And, believe me, this entire issue is not as simple as it sounds. For the record, even though I work in a border state, we aren’t part of the border health system. I’m in the north, where the vast majority of the population are Hispanics that have been here since the Re-conquest in 1693. They have very little in common with Mexican citizens, even speaking a different dialect of Spanish.
That said, we have a sprinkling of non-citizens. Some passing through, some coming to work here. Some legal. Some illegal. The only problem the illegals give me is they can’t get insurance, are generally dirt poor, and don’t qualify for Patient Assistance programs for medications. Treating their diabetes becomes a game of harm reduction using the $4 Formulary at Wal-Mart.
Now, I hear stories of hospital ERs along the border having to close because they’ve bankrupted themselves serving illegals who don’t pay. I don’t even know if that’s true or not. I’ll bet there are urban ERs in cities with no illegals (if there are any such cities) that face similar cash crisis just from uninsured citizens who are forced to use ERs as their primary care physicians.
I think it is easy for many people to get on a high horse about “illegals” and spout off about refusing them health care and sending them back where they came from. On the surface that sounds only mildly cold, but sensible. If we do not really have the resources to help our tax-paying citizens; how can we justify spending money on people who have snuck in, are breaking our laws, and not paying their way?
But not so fast. The world is not as black and white as all that. It is a million shades of gray, and I want to introduce you to just one. And I’ll call her . . . Maria. That’s not her real name of course.
Maria is now 18, but I’ve know her since she was 14-years-old. When I first met her, she was a chubby little thing with significant acanthosis nigricans on the back of her neck. AN as we call it, signals high levels of insulin, which is suggestive of developing insulin resistance and is probably the only visible warning sign (other than obesity) of developing Type-2 Diabetes. It is a dark, velvety patch of skin, and we generally only see it in non-whites. The poor kid was thinking it was dirt and had been trying frantically to scrub it off for months.
Her blood sugar was already in the pre-diabetes range, but not horrible. We decided to approach her problems with the old fashioned diet and exercise approach as she was not happy with her weight anyway. Just cutting out the Cokes took ten pounds off her in six weeks.
But now, four years after I first met her, Maria is back in my office, skinny accept her belly. Her baby is due in late August, and I’m running what we call an Oral Glucose Tolerance Test, or OGTT on her. I use a super-duper accurate blood glucose machine called a HemoCue 201, which is accurate to within 2% of a lab value, to get a base line fasting blood sugar. Then I force her to drink high-tech Kool-Aid, and retest her at set intervals.
It’s the old-fashioned (but standard of care) way to dx gestational diabetes. The process is time consuming, so it gives me a chance to do some health education of a more general sort—like making sure she’s not doing crack cocaine or sniffing glue while she has a passenger inside her body.
She is telling me that she had applied for a job as a maid at a hotel in Santa Fe, but could that they couldn’t hire her.
Oh really? Why not?
She shrugged, “I don’t have a Social Security card, and with the new laws they won’t hire anyone who doesn’t have one.”
Not putting two-and-two together to get four, I naturally assume her parents for whatever reason didn’t get her a card when she was born, so I say, Why on earth don’t you have a card?
“Ummm… well, I’m not a citizen,” she tells me. She blushes, casts her gaze downwards, staring at her hands in her lap.
No shit. I didn’t know that. Well, you grew up here, didn’t you?
“Yeah. I’ve been here most of my life.”
How old where you when you came here?
So, you’ve been here since, like, first grade?
Do you even speak Spanish?
“No.” She laughs, “well, a few of the ‘bad’ words.”
You and me both!
So the conservative hawks would see this girl deported to Mexico. This pregnant teenager who does not even speak Spanish. This woman-child who did K-through-12 in our schools. This kid whose lived virtually her whole life here.
She didn’t swim across the Rio Grande, or scale a border fence. She isn’t a drug dealer. In fact, she was trying to get a job. A job not too many citizen are interested in having.
Welcome to the real world. Not black and white. Not living color either, but a million shades of gray. A million Marias.
A world that is not as simple as we’d like it to be.