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(en) The Utopian #2 - Reaching Out to a Challenging Community - by SANDRA YOUNG

From Worker <a-infos-en@ainfos.ca>(http://www.utopianmag.com/)
Date Sun, 13 Oct 2002 03:16:50 -0400 (EDT)


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Imagine that you are fifteen years old and pregnant. You
find yourself in a country where you share no common
language. You have never seen a health care provider in
your life. You know that you want your baby born healthy,
and born a citizen of this new country. So you make your
way to a clinic, where strangers ask you all kinds of ques-
tions you don't understand about a "medical history" you
do not have, make you take off all your clothes and touch you
in very intimate ways. Now imagine being that health care
provider.

Las Islas Family Medical Group in Oxnard, California, 40
miles northwest of Los Angeles, is a county-based commu-
nity clinic which sees some 1,200 patients per month. Our
ten physicians and three Family Nurse Practitioners pro-
vide medical care to an agriculture-based community with
a large monolingual Spanish-speaking population.

We have long prided ourselves on our ability to provide
respectful quality medical care to our patients who are
often lacking in educational skills and financial resources.
Recently, however, the rapidly growing Mixteco population
in our county has challenged our complacency.

The Mixteco are an indigenous people of southern
Mexico, mostly the state of Oaxaca. Their existence as an
organized community in that area predates Europeans by
over 2,000 years. Since the conquest by Europeans in the
sixteenth century, the Mixteco and other indigenous
groups have been marginalized into the least fertile, hilly
areas of Oaxaca. Subsistence farming was subdivided into
smaller and smaller plots as the indigenous population
grew. Massive deforestation of the area by the Mexican
lumber industry in the first half of the 20th century
turned huge areas of Oaxaca into non-farmable wasteland.
At the same time, large agricultural interests in both Baja
California and the United States began to court indige-
nous groups as a new and easily exploitable cheap labor
source. It is estimated that some 300,000 inhabitants of
Oaxaca, mostly indigenous peoples, have migrated over
the last thirty years to other parts of Mexico and the U.S.
The Mixteco make up a large part of these emigrants.

I had visited Oaxaca several times to enjoy the richness of
the agricultural ruins, artisan handcrafts, and to attend the
spectacular "Guelegetza," an annual outdoor dance festival
which features the music and dancing of all the region's
indigenous groups. From these travels, I had a rudimenta-
ry understanding of the area and its history. So I was
pleased but surprised when I first began to identify
Mixteco patients at the clinic. After all, it's a 3,000-mile
journey. Over the last year, the number of Mixteco-speak-
ing patients has risen dramatically.

It is estimated that Ventura County now has at least 5,000
and perhaps 20,000 people for whom Mixteco is their pri-
mary language. Many of these people are monolingual--
they do not speak Spanish, let along English; most have
never had medical care before in their lives. We see them
primarily for prenatal care. (In California, all pregnant
women may apply for Medicaid, whether they are legal res-
idents or not.) It often takes them months before they are
able to navigate the system, so we see them late in their
pregnancies. Often, they do not know their month of con-
ception. If there have been previous births, they are likely
to have been at home, without a known birth weight.

The Mixteco as a rule are very small people, so our stan-
dard measurements are not really appropriate in accessing
fundal height, expected weight gain, etc. Most are field
workers who continue to work into very late pregnancy to
be able to afford their rent. Most have inadequate nutri-
tion and housing. The majority cannot read or write in
any language. And there are several dialects within the
Mixteco language, so that not all of these people can even
communicate with each other.

As the details of this picture started to emerge, it became
clear that we needed to develop a whole new system to
bring these patients into the health care network. After
getting the green light from my clinic's medical director, I
started to publicize a community meeting, where we could
begin to explain to people how to access community
resources and the importance of regular and early prenatal
care. Our clinic's prenatal educator and my medical assis-
tant helped to get the word out. I solicited donations (like
ten cans of menudo), so at least we could give people a
good hot meal.

Our first real breakthrough came when a registered nurse
who works in a maternal-child health program called to
say that not only would she like to be part of the organiz-
ing effort, but that she knew a community organizer who
spoke fluent Mixteco and Spanish. Antonio works with a
group of lawyers who are helping migrant workers attain
legal rights, and who received a grant from the U.S. Census
Bureau to help get Mixtecos counted for the 2000 census.
He agreed to join forces with us and translate from
Spanish to Mixteco for the meetings.

Our publicity for the meeting was mainly word of mouth
within our own clinic. I was thrilled when twenty-five peo-
ple jammed into our little billing office and Mixteco
Community Organizing Project was born.

Two months later, the successes are great and the chal-
lenges greater. We've involved some sixty families in our
meetings. By and large, our patients show up for their pre-
natal care visits and are having healthy
babies in the hospital. Most continue on
with the clinic for well-child visits and fam-
ily planning services. We've already had to
change the name of our meetings from
"Reunión Mixteca" to "Reunión Indigena"
as families from other southern Mexican
indigenous groups have joined us.
We now have a part-time employee at Las
Islas who speaks fluent Spanish and
Mixteco. She is proving to be a tremendous
asset in communicating with our patients
and demonstrating our commitment to
serving their needs.

The barriers are still incredible. Transporta-
tion is a huge issue. Getting to the clinic
usually involves walking or taking the bus.
("Lucky" patients who can get a ride may
be dropped off at 7 a.m. and picked up at
4.) We are using a County-sponsored taxi
voucher program to get patients in labor to
the hospital, but this involves a lot of time
spent in teaching patients how to use the vouchers.

It is difficult to stay in contact with our patients. Many
don't have phones, change addresses often, and leave the area
for months out of the year when local employment is scarce.
We need to build our "necessities of life" program. The
small amount of food and clothing we are able to provide is
far from adequate. Fortunately, as each day goes by, some-
one new comes to  donate time or resources. Our hard-
working clinic staff keeps finding new and better ways to
communicate and teach.

Our short-term goals include enlisting some of our fami-
lies in a Public Health program, which will train people to
go into their own communities as public health promoters.
Those who are recipients of help now will be the leaders in
providing help to the newly arrived in the future. We need
to learn more about the Mixteco culture, language and
beliefs to be able to provide respectful quality medical
care. We need to form links with other immigrant commu-
nities in California, Oregon and Washington to ensure
continuity of care to the immigrant population.

The work is enormous. But the potential benefits to the
entire community--English-, Spanish- and Mixteco-speak-
ing--are enormous also. Quality health care, living wages,
decent work and living conditions, mutual respect and cel-
ebration of diversity are the bases of a strong and stable
community. It's my hope that we are taking the first baby-
steps towards those ends.


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