Navigating healthcare in the Rio Grande Valley

Anna Sanchez, a childhood friend and a Rio Grande Valley (RGV) native comes from a low-income background. Anna and I were raised in Hidalgo County, one of four counties in the RGV where 92.5% of the population are Hispanic/Latino. The RGV is a region located in South Texas along the Texan border with Mexico. Anna’s parents, like mine and many others in the RGV, are Mexican immigrants. Throughout her life, she and her family have struggled with accessing healthcare. These experiences have shaped how she views and navigates the medical system. 

As children, Anna and her seven siblings were insured under Medicaid, a government health programme that is required to provide coverage to certain groups (such as children), while her parents were uninsured. In Hidalgo County, 33.2% of the population under 65 years of age is without insurance—a percentage exceeding that of the state of Texas. Although Medicaid was able to partially cover expenses, the costs of medical services were still beyond what her parents were able to afford. To avoid a trip to the clinic, whenever Anna became ill, she would research her symptoms and self-diagnose. Based on her self-diagnosis, she would then utilise over-the-counter medications to treat herself at home. With the Rio Grande Valley’s proximity to the Mexican border, it is common for people to purchase medication from Mexico to sell at local flea markets, where Anna would find many of her medications at an affordable price without needing a prescription. Only when symptoms worsened and self-prescribed medications were no longer effective would the family visit a physician, allocating what little savings they had beforehand to afford the visit. 

Usually, a vehicle was needed to access medical facilities, a luxury that not many RGV residents can afford. In Anna’s case, there was only one family car, which was constantly out of commission. To attend appointments, they would occasionally solicit help from their neighbours, a favour they would eventually return. Anna felt she could rely on her community since many of them shared the same hardships. Other times, Medicaid’s transportation services were used. However, the services provided by Medicaid required appointments in advance, meaning when a sudden health complication occurred, this was not an option. 

Anna’s parents found low-cost clinics in local areas for their children and themselves. Hidalgo County is designated a medically underserved region as of 2019, therefore limited options are available, especially at low cost. The RGV has a physician to patient ratio of 124 physicians for 100,000 people—almost half of the United States’ average of 240 physicians for 100,000 people. This meant that when Anna did go see a physician, she could expect to wait for four hours, on average, to be seen. Anna’s longest visit lasted eight hours. Meeting with a physician requires most if not the entire day, creating an additional barrier for socioeconomically disadvantaged groups as it results in loss of a day’s income. In some medical specialties, such as psychiatry, scheduling appointments had to be done several months in advance, with waitlists up to nine months for an initial take. This is of great concern, especially due to the higher burden of mental health disorders amongst RGV residents. In fact, a 2019 survey reported that 14.1% of the Rio Grande Valley’s population suffer from moderate depression which is nearly two times higher than the national average of 8.1%.

Visiting Mexico for affordable medical attention is not uncommon in the RGV, however, this is not an option for people with temporary or complicated immigration statuses. Many of the low-cost clinics Anna visited were found through word of mouth. She believes that this was the most reliable source of acquiring information because online searches gave results for clinics significantly out of her family’s budget, even when they were listed as being inexpensive. 

Many RGV residents have to choose between having to pay for a visit to the physician, and any required medication, or paying for housing needs. Hidalgo County has 23.9% of its population living in poverty, so low-cost clinics are essential. To receive access to these low-cost clinics, a tax form is needed as proof of being socioeconomically disadvantaged. Despite these clinics being specifically aimed at low-income families, many are still unable to afford proper treatment or care. Anna and her family were only able to pay for the most basic of services such as routine dental cleaning. Any extensive care or additional procedures—like needing a filling for a cavity—was usually unaffordable and could lead to negative implications on their long-term health, such as tooth decay.

Spanish is the primary language spoken at home for approximately 78% of the RGV’s population. It was the sole language used by Anna’s parents while she was growing up. While some physicians spoke Spanish and were able to communicate with them, in most cases, the physicians only spoke and understood English. Anna recalls that at the young age of seven, her parents would have to rely on her to communicate their symptoms as well as translate the physician’s diagnosis. As a child, she would struggle with translating certain medical terms, so she had to learn to be descriptive to ensure that her parents received proper medical care. Any error in translation and communication could have undoubtedly resulted in a misdiagnosis and improper treatment for Anna’s parents. 

Once Anna reached the age of 18, she no longer qualified for Medicaid and her fears of being unable to afford medical attention as a child followed her into adult life. Due to years of limited access to healthcare, Anna continued to avoid the system that could not assist her. When she qualified for healthcare coverage through her employment, she was lost in how to navigate the unfamiliar system. Having grown up with anxieties around not having access to insurance, she has now become reluctant to rely on it. Anna Sanchez utilises her experiences and dedicates her free time to advocacy work to aid those facing similar socioeconomic barriers in finding resources and information.