Immigrants cross the Mexican border into California in search of a new life. Many bring along with them pharmaceuticals, including antibiotics, sold over the counter in Mexico, but illegal without a prescription in the United States. Santa Ana, California, is located several hours north of the U.S.-Mexican border. The city is a magnet for Mexican immigrants. In the last 40 years, its population has tripled to 338,000, according to the latest census.
Seventy-four percent speak Spanish at home, the greatest proportion for any large U.S. city. Nowhere is that more apparent than downtown Santa Ana, where Joe Vargas, a public health worker, spends a lot of time talking to shopkeepers and street vendors.
One of the places he meets them is Fourth Street, [in] the heart of Santa Ana. "If you speak Spanish or want to buy a Latino product, you can buy it here," he said. "You can purchase anything from wedding dresses, quincinera [15th birthday] dresses, food products, shampoos from back home here. In many instances, you can purchase a wedding dress, and at the same time wire money back home or receive money from back home. So, that's the beauty of this street, because you feel like you are at home, because many of these places only speak Spanish and are able cater to your Latin American country."
Flyers distributed on the street announce everything from free legal advice and clothing bargains to a new hair salon. The passersby are largely undocumented, poor and without medical insurance. Joe Vargas said what little money these people earn is spent on food and housing, not health care. "Our mission is to educate," he said. "We are into primary prevention."
Mr. Vargas is the director of Safe Health Care Project, a program that works to raise awareness among the immigrant-dominant community of appropriate health care options. Local advocates demanded the service when two infants died after receiving injections purchased at illegal clinics.
"What we are trying to do is to insure that these individuals [are] aware of legitimate health care services that we have for them in our community," he explained. "Even though they are not documented here in the United States, there are places where they actually can and do receive some sort of care."
Joe Vargas takes his message to schools and churches, where he is alarmed by the ignorance of basic health care and the fear of using legitimate providers because of legal status.
"Sometimes I hear that people have never been to a doctor and have only seen lay people in their community who were physicians 15 to 20 years ago, and that is their source of care," he said. "I also hear of individuals buying medication from drive-by vans that come by with pharmaceuticals and freely sell these pharmaceuticals from other countries out of their vans. Who knows what the expiration date is on them? Who knows how effective they are? Who knows what the drug reactions are to the individuals? We can see there is a lot of misinformation out there, and we are trying to correct this."
Joe Vargas trains health promoters called promotoras to go door-to-door to educate their neighbors and friends on appropriate health care.
That's what Violeta Dominguez does for Puente a La Salud, or "Bridge to Health," an outreach program of a local hospital in Orange County that serves the Santa Ana community. She is part of a medical team on wheels, a mobile van that brings clinical services to migrant agricultural workers in the fields and, on a recent day, to senior citizens.
The van with its green and white awning to provide shade from the sun was parked in front of a community center. On board were a nurse pactitioner, a registered nurse and two promotoras, including Violeta Dominguez.
A woman with dark hair approached with her older mother. They sat down for an initial interview, which revealed that the mother was a diabetic and new arrival to the United States. The daughter was a housekeeper and had no legal documents.
Violeta Dominguez stepped in to assure the women that the fee was low and the information would be kept private. When they got to the subject of drugs, which the mother's son had purchased without a doctor's prescription in Mexico, Violeta Dominguez advised the women of the harm that can cause.
The promotora warned the women that drugs bought without a prescription or borrowed from a neighbor is risky business. "Instead of getting you better they can kill you," she said. The mother then received a physical exam, and got scheduled for regular check-ups to keep her diabetes and any other health issues under control.
Violeta Dominguez has been a promotora for 10 years. She said that as a Mexican-American, she has something to offer. She can help new immigrants navigate the medical system in the United States. "We are from the same community," she said, "the same people, and we understand each other and they begin to trust me. In that way I can make a difference."
This is part four of VOA's five-part series on Curbing Abuse of Antibiotics.