Hispanic immigrants often rely on clinics for health care

COLUMBIA, Mo. -- After five years of repetitive labor in a chicken-processing plant in southwest Missouri, Edilma Pérez can hardly move her wrists without feeling pain.

When Pérez was diagnosed with carpel tunnel syndrome, worker's compensation paid for her first doctor visit. After her second visit, she said, the company let her go. Now, Pérez gets care at the Carthage Community Clinic like most of her co-workers who share the fear of losing their jobs if they collect compensation.

The free clinic is the mainstay of Hispanic health care in Carthage, a town in Jasper County, where the number of Hispanics has more than tripled since the 1990 census.

Before the clinic opened, Hispanics "just didn't get care," said Carol Cooper, director of the clinic.

After three years of operation, the clinic has gained the trust of an isolated population often suspicious of public services, and now 75 percent of the patients are Hispanic. There's just one problem: Its funding is quickly running out.

Throughout rural Missouri, health care for Hispanic immigrants suffers from lack of interpreters, lack of affordable care and lack of finances to do more. In small towns where the meatpacking industry has recruited thousands of Hispanics from the border area in the past decade, their numbers have skyrocketed. The average increase of Hispanics in four rural southwest counties was 800 percent since the 1990 census. A state budget shortfall and dwindling federal funds have rural clinics and hospitals fending off a health-care crisis.

Language a barrier

In a health-care survey of 300 Hispanic families by Missouri Southwest State University, 60 percent said they had poor English skills or none at all. About 40 percent said language was the primary barrier to getting health care; another 40 percent cited cost.

When the influx of immigrants began about five to 10 years ago, many towns only had one or two people who could translate for the hospitals and private doctors. Agencies receiving federal funds such as Medicaid are required to provide interpretation services under the Civil Rights Act of 1964. In 2000, President Bill Clinton tried to push greater enforcement through an executive order requiring providers to have written policies on Limited English Proficiency (LEP) services.

Now, most hospitals officials say they have some form of interpreter services, whether they use volunteers, bilingual staff or interpreter hotlines. The question is quality. In a survey of 13 hospitals in mid-Missouri conducted by Adelante, a bilingual newspaper in Columbia, 11 hospitals said they do not have training for interpreters.

Without training, interpreter errors are more prevalent and can lead to dangerous misunderstandings, such as taking wrong dosages of medication. Just one word translated wrong can mean the difference between life and death.

Such was the case for a St. Louis woman, whose bilingual relative told her she had six months to live. The doctor had actually said she needed to return in six months for a visit. Maria Smith of the U.S. Department of Health and Human Services, Office for Civil Rights, cited this case as an example of what can happen when family members are used as translators.

In the southwest survey, 30 percent said they never had an interpreter when they went to seek health care; 60 percent said only sometimes.

Hospitals as well as doctors are penny-pinching on translators by overworking bilingual employees.

Monica Montalvo, a former blood specialist at University Hospital in Columbia, grew frustrated at the translation problems she saw during her 7 1/2 years at the hospital. Many times, she would work late to interpret voluntarily, when she couldn't fit it into her day. She ended up leaving her job last year. She knows of cases in which children have been used to interpret for their parents.

"What happens if that mother had to say something very personal?" she said. "Her child should not be hearing that."

Jeff Hoelscher, University Health Care spokesperson, said hiring an on-staff interpreter would be optimal, but it's not feasible financially. For now, they call interpreters on a case-by-case basis.

Not providing interpretation services is a civil rights violation, said Fred Laing Office of Civil Rights regional manager. Since the LEP policy was issued, only a scant handful of complaints have been filed in Missouri, said Laing.

Although Maria Smith said she hears concerns from Latino communities, the people are reluctant to file a complaint because it would cause them problems. Cheri Heeren, director of the Pettis Community Partnership in Sedalia, said she chose not to file a complaint against two physicians who refused to pay for the partnership's interpreter services.

"People didn't want to make waves," she said. "We have to work with these people on a daily basis."

In emergency cases, interpreters are crucial. In May 2000, five Mexican immigrants in Osage Beach, victims of a car crash, found themselves in the emergency room surrounded by nurses and doctors who could not understand them.

The Lake Regional Health System staff did not have an interpreter other than one woman who was in the accident.

Since that time, the hospital has hired bilingual employees and extended the list of translators, said Vicky King, CoxHealth spokeswoman. But translation problems aren't the only ones that face emergency room personnel. Throughout rural Missouri, immigrants are flooding the emergency rooms. Around the country, hospitals are experiencing million-dollar deficits because of the high emergency bills for uninsured patients, among them immigrants.

Federal law says undocumented immigrants cannot receive public-money services, like Medicaid, except in the case of emergency or pregnancy. Because immigrants cannot see a doctor when the illness is in its early stages, they go to the emergency room when the case is at its worst point, said Greg Johnson, CEO of the nonprofit hospital Cox Monett.

"The Latino community is providing a service to Monett, and it's unfortunate that they can't access our health care system," Johnson said.