By Naeisha Rose
The mayor’s initiative promises to provide access to all New Yorkers regardless of immigration or socioeconomic status
Mayor Bill de Blasio’s plans to provide quality health care to all New York City residents regardless of income and immigrant status through his NYC Care Card initiative, which will start on Aug. 1 with a rollout in the Bronx.
This program will close the gap for the 300,000 New Yorkers who are ineligible for health care and will have a huge impact on both the documented and undocumented Haitian community throughout New York City.
There are approximately 651,500 Haitian immigrants across the United States, and an estimated 13 percent or 87,000 live in New York City, according to the Mayor’s Office of Immigrant Affairs, which used calculations from 2013 to 2017 Census data. There are approximately 3,200 Haitian immigrants in the Bronx and an estimated 34 percent or 1,800 are undocumented and will eligible to be some of the first beneficiaries of this program in two months time.
With the NYC Care Card, individuals will have access to NYC Health + Hospitals, the nation’s largest public health care system, which has 70 patient care locations including 11 hospitals and dozens of community-based health centers.
The purpose of the mayor’s initiative is to make sure that New Yorkers, regardless of their socioeconomic or immigrant status are able to access health care so that they won’t delay necessary treatments or exams until it’s too late and end up in the emergency room in hospitals where wait times are long and costly, according to NYC Health + Hospitals.
“In New York City, you have the right to guaranteed health care. It doesn’t matter who you are or where you come from: if you live here, you have the right to see a doctor,” according to NYC Health. “NYC Care will guarantee a dedicated primary care doctor, preventive care, and 24/7 customer service.”
Berthilde Dufrene, the founder of the Haitian American Nurses Association of Rockland County and the chief nurse officer at the Office of Mental Health in Rockland County, believes this would be a great program for undocumented Haitian immigrants.
“Health care is a right for everybody,” said Dufrene. “The care of people – if we do not attend to it will impact us. Whenever we talk about the measles outbreak or the misbirth of babies, the bottom line – if the people are our neighbors and they are living in our country their health impacts us and it is to our advantage to have programs like these and to help people access healthcare.”
Most illnesses are not contagious like measles, but without prevention, for all those that want it outbreaks can occur, especially among those without access to vaccinations, according to Dufrene.
“However, we do have infectious diseases and we do have other diseases that have a great social impact when they are not addressed,” said Dufrene. “When a baby dies because mom was unable to receive prenatal care it impacts an entire community whether or not the person is undocumented. I do believe programs like that helps people overall.”
Making sure that all New Yorkers, including undocumented immigrants, get insured would help to alleviate the workload of emergency rooms across the city and medical bills for patients that would have been cheaper with preventative care treatment, according to Dufrene.
“ER costs get transferred to us because we cannot refuse them care once they go to the emergency room,” said Dufrene. “They do receive services, but much more expensive services, so prevention is worth more than an ounce of cure.”
A regular doctor’s visit is approximately $100 or less, however, a few hours in an emergency room could cost a patient ten times would they would have paid for preventative care if not more, according to Dufrene.
“In the emergency room, the care is fragmented,” said Dufrene. “Every single person that comes to see that patient for whatever reason bills that patient.”
A patient that goes to the ER will most likely be billed by their consulting doctor, a phlebotomist (a doctor that draws blood), a specialist for a particular ailment and individual exhibits irrational behavior during their stay they may also charge for a psych evaluation, if not more, according to Dufrene.
“A lot of unnecessary tests takes place or it might not be unnecessary but situational events occur as a result of the fact that this person ended up in the emergency room,” said Dufrene. “Everything has to be looked at and you will be billed for things that might not be necessary.”
People going to the emergency room for regular care creates a backlog for patients are in true emergencies and need to be attended to quickly and costs the hospital money, according to the HANA founder.
“If the hospital does not have the staff they have to bring in additional staff,” according to Dufrene. “It takes additional doctors or subject experts to address a need in the ER, and people think that we are not paying, but we are paying. Its call Medicaid and we do have to subsidize the hospital for the visit.”
Over the years the chief nursing officer has seen what type of illnesses tends to be prevalent within the Haitian community.
“Haitians are of African descent and as such we have all the illnesses that plague people of African descent,” said Dufrene.”We have a high rate of diabetes, because of our diet and the manner that we eat.”
Hypertension, kidney failure, and cancer are some of the other diseases that are dominant within the community.
“If you do a regular screening for prostate and find it early enough you can be treated, but if you wait later with cancer as it stands not only is the presence and suffering way more, the cost is a lot more and you require a lot more care,” said Dufrene. “Among women, breast cancer is of huge concern. It’s underappreciated and a lot of Haitian women are not going to preventative medicine. It’s undereducation as well.”
Some women within the community believe that mammograms can cause cancer instead of preventing it, according to Dufrene.
“X-rays and rays of any kind, yes, but they have to be a large amount,” said Dufrene. “The nature of what they hear, no one has taken the time to explain that to them.”
Mistrust in the American health care system and focus on the care of their own families has also led to many Haitian women not getting screened for breast cancer.
“The strangest thing is that some really do not want to know because they are too busy and blissful in taking care of their family and they do not want to worry about that and others fear doctors misdiagnosing them or experimenting on them,” said Dufrene. “They really have these myths about care and our health care system that has to be demystified for our foreign communities and diaspora communities.”
The $100 million program will also include mental health care, according to First Lady Chirlane McCray.
“When we fail to invest in wellness and prevention, we pay the price in dollars spent and lives damaged. New York is pioneering a better, more inclusive approach and will continue to lead the nation in providing behavioral health services to every person in our city,” said McCray.
In Haiti, mental health care is not a big focus in the country so it’s not often something sought after by Haitian immigrants in the United States, said Dufrene.
“It is a taboo subject, and even if they do access care they do it only during a time of crisis and they stop taking the medication and their illness returns as a result,” said Dufrene. “There is also a belief system that makes it difficult for them to realistically accept mental health symptoms.”
Some people within the community will blame an individual’s mental health crisis on voodoo or bad karma, according to Dufrene.
“You would often hear Haitians saying that somebody did that to him,” said Dufrene. “People being emotionally unstable is rationalized as the malice of others instead of having a real diagnosis.”
Haitian families deeply love their family members no matter what and will take care of them if they are mentally ill, but will keep them hidden away from the rest of the community so that they won’t be considered a public nuisance, according to Dufrene.
The mayor’s plan won’t be fully implemented across the five boroughs until the end of 2020, according to NYC Health.
“It’s an important first step and this gives them the opportunity to get data and to see how they could extend it down the line,” said Dufrene, but in the meantime there are other programs. “There are community programs such as Hudson River Health Care, which have a sliding scale payment program and they do not refuse care because someone is undocumented.”
At HANA, the nurses association works to reach out to the community through its many chapters to educate the public about the types of affordable programs that are available to them throughout New York State.
“We’re on track to guarantee health care for every single New Yorker. Access to quality and affordable health care is one of the biggest burdens working people face. Now they won’t face it alone,” said de Blasio.