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Putting a Face on the Invisible

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Topics in Health: Lessons From The Field

Putting a Face on the Invisible

Reporting on Health in Undocumented Communities

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Federal health reform will leave out California's two million undocumented immigrants, a dilemma for multi-status families like Norma Navarro's. Her 7-year-old son Angel is a citizen, but her 10-year-old daughter Aneth is not, meaning they'll have significantly different health care experiences. Photo by Brian Myers, Media Arts Center San Diego

Benita and her siblings rarely returned to their neighborhood park after they saw the park rangers. They looked too much like police officers and her parents were afraid they’d be arrested. Alma drove in short bursts over San Antonio’s hot asphalt, mostly to pick up her son from elementary school and to her job cleaning homes. Enrique Bahena drove across San Diego to a free clinic far from his neighborhood so he could get care without sharing his name, address or phone number.

The cloud of fear that undocumented immigrants live under on a daily basis colors huge parts of their lives. And not surprisingly, it can affect their health. In the U.S., undocumented immigrants can find care in community and charity-care clinics, and undocumented women can get prenatal and delivery care through Medicaid. Undocumented immigrants are recipients of most of the $2 billion the U.S. spends every year on emergency Medicaid, which goes to people who need emergency room care and don’t qualify for any other insurance. And they pay about $15.75 billion to Social Security through use of false Social Security numbers. That money goes in to a so-called earnings suspense fund and is deposited into the Medicare trust fund. Generally speaking, undocumented immigrants can receive emergency room care and, if they live in a city with a network of clinics, can get primary care. But if they need specialty care—say, if they have cancer, kidney failure or birth defects—they are out of luck. If they live in a rural area without many clinics, they are similarly on their own.

This is . Undocumented immigrants are excluded from expansion of Medicaid and don’t qualify for subsidies under the law’s new health care marketplaces. As part of the ongoing discussion of immigration reform, some Republican members of Congress have suggested that undocumented immigrants should, however, be beholden to the individual mandate, which requires every American to have health insurance or face a tax penalty. Some versions of the reform bill would require them to have unsubsidized private health insurance for 15 years before they could be eligible for either Medicaid or subsidies under the marketplaces.

Most of this I didn’t know before I started working on my project on health care for undocumented immigrants for the Dennis A. Hunt Grant for Health Journalism, through the California Endowment and USC. I had a sense that this was a shadow part of the health care system. How did people find care? Who provided it? Were they demonstrably sicker because of barriers to care?

And, perhaps most pressing to me as a reporter, why would any undocumented immigrant talk to me? If I were them, I concluded, I wouldn’t talk to me.

This was the daunting thought I faced as I embarked on this story. I only speak English. I’m a middle-class white girl from San Francisco, and I was keenly aware of the power imbalance. If their name appeared in my article, I feared, someone could be deported.

So I faced two challenges: One, how to find undocumented immigrants who were willing to speak to me, and, two, how to act with integrity and respect when dealing with those immigrants.

Finding the right sources

It turned out, finding sources was far easier than I expected. Here are the places that were the greatest help:

Labor Groups

One Sunday morning in mid October, I found myself riding around a neighborhood in the southside of San Antonio with two members of the Brown Berets. This sounds more daring than it was. They were father and son -- the father with a club foot and one eye (and glasses for that eye) and the son wearing a bright yellow shirt bearing a smiley-face emoticon. The pair were more like Boy Scouts than gang members. (The gang analogy was theirs.) But this group was more like a community improvement association. They cleared brush from elderly neighbors’ yards, and they were politically involved.

In fact, that’s how I met them. I’d attended a rally for labor rights two days before, at the invitation of Jaime Martinez, the director of the Cesar Chavez Service Center, formerly a union hall for a company that has since moved to Mexico. Martinez was forever organizing rallies, calling in reporters from the local Spanish- and English-language news programs. It was Martinez who introduced me to the Brown Berets and a number of other sources. And it was the Brown Berets who helped get some of their undocumented neighbors to talk to me.

This story repeated itself over and over again. In San Diego, it wasn’t an immigrant rights group but the Employment Rights Group that connected me to Bahena and Alejandro Raya, one undocumented and the other the only green card-holder in his family of seven. Since immigrants, in general, and undocumented immigrants, in particular, tend to take hard-labor jobs, often with fewer labor protections, it was the labor groups that knew immigrants and were willing to help.

Schools

In both San Antonio and San Diego, the school districts have created a network of school-based clinics. These clinics would see any student or sibling up until age 19. So before I traveled to San Diego, I began emailing and reaching out to every school with a clinic, asking for permission to meet the staff and, perhaps, talk to a family. I was lucky that Cynthia Marten, principal of Central Elementary School and a fiery advocate for her kids and their parents, invited me in and introduced me to her staff and Norma Navarro, the soft-spoken 28-year-old mother of Aneth, 11, and Angel, 7.

Facebook

It sounds cliché, but I found some of my best sources on Facebook. First, I started identifying the major immigrant-rights and Dreamer (undocumented immigrants under age 32) groups on Facebook. These include United We Dream, Educators for Fair Consideration and more. These connections led to an invitation to one of their meetings, an hour-long interview with all of them, and, later, a one-on-one interview with Nancy, who turned out to have .

That’s not all I found on Facebook, though. I noticed something: Many of the Dreamer activists on Facebook at the time had the word, “Undocumented,” “Paperless” or “Iamstillundocumented” in their names, either as their middle names or as their last names. This was a clear trail to follow (and an interesting story in itself). I didn’t know what I expected to find out of this, other than just to find out more about what it was like for these Dreamers.

Then one night, I was on Facebook just before bed when I saw that one of these new friends had posted a photo of a letter a friend had given her. It described her as an excellent nurse and urged her not to give up. Since my story is about health care and for a nurses magazine, I got excited. I ed her through Facebook and asked if she’d be willing to speak to me for my story. She was and in the week since the article came out, I’ve received feedback that hers is one of the most powerful in the article.

Nuances of Interviewing Undocumented Sources

When I applied for the Hunt grant, I was clear that I didn’t want to write about undocumented immigrants as victims. I have tremendous respect for people who must choose between two equally important options.

So as I began reporting this story, it was important to me that I do my best not to coerce any information out of my undocumented sources and to show them that I considered them equals.

Start With Education

Working with undocumented sources is similar in some ways to working with anyone naïve about the media. I explained to them why I was talking to them, what I would do with the information they gave me, and talked to them about the potential consequences of talking on the record with me. The nuance is that I encouraged sources more than once to think about whether they wanted to use their real names or not.

Do the Interview Where They’re Comfortable and with Whom They’re Comfortable

I found interviews worked best if I conducted them in the presence of someone the source respected. That could be the Brown Berets, Cynthia Marten, or Jaime Martinez. Since I don’t speak Spanish, there could be four people in the room—sometimes six, when I was working with radio and video producers for a piece for the local public radio station. Not only did sources feel better about talking to me, but I got a better sense of the source’s personalities when they spoke to the person they were familiar with.

Don’t Push

I’m already aware that an interview is an act of generosity on the source’s part, and I try to show my appreciation. But when thesource is at a power disadvantage or may not understand how the American system works, I tried to be doubly respectful. What this meant is that I tried to carefully read a source’s tone, inflection and body language to see what they were comfortable talking about. Sometimes, I would preface a series of questions with, “Do you mind if I ask about…” And I often reminded people that they didn’t have to tell me anything they didn’t want to. And I really meant it.

At one point during my interview with Navarro, the principal, Marten, leaned over to me and said, “I can tell you are really empathetic and respectful, and she can see it, too.” That is exactly what I was going for.

Be Helpful

Every reporter is different, but I felt it was really important to give back to my sources in an appropriate way. I would never breach ethics, but I could offer what I’m good at—gathering information. So when a woman in San Antonio broke down in tears upon hearing that there were clinics that would see her, even without a Social Security number, I asked her if she’d like me to get her that information. She said yes, and a few days later, I send the information to Martinez, who had introduced me to her.

The same happened when I interviewed Navarro. She said she didn’t know how to apply for Deferred Action for Childhood Arrivals, or DACA, President Obama’s executive order that allows undocumented young people to stay in the U.S. without threat of deportation. I asked if she’d like me to get her more information on that. She said she would, so I asked a source I had interviewed a few weeks before, someone involved in United We Dream, if he could recommend a reputable person in San Diego. Again, I passed that information along to Marten, who gave it to Navarro.

My hope is that this story was as positive an experience for my sources as it was for me. It turned out that my fear was unfounded. I found myriad immigrants willing to share their stories. And it turned out that there was something in it for them: An accurate depiction of what it’s like to be undocumented and sick in America.

Photo Credit: Brian Myers, Media Arts Center San Diego

Heather Boerner is a freelance healthcare journalist in San Francisco. Here are two of the stories she wrote for her Hunt Grant:

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