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Emergencia Médica: Dealing with health care can be the real pain for immigrants 

Latinos -- legal or illegal -- have the smallest proportion of people with health insurance

When Roberto Boyzo's friend refused to see a dentist for a nagging tooth problem, Boyzo was concerned but not surprised that his friend would postpone seeking dental care until the next time he returned to his native Mexico.

"I said, ‘Really?'" recalls Boyzo, a 40-year-old Mexican immigrant who lives in Bellevue. "‘You'll deal with all of that pain?'"

For many Hispanic immigrants -- both legal and illegal -- the pain is often more tolerable than the cost of medical care, the frustration of being misunderstood by doctors and the fear of being asked to fill out documents. 

"People are scared," Boyzo says. For Latinos, going to the doctor "is hard and complicated."

Allegheny County is home to nearly 20,000 Latinos. But according to public-health researchers and local Hispanic community leaders, their access to health care is limited at best. 

The obstacles they face -- socioeconomic, language, cultural -- leave many relying on free or low-cost health clinics, which don't require health insurance and which employ Spanish-speaking doctors and nurses. However, even those clinics don't always attract illegal immigrants wary of facing personal questions that could reveal their undocumented status.

In 2008, Dr. Patricia Documet, a professor of behavioral and community health sciences at the University of Pittsburgh, published a report analyzing the health-care access of Latinos nationwide and in Southwestern Pennsylvania. The report revealed that 34 percent of Hispanics in the U.S. did not have any health insurance, compared to 13 percent of whites and 21 percent of blacks. 

Closer to home, 38 percent of Latinos living in Southwestern Pennsylvania were uninsured. Additionally, the report stated, nearly 23 percent had not seen a doctor within the past year. 

"Latinos -- legal or illegal -- have the smallest proportion of people with health insurance," says Documet. 

According to Jane Delgado, president and CEO of the National Alliance for Hispanic Health, most Latinos work in industries that don't offer health benefits. But because they're working, she says, they don't qualify for public health assistance.

As a result, they're faced with a dilemma common to many Americans: Buy costly private health insurance or simply pray that you don't get sick or injured. But, Delgado says, that's easier said than done when you're working as a dishwasher or landscaper making little more than minimum wage, as is the case with many Latinos. 

"A lot of [Latinos] want health insurance," she says. "But they can't afford it."

Take Boyzo, for example. He works at a restaurant on the North Side, where he earns roughly $500 every two weeks. Even with the added earnings of his employed wife, he says it would be too expensive to afford, say, a $700-per-month family health-insurance plan to cover his wife and kids.

"The prices are too high," he says.

But even after Latinos jump over the health-insurance hurdle, Delgado says, they still face a health system "that doesn't know how to handle Hispanics," especially when it comes to language and culture.

 "There's really not that infrastructure there for people who don't speak English," says Andrea Kamouyerou, Latino outreach specialist at the Consumer Health Coalition.

Filling at least part of the void is Salud Para Niños, a Spanish-language health clinic run by Children's Hospital of Pittsburgh. Created in 2002, the clinic offers bilingual pediatric care and immunizations for both the insured and uninsured. 

"You want to speak the same language your provider speaks," says Dr. Diego Chaves-Gnecco, director of the bilingual program. "If you have language barriers, that can result in medical errors."

Salud Para Niños operates three times a week in its Oakland office, caring for insured patients who make appointments ahead of time. But once a month, the program also cares for uninsured patients at the Birmingham Clinic, on the South Side.

According to Kamouyerou, the Birmingham Clinic is one of just a few free or low-cost health clinics in the area that serve uninsured patients, many of whom are Latinos. "It's the only option outside of the [emergency room]," she says, noting that Catholic Charities, Downtown, also offers free or low-cost health care. "But there are often long waiting lists for those services."

Missing from those waiting lists, however, are many illegal immigrants who fear that a trip to the doctor could end in deportation.  

Victor Diaz, CEO of the Pittsburgh Metropolitan Area Hispanic Chamber of Commerce, says undocumented immigrants "rarely go to a doctor" because they worry about what kinds of questions they will be asked. He says the argument that illegals are taxing our nation's health system by receiving an abundance of free medical care is "preposterous."

"For an undocumented immigrant to go to the hospital, it's got to be pretty bad," Diaz says. "They're afraid. The last thing you want to do is put yourself in a position where you're going to be asked questions or have to fill out documents."

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