First off, I’m grateful for the opportunity to be part of the Grady immersion experience. This trip provides the unique opportunity to work with a specific patient population within the local Hispanic community: undocumented individuals suffering from end stage renal disease.
Today our group started the morning with a tour of Grady, including the emergency, trauma and dialysis units. Afterwards, we had a group huddle to discuss the pre-experience assigned literature we read. The intersection of healthcare and government policies, specifically access to health care services for undocumented immigrants, was the key topic.
To offer a brief recap, individuals from this population cannot qualify for government health insurance and, often, cannot afford private health insurance. Without insurance, they cannot receive the routine dialysis treatments they need to survive and maintain a decent quality of life. However, no one can be denied emergency health care services in the United States. Undocumented immigrants must therefore wait until their condition worsens to the point of crisis and then report to the emergency room for dialysis treatment. While this loophole offers some hope, it severely impacts the quality of life these individuals are able to have. Grady has sought solutions to this issue while staying within bounds of current policies.
After our roundtable discussion, we went to the dialysis unit and met with some of the patients and staff. We broke into groups of three and met with individual patients, asking them general questions about their day-to-day lives and current health issues. One of the other topics we discussed during our roundtable was patient adherence to the renal diet. Patients in end stage renal disease have to avoid certain potassium-rich foods, in addition to other dietary restrictions. Adherence to the diet is an issue within all populations, but I wondered if there were cultural-specific reasons within the Hispanic community.
I asked the patient we interviewed, a man in his mid-40s who has been receiving dialysis treatments for six years, what he thought the reasons were behind non-adherence. He explained that economic barriers were a factor because many families couldn’t afford the healthier foods they were suppose to eat. He also said it was very difficult for one person to maintain a specific diet when they lived with many people who did not follow the diet. I also asked him what the morale was like between the Hispanic patients and the health care staff. He replied that, just as it is everywhere, some people were kind and some were not. When asked if he believed there was trust between the two groups, he said “no.”
Why is there a perceived lack of trust? It could be because these patients and the health care providers aren’t able to establish routine schedules and, therefore, are incapable of building the same kind of relationship that insured patients are able to have with their health care team. It could also be due to burn out within the health care staff, who are faced with a large patient population, a lack of consistent scheduling and staff shortages. Or, perhaps, the lack of trust is related to the fear undocumented individuals have of any agency that is driven by government policy. It’s difficult to say, but it may factor in to the issue of diet non-adherence. Are we more likely to take diet advice from someone we trust, like our family and community, or from people we barely know?
Our interview concluded and, as we prepared to leave, I told the patient “nos vemos el jueves.” (We’ll see you on Thursday.) He responded automatically, “primero Dios.” (First God.) This is a common response, as Latino communities’ concept of time is oriented in the present. They don’t worry about the future, but rather live for today.
“Hay más tiempo que vida.” (There’s more time than life.)
Que Dios los bendiga,