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Packed in a pink, paint-chipped cabinet beneath the Galindos' bathroom sink are baggies of penicillin and tetracycline capsules. The antibiotics were brought up from Mexico where pharmaceutical medicines are available without a prescription. Maria Galindo shakes a handful of the tetracycline into her palm, tossing three of them casually into her mouth. She offers the rest to her husband, Eduardo.
The Galindos, who asked that their real names not be revealed, take the penicillin for coughs, ear aches, and sore throats. They use the tetracycline like orange juice, swallowing a tablet or more a day to ward off colds and flu. Although they are legal California residents and eligible for Medi-Cal, the Galindos prefer to use medicines from Mexico rather than involve themselves with a health-care system they think could lead to their deportation.
"There are eyes in every doorway of every clinic," Maria says, speaking in halting English from their Capp Street apartment. "We are surrounded by people who have hateful feelings toward us and who want us out of this country."
Eduardo, a supervising janitor at a local high school, leafs through a worn, bilingual Red Cross First Aid book he and Maria have been studying in the evenings. "I assume we'll have to do wound care one day," he says, referring to this part of the Mission District where there are many shootings. "That is the only option because we can't go to the hospital."
Since the passage of Proposition 187, the 1994 "Save Our State Initiative," families like the Galindos worry that the crackdown against illegal aliens will be directed against legal immigrants as well. The proposition, which is being challenged in the courts, would discourage illegal immigration by denying health and social services to an estimated 1.3 million undocumented individuals living in California. Provisions would deny medical care and would require state agencies to report persons suspected of being in the state illegally.
With the proposed Immigration in the National Interest Act pending in a joint congressional conference committee, the Galindos anticipate the worst. Should the federal act, which could be ready for President Clinton's review later this month, pass as written it would make legal immigrants deportable if they receive Medi-Cal or other state health insurance or health-care benefits for more than 12 months. A second provision of the legislation requires that in applying for benefits the legal immigrant must combine the income of his sponsor with his own for 10 years or until he becomes a U.S. citizen. Physicians claim this will put many immigrants over the eligibility level of $23,634 per family and warn that denying Medi-Cal will promote risky medical practices. They cite a UCLA study released last month, which estimated that as many as 830,00 noncitizen legal immigrants living in California could be denied Medi-Cal under the proposed legislation.
The bill would also increase the number of Border Patrol agents, create pilot programs for employers to verify work eligibility, and deny public education to undocumented immigrants. The president has said he would veto any legislation that prevents children from attending school, but physicians fear that that is his only objection.
"If you feel like safe access to medical services is being cut off, you'll rely on other medicines or practices," says Dr. Michael Rodriguez, a volunteer physician at the medical clinic of the Mission-based Central American Refugee Center. "If people feel they have health problems, they'll take medicines that are available even if they are for other illnesses. They are often unaware of what they are taking and what they are putting in their bodies."
Pharmaceutical drugs come into San Francisco's Mission District from Central America and Mexico by friends or family returning from a visit to their native countries. These antibiotics are used to address all types of aches and pains -- from bronchitis and ear infections to tuberculosis and urologic problems, says Claire Mortimer, a family nurse practitioner at San Francisco General Hospital. Unfortunately, the misuse of antibiotics can lead to drug-resistant infections that are difficult to treat. "One of the most common things that happens," says Mortimer, "is that people will take medication regularly whether they need it or not. The consequences are that the bacteria becomes stronger and passes on resistant strains within the community. This affects the health and safety of everybody. Disease doesn't check immigration status. We can't isolate the public health system."
"We are allowing for emergency medical care," Kayes says. "Americans have gotten loud about the need for reform. What you're hearing is the last gasp of the opposition. Liberals don't get it. There's no big federal surplus to finance immigration."
But health-care advocates say Kayes is ignoring the psychological impact of the legislation.
"A lot of my patients have been without medication for months because they are fearful of receiving services," Mortimer says.
In a recent statewide survey of 58 health officials by the California Conference of Local Health Officers, 10 percent said they had seen a "sizable decrease in Latino patient contacts" since the passage of Prop. 187. Thirty-seven percent said they knew of persons who had delayed seeking medical exams for AIDS, tuberculosis, and rape.