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July 25, 2014

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Health care:

For Hispanics, illicit care is worth the risk

They have practical, cultural reasons for choosing their providers

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Leila Navidi

Catalina Alfonso inside her home in Las Vegas Wednesday, April 13, 2011.

Surgery Death

The location where the surgery occurred. Launch slideshow »

KSNV: Botched Surgery Death

KSNV Channel 3 coverage of a court hearing in the death of Elena Caro. Two Colombian nationals -- Ruben Dario Matallana-Galvas, 55, and Carmen Olfidia Torres-Sanchez, 47 -- are facing murder charges in what police have called a botched surgery death. Caro was seeking buttocks enhancement surgery.

The little-understood world of how health care and medical procedures are obtained by many Hispanics in Las Vegas was displayed in distinctly different scenes last week.

In downtown Las Vegas, Colombians Ruben Matallana-Galvas, 55, and his wife, Carmen Olfidia Torres-Sanchez, 47, were charged with murder for injecting Elena Caro, 42, with silicone in her buttocks in the back of a tile store on East Charleston Boulevard. Caro had wanted to enhance her backside; instead she ended up dead. Matallana-Galvas told authorities he was a homeopathic doctor in Colombia.

On the east side of town, Catalina Alfonso, 46, who lived in Mexico until immigrating to Las Vegas six years ago, grew sad as she watched the news about the death on Spanish-language TV. But she shrugged off the fact that the procedure was attempted by people not licensed as U.S. doctors. She tends to avoid “doctores Americanos,” she said. They cost too much, don’t speak Spanish, and frankly she doesn’t think they heal as well.

As she talks, she shows her collection of healing herbs, dried flowers and what she describes as a cholesterol-lowering concoction made primarily of raw — and thoroughly blended — cactus.

Indeed, many Hispanics — especially the uninsured and/or illegal immigrants — get their health care in living rooms, kitchens and in back offices. Much of it is legal, such as the herbs Alfonso buys at the local “botanica” — neighborhood shops that Hispanics frequent in search of their favorite powders and leaves for common ailments.

Some of it is illegal, such as medicines people buy in Mexico without a prescription and sneak across the border. Alfonso confesses to getting injections of B-12 from a salesclerk at one botanica.

Earning $9 an hour as a nighttime helper at a Mexican restaurant doesn’t allow for much spare cash to go to doctores Americanos, she said. She is quick to explain that where she comes from, it’s not uncommon for locals and family members, as well as friends, to give each other shots.

Welcome to the highly developed, long existing world of alternative medicine as practiced in Hispanic communities in Las Vegas and across the U.S. These botanicas and other medical venues — improvised or not — are favored by people who can’t afford Western-style care or have little interest in doctors who don’t understand the highly ingrained, ancient ways many cultures have when it comes to their healing practices.

“I grew up with yerbas (herbs) and curanderos (folk healers),” Alfonso said, adding that those with everything from broken bones could visit a huesero (community bone setters), or spend some time with a sobadero (spiritual masseuse), in search of cures. Mostly she grew up with her mother’s health recipes that were passed down in an oral fashion. She describes taking care of family members with plants and herbs — boiled, drunk in teas and eaten.

In short, she explains, Hispanic immigrants don’t necessarily run for the Tylenol or call the doctor. Most likely, they might go the neighborhood botanica.

•••

Folk medicine has existed since the days of hunters and gatherers, said Alan Kilpatrick, a professor of American Indian studies at San Diego State University and an expert on folk healers and shamanism. Over several years his team documented more than 800 plants and herbs used by the Peruvian curanderos, which, he said, were often highly trained botanists who act as medicine men in Native American cultures, offering healing plants “that were often just as good as their Western counterparts” and simultaneously performing spiritual “cleansings,” bringing a spiritual and botanical approach to healing.

Although many in the Western world may consider much of this tea-drinking, egg-rubbing, spirit-invoking medicine not much better than doing the “Hokey Pokey,” Kilpatrick, a believer in alternative medicine, points out the placebo effect when it comes to testing Western medication. People get better on sugar pills. Why not get better with cactus drinks?

“Sometimes we have no idea why some people get better. They just do.”

Although it contrasts with Western medical care, which is based on science, facts, reason and logic, this style of alternative healing, including spirituality, is common among Latin American and other international indigenous cultures, according to the Rev. Bruno Mauricci, pastor of St. Peter the Apostle Roman Catholic Church in Henderson, who heads up the Las Vegas Diocese’s Hispanic outreach program. Mauricci, who hails from Peru, explains that for Hispanics, health care is more holistic in general.

“They don’t just take a pill, they believe in the spiritual healing, the mind-body-soul connection, and they go to their curanderos in part because they have this component. In Latin America, doctors spend a lot more time talking to their patients,” he said. “We don’t have this thing where a doctor is writing a prescription five minutes after they’ve walked in the office, already on their way out. It’s not uncommon for a doctor to spend up to an hour with their patient. You don’t find that here.”

Still, spirituality is for many just as important as the medical component, he said. At his church, parishioners will mistakenly call him “Doctor” in confession, and conversely, will call their doctor “Father.”

Many end up at the hospital or doctors’ offices when all else fails, said Sylvia Vasquez, who manages interpretation services at University Medical Center. She and her colleague, Alvaro Vergara Mery, witness the clash between old-world practices in the new Las Vegas on a daily basis.

“Many patients show up not knowing what medications they have taken before,” Mery said. “Latino patients don’t ask much about their medical care.” It’s possible they have had some shots somewhere, or taken some pills, but don’t know what they were.

Vasquez said: “For those with little education, they are not used to questioning doctors or asking questions about their health care. They are very accepting of authority.”

There are other common problems. “Some people come in here, and they use false names, because they are using someone else’s Social Security cards,” Vasquez said. “It’s problematic. Others speak another dialect from Latin America, and we realize they don’t understand Spanish.”

Then there are the doctors who prescribe medications that patients can’t afford, driving Hispanics back to their neighborhoods in search of something to take its place, or even “ordering” medication from Mexico through a friend who is going there.

“Many doctors don’t seem to have an idea of how much their prescriptions they write cost. They may cost $45, but the patient may not have that kind of money.”

A patient’s education level often dictates what kind of medical care he will seek.

“In Argentina, where I come from, we see a big difference between the educated and noneducated patients,” said Dr. Oscar Ingaramo, a pediatrician at the UMC intensive care unit who trained at a hospital on the U.S.-Mexico border. “The more education a patient has, the more they tend to believe in Western medicine,” he said.

The main problem with alternative medicine is it can extend the amount of time before a patient turns to a doctor for help, by which time a patient’s condition may have turned serious, he said. Coupled with that are the cultural and educational barriers that prevent many families from integrating into a medical system that they don’t understand.

“It’s more comfortable for many patients to go to the alternative medical system. It’s what they know. No one is going to ask them for documents concerning their legal status there,” Ingaramo said.

Although the local Mexican consulate offers information regarding low-cost clinics and organizations for residents with little money, for Alfonso low-cost clinics are not a welcoming option.

“These clinics often want you to bring in your last pay stub. What if you don’t have one?” she said. “What if you aren’t working, or if you work for cash?”

In short, the fewer forms she has to fill out, the better, she said. Why go through all the hassle when you can go down the street to the botanica and get “what you need.”

In a phone conversation, Las Vegas’ Mexican consul, Mariano Lemus Gas, sounded frustrated with the medical care for the local Hispanic population, many of whom are Mexican citizens.

Immigrants in search of help or medical care are vulnerable to exploitation by those who pose as doctors or healers, he said.

And there’s a history of that in Las Vegas. Just two years ago, authorities closed a botanica after a woman began bleeding profusely during gynecological surgery in a backroom and needed to be taken to a hospital. Investigators found a crude surgical suite including a cabinet with intravenous and injectable medications, many with Spanish labels, and a log with the names of patients and procedures.

The health care of Las Vegas Hispanic immigrants “is a (public health) Molotov cocktail. The medical establishment doesn’t speak Spanish, many immigrants have a third-grade education, and they can’t afford medical care.” He said he wished local authorities would do more to investigate botanicas selling medication without a prescription.

That wouldn’t make much of a difference, said Jaime Rodriguez, a former internist from Mexico City who works as an emergency medical technician at American Medical Response. That the U.S. has the most expensive health care system in the world is not lost on immigrants, he said.

“If I am an immigrant, and I break a bone, I will probably call up a friend who broke his bone before and asked him where he went and if he knew of anyone who could fix it,” Rodriguez said. “Maybe he will give me the name of someone who knows how to set bones, maybe it’s a huesero, a bone setter, and they learned to do it back in Mexico or maybe they had some medical training. If they can’t fix it, they might refer me to someone else.

“Only if nothing works, will I go to the hospital. The notion that Latinos are rushing to the emergency rooms for everything is nonsense.”

It’s not just the older generations of Hispanics that turns to their families and local healers for medical attention. At the Dog Store in Henderson, groomers Samuel Zamora, 38, of Mexico, and Blanca Orellana, 24, of Guatemala, talk for hours about growing up in small towns that lacked medical care.

“My father knows all about those plants,” Zamora said. “He knows how to set bones, too. Only this one didn’t heal right.” He shows a finger that didn’t heal properly.

Nevada’s Health officer, Dr. Tracey Green, says she is shocked by Caro’s death allegedly at the hands of unlicensed individuals coming from across the border to provide underground services in back alleys. She had no information as to just how frequent or extensive such practices are.

“We can’t go knocking on people’s doors unless there is a reason to think there is something illegal going on,” she said. She encourages anyone who suspects fraudulent activity to report it.

But for many like Alfonso, cost of medical care largely dictates where she will get it. Unfortunately, she muses, she’ll have to foot the entire bill for her next medical expenditure: surgery on one eye that will cost her $3,200.

“I spent a long time looking for this eye doctor,” she said. “I am aware that I need to be concerned with who I go to.”

But if a traveling dentist came by, she might think about it.

“Dentists are so expensive here in America.”

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  1. Desai or the guy reusing needle guides (I won't mention his name because he would sue) or one of these "doctors" does it really make a difference? The established Doctors can put up a better legal defence with their insurance companies and attorneys.

  2. The FDA needs to be changed.
    People should be given access to whatever they need. They should also be held completely responsible for the use of such drugs/procedures/substances; so therefore, if they lack knowledge they need to seek a doctor who is qualified and knows. All drugs should be available to the adult public. People need to own their lives, and by assuming responsibility for their lives, they will do better and be careful.

    Medical costs are high because big government and greedy people wanted the money generated from the sales of medicines, procedures, and substances. That is FACT.

    Let's make medical care accessible to ALL by reforming the FDA and giving individuals the right to manage their own health care. Maybe that will encourage children to learn as much as they can while in our FREE schools here in the USA!