LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Thursday, June 17, 2010

Illegal aliens

I’m guilty of viewing everyone as a citizen of humanity. I don’t give much thought to nationality. But this thing in Arizona brought the whole citizenship concept bubbling up to the top of my frontal cortex over the last few weeks.

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?

“Kindergarten, actually.”

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.


Blogger Scott said...

"The world is not as black and white as all that. It is a million shades of gray ..." to which I would just respond by noting a favorite quote from one of my least favorite people, radio talk-show host Dr. Laura Schlessinger, who has stated "When you're the victim of the behavior, it's black and white; when you're the perpetrator, there are a million shades of gray." It always adds a different perspective, we can only hope!

8:28 AM  
Blogger Kassie said...

...and when you're neither victim nor perpetrator you have to choose how you see it. I think we could benefit on this issue from seeing more shades of grey, but mostly I think we could benefit from remembering people like Maria. thanks for sharing her story.

10:11 AM  
Blogger Nancy said...

This is a great perspective. The whole "illegals" issue... clearly there's no easy answer. To so many people, it's easy to just suggest blanket solutions - kick 'em all out (not compassionate toward stories like this or the ones I've heard of families having to choose to put money toward keeping their car functioning - which they need to get to the job where the employer doesn't care if they're legal - or paying for the citizenship process - ugh, to have to make choices like that!) or give 'em all citizenship (NOT wise at all). I think Arizona has the right idea - it just needs to be tempered with some common sense and judgement.
As my Puerto Rican friend keeps reminding me, other nations around the world - Europe, Asia, etc - expect you to carry papers and be able to explain what you're doing there. We have a country to protect too.

10:55 PM  
Anonymous James Kildare said...

suffer from a chronic disease that is the back pain and I have already four years living with it, it's hard to say but the pains are intense and I have an 8 year old son asking if I can recover and get out of my bed to go for a walk with them park as a family ...

10:03 AM  
Anonymous Sysy Morales said...

Man...thanks for this post. We need reminders like this these days. I'm tired of all of the ignorance out there regarding this issue. So thanks for making us think a little broader.

3:32 PM  

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