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LATINO USA

THE CLINIC

MARIA HINOJOSA, HOST: Dear listener, for this episode of Latino USA
we are going to do something a little bit different. Now, normally when we
interview people who speak Spanish, we translate all of their interviews into
English. Today, we’re not going to translate any of the Spanish because we
wanted to preserve their voices and let them communicate their stories with
their own words.

So we’re going to ask you to listen even if you don’t understand every
single word. We think you’re going to get a lot from this story.

We should mention that parts of this story might be disturbing for some of
our listeners.

And if you’d like a transcript of everything translated, you can find it online
at latinousa.org.

Here’s the show.

DR MATILDE RIOS: Bueno, Señora Marta… ​[Well, Mrs. Marta…]

SOPHIA PALIZA-CARRE: In a health clinic in Chicago, Marta Flores is


receiving some news.

DR RIOS: Yo le mandé a buscar se acuerda? Para que le hicieran un


test… ​[I sent someone to look for you so you could get a test done,
remember?]

SOPHIA: Her doctor walks into the exam room. And she barely closes the
door, before she gets right to it.

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DR RIOS: ...Porque cuando le hicieron el test de la sangre su azúcar
estaba alta. ​[Because when they did your blood test your sugar levels were
high.]

MARTA FLORES: Oooh.

DR RIOS: Tranquila. tranquila. Entonces quise comprobarlo. Y le salió un


poquito alto. ​[Easy, easy. I wanted to confirm the results and they are a bit
high indeed.]

MARTA: Oooh.

DR RIOS: Si. Le salió. ​[Yes. They are.]

SOPHIA: Marta is clearly taken aback. The doctor tells her the high blood
sugar means something else for Marta.

DR RIOS: Entonces con este test tenemos diagnóstico de diabetes. ​[So


with this test we have a diagnosis of diabetes.]

DR RIOS: Es un diagnóstico nuevo para usted. ​[It’s a new diagnosis for


you.]

MARTA: Tengo diabetes? ​[I have diabetes?]

DR RIOS: Si. si si, tiene diabetes, si. ​[Yes, yes. You do, yes.]

MARTA: Oy.

(PAUSE)

MARTA: Y se puede borrar? ​[And can one get rid of it?]

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DR RIOS: Nunca se borra, perro se controla. ​[You can’t get rid of it, but it
can be controlled.]

MARTA: (hisses)

This is a new diagnosis for Marta, but she’s been coming to this clinic for
10 years. She is 66 years old and she’s originally from El Salvador.

Marta doesn’t say much or ask many questions after she hears she has
diabetes. But after the physical exam, she seems to get less calm.

(sound of Marta breathing for the doctor)

DR RIOS: Pregúnteme todo lo que quiera.​ ​[Ask me anything you want.]

MARTA: Bueno, lo que yo le estoy escuchando doctora...es que me está


complicando. Porque más pastillas, más pastillas. Y la diabetes y todo esto
viene a repercutir cuando ya estoy viejita. ​[Well, what I am hearing from
you Dr… is that it’s getting complicated for me. Because I need more and
more pills. Now the diabetes. And all of this goes down when I am getting
older.] ​(Slams hands down)

DR RIOS: Bueno, con los años… ​[Well, as the years pass by...]

MARTA: Me da...como que me da nervios. ​[It makes me… it makes me


nervous] (​ voice cracks)

DR RIOS: Bueno, con los años a todos nosotros nos pasa. Hay más
enfermedades con los años, con la edad. Eso es así. ​[Well, it happens to
all of us as the years pass by. More illnesses come with time, with old age.
It’s like that.]

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Marta is also worried about what her daughter will say when she hears
about her diagnosis.

MARTA: Problema que voy a tener con mi hija. ​[I am gonna have a
problem with my daughter.]

DR RIOS: Por qué? ​[Why?]

MARTA: A veces me agarraba un poquito de jugo de naranja y le echaba


hielo, nada menos que anoche. Oy bien rico. Y dijo mi hija: no esté
tomando jugo de naranja que eso tiene mucho dulce. ​[Sometimes I get a
bit of orange juice and throw ice on it, like last night. Oof so good. And my
daughter would tell me: don’t be drinking that because it has too much
sugar.]

SOPHIA: Diabetes can be genetic but it can also be brought on by


diet—especially sugary drinks.

MARTA: Agua no me gusta ni porque tenemos agua allí buena de bote. No


me gusta el agua. Yo siento que me pone el estomago asi bien feo el
agua! ​[I don’t like water. And we have good, bottled water but I don’t like it.
It makes my stomach feel weird!]

SOPHIA: Marta says that when she sits down to eat she forgets all about
what the doctors tell her she should be eating.

MARTA: Mire, a mi me gusta en la mañana un huevito picadito así con


cebolla y una rodajita de pan. ​[Look, in the mornings I like to have a
chopped egg with onions and a slice of bread.]

SOPHIA: Then, Marta begins to list to me all of her favorite foods.

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MARTA: Me gusta la avena también. La banana… yo soy fanática de la
banana. Incluso tengo una mire, por si me da hambre! ​[I like oatmeal too.
And bananas… I am a banana fanatic. I even have one with me right now,
look! In case I get hungry.]

SOPHIA: She opens her purse and shows me the banana she has stashed
there.

MARTA: O por si paso por allí, un pedacito de pan (laughs). Pero es malo
por la diabetes, el pan y la banana... ​[And if I can, I’ll bring a slice of bread
too (laughs). But they’re bad for diabetes, bread and bananas...]

SOPHIA: I want to hear more about her banana fanaticism, but we are
interrupted by her cell phone buzzing...

MARTA (phone): Me está llamando mi hija quizás…. Aló, Lidis? ​[My


daughter is calling me I think… Hello, Lidis?]

SOPHIA: It’s Marta’s daughter calling to see when she can pick her up.
And Marta gives her the news.

MARTA: Sabes, hay malas noticias...Tengo diabetes. ​[You know, there is


some bad news… I’ve got diabetes.]

LIDIS: Ayayay

(THEME SONG)

MARIA: From NPR and Futuro Media—This is Latino USA. I’m Maria
Hinojosa. Today: Latino USA is a fly on the wall at the largest free health
clinic in the country. We hear the intimate conversations people have at the
doctor’s office.

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(THEME SONG OUT)

MARIA: Going to see the doctor is almost always a stressful and vulnerable
experience. It’s a place where anxieties about your body and your life are
super heightened, and where everything can change with just a few words
from your doctor.

Undocumented people generally can’t access insurance and so their


healthcare options are very limited.

But one of the places they can go are free health clinics.

Free clinics have only been around in the United States starting in the
1960s and 70s. They were places that popped up to deal with the growing
number of young people who were runaways or insured or addicted to
drugs.

(NEWS CLIP:​ ​What’s a free clinic? It’s where our growing up children go for
help when they can’t or won’t come home.​)

MARIA: The first one was the Haight Ashbury Free Clinic, which came to
be after a flood of young people ended up in San Francisco for the summer
of love.

(NEWS CLIP: ​Dentists, doctors, lawyers and other professionals are here
as volunteers… they treat all the embarrassing ailments of the youngsters.
Venereal disease, drug complaints, hepatitis from shooting drugs from dirty
needles, pregnancy problems. Here, for example, was developed that form
of teenage group therapy where the kids just “talk out” their emotions.)​

MARIA: Today, there are 28 million uninsured people in the United States,
and free clinics can often be their only safety net.

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We are going to spend time in one of those clinics — in fact, it’s the largest
free health clinic in the United States. It’s called CommunityHealth in
Chicago. And it only serves people who don’t have health insurance.

Now, it’s almost impossible for journalists to get behind the scenes’ access
to medical centers because there are a lot of laws —and rightly so— that
protect patients’ privacy.

So when CommunityHealth in Chicago told us they would give us full


access to their facilities, we saw this as a rare opportunity to observe the
daily dramas that unfold there. We spent 3 days sitting in on doctors’
exams, and talking to patients and staff.

And all of this to try to capture a snapshot of how undocumented life


manifests itself both physically and mentally.

Now, at the beginning of this show you heard producer Sophia


Paliza-Carre. This past summer she flew to Chicago along with producer
Antonia Cereijido. And Antonia is gonna take it from here.

GABRIEL: Entramos? [Should we go in?]

ANTONIA: Si! [Yes!]

(KEYS JANGLE)

ANTONIA: The clinic is located in Chicago’s Ukranian Village — a quiet


residential neighborhood. It takes Gabriel Dominguez half an hour by car to
get to the clinic every morning.

GABRIEL: Entonces lo que hago pues también da. Siempre es esto de la


seguridad. Parece sencillo pero definitivamente es muy importante. ​[So

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what I do also contributes. It’s always about security protocols. Seems
simple but it’s so important.]

ANTONIA: Gabriel is the custodian at CommunityHealth and he is in


charge of opening the clinic’s unassuming glass doors every day around 8
o’clock.

GABRIEL: Soy como el motor de aquí indirectamente, no? ​[I am like the
main engine here indirectly, right?]

ANTONIA: Gabriel has a kind face transition lenses and a lot of tools
hanging off of his belt loop.

GABRIEL: Soy como, tipo, vigilante, como tipo de todo aquí. [​I am like, a
bit of a security man, a bit of everything here.]

ANTONIA: He leads me inside the building and I thank him for letting me in.
But as soon as I start to leave in search of the front desk— he stops me.
He lets me know that he’s like me, he documents the world.

(sound of zumba music)

GABRIEL: Ya, entonces yo participo también. Ahorita yo no estoy ahí


porque yo estoy grabando, no? ​[So, I participate too. Right now I am not
there because I am recording, right?]

ANTONIA: He pulls up Facebook to show me videos he took of his zumba


classes. He even bought a stabilizer which makes the videos look very
professional.

ANTONIA: Sos el único hombre? [​Are you the only man in the class?]​

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GABRIEL: No, somos, a veces — hay más mujeres que hombres, si. [​No,
we’re sometimes — there are more women than men, yes. ​]

ANTONIA: Por qué los hombres no van? [​Why won’t men attend?​]

GABRIEL: Porque tienen pena. Piensan, “oh es que no se bailar bien.” No


se trata de eso, se trata de que te muevas y simplemente rompas las
barreras. Si de por sí es difícil la vida y encima te pones barreritas… peor.
[​Because they’re embarrassed. They think “oh, I don’t know how to dance
well.” But it’s not about that at all. It’s about moving yourself and just
breaking barriers. This life is hard as it is and then on top of that you put
little barriers… worse.​]

(MUSIC ENTERS)

ANTONIA: Over the next three days, we meet a lot of characters.

(MONTAGE OF ANTONIA AND SOPHIA GREETING PEOPLE)

ANTONIA: If you were to take a God’s eye view of the clinic while my fellow
producer Sophia and I spent time there, we would look like Pac-Man ​—
gliding around a maze of corridors, chasing patients.

And the patients’ path through this maze starts at the front desk.

(FRONT DESK PHONE RINGING)

ANTONIA: According to the front desk, Monday and Thursday mornings


are their busiest times.

DOLORES MENDEZ: No sé por qué pero son los días más ocupados. Los
pacientes llegan enfermos porque comieron mucho en el fin de semana
(laughs) y vienen a una consulta. [​I don’t know why but those are the

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busiest days. Patients arrive sick because they ate too much during the
weekend (laughs) and they come in for an appointment.​]

ANTONIA: This is Dolores Mendez. And her name could not be more
perfect for her position.

DOLORES: We were talking to a patient and he asked me what my name


​ hen you have pain,
was. He said “Oh I forgot”. And I said it’s very easy ​— w
think of me. That’s my name: Dolores.

ANTONIA: Overall, the clinic sees 8,500 patients year. To be able to get
care here, an individual patient must have no insurance and have an
annual salary of under $30,000. The clinic doesn’t treat kids because
Illinois provides healthcare to minors regardless of status.

Once a patient checks in, they sit in the skylit waiting room. Their names
are called out one by one.

Dolores: Jose Ingles, estación cuatro por favor. ​[Jose Ingles, station four
please]

ANTONIA: They take their vitals.

(AMBI: Yeah empty out those pockets we don’t want that showing up on
the scale…)

ANTONIA: And then the patients are led to their appointment. There are
neurologists, opthamologists, even a dentist who will extract your teeth
while you listen to calming retro jams.

(CLIP OF DENTIST WORKING WITH RADIO ON)

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ANTONIA: The exam rooms in the clinic are laid out in a u-shape. The
nucleus of the clinic is in the center of the U and it’s an open space with
computers and chairs where the doctors and staff hang out. Every morning
and afternoon, the staff gathers here for a briefing called “the huddle” which
Sophia caught on the first day.

(CLIP OF THE HUDDLE:...thanks guys. Very quick today.)

SOPHIA: The morning huddle is led by Emilia Pilch. She’s from Poland,
moved here 13 years ago.

EMILIA: You know, economy in Poland wasn’t that great ​— ​isn’t that great I
guess. So we just came here with my parents.

SOPHIA: The Chicago metropolitan area has the largest Polish community
in the United States. And the clinic reflects that. About a third of patients
are Polish speakers and that’s part of why we wanted to visit
CommunityHealth. Almost all of the patients we spoke to there were
immigrants.

Emilia briefs the doctors, but she also maintains this leader board at the
center of the clinic.

EMILIA: If a provider is really, really good at it, we give them a shoutout at


the huddle.

SOPHIA: It’s this whiteboard with names, like the highest score ranking in
an arcade game but all the names on it are residents. And instead of a
point total, the categories are things like:

EMILIA: “Diabetics with A1C less than 9%”

SOPHIA: Things us non-doctors wouldn’t understand.

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EMILIA: That means that their diabetes is well-ish controlled. Anything over
9%, very uncontrolled, so very high sugar right.

SOPHIA: And the residents are pretty into these rankings.

EMILIA: (laughs) It’s pretty competitive to be honest. Like it’s so tiny but
they always look for their names. Some of them have been there in there
for like you know 8-10 times, the same names. So they’re very like, you
know, we’re kind of — Ah! Dr. Rios you’re awesome.

SOPHIA: Dr. Matilde Rios interrupts Emilia as she scours the board for her
own name.

EMILIA: Yes, you are there. Well it’s for the residents only so, you know?

DR RIOS: Oh, it's only for the residents?

EMILIA: Yeah so you are off the hook.

SOPHIA: She’s the doctor who diagnosed Marta at the beginning of the
story.

(AMBI: You have to tell them the story!


Oh she’s told me, I’ve heard about the cats…)

SOPHIA: And… she’s often the center of attention. I am told I must hear
the story behind the name of her cat “Nacho”.

DR RIOS: Ok my grandson gave me a joke — what is the cheese that is


not yours? Nacho cheese. Na-cho-cheese. It’s a good one!

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SOPHIA: Dr. Rios has been a volunteer doctor at the clinic for 8 years and
so she has a special connection with many of her patients. Both Antonia
and I spent a lot of time with her and in her exam room. Between
appointments, Dr. Rios told Antonia a little more about herself.

DR. RIOS: Yo vengo a hablar contigo. [I come here to talk to you].

ANTONIA: Dr. Rios — like many of her patients — is an immigrant. She


came to the U.S. from Uruguay in the late 70s. At the time there was a
military dictatorship in power and the administration was targeting civilians
they believed to be part of a guerilla terrorist group.

DR. RIOS: They would also take you to jail because you had a family
member who was involved. They would take you too.

ANTONIA: And you were afraid?

DR RIOS: Yes, yes. We were. That’s why we emigrated.

ANTONIA: Her family moved to Chicago in 1983 and Dr. Rios started her
career in private practice. She worked for three decades and then decided
to retire. But — if you can’t tell — Dr. Rios has a lot of energy and so she
started to get restless. And one night, while she was googling at 2iam —
something she told me she actually does very frequently — she learned
about this clinic — CommunityHealth — and thought it was exactly the kind
of place she would like to volunteer at.

But when she first started coming, she didn’t exactly feel welcome.

DR RIOS: I didn’t know anybody and I saw all these professors from
Northwestern, Rush, walking talking and giving classes and I ask “what am
I doing here?”. Because I didn’t know anybody. I was going to quit — I felt
very uncomfortable.

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ANTONIA: But then she got a little encouragement.

DR RIOS: But someone from the front desk came and said “oh my god Dr.
Rios all the patients like you so much, they all want to come back to you!”
So I said ok, maybe I can do something good here.

ANTONIA: Matilde is retired. She doesn’t get paid to see patients. None of
the doctors do. It takes over 1,000 volunteers to keep CommunityHealth
running.

(MUSIC ENTERS)

SOPHIA: The way CommunityHealth runs is that all the doctors are
volunteers. Some are retired, but many are full-time doctors who spend a
few hours a month at the clinic.

And all of the prescriptions provided at CommunityHealth are free for


patients — even really expensive things like insulin. They even have their
own pharmacy.

CommunityHealth was founded in 1993 by an Italian immigrant. A kidney


doctor, he was concerned with the number of uninsured people in Chicago,
so he opened a storefront clinic that took patients twice a week. The
demand grew so much that in 2010, they even opened a second clinic to
serve more people. But then, in 2014, the Affordable Care Act went into
effect.

(MUSIC OUT)

(OBAMA SPEECH CLIP: And millions of Americans finally have the same
chance to buy quality, affordable healthcare and the peace of mind that
comes with it, as everybody else).

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SOPHIA: And many of the clinic’s patients were able to get coverage for
the first time. In fact, so many that CommunityHealth decided to close their
second clinic because of a drop in demand.

(CLINIC CONVERSATION AMBI: Buenos días?) [​Good morning?]​

SOPHIA: But at least one patient Antonia spoke to felt that getting
insurance actually put him in a worse position.

JOSE INGLES: Vengo hacer una cita. [​I am here to make an appointment​].

ANTONIA: José Ingles stopped going to CommunityHealth when he began


getting insurance through his work but now he wants to return to the clinic.
The front desk tries to explain to him that now that he’s insured, he can’t.

FRONT DESK: Usted ya no puede continuar recibiendo servicios acá en la


clínica porque usted dijo que tiene aseguranza. [​You can’t continue to
receive care here at the clinic because you said that you’re insured.]​

JOSE: Aquí tengo una carta para la clínica. [​Here I have a letter for the
clinic.​]

FRONT DESK: Ok me puede mostrar la carta por favor? [​Ok, can you
show me the letter please?​]

ANTONIA: Jose hands the front desk person a letter. In it, he formally
declines his new health insurance. He tells her he’s decided to stay
uninsured in order to be able to keep going to CommunityHealth.

The letter is taken behind the desk to Vickie Chester, the Patient Services
Manager. Vickie tells me that this circumstance is not that rare.

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VICKIE CHESTER: Often times people will elect to cancel their insurance
for the sake of returning here, which is not something that we encourage
them to do.

ANTONIA: What this means is that Jose would lose coverage in case of an
emergency since CommunityHealth only offers preventative care. But Jose
tells me that it’s worth the risk for him.

JOSE: Aquí me estaban haciendo mejor. [​They attended to me better


here.​]

ANTONIA: Because he feels financially, he isn’t getting by month to month.


Again, he is willing to risk a surprise visit to the emergency room because
his insurance is costing him so much.

JOSE: Y las cremas que me dieron por allá no me sirvieron para nada. Y
aparte pues, perdí dinero. [​And the creams that they gave me didn’t work at
all. So then on top of that, I lost money.​]

ANTONIA: Under his work’s insurance he says he is now being charged


$5000 to cover the cost of his lotions to take care of his eczema. When he
was a CommunityHealth patient, they were free.

(PILLS SOUND)

ANTONIA: I want to go check out where all these free meds are.

And so I find myself in the clinic’s pharmacy. Dr. Rios is there and she lets
me know the low down on one of her patients.

DR RIOS: So we are here because we have a patient with very high


cholesterol called familial hypercholesterolemia. And she is taking a
medication who lower the cholesterol. What I think now — she may not be

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taking the medication. That’s something that many times we find. That they
prescribe the medication, they get the medication from here but they don’t
take it. So she’s coming today, I have to really ask if she’s really taking.
She will say yes and then after I have to go around with other question and
sometimes they say no, really I didn’t take it.

ANTONIA: Her patient, Irma, arrives and is led to the exam room, I follow
closely behind.

DR RIOS: Hola señora, cómo se siente usted? [​Hi ma’am, how are you
feeling?]​

IRMA: Bien. [​Good.​]

DR RIOS: Se siente bien. Está tomando la medicina? [​You’re feeling well.


Are you taking the medicine?]​

IRMA: Si. [​Yes.​]

ANTONIA: Dr. Rios cuts her gaze away from Irma and towards me with a
sly expression that says “see, told you so”.

DR RIOS: No la parado ningún día? O la ha parado algunos días? [​You


haven’t stopped taking it any day? Or some days?]​

IRMA: Unos días porque he estado yendo mucho al baño en las


madrugadas. 3 o 4 veces a la madrugada. [​Some days because I’ve been
going to the bathroom a lot during the night. 3 or 4 times.​]

DR RIOS: Está orinando más. [​You find yourself wanting to pee more
frequently.]​

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IRMA: Ajá. Entonces he estado suspendiendo un poco para que pueda
dormir. [​Yeah. So I’ve been suspending it a bit so I can sleep.]​

ANTONIA: It seems like Irma is starting to give in to Dr. Rios. She is saying
that there are nights that she skipped the medicine because she feared that
it was keeping her up.

DR RIOS: Bueno, este… Los resultados, es que el colesterol está altísimo.


Es como no está tomando la medicina. Entonces usted piensa que puede
ser por eso que está tan alto? [​Well, um… The results just show that your
cholesterol is super high. It’s like you’re not taking the medicine at all. Do
you think that’s why your results are so high?]

IRMA: Si. [​Yeah]​

DR RIOS: Porque no la está tomando? [​Because you’re not taking it?]​

IRMA: Si. [​Yeah]​

DR RIOS: Ok. Bueno [​Ok, right...]​

ANTONIA: Dr. Rios seems genuinely shocked she was able to get Irma to
admit she wasn’t taking her medicine so quickly. And she tells Irma she’s
worried about her needing to get up in the middle of the night to use the
bathroom, that it might be a sign of another problem, and that she’s going
to order some tests.

DR RIOS: Quieres hablar más? [​Do you want to talk a bit more?​]

ANTONIA: Si, perfecto. Dónde? [​Yes, perfect. Where?​]

DR RIOS: Acá! [​Over here!]​

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Irma and I sit in an empty exam room.

ANTONIA: Como está? [​How are you?​]

IRMA: Bien. [​I am okay.]​

ANTONIA: Yo la verdad, no me gusta venir al doctor (laughs). [​Truth is, I


don't like going to the doctor (laughs)​].

IRMA: (laughs) Si entiendo, entiendo. Es algo… Bueno, por mi parte


también así me daba mucho miedo venir al médico pero a la vez es bueno.
[​(laughs) Yes, I get that. It’s something… Well, in my experience it used to
make me very afraid to come to the doctor but at the same time it’s a good
thing.]​

ANTONIA: I close the door so we can talk privately.

IRMA: Mi historia es algo cruda. Pero vine porque no sabia donde yo tenía
que dirigirme. [​My story is a bit heavy. But I came here because I didn’t
know where to turn.​]

ANTONIA: I learn that there are things in Irma’s life that are not so easily
fixed just by taking the pills for cholesterol that Dr. Rios so desperately
wants her to take.

Irma opens up about very personal things and even though I have her sign
a consent form with her full name — all of the patients we spoke to did —
because of the nature of her story we have decided not to include her last
name.

ANTONIA: Hace cuánto tiempo que está en los Estados Unidos? [​How
long have you been in the U.S?​]

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IRMA: Llevo como unos 12 años aquí. [​I’ve been here for about 12 years
now.]​

ANTONIA: When she arrived to the U.S. she started to work in


housekeeping at a hotel in Evanston, Illinois, a wealthy suburb north of
Chicago. But she stopped after something happened at her work.

IRMA: Ahorita no estoy trabajando por toda esta secuela que ha estado
pasando. (pausa) En mi trabajo hubo una violación física en mi persona. El
manager me violaba en el trabajo. [​Right now I am not working because of
all the repercussions of what happened. (pause) At work, there was a
physical violation of my body. The manager used to rape me at work​.]

ANTONIA: Irma says she was frequently raped by her manager.

IRMA: Por el puesto que ocupaba se sentía poderoso, se sentía fuerte,


sentía que él podía hacer lo que él quería y con amenazas. [​Because of
the position he held, he felt powerful, strong, that he could do whatever he
wanted through threats.​]

ANTONIA: Irma says that the people at her job didn’t support her and that
many of her colleagues were facing similar treatment but couldn’t speak up
because they did not want to lose their jobs.

IRMA: Y yo las entiendo. [​And I understand their position.]​

ANTONIA: Yet finally, one day she gathered the courage to leave her job
and file a complaint with the local police.

IRMA: Era muy fuerte para hablar y decidir yo hacer esto. Fue una decisión
que me costó muchísimo trabajo por lo mismo de las amenazas, la presión
que tenía de esa persona. De todo. No, no te imaginas. [​It was really hard
to talk about this and decide to do this. It was a decision that took so much

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work because of the threats, the pressure that I had from this person.
Everything. You can’t imagine.]​

ANTONIA: She struggled to find help until learning about this place,
CommunityHealth.

IRMA: Es muy triste que buscas lugares que te apoyen y no hay


presupuesto. [​It’s so sad to look for places that can help you just to find out
there are no resources.​]

ANTONIA: In addition to the doctor, she sees a therapist here. And with
help, she’s been able to reframe what happened to her.

IRMA: No perdí mi trabajo, gané. Gané yo por mi parte la libertad de ser


mujer. De expresar lo que había pasado ahí y luchar. [​I didn’t lose my job, I
won. I won the freedom to be a woman, to express what happened in there
and fight back.]​

ANTONIA: She’s been here for only a year. She admits there’s still a lot of
work to be done.

IRMA: Son pesadillas o momentos que recuerdas que no se te pueden


olvidar. El miedo, el temor, todo. Es difícil estar saliendo adelante para
sacar todo esto y superarlo. [​There’s nightmares or moments that you
remember that you just can’t forget. The fear, the anxiety, everything. It’s
hard to move forward.​]

(MUSIC IN)

ANTONIA: Pople who argue undocumented immigrants shouldn’t have


access to healthcare pose their position as one about lack of resources.
Undocumented migrants are invaders coming to take advantage of our
system, to use our benefits, and take our jobs.

21
But what this argument leaves out is the altogether common situation in
which our system takes advantage of them.

During days at CommunityHealth, we started to see how this one clinic is


trying to treat patients by not just addressing their physical health but also
taking into consideration the system in which they live.

MARIA: Coming up on Latino USA, we unpack the unique challenges of


caring for the undocumented. Stay with us, no te vayas.

MIDROLL

MARIA: Hey! We’re back. And producers Sophia Paliza-Carre and Antonia
Cereijido have been observing the inner workings of the largest free health
clinic in the nation.

CommunityHealth is located in Chicago and it only serves people without


health insurance. Their most common diagnosis are: high cholesterol, high
blood pressure and diabetes — three of the most common health problems
in the U.S.

And like doctor’s offices across the country, this clinic treats the physical
symptoms of these issues. But it also takes into account the very specific
needs of their immigrant and often undocumented patients.

Now, it’s evening time at the CommunityHealth Clinic in Chicago and our
producer Sophia is going to pick up the story from here.

SOPHIA: The clinic normally has the quiet feeling of a doctor’s office, in
which sound is trapped in the carpet of the waiting room and doctors speak
in soothing tones.

22
But there are certain periods of time when the quiet clinic becomes a
classroom.

(STUDENTS TALKING IN THE BACKGROUND)

SOPHIA: In the evening, dozens of medical students come from nearby


universities. They see patients and write up their charts.1

And a few of them hang out in the blood lab.

(CENTRIFUGE SOUND)

ITZEL LOPEZ: Some centrifuges are running. We’re running a couple vials
that patients have given us to test their blood.

SOPHIA: (laughs) You say that like it’s ​blood​, like in a horror movie.

ITZEL: I know right? I’m count Dracula, basically no, yeah.

SOPHIA: In the back room is Itzel Lopez, Tyler Miksanek and Craig
Johnson. Or as Tyler puts it:

TYLER MIKSANEK: This is the original squad.

SOPHIA: On their first rotation at the clinic, they were all assigned together.
They primarily are responsible for drawing patient’s blood in order to test
STIs and blood sugar.

SOPHIA: So what year are you in med school?

ITZEL: First year. Well, we are rising second years — we are in the
summer before the rest of our lives.
1
​http://www.communityhealth.org/student-run-clinics-and-ilgivecommunity/#.Xdquj-dKgWo

23
SOPHIA: All three of them are in the process of considering their next steps
after medical school. And it turns out, Itzel isn’t new to CommunityHealth.

ITZEL: So I took a gap year in between graduating undergrad and then


coming to medical school, and I interpreted here.

SOPHIA: Iztel’s parents are immigrants.

ITZEL: So as the cultural and linguistic broker I was often in those clinical
spaces with them. And just realizing how special and vulnerable those
conversations can be and how difficult sometimes, and how things get
missed.

SOPHIA: What she saw made her want to be a doctor, especially a


bilingual doctor.

ITZEL: As soon as you speak their language even if you don’t look like
them they’re like, oh my gosh! Like they bring in their kids and the kids
don’t have to interpret for them anymore and they don’t have to go through
this weird, awkward exchange. So it’s important to me and I really hope
whether is here in Chicago or anywhere else, that I do serve a largely
Latino population.

(MUSIC)

SOPHIA: Language is a major issue at the clinic. Their patients speak 34


different languages. Though more than half of them prefer to have their
exams in Spanish.

And while several doctors speak more than one language, like Dr. Rios, the
clinic does have volunteer interpreters. The interpreters can be found sitting

24
in a row of bright orange chairs at the center of the clinic. Like soccer
players on a bench, they wait to be called into the fray.

WILL HESTER: Yes, I am grading papers. I’m teaching summer school and
I grade papers while I wait.

SOPHIA: This is Will Hester, he’s a Spanish teacher and a certified medical
interpreter.

WILL: It’s a Spanish 101 class so they had to write letters to an imaginary
pen pal.

SOPHIA: I ask him how he got into interpreting.

WILL: I was looking for some place to volunteer and my husband said you
need to go to this clinic and you need to serve. And I said oh I can’t do it I
don’t know the word for elbow, you know? And my husband said go get a
book, learn the word (laughs). And that’s what I did.

SOPHIA: Will approaches interpreting a specific way. Like he’s not just
trying to convey the meaning of words, he’s trying to create a more
equitable world.

WILL: My job is to allow our Spanish-speaking patients to have the same


access to the US healthcare system as do patients who speak English. And
to put them on an equal footing. Because what’s important in that moment
is the connection between the physician and the patient.

The interpreter is an important part but we should be an important part in


the background.

SOPHIA: In other words, his mission is to convey a patient’s words and


emotions as accurately as possible.

25
SOPHIA: And Antonia got to see him put these very principles in action.

ANTONIA: I am sitting in on an exam with a patient named Eluterio.

He is trying to explain to his doctor, Nazia Babul, that he is getting blisters


under his teeth. He opens his mouth wide.

ELUTERIO: Unas ampollitas así chiquiticas acá…abro la lengua. [​Small


blisters here… I’ll open my mouth and show you.]​

ANTONIA: Dr. Babul is proficient in spanish, and can understand that


something is wrong with Eluterio’s teeth but she can’t figure out exactly
what he is saying

DR NAZIA BABUL: Yo tengo un poco dificil tiempo para comprender. [​I am


having a bit of a hard time understanding…]

ANTONIA: And so she steps outside momentarily to bring Will in.

DR BABUL: Así que usted puede explicar amigo una vez más, cómo se
siente? [​So now could you explain one more time how you feel?]​

WILL: Can I pre-session?

DR BABUL: Oh sure.

WILL: Hola! Me llamo Will, soy intérprete. Voy a ayudarle a comunicar


directamente con ellos. Pueden hablar directamente como si yo no
estuviera. [​Hi! My name is Will and I am an interpreter. I am going to help
you communicate directly with them. You can talk as if I wasn’t here.​]

26
ANTONIA: Will begins translating for Eluterio. And he does it like he is an
actor, embodying a new role. He talks in the first person.

WILL: So I was going to ask if I could get something better because there
have been blisters to come up under the teeth.

DR BABUL: Ok, ok. With this information I’m going to take it back to the
clinic coordinator.

WILL: Con esta información que me ha dado voy a consultar con la


coordinadora de la clínica para determinar si necesita ir urgentemente al
dentista por ejemplo hoy o si se puede esperar unos días. [​With this
information that you have given me I am going to consult with the clinic
coordinator to determine if you need to go to the dentist today or if it can
wait a few days.]​

ELUTERIO: Si me puedo esperar unos días. [​I can wait a few days.​]

WILL: I can wait a few days.

ELUTERIO: A ver cómo me siento… si ya me siento bien, sino que no


podía comer. [​To see how I feel… I already feel fine, it’s just that I couldn’t
eat.]​

WILL: I feel fine, its that I couldn’t eat.

ANTONIA: It feels like Will is the human version of Clippy—that digital


paperclip that used to show up on Word documents. Will is very helpful.

DR BABUL: Muy bien. Ok. Gracias por su tiempo hoy. ​[​Great. Ok. Thank
you for your time today.]​

ANTONIA: Eluterio seems very at home at the doctor’s.

27
ANTONIA: Te costó ir al doctor? ​[Was it hard coming to the doctor’s?​]

ELUTERIO: No… no. Pero mucha gente dice, “no pa’ que voy si me
muero, que me muera”. [​No… no. But a lot of people say “for what? If I am
gonna die, I’ll die.'']​

ANTONIA: Pero vos no? [​But not you?​]

ELUTERIO: Y luego cuando se sienten malos si van. Si… pero a mi no, no


me ha costado. Siempre he venido. [​Then when they feel bad, they go.
Yes... not me. It’s not hard for me to come, I always have.​ ]

ANTONIA: Y por qué quiso venir a los Estados Unidos? [​And why did you
want to come to the United States?]​

ELUTERIO: Pues porque es una vida mejor aquí en Estados Unidos.


[​Because it’s a better life here in the US​.]

ANTONIA: Ustedes son ciudadanos? [​Are you guys citizens?​]

ELUTERIO: No… pero no me vaya a reportar! Jajaja [​No… but don’t report
me! (laughs)​]

ANTONIA: No!

ANTONIA: We’re not using Eluterios last name, because of his status. As
you can tell, he’s a pretty easy-going guy. But he’s had to face a lot of
challenges.

For as long as he’s been in the U.S. he’s had diabetes and he’s had to
manage it along with other health problems mostly due to his work.

28
ANTONIA: Y a qué se dedica? [​And what do you do for work?]​

ELUTERIO: Soy dishwasher. [​I work as a dishwasher.]​

ANTONIA: Dishwasher? Hace cuánto tiempo? [​Dishwasher? Since when?​]

ELUTERIO: Desde que vine… 25 años. [​Since I arrived… 25 years.​]

ANTONIA: En el mismo restaurante? [​At the same restaurant?]​

ELUTERIO: No, trabajé en Benihanas, en uno que se llamaba Ed


Debevic’s. [​No, I worked in Benihana, in another called Ed Debevic’s.]​

ANTONIA: Eluterio wears special compression socks that go up to his


knees to help with circulation because he stands for so long during his job.
He also puts on creams and lotions at night to help deal with the pain.

But he says his circumstance doesn’t compare to what his family in Mexico
has dealt with recently.

ELUTERIO: Ya nos han matado a tres sobrinos. Se metieron a sicarios y


todo eso y pues, el que entra ahí ya no sale.​ ​[​They have already killed
three of our nephews. They became hitmen and all of that and whoever
enters that, doesn’t come out of it.]​

ANTONIA: He says this is why he brought his family to the U.S. His
nephews were only 19 and 20 when they got involved with sicarios or hit
men. And he feared his children would find a similar end.

ELUTERIO: Bien feo los mataron y… ya el último que mataron no más la


cara se lo desfiguraron con un cuchillo yo creo. Toda la cara para que no lo
conociera. [​They killed them brutally... the last one that they killed they just
defaced him with a knife, I think. All his face so he couldn’t be recognized.​]

29
ANTONIA: Qué feo. [​How awful.​]

ELUTERIO: Lo reconocieron por un tatuaje que traía en una mano. [​They


recognized him because of a tattoo he had on his hand.​]

ANTONIA: His fear was heightened because he already lost a son in


Mexico not to the drug war, but because of a freak accident.

(MUSIC)

ELUTERIO: El primero se me quemó. De dos años. Cayó en una tina de


agua hirviendo y se quemó, se coció todo este bracito. [​The first one got
burned. He was two years old. Fell into a boiling bath tub and got all of one
of his little arms cooked.​]

ELUTERIO: Era el mayor. [​He was the oldest.]​

ANTONIA: Se murió? [​He died?]​

ELUTERIO: Si, no aguantó el dolor. No le aguantó el corazón del dolor que


tenía. [​Yes, he couldn’t stand the pain. His heart couldn’t take it.]​

ANTONIA: During Eluterio’s exam, Dr. Babul asked if he’d be interested in


seeing other specialists including a mental health counselor.

DR. BABUL: Quieres hablar con personas sobre los problemas que usted
tiene? [​Do you want to talk with someone about the problems you have?]​

ELUTERIO: Si me la dan pues si. [​If that’s an option, yes.]

(MUSIC OUT)

30
ANTONIA: The counselor’s room is three doors down from where Eluterio
and I are sitting.

The room has this surreal quality. When a patient is inside the counselor’s
room no one can hear what they are saying because for privacy there is a
white noise machine sitting just outside.

(WHITE MACHINE NOISE)

But if you were to be able to see inside you would see something very
unusual. Even though there are no windows, there are dozens of living
plants, mostly bamboo. The counselor whose office it is jokes that the
plants live off of love.

It is in this room that Irma the housekeeper we heard from earlier once
shared her story and started to find a personal sense of justice. It’s where
Eluterio might tell his story one day.

(MUSIC)

It’s a room where living beings — plants without sunlight, people without
status — can grow.

MARIA HINOJOSA: Coming up, the last patient we hear from at


CommunityHealth.

Stay with us, no te vayas.

SECOND BREAK

MARIA: And we’re back.

31
For the last few days, producers Sophia Paliza-Carre and Antonia Cereijido
have gotten to watch how CommunityHealth works — from how they deal
with patients who are more comfortable in a different language, to patients
with mental health issues. But despite the clinic’s breadth of services, they
have learned that many of the providers actually wish… the clinic didn’t
exist at all.

Sophia Paliza-Carre takes it from here.

SOPHIA: In total we spent three days at CommunityHealth.

And over the course of that time, we talked to a lot of patients who were
happy with their care. And many of them, had been coming to the same
clinic for years, decades even. CommunityHealth treats more than 8,000
people a year.

And the reason why they can do that is because they are privately funded.
That means they’re supported by individuals but also by huge networks like
the University of Chicago Medical School and giant pharmaceutical
companies like Pfizer. It takes an army to make it run. Remember, they
have over 1,000 volunteers.

DR MARGARET BAVIS: I think CommunityHealth does a very nice job of


using all the different types of providers in a really innovative way and I
think that type of innovation needs to be part of that national conversation
about health policy.

SOPHIA: This is Margaret Bavis, a nurse practitioner at CommunityHealth


and an Assistant Professor at Rush University. And while she is very proud
of the work the clinic does, she tells me that she and other providers
sometimes feel conflicted about their work.

32
DR BAVIS: The founder of CommunityHealth, Dr. Garella, when he was
here last year for the 25th anniversary — and he has since passed away —
but he, in his speech at our celebration, made a statement about how he
wished we didn’t need to exist.

(MUSIC)

DR BAVIS: And I always think about that and take that to heart.

SOPHIA: And she echo-ed a thought we had heard from several of the
doctors here: that CommunityHealth is just a stopgap.

DR BAVIS: To that end, you know, can we replicate this everywhere and
should we have to? I mean can we get the discussion to include everybody
regardless of status?

SOPHIA: Dr. Bavis believes healthcare should be a human right, but she
points out to me that even if you don’t believe that — there’s a public health
argument to be made. When diseases spread, they don’t discriminate.

DR BAVIS: If we don’t give everyone the opportunity for measles


vaccination then we are putting ourselves at risk. If we don’t give everybody
an opportunity to have access to healthcare we are putting everyone at risk
around us.

SOPHIA: But undocumented communities aren’t just dealing with infectious


diseases. There’s an inherent stress in trying to navigate our country’s
immigration system.

The final patient we are going to meet is Maria Magaña.

(DR. EMILY HENDEL GREETS MARIA MAGAÑA)

33
SOPHIA: Dr. Emily Hendel swivels around her computer screen to show
Maria her blood tests.

DR EMILY HENDEL: Su diabetes fué muy bien controlada. [Your diabetes


is well controlled!]

MARIA M: (claps) (laughs) Estoy haciendo muy bien. [I am doing very well!]

DR HENDEL: (laughs) Si! [Yes!]

SOPHIA: Maria has the vibe of someone who grew up getting gold stars for
perfect attendance.

DR HENDEL: Su colesterol en total fué 124, normal es menos de 200. Esto


es perfecto. [​Your cholesterol in total was 124, the normal value is below
200. This is perfect.]​

MARIA M: Ohhh ok!

SOPHIA: And she takes that optimistic energy into an interview with me.

SOPHIA: How long have you been coming here?

MARIA M: Wow. I’ve been here since 1996.

SOPHIA: Maria has been living in Chicago for 28 years, though she is
originally from Mexico City. But she didn’t get her legal residency until a few
years ago.

Having her papers now, should mean that she can sign up for healthcare.

MARIA M: I could apply for that, but for a while I can’t. I can’t. I have to wait
5 years and I only have like 3 years.

34
SOPHIA: Maria wants to apply for Medicaid, and as a permanent resident
she can do that. But instead of doing that, she wants to wait 5 years until
she can become a naturalized citizen first, before she tries to get
healthcare. She switches to Spanish to better explain her concern.

MARIA M: Podría esperar pero prefiero no agarrar. Ahora dicen que


cualquier residente legal que pida ayuda pública, tanto Medicaid, food
stamps y otro requerimiento de medicina eres carga pública y no podrías
cualificar para la ciudadanía. [​I could do that but I prefer not to take. Now
they’re saying that any legal resident that asks for public help, including
Medicaid, food stamps and other requirements, you’re a public charge and
can’t qualify for citizenship.]​

SOPHIA: What’s she’s talking about here are the changes that the Trump
administration has proposed to make it more difficult for migrants to seek
green cards. The idea was that if migrants applied for benefits like Medicaid
or food stamps they could be seen as a “public charge” — meaning
dependent on the government and therefore ineligible for residency.

The rule was supposed to go into effect in October of this year, but it was
struck down by several federal judges.

And actually the rule wouldn’t apply to people like Maria because she is
already a permanent resident. But there has been so much confusion
around this new rule, that many immigrants have dropped their housing,
food, or medical benefits out of fear.

MARIA M: With the Obamacare going to be a nightmare for us.

SOPHIA: Maria has considered getting covered through the Affordable


Care Act instead of Medicaid, but she tells me she can’t afford it.

35
MARIA M: It was so expensive. It’s I pay insurance or I pay my rent.

(MUSIC)

MARIA M: The immigration situation for our community is crazy, completely


crazy.

MARIA M: Yo no puedo conducir. No puedo conducir porque me da


nervios, y empiezo a sudar, me sudan las manos, me suda el cuerpo y
tiemblo. Voy así. El volante me duele las manos cuando ya termino porque
el stress es muy alto. Y eso me da ansiedad. Mucha ansiedad. [​I can’t
drive. I can’t drive because I get nervous and I start sweating. My hands
sweat, my body sweats and I start shaking. I go around like this. The wheel
hurts in my hands when I am done driving because the stress is so high.
And that gives me anxiety. So much anxiety.]​

SOPHIA: And that anxiety is what many of the patients we talked to face in
their everyday lives.

From the beginning of our time here, we wanted to know what it would look
like if undocumented people weren’t excluded from our healthcare system.
And we observed what a difference it makes to have interpreters who care,
free medicine, and access to mental health treatment.

But this is just one clinic, and even though it’s the biggest free clinic, it
serves less than a hundred people a day. There are 11 million
undocumented immigrants across the U.S.

Maria says the way people think about immigrants in this country is all
wrong.

MARIA M: Sólo… pues trabajamos. Quizás un trabajo que no quieren


hacer. Pues nosotros lo hacemos, lo cogemos y lo hacemos. Porque en

36
América tu eres cero. Somos nada. Y eso es lo que mata y frustra las
personas [​We just...work. Maybe a job that they don’t want to do. We do it,
we take it and we do it. Because in America you’re zero. We’re nothing.
And that’s what kills and frustrates people.​]

SOPHIA: She says in America, we’re worth nothing. And that’s what kills
and frustrates people.

MARIA M: Y estamos enfermos. [​And so we’re sick.​]

(MUSIC)

ANTONIA: At 6pm, the clinic closes down for the day.

(AMBI CLIP OF LEAVING THE CLINIC)

ANTONIA: Even though we won’t be around to chase patients down the


corridors with our microphones...tomorrow CommunityHealth will re-open
the doors and start the cycle again.

---
MARIA H: Our thanks to the many patients, staff and volunteers at
CommunityHealth who spoke with us. Especially those who allowed us into
very intimate moments in their lives.

ENDING THEME MUSIC

This story was produced by Antonia Cereijido and Sophia Paliza-Carre and
edited by Fernanda Camarena.

Additional reporting by Maggie Freleng.

37
The Latino USA team includes Miguel Macias, Janice Llamoca, and Alissa
Escarce. With help from Jeannie Montalvo and JoAnn DeLuna. Fact
checking by Nidia Bautista. Our engineers are Stephanie Lebow and Julia
Caruso. Our Production Manager is Natalia Fidelhotz. Our digital team
includes Julio Ricardo Varela and Amanda Alcántara. Our interns are
Adriana Tapia and Juan Diego Ramirez. Our theme music was composed
by Xenia Rubino.

I am your host and Executive Producer Maria Hinojosa.

38