Kadiatu Hodges

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Kadiatu Hodges shares her perspective on immigrant access to health care in the United States and the political and social barriers that lead to health consequences of Latino immigrants. Having lived in several different nations of the world, including parts of West Africa and Mexico, she has experienced a range of healthcare systems and can compare them to the system in the United States. Hodges’ own experience studying abroad in Jalisco, Mexico during college influenced her to become the manager of the Farmworker Health Program (FHP) for three years. There she did education and outreach programs, provided care in a clinic, and worked closely with many migrant farmworkers. Now a public health nurse with Wake County, Hodges shares several stories of patients who have struggled with the healthcare system and provides analysis of the many cultural barriers that often prevent Latino immigrants from accessing health treatment.



Radha Patel: Okay, well good afternoon. My name is Radha Patel. I’m the interviewer for today. I’m interviewing Kadi Hodges, who is a nurse that works with the Farmworker Health Program, I believe. We are in a… we are in a Café Carolina, I think, in Cary, North Carolina on April 23, 2014. Alright, could you maybe give me a brief background about yourself and of your interests in health and the Latino population?
Kadiatu Hodges: Sure. I am a public health nurse with Wake County and for three years, I was the manager of the Farmworker Health Program there.
RP: Okay, cool. Could you tell me a little bit about what kind of things you did there?
KH: Sure. Our job there was—we did education and outreach to camps, so we went out to visit twice a week in the evenings. We went to camps in Wake county, Franklin county, and some of the surrounding counties. And then in the summer, seasonally when there were a lot of migrants here, especially during tobacco season, we operated a clinic for farmworkers—we did that two nights a week as well.
RP: Cool, cool. What made you want to get involved with this program in particular? Was there anything?
KH: Well I did a study abroad program when I was in college and spent half a year in Mexico and loved it there and almost majored in Spanish, Spanish in college. And so I had sort of a long-going interest in Mexico and Latino, and being a nurse who does not like to work in the hospital (laughter), it seemed like just a great opportunity.
RP: Cool. What part of Mexico were you in, if you don’t mind me asking?
KH: Jalisco.
RP: Oh okay—we had to memorize a map for class (laughter).
KH: (laughter) Although, I’ve been to Guanajuato—great city.
RP: Yea, I really liked it there. So Jaslina mentioned that most of—did you work with her a lot?
KH: Yes, I did.
RP: Okay, so she said that most of the population was male and from Mexico, and a very broad age range—was that the same for you?
KH: Yes. So when she was there during her experience, it was primarily during tobacco season and in tobacco season, we mostly worked with H-2A migrants who were there to work in tobacco. And so the county has an influx of primarily young men between…usually about 18 and, you know, early 50s who had come to the county for three or four months to work in tobacco. The rest of the year, we would serve seasonal farmworkers, which is the term that we used for people who were here, really, for all seasons, so it’s sort of a misnomer. And that was primarily people who were working in nurseries—that was where most of their work was. And those people were of a very wide rang of ages and backgrounds—primarily from Mexico, but you know, people of all roles in the family. So it was, you know, children through older people.
RP: Wow, so children were working at the nurseries?
KH: Yes, yea, we would see children working in nurseries.
RP: How old…how young?
KH: We would see kids, you know, down to ten who were working with their parents in the nurseries.
RP: Is that legal?
KH: Is that legal? Probably not. Yea, but kids who work in farmworker families and agriculture families often don’t have available childcare in the afternoon, so often they’d have to be with their parents in the afternoon, so they would end up working too. I mean, they would—they probably weren’t getting paid for it, but they were in the fields.
RP: Wow, okay. So what sorts of proj—oh well I guess I already asked you that one. Was there anything else, other than—so you were—were you with the doctor the whole time or was it—well, what sorts of health care did you provide?
KH: Let’s see. So we did two nights a week. Somebody from our team would do education and that would be primarily going out to camps. We would do health assessments of everybody, so we would sort of do interviews about weather anybody needed immediate healthcare attention or whether there was anything that should be on our radar. We would check everybody’s blood pressure while we were there, we would distribute over the counter medication so that everybody had some Tylenol and, you know, some Benadryl while they were there. So we would do that at camp. We also did vaccine outreach, so we had a vaccine program and we’d go out to camps and, you know, make sure everybody has tetanus vaccines, have had some basic childhood vaccines, which lot’s of people had not had. At the clinic, I was the clinic manager, so we were staffed mostly with nurse practitioners and PAs (Physician’s Assistants) and nurses, and we would see basic health complains. A lot of musculoskeletal problems, a lot of injuries from working in fields, a lot of green tobacco sickness.
RP: Green tobacco sickness?
KH: It’s just—it’s transdermal nicotine poisoning. It’s what you get form touching tobacco plants, which almost 100% of farmworkers would get that during the summer. Yea, so lots of people would be very sick coming in. we’d also see people who had, you know, debilitating injuries or illnesses who, you know would call us in the middle of the night and have a broken leg and would have been like that for three days. And we’d, you know, try to find health care providers for them.
RP: Okay, could you walk me through the process of—so I assume most of the people you worked with weren’t insured?
KH: No, none of them were—maybe I had two patients who had insurance.
RP: Throughout the three years?
KH: Yes, throughout all the years.
RP: Okay, so could you maybe walk me through the process of—like if I were an uninsured farmworker and I had maybe sort of a minor-ish illness, how would that work?
KH: When we would see people, mostly we would find people that had illnesses rather than them come—
RP: Okay so they wouldn’t come to you?
KH: Well sometimes they did. We kept out phone number the same from year to year and people who had been around for a while, who were familiar with us would contact us sometimes to let us know. But more often, we would go into a camp and find somebody had been sick for a while and has been wanting to get health care but didn’t know how to do it. And so, I mean, often we would, you know, we would drive around the camps and try to hit all of them periodically through the summer and so most typically we would find somebody who was sick. Or they would call us, or their friend would call us and tell us they were sick and we would, you know, assess over the phone the severity of it and, you know, if it was somebody who could wait a few days, we would get them into our clinic and see them there, and if it was somebody who couldn’t wait, then we would drive out there and pick them up and find either an urgent care or take them to an emergency room, something like that. And we would translate for them and we had a small budget to pay for emergencies too, so often we would pay for people’s hospital visits or emergency care visits.
RP: Okay, did you find that the money was enough for the most part or is there a lack?
KH: No, no, there was never enough money for all of the medical emergencies that we had, especially for dental emergencies. Dental emergencies were just a huge part of our budget. So we would see lots and lots of people who either had—these are young men so they’re primarily healthy when they get here, but they have lots of, you know, impacted wisdom teeth or an abscessed tooth or something else that can—you know an abscessed tooth can be life threatening and it’s also extremely expensive to treat.
RP: What is an abscessed tooth?
KH: An abscess—an abscess tooth is when you get an infection beneath the tooth, so it’s sort of an infection in the jaw. And it can happen to anybody and it can happen at any random time—it can happen very suddenly. So just one morning, you wake up and you have a throbbing tooth and you have a little infection under your tooth and it can cost you easily a thousand dollars to treat it.
RP: Is that what you’d get a root canal for? I’m just curious.
KH: You can get a root canal for that. Yea, that is a possibility. More typically they would have abstractions, which are expensive but also take care of it. But untreated, you could—you could die from it in a matter of days.
RP: Okay, so what would happen when the funds that the Farmworker Health Program provided weren’t enough?
KH: Often, we would seek out a visit and not be able to pay for it. It would just happen that, you know, we would just have to tell people that, “if you can pay something for it, go ahead and pay something for it, but if you can’t it’s more important for you to get care for chest pain than it is for you to be able to pay for it.”
RP: Okay, so how would that work in terms of, I don’t know, the future?
KH: I mean it’s a terrible, terrible thing to be able to tell people that, but I mean, it was often the only option if somebody needed emergency medical care and there was no way to pay for it, we would tell them to take it anyway, which is what people do here, too. It’s not something that’s exclusive to immigrants—if you need medical care, you go get it. Figure it out tomorrow if you can pay for it.
RP: Okay, great.
KH: Well, not great, but—(laughter).
RP: Well yea (laughter).
KH: It is what it is.
RP: Yea, so you said that you would encourage people to seek medicine. Would they listen?
KH: Do I think they would listen?
RP: Yea, do you think they would just be like “Oh, you know, whatever” or…?
KH: No, I found that the patients that I had were much less willing to seek out care they couldn’t afford than other patient populations that I’ve worked with. They were extremely conscientious about wanting to pay their bills. People who are on—either on work visas to be here or people who are undocumented were generally really scared that a bill would get them kicked out of the country or that they wouldn’t be able to renew their visas. So yea, they were really, really worried about that. I mean also to the point that I think people would endure life-threatening problems so that they would not lose their work status.
RP: Yea, okay. Do you have any, I don't know, experiences that really struck you while you were there? They can be related to health or not. That's a really vague question.
KH: Yea, that is a vague question. Tell me what you’re thinking of.
RP: I don’t know—do you have any—maybe did you have a patient who had some sort of horrible disease and couldn’t do anything about it? Or, I don’t know, or an injury?
KH: Okay, so we had a patient who called us. Well I think a friend of his called us initially because his friend had out phone number. The patient was seventeen or eighteen, really young. He had gotten there the day before, didn’t know—he literally did not know what town he was in—knew nothing about what was going on around him, didn’t know anybody at his camp, and said that his throat was hurt really bad. And so we thought he has strep throat because that happens and our big worry was that we was going to spread it to other folks in camp because they live in these really close quarters, so if somebody gets an infectious disease, everybody gets an infectious disease. So we went out and picked him up a couple hours later, took him to an urgent care, and the urgent care said, “he needs to go to the emergency room right now.” He had an—he had an abscess in his throat that—so it was like an infection growing in—but those, when they grow can swell your throat closed. So it’s like literally it could be hours before he couldn't breathe. And so I always—it struck me really dramatically that his story…he was so young, had no idea where he was, no idea how to get himself treated anywhere. And you know, one of the first things we would do with everybody when we did camp visits was teach everybody how to call 9-1-1. Because when you think about the most basic thing you know how to do to access health care—if you think you’re gonna die, you call 9-1-1. And people don’t know that when they are from a different country. And so he is just sitting there, literally on the verge of death and it’s just fortunate that somebody around him, you know, had a phone number to somebody to get him case, but you know, on his own, he could not have kept himself alive for the day.
RP: That’s terrifying. Okay well thank you for sharing that. If you have any more, feel free to tell them whenever. So I guess going back to (pause for interviewee to check phone for important call)—so I guess going back to what we were talking about a little bit, do you feel like the people that you worked with felt like they had a right to receive health care, regardless of if there were any other barriers? Do you think that people would be oh, you know— oh, well I guess there weren’t very many undocumented folks, but I guess if they were, maybe people would be like, “oh this is the price I have to pay” or was it a range or…?
KH: Tell me that question again.
RP: Do you feel like people…people felt like they had a right to access health care or do you think it was—.
KH: No, I think people felt like they didn’t know how to access healthcare, they didn’t know if it was appropriate for them to seek healthcare. Even the most severe situations, people would be sitting at home with the most severe symptoms you can imagine—people having symptoms of heart attacks and I would tell them, “you have to get to a doctor right now” and people would say “No, I can’t pay for it. I’m not going to go.” Yea, consistently, I really had to convince people to seek healthcare. But I mean, also there is a big cultural difference between when you seek healthcare. And so people did not necessarily think that this was a health care system that was gonna benefit them. And so if this is not the health care system you’re used to, it’s not necessarily what you’re gonna see. Because the people that we see were not generally from urban areas; they were from, you know, rural Mexico and frequently had never seen a doctor in their life. So, it wasn’t their first thought when they were sick—with “I’m gonna go to the doctor.”
RP: Okay, that’s very interesting. Were there any other cultural barriers that you can think of? Cultural or social barriers for them to not want to receive healthcare?
KH: Everything. Everything is a cultural barrier and social barrier. There were so many barriers to getting healthcare: not being able to speak the first language of somebody who answers the phone, just, I mean that alone can be the reason that you don’t seek healthcare for something. So, not being able to speak on the phone, transportation is huge, being worries about missed wages for doctors appointments was enormous—lots of people would miss very important appointments because they didn’t want to miss, you know, three hours of wages. It was that important to them. There are a lot of cultural differences in how people perceive healthcare and what it is that people want when they go to a healthcare provider, and I often felt like what we could offer in a clinic was not what people wanted. Like we could give people a lot of services that we thought were fantastic, but it was not necessarily the services that they wanted. And so there was—there’s a program like ours in Greene County and they did a survey asking patients what they wanted out of healthcare. Have you heard about the survey that they did?
RP: No, I haven’t.
KH: It’s something like 80% of their patients said that what they wanted was to see a traditional healer. They did not want to see a doctor.
RP: Really? Here in North Carolina? Wow!
KH: Yea, so I mean, we can give you a clinic, but if a clinic’s not what you want, then you’re probably not gonna seek that out very aggressively.
RP: That’s interesting—80%!
KH: Yea, it was huge! It was huge. I mean, and lots of our patients have never seen a doctor.
RP: So do you know what the traditional medicine that they’re talking about is referring to? Like is it… I don’t know.
KH: I think it’s a variety of different things, depending on where you’re from, depending on if you’re from an urban or rural area… I know that in our area, we had a very popular provider with a fellow named Andrew who was a pugador, which is like a type of massage that is a part of traditional healing practices of Mexico and our patients really liked going to him.
RP: That’s really cool! Okay, so this is sort of off topic, but what do you think about The Affordable Care Act and its impact on the Latino population?
KH: I’m not very familiar with that. The clinic that we had was not dependent at all on insurance—we got grants to run the clinic.
RP: What was the name of the clinic?
KH: I think it was Wake County Farm Worker Health Clinic… it’s a part of a county service -- but we got a grant from the state that paid for the entire clinic so like we didn’t charge anybody, we didn’t, you know, take any insurance. It really didn’t have any impact on me, so I’m not a good person to answer that.
RP: Oh that’s okay, no worries, I’ve been getting a pretty broad range of answers about that one. So when you’re talking to people here—I guess this is kind of more relevant to Jaslina because she’s on a college campus, but when you talk about your experience there, and maybe regular people who don’t really know anything about this, what sorts of reactions do you get? Do you – get antagonistic responses like, “oh, you know, why are you working with those people?” or is you know more like a…?
KH: I would say the most common reaction I get is “there are migrant farm workers here?”
RP: Really?!
KH: Yeah, I don’t, I don’t think that very many people know that those folks exists. They’re very hidden.
RP: Yeah, I guess that makes sense.
KH: Yea, I think they’re primarily surprised that there’s anyone here.
RP: Okay, that’s strange! So you don’t really see a lot of antagonistic responses?
KH: I think that people are more antagonistic if I refer to…caring for undocumented clients, but most of our clients are not undocumented, probably 75 percent of our folks were here on H-2A visas. But I’d imagine the response would be different if we talked about documentation status, but very few people know that there’s any farmworkers here.
RP: That’s so strange! So, so, what types of things do you think regular people like me could do just to I guess ease the situation, maybe make things better. Solutions?
KH: I have no idea (laughter). Really!
RP: No worries, that’s okay.
KH: I mean I think that a lot of folks who’ve worked in positions like this seem to get involved in political activism… but I don’t see things changing very much as a result of any kind of activism, I don’t know that the things we do on a day to day basis matter that much.
RP: Okay, yeah, what about us as a nation? Or as a state? Is there and anything that—an ideal solution—maybe this is not feasible, but what do you think an ideal solution would be?
KH: An ideal solution. I think that the way we put up our border is really—I think that’s really the crux of our issue…that we are—I know this is not a popular opinion, but our strictness in border security…to me it just seems counter-productive. I think we spend a lot of time trying to keep people out of the states who are gonna be here no matter what you do. And when we had more relaxed border security, when people were about to come in and out of the country more easily, it didn’t cost us as much as a nation and people were able to go back to Mexico when they needed something and come back to Mexico when they were done needing that thing. And I think that we talked ourselves more that forcing people to cross the border at these high prices, which is such a risky thing to do, and then when they come here, they feel like they’re stuck here. If people were able to, say, go back to Mexico to get their dental work done, it would be so much cheaper for us. Like people…I mean I heard so many patients complaining about the price of things here just being ridiculous. If they could go home, get their dental work done for a hundred bucks, and come back here, we wouldn’t have to pay to do all of that.
RP: Yes, I never thought about it from the health-care side. That’s interesting. Have you—this is a strange one—but have you worked with anyone who had PTSD (Post Traumatic Stress Disorder) from crossing the border, maybe? Anything like that?
KH: I heard a lot of stories about people having tremendous losses from border crossing. I had one patient whose child crosses with her when he was, I don’t know, 7 or 10 years old, and he became severely dehydrated during the trip and had kidney failure and he died as a teenager because of that.
RP: While he was crossing or later on?
KH: Later on. It was years later, but it was a long-term route. So he became severely dehydrated, kidney failed while they were crossing, and then he came here and was on dialysis for years and years, and he died several years later. I had another patient who was—I don’t remember his story—I think he was bitten by a snake while he was crossing and was left for dead by the group that he was with, and his survival was just this amazing story. I mean people—people are willing to risk so much to cross the border. It’s awful to put people through that when we could just let them cross and then they’d go back home when they were done, which is what people usually do—come here to save money and then go home.
RP: I’ve heard a lot of people say that if we just opened the border and made it kind of like Canada or something, it would probably be about the same amount of people. People think that, you know, people would flood in, but I don't know, I’ve heard—
KH: Yea, I don’t think it would be. I think that if we opened the border, that people would come and they’d go home.
RP: People like it there better! I mean, it’s what they’re used to.
KH: Right yea, I don't think immigrants want to come here and get trapped the way they do. They want to be able to go home sometimes.
RP: Yea, definitely. So we mentioned this a little bit earlier, but so you don't—what do you think about public perception and how that can influence policy? Do you think that’s not actually very feasible or…?
KH: Tell me what you mean.
RP: So if more people were aware that, “Hey, we have farmworkers in our state,” or “Hey, they have a lot of problems that you know, should be fixed and it’s not right,” do you think that the policy would actually change? Do you think that politicians would listen?
KH: I don't know, I don't have very high expectation of politicians lately…or the administration—(laughter) or law changes to affect many things. I do think that the general acceptance where we are is lacking. I feel like if we could accept that many immigrants are here and that if we don’t offer them appropriate health care, it’s not good for us. Like to have people who don't have prenatal treatment or have broken legs—just ends up being more expensive. I think that we’re generally not very realistic about where we are and I think that would help a lot—if we were more straightforward in saying, “We’re here.”
RP: Okay, great. So if you have anything else you’d like to share, we can do that. Other than that, I think I’m pretty much done with questions.
KH: I would share that I have personally, all of the advantages that I need to access healthcare. I have insurance, I’m a native English speaker, I have very high health literacy, I have a car, I have a job where I get paid when I’m sick, and I still can’t access healthcare the way I want to. I think our healthcare system is really, really a mess, really chaotic. And I think that for people who are missing any of those components, it is impossible to get good healthcare. I think, even if you have all of those components working for you, it’s confusing, there’s poor communication, it’s expensive, hard to get places. And if you don’t have those things, it’s easier to die at home than it is to get appropriate healthcare.
RP: That’s interesting, thanks for sharing. What—how, how can that change? I don't know, how do you think that can…? Do you think it's more of a policy problem or a people problem?
KH: Well, I personally think the problem is, I think we need third care health insurance.
RP: We need what?
KH: That we need third care health insurance, I think we need general health insurance, the same one for everybody to level the playing field in terms of paying for health insurance. But that’s just my opinion. I think our healthcare system is really disconnected in communication of the poor and—and coordination is just a mess. I kind of think that—I’ve lived in a lot of places in the world—I think that American healthcare is a lot like healthcare in the third world. I don’t think it’s really much better. I’ve been in other places that just amazed me at how good their healthcare is and I don’t think we have very good healthcare here. Our system is just, sort of, inherently clogged right now, and if you’re not really persistent and really good at advocating for yourself, you cannot get good healthcare here.
RP: Okay, interesting. I’ve heard that a lot too, lately at least. Okay well, I guess that’s it. Thank you very much!