FW: Clinic coverage in the NY Times

[Guest guest]

I thought some of you might appreciate this coverage of the important work that you do!

Cheers,

Lighthall, Ph.D.Research CoordinatorRelational Culture Institute1069 N. FultonFresno, CA 93728530 304-0038 (mobile)david@...

October 7, 2002

A Neighborhood Clinic Helps Fill the Gap for Latinos Without Health CareBy LYNETTE CLEMETSON

ASHINGTON, Oct. 6 — MariBel lives near several good doctor's offices and hospitals, but as far as she is concerned they might as well not be there at all. Her housecleaning and restaurant jobs have never provided health insurance. Few local facilities have Spanish-speaking staff members. Even making an appointment, given her limited English skills, is a daunting, often humiliating, experience.

"They don't understand my language, my culture, my issues," said Ms. , 40, who came to the United States from El Salvador 15 years ago and is now a legal resident. "I would rather wait and see a doctor on a visit to El Salvador than go through that difficulty."

Although Ms. recently got insurance through a new city program for the poor, she prefers to rely solely on La Clínica del Pueblo, a scrappy but welcoming neighborhood clinic in the heart of Washington's Latino community that operates primarily in Spanish and treats anyone regardless of legal status or ability to pay.

In Latino enclaves nationwide, facilities like La Clínica are filling gaps in the health care system that sometimes leave Hispanics feeling shut out. The number of Americans without health insurance rose significantly last year, new census figures show, to 14.6 percent. An estimated 30 to 37 percent of Hispanics living in the United States are uninsured, the figures indicate, the largest percentage of any ethnic group.

For immigrant communities in particular, neighborhood clinics address a number of barriers to health care. The majority of Latinos who are uninsured are working poor, juggling part-time jobs that do not provide benefits. Those in poverty are often barred from aid as a result of 1996 welfare changes, which cut access for new immigrants to programs like Medicaid and the Children's Health Insurance Program.

Some forms of public assistance have been reinstated since 1996, and additional restorations, such as the Immigrant Children's Health Improvement Act, are pending before the Senate. But figuring out who qualifies for assistance in immigrant families, which often have members of varying legal status, is difficult.

Many of those who qualify for aid are afraid to apply, fearful that being perceived as a burden on society will hurt their residency or citizenship applications.

Ms. had all of those concerns when she first used the Washington clinic more than 10 years ago. "I don't know what we'd do without La Clínica," said Ms. , whose entire family has used the clinic for everything from routine checkups to emergency care.

Housed in an old Presbyterian church turned multipurpose community center a few miles north of the White House, La Clínica del Pueblo is not known by many outside the neighborhood.

But ask nearly any neighborhood resident and he or she will automatically point the way — past the street vendors selling fresh sliced mangoes, through the double doors papered with colorful fliers, up the dimly lighted stairway — to the main reception area abuzz with activity.

Started with a volunteer doctor in 1983 to serve the influx of Central Americans into Washington, La Clínica initially was open only on Tuesday nights. Today, with a $4 million operating budget provided by the city and federal governments and by private donors, the clinic operates full time with 46 staff members and more than 100 volunteers, all of whom speak more than one language. Of the roughly 500 patients who file in and out each week more than 90 percent are uninsured.

"We've always had to come through the back door of the health system," said Dr. Romagoza, La Clínica's executive director. "So here we open the door as wide as possible."

Government and mainstream health care institutions are becoming more appreciative of community facilities like La Clínica. Chronic illnesses like heart disease and diabetes are increasing rapidly among Latinos, as are socially transmitted diseases like H.I.V. and hepatitis. Poor access to primary care, health care officials realize, will result in greater long-term costs to the system.

In August, President Bush announced a plan to pay for 1,200 new community health care centers over the next five years.

"It's fundamental to the entire health system, and to the economy, to improve the health status of Hispanics in the U.S.," said Dr. Elena Rios, president of the National Hispanic Medical Association, a Washington-based organization of Hispanic doctors.

One of the programs being expanded by La Clínica and other centers is the "promotores de salud" or "health promoter" program. The program trains community members to be lay health workers who circulate through neighborhoods espousing the benefits of healthy habits and preventative care.

The centerpiece of La Clínica's promotores program is "Domingos saludables" or "healthy Sundays." The once-a-month health fair, usually held at neighborhood churches, offers free blood pressure, glucose and cholesterol testing, nutrition and exercise guidance and counseling on substance abuse, mental health care and H.I.V. prevention.

Rebeca Muñoz, a dental assistant who stocked hospital supply rooms in her native El Salvador before coming to the United States in 1994, works several nights a week as a promotora in H.I.V./AIDS prevention.

"It's not like doctor and patient," said Ms. Muñoz, 49, a soft-spoken wife and mother of four who spends hours at self-service laundries, parks and bus stops talking to people about safe sex and intravenous drug use. "We respect the people, and they respect us. Everyone is just talking in Spanish, and soon people are not afraid. It's like family."

Similar health promoter programs operate in other cities, including Chicago, El Paso and Providence, R.I.

"We've seen that these people have enormous credibility in their communities," said Yanira Cruz, director of the Institute for Hispanic Health at the National Council of La Raza, a Hispanic advocacy agency that is helping La Clínica pay for a new promotores position dedicated to diabetes.

In April, La Clínica received a $900,000 grant from the District of Columbia Department of Housing and Community Development to renovate a 12,000-square-foot facility a few blocks from the existing clinic. Dr. Romagoza is thrilled, but he says the growing support given to clinics such as his does not lessen the need for federal and state agencies and local hospitals and doctors to better serve changing populations.

MariBel could not agree more. She hopes to become a citizen, and, she adds, she intends to vote.

"The politicians, the leaders, they want to ignore us," she said. "They think they can speak a slogan in Spanish and this is enough — but it is not enough for me. They have to pay attention to our issues." In the meantime, La Clínica, she knows, is there.

Copyright The New York Times Company | Permissions | Privacy Policy

[Guest guest]

I will be out of the office until October 14, 2002 and will respond to your

message when I return.