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Originally published Saturday, January 25, 2014 at 6:06 AM

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A unique prescription for immigrant health care

A nonprofit clinic that serves poor Latino immigrants in Philadelphia focuses not just on treatment but also on addressing underlying causes of illness, such as poor nutrition, illiteracy and urban violence.


The New York Times

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PHILADELPHIA — Like many other immigrants, Mery Martinez has no legal status in the United States, no health insurance and no money.

But she does have leukemia, and has been struggling to find treatment for the disease, first in New York and more recently in Philadelphia. Here, a hospital emergency room rejected her on New Year’s Day because she had not yet qualified for the state assistance that could have paid for the medical attention she needed.

With rising anxiety, and a rash that she attributed to her illness, Martinez walked recently into a clinic run by Puentes de Salud, a nonprofit group of doctors, nurses and medical students that provides primary care to Philadelphia’s undocumented, uninsured and impoverished Latino immigrants.

In a consulting room provided by the University of Pennsylvania’s medical school, Martinez, 38, who is from Honduras, was examined, given a flu shot and advised on how to navigate the health system by Spanish-speaking volunteer doctors and nurses who run the clinic two evenings a week.

Puentes de Salud, which in English means “bridges of health,” was founded to provide low-cost but quality health care and social services to the growing Latino population in South Philadelphia and began treating patients in 2006. A co-founder, Dr. Steve Larson, said the organization distinguished itself from other community-health groups by addressing underlying causes of illness, such as poor nutrition, illiteracy or urban violence.

“It’s not about me writing prescriptions,” said Larson, 53, a professor of emergency medicine at the University of Pennsylvania who said he began to develop his approach to community medicine while working in rural Nicaragua in the early 1990s. “This is an underground health system.”

While Puentes operates openly in partnership with community organizations, hospitals, universities and governmental institutions, many of the patients — like Martinez — live in fear of immigration officials.

The new federal health care law does not provide assistance to illegal immigrants, who are generally ineligible for Medicaid, cannot get federal subsidies for private insurance and cannot use the new insurance exchanges to buy unsubsidized insurance with their own money.

Under the federal Affordable Care Act, such immigrants are exempt from the requirement to have insurance. They remain eligible for certain types of emergency care under Medicaid if they have low incomes and meet other criteria, and they may receive care from free and charitable clinics in some places.

Puentes, which has treated about 3,300 patients, caters largely to people whose lack of insurance and legal immigration status may make them ineligible for treatment under other programs. Many patients are further handicapped by poor or nonexistent English.

The organization will obtain Martinez’s medical records from Bellevue Hospital Center in New York, where she was previously treated, and arrange for her to see an oncologist at the Hospital of the University of Pennsylvania. With a life-threatening condition, she is expected to qualify for free treatment under Pennsylvania’s Emergency Medical Assistance Program once she is enrolled.

For the treatment and advice at the clinic, Martinez paid $20; any subsequent visits will cost her $10 each.

The minimal fees are a necessity to Martinez, who since walking across the Mexican border into Texas in 2003 has worked as a house cleaner but is now unemployed and, she said, has no income. She settled in Philadelphia after leaving New York because, she said, she could no longer afford to live there. She eats with friends and avoids going to food pantries because she fears her status will be discovered.

“I don’t want to use them,” she said through an interpreter, in a tearful interview. “I might be deported.”

The low costs for patients are made possible by volunteer services by Larson and other medical staff members and by in-kind donations ranging from real estate to flu shots. The organization has only two full-time employees; its clinics are run mostly by volunteer medical students from Philadelphia hospitals, and its preventive care services are provided by community volunteers.

Larson is seeking financial help to open a 7,000-square-foot clinic where, in keeping with his emphasis on prevention, half the space would be devoted to clinical services and half to education that includes nutritional advice, literacy tutoring and sex education.



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