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underserved populations

Undocumented Immigrants, the law, and healthcare

By | Health, Healthcare Policy, underserved populations | One Comment

A high school Valedictorian in Texas announced that she was an undocumented immigrant this week, sparking a debate about who should and should not be enjoying the benefits of residency in the US.  Larissa 20160423_blp901Martinez stated the following:

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Lovely, brilliant Valedictorian

“By sharing my story, I hope to convince all of you that if I was able to break every stereotype based on what I’m classified as — Mexican, female, undocumented, first generation, low-income — then so can you.” 

My maternal grandparents are from Italy.  My mother is a first-generation American.  I was the first person in my family to go to college, which happened later in my life because my parents didn’t really see the benefit.  After all, my father never graduated high school, and no one in either of their families had been to college and they turned out just fine.

Naturally, in our changing economic climate that was a mistake.  However, back to the undocumented part… When my grandparents came here it was much easier to become a legal resident of the US.  My grandfather was so unbelievably proud to become an American Citizen, after the long and grueling process of naturalization.  He only spoke Italian when he arrived, and worked at low-paying jobs doing manual labor.  He learned English.  He studied, he sweated, and he passed the test after 12 years.

Larissa says that she and her mother have been trying to become a citizen for seven years, and that the US Immigration system is broken.

I am going to make comparisons here.  Preparing for the tomatoes.  tomatoe-thrown

While the US Immigration system is probably broken, the Mexican Immigration system is equally as convoluted and full of red tape.  I cannot just walk into Mexico with my children and set up housekeeping, as Larissa’s mother did.  News stories I read about her family stated that they ‘fled’ to the US; from an abusive, alcoholic father, apparently. It seems to me that it was probably not necessary to illegally enter the US for that reason. I will assume that Larissa’s mother wanted an American life for her children.

In 2011, the Mexican government enacted a ‘softer’ law about undocumented immigrants to Mexico. Up until then, this was the law:

  • Under the Mexican law, illegal immigration is a felony, punishable by up to two years in prison.
  • Immigrants who are deported and attempt to re-enter can be imprisoned for 10 years.
  • Visa violators can be sentenced to six-year terms.
  • Mexicans who help illegal immigrants are considered criminals. 
  • The law also says Mexico can deport foreigners who are deemed detrimental to “economic or national interests,” violate Mexican law, are not “physically or mentally healthy” or lack the “necessary funds for their sustenance” and for their dependents.

Sick and poor undocumented people are not supported by the Mexican government.

So, when Larissa’s family arrived in the US, the law in Mexico was pretty harsh.  Had I done the same thing with my children, I would have been imprisoned for two years and charged with a felony, then deported. The law has since been changed to an administrative and financial penalty, and it is possible to obtain Mexican residency unless you are sick or poor. Larissa’s family was poor.

illegal-immigrants3Having said all that, am I in favor of deporting all undocumented immigrants? No, of course not.  I am in favor of naturalizing them; they already live here and contribute to the economy.  As a matter of fact, they have historically contributed to Social Security and never collect the benefits.  Of course, there are people who work “Off the books”, but the large majority actually contribute to all payroll taxes via a false Social Security number. And this is not the fault of their children, who know no other life.illegal-immigrants-pay

However, if they commit crimes against other people, I am in favor of instantly deporting them.  Not in a year, not after a prison term that we pay for.  That very moment. Mexico can keep her problem children. They have high standards for Americans emigrating to Mexico.

Let’s get to the healthcare part! 🙂

The Affordable Care Act specifically prohibits undocumented immigrants from purchasing health insurance through the marketplace.  Undocumented immigrants can sometimes get coverage through an employer.  They can purchase private health insurance, which is expensive.  If they are a college student, they can purchase a student plan through a university.  These are usually cheap.

Also, a 2012 federal law provides temporary work authorization and relief from deportation to undocumented children and young adults who arrived in the U.S. before turning 16. It’s part of the Deferred Action for Childhood Arrivals law, known as DACA. Undocumented immigrants who qualify are eligible. Since we really cannot blame kids for the actions of their parents, I think it is a good concept. In California, undocumented immigrants may be allowed coverage under Medi-Cal if they have DACA status.

I see no problem with undocumented immigrants buying health insurance through the marketplace.  More people = lower prices according to our government.  Also, these folks currently seek primary care in Emergency Departments all over the US because they have no insurance.  11 million undocumented people can clog up a lot of ED’s.  Let’s make them pay for insurance like everyone else, and stop using the ED as a PCP’s office.

While I do not have the answer to the problems we have with undocumented immigrants, I would say that Larissa probably made an error when she did this.  Many people will see it in a negative light.  She is still in the country illegally.  I hope Yale knows her immigration status, and that she is prepared to get a student visa.  She is a smart kid, so she probably thought of this.

However, great job on those grades, girl! I hope you are a great neurosurgeon.

And we don’t need that wall.

Love,

Janie

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Out of the Mouths of Babes – Substance Abuse

By | Advocacy, underserved populations | No Comments

My 12 year old kid: Mom, why do people go to jail for being addicted to drugs?

Me: Well, sweetie….. because the healthcare system is broken, and the justice system is also broken.

My Kid: Shouldn’t they go to counseling? If they weren’t selling drugs to kids or something?

Me: They should. Probably inpatient rehab.

My Kid: Why don’t they?

Me: Because inpatient rehab is expensive

My Kid: Wouldn’t it be cheaper to send them to rehab for six months instead of sending them to prison forever?

Me: Yes, baby. It would. In money and lives.

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EKO- a high tech Stethoscope to save lives all over the world! Wow!

By | Health, International Nursing, underserved populations | No Comments
[box]Let’s say you are on the SMYS Mission to Haiti with NO Cardiologist anywhere for a few hundred miles. [/box] 
Your patient presents with dizziness and shortness of breath upon exertion, transient chest pain, and fatigue.  There is a 12 lead EKG available which shows normal sinus rhythm, and no ST elevation, but there is T-wave inversion in the inferior leads. The patient complains of dizziness during the EKG, with no exertion and no dysrhythmia.  He has no pain at the moment.
You hear SOMETHING when you listen to the heart, but you are not sure what it is because you have never heard it before.  You have nothing to compare it to, and neither does anyone else at this remote Haitian outpost.  It is not a normal heart sound, and that is all you can be sure about.
What do you do? 
There is no Cardiologist. Transporting every patient with these symptoms is just not an option.  These people are poor, and emergency care is a precious resource.  For that matter, is this sound an emergency? Is the patient having a bit of atrial fibrillation, but transient and with an overall low burden? Or is there something structurally wrong with the heart? Are those sounds you are hearing the classic auscultatory finding of Mitral Valve Prolapse; a mid-to-late systolic click followed by a late systolic murmur? Does this person need a Cardiac Cath, an ECHO, an aspirin regimen, or a wait-and-see?

You don’t know. How do you find out? Turn to the Eko Core!

So, what is this thing? The Eko Core Digital Stethoscope is the first & only FDA-approved digital stethoscope on the market to let clinicians amplify heart & lung sounds 40X, wirelessly sync to the HIPAA-compliant Eko Mobile App, visualize, record, save sounds, and forward them on for a second opinion. 

Why is it important? The Eko Core Digital Stethoscope is bringing the stethoscope into the 21st century. Now clinicians can hear heart & lungs sounds more clearly, and get support from their team across the hospital or across the globe. The sounds can also be integrated into the EHR and monitored over time for better consistency of care. The Eko Core and Mobile App is being used in cardiology, newborn screenings, pediatric cardiology, teaching, telemedicine, low-resource care, and primary care by clinicians at hundreds of institutions across the country including Harvard, Mayo Clinic, UCSF, and more.

This is what a 21st century stethoscope looks like!

This is what a 21st century stethoscope looks like!

There are two versions of the Eko Core:

    • 1. “Eko Core Attachment” ($199) attaches onto the regular stethoscope you already have! It attaches to almost all known stethoscope brands such as Littmann, Welch Allyn, ADC, and Ultrascope. You can digitize your own stethoscope!
    • 2. “Eko Core Bundle” ($299) includes the Eko Core Attachment pre-attached to a cardiology-grade stethoscope. Just take it out of the box, and it’s ready to go.

Impact on global health: The Eko Core Digital Stethoscope can be used to improve access to specialty care to billions of patients in low-resource countries around the world. Take Haiti, the poorest country in the western hemisphere with the highest rate of maternal & infant mortality. Eko is used by clinicians in rural clinics there as a relatively inexpensive tool for cardiopulmonary screenings and to secure specialist second-opinions. It can even be live-streamed. Recently, a Nurse Practitioner in Haiti used an Eko Stethoscope to wirelessly send heart sounds to a Cardiologist for a consult…who happened to be on a cruise at the time. Check out the article on it here here.  How awesome is that?

And this company is so cool they are partnering with Show Me Your Stethoscope by providing Eko stethoscopes for our Mission Trips!! 

  • And….Visit www.ekodevices.com for more info and use discount code SMYS2016 at checkout! Members get a $15 discount, AND Eko will donate $15 for every order to the SMYS Foundation. 

 

Apparently people love this thing…. Check out the awards and recognition.

TIME Magazine’s Best Inventions of 2015

New York Times

Washington Post

TechCrunch

MedGadget

Let me know if you like it!

Love,

Janie

smys eko 1

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I am not sure it gets any worse than this

By | Advocacy, underserved populations | 3 Comments

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An 86-year-old Florida man said he killed his wife while she slept because she was in poor health and he could no longer afford her medications, according to an arrest affidavit.murder

William J. Hager of Port St. Lucie said he had been thinking about killing his wife Carolyn for several days because she was in pain. After Hager shot his wife Monday morning, he went to his kitchen and drank coffee, called his daughters and later dialed 911.murder (1)

“I want to apologize I didn’t call earlier. I wanted to tell my kids what happened first,” detectives quoted him as saying.

Hager faces a first-degree murder charge.”

Ok, so this happened.  

What the hell is going on in this country? Where is the disconnect? The elderly should not have to go without their medications because of money! Is this a case of the medicare doughnut hole? Did this guy not know that he could ask drug manufacturers to give him discounted medication for his wife? Was the PCP unaware of the situation?

Didn’t it occur to him to go to a hospital and tell them he felt like he wanted to kill his wife? Was he mentally ill? Couldn’t he call his daughters and ask for help?

This man is 86 years old and will spend the rest of his life in prison.  waldenu_minitype

And if he is telling the truth, he shot his wife to put her out of her misery.

I am ill. Seriously.

 

 

 

 

 

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