THE STORY

INFORMATION AT INITIAL ENCOUNTER who? what? where? when? how? why? Lives with the father of the baby in a poor house- hold, but doing ok Social contacts limited to hus- band’s unstable, risky job and some neighbors Migra-ted recen-tly due to higher levels of pover-ty in Mexico LAURA Illegal status as undo-cumen-ted immi-grant in the US Young healthy Latina woman pregnant for the first time First winter in Wis-consin

ACCESS COMPONENTS IN PLACE Place for care Necessary skills present New policy!! Old policy Provider Works at a Community Health Center near Laura’s home. Jan ’06: new state health policy!! Badger Care coverage for pregnant undocu-mented women Federal and state funding for CHC’s to take care of the under-served (low) KAREN Bilingual, culturally sensitive nurse midwife Mission of the CHC: providing language- and culture- sensitive care

KAREN LAURA resources need OUR MISSION: To improve the health of Latinos in Wisconsin KAREN LAURA Make sure interaction happens resources need OUTREACH Laura was informed of available access

KAREN The interaction never happened Laura’s baby died LAURA Why?

Laura’s poor level of functionality was stressed and lonely, got depressed Did not eat well, the baby was born 8 weeks early Breast feeding became problematic Did not know how to dress for winter Did not know how to take care of a sick baby Was not able to reach baby’s dad at work Did not get a good interpreter at the emergency room, did not understand the baby’s condition She knew she had no rights to services and was afraid that any institution would deport her if she ask for help She knew LHO was a struggling non-profit that did health education only (not care) so she didn’t call us

Information gathered after access failed Without her family’s approval, she and her boyfriend used the money saved for their wedding to pay the “coyote” to cross the border, her parents didn’t want her leaving The baby’s dad depended on a friend to get to work so he was saving to buy a car, the baby was an unexpected expense, she waited to tell him about the pregnancy She wanted to wait until she could send money to contact her family so they could see the benefit of her leaving, and she didn’t call her mother or sister for advice about the baby

Information gathered after access failed They considered it too risky to ask the employer for a poof of (low) income, a requirement to receive the coverage She knew she had no rights to services and was afraid that any institution would deport her if she ask for help She knew LHO, as many other non-profits, is struggling for resources and that only gave health education, not health care so she didn’t call us