July 8, 2014

By Simar Nagyal

The clinic is located in the foothills of the Blue Ridge Mountains.

The clinic is located in the foothills of the Blue Ridge Mountains.

After passing through the breathtaking Blue Ridge Mountains, I have finally arrived at my place of work for the next few summer weeks. For my research, I am characterizing the healthcare access of farmworkers, particularly those of indigenous descent, at a local charitable clinic. In addition, I will be volunteering with the clinic’s Farmworker Health Program, providing assistance with outreach and patient case management.

Situated away from the busy areas of downtown, the clinic is located in a building that also houses a thrift store and a Christian charity that provides resources for food, housing, financial assistance, etc. As a charitable organization, the clinic offers a range of medical services at a suggested donation of five dollars per visit and two dollars per medication (with noted exceptions). Services include primary care, dental care, mental health counseling, medication assistance program and are only available to uninsured[1] residents of the North[2]* County who has who meet certain income guidelines At the clinic, nearly ninety percent of the patients earn an annual household income of below $15,000, and nearly seventy percent are either unemployed or disabled/retired. The clinic has especially partnered up with a state-wide Farmworker Health Program to conduct field outreach with farmworkers in three different counties in North Carolina and to provide health education and case management services. The organization financially sustains itself through private donations and grants. The clinic functions with volunteer physicians and one full-time healthcare provider. It, also, partners with numerous providers throughout the area for referrals. Employing 18 staff and more than 200 volunteers, the clinic has served a total of 12,024 patients to-date at services valued at nearly $5.5 million in 2012.

On my first day, I had the privilege of meeting two farmworker women who agreed to speak with me. The first farmworker, Lucy, had moved to the United States from the Guatemala at the age of 28 and had worked in the fields of North Carolina for 16 years. She had come in to the clinic for her “bazillionth” exam, as she put it. For the past couple months, she had been having gastroinstential problems that the doctors had been unable to diagnose. Despite using the clinic’s services, she had had to go to area hospitals for costly specialist exams. Drowning in medical debt and still not one step closer to her diagnosis, she had just grown weary and suspicious of doctors.

She posited that her lack of knowledge of the English/Spanish language may have impacted her quality of healthcare. As a proud member of the Awakatek people of Guatemala, she primarily spoke the indigenous Mayan language of Awakatek.  Although she had some knowledge of Spanish, she outright indicated that she preferred to speak to her healthcare professionals in her mother tongue. Even communicating through an Awakatek interpreter would suffice. The clinic did have two Spanish interpreters. Interpretive services were not available for lesser popular languages such as Awakatek due to lack of financial support. Certainly, locating an interpreter in the area who had knowledge of a language spoken by less than 20,000 people in the world would be a difficult task. However, doing the most good (in this case, providing translators) for the most people (Spanish-speaking patients) unfortunately leaves speakers of other languages at a disadvantage.

Despite having access to the American system of healthcare, if given the opportunity, Lucy would opt for natural medicines and herbal treatments such as a traditional manzania tea for sore throats and colds. Through her descriptions of the sources of healthcare in her native home of Guatemala, she revealed a sense of pride in her culture and a continued indigenous identity despite having immigrated to the States years ago.

The same day, the outreach worker, Jim, introduced me to Camila, another farmworker, who was from Quiche. He informed me that she belonged to the K’iche’ people of Guatemala. A young and fresh-faced gal, Camila had come to the clinic for a tooth extraction. Her two-year old son had accompanied her. During our interview, when I asked her the question: Cual es su primer idioma? (What is your first language). She answered firmly, ”Espanol.” Confused, I rephrased the question: Habla en un dialect? (Do you speak a dialect). No. I asked whether she identified as an indigenous person. Again, she rejected such a possibility. However, her broken Spanish hinted that Spanish may not be her mother tongue.

When I informed Jim about the dilemma, he stated that some indigenous persons choose to not admit to their heritage. Guatemala has a long history of oppression of native peoples. Out of fear of discrimination, a person may deny any association to her indigenous identity. Furthermore, it was not uncommon for descendants of Mayan groups to not know their indigenous languages. In recent times, the children are not taught the language and parents prefer to teach their kids Spanish instead.

Unfortunately, this reality does not only pertain to indigenous groups in Guatemala. Native groups throughout the Americas have faced the question of whether to forsake their indigenous way of life and merge in with the mainstream or protect and cherish their quickly vanishing culture.


[1] According to the Affordable Care Act, most people are required to have health insurance. However, a certain portion of the low-income demographic is ineligible for Medicaid or employer-sponsored insurance. Furthermore, as offered under the Affordable Care Act, North Carolina’s has chosen to not expand Medicaid, and so only 27% of low-income adults in NC receive Medicaid coverage due to categorical restrictions.

[2] An estimated 13,000 (excluding the elderly) are uninsured in the county according to 2010-2011 county data.