Healthcare

Overview

The healthcare system in America is a mangled web of bureaucracies that can be very daunting for incoming immigrants. The Senegalese, like many other immigrant groups, survive within this crazy system by meeting challenges as a community, rather than on an individual basis. Organizations like the African Services Committee and the Association of Senegalese in America clarify legal matters and minimize the confusion that often is a result of trying to understand healthcare in the United States. These associations also provide social services and housing help, and the African Service Committee in particular has a huge outreach program to educate people about HIV/AIDS.

Legal and Financial Issues

Immigrants, especially those unfamiliar with Western medicine, are often reluctant to seek medical attention when they are ill for a variety of reasons. One prominent reason is the uninviting nature of government programs. According New York State law, immigrants who arrived before August 22, 1996 are eligible for Medicaid, while those who arrived after that date are subject to a five-year bar on public health insurance. The effect of this is that all Senegalese would be able to seek emergency treatment, but not all of them would be eligible for treatment of chronic conditions. The Medicaid brochure provides a lot of information about eligibility, but that does not help new immigrants because they do not yet know English well enough to understand it.

Older immigrants have formed organizations to help Senegalese (and other West African) immigrants get the care they need. The aforementioned African Services Committee, for example, provides people to go to hospitals with immigrants and act as guides and translators. In this way, immigrants can access low-cost healthcare even if they are not familiar with the system.

Even those familiar with the system, however, may fear a hospital visit because of the legal documentation required for patients. Medicare and Medicaid are programs funded by the US government, and therefore eligibility depends on a legal immigration status (citizen or legal resident). In fact, this rule applies for all services funded by tax-dollars, such as welfare and food stamps. Major hospitals, although they require documentation for treatment, are not allowed to refuse treatment to the seriously ill. These hospitals are also prohibited from reporting undocumented immigrants to the Immigration and Naturalization Services Bureau.

Cost is also a major concern when it comes to healthcare. Private facilities charge large sums that a new immigrant would not be able to afford. Even public hospitals now require co-payments for insurance and non-insurance holders that can be between twenty and forty dollars a visit.

Cultural Differences

Barriers

Another reason immigrants may resist American healthcare is because of a distrust of Western medicine. Western medicine has a long history of being insensitive to long-held practices of people from other parts of the world. Coupled with a language barrier, an immigrant can sometimes feel trapped by a doctor or pressured to take medicine he is suspicious of. Because immigrants tend to group together through country of origin, language, and dialect, hospitals need to respond to the communities they serve. A New York Times article dating back to 1994 talks about Dr. Francesca Gany, an internist at Bellevue hospital who, though unfamiliar with Senegalese culture, began to learn more about the community at 116th Street.

Healthcare in Senegal

The final difficulty for these West African immigrants may be unfamiliarity with the healthcare system in America. In Senegal, traditional healers are an important part of healthcare. In many villages, the healers provide as much, if not more medical assistance to the ill than trained doctors. Healers practice indigenous medicine which combines science and Divination. They are usually trained by other healers, often family members.

In Senegal, the state does not have the money to cover everyone, so many private providers have emerged. Churches, for example, provide care for relatively low fees, and people use community insurance. Community insurance is a system in which individuals contribute money to a general pool; when one contributer is sick, he can dip into that fund to pay for treatment. This behavior is indicative of the way networks operate within Little Senegal. If someone cannot produce documentation to be treated at a public facility, members of the community will pool funds in order to pay for private care. (For more information about the importance of networks in immigrant communities, specifically the Sengalese, see Money Has No Smell, by Paul Stoller.)

Interacting with the Community

Talking to shop owners in Little Senegal showed us that traditional healing is still used by Senegalese in New York. Since the Mouride principles emphasize hard work, the main complaint among Senegalese is exhaustion, often referred to as tooy. The scientific explanation of tooy is that it is a somatisation syndrome, similar to chronic fatigue syndrome (Ebin 1990-91, XXIII, 3: 365-385)

Kell

Although the shop owners were very busy, one customer at 219 116th St explained that in Senegal, tooy is treated with kell, a dried plant that is soaked and made into a cold tea; it is not boiled, just washed and soaked in water to release its essence. The people we talked to said that kell cleans out your system. Tooy can also be treated with soup made of bone marrow. In the United States, gelatin is used instead of this soup because it is more readily available.

Bissap

Finally, we learned about the very popular bissap, a tea made from hibiscus flowers. The dried petals are washed and then boiled, turning the water a bright red. Unlike the hot tea Americans think of, the Senegalese drink the bissap after it has cooled. Bissap is not specifically a medicine, but it is also said to clean out your system and is sometimes used in conjunction with the kell.