The strain on local resources such as health care is just one of the challenges presented by immigration in Madison County.

With an influx of new residents over the past few years, local health care providers have been pushed to expand services and learn new skills in order to adequately serve the entire population.

Eight years ago, the Madison County Health Department had no need to have Spanish interpreters on staff. Today, the department has four interpreters on contract working part-time.

One of the interpreters works specifically with the department’s HANDS program, which is a voluntary, intensive home visitation program designed to assist parents at critical development points during their child’s first two years of life. The program targets women during their first pregnancy to assist with child development, parenting skills, health services and other resources.

Two interpreters work in health department clinics, and one splits her time between clinic services and MEPCO Home Health/therapy home visits, said Christie Green, administrative services manager for the health department.

“We had very few people coming to our clinics who needed interpreter assistance,” Green said. “There was a delay between the increase of immigrant population in the county and an increase in the number of non-English speaking clients that we see.”

“I believe that a large part of that had to do with trust,” she said. “As word got out in the community that we had an interpreter available, and that we provided services regardless of a person’s citizenship or immigrant status, more people began coming in.”

All of the interpreters are native speakers. Green said the department also has a contract with a Lexington agency which maintains a cadre of interpreters who are fluent in a number of different languages.

There also is “a contract with a telephonic interpreting service that we can use if a face-to-face interpreter isn’t available,” Green said. “We do not have any bilingual nursing or clerical staff right now, although we have been listing that as a preference in some of our advertisements for job openings.”

“While Spanish is the predominant language for which we use interpreter assistance, we also have families who speak Mandarin, Punjabi, Arabic and other languages,” she added.

There are no Spanish-speaking employees at Pattie A. Clay Regional Medical Center, said Jo Helen Cloys, director of patient and public relations at the hospital.

Cloys said she has a certification in Spanish, but would not call herself fluent in the language.

“We have a list of interpreters and contracts with several companies that provide that service, either in person or on the phone,” she said.

Providing care

Unlike other government aid programs, such as Medicaid, food stamps and other services, the health department’s services are not contingent on citizenship status, Green said.

The health department does not ask about citizenship status for any of the services provided directly in the clinic, except for the Breast and Cervical Cancer Treatment Program, which is administered through Medicaid.

“Our nurses can enroll women in this program to help them get Medicaid coverage if they’ve been diagnosed with cancer,” Green said. “If a woman is not a citizen, she doesn’t qualify for this type of Medicaid coverage (or any other, for the most part).”

Spanish-speaking patients make up a small percentage of those served at the health department.

In the fiscal year 2007-08, the health department served 19,000 adults and children in all of its Madison County locations. Of those patients, only 2 percent — about 400 patients — spoke Spanish.

Of those Hispanics served, 31 percent were women, 7 percent were men and the remainder were children younger than 12.

“We are seeing, however, a small increase over time,” Green said, citing the total Hispanic patient population during fiscal year 1999-00 as only .3 percent.

In public health, the concern is for the overall health of the community, Green said. As the demographics of the county have changed, the department has had to change the way it thinks about cultural competency, the provision of services and customer relations, she said.

“Providing services with an interpreter’s assistance is a real skill,” she said. “We must be very intentional in our efforts to make sure that everyone feels welcome. We want everyone to be healthy and to have access to basic preventive health care.”

“For immigrants, one of the most important things that we may do is tell them about other resources in the community that can help with health care or other basic needs,” Green added.

The most commonly used services used by the Hispanic population are WIC, Well Child and Family Planning, which mirrors the total population, Green said.

At Pattie A. Clay, the services most used by immigrants are in the emergency room and the obstetrics department.

“A baby born in the U.S. to immigrants — legal or illegal — is automatically a U.S. citizen and entitled to all benefits,” Cloys said.

The hospital does not ask its patients about citizenship status, Cloys said.

“We have a question about race and we ask for a Social Security number, but we don’t record or report immigration status,” she said.

Of 84,120 patients served at Pattie A. Clay last year, one in every 37 patients — or 2, 266 patients — listed a Hispanic race on hospital documents. About 26,000 patients did not list a race or ethnicity.

About 72 of those Hispanics served were from Central or South America, 22 were from Cuba, 144 were from Mexico and 20 were from Puerto Rico. About 2,000 patients are listed on hospital records as “unknown Hispanic.”

Almost 56,000 patients are listed as “non-Hispanic” on information provided by the hospital.

The biggest impact of immigrants on the hospital is financial, Cloys said.

“Very few, if any, have insurance,” she said.

On average, the hospital loses about $5 million (a year) on uninsured patients of all races.

“This is one reason health care costs are so high,” said Cloys.

In the United States, an estimated $1.1 billion per year in health care costs are accumulated for undocumented men, women and children, according to the Rand Corp., a non-profit think tank.

No insurance

Undocumented non-citizens accounted for 22 percent of the nonelderly uninsured population in 2006, according to a March report by the Kaiser Family Foundation.

Because of their high uninsured rate, undocumented immigrants received significantly less health care than citizens, the report said. They also are much less likely to have a usual source of care, to have had any recent contact with a health professional or to receive preventive or primary care.

As a result, undocumented immigrants have significantly lower per capital health care expenditures. In 2005, the average annual per capital health expenditures for non-citizens were $1,797 versus $3,702 for citizens, the report said.

More than one-fourth of Hispanic adults in the U.S. lack a usual health care provider, and a similar proportion report obtaining no health care information from medical personnel in the past year, according to a report by the Pew Hispanic Center.

Previous research by the U.S. Centers for Disease Control and Prevention has shown that Hispanics are about twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider.

The 2007 Latino Health Survey found that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance. The survey also found that foreign-born and less-assimilated Latinos — those who mainly speak Spanish, who lack U.S. citizenship, or who have had only short tenures in the United States — are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice.

The Kaiser Family Foundation also found that undocumented immigrants are much less likely to use the hospital emergency room than citizens.

Dental health can really suffer, too, said Rona Comley, advocate/recruiter for the Madison County Migrant Program. The children she works with in the program seem to have a lot of cavities and the parents’ dental health suffers, too.

“They’re not getting the dental care they need,” she said.

The language barrier

For Mary Bonilla, an immigrant from Columbia, one of the challenges of living in Madison County is communicating with Americans.

When she goes to the doctor, she always takes her daughter —an English as a Second Language teacher in Madison County Schools — to interpret for her.

But for so many other Hispanics, communicating with the doctor can be a difficult experience.

“In many cases, people rely on their children to translate — because children who are born here are normally bilingual — which is very dangerous,” said Sandra Anez Powell, program coordinator for the Madison County chapter of Muejers Unidas (United Women). “To put a child in that position is not fair. It can be very traumatic for the child.”

Lorie Love can be reached at llove@richmond

register.com or 624-6690.