At the Clinica del Pueblo (the People's Clinic) in NorthwestWashington, the telephone rings every few seconds, but thereceptionist tells callers in Spanish that no appointments areavailable for six weeks. Patients have to climb three flights to getto the clinic, where nurses and volunteer medical students examinethem in closet-sized cubicles among stacks of files and shelves ofmedicine.
'We are open six days a week, 12 hours a day, and we use upevery available space,' said Andrew Schamess, the private, nonprofitclinic's only full-time physician. 'But we have to turn away farmore people than we can see, often with serious problems. It breaksyour heart every time.'
Pressure on this clinic, and a half-dozen others in theDistrict's Latino community, has worsened in recent weeks because ofnew welfare and immigration laws that tighten restrictions on whomay receive federal health benefits. Also, there are concerns abouta proposal by D.C. officials to shut down one of the clinics andshift its services to a health center 12 blocks away.In the suburbs, Latinos generally have more health care options.Although there are fewer low-cost clinics in their neighborhoods,their incomes are higher, and a greater percentage are legalpermanent residents who are eligible for public health assistance orhave jobs that provide private health insurance.In the District, the half-dozen low-cost, bilingual healthcenters serve the large concentration of Latinos in the District'sAdams-Morgan, Mount Pleasant and Columbia Heights neighborhoods.Together, they see more than 30,000 people a year, most of whom arepoor and uninsured immigrants, and they treat everything fromtoothaches and croup to cancer and AIDS.Jose Blanco, 54, a security guard from El Salvador, calls theClinica del Pueblo , in Columbia Heights, an 'island of salvation'for his children's checkups and his own diabetes. 'Our salaries aretoo low to pay for insurance, but here they give you medicine free,and if you have to go to the hospital, they send {anEnglish-speaking person} with you to explain.'Although booked to capacity, the clinics collect little moneyfrom patients. More than 70 percent of Latinos in the city have nohealth insurance, and their average per-capita income is about$15,000. In addition, many clients are Central American refugees whoare in the United States under temporary amnesty and cannot receivepublic medical assistance. Many of them work at low-level jobs thatprovide no health insurance. Most clinics charge modest fees basedon income but treat some patients for free, relying on a combinationof grants, donations and volunteers to make ends meet.Latino patients say that in addition to offering inexpensivecare, the clinics are especially sensitive to their cultural andlegal concerns. They don't, for instance, ask prospective patientsabout their immigration status -- a policy much appreciated since,according to community leaders and federal officials, at least 20percent of the District's estimated 85,000 Latino residents are inthe United States illegally.One development causing concern for community health careproviders was a proposal last month by officials of the PublicBenefits Corporation, which has replaced the District's publichealth department, to close the public Adams-Morgan Clinic, whichtreats 800 patients a month. They would merge it with Unity HealthCare, a four-story private, nonprofit clinic in Columbia Heightsthat serves 3,500 patients a month. Community leaders and theAdams-Morgan clientele have vehemently protested, citing concernsabout the 12-block walk and losing a medical staff they have come totrust.'Please don't close my clinic,' Elba Cabrera, 34, ahousekeeper from El Salvador, pleaded with officials at a recentpublic forum. 'My doctor told me they might close it, and I cried alot. I love everyone there.'But officials of the Public Benefits Corporation said theyneed to find creative ways to improve neighborhood health care whilemaking it more cost efficient, in part by combining services atseveral of the District's 11 public neighborhood health centers.Moving the tiny Adams-Morgan clinic from its crampedquarters in the Marie Reed Elementary School to the spacious UnityHealth Care building, officials said, would be a logical andinnovative experiment in public-private health collaboration. Butofficials said that after hearing such strong opposition, they donot want to run roughshod over the Latino community and will takeanother look at the proposal.'We are trying to establish a primary care system that willbe available to all groups, and we are particularly committed to theuninsured and to people who have traditionally been denied access tohealth care. That certainly includes the Hispanic community,' saidBetsy Reveal, benefits corporation board chairman. 'We don't care ifthey're employed or unemployed, legal or not legal. We want to makesure there is adequate primary care in the community.'The issue of trust is especially important for local Latinosthese days, because new federal rules require local governments toreport the immigration status of those who apply for publicassistance. Officials at several clinics said they are no longersure whether to encourage clients to apply for Medicaid -- federalmedical assistance to the poor -- even for their legal children. Andsome immigrants, they said, have been afraid to come in fortreatment lest they be deported.Recently, local Medicaid processing centers sent out noticesto applicants telling them that in some cases the centers now mustreport illegal residents to the Immigration and NaturalizationService. Officials will not ask the immigration status of thoseseeking Medicaid for their children, the notice said, but 'when webecome aware . . . that you or a member of your household' isillegal, 'we must document that fact. This documentation isavailable to the INS.''There are so many rumors, and people are scared,' said TeresaRosa, a social worker at Unity Health Care. 'We are afraid if wesend in the {Medicaid} forms, we may be doing people more harm thangood.' Officials at Unity and other clinics said some mothers whoare illegal immigrants are sending their children in with neighborsbecause they do not want to risk being caught.At Columbia Road Health Services, a nonprofit clinic inAdams-Morgan, staff member Gina Clifford said some longtime clientshave 'gone underground' and asked if they can be treated at home.One illegal immigrant named Marta, a part-time housekeeper fromSouth America, said the clinic had helped her through severalpregnancies and found her shelter when her husband beat her.Now, though, she is afraid to apply for Medicaid for herchildren.'My children are American citizens, but I have no papers,' shesaid.Even for those who are legal, health care providers in thecommunity say they are concerned about the effect of new welfare andimmigration laws on Latinos. Some Central American refugees onceeligible for Medicaid have been barred from receiving it. Also, manypoor immigrants sponsored by relatives may no longer qualify forMedicaid because their sponsors' income is now counted in decidingeligibility.At Unity Health Care last week, a Guatemalan refugee,Vitalicio Mendez, 36, paced the floor as he waited for his pregnantwife to have an exam. The construction worker, who is in the UnitedStates on a temporary work permit, said that his family was turneddown for Medicaid and that he cannot afford the $50 a month it costsfor health insurance from his employer.'I am healthy, so I don't need it, but I have a wife, fourchildren and another one coming,' he said. 'What if I end up in{immigration} court? Who will help them then?'
