Assignment: Individual Managing Staff Paper
Assignment: Individual Managing Staff Paper
The fear of cost can be understood as a form of violence that is not something experienced by people who have health insurance or sufficient resources. Like chronic disease, certain dimensions of fear can be seen to have a “preferential option for the poor” (Farmer 2005, p. 140). Language, Discrimination & Immigration Status as Dimensions of Fear Another prominent dimension of fear reported by participants was particular to an immigrant community. The ID is so-named because it is one of the most diverse neighborhoods in the state (Childress, 2009). The data maps we created revealed a high percentage of foreign- born residents in the International District, and a statistically significant number of which are not U.S. citizens, and that a high percentage of Spanish speakers in the ID do not speak English very well (U.S Census Bureau, 2010). In the past, this diversity was associated with negative social and economic conditions and the neighborhood and was viewed through a lens of blight. Over the past few years, this diversity has come to be recognized by some as an asset, but challenging mainstream views of the neighborhood has been difficult and stereotypical negative discourse and attitudes remain common. Participants in our study expressed strong sentiments regarding discrimination that immigrants face on multiple levels on a daily basis. They feel that people with a Spanish accent or who lack English-speaking skills are discriminated against in institutions like doctor’s offices, clinics and hospitals. ECM’s One Hope clinic caters to the needs of the immigrant community and attempts to address these concerns by providing professional translation in the clinical setting. In addition, patients all receive an “exit interview” (“salida”) by a Spanish-speaking community health worker who goes over instructions and health information that the patient has received from the provider. However, care at One Hope is not the norm in Albuquerque. Participants described, in detail, the discrimination that they commonly experience. Discrimination often takes the form of tacit disapproval on the part of the receptionist in healthcare settings who makes people feel that they are a burden or that they should be ashamed of their inability to communicate. Almost all of those interviewed reported numerous instances when receptionists at various health clinics in Albuquerque refused to speak Spanish to patients, often literally telling them to speak English because “you’re in America now.” One participant said, “…they feel that discrimination…why do you need help, you aren’t supposed to be in this country…so they are afraid and don’t ask [for help].” The attitudes of institutional actors in healthcare settings can become what Larchancé (2011, p. 859) called “intangible mechanisms of creating or reproducing population hierarchy” in relation to immigrants and ethnic difference.
38 Health Disparity and Structural Violence- Page-Reeves, et al.
Journal of Health Disparities Research and Practice, Volume 6, Issue 2, Summer 2013
She argues that this influences social practices through what she defines as “powerful ‘subjectivation’ effects” that are both psychological and political, influencing and shaping the behavior of immigrants and institutional actors in a dynamic of hierarchy. This process, in turn, contributes to the construction of immigrants as undesirables. Although hospitals have policy regarding the provision of professional interpreters, participants said that they are still made to feel guilty—as if it is somehow their fault that they need this service. At the same time, participants reported a dearth in bilingual support at clinics. This is especially problematic in a state with such a large Spanish-speaking population. One of the interviewees, who also has a job as an interpreter at a large hospital, indicated that the interpretation provided is often very poor. In one example from a psychiatric out-patient clinic, a psychiatrist asked the patient if they had been unable to concentrate recently. The interpreter, a native Spanish speaker and fluent in English, asked the patient if they had been constipated recently. The patient responded that they had not been constipated, although they had been suffering from an inability to concentrate. This would be funny if it were not so tragic. The explanation for this critical mistake given by the interviewee was that the medical interpreters are generally disinterested and not fully-invested in what they do—further reflecting structured inequality in employment options for individuals who while they may be bi-lingual are not credited with other skills meriting a higher salary. For good reason then, people who have an accent when they speak English fear being made to feel stupid or incompetent, and people who cannot speak English are afraid of finding themselves in a situation where they cannot communicate their symptoms, or understand what people are saying or what they are being told to do. These language/discrimination-based fears are often enough to make people refuse to go out to seek assistance until their health problems become acute. People’s language-related fears are a reflection of experience, but fear reported in relation to discrimination is more than merely a concern over language proficiency. Many of the immigrant households in the ID have members with problematic immigration status. The number of individuals in the ID who do not have immigration documents (“undocumented”) is high. Participants felt that this fact tinges the experience of people who have an accent or difficulty speaking or understanding English. They reported that the level of care and treatment that Spanish-speakers receive is different from that of people who are presumed to be citizens. As a result, people fear being singled-out for different treatment or being treated as if they are illegal, whether they are or not. By definition, being illegal implies that they are bad people. One participant expressed how this difference in treatment is perceived, saying “These people, even when in the hospital or the waiting room, there’s a big sign that says we’re not going to discriminate anybody or whatever…[but] the immigrant people