Laboring for better health care

Day laborer Gonzalo Moran says he was charged $300 for Tylenol.
Guardian photo by Reed Nelson

Gardening, plumbing, construction, janitorial work and washing dishes: the jobs day laborers perform for San Franciscans are done with their bodies. Their physical fitness is their gateway to work.

It's that physicality they risk on the job every day. Undocumented Latino laborers have a hard time reaching options for medical care though, even in a sanctuary city like San Francisco.

To be clear, San Francisco has gone far and beyond many cities to provide medical care. The city's Healthy San Francisco program, UCSF, and a smattering of nonprofits all provide medical care to undocumented immigrants, which often includes day laborers.

The problem is not a matter of options, but a matter of trust.

James Quesada, an anthropology professor at San Francisco State University who studied health care options for day laborers, said even when options are available, many day laborers actively avoid them.

The specter of deportation is always lurking, he said, stopping many from seeking clinics in the first place.

"Despite the fact that we're a sanctuary city, there's always that fear and threat that someone could come at any time," Quesada said. "There are do-gooding public health services for them, public health contracted satellite clinics and the like. But one of the hardest things is to really convince them that they're not in peril by going."

At the U-Haul rental facility near Bryant street, laborers stand in pairs waiting for potential customers to drive by. When a customer comes into sight, they'll start toward the passing car in huffing sprints. Their work is unpredictable and never guaranteed.

One man the Guardian spoke to, Gonzalo Moran, 62, cited one health care center as a timely godsend: the Mission Neighborhood Health Clinic. The wait there is only half an hour, he said, and in an emergency they make referrals to SF General Hospital.

But heading to SF General for care can carry a high price tag in both time and money, and results are not guaranteed.

"One day I had a toothache, I went to the emergency [room], was there from about four o'clock in the morning to four o'clock in the afternoon," Moran said. "I told them I was homeless, that I didn't have no income, I have no immigration papers or nothing. A nurse came to check on me, my tooth. They just gave me a prescription for Tylenol, but then a month later they sent me a bill for $300. For Tylenol."

Moran isn't necessarily out on the streets, but crashes regularly at different places. Whenever he tried to get a credit score the bill would come up in searches.

The hit wasn't only monetary. The day he spent at the hospital was a day he could have worked.

Moran's story reflects findings made by Quesada in his research. Though many providers claim to help the undocumented, the level of service can depend on just which doctor or nurse you happen to get that day. Service and safety are uneven, and there's no way to keep track of it all.

"It's a patch quilt, a moving target," he said.

Moran told his story with strong English skills gained through City College classes, but he's had the time to learn — the El Salvador native landed in the United States in 1976 to earn money for his family. Others Quesada talked to were not as lucky.

In his research on undocumented day laborers and health care, he found many who avoided clinics and hospitals for fear of being deported. Quesada found the laborers in the streets, and spent time in clinics and hospitals to find what kept them away from medical care. What he found was fear.

Some men would jump even at the sight of a rent-a-cop security guard, he said.

In an academic paper he published on the subject, Quesada related the story of Juan, a day laborer in his 50s who suffered terrible tooth pain. He refused to seek help.