‘TENNderCare’ offers health care for uninsured children


JOHNSON CITY, Tenn. — Although free health care is available to all children, Hispanics are the least likely of all children in the United States to receive it.

One reason may be that they tend to be healthier. But another could be that language barriers and lack of transportation lead parents who don’t speak English to avoid waiting rooms.

Juanita Luevanos’ two children, who were born in the United States, qualified for TENNderCare, a state-funded health care plan for children 21 and younger that provides physicals, immunizations, hospital visits, specialty care and more. The program offers a free checkup each year for children ages 3 to 20. But it was not easy to get TENNderCare for her children, Luevanos said.

“If you don’t know how to speak English,” she said, “it is hard.”

“I don’t have health care for myself, but I have it for my children,”said Luevanos, who works at a restaurant in Jonesborough.

Children enjoy the child play area at the East Tennessee State University Downtown Clinic in Johnson City, which cares for uninsured patients. (Sloane Trentham/El Nuevo Tennessean)

Children enjoy the child play area at the East Tennessee State University Downtown Clinic in Johnson City, which cares for uninsured patients. (Sloane Trentham/El Nuevo Tennessean)

Luevanos’ situation is not uncommon. But the Johnson City Downtown Clinic, which provides health care for the uninsured, homeless and migrant populations, offers a solution.

“We recognized way early that we would be working with the Spanish-speaking community and that required interpreters,” said Sue Reed, director and nurse practitioner at the clinic run by East Tennessee State University.

The downtown clinic, a federally qualified health center, sends an interpreter with children and their parents to specialty doctors.

“It has really opened the door to specialty care for our children,” said Reed.

Claudia Lopez, public health nurse at the Johnson City/Washington County Health Department, said learning a language takes time.

“You start to understand first,” she said. “But as far as speaking, that is harder. You want to say so many things, but you don’t have the words.”

Lopez, who often makes home visits, mentioned a less obvious reason why children may not receive health care: lack of transportation.

Sometimes parents have no way to get to an appointment because they don’t have access to a vehicle. Lopez attributes this to lifestyle differences. In countries like Mexico, she said, for some families it is normal for a man to go to work in the only car while a woman stays at home or never learns to drive. To get places, these women either walk or take public transportation.

“The public transportation system in the United States is more complicated,” said Lopez. “[These mothers] are afraid. With time they become more independent. They are able to work the system and take the kids to the appointment.”

Though many parents may not know, TENNdercare offers transportation to appointments. While the language barrier and lack of transportation may prevent health visits, another reason Hispanics are least likely to receive health care could be they do not need to go as often. According to a National Health Interview Survey from 2008, Hispanic children were not as likely to have respiratory, food and skin allergies as do people of other ethnicities. They were also less likely to be on regular medication.

According to the survey, 4 percent of Hispanic children had Attention Deficity Hyperactivity Disorder compared to 9 percent for black children and 10 percent for non-Hispanic whites.

The statistics show Hispanic children are not as likely to experience specific health problems and were less likely to have a regular place for health care.

According to the Campaign for Children’s Health Care, having a regular health care provider is linked to good health. It ensures that someone knows a child’s medical history, keeps immunizations up to date, and encourages a trusting doctor-patient relationship.

Some studies have been conducted on the “Hispanic Paradox,” a finding that Hispanics are healthier than non-Hispanics despite their overall lower socioeconomic conditions.

This discovery contradicts other stud­ies that show lower social classes tend to be unhealthier than higher social classes. However, other studies say the paradox does not exist.

“People from other countries come here to get a better life,” said Lopez.

“They are people, too. They have children. I hope there will be some kind of solution in the future. I don’t think it is good for them to not get health care. But that’s just the way it is.”

One of the most common problems of non-English speaking patients is the language barrier. Although some health-care companies and administrators may not know it, federal law requires them to help patients who do not speak English.

The “Enforcement of Title IV of the Civil Act Rights of 1964, National Origin Discrimination Against Persons with Limited English Proficiency” states that any company that receives federal money has “a responsibility to ensure meaningful access to their programs and activities by persons with limited English proficiency.” This includes offering inter­preters.

“Paying an interpreter is cheaper than paying for a lawsuit,” said Melanie Mar­quez, a graduate assistant at the ETSU Language and Culture Resource Center.

Kayla Bobbitt, service-learning coordi­nator at the center, said she has noticed a lack of interpreters and the problems it causes. She also said it is important for the Hispanic community to realize that they are protected by law. All anyone has to do is ask for an interpreter.

Marquez said a shortage of interpret­ers can be dangerous. When a doctor checks symptoms and gives medical directions, it can be a matter of life and death.

If the language barrier causes miscom­munication, several problems can arise. Interpreters need to be trained profes­sionals who know medical terminology in both languages, they said.

Since many children of immigrants are bilingual, they are expected to interpret at medical appointments for both the doctors and the parents. To Marquez, this is not ethical.

“Children are not doctors,” she said. “They don’t know” what doctors know.

Children should not be responsible for interpreting for several reasons other than not knowing medical jargon, Mar­quez and Bobbitt said. Emotions can get in the way and put a lot of pressure on a child. Children should not be exposed to adult matters such as sexually transmit­ted disease, especially if it concerns their parents.

Marquez suggested that instead of relying on children or other personnel who aren’t qualified, hospitals and other medical companies should hire profes­sional interpreters or provide training in medical interpreting for their bilingual employees. She said everyone has a right to understand their health.

“We are talking about people,” said Marquez. “Not things, not animals. People.”

For more information on transportation for health care, contact TennCare Select of Tennessee at (800) 263-5479.


Editor’s note: This story was previously published on El Nuevo Tennessean

Leave a Reply