Anthropology & Health Journal - AHJ. No.

1 7-15 (2008)
ID: ahj000001 - http://www.ahj.syllabapress.com/issues/ahj00001.html

“Just Because You Don’t Have Papers, Doesn’t

Mean You Won’t Get Sick”
Health Care Experiences of Latinos in Mount Plea-
sant, Washington, D.C.

Claire F. Selsky, M.A.

Independent Researcher. M.A., Latin American Studies, The George Washington University.

ABSTRACT 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 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.

RESUMEN Hoy en día, hay aproximadamente 45,000 inmigrantes latinoamericanos viviendo en Washington, D.C. La
gran 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 el
desplazamiento; la separación familiar; la falta de acceso a atención médica o la percepción de aquella falta; y los
obstáculos 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 esta
comunidad. La conclusión del artículo presenta sugerencias sobre lo que pueden hacer los proveedores de salud y
miembros de la comunidad para mejorar las experiencias y resultados para inmigrantes latinos. Copyright © 2008
Anthropology & Heath Journal & Syllaba Press. All rights reserved.

Palabras claves: Latino, Salud, Washington D.C., Antropología Médica.

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 from
Latin 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,
Correspondense to: Claire F. Selsky. M.A., Latin American Studies. The George
Washington University 1923 35th Place NW Apt. 4, Washington, D.C. 20007,
USA. Email address: CFS25@Georgetown.edu
wealthy and poor. Those who come illegally, speak no or
little English, and have little income and savings, often find
themselves without access to health care. The health care
needs and experiences of Latinos, the major ethnic group
within 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

Received: 25 July 2008 / Accepted: 15 September 2008 / Published Online: 30 October 2008
2011-5776 /$ - see font matter. Copyright © 2008 Anthropology & Heath Journal & Syllaba Press. All rights reserved.
 8 “Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”

Table 1. The Eighteen Latino Immigrant Research Participants and Summary Findings about Their Health Care Access

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 my
findings and suggest ways to ameliorate health care expe-
riences of Latinos in Washington, D.C.
Literature Review
This literature review discusses anthropological and
related research applicable to this article. The section first
discusses literature on Latinos and health care in the United
States and then provides a more focused look at Latinos and
health care in Washington, D.C.
Latinos and Health Care in the United States
A growing body of research in cultural anthropology
addresses 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 Fernandopulle
2005). Other social scientists have studied immigrants in
the U.S. generally (Cohen 1979) and more specifically, in
Washington, D.C. (Modan 2006).

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Claire F. Selsky.
Urban sociologists A. and S. Greer document that
race and income levels are strongly correlated with health
status and the utilization of and access to services in their
edited volume (1983). Compared to higher income or White
families, members of the Black community and low-income
families report more restricted activity and disability days
and report chronic activity limitation and describe their
health statuses as poor or fair (McKinley et al. in Greer and
Greer, 1983, pg. 126). McKinley cites four reasons for the
discrepancy in health among races and socioeconomic le-
vels: inequality of access; the welfare/insurance scheme
causing people to fall through gaps in coverage, leading to a
two-class system of health care; focus on equality of access
rather 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 are
relevant 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 hurts
the poor. As Farmer notes, biotech and pharmaceutical
firms make amazing discoveries, but lean heavily on public
funding and make a great deal of private profit. He explains
today’s medical system as a system in which health is a
commodity and doctors conduct “commercial transactions”
with patients (2003, pg. 162). Farmer’s analysis of the U.S.
health care system provides a foundation for understanding
the frustrations of those who do not have the money, most
often the poor and the uninsured, to purchase the commodi-
ty of health.
Singer (2004) and Singer and Clair (2003) discuss the
correlation between socioeconomic class and health/health
care access. In his article, “Why Is It Easier to Get Drugs
than 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 treatment
remains a challenge for drug users who want to overcome
their 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 than
on preventing and treating addiction.
In Singer and Clair’s article “Syndemics and Public
Health: 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 the
critical biocultural approach, which looks at understandings
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9
of 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 the
Bay area of California and finds that African Americans
and Latinos without health insurance delay seeking care
because of cost, do without medications, have negative
views of safety net health care, and experience discrimina-
tion (2004). She details the effects of being uninsured on
health: the uninsured have a higher risk of premature death,
are more likely to be diagnosed in late stages of cancer, and
those who have been hospitalized for heart attacks are more
than 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 to
feel 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 the
likelihood that an American is insured, citing that 35.7 per-
cent of Hispanics, 20.8 percent of black Americans, and
14.5 of white Americans are uninsured (2005, pg. 157). Ad-
dressing the Hispanic community specifically, Sered and
Fernandopulle 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 participants
was minimized by strong cultural mechanisms of emotional
and behavioral control. Her research found that settlers du-
ring the early stage of entry to the United States were at
high risk of suffering from health problems compared to
those who were well-established immigrants (pg. 271). In
line 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 from
the 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 Mount
Pleasant community use language to legitimize themselves
as community members and to discredit others. In studying
the neighborhood, Modan observes the role of filth, both
10
actual and symbolic. She notes that debilitating infectious
diseases are able to flourish in areas with poor sanitation.
This spread of infectious diseases happens especially in
densely populated areas where pathogens with short life-
spans are able to find new hosts before they die (pg. 142).
Living in an area like Mount Pleasant as an immigrant often
guarantees close quarters and old buildings. Consideration
of this aspect of immigrant city living is important in un-
derstanding one reason that sickness is more likely to spread
in an area like Mount Pleasant than somewhere that is spar-
sely populated, with new buildings and excellent sanitation.
Research Methods
Research on the Neighborhood
In doing background research on the neighborhood of
Mount Pleasant, I consulted materials available in the libra-
ry such as books, encyclopedia articles, and news articles.
In order to gain a more personalized understanding of
neighborhood of Mount Pleasant, I contacted various neigh-
borhood organizations. Finally, having lived near Mount
Pleasant and having worked in Mount Pleasant as an ESL
teacher for over a year, I observed everyday life in the
neighborhood and met several Latino residents informally.
Research with the Immigrants
As a former adult ESL teacher in Mount Pleasant,
Washington, D.C., I was fortunate to have a connection
with Latino students at the school. In May of 2007, I provi-
ded approximately 30 students at the school with a verbal
explanation of my project, followed by a form asking them
to indicate their interest in participating in my thesis re-
search. In all, I interviewed eighteen adults who lived in or
near Mount Pleasant during the summer and fall of 2007.
I conducted most of the interviews at the school whe-
re I taught in Mount Pleasant. I used a list of guided ques-
tions to facilitate comparing and contrasting immigrant sto-
ries. All interviews with immigrants were conducted in
their native language, Spanish. Quotations in this article are
translations from Spanish to English by the author. All of
the names of individuals included in this article are invented
to preserve their anonymity.
Research with the Health Care Providers
From December 2007 to April 2008, I conducted in-
terviews with health care providers. I contacted the provi-
ders by e-mail explaining my research project and asking if
they would be willing to be interviewed. I interviewed two
health care providers at their clinics.
“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”
Voices of the Immigrants
Common Themes
Of the eighteen immigrants I interviewed, fourteen
had come illegally, and only half had ever visited a doctor
or hospital in the United States. Eleven of those interviewed
experienced separation from their immediate family mem-
bers (spouse or child(ren)) for periods of many years at a
time. Those who shared their opinions on the current health
system often expressed satisfaction with services rendered,
but an inability to pay out of pocket health service costs.
Below are the stories of four immigrants that illustrate the
role of citizenship status and the common themes of displa-
cement, family separation, acculturation issues and lack of
access to health care or lack of access to funds for health
care.
Immigrant Stories
Legal Immigration and Health Insurance. Sofia is a
Dominican who has lived in the United States for nineteen
years. She came with an official work visa. She says that “I
am a person who is very popular among people with money,
so I work for these people, I know these people…when I
decided to go, I only had to talk to someone who already
knew me well…” She worked in people’s homes taking
care of their children and cooking. Today, Sofia is 67 years
old.
Sofia left two children in the Dominican Republic
when she decided to come to the United States. Today they
are 46 and 47, and Sofia speaks with them both regularly.
Sofia’s mother raised her children in the Dominican Repu-
blic.
When Sofia needs to go to the doctor, she goes. She
has never needed to go to the hospital. She is a resident now
and has health insurance. She says the only medicine she
uses regularly at home is Advil. She says she goes for
check-ups, “every year… or every four years…” Sofia
thinks that she could improve her health by “eating a lot,
exercising a lot and drinking a lot of water.” She feels safe
where she lives and walks a lot. “If God allows it,” she
would like to stay in her current apartment in the years to
come.
Having come to the United States legally, Sofia has
been able to secure work and health insurance. Because of
having health insurance, she does not hesitate to visit a doc-
tor when she does not feel well. She is an example of a le-
gal immigrant who takes advantage of United States go-
vernment programs and benefits.
Like Sofia, Teresa came to the United Status legally.
Teresa is from Mexico City, Mexico. She came to the Uni-
ted States in 1959 and is 80 years old. She came to the Uni-
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Claire F. Selsky.
ted States, contracted by diplomats to be a caregiver for
their children. After a year, she felt she had paid the debt
owed to the “señores” who paid for her flight and her paper-
work. She says that, “I, by myself, became a resident.” She
thought about returning to Mexico, but did not because she
did not have enough money and her son had already been
born in the United States. She raised her son with her son’s
father, though the couple separated once the child had
grown up.
Teresa’s apartment is paid for by the United States
government. She says that the government pays her rent,
which is costly. Before, there were rats and cockroaches in
her apartment, but now, the walls have been painted, it has
been renovated, and her apartment is clean. Teresa’s son
lives in Gaithersburg and wants her to go live with him, but
Teresa prefers to live alone. At age eighty, Teresa still
works in Washington. She takes the bus on 14th street or on
16th street, and travels to 14th and U Street, NW. There, she
cleans offices.
Teresa has visited many doctors and hospitals in the
United States. She had an operation on her heart because
she was having difficulty breathing. Her doctor spoke Spa-
nish. Her private health insurance covered much of the cost.
Because she is now a citizen, she also receives Medicare.
She says that her experiences with health insurance compa-
nies in the United States have been positive.
Teresa considers herself to be in good health because
she is working. If she was sick, she says, she would not be
able to work. She likes where she lives because it is near her
clinic, but does not feel safe in the area. She says that her
building used to be run by a young man who allowed
drunks and drug users into the building. They used to smoke
there, she says. Today, however, the building is better, be-
cause there is a new owner and the apartments have been
remodeled.
Teresa is an example of a Latina who has been able to
care for her health in the United States. She has been gran-
ted citizenship and has both private and public health insu-
rance. She has had operations on her heart as well as cata-
ract surgery. She was able to have these surgeries because
her health insurance covered most of the cost. She has led
an active life and continues to lead an active today.
Illegal Immigration and Health Insurance. Julia came
to the United States four years ago from a town in El Salva-
dor. She traveled by herself to her cousin’s home. Today, at
age 35, she lives in an apartment with two other adults in
Washington, D.C. She has a daughter in El Salvador who is
ten years old. She has one job, which she says might be
considered good, but “to live better, it would be better to
have two jobs.” She cleans in a restaurant.
Julia has been to a doctor in the United States. She
says she would only go to a doctor if her insurance covers
it. She went to the hospital once when her building was
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11
fumigated because she inhaled the fumes and had an aller-
gic reaction. At the hospital, someone was called to transla-
te. However, she said that “there are always problems [with
communicating], the appointment takes longer because the-
re is not always someone [available] to translate what is
said.” Luckily, she had health insurance at the time.
A friend told her about health insurance and how to
apply. She had to give proof of residency and her checking
information, but was not asked about her citizenship status.
She says she only had to sign up for the card and now, her
health care is completely paid for at the doctor. After sig-
ning up, she had her health insurance card within two
weeks.
While Julia is living in the United States illegally, she
says she only needs an ID at the hospital, not proof of citi-
zenship. There, she shows her passport and gives her health
insurance information. She says they do not ask her for her
social security number. She has no social security number,
legally or illegally. Having visited doctors in the United
States for check-ups, Julia knows she has high cholesterol.
Because of this, she now does exercise and has changed her
cooking habits. She uses olive oil now when cooking, pre-
pares food without fat, butter and cholesterol, and no longer
eats sour cream. She is happy living in her home where she
is near her workplace.
Julia was met with some medical difficulties, but be-
cause she secured health insurance, she was able to overco-
me them; her health experiences have been mostly positive
because of this. Word of mouth allowed her to figure out
how to go about obtaining health insurance, which in her
case, seems to have been helpful in covering medical ex-
penses.
Illegal Immigration and No Health Insurance. Ra-
fael came to the United States three years ago from El Sal-
vador. Today, he is 25 years old. He traveled through the
desert with a group made up of people from El Salvador,
Belize, Honduras and Mexico. He came alone. He is not
married and has no children. Rafael says that his current
economic situation is ok, “más o menos.” He lays bricks
for a living.
Rafael shares that when he needed to visit the hospi-
tal, he chose not to go. He did not go because it is “too ex-
pensive” and because “we don’t have insurance.” He wo-
rries about the documents that he might be asked to provide
at the doctor’s office or at the hospital. He imagines he will
be charged double what others, who have insurance, are
charged. In an emergency situation, he would go to the hos-
pital, but “not happily.”
Rafael was injured at work and “needed to go to the
doctor, but could not go because [he] does not have insuran-
ce, and if he goes to the doctor, [he] imagines they will
charge maybe ten thousand dollars, an amount [he] does not
have in hand.” His back was hurting after taking down scaf-
12
folding at work. He almost could not walk, but, “well, [he]
had to work.” His job does not cover health care.
Rafael does not feel safe in the Columbia Heights
area where he lives. He says that “always down there, there
are always problems, like, a little while ago, a friend of mi-
ne was beaten up… some Blacks beat him up…they robbed
him, they beat him up, and then further up [the street], they
beat up another guy. It is not safe after ten at night.” He
feels the same about neighboring Mount Pleasant, because
there, “they beat up a guy at eleven at night.” He’d like to
change where he lives, but says that “if you are not a resi-
dent, you don’t have papers, it is quite difficult to get an
apartment.” He currently lives in an apartment where he
pays rent, but has signed no documents or contracts.
Rafael does not know if he is in good health because
while he knows he needs to have a check-up, “a check-up is
a little expensive.” He says he will have a check-up when
“there is insurance for everyone.” When asked about his
own health situation, Rafael said, “I think they should give
insurance to people that don’t have papers. Just because
you don’t have papers, doesn’t mean you won’t get sick.
And if we work in this country, it is to improve our situa-
tion, and through us, they [U.S. citizens] improve the situa-
tion here in the United States.”
When asked why he did not go to the hospital alt-
hough he needed to do so, Rafael responded that “we don’t
have insurance.” He responded with “we” when asked
about his personal health situation as well. This phrasing is
striking because when Rafael used the pronoun “we,” he
linguistically extended his experience to his fellow Latino
immigrants.
Voices of the Providers
The Neighborhood Dentist
One bilingual, bicultural dentist works on Mount
Pleasant Street. Dr. Rodriguez has owned his own practice
in Mount Pleasant for eighteen years. He estimates that 60
to 70 percent of his patients are Hispanic. The dentist and
his staff are fluent in both English and Spanish, so there are
few language barriers. Dr. Rodriguez has the HIPAA laws
translated into Spanish for patients to read and sign, if they
cannot understand the English version.
At the office, patients often complain of a lack of pro-
per dental insurance coverage. In fact, Dr. Rodriguez esti-
mates that only about 60 percent of his patients have dental
coverage. They also speak of the high cost of life in the DC
area and time limitations that affect their ability to care for
their teeth. These are the most common reasons patients
share with the dentist for not addressing their oral health
care issues.
After working in the community for many years, Dr.
Rodriguez has noted a correlation between immigrant
“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”
knowledge about dental health and socio-economic status.
He states that: Those who are well educated that had access
to a better economic life back in their native countries gene-
rally have a better understanding of oral health care due to
better access to dental care. However, those in the low or
middle income bracket for the most part, exhibit less un-
derstanding of the preventive aspects of dental health due to
the lack of access which is greatly related to their limited
financial situation (Dr. Rodriguez, personal communication,
January 31, 2008).
Dr. Rodriguez’ experience has showed that those who
can afford to pay for dental care, or have dental insurance
coverage, are most likely to practice prevention by schedu-
ling regular check ups.
According to the neighborhood dentist, investing time
and money on preventative health care to prevent disease is
the greatest challenge the immigrant population faces. Over-
coming this barrier means having a change in consciousness
which in most cases requires a change in lifestyle. For this
reason, Dr. Rodriguez believes that educating patients about
preventative care is extremely important.
Dr. Rodriguez hopes to change local policy so that
dentists who study outside of the country can practice in the
United States, using a model much like the international
physician model, in which the doctor studies elsewhere but
passes a qualification exam in the United States. In this
way, more Hispanic dentists would be able to practice in the
United States and cater to this growing community.
The Neighborhood Clinic
A bilingual clinic is situated near Mount Pleasant.
There, patients can meet with bilingual staff and doctors
and expect to be met with cultural understanding and fair
costs. While services are on a sliding fee, “no one would be
turned away if they can’t pay, and actually the payment
happens after the service, so they can just walk out the door
after if they want to, but most people do want to contribute,
they want to feel like this isn’t just a hand-out” (Cristina,
personal communication, March 29, 2008).
The clinic has become a gathering place for the com-
munity, where individuals and families seek treatments for
general medical issues as well as mental health issues. After
meeting with Cristina, a development staff member at the
neighborhood clinic, it was clear how important this clinic
is for the members of the community. Staff at the clinic
have found that:
[The clinic] is a first step for folks as they engage after finding
jobs and a safe place to live. Even though coming to the doctor isn´t ne-
cessarily where they want to come, they come [here] because we have a
reputation as a community center, as a safe haven, as a place for informa-
tion (personal communication, March 29, 2008).
Generally, patients come to the clinic due to symp-
toms of illness or because they have a requirement to meet,
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Claire F. Selsky.
such as needing a vaccine in order to attend public school.
However, once patients have visited the clinic for the first
time, what usually brings them back are a variety of chronic
diseases such as diabetes, hypertension, obesity related di-
seases and cardiovascular related diseases.
Diabetes is a grave problem that health providers at
the clinic often see. In fact, they see it disproportionately to
the general population. Cristina explained that “Latinos, in
general, have higher rates of diabetes than other immigrant
groups or other ethnic groups. And in this area, in particu-
lar, in immigrant Latinos, we´re seeing Type II Diabetes in
extraordinary volumes” (personal communication, March
29, 2008). What this means for patients is an emphasis on
lifestyle change, such as diet and exercise, to help control
the disease. Because of the high rate of diabetes in people
who come to the clinic, health providers work hard to try to
teach patients how to cook traditional foods in healthier
ways, like replacing lard with olive oil (Cristina, personal
communication, March 29, 2008).
In terms of mental health, the vast majority of pa-
tients who come to the clinic are diagnosed with Post Trau-
matic Stress Disorder. For Central Americans, this affliction
is often rooted in the political violent crises of the 1970s
and 1980s. Furthermore, the immigrant experience itself
can be traumatic. As Cristina states:
If you come illegally, crossing the border is extremely dangerous,
a lot of women get sexually victimized, there are a lot of families that get
split apart. What we see a lot is the mom or dad will come here first,
leave the kids at home with Grandma, and five years later when it’s fina-
lly stable enough to send for the kids, the kids don’t recognize their mot-
her, they learn English faster, and there [is] cultural dislocation. If you
were ten when your neighborhood was burned to the ground by govern-
ment troops, you’re not going to be dealing well and you’re not going to
be able to teach your children to deal well. So we deal with a lot of de-
pression and substance abuse (personal communication. March 29,
2008).
According to reports from the health care providers at
the clinic, most often, patients who come for substance abu-
se treatment are addicted to alcohol. At the clinic, health
providers use a mental health model in which patients are
dually diagnosed. The idea of dual diagnosis for treatment
addiction allows for all behavioral health and addictions
needs to be addressed in one setting and for varying mental
health needs to be seen as related (Foundations Associates,
2007). For example, excess drinking could be due to depres-
sion and/or an anxiety disorder (Cristina, personal commu-
nication. March 29, 2008).
At the neighborhood clinic, health providers aim to
provide “culturally appropriate health care.” This approach
“means not just speaking someone’s language, but unders-
tanding where they come from, where they are and where
they’re going. Their whole socio-economic status and their
historical context informs [the] type of care”(Cristina, per-
sonal communication, March 29, 2008).
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13
Many patients who come to the clinic are not familiar
with Western biomedicine. In fact:
Patients, before coming to the clinic, if they were lucky, they’ve
seen a doctor once in their lives, and that’s when they were born, and
maybe when they were giving birth, if they gave birth prior to coming
here, if they were lucky. If they were to stay in their home country, if they
were lucky, [they saw a doctor] when they died. And all the other times,
when they were sick, they take care of themselves in a number of ways.
They see a huesero, or curandero, or hiervero or take a certain tea that
grandmother says [to] take, or go to a local pharmacy and prescribe
[oneself] something (personal communication, March 29, 2008).
For the provider, it is crucial to understand that many
Latino immigrant patients are not familiar with the medical
setting, and they may associate it with emergencies such as
birth and death. They also may not understand how pres-
criptions are filled in the United States. Finally, they may be
used to taking herbal remedies or seeing non-medical com-
munity leaders for health guidance.
Latino culture teaches patients never to question a
doctor. For many Latinos, when viewing a doctor, “he’s
god, she’s god” (personal communication, March 29, 2008).
What this means is that even if a patient does not unders-
tand directions given by a doctor, he or she may nod, keep
quiet and leave the office confused. For this reason, provi-
ders at the clinic, as one provider commented, “need to
know… how to break down those barriers.” One scenario
provided by the staff member is the following:
[Providers] need to understand that a patient might be taking an
herbal remedy and feel like the doctor might think that’s backward, and
so they don’t disclose it, but then the herbal remedy might contraindicate
with the blood pressure medicine that the doctor’s prescribing. If the
provider doesn’t ask the right questions, those things won’t come to light
and the patient could even get sicker and say, oh this medicine isn’t wor-
king, I’m never going to going to back to this doctor again (Cristina,
personal communication, March 29, 2008).
Providers need to ask questions about use of herbal
remedies in a way that patients would feel comfortable to
share such information.
Below is another example of providing culturally
competent health care to the Latino immigrant:
After September 11, people came to the clinic because it was a
place where they felt safe. Our mental health program swung into action
and they started doing these support groups… But in the course of coun-
seling with this one woman who was from El Salvador, she said, I can’t
escape this feeling like I want to go on my roof. I want to go on my roof.
That’s the only place I would feel safe. And if you were not familiar with
what happened in El Salvador you would say, [the] twin towers fell down
because an airplane flew into them, and this person wants to feel safe on
her roof? This makes no sense. But our counselor, who was from El Sal-
vador, knew that in small villages all the military troops would come on
foot, so that place that you would hide to be safe was on your roof. And
so she was able to interpret the cultural context of this woman’s anxieties
and fears and interpret what those meant in a new context and work with
her through that (personal communication, March 29, 2008).
This example shows that, although immigrants are
living in the United States, their previous experiences in
their home countries often affect their health experiences in
their new location. For this reason, it is essential that health
care providers understand their patients’ backgrounds.
14
A final example of cultural appropriateness shows the
role of one’s socioeconomic status in procuring treatment:
If somebody should take blood pressure medicine and the latest
blood pressure medicine is exactly the right one for them, and it costs 30
bucks a pill, the doctor could prescribe it, but the patient won’t get it.
And if the doctor doesn’t understand the patient’s socioeconomic situa-
tion, the doctor’s going to think, this patient is noncompliant. There’s this
judgment that happens in medicine where you intake the patient, you
diagnose the patient, and then you give them guidance, and if they don’t
follow your guidance, then something’s wrong with them. And it isn’t,
what is their situation that is not allowing them to following your guidan-
ce?… it’s, they’re bad. Or they’re just stubborn. They don’t listen... Pro-
viders have to do a lot more investigating, could you pay for a twenty
dollar pill remedy, or is there a combination of two others medicines that
costs ten dollars that works just about as well? You have to be creative so
that the patient actually could comply with the recommendation. And
that means knowing what is [his] living condition, that means knowing
how many people [he is] supporting, what [is his] insurance situation,
and really understanding where [he’s] coming from and where [he is]
right now (Cristina, personal communication, March 29, 2008).
As this scenario demonstrates, simply diagnosing a
patient and writing a prescription is often not enough to en-
sure positive health outcomes for Latino immigrants. Ins-
tead, cultural understanding as well as attention to socioeco-
nomic status is required in order to provide patients with
treatment regimens with which they could comply.
The neighborhood clinic is of great value to local re-
sidents, for both their physical and mental health. The Lati-
no immigrants of Washington, D.C. are fortunate to have a
place that understands their backgrounds and their current
living situations and aspires to help them improve their fu-
ture health outcomes.
Conclusions and Looking Ahead
The recurring theme among those who came to the
United States illegally is a lack of access, or perceived lack
of access, to health care, due to social and economic ba-
rriers. While some expressed a lack of knowledge about
how to acquire health care, others thought that their illegal
status prohibited them from acquiring it. Many immigrants
noted the high cost of medicines and medical care, inclu-
ding those with health insurance.
More than half of the immigrants who I interviewed
left a spouse or child behind in their home countries. In ad-
dition, many immigrants came from countries that experien-
ced horrific civil wars in the 1970s and 1980s (Guatemala,
El Salvador). Finally, the immigrant experience itself is
cause for negative health outcomes, both mentally and phy-
sically. It is probable that many of the Latino immigrants I
interviewed might benefit from support groups, counseling,
regular check-ups and nutritional counseling.
Both the dentist and the clinic representative discus-
sed health related issues common to Mount Pleasant’s Lati-
no immigrant population. Both outlined how culture affects
understanding of one’s health and the importance of fami-
“Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”
liarity with Latino culture when treating a Latino patient. In
addition, both providers stressed the role that economic
class plays in Latino health care experiences, as it correlates
with level of health knowledge and ability to acquire health
services.
Latinos in the Washington, D.C. area are eager to
share their experiences and their frustrations with the health
care system. Employed by U.S. citizens, these immigrants
are often unknowledgeable about their health rights. Other
immigrants forego care due to economic constraints. Some
know about health insurance but do not know how to acqui-
re it. Others are not accustomed to regular medical visits
and seek care only in emergency situations.
While immigration is a highly debated policy topic
today, Latino immigrants that are here today have demons-
trated a pressing need for health care and health informa-
tion. As Rafael said, “just because you don’t have papers,
doesn’t mean you won’t get sick.” Health services nation-
wide must take the special needs of Latino immigrants into
account.
Educating Latinos must be a priority in health care.
Basic health education is especially needed in the areas of
sexual health and nutrition. In terms of access, this group
needs bilingual, culturally appropriate information on obtai-
ning health services in Washington, D.C. and on how to
acquire health insurance.
It is our duty as health providers, researchers and
community members, to support organizations and provi-
ders that cater to educating and providing health services to
Latino immigrants in Washington, D.C. Only when we take
into consideration cultural, socioeconomic and biological
determinants of Latino immigrant health, can we begin to
create positive health outcomes for this underserved popula-
tion.
Acknowledgments
I am deeply grateful to my research participants for
their generosity in giving me their stories to share in this
article.
I am also grateful to the Lewis N. Cotlow fund of the
Department of Anthropology at the George Washington
University for funding my research.
Finally, I thank my M.A. thesis director, Professor
Barbara Miller, for introducing me to medical anthropology.
Her guidance was of great value to me during the research
and writing of this article. I also extend thanks to Professor
Catherine Allen for her support.
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Claire F. Selsky. 15

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