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“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”

“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”

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Today, there are approximately 45,000 Latin American immigrants living in Washington, D.C. The largest number of these immigrants come from Central America as illegal immigrants who are monolingual in Spanish, uneducated and economically disadvantaged. While their citizenship status, education and economic levels affect their experiences with the United States health care system, cultural factors also play a significant role. This article examines how Latino immigrants in Washington, D.C. experience and navigate the U.S. health care system.

Personal experiences with the health care system in Washington, D.C. illuminate the common themes of displacement; family separation; lack of access to health care or perceived lack of access to health care; and cultural, social and economic barriers to health care for the underserved Latino population. Insights from local Latinoserving health care providers detail the challenges that providers face in serving this population. The article concludes with suggestions about what providers and community members can do to improve health experiences and outcomes for Latino immigrants. Copyright © 2008 Anthropology & Heath Journal & Syllaba Press. All rights reserved.
Today, there are approximately 45,000 Latin American immigrants living in Washington, D.C. The largest number of these immigrants come from Central America as illegal immigrants who are monolingual in Spanish, uneducated and economically disadvantaged. While their citizenship status, education and economic levels affect their experiences with the United States health care system, cultural factors also play a significant role. This article examines how Latino immigrants in Washington, D.C. experience and navigate the U.S. health care system.

Personal experiences with the health care system in Washington, D.C. illuminate the common themes of displacement; family separation; lack of access to health care or perceived lack of access to health care; and cultural, social and economic barriers to health care for the underserved Latino population. Insights from local Latinoserving health care providers detail the challenges that providers face in serving this population. The article concludes with suggestions about what providers and community members can do to improve health experiences and outcomes for Latino immigrants. Copyright © 2008 Anthropology & Heath Journal & Syllaba Press. All rights reserved.

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Published by: Syllaba Press International Inc. on Dec 10, 2008
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05/09/2014

 
Anthropology & Health Journal - AHJ. No. 1 7-15 (2008)
ID: ahj000001 -
http://www.ahj.syllabapress.com/issues/ahj00001.html 
Immigrants make up more than seventeen percent of Washington's metropolitan area population. Of the immi-grants living in the capital, nearly 40 percent come fromLatin America, and the largest group comes from El Salva-dor (Schifferes, 2003). This group consists of legal and ille-gal immigrants, monolingual and bilingual immigrants,wealthy and poor. Those who come illegally, speak no or little English, and have little income and savings, often findthemselves without access to health care. The health careneeds and experiences of Latinos, the major ethnic groupwithin in the “new” D.C. immigrant population of the twen-tieth century, is the focus of this article.To investigate how Latinos navigate the health sys-tem in the United States, I interviewed eighteen Latino im-migrants and two health care providers in Washington, D.C(Table 1). The article first introduces literature relevant to
“Just Because You Don’t Have Papers, Doesn’tMean You Won’t Get Sick”
 Health Care Experiences of Latinos in Mount Plea- sant, Washington, D.C.
Today, there are approximately 45,000 Latin American immigrants living in Washington, D.C. The largestnumber of these immigrants come from Central America as illegal immigrants who are monolingual in Spanish,uneducated and economically disadvantaged. While their citizenship status, education and economic levels affecttheir experiences with the United States health care system, cultural factors also play a significant role. This articleexamines how Latino immigrants in Washington, D.C. experience and navigate the U.S. health care system.Personal experiences with the health care system in Washington, D.C. illuminate the common themes of displacement; family separation; lack of access to health care or perceived lack of access to health care; and cultural,social and economic barriers to health care for the underserved Latino population. Insights from local Latino-serving health care providers detail the challenges that providers face in serving this population. The article conclu-des with suggestions about what providers and community members can do to improve health experiences and out-comes for Latino immigrants. Copyright © 2008 Anthropology & Heath Journal & Syllaba Press. All rights reser-ved.
 Keywords:
Latino, Health, Washington D.C., Medical Anthropology.Hoy en día, hay aproximadamente 45,000 inmigrantes latinoamericanos viviendo en Washington, D.C. Lagran mayoría de estos inmigrantes entran ilegalmente de Centroamérica; sin educación, hablando solamente español,y con desventajas económicas. Mientras sus estatus legales, niveles de educación y económicos afectan sus expe-riencias dentro del sistema de salud estadounidense, los factores culturales también juegan un papel importante.Este artículo investiga la manera que los inmigrantes latinos en Washington, D.C. entienden y navegan por el siste-ma de salud.Las experiencias personales con el sistema de salud en Washington, D.C. iluminan temas comunes como eldesplazamiento; la separación familiar; la falta de acceso a atención médica o la percepción de aquella falta; y losobstáculos culturales, sociales y económicos que se presentan a la atención médica para la comunidad latina. Pro-veedores de salud locales que atienden a los latinos detallan los desafíos que ellos enfrentan cuando sirven a estacomunidad. La conclusión del artículo presenta sugerencias sobre lo que pueden hacer los proveedores de salud ymiembros de la comunidad para mejorar las experiencias y resultados para inmigrantes latinos. Copyright © 2008Anthropology & Heath Journal & Syllaba Press. All rights reserved.
 Palabras claves:
Latino, Salud, Washington D.C., Antropología Médica.
Correspondense to:
Claire F. Selsky. M.A., Latin American Studies. The GeorgeWashington University 1923 35th Place NW Apt. 4, Washington, D.C. 20007,USA. Email address:CFS25@Georgetown.edu 
Claire F. Selsky, M.A.
 Independent Researcher. M.A., Latin American Studies, The George Washington University.
ABSTRACTRESUMEN
Received: 25 July 2008 / Accepted: 15 September 2008 / Published Online: 30 October 20082011-5776 /$ - see font matter. Copyright © 2008 Anthropology & Heath Journal & Syllaba Press. All rights reserved.
 
this study. My research methods are covered in the follo-wing section. Then, I present the stories of selected immi-grants and health care providers. Finally, I summarize myfindings and suggest ways to ameliorate health care expe-riences of Latinos in Washington, D.C.
Literature Review
This literature review discusses anthropological andrelated research applicable to this article. The section firstdiscusses literature on Latinos and health care in the UnitedStates and then provides a more focused look at Latinos andhealth care in Washington, D.C.
 Latinos and Health Care in the United States
A growing body of research in cultural anthropologyaddresses how the poor and uninsured experience the U.S.health care system (A. and S. Greer 1983, Singer and Clair 2003, Singer 2004, Becker 2004, Sered and Fernandopulle2005). Other social scientists have studied immigrants inthe U.S. generally (Cohen 1979) and more specifically, inWashington, D.C. (Modan 2006).
“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”
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Anthropology & Health Journal - AHJ. No. 1 7-15 (2008)
ID: ahj000001 -
http://www.ahj.syllabapress.com/issues/ahj00001.html 
Table 1.
The Eighteen Latino Immigrant Research Participants and Summary Findings about Their Health Care Access
 
Urban sociologists A. and S. Greer document thatrace and income levels are strongly correlated with healthstatus and the utilization of and access to services in their edited volume (1983). Compared to higher income or Whitefamilies, members of the Black community and low-incomefamilies report more restricted activity and disability daysand report chronic activity limitation and describe their health statuses as poor or fair (McKinley et al. in Greer andGreer, 1983, pg. 126). McKinley cites four reasons for thediscrepancy in health among races and socioeconomic le-vels: inequality of access; the welfare/insurance schemecausing people to fall through gaps in coverage, leading to atwo-class system of health care; focus on equality of accessrather than quality of medical care; and the failure to eva-luate the effectiveness and appropriateness of medical prac-tices and technology (pgs. 126-129). These four issues arerelevant to Latino immigrants in Washington, D.C.In
 Pathologies of Power: Health, Human Rights, and the New War on the Poor 
, medical anthropologist and medi-cal doctor Paul Farmer discusses how the United States’system of health care benefits those with money and hurtsthe poor. As Farmer notes, biotech and pharmaceuticalfirms make amazing discoveries, but lean heavily on publicfunding and make a great deal of private profit. He explainstoday’s medical system as a system in which health is acommodity and doctors conduct “commercial transactions”with patients (2003, pg. 162). Farmer’s analysis of the U.S.health care system provides a foundation for understandingthe frustrations of those who do not have the money, mostoften the poor and the uninsured, to purchase the commodi-ty of health.Singer (2004) and Singer and Clair (2003) discuss thecorrelation between socioeconomic class and health/healthcare access. In his article, “Why Is It Easier to Get Drugsthan Drug Treatment in the United States?” Singer compa-res the accessibility of illegal drugs to the accessibility of medical care. He shows that while drugs flow into U.S. ci-ties, towns and rural areas, securing effective drug treatmentremains a challenge for drug users who want to overcometheir addictions (2004, pg. 287). Specific to the Latino com-munity, Singer states that mass media presents the drug user as a criminal, often characterizing him as Black or Latino(2004, pg. 296). He adds that the United States only provi-des one third of the federal drug budget for prevention or treatment (2004, pg. 298). Singer shows that the United Sta-tes focuses its attention on criminalizing usage rather thanon preventing and treating addiction.In Singer and Clair’s article “Syndemics and PublicHealth: Reconceptualizing Disease in Bio-Social Context,”the authors stress that biomedicine’s conceptualization of disease as objective, clinically identifiable and as a bounda- ble entity, is problematic. Instead, the authors support thecritical biocultural approach, which looks at understandingsof illness and how social, political, economic and environ-mental conditions affect health outcomes (2003, pg. 424).The research on which this article is based employs the cri-tical biocultural approach.Becker undertook a large-scale interview study in theBay area of California and finds that African Americansand Latinos without health insurance delay seeking care because of cost, do without medications, have negativeviews of safety net health care, and experience discrimina-tion (2004). She details the effects of being uninsured onhealth: the uninsured have a higher risk of premature death,are more likely to be diagnosed in late stages of cancer, andthose who have been hospitalized for heart attacks are morethan twenty-five percent more likely to die while in the hos- pital (2004, pg. 259). Becker adds that those who are unin-sured are more likely to delay health care because of cost, be it unmedicated or undermedicated, and are more likely tofeel discriminated against because of being uninsured(2004, pg. 262).Sered and Fernandopulle show how, and how often, people “fall through the cracks” of the U.S. health care sys-tem (2005). The authors explain that race is related to thelikelihood that an American is insured, citing that 35.7 per-cent of Hispanics, 20.8 percent of black Americans, and14.5 of white Americans are uninsured (2005, pg. 157). Ad-dressing the Hispanic community specifically, Sered andFernandopulle note that 37 percent of Hispanic men die pre-maturely compared to 21 percent of white men. They sug-gest that access to good health care could reduce many ra-cial disparities in health outcomes in the United States(2005, pg. 158).
 Latinos and Health Care in Washington, D.C.
In an early study, Cohen (1979) addressed health is-sues among Latino immigrants in Washington, D.C., sug-gesting that poverty-related stress among her participantswas minimized by strong cultural mechanisms of emotionaland behavioral control. Her research found that settlers du-ring the early stage of entry to the United States were athigh risk of suffering from health problems compared tothose who were well-established immigrants (pg. 271). Inline with this article’s findings, Cohen states that after stud-ying the Hispanic community in Washington, D.C., the lack of insurance coverage results in individuals making fewer visits to the physician (pg. 278). Cohen’s observation fromthe 1970s holds true today, more than three decades later.Using an approach that combines linguistic anthropo-logy, cultural geography and urban anthropology, Modan(2006) discusses how members of the multi-ethnic MountPleasant community use language to legitimize themselvesas community members and to discredit others. In studyingthe neighborhood, Modan observes the role of filth, both
Claire F. Selsky.
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Anthropology & Health Journal - AHJ. No. 1 7-15 (2008)
ID: ahj000001 -
http://www.ahj.syllabapress.com/issues/ahj00001.html 

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