(Interview 6/2013. Oil on linen 40 ins.x 30 ins.)
Artist Note (2013)
This is a look at an immigrant population’s access to healthcare through the eyes of a physician-scientist who volunteers his time at a local clinic.
Immigrants residing in the US lawfully may buy health insurance on the Affordable Care Act (Obamacare )marketplaces. They are also eligible for premium subsidies. This includes those on work or student visas.
Undocumented immigrants, however, are not eligible to buy health insurance Marketplace plans but they may apply on behalf of lawfully present individuals.
In a 2016 blogpost, Harold Pollack, health policy and public health educator wrote, "The ACA specifically excluded the undocumented. It did provide additional funds to Federally Qualified Health Centers that often care for immigrants. Yet undocumented immigrants were excluded from the Medicaid expansion and from participating in state health insurance marketplaces.
Documented or undocumented. This doctor explains what happens to sick people when they don't get treatment.
A primary care issue turns into a person needing to see multiple specialists with all the concomitant costs of heart surgery, etc. "... putting off treatment creates a financial strain because it is very costly to treat a patient in the emergency room, and also very costly to treat a patient whose illness is in its later stages...We have to have the foresight to know what not intervening early means.”
When asked how he would change things in an ideal world, the subject said we would benefit from having more primary care physicians and frontline clinics perhaps run by nurse practitioners, electronic medical records, greater availability of generic drugs, and reduced duration for drug patents.
"Then, when it’s close to being too late, the patients will show up to the emergency room with their illnesses at a late stage.”
This portrait story takes a look this subject's experience as a volunteer doctor at a clinic serving the under-insured immigrant and the uninsured undocumented immigrant community.
(from a 2013 interivew)
Doctorate of Medicine and of Philosophy (MD-PhD) Student, Insured, 30
This is a look at an immigrant population’s access to healthcare through the eyes of a physician-scientist who volunteers his time at a local clinic.
The subject has volunteered in a variety of public hospitals and free clinics for over a decade.
The free clinic where he volunteers operates on grants and donations. He says,“For example, drug companies donate generic medications.”
The entire staff, nurses, doctors, translators, are volunteers. As an undergraduate he volunteered in the emergency department at two NYC hospitals. Now he volunteers at a local clinic that serves underinsured, undocumented Asian immigrants.
The subject says of the patients he treats, “Immigrants aren’t going anywhere, and their health will impact the healthcare industry.”
The subject has great compassion for his patients at the free clinic. “I love the people.” The clinic is open one evening a week for 3 ½ hours. The clinic is staffed by an attending physician, translators, volunteers, medical students and residents, all of whom volunteer their time to treat these patients.
This doctor says that working in these settings allows him to experience medicine in its pure form without advanced technologies that are commonplace in hospitals. Treatment at the clinic is more dependent on history-taking, the physical exam, and clinical acumen.
“If there are no free clinics for this poor, underserved community, then there will be no preventative medicine. With no preventative medicine, a patient’s pathology will get worse over the years since it won’t be monitored and treated.
"Then, when it’s close to being too late, the patients will show up to the emergency room with their illnesses at a late stage.”
The subject explained that putting off treatment creates a financial strain on society because it is very costly to treat a patient in the emergency room, and also very costly to treat a patient whose illness is in its later stages.
The progression of untreated illness can be very grim.
This doctor has treated several patients with prolonged hypertension who exhibit the same pattern of illness over time. He observes that patients with high blood pressure go untreated during the early stages and complications arise.Untreated high blood pressure leads to hardened blood vessels. This causes the heart to work harder because it has to pump against increased pressure. “The stymied functioning of the heart leads to decreased delivery of blood to the body, which can lead to even higher blood pressure through a physiological mechanism that aims to optimize blood flow to vital organs.”
"After many years, organs such as the kidneys will deteriorate due to a long period of time with decreased blood flow. Eventually, the patient may need a kidney transplant. At some point in this cycle the person will end up in an emergency room due to some consequence of their prolonged high blood pressure."
“All this happens because an at-risk person did not have routine blood pressure checks to catch problems early.” A primary care issue turns into a person needing to see multiple specialists with all the heart surgery costs, etc.
“We have to have the foresight to know what not intervening early means.”
Regarding the politics of healthcare, the doctor believes that expanding Medicaid as part of the Affordable Care Act is absolutely necessary.
The undocumented residents who visit his clinic will not gain insurance through Medicaid expansion because only legal residents are provided for in the new healthcare law. However, lack of preventive care plagues the poorer communities of legal residents as well.
“Poor people, legal or not, experience the same outcomes from lack of primary care.” Medicaid expansion would insure many millions, giving low-income wage earners access to healthcare."
Low-income, legal residents would gain access to health insurance in the states that agree to expand their Medicaid programs. The US Supreme Court made the provision to expand Medicaid under the Affordable Care Act optional for the states.
When asked how he would change things in an ideal world, subject said that that we would benefit from having more primary care physicians and frontline clinics (perhaps run by nurse practitioners); electronic medical records; greater availability of generic drugs and reduced duration for drug patents.
The subject believes that there should be changes in the disparity in doctor salaries. “It’s inappropriate for dermatologists and radiologists to earn much more than primary care physicians when the expertise in those professions is not as vital to public health. Another improvement can be with how physicians are paid. Perhaps having a system where physicians work in teams with a set salary will take the financial incentive out of fee for service.”
Regarding public health, the subject feels that diet and lack of exercise are the biggest contributors to common public health pathologies such as hypertension, diabetes and high cholesterol.
Subject’s Background
The subject’s parents fled Sri Lanka during the Sri Lankan Civil War. The family went to London, Canada, and finally settled New York. The subject was born in Canada. He became an American citizen when he was 10 years old.
The subject spent his childhood in a lower middle-class area with a predominantly Hispanic and black population.The neighborhood saw its share of gangs and drug use. Many of the his classmates died, went to jail, or became drug dealers.
Teenage pregnancy was common among girls as young as thirteen years old . Many dropped out of school. Some students brought guns and other weapons to school. Yet, the subject never felt threatened.
“Why did you succeed when others from your neighborhood did not? “ I asked.
“There is a culture of hopelessness.” He said. I asked what can be done about it.
The subject said, “Deal with the gang violence. Get rid of all fast foods and replace with readily available fresh food. No vending machines. Physical fitness awareness. Impose school uniforms, which will get rid of the peer pressure of having to dress in expensive clothes they can’t afford in the first place. Try to have good role models in schools, since many kids grow up in single-parent households lacking any semblance of a role model.”
In high school, the subject wanted to be a writer and musician. He hated science because of the unimaginative way it was presented in the high school curriculum. As an English major at a large city university, the subject discovered genetics when he had to take a general requirement. He switched his major from English to a double-major in Biology and Philosophy.
The subject has had many jobs starting as a bus boy at 16. He worked in retail stores and supermarkets until his studies landed him jobs studying genome sequencing with top researchers at a prestigious university.
In 2011 the subject found himself in the role of patient. He got food poisoning. An infection spread to his lungs. Health insurance for students is part of the MD-PhD program. His dean of student affairs of this major teaching hospital “really took care of me.”
“They spent thousands of dollars on my care. I felt privileged as a med student.” The subject does not know what would have happened if he had not been treated immediately.
“Perhaps my lungs would have deteriorated overtime.” Because of this episode, the subject feels for the patients in his community clinic who would not have such timely access to clinical resources if put in the same situation.