Category Archives: Immigrants and refugees
Michael K. Gusmano is a research scholar at the Hastings Center in Garrison, New York and former president of the American Political Science Association’s Organized Section on Health Politics and Policy. After completing his PhD in political science at the University of Maryland at College Park, Gusmano was a Robert Wood Johnson Foundation (RWJF) Scholar in Health Policy Research at Yale University from 1995 to 1997.
The nation’s 11 million undocumented immigrants constitute a “medical underclass” in American society. [1,2] Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA) of 2010, because they are not “lawfully present” in the United States.  Federal health policy does provide undocumented immigrants with access to safety-net settings, such as an acute-care hospital’s emergency department (ED), or a community health center (CHC). Since 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) has required that all patients who present in an ED receive an appropriate medical screening and, if found to be in need of emergency medical treatment (or in active labor), to be treated until their condition stabilizes. CHCs such as Federally Qualified Health Centers and other nonprofit or public primary care clinics serving low-income and other vulnerable populations trace their origins to health policy that includes the Migrant Health Act of 1962. 
Faith Ikarede Atte, RN, MSN, is a Future of Nursing Scholar studying for her PhD at Villanova University, supported by Independence Blue Cross Foundation. The Future of Nursing program is a project of the Robert Wood Johnson Foundation.
There are things in life so personal and private that when one vocalizes them, there is fear of being judged. It was eleven years ago that I had a personal encounter with myself. It is admittedly odd to look back at the path that I have walked on, now overgrown and distant—yet still so close to my heart.
Eleven years ago is when I lost a sense of who I was in the eyes of society, and I had to look within myself to find my footing. It is during this time that I had arrived from Kenya, full of vigor, light spirited and quick to laughter. I was hungry for knowledge and the sky was the limit.
Little did I know that life was about to teach me a lesson. It became obvious to me that my accent was different. Most immigrants can identify with the situation of being different. The more I spoke, be it in class or in a group of people, the more I felt isolated due to reactions like, “What did you say? Speak up. Your accent is too thick. I don’t know what you are saying.”
Seth M. Holmes, PhD, MD, is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program and an assistant professor of public health and medical anthropology at the University of California, Berkeley. The following is an excerpt from his recently published book, Fresh Fruit, Broken Bodies: Migrant Farmworkers in the United States.
“The first Triqui picker whom I met when I visited the Skagit Valley was Abelino, a thirty-five-year-old father of four. He, his wife, Abelina, and their children lived together in a small shack near me in the labor camp farthest from the main road. During one conversation over homemade tacos in his shack, Abelino explained in Spanish why Triqui people have to leave their hometowns in Mexico.
In Oaxaca, there’s no work for us. There’s no work. There’s nothing. When there’s no money, you don’t know what to do. And shoes, you can’t get any. A shoe like this [pointing to his tennis shoes] costs about 300 Mexican pesos. You have to work two weeks to buy a pair of shoes. A pair of pants costs 300 Mexican pesos. It’s difficult. We come here and it is a little better, but you still suffer in the work. Moving to another place is also difficult. Coming here with the family and moving around to different places, we suffer. The children miss their classes and don’t learn well. Because of this, we want to stay here only for a season with [legal immigration] permission and let the children study in Mexico. Do we have to migrate to survive? Yes, we do.
For nearly 25 years, Robert Wood Johnson Foundation Community Health Leader Carmen Velásquez, MA, has helped members of Chicago’s immigrant community access the health care they need. She founded the Alivio Medical Center in 1988, which has now grown to six locations that serve 25,000 patients annually. Two more clinics are slated to open later this year.
In recognition of her work, Illinois Governor Pat Quinn proclaimed October 2, 2013 “Carmen Velásquez Day.” At an event celebrating Latino Heritage Month at the National Museum of Mexican Art in Chicago, Quinn called Velásquez “a true pioneer in public health policy and health care affordability.”
“As the immigrant population in the Pilsen neighborhood grew in the 1980s, Carmen Velásquez was among the first to see the crying need for a health clinic, so she went out and built Alivio Medical Center,” he said. “Hundreds of thousands of Illinoisans are alive today thanks to her, proving that one person truly can make a difference.”
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other critically important nursing issues. These are some of the stories in the August issue:
Nurses Advocate for Health System Change
Like so many others, nurses, too, have bad personal experiences with the health care system—but several RWJF Scholars have turned those challenges into efforts to make positive change. They are using their experiences with violence, bullying, poor care coordination, and other health problems to advocate for more access, better care, and other reforms.
Nurse Leader Combats Cancer Among African Immigrant Women
After a difficult experience trying to get care for her mother, RWJF Community Health Leader Ifeanyi (Ify) Anne Nwabukwu’s eyes were opened to the difficulties immigrants face accessing health care in the United States. Nwabukwu founded the African Women’s Cancer Awareness Association, which aims to address disparities in awareness, prevention, and access to quality health care services. The Association opens its doors to all people, but targets African immigrant women, and especially those who are underserved or uninsured.
A Fast Track to Bachelor’s Degrees in Nursing
A new initiative designed to ease the transition between associate and baccalaureate degree nursing programs opened its doors to its first class of students this summer. Based at the School of Nursing at California State University, Los Angeles, the program enables students with associate degrees in nursing to earn baccalaureate degrees in nursing in 12 months. Supporters say the program will eliminate redundant coursework, enhance diversity in the nursing workforce, and help develop more nurse leaders.
Human Capital News Roundup: Emergency room use, immigration, helping youth think about the way they think, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
A new report that provides the first comprehensive assessment of the nation’s public health nurse workforce finds public health nurses have very high levels of job satisfaction, but concerns about job stability and compensation. The report also finds that public health departments struggle to hire nurses and fill vacancies. Among the outlets to report on the findings: Nurse.com, Fierce Healthcare, and HealthLeaders Media. Read more about the report here and here.
Patients with low socioeconomic status use emergency rooms (ERs) more often than primary care because they perceive ERs to be more convenient, less costly and of better quality, according to a study led by RWJF/U.S. Department of Veterans Affairs Clinical Scholars program alumna Shreya Kangovi, MD. Among the outlets to report on the findings: Kaiser Health News’ Capsules blog, Health Day, and Health Canal. Read more about the study.
The U.S. Supreme Court’s recent decision to overturn a 2003 federal law that prohibited government-funded clinics from serving sex workers was also a smart public health decision, Celeste Watkins-Hayes, PhD, recipient of an RWJF Investigator Award in Health Policy Research, writes in a blog post for The Atlantic. “These providers grapple with how to keep all populations safe, not just those engaging in legal and socially desirable behavior,” Watkins-Hayes writes. “As a result, the very people who need the most access to HIV preventive and treatment measures may not receive them … [not] allowing them to take a neutral stance that allows them to focus first and foremost on risk reduction … is counterproductive in the fight against HIV/AIDS and other sexually transmitted diseases.”
This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Thomas Tsang, MD, FACP, is a former Senior Advisor to the Governor, State of Hawaii and alumnus of the RWJF Health Policy Fellows program.
Last week, the Supreme Court upheld the Affordable Care Act (ACA) and ruled that the individual mandate is constitutional. As I reflect upon the positive impact of the Supreme Court decision on the tens of millions of Americans who are uninsured and have no access to affordable care, I reflect also on how my own family could have benefitted from legislation like this two decades ago and how my parents’ health status may be different.
We were the classic immigrant story. We emigrated from Hong Kong in the early 70s with the notion that things would be better in America. My father worked 14-hour days, six days a week as a cook at a Chinese restaurant in suburban New Jersey. The eight of us had no health insurance for close to 20 years. My family did not qualify for Medicaid, and paid for medicines and doctor visits as needed.
Things were fine until my parents reached their late 50s. They were diagnosed with one chronic disease after another because signs and symptoms had appeared that forced them to seek medical attention. First, it was hypertension, then diabetes, then heart disease and ultimately renal disease. We were fortunate that none of us had a life-threatening condition that required acute hospitalizations when we did not have coverage. By the time my parents qualified for Medicare, they each had accumulated at least three chronic conditions and were taking at least six or seven medicines.
Aside from paying for their own medical problems, they needed to pay for the medical care for their six children—visits for dental care, vaccinations, strep throats, food poisoning, high fevers plus the occasional antibiotic shots that my mom requested each time from the pediatrician. My parents had neglected their own medical needs at times in exchange for housing, food and clothes for the eight of us.
I wonder, what if they had access to basic primary preventative services, screenings or physicals when they were 40s or 50s? What if they had subsidies and if their employers had access to affordable plans in a health insurance exchange? Maybe their diabetes and hypertension could have been controlled enough to prevent the nephropathy or the congestive heart failure?
The restaurant where my father and brother worked simply did not make the margins to afford health insurance for their employees. They operated on margins of three to five percent at best. Similarly, my sister who worked in a sewing factory in Chinatown had no insurance until she switched to a manufacturing-job in the suburbs of Philadelphia in her late 50s. Like our parents, she entered the Medicare program with at least two chronic illnesses and four medicines.
The last four years, I worked on the health care reform legislation on the congressional level, implemented parts of it as part of the Department of Health and Human Services and most recently worked on a health care transformation agenda for the State of Hawaii. I am astounded at the how penny-wise and pound-foolish opponents of the Affordable Care Act have been. A study conducted by the Commonwealth Fund in 2009 concluded that the uninsured cost Medicare an average of $1,000 per beneficiary, because they have higher rates of heart disease, diabetes and joint problems compared to those with insurance.
The cost of our health care system is now $2.9 trillion, and close to 18 percent of our Gross Domestic Product. It is unsustainable for American businesses including many of the small businesses such as the ones my father and sister worked in.
The Affordable Care Act offers a glide-path for the delivery system. It pivots us to a path of rehabilitation that will give 30 million Americans access to basic benefits offered in insurance exchanges with tax subsidies. The delivery system innovations such as Accountable Care Organizations supported by holistic payment policies would move us away from the fee-for-service treadmill, improve on quality and likely trigger new innovations for greater efficiency and value.
As the law is implemented over the coming months, the framework of Meaningful Use (from the HITECH Act of 2009) is put in place, and patient-centered delivery system redesigns spread, I feel a sense of hope and order that things will be on the mend. The ACA is far from perfect, but now the country can start healing together and work on finding better solutions for future generations who believe that life is indeed better here in America—as my parents and I still do.
Alfredo Quinones-Hinojosa, MD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program. He is director of the brain tumor program at Johns Hopkins’ Bayview campus, and an associate professor of neurosurgery and oncology at Johns Hopkins University. Read more about Quinones-Hinojosa here.
Human Capital Blog: When you came to the United States, you started as a migrant worker and worked your way up to the renowned brain surgeon you are today. Why did you choose brain surgery?
Alfredo Quinones-Hinojosa: A lot of times, especially when I first came to Johns Hopkins, patients sensed that I had an accent and I didn’t fit the stereotype of a brain surgeon. Sometimes comments came out of their mouths that would really upset my staff. But at the end of the day we’re all the same. No matter how different we are from one another, our brains are all the same. The same beautiful color, same shape and size. I can’t tell the difference between brains of different races, religions or classes.
Brain cancer is dangerous and devastating. I believe it’s a horrendous disease that affects the most beautiful organ of our body. That’s why I dedicated my life to try to find a cure. I don’t know if I’m going to find a cure but I‘m going to give it my best. I want to give my patients hope by knowing there’s someone like me who has made his life purpose to try to find a cure.
HCB: You recently published a book titled “Becoming Dr. Q: My Journey from Migrant Farm Worker to Brain Surgeon.” What inspired you to write the book?
Quinones-Hinojosa: A lot of people have written about me – journals, magazines, newspapers – but I don’t think they get me. They get excited about my past, which I am very proud of and clearly it’s the reason I am who I am today. But the book is really about my present and the future, what’s really exciting about my life. The book talks about how I battle life and death every day inside and outside of the operating room, and my own experiences and brushes with death – some that I’ve never told anybody before. And I relate all that to my experiences with my patients, and what it’s like to battle brain cancer. I am in the business of giving hope. I dedicated the book to my patients and their families and all those people who believe in me, who have given me an opportunity to do what I do today. They trust me with the life of their loved ones and their own lives, and I thank them and my family for being right next to me during these adventures.