrutiny could be a good way of addressing the physician shortage in these neighborhoods.\u003c/p>\n\u003cp>“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”\u003c/p>\n\u003cp>The waiting rooms at the bodega clinicas reflect the everyday maladies of peoples’ lives: a glassy-eyed child rests listlessly on his mother’s lap; a fit-looking young woman waits with a bag of ice on her wrist; a pensive middle-aged man in work boots stares straight ahead. For patients with ordinary complaints, the medical care at these bodega clinicas may be suitable, say county health officials and medical experts. But they say problems arise when the illness exceeds the boundaries of a physician’s skills or the patient’s ability to pay cash.\u003c/p>\n\u003cp>Dr. Raul Joaquin Bendana, who has been practicing general medicine since 1987 in South Los Angeles, said bodega clinicas will refer patients to him when, for example, they have uncontrolled diabetes. “They refer to me because they don’t know how to handle the situation,” he said. The clinica physicians by and large appear to have current medical licenses, a sample showed, but experts say they are unlikely to be board certified as specialists or have admitting privileges at area hospitals. That can mean some clinicas attempt to continue to treat patients who face serious illness.\u003c/p>\n\u003cp>Olivia Cardenas, a 40-year-old restaurant worker who lives in Woodland Hills got a free pap smear at a clinica that advertises “especialistas” including gynecology. The pap smear came back abnormal, and the doctor told Cardenas she had cervical cancer. “Come back in a week with $5,000 in cash, and I’ll operate on you,” Cardenas said the doctor told her. “Otherwise you could die.”\u003c/p>\n\u003cp>Although Ms. Cardenas had gone to the clinica for years, she was shocked by the directive. She declined to pay the $5,000. Instead, a family friend helped her apply for Medicaid and she went to a licensed hospital for treatment. The diagnosis, it turned out, was correct.\u003c/p>\n\u003cp>Health care experts say clinicas’ medical practices would come under greater scrutiny if they were brought closer into the fold. Howard Kahn, chief executive of L.A. Care Health Plan, the nation’s largest public health plan, which contracts with private managed care companies, said: “I’m big on the idea that connectedness breeds quality.” Some here hold an uneasy hope that the clinicas could learn from licensed health centers how to follow their patients’ diabetes, hypertension and asthma, adopt electronic medical records and employ medical assistants to keep patients on track.\u003c/p>\n\u003cp>But being connected would mean the clinicas’ cash-only business model would need to change. Dowling, the UCLA researcher, said the lure of newly insured patients in 2014 might draw them in: “To the extent there are payments available, the legitimate ones might step up to the plate.”\u003c/p>\n\u003cp>Calls to a half dozen such clinics were met with no comment or were unreturned. There is at least one early indication that the clinicas may sit this one out: Clinica Mi Pueblo, regarded as scrupulous and well-run, recently sold four of its 11 clinics to a health maintenance organization over concerns that when the Affordable Care Act takes hold next year, it will lose a significant portion of its cash business.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News in collaboration with the New York Times.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.\r\n\r\nCounty health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide. Staffed with Spanish speaking medical providers, few of these low-rent clinics accept private insurance or participate in Medicaid managed care plans.","status":"publish","parent":0,"modified":1358534913,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":1152},"headData":{"title":"As ‘Bodega Clinicas’ Fill Void, Officials Torn on Embracing Them | KQED","description":"The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.\r\n\r\nCounty health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide. Staffed with Spanish speaking medical providers, few of these low-rent clinics accept private insurance or participate in Medicaid managed care plans.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"9942 http://blogs.kqed.org/stateofhealth/?p=9942","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/01/14/as-%e2%80%98bodega-clinicas%e2%80%99-fill-void-officials-torn-on-embracing-them/","disqusTitle":"As ‘Bodega Clinicas’ Fill Void, Officials Torn on Embracing Them","path":"/stateofhealth/9942/as-%e2%80%98bodega-clinicas%e2%80%99-fill-void-officials-torn-on-embracing-them","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Sarah Varney, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/January/13/Varney-Clinicas.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_9953\" class=\"wp-caption alignleft\" style=\"max-width: 320px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/photo-2.jpg\">\u003cimg class=\"size-full wp-image-9953\" title=\"photo-2\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/01/photo-2.jpg\" alt=\"\" width=\"320\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Sarah Varney/Kaiser Health News)\u003c/figcaption>\u003c/figure>\n\u003cp>The so-called bodega clinicas that line the streets of Los Angeles’ immigrant neighborhoods blend into a dense forest of commerce. Wedged between money order kiosks and pawn shops, these storefront doctors’ offices treat ailments for cash: a doctor’s visit is $20 to $40, a podiatry exam is $120 and at one bustling clinica, a colonoscopy is advertised on an erasable white board for $700.\u003c/p>\n\u003cp>County health officials describe the clinicas as a parallel health care system, servicing a vast number of uninsured Latino residents, yet the officials say they have little understanding of who owns and operates them, how they are regulated and the quality of the medical care they provide. Staffed with Spanish speaking medical providers, few of these low-rent clinics accept private insurance or participate in Medicaid managed care plans.\u003c/p>\n\u003cp>“Someone has to figure out if there’s a basic level of competence,” said Dr. Patrick Dowling, professor and chair of the department of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.\u003c/p>\n\u003cp>Not that researchers haven’t tried. Dr. Dowling, for one, has canvassed the local clinicas for years as part of his research for the state to document physician shortages. What he and others have found, however, is that clinca owners were reluctant to answer their questions.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>What is certain, though, is that despite their name, many of these clinicas are actually private doctor’s offices, not licensed clinics which are required to report regularly to federal and state oversight bodies. It is a distinction that deeply concerns Kimberly Wyard, chief executive of Northeast Valley Health Corporation, a non-profit group which runs 13 accredited health clinics for low-income Southern Californians. “They are off the radar screen,” said Wyard of the clinicas, “and it’s unclear what they’re doing.”\u003c/p>\n\u003cp>But driven by fast-approaching deadlines set by the Affordable Care Act, health officials in Los Angeles are vexed over whether to embrace bodega clinicas and bring them –- selectively and gingerly –- into the network of tightly regulated public and non-profit health centers that are driven more by mission than by profit to serve the uninsured.\u003c/p>\n\u003cp>Health officials see in the clinicas the tantalizing opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to 2 million currently uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care. And the clinicas, public health officials note, are already well established in the county’s poorest neighborhoods where they are meeting the needs of Spanish-speaking residents. The clinicas also could continue to serve a market that the Affordable Care Act does not touch: undocumented immigrants who are prohibited from getting health insurance under the law.\u003c/p>\n\u003cp>Dr. Mark Ghaly, deputy director for Community Health at the Los Angeles County Department of Health Services, said bodega clinicas, a term he seems to have coined, that agree to some scrutiny could be a good way of addressing the physician shortage in these neighborhoods.\u003c/p>\n\u003cp>“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”\u003c/p>\n\u003cp>The waiting rooms at the bodega clinicas reflect the everyday maladies of peoples’ lives: a glassy-eyed child rests listlessly on his mother’s lap; a fit-looking young woman waits with a bag of ice on her wrist; a pensive middle-aged man in work boots stares straight ahead. For patients with ordinary complaints, the medical care at these bodega clinicas may be suitable, say county health officials and medical experts. But they say problems arise when the illness exceeds the boundaries of a physician’s skills or the patient’s ability to pay cash.\u003c/p>\n\u003cp>Dr. Raul Joaquin Bendana, who has been practicing general medicine since 1987 in South Los Angeles, said bodega clinicas will refer patients to him when, for example, they have uncontrolled diabetes. “They refer to me because they don’t know how to handle the situation,” he said. The clinica physicians by and large appear to have current medical licenses, a sample showed, but experts say they are unlikely to be board certified as specialists or have admitting privileges at area hospitals. That can mean some clinicas attempt to continue to treat patients who face serious illness.\u003c/p>\n\u003cp>Olivia Cardenas, a 40-year-old restaurant worker who lives in Woodland Hills got a free pap smear at a clinica that advertises “especialistas” including gynecology. The pap smear came back abnormal, and the doctor told Cardenas she had cervical cancer. “Come back in a week with $5,000 in cash, and I’ll operate on you,” Cardenas said the doctor told her. “Otherwise you could die.”\u003c/p>\n\u003cp>Although Ms. Cardenas had gone to the clinica for years, she was shocked by the directive. She declined to pay the $5,000. Instead, a family friend helped her apply for Medicaid and she went to a licensed hospital for treatment. The diagnosis, it turned out, was correct.\u003c/p>\n\u003cp>Health care experts say clinicas’ medical practices would come under greater scrutiny if they were brought closer into the fold. Howard Kahn, chief executive of L.A. Care Health Plan, the nation’s largest public health plan, which contracts with private managed care companies, said: “I’m big on the idea that connectedness breeds quality.” Some here hold an uneasy hope that the clinicas could learn from licensed health centers how to follow their patients’ diabetes, hypertension and asthma, adopt electronic medical records and employ medical assistants to keep patients on track.\u003c/p>\n\u003cp>But being connected would mean the clinicas’ cash-only business model would need to change. Dowling, the UCLA researcher, said the lure of newly insured patients in 2014 might draw them in: “To the extent there are payments available, the legitimate ones might step up to the plate.”\u003c/p>\n\u003cp>Calls to a half dozen such clinics were met with no comment or were unreturned. There is at least one early indication that the clinicas may sit this one out: Clinica Mi Pueblo, regarded as scrupulous and well-run, recently sold four of its 11 clinics to a health maintenance organization over concerns that when the Affordable Care Act takes hold next year, it will lose a significant portion of its cash business.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News in collaboration with the New York Times.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/9942/as-%e2%80%98bodega-clinicas%e2%80%99-fill-void-officials-torn-on-embracing-them","authors":["8344"],"categories":["stateofhealth_11"],"tags":["stateofhealth_38","stateofhealth_407"],"featImg":"stateofhealth_9953","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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