Undocumented Immigrants Are Too Scared to Go to the Doctor

One of Chely Yanez's favorite places to approach people is the laundromat. It's a guaranteed captive audience. "I can get people to stand still and listen," she tells me in Spanish. "They have no place else to be; they can't say they're rushing off to an appointment."

Yanez, who came to the US 24 years ago from Jalisco, Mexico, is a volunteer promotora—which literally translates from Spanish as "promoter" but is a term in Latino communities for a community health worker. Her job is to convince people that they can go to the doctor without being deported.

She and her friend Maria Ponce de Leon spend a few days a week canvasing in Boyle Heights, a Los Angeles neighborhood where 94 percent of the population is Latino. They go door to door in apartment complexes, stand outside schools and supermarkets, and stake out laundromats in order to distribute health information.

In LA, you don't have to have legal status to get medical treatment—there's a free program that serves undocumented immigrants in the area. But many of the estimated 1 million undocumented immigrants who live in the LA metro area don't know this. Yanez and Ponce de Leon tell me that Trump's talk of immigration bans and the border wall casts a long shadow; many immigrants they come in contact with day to day are afraid to leave their homes, even to go to the doctor.

"I'm seeing fear, fear, fear," Yanez says. "People are scared to give out their names and numbers because they don't know where that information's going to go. They don't want to see doctors or come into the clinic."

Ponce de Leon, who is originally from El Salvador and has been living in LA for 28 years, witnesses the same thing. The main objective of the promotoras, she tells me, is to encourage people to come into the local clinic for anything from routine wellness visits to cancer screenings. Mostly, they want to let people know their options. She says many have no idea that there are so many resources available even to undocumented immigrants.

"Sometimes people don't open their doors, they're worried about immigration, they're scared to admit they don't have papers," says Ponce de Leon. "When I give them information, they'll say, 'It's for my cousin, it's for my neighbor.' They don't want to admit they're undocumented, but they're in desperate need of healthcare."

Often she'll give out her own contact information so that they can call her. She'll spend time talking with them, working to build up a rapport and trust, assuring them that the doctor's office is a safe place. She'll give them data about the importance of getting annual physicals, and the incidence of diabetes and high blood pressure among Latinos. "We're not that well-informed about preventative measures," she says of the Latino community.

Without revealing any names or personal information, she shows me a list of about 15 people she recently signed up for free healthcare. Every single one of them is undocumented.

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Clínica Romero, which operates two clinics in predominantly Latino neighborhoods in LA and sponsors the promotora program where Yanez and Ponce de Leon volunteer, serves about 11,000 patients a year, most of them poor. The staff there has noticed a change in people's behavior patterns since Trump took office.

"We get phone calls from patients calling to cancel their appointments," Clínica's executive director, Sandra Rossato, tells me. "They're afraid to come in, and they'd rather not leave their home because they feel unsafe."

The clinic has rushed to put new protocols in place. It has a code now—which Rossato asked I not disclose—to immediately notify staff if Immigration and Customs Enforcement (ICE) is in the building. So far it hasn't had to use it, but it wants to be prepared.

"For us, it's the importance of making sure that if patients are in the building and ICE walks in, that we have a way to get them out of the building and to protect them," Rossato says. "We have attorneys on standby that we can pick up the phone and call."

Around the time of the election, promotoras gave out information about free legal services along with cards, written in Spanish, to hand to an officer in case of arrest that explain they don't speak English.

The LA mayor's office has jumped in with additional funding to support the promotoras program. "The city is taking proactive steps to empower local communities about their rights," says Linda Lopez, the head of the Office of Immigrant Affairs for the city. "There's definitely an energy in LA that's unique that has empowered individuals to think about this in a different way."

Rossato says that now more than ever, the promotoras are a key component in getting people to come to the doctor. "It's human contact," she says.

Promotoras aren't new—it's a tradition dating back decades in Mexico and Central and South America. But it was often informal. It didn't have a name. Rossato estimates that Clínica Romero has had promotoras in one form or another for over 30 years. But in the past five years, they've formalized the program. The 40 promotoras who work here now are trained in leading workshops, the ins and outs of healthcare options, and in just about every service the city provides.

"They're trained not to troubleshoot," says Rossato. "They know how far they can go. Once there's trust, it opens the door for other services." Promotoras will often refer people to substance abuse counselors, specialists, exercise classes even non-health related services like low-cost emergency legal help. It's all connected, says Rossato. "It will affect your health at the end of the day."

The promotoras are mainly women, but there are some men who volunteer for the program (promotores). They work in pairs, for safety.

After the laundromat, Yanez and Ponce de Leon walk to a nearby apartment complex to door-knock. Some people aren't home, or if they are they aren't answering the door. Other times, someone calls out from behind the door, asking who it is. The door might open just one inch. Yanez introduces herself in Spanish, says she's from the clinic, and asks if the person has a doctor. The door opens a little more. Within a few minutes, the door is wide open, the promotoras are almost completely inside the house, laughing with the person on the other side of the door.

Yanez and Ponce de Leon admit that they get plenty of doors slammed in their faces. But they also sometimes get invited into homes spontaneously for a meal. They exchange recipes, they talk about their kids. They often become Facebook friends with the people they visit.

While the three of us are chatting in the courtyard of an apartment complex, Ponce de Leon gets a text from a woman she recently met at a community event. The woman is in an abusive relationship, and Ponce de Leon has been trying to gently coax her to get emergency help, to get out, giving her contacts for counseling services and a place to stay. But for now, Ponce de Leon is texting with her, talking with her, being a friend.

Yanez tells me about a woman she got to come into the clinic for a cancer screening—a specialist detected her cancer early and the woman is in good health now. "I get such satisfaction when I see someone in the supermarket and they thank me; 'Oh, thank you for the doctor, for giving me a specialist.'"

Rossato says they set goals—getting a certain number of people to show up for an event, or meeting a quota of signing people up for healthcare. The clinic is exploring other creative ways to reach their patients—for example, they've recently started distributing at-home colon cancer screenings, where a person can send in a stool sample to the lab to be tested without having to leave their home.

But Rossato is convinced that the promotoras will be the backbone of the clinic going forward. "We can't provide services if we don't have patients," she says. "The only way to bring patients in, and to ensure they don't stay in their homes because they're afraid, is to get the word out. To reassure them that this is a safe place. Not just through medios like Facebook and Twitter. Many of them need medications. This is one of the most critical times to have promotoras and get them out into the community. They're it. They're the ones that are going to help us."

Cole Kazdin is a writer living in Los Angeles.