Hispanics recieving more care in Rockland
By MELISSA KLEIN, JANE LERNER AND LEAH RAE

THE JOURNAL NEWS
(Original Publication: July 22, 2007)

It may not be good manners to approach a pregnant woman and ask about her obstetrical visits, but Glenys Tejeda is aiming for good health care.

Tejeda goes to restaurants, laundries, stores and other gathering spots in Yonkers to find women who are expecting and have not visited a doctor.

"One of the main reasons is they're afraid," Tejeda said. "Sometimes they don't have the money. They think they have to pay. They don't know about health insurance. Sometimes some of them are not documented and they think they have no rights."

Tejeda is one of three staff members in an outreach program started about a year ago by the Mount Vernon Neighborhood Health Center to bring pregnant women into the health care system. Most of those she encounters are Hispanic.

The effort is one way the Mount Vernon Neighborhood Health Center network, which includes centers in Yonkers and Greenburgh, is adapting to a burgeoning population of Hispanic patients. The number of Hispanic patients at the Mount Vernon site grew to 33 percent in 2006 from 6 percent in 2001.

"We make certain that most of the new staff that we hire are bilingual and can speak Spanish," said Carole Morris, chief executive officer of the health-center network.

The increase is a trend that is playing out at most of the federally funded health centers in the Lower Hudson Valley. Nationwide, the number of Hispanic patients seeking care at health centers grew by 52 percent to 4.8 million between 2000 and 2005, outpacing all other racial or ethnic groups, according to data from the Health Resources and Services Administration, which oversees the centers.

Locally, the spike in patients and an infusion of funding has prompted the health care centers to expand. Greenburgh Health Center has just won long-fought town approval to build a bigger center. Peekskill-based Hudson River HealthCare is going to open its 14th location this fall in the largely Hispanic village of Haverstraw. And the Open Door network has a new Mount Kisco center in addition to elementary school outlets where children can receive immunizations, checkups and other services during the day.

Pablo Espinoza, an immigrant from Ecuador, took off time from his painting job to bring his 5-year-old daughter, Sofia, to Open Door in Ossining last week for her checkup and immunizations. He watched as Dr. Mary Rose Puthiyamadam charted her growth on a computer screen.

"I think it's a good option," Espinoza, who lives in Ossining, said of the health center. "It's a great help. There are a lot of services. The fact that they have Hispanic people working here is also a help - I think the bilingual system is good for the whole community."

This is an continuing demographic shift for the community health centers, which were born in the civil rights era and focused locally on the black community.

"Community health centers are built on a principle that is adhered to throughout the civilized world, which is that it behooves a community to have healthy residents," said Georganne Chapin, president and CEO of Hudson Health Plan, a nonprofit managed-care organization.

Over time, they have catered to a range of people who lack access to private, costlier medicine.

Three centers in Rockland
Rockland's immigrant Hispanic population has had a mixed experience at the county's three federally funded health care clinics, advocates said.

"There were barriers to access probably related to misundertandings and language," said Gail Golden, co-chairwoman of the Rockland Immigration Coalition.

All three of the federally funded clinics are run by Jewish organizations.

Critics have charged that the Ben Gilman Medical and Dental clinic, run by Monsey-based Community Medical and Dental Care Inc., which receives federal funding, violates the rights of people who want to use its services by closing on Saturdays, the Jewish Sabbath.

The state Division of Human Rights is still investigating a complaint against the Gilman clinic filed by the Spring Valley branch of the National Association for the Advancement of Colored People.

Sharon Milner, executive director of the Gilman center, said the clinic makes every effort to serve a diverse population.

The center is still closed on Saturday, but open every other Sunday.

She estimates 40 or 50 percent of the people who come to the Gilman center are Spanish-speaking. The other half are black, including many Haitian immigrants.

"We always have people on staff who speak Spanish or Creole," Milner said.

Nelly Mitnick, a native of Peru, was quick to offer assistance Friday to Maria Santos, a recent immigrant from Ecuador who brought two of her nine children in to see a dentist.

"People feel much more comfortable when you speak to them in their own language," Mitnick said as she helped Santos fill out forms.

Santos, who lives in Nanuet, said she heard about the Gilman center from a friend. Her youngest children have health insurance through the Child Health Plus program. Santos said she wished she could also see a dentist, but she does not have health insurance.

The dental department is among the busiest sections of the clinic, Milner said.

The number of patients seeking care at the center has grown in the two years since the Gilman center opened. Growth in the Hispanic population is probably responsible for some of the increase, she said.

Hispanics make up a large number of the patients dentist Charles Guevara sees at the clinic.

"I wouldn't say that the number of Hispanics is increasing," Guevara said as he took a break between patients at the 2-year-old clinic. "They have been a large part of our patient base."

A much smaller percentage of Hispanic patients use the services of the Monsey Health Center, Milner said.

She attributes the difference to geography - the Monsey clinic is in a largely Jewish orthodox and Hasidic neighborhood, while the Gilman center is in Spring Valley, home to many blacks and Hispanics.

Golden said the immigration coalition also refers people to the federally funded Refuah Health Center in New Square, a Hasidic village.

The center primarily serves the area's large Hasidic population, but also serves "all who wish to avail themselves of the center," its Web site says.

Spanish-speaking patients have generally had a good experience there, Golden said.

Clinic for Haverstraw
But she and other advocates are looking forward to the fall when Hudson River HealthCare opens its new clinic in Haverstraw.

The organization recently got a $400,000 federal grant to open a center that will offer preventive care and treatment for children and adults. Special attention will be paid to chronic medical conditions such as diabetes, cardiovascular disease, asthma and obesity.

Hudson River HealthCare is still looking for a location in the village where a majority of the residents are Spanish-speaking.

"Our experience is that there is always a patient base waiting for us to open," said Dorothy L. DeBiase, spokeswoman for Hudson River HealthCare.

The organization has experience providing "culturally appropriate care," DeBiase said.

"It's not just language," she said. "There are a whole number of barriers to care, and it is the job of a community health center to break down those barriers."

Patients at the health centers pay on a sliding scale based on income. Some have insurance, and at many centers, about half do not.

Undoubtedly, many clients are undocumented immigrants, but it's not clear how many. Patients are not asked about their immigration status. Illegal immigrants are not eligible for Medicaid coverage, except for prenatal and emergency care. Public dollars do offset the cost of care at community health centers without regard to status.

Health advocates list a number of reasons for spending those dollars. Along with humanitarian ones, there are practical ones, such as making sure contagious diseases are treated, treating chronic conditions before they require more costly care and delivering basic health care in the most cost-effective way.

"One could argue, 'Why are we making this service accessible to people who might not be legal?'" said Lindsay Farrell, president and CEO of Open Door Family Medical Centers.

Without such basic services, she said, patients would wind up in the emergency room.

The number of patients at Open Door has doubled over the past seven years, topping 30,000.

Its home base in Ossining, opened 35 years ago, has grown in recent years, with new administrative offices across the street and a meeting space next door. Three more Open Door centers have opened in Sleepy Hollow, Port Chester and most recently Mount Kisco in late 2005. The Port Chester facility relocated and doubled its size.

Hudson River HealthCare has also expanded with federal grants. The center was opened in 1975 as the Peekskill Area Ambulatory Health Center by a group of black women to serve their community.

In 2000, 27 percent of the patients in Peekskill were Hispanic. By last year, the number had jumped to 42 percent. About one-third of the employees are Hispanic and another 10 percent speak Spanish.

After years of the uninsured population holding fairly steady, the number of patients without insurance in Peekskill jumped by 613, or 2 percent, from 2005 to 2006.

Anne Nolon, president of Hudson River HealthCare, said the Peekskill center was working to accommodate the growth in patients.

Among the other challenges faced by the centers is finding specialists willing to take patients who have no insurance. Recruiting staff can be difficult, particularly nurses who can often find more competitive salaries and benefits at hospitals and nursing homes.

The prenatal outreach program started by the Mount Vernon network appears to be a success.

Almost 190 women have received care through the program, including about 120 Hispanic women.

When Tejeda is out in the community now, she encounters some of the same women she had encouraged to get care with their healthy babies.

"It's a pleasure to see them," she said.

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