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Invisible Patients 

A growing population of undocumented, uninsured workers need health care in New Orleans.

When you are illegal, there are things you don't know how to do, how to protect yourself," says Pedro, a subcontractor from Tampico, Mexico, who asks that his last name not be disclosed because he is undocumented.

"Right after Katrina, I was getting sick every six months. I get a big old blister ... two or three at a time," he says, motioning to silver-dollar-sized circles on his forearms. "Everybody started getting skin diseases."

Two years after Katrina, Pedro is representative of the growing Hispanic labor force that continues to migrate to New Orleans, following work opportunities in rebuilding. And like many other Hispanic residents in contract and day-labor jobs, he knows the difficulties of navigating New Orleans' notoriously overtaxed health-care system as an undocumented immigrant.

When Dr. John Estrada founded the Latino Health Access Network (LHAN) five years ago, the goal was to provide "culturally specific health care for the uninsured and underinsured." At the time, Hispanics represented about 3 percent of New Orleans residents. Partnering with the Daughters of Charity Health Center and the Hispanic Apostolate Pastoral Services Archdiocese of New Orleans, the bulk of LHAN's work was aimed at coordinating services around family-practice issues.

"Post-Katrina, we had an influx of a different Latino population," says Estrada, an associate professor of pediatrics at the LSU Health Sciences Center and an LHAN board member. He says the major differences in the Hispanic community now are that the migrant laborers who have followed work to New Orleans are largely single men who are here without any family or social support networks and who are more prone to work-related accidents. Many are hesitant to seek health care because they are afraid of deportation.

The most recent state figures from a late 2006 survey conducted by the Louisiana Public Health Institute and the Centers for Disease Control put the local Latino population at just under 10 percent of the city's population, though many who work with the community suspect it is more.

"This population doesn't want to be counted," says Jennifer Whitney, one of the coordinators of the Common Ground Health Clinic's Latino Health Outreach Project (LHOP).

Regardless of the exact numbers, some clear concerns emerge as this population finds its way into New Orleans health care.

"The No. 1 problem is to have translators," Estrada says. When a patient cannot communicate their illness or understand a diagnosis, even simple instructions, like getting the proper medication, can be difficult, he says.

"When you don't speak English, just to get medication for coughs is really hard," says Pedro, the subcontractor from Mexico. He considers himself lucky because after 10 years of working construction in the United States, he is bilingual. He gets primary care and medication from the Daughters of Charity clinic and, when he can, serves as an informal translator for coworkers.

"My friends, they're like, 'Pedro, can you come to the pharmacy with me to get medication for a cough?'" he says, remembering how confusing it was to buy simple, over-the-counter medications when he was new in this country.

LHAN is in the process of training translators and community health promoters to work with hospitals and clinics, and to assist Spanish speakers in navigating health care. Other organizations, including the LSU health system, are actively recruiting bilingual staff to work in administrative and secretarial positions. The New Orleans Department of Health recently hired two bilingual physicians to work in the four operational clinics under its direction. Still, representatives from all of these initiatives say that there is a growing need for bilingual services.

"Language is really one of the biggest pieces," Whitney agrees.

Around 6:30 a.m. every Thursday morning, Whitney and a group of bilingual volunteers from LHOP set up a mobile clinic on the corner of Claiborne Avenue and Martin Luther King Boulevard — a high-traffic pickup spot for migrant day labor. Inside the LHOP van, a volunteer physician gives primary-care check-ups and administers tetanus and hepatitis vaccines. Skin infections and respiratory irritation are two of the most common work-related illnesses LHOP physicians see. On the neutral ground, another set of volunteers hands out several cardboard boxes worth of free protective work gear — gloves, glasses, respirators — and explains how to properly fit and use them to the steady stream of mostly Spanish-speaking men.

By 7 a.m., the gloves are all gone. Not long after, the respirators start running out. Then the protective eyewear.

Any given week, 30 to 60 day laborers visit the LHOP mobile clinic during a two-hour period. And while it has made a great impact on the health of its patients, Whitney is the first to state that it is not a permanent solution to the health problems of the Hispanic migrant community.

"On the street, we can only do so much. We can't give an EKG," she says. Whitney believes that anything short of universal health coverage would not adequately meet the needs of the Hispanic day laborers — or any other underserved group.

Whitney sees financial logic in making health-care more accessible to migrant workers. "Denying health insurance, denying preventive care to people so they end up in the [emergency room], that costs more," she says.

While no one seems to be tracking how migrant laborers are using emergency rooms for care, the U.S. Department of Labor (DOL) cites "falls from elevated surfaces" as the most common work-related hazard in the New Orleans area. Nationally, Hispanics account for nearly half of all contractor injuries in construction, according to the U.S. Bureau of Labor Statistics, which does not break down the numbers by region.

Before the storm, the only health statistics that were really followed in the local Hispanic population were birth and death rates. Now that the makeup of that community has changed, other indicators of health are something that the Louisiana Department of Health and Hospitals (DHH) needs to start tracking, says Jolie Adams, a spokesperson DHH.

"The thing that has changed the most [about the Latino population] — you see more of the trauma and injuries from construction-type jobs," says Gail Gibson, a registered nurse and associate nursing administrator at LSU Interim Hospital, formerly University Hospital.

"We have a lot of patients who stay here a little longer than we expect," says Gibson, who has worked for the LSU hospital system for 21 years. Even though hospitals are required to take all patients who need emergency care, regardless of documentation status, many migrant workers fear deportation if they seek care. The result, Gibson says, is that "you have those who wait until they're extremely sick and then require more complex care."

Compounding this delay is the fact that because so many migrant workers are here without any family or social network, it can be extremely difficult to find someone who will be responsible for their long-term care if they need help.

Alberto Mijia stands in the parking lot of the Upper Ninth Ward Lowe's Home Improvement on Elysian Fields Avenue with about a dozen other men speaking in Spanish.

"The majority (of us) have had breathing problems," Mijia says, nodding toward the men milling around behind him. They don't give their names because they are all undocumented immigrants from Mexico, Honduras or Guatemala.

"We work in demolition, construction," Mijia says. "But many times, the bosses don't give us masks or gloves or glasses or filters."

A dusty blue truck passes and the men lean toward it, looking for the signal that the driver needs workers. He does not. Mijia continues talking.

"We need protection," he says. "Without a mask, we can't work."

"We really want people to wear personal protective equipment," says Tom Harris, a toxicologist with the Louisiana State Department of Environmental Quality. Since 2005, his department has overseen 6,462 demolitions of buildings suspected of containing asbestos. While more than 30,000 air samples taken in that time period have not turned up a single positive result for airborne asbestos, he cautions that "dust itself is a respiratory irritant."

According to Sharon Worthy, a spokesperson for the DOL's Occupational Safety and Health Administration (OSHA), "employers are responsible for monitoring workplaces for hazards and providing appropriate personal protective equipment," and employees are protected by OSHA regardless of their documentation status. However, homeowners who hire informal labor generally are not considered employers. Plus, many migrant laborers do not know their legal rights and protections and fear that if they speak up they will be deported.

"The moral and ethical question is: How do we provide health care to a population that is here illegally?" LHAN's Estrada asks. "If it wasn't for these people, we wouldn't be able to rebuild. It is our moral obligation to help people."

click to enlarge Migrant workers stand outside a local business hoping to find work for the day. What they aren't likely to find is accessible health care. - DAVID WINKLER-SCHMIT
  • David Winkler-Schmit
  • Migrant workers stand outside a local business hoping to find work for the day. What they aren't likely to find is accessible health care.
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