Undocumented And Uninsured: The Cultural Implications Among Latinos At Hospitals During COVID-19
Ana Chagoyán lost her 40-year-old brother Juan from what a Charlotte hospital says was COVID-19 pneumonia. Before Juan's death on July 20, Ana said, her 57-year-old mother was in critical condition with COVID-19.
"We are desperate because, well, with my brother’s death, my sick mother, with small children, with bills that we have to pay, it is not easy," she said. "It’s just not easy."
At least eight of 10 members of the Chagoyán family, all living under the same roof in the Cabarrus County town of Midland, either showed symptoms or tested positive for the coronavirus.
But Juan was hospitalized for a stroke, not COVID-19. The family believes that based on Juan's listed cause of death, he was only properly treated for his COVID-19 diagnosis and not for the effects of the stroke.
Family members were under a strict quarantine order by Cabarrus County, so they weren’t able to see him or interact with hospital staff in-person when Juan was hospitalized. They say the hospital, Carolinas Medical Center, wasn’t straightforward about Juan’s actual condition. His records show that after the stroke, he was 85% disabled and would never be the same, but the family members say they never knew.
In an email, a spokesperson for Atrium Health, which operates the hospital, shared the following statement:
"At Atrium Health, patients are treated by healthcare providers according to their individual medical needs. Patients come into the emergency department with many different signs, symptoms, conditions and diagnoses. Each patient’s healthcare provider makes the determination as to the appropriate way to treat that individual patient. Due to privacy restrictions, we are not able to discuss details of particular patients nor their care."
The medical community has been outspoken about the dangers facing Latinos and those in the country without legal status during the coronavirus pandemic, including Dr. Viviana Martínez-Bianchi, a member of the COVID-19 advisory team for historically marginalized groups at the North Carolina Department of Health and Human Services.
“There are a lot of inequities that the pandemic has unmasked in access to health, as well as education, as well as socioeconomic status, like the type of essential work they do,” she said.
Martínez-Bianchi says she’s heard of cases of hospitals and clinics refusing care for Spanish-speaking patients with COVID-19 symptoms because of communication barriers. She confirms that there have been no official reports and, therefore, the department has no cases to investigate.
“(If) they're being rejected without being seen, we need to learn about it so that we can do something about it,” Martínez-Bianchi said.
Outside of her work with the state health department, Martínez-Bianchi is a doctor at Duke Family Medicine. As a health scholar, she researches issues of health equity within her own health system and across the state. She’s found that one of the hardest things for Latinos to do is self-advocate in the hospital. This became even harder because of the pandemic: Many COVID-19 restrictions don’t allow for family or advocates to be with patients.
Before the pandemic, more than any other group, North Carolina Latino adults were less likely to see a doctor because of cost and lack of insurance. And those are just the financial barriers.
Martínez-Bianchi says health care systems need better interpretation services because there are still limitations in how people are being understood in hospitals, especially during emergency room visits. In the last decade, there’s been a push for translators shifting from just being language interpreters to also being experts on cultural differences.
The Chagoyán family’s attorney, Melissa Hordichuk of the Access to Justice Project group in Charlotte, says there are organizations like hers that try to advocate for marginalized groups in health care, but it’s become harder to achieve due to the pandemic.
“If you don't speak English and you're an undocumented immigrant, the preexisting mechanisms there were for advocates don't really exist now because of COVID,” Hordichuk said.
Vanessa Cruz Nichols, a political science professor at Indiana University, studies political factors that impact immigrants' relationship with health care. She agrees that if hospitals hired more health care workers that reflect the communities they serve, there’d be less inequity among immigrants and other marginalized groups.
“They have to be reassured that their information is going to be secure and that of their family members, especially if they're undocumented,” she said. “Latinos (may) then feel comfortable seeking help from health care providers and establishing a good relationship there.”
But Cruz Nichols also says the underlying cause is the United States’ history of aggressive immigration policies and policing.
“The way in which police interact with people in the community is going to spill over into other ways in which people interact with other forms of authority in their county and their state,” she said. “They're very much intertwined.”
Juan’s niece, Joseline Gonzalez, said her uncle was reluctant to go to the hospital because of the fear that his immigration status, his inability to pay and lack of medical insurance would play a role in the quality of his care.
“He was scared to go to the hospital because he’s like, 'They’re gonna kill me! They’re gonna say I tested positive!'" she said.
Juan was confirmed positive for COVID-19 at Atrium Health, but the test he took just before his stroke through Novant Health came back negative.
Cruz Nichols said immigrant communities tend to be more reluctant to make health care appointments and also less trusting of doctors and health care officials because of the political context that, she said, treats them in a hostile manner.
In contrast, the state health department is asking members of the Latino community to self-advocate — that is, to report any difficulties they have with health care systems due to a language or cultural barrier, and whether medical care was denied at all. Martinez-Bianchi says culturally, Latinos may see this as questioning authority, which isn’t common practice, especially among the older generations.
Martínez-Bianchi hopes that the issues exposed by the pandemic will serve as a catalyst for the Latino community to strive for systemic change in health care and beyond.
“We have to organize as a community so that changes occur not only during the pandemic but long-term so that we do not continue to suffer these inequities,” she said.
It’s also important to note that the average American has little expertise about the ways hospitals work to begin with compared to clinicians and hospital staff. So language barriers and cultural differences make that even harder for the Latino community.
By the end of August, Latinos still represented a little over a third of all recorded cases of the coronavirus in North Carolina.
This article is the second in a two-part series that explores how the Latino, Spanish-speaking and undocumented community has been affected by the coronavirus pandemic in North Carolina through the story of the Chagoyán family in Midland. Part 1 can be found here.
A Spanish version of this story is available on La Noticia.
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