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Anthropology & Health Journal - AHJ. No.

1 7-15 (2008)
ID: ahj000001 -

“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-

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 wealthy and poor. Those who come illegally, speak no or
Washington's metropolitan area population. Of the immi- little English, and have little income and savings, often find
grants living in the capital, nearly 40 percent come from themselves without access to health care. The health care
Latin America, and the largest group comes from El Salva- needs and experiences of Latinos, the major ethnic group
dor (Schifferes, 2003). This group consists of legal and ille- within in the “new” D.C. immigrant population of the twen-
gal immigrants, monolingual and bilingual immigrants, 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-
Correspondense to: Claire F. Selsky. M.A., Latin American Studies. The George
Washington University 1923 35th Place NW Apt. 4, Washington, D.C. 20007, migrants and two health care providers in Washington, D.C
USA. Email address: (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- States and then provides a more focused look at Latinos and
wing section. Then, I present the stories of selected immi- health care in Washington, D.C.
grants and health care providers. Finally, I summarize my
findings and suggest ways to ameliorate health care expe- Latinos and Health Care in the United States
riences of Latinos in Washington, D.C. A growing body of research in cultural anthropology
addresses how the poor and uninsured experience the U.S.
Literature Review health care system (A. and S. Greer 1983, Singer and Clair
2003, Singer 2004, Becker 2004, Sered and Fernandopulle
This literature review discusses anthropological and 2005). Other social scientists have studied immigrants in
related research applicable to this article. The section first the U.S. generally (Cohen 1979) and more specifically, in
discusses literature on Latinos and health care in the United Washington, D.C. (Modan 2006).

Anthropology & Health Journal - AHJ. No. 1 7-15 (2008)

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Claire F. Selsky. 9

Urban sociologists A. and S. Greer document that of illness and how social, political, economic and environ-
race and income levels are strongly correlated with health mental conditions affect health outcomes (2003, pg. 424).
status and the utilization of and access to services in their The research on which this article is based employs the cri-
edited volume (1983). Compared to higher income or White tical biocultural approach.
families, members of the Black community and low-income Becker undertook a large-scale interview study in the
families report more restricted activity and disability days Bay area of California and finds that African Americans
and report chronic activity limitation and describe their and Latinos without health insurance delay seeking care
health statuses as poor or fair (McKinley et al. in Greer and because of cost, do without medications, have negative
Greer, 1983, pg. 126). McKinley cites four reasons for the views of safety net health care, and experience discrimina-
discrepancy in health among races and socioeconomic le- tion (2004). She details the effects of being uninsured on
vels: inequality of access; the welfare/insurance scheme health: the uninsured have a higher risk of premature death,
causing people to fall through gaps in coverage, leading to a are more likely to be diagnosed in late stages of cancer, and
two-class system of health care; focus on equality of access those who have been hospitalized for heart attacks are more
rather than quality of medical care; and the failure to eva- than twenty-five percent more likely to die while in the hos-
luate the effectiveness and appropriateness of medical prac- pital (2004, pg. 259). Becker adds that those who are unin-
tices and technology (pgs. 126-129). These four issues are sured are more likely to delay health care because of cost,
relevant to Latino immigrants in Washington, D.C. be it unmedicated or undermedicated, and are more likely to
In Pathologies of Power: Health, Human Rights, and feel discriminated against because of being uninsured
the New War on the Poor, medical anthropologist and medi- (2004, pg. 262).
cal doctor Paul Farmer discusses how the United States’ Sered and Fernandopulle show how, and how often,
system of health care benefits those with money and hurts people “fall through the cracks” of the U.S. health care sys-
the poor. As Farmer notes, biotech and pharmaceutical tem (2005). The authors explain that race is related to the
firms make amazing discoveries, but lean heavily on public likelihood that an American is insured, citing that 35.7 per-
funding and make a great deal of private profit. He explains cent of Hispanics, 20.8 percent of black Americans, and
today’s medical system as a system in which health is a 14.5 of white Americans are uninsured (2005, pg. 157). Ad-
commodity and doctors conduct “commercial transactions” dressing the Hispanic community specifically, Sered and
with patients (2003, pg. 162). Farmer’s analysis of the U.S. Fernandopulle note that 37 percent of Hispanic men die pre-
health care system provides a foundation for understanding maturely compared to 21 percent of white men. They sug-
the frustrations of those who do not have the money, most gest that access to good health care could reduce many ra-
often the poor and the uninsured, to purchase the commodi- cial disparities in health outcomes in the United States
ty of health. (2005, pg. 158).
Singer (2004) and Singer and Clair (2003) discuss the
correlation between socioeconomic class and health/health Latinos and Health Care in Washington, D.C.
care access. In his article, “Why Is It Easier to Get Drugs
In an early study, Cohen (1979) addressed health is-
than Drug Treatment in the United States?” Singer compa-
sues among Latino immigrants in Washington, D.C., sug-
res the accessibility of illegal drugs to the accessibility of
gesting that poverty-related stress among her participants
medical care. He shows that while drugs flow into U.S. ci-
was minimized by strong cultural mechanisms of emotional
ties, towns and rural areas, securing effective drug treatment
and behavioral control. Her research found that settlers du-
remains a challenge for drug users who want to overcome
ring the early stage of entry to the United States were at
their addictions (2004, pg. 287). Specific to the Latino com-
high risk of suffering from health problems compared to
munity, Singer states that mass media presents the drug user
those who were well-established immigrants (pg. 271). In
as a criminal, often characterizing him as Black or Latino
line with this article’s findings, Cohen states that after stud-
(2004, pg. 296). He adds that the United States only provi-
ying the Hispanic community in Washington, D.C., the lack
des one third of the federal drug budget for prevention or
of insurance coverage results in individuals making fewer
treatment (2004, pg. 298). Singer shows that the United Sta-
visits to the physician (pg. 278). Cohen’s observation from
tes focuses its attention on criminalizing usage rather than
the 1970s holds true today, more than three decades later.
on preventing and treating addiction.
Using an approach that combines linguistic anthropo-
In Singer and Clair’s article “Syndemics and Public
logy, cultural geography and urban anthropology, Modan
Health: Reconceptualizing Disease in Bio-Social Context,”
(2006) discusses how members of the multi-ethnic Mount
the authors stress that biomedicine’s conceptualization of
Pleasant community use language to legitimize themselves
disease as objective, clinically identifiable and as a bounda-
as community members and to discredit others. In studying
ble entity, is problematic. Instead, the authors support the
the neighborhood, Modan observes the role of filth, both
critical biocultural approach, which looks at understandings

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

actual and symbolic. She notes that debilitating infectious Voices of the Immigrants
diseases are able to flourish in areas with poor sanitation.
This spread of infectious diseases happens especially in Common Themes
densely populated areas where pathogens with short life-
spans are able to find new hosts before they die (pg. 142). Of the eighteen immigrants I interviewed, fourteen
Living in an area like Mount Pleasant as an immigrant often had come illegally, and only half had ever visited a doctor
guarantees close quarters and old buildings. Consideration or hospital in the United States. Eleven of those interviewed
of this aspect of immigrant city living is important in un- experienced separation from their immediate family mem-
derstanding one reason that sickness is more likely to spread bers (spouse or child(ren)) for periods of many years at a
in an area like Mount Pleasant than somewhere that is spar- time. Those who shared their opinions on the current health
sely populated, with new buildings and excellent sanitation. system often expressed satisfaction with services rendered,
but an inability to pay out of pocket health service costs.
Research Methods Below are the stories of four immigrants that illustrate the
role of citizenship status and the common themes of displa-
Research on the Neighborhood
cement, family separation, acculturation issues and lack of
In doing background research on the neighborhood of access to health care or lack of access to funds for health
Mount Pleasant, I consulted materials available in the libra- care.
ry such as books, encyclopedia articles, and news articles.
In order to gain a more personalized understanding of Immigrant Stories
neighborhood of Mount Pleasant, I contacted various neigh-
borhood organizations. Finally, having lived near Mount Legal Immigration and Health Insurance. Sofia is a
Pleasant and having worked in Mount Pleasant as an ESL Dominican who has lived in the United States for nineteen
teacher for over a year, I observed everyday life in the years. She came with an official work visa. She says that “I
neighborhood and met several Latino residents informally. am a person who is very popular among people with money,
so I work for these people, I know these people…when I
Research with the Immigrants decided to go, I only had to talk to someone who already
knew me well…” She worked in people’s homes taking
As a former adult ESL teacher in Mount Pleasant, care of their children and cooking. Today, Sofia is 67 years
Washington, D.C., I was fortunate to have a connection old.
with Latino students at the school. In May of 2007, I provi- Sofia left two children in the Dominican Republic
ded approximately 30 students at the school with a verbal when she decided to come to the United States. Today they
explanation of my project, followed by a form asking them are 46 and 47, and Sofia speaks with them both regularly.
to indicate their interest in participating in my thesis re- Sofia’s mother raised her children in the Dominican Repu-
search. In all, I interviewed eighteen adults who lived in or blic.
near Mount Pleasant during the summer and fall of 2007. When Sofia needs to go to the doctor, she goes. She
I conducted most of the interviews at the school whe- has never needed to go to the hospital. She is a resident now
re I taught in Mount Pleasant. I used a list of guided ques- and has health insurance. She says the only medicine she
tions to facilitate comparing and contrasting immigrant sto- uses regularly at home is Advil. She says she goes for
ries. All interviews with immigrants were conducted in check-ups, “every year… or every four years…” Sofia
their native language, Spanish. Quotations in this article are thinks that she could improve her health by “eating a lot,
translations from Spanish to English by the author. All of exercising a lot and drinking a lot of water.” She feels safe
the names of individuals included in this article are invented where she lives and walks a lot. “If God allows it,” she
to preserve their anonymity. would like to stay in her current apartment in the years to
Research with the Health Care Providers Having come to the United States legally, Sofia has
been able to secure work and health insurance. Because of
From December 2007 to April 2008, I conducted in- having health insurance, she does not hesitate to visit a doc-
terviews with health care providers. I contacted the provi- tor when she does not feel well. She is an example of a le-
ders by e-mail explaining my research project and asking if gal immigrant who takes advantage of United States go-
they would be willing to be interviewed. I interviewed two vernment programs and benefits.
health care providers at their clinics. 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. 11

ted States, contracted by diplomats to be a caregiver for fumigated because she inhaled the fumes and had an aller-
their children. After a year, she felt she had paid the debt gic reaction. At the hospital, someone was called to transla-
owed to the “señores” who paid for her flight and her paper- te. However, she said that “there are always problems [with
work. She says that, “I, by myself, became a resident.” She communicating], the appointment takes longer because the-
thought about returning to Mexico, but did not because she re is not always someone [available] to translate what is
did not have enough money and her son had already been said.” Luckily, she had health insurance at the time.
born in the United States. She raised her son with her son’s A friend told her about health insurance and how to
father, though the couple separated once the child had apply. She had to give proof of residency and her checking
grown up. information, but was not asked about her citizenship status.
Teresa’s apartment is paid for by the United States She says she only had to sign up for the card and now, her
government. She says that the government pays her rent, health care is completely paid for at the doctor. After sig-
which is costly. Before, there were rats and cockroaches in ning up, she had her health insurance card within two
her apartment, but now, the walls have been painted, it has weeks.
been renovated, and her apartment is clean. Teresa’s son While Julia is living in the United States illegally, she
lives in Gaithersburg and wants her to go live with him, but says she only needs an ID at the hospital, not proof of citi-
Teresa prefers to live alone. At age eighty, Teresa still zenship. There, she shows her passport and gives her health
works in Washington. She takes the bus on 14th street or on insurance information. She says they do not ask her for her
16th street, and travels to 14th and U Street, NW. There, she social security number. She has no social security number,
cleans offices. legally or illegally. Having visited doctors in the United
Teresa has visited many doctors and hospitals in the States for check-ups, Julia knows she has high cholesterol.
United States. She had an operation on her heart because Because of this, she now does exercise and has changed her
she was having difficulty breathing. Her doctor spoke Spa- cooking habits. She uses olive oil now when cooking, pre-
nish. Her private health insurance covered much of the cost. pares food without fat, butter and cholesterol, and no longer
Because she is now a citizen, she also receives Medicare. eats sour cream. She is happy living in her home where she
She says that her experiences with health insurance compa- is near her workplace.
nies in the United States have been positive. Julia was met with some medical difficulties, but be-
Teresa considers herself to be in good health because cause she secured health insurance, she was able to overco-
she is working. If she was sick, she says, she would not be me them; her health experiences have been mostly positive
able to work. She likes where she lives because it is near her because of this. Word of mouth allowed her to figure out
clinic, but does not feel safe in the area. She says that her how to go about obtaining health insurance, which in her
building used to be run by a young man who allowed case, seems to have been helpful in covering medical ex-
drunks and drug users into the building. They used to smoke penses.
there, she says. Today, however, the building is better, be- Illegal Immigration and No Health Insurance. Ra-
cause there is a new owner and the apartments have been fael came to the United States three years ago from El Sal-
remodeled. vador. Today, he is 25 years old. He traveled through the
Teresa is an example of a Latina who has been able to desert with a group made up of people from El Salvador,
care for her health in the United States. She has been gran- Belize, Honduras and Mexico. He came alone. He is not
ted citizenship and has both private and public health insu- married and has no children. Rafael says that his current
rance. She has had operations on her heart as well as cata- economic situation is ok, “más o menos.” He lays bricks
ract surgery. She was able to have these surgeries because for a living.
her health insurance covered most of the cost. She has led Rafael shares that when he needed to visit the hospi-
an active life and continues to lead an active today. tal, he chose not to go. He did not go because it is “too ex-
Illegal Immigration and Health Insurance. Julia came pensive” and because “we don’t have insurance.” He wo-
to the United States four years ago from a town in El Salva- rries about the documents that he might be asked to provide
dor. She traveled by herself to her cousin’s home. Today, at at the doctor’s office or at the hospital. He imagines he will
age 35, she lives in an apartment with two other adults in be charged double what others, who have insurance, are
Washington, D.C. She has a daughter in El Salvador who is charged. In an emergency situation, he would go to the hos-
ten years old. She has one job, which she says might be pital, but “not happily.”
considered good, but “to live better, it would be better to Rafael was injured at work and “needed to go to the
have two jobs.” She cleans in a restaurant. doctor, but could not go because [he] does not have insuran-
Julia has been to a doctor in the United States. She ce, and if he goes to the doctor, [he] imagines they will
says she would only go to a doctor if her insurance covers charge maybe ten thousand dollars, an amount [he] does not
it. She went to the hospital once when her building was have in hand.” His back was hurting after taking down scaf-

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

folding at work. He almost could not walk, but, “well, [he] knowledge about dental health and socio-economic status.
had to work.” His job does not cover health care. He states that: Those who are well educated that had access
Rafael does not feel safe in the Columbia Heights to a better economic life back in their native countries gene-
area where he lives. He says that “always down there, there rally have a better understanding of oral health care due to
are always problems, like, a little while ago, a friend of mi- better access to dental care. However, those in the low or
ne was beaten up… some Blacks beat him up…they robbed middle income bracket for the most part, exhibit less un-
him, they beat him up, and then further up [the street], they derstanding of the preventive aspects of dental health due to
beat up another guy. It is not safe after ten at night.” He the lack of access which is greatly related to their limited
feels the same about neighboring Mount Pleasant, because financial situation (Dr. Rodriguez, personal communication,
there, “they beat up a guy at eleven at night.” He’d like to January 31, 2008).
change where he lives, but says that “if you are not a resi- Dr. Rodriguez’ experience has showed that those who
dent, you don’t have papers, it is quite difficult to get an can afford to pay for dental care, or have dental insurance
apartment.” He currently lives in an apartment where he coverage, are most likely to practice prevention by schedu-
pays rent, but has signed no documents or contracts. ling regular check ups.
Rafael does not know if he is in good health because According to the neighborhood dentist, investing time
while he knows he needs to have a check-up, “a check-up is and money on preventative health care to prevent disease is
a little expensive.” He says he will have a check-up when the greatest challenge the immigrant population faces. Over-
“there is insurance for everyone.” When asked about his coming this barrier means having a change in consciousness
own health situation, Rafael said, “I think they should give which in most cases requires a change in lifestyle. For this
insurance to people that don’t have papers. Just because reason, Dr. Rodriguez believes that educating patients about
you don’t have papers, doesn’t mean you won’t get sick. preventative care is extremely important.
And if we work in this country, it is to improve our situa- Dr. Rodriguez hopes to change local policy so that
tion, and through us, they [U.S. citizens] improve the situa- dentists who study outside of the country can practice in the
tion here in the United States.” United States, using a model much like the international
When asked why he did not go to the hospital alt- physician model, in which the doctor studies elsewhere but
hough he needed to do so, Rafael responded that “we don’t passes a qualification exam in the United States. In this
have insurance.” He responded with “we” when asked way, more Hispanic dentists would be able to practice in the
about his personal health situation as well. This phrasing is United States and cater to this growing community.
striking because when Rafael used the pronoun “we,” he
linguistically extended his experience to his fellow Latino The Neighborhood Clinic
A bilingual clinic is situated near Mount Pleasant.
Voices of the Providers There, patients can meet with bilingual staff and doctors
and expect to be met with cultural understanding and fair
The Neighborhood Dentist costs. While services are on a sliding fee, “no one would be
turned away if they can’t pay, and actually the payment
One bilingual, bicultural dentist works on Mount
happens after the service, so they can just walk out the door
Pleasant Street. Dr. Rodriguez has owned his own practice
after if they want to, but most people do want to contribute,
in Mount Pleasant for eighteen years. He estimates that 60
they want to feel like this isn’t just a hand-out” (Cristina,
to 70 percent of his patients are Hispanic. The dentist and
personal communication, March 29, 2008).
his staff are fluent in both English and Spanish, so there are
The clinic has become a gathering place for the com-
few language barriers. Dr. Rodriguez has the HIPAA laws
munity, where individuals and families seek treatments for
translated into Spanish for patients to read and sign, if they
general medical issues as well as mental health issues. After
cannot understand the English version.
meeting with Cristina, a development staff member at the
At the office, patients often complain of a lack of pro-
neighborhood clinic, it was clear how important this clinic
per dental insurance coverage. In fact, Dr. Rodriguez esti-
is for the members of the community. Staff at the clinic
mates that only about 60 percent of his patients have dental
have found that:
coverage. They also speak of the high cost of life in the DC [The clinic] is a first step for folks as they engage after finding
area and time limitations that affect their ability to care for jobs and a safe place to live. Even though coming to the doctor isn´t ne-
their teeth. These are the most common reasons patients cessarily where they want to come, they come [here] because we have a
share with the dentist for not addressing their oral health reputation as a community center, as a safe haven, as a place for informa-
care issues. tion (personal communication, March 29, 2008).
After working in the community for many years, Dr. Generally, patients come to the clinic due to symp-
Rodriguez has noted a correlation between immigrant toms of illness or because they have a requirement to meet,

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Claire F. Selsky. 13

such as needing a vaccine in order to attend public school. Many patients who come to the clinic are not familiar
However, once patients have visited the clinic for the first with Western biomedicine. In fact:
time, what usually brings them back are a variety of chronic Patients, before coming to the clinic, if they were lucky, they’ve
diseases such as diabetes, hypertension, obesity related di- 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
seases and cardiovascular related diseases. here, if they were lucky. If they were to stay in their home country, if they
Diabetes is a grave problem that health providers at were lucky, [they saw a doctor] when they died. And all the other times,
the clinic often see. In fact, they see it disproportionately to when they were sick, they take care of themselves in a number of ways.
the general population. Cristina explained that “Latinos, in 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
general, have higher rates of diabetes than other immigrant [oneself] something (personal communication, March 29, 2008).
groups or other ethnic groups. And in this area, in particu- For the provider, it is crucial to understand that many
lar, in immigrant Latinos, we´re seeing Type II Diabetes in Latino immigrant patients are not familiar with the medical
extraordinary volumes” (personal communication, March setting, and they may associate it with emergencies such as
29, 2008). What this means for patients is an emphasis on birth and death. They also may not understand how pres-
lifestyle change, such as diet and exercise, to help control criptions are filled in the United States. Finally, they may be
the disease. Because of the high rate of diabetes in people used to taking herbal remedies or seeing non-medical com-
who come to the clinic, health providers work hard to try to munity leaders for health guidance.
teach patients how to cook traditional foods in healthier Latino culture teaches patients never to question a
ways, like replacing lard with olive oil (Cristina, personal doctor. For many Latinos, when viewing a doctor, “he’s
communication, March 29, 2008). god, she’s god” (personal communication, March 29, 2008).
In terms of mental health, the vast majority of pa- What this means is that even if a patient does not unders-
tients who come to the clinic are diagnosed with Post Trau- tand directions given by a doctor, he or she may nod, keep
matic Stress Disorder. For Central Americans, this affliction quiet and leave the office confused. For this reason, provi-
is often rooted in the political violent crises of the 1970s ders at the clinic, as one provider commented, “need to
and 1980s. Furthermore, the immigrant experience itself know… how to break down those barriers.” One scenario
can be traumatic. As Cristina states: provided by the staff member is the following:
If you come illegally, crossing the border is extremely dangerous,
[Providers] need to understand that a patient might be taking an
a lot of women get sexually victimized, there are a lot of families that get
herbal remedy and feel like the doctor might think that’s backward, and
split apart. What we see a lot is the mom or dad will come here first,
so they don’t disclose it, but then the herbal remedy might contraindicate
leave the kids at home with Grandma, and five years later when it’s fina-
with the blood pressure medicine that the doctor’s prescribing. If the
lly stable enough to send for the kids, the kids don’t recognize their mot-
provider doesn’t ask the right questions, those things won’t come to light
her, they learn English faster, and there [is] cultural dislocation. If you
and the patient could even get sicker and say, oh this medicine isn’t wor-
were ten when your neighborhood was burned to the ground by govern-
king, I’m never going to going to back to this doctor again (Cristina,
ment troops, you’re not going to be dealing well and you’re not going to
personal communication, March 29, 2008).
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, Providers need to ask questions about use of herbal
2008). remedies in a way that patients would feel comfortable to
According to reports from the health care providers at share such information.
the clinic, most often, patients who come for substance abu- Below is another example of providing culturally
se treatment are addicted to alcohol. At the clinic, health competent health care to the Latino immigrant:
providers use a mental health model in which patients are After September 11, people came to the clinic because it was a
place where they felt safe. Our mental health program swung into action
dually diagnosed. The idea of dual diagnosis for treatment and they started doing these support groups… But in the course of coun-
addiction allows for all behavioral health and addictions seling with this one woman who was from El Salvador, she said, I can’t
needs to be addressed in one setting and for varying mental escape this feeling like I want to go on my roof. I want to go on my roof.
health needs to be seen as related (Foundations Associates, That’s the only place I would feel safe. And if you were not familiar with
2007). For example, excess drinking could be due to depres- 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
sion and/or an anxiety disorder (Cristina, personal commu- her roof? This makes no sense. But our counselor, who was from El Sal-
nication. March 29, 2008). vador, knew that in small villages all the military troops would come on
At the neighborhood clinic, health providers aim to foot, so that place that you would hide to be safe was on your roof. And
provide “culturally appropriate health care.” This approach 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
“means not just speaking someone’s language, but unders- her through that (personal communication, March 29, 2008).
tanding where they come from, where they are and where This example shows that, although immigrants are
they’re going. Their whole socio-economic status and their living in the United States, their previous experiences in
historical context informs [the] type of care”(Cristina, per- their home countries often affect their health experiences in
sonal communication, March 29, 2008). their new location. For this reason, it is essential that health
care providers understand their patients’ backgrounds.
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14 “Just Because You Don’t Have Papers, Doesn’t Mean You Won’t Get Sick”

A final example of cultural appropriateness shows the liarity with Latino culture when treating a Latino patient. In
role of one’s socioeconomic status in procuring treatment: addition, both providers stressed the role that economic
If somebody should take blood pressure medicine and the latest class plays in Latino health care experiences, as it correlates
blood pressure medicine is exactly the right one for them, and it costs 30 with level of health knowledge and ability to acquire health
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- services.
tion, the doctor’s going to think, this patient is noncompliant. There’s this Latinos in the Washington, D.C. area are eager to
judgment that happens in medicine where you intake the patient, you share their experiences and their frustrations with the health
diagnose the patient, and then you give them guidance, and if they don’t care system. Employed by U.S. citizens, these immigrants
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-
are often unknowledgeable about their health rights. Other
ce?… it’s, they’re bad. Or they’re just stubborn. They don’t listen... Pro- immigrants forego care due to economic constraints. Some
viders have to do a lot more investigating, could you pay for a twenty know about health insurance but do not know how to acqui-
dollar pill remedy, or is there a combination of two others medicines that re it. Others are not accustomed to regular medical visits
costs ten dollars that works just about as well? You have to be creative so and seek care only in emergency situations.
that the patient actually could comply with the recommendation. And
that means knowing what is [his] living condition, that means knowing While immigration is a highly debated policy topic
how many people [he is] supporting, what [is his] insurance situation, today, Latino immigrants that are here today have demons-
and really understanding where [he’s] coming from and where [he is] trated a pressing need for health care and health informa-
right now (Cristina, personal communication, March 29, 2008). tion. As Rafael said, “just because you don’t have papers,
As this scenario demonstrates, simply diagnosing a doesn’t mean you won’t get sick.” Health services nation-
patient and writing a prescription is often not enough to en- wide must take the special needs of Latino immigrants into
sure positive health outcomes for Latino immigrants. Ins- account.
tead, cultural understanding as well as attention to socioeco- Educating Latinos must be a priority in health care.
nomic status is required in order to provide patients with Basic health education is especially needed in the areas of
treatment regimens with which they could comply. sexual health and nutrition. In terms of access, this group
The neighborhood clinic is of great value to local re- needs bilingual, culturally appropriate information on obtai-
sidents, for both their physical and mental health. The Lati- ning health services in Washington, D.C. and on how to
no immigrants of Washington, D.C. are fortunate to have a acquire health insurance.
place that understands their backgrounds and their current It is our duty as health providers, researchers and
living situations and aspires to help them improve their fu- community members, to support organizations and provi-
ture health outcomes. ders that cater to educating and providing health services to
Latino immigrants in Washington, D.C. Only when we take
Conclusions and Looking Ahead into consideration cultural, socioeconomic and biological
determinants of Latino immigrant health, can we begin to
The recurring theme among those who came to the create positive health outcomes for this underserved popula-
United States illegally is a lack of access, or perceived lack tion.
of access, to health care, due to social and economic ba-
rriers. While some expressed a lack of knowledge about Acknowledgments
how to acquire health care, others thought that their illegal
status prohibited them from acquiring it. Many immigrants I am deeply grateful to my research participants for
noted the high cost of medicines and medical care, inclu- their generosity in giving me their stories to share in this
ding those with health insurance. article.
More than half of the immigrants who I interviewed I am also grateful to the Lewis N. Cotlow fund of the
left a spouse or child behind in their home countries. In ad- Department of Anthropology at the George Washington
dition, many immigrants came from countries that experien- University for funding my research.
ced horrific civil wars in the 1970s and 1980s (Guatemala, Finally, I thank my M.A. thesis director, Professor
El Salvador). Finally, the immigrant experience itself is Barbara Miller, for introducing me to medical anthropology.
cause for negative health outcomes, both mentally and phy- Her guidance was of great value to me during the research
sically. It is probable that many of the Latino immigrants I and writing of this article. I also extend thanks to Professor
interviewed might benefit from support groups, counseling, Catherine Allen for her support.
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-

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Claire F. Selsky. 15

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