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July 27, 2003

Host:
Feliciano Vera
Topics:
· PAN (Protect Arizona Now) Initiative;
· INS changes;
· Breaking the barriers to health care
In-Studio Guests:
Richard Ruelas, columnist for "The Arizona Republic;"
Russell Ahr, spokesman for the Bureau of Immigration and Customs Enforcement.
Gail Petersen, Director, Breaking the Cycle program;
Sylvia Echavestock, president and CEO, Mountain Park Community Healthcare

">>" Feliciano: This afternoon on "Horizonte," backers of an initiative targeting undocumented immigrants reject discussions with Hispanic media. This, as the measure faces allegations of campaign finance violations. Plus, a look at the new INS under the office of homeland security, the backlog for processing cases and goals to reduce that backlog. And health services for the Latino community. We examine the challenges and efforts for improvement. I'm your host, Feliciano Vera. Before we get to those topics, here's an update on some stories from the week. More Latino students at the University of Arizona. That's the goal of university president Peter Likens. Likens made the announcement about boosting Hispanic enrollment from 14 to 25% as part of a university reorganization aimed at recruiting and retaining students. And stricter guidelines for bilingual education programs are in the works. Arizona attorney general Terry Goddard ruled that state schools chief Tom Horne is within his power to make it more difficult for students to opt out of English immersion. The issue of how to best educate English learners remains an emotional one in the Latino community. A citizens initiative called "protect Arizona now" seeks to require proof of citizenship when registering to vote, require ID when voting, and require proof of citizenship when requesting nonfederally mandated services. This week, backers of the initiative announced they would no longer communicate with Spanish language media until their senior advisor, state representative Randy Graf, gets an apology. On the heels of this announcement, a group opposing the measure is asking the state Attorney General's Office to review the initiative's web site for compliance with campaign finance laws. Here to fill in the details is Richard Ruelas, columnist for "The Arizona Republic." Richard, welcome to "Horizonte." "

>>" Richard Ruelas: Good afternoon. "

>>" Feliciano: What is this about? Why is the Protect Arizona Now committee refusing to engage in conversation with the Latino media? "

>>" Richard: It's some very twisted logic. I'll try to put it in the best terms I can from what the committee told me. Apparently, the logic goes that Ben Miranda insulted Randy Graf by saying that since he is for the initiative, that either makes him a racist or an uneducated fool. Ben Miranda is a leader in the Hispanic community. The Spanish language media is also a part of the Hispanic community. Therefore, the Hispanic community needs to silence Ben Miranda or not hear Protect Arizona Now's message through their media. It seems disjointed but in their mind it makes perfect sense. "

>>" Feliciano: Didn't Randy Graf appear on the show -- channel 33 this week? "

>>"Richard: Although they said they banned all media, Randy Graf was called up not through the committee, not through Protect Arizona Now, but called up by a reporter for Channel 33, and did a one-on-one with them this week, about a 2-1/2 minute package. It was a big thing that led the newscast. The next day, Ben Miranda was given a chance to appear and apologize, which he refused to do, but, so, yeah, Randy Graf has now broken that, but the ban still goes on. Also, kind of in contrast to what they are saying about the Hispanic community being homogenous, the committee says they are getting calls from valley Hispanics who says Ben Miranda doesn't speak for me, but yet that doesn't break that shell that they feel of the Hispanic community being a collective. I think if you do see the Hispanic community as one big "they", it makes -- that's how they do it, that makes their logic work and makes life a lot easier. If everyone is just a "they," you don't have to worry about shades of gray, everyone is one collective. "

>>"Feliciano: So despite Representative Graf's appearance, everybody is on the bandstand? "

>>"Richard: It looks like the bandstand they want is this apology, which I don't think they are going to get, but it's an odd punishment, because they are punishing themselves. We're not going to get our message out through a media outlet until we get an apology. It hurts them. If they follow through with who used Ben Miranda's comment, the public used his comments. Most television stations used his comment. Ben Miranda was on "Horizon" with Randy Graf. If they are going to follow through on who uses Ben Miranda, they should be silencing themselves from all media, until Ben Miranda apologizes, but they are just singling out the Spanish language media at this point. "

>" Feliciano: Now, in a related story, the Arizona Advocacy Network is requesting that the state Attorney General's Office look into campaign finance violations on the Protect Arizona Now web site. What are the allegations? "

>>" Richard: Apparently, they are seeing there is nothing on the web site that tells you how they are getting their money, how they are formed, who backs them, which, you know, I'm not a careful reader of the campaign finance laws, but it seems like it's less than you would find on another web site. I guess opponents could just ask them, what part of "illegal" do they not understand. "

>>" Feliciano: Have they modified the web site since the complaint has been filed or does the language still stand? "

>>" Richard: It was sort of a lack of language. It was lack of ways to see who was behind it. There is another committee. Their names, as last I checked, were not listed on the site. And I think maybe the law requires that you sort of mention that, mention your committee, mention who you are formed by, who its leaders are. I think that's an unknown right now. "

>>" Feliciano: So the Protect Arizona Now initiative is off to a start full of fits and stops. Richard, thank you for joining us."

>>" Richard: Thank you, Feleciano. "

>>" Feliciano: What was known as the Immigration and Naturalization Service and Customs Service have been realigned under the Office of Homeland Security. The goal, to improve the prevention of illegal immigration and smuggling and to better the processing of immigrants seeking legal status. In a moment we'll talk about the new immigration bureau. First, Paul Atkinson talks about the shifting of duties to the Department of Homeland Security. "

>>" Reporter: The border patrol was the Immigration and Naturalization Service's most noticeable component. The agencie's work away from the border was less seen. Agents track down criminal aliens, process jail inmates for deportation, checked I-9 forms and ID to determine if people could legally work in the U.S., and process thousands of applications for legal residency and citizenship. "

>>"Lisa Magana: It's always been responsible for illogical mandates. "

>>" Reporter: ASU's Chicano Studies professor Lisa Magaña has studied the INS and has a new book on the agency that will be published this fall. "

>>"Lisa: It was an agency responsible for controlling illegal immigration when I would suggest illegal immigration is uncontrollable. It's always been set up to look ineffective. Because it's looked ineffective, I think it's easier to reorganize it, move it into different departments, which is what's going on right now. And it's historical. It's been moved and placed in different departments throughout history. "

>>" Reporter: The INS reported to the Department of Justice and had five distinct missions. Border patrol, inspection, investigations, detention and removal, and services and benefits. Beginning March 1st of this year, the 111-year-old agency was disbanded. Its responsibilities now fall under the Department of Homeland Security. The new agencies and their mission, the Bureau of Customs and Border Protection, includes Border Patrol, Board of Entry Inspectors and Agriculture Inspectors. The Bureau of Immigration and Customs Enforcement oversees immigration investigations, customs investigations, detention and removal of immigrants, and intelligence for national security. The Bureau of Citizenship and Immigration Services handles the processing of people applying for legal residency, asylum and citizenship. "

>>" Russel Arh: The important thing to emphasize is that there is no interruption of service to the public. As far as the public perception after March 1, there really aren't very many perceivable differences. You'll find for a large part, the same officers in the same locations doing the same job, but the purpose was to consolidate functions that had for a long time been viewed as duplicative. "

>>" Reporter: Those applying at the Phoenix office find a building and agency much different from the one under INS. A canopy shades people waiting outside of the building on Central Avenue. Inside, the waiting room has doubled the size it was a couple years ago and new service windows have also been added. "

>>" Al Gallmann: They've done away with our lines early, early in the morning. People know if they are here by 1:30 in the afternoon, we see them. So we do have a few diehards that start lining up at 5:00 in the morning, but most of our traffic now is fairly steady all day long. We try to not to keep them outside too long at all. "

>>" Reporter: A new building entrance and plaza is under construction for those seeking assistance with immigration matters. Also under construction are new detention and processing facilities for those apprehended by investigation agents. "

>>" Tom Baranick: In the '90s when the alien immigration problem got to be severe across the border, it overwhelmed the facilities that we had to the point where it was affecting safety and security, so that was the impetus to start this whole project, which was to expand our detention processing and holding facility. "

>>" Reporter: The overhaul of immigration facilities in Phoenix was planned well before the reorganization of the former INS. There is no question improvements to the building will help more immigrants be processed and decrease a backlog of cases. The bigger question is will the organizational restructuring of the former INS improve the nation's ability to deal with immigration. "

>>" Feliciano: Joining me now is Russell Ahr, spokesman for the Bureau of Immigration and Customs Enforcement.

">>"Welcome to the show, Mr. Ahr. "

>>" Russell Ahr: Thank you very much. "

>>"Feliciano: ICE, BCIS, BCDP, we've got an alphabet soup of organizations that have come into play after INS has been restructured. What do each of these organizations do? What do they stand for? "

>>" Russell: Sure, on March 1st, the functions of the old Immigration and Naturalization Service was absorbed into the Department of Homeland Security. What we now have under DHS are three new bureaus, two for enforcement and one for services. We've got an enforcement bureau on the border, which is comprised of the former immigration inspectors, customs inspectors and the border patrol. That's known as the Bureau of Customs and Border Proctection. we also have a single bureau responsible for interior enforcement, that's the Bureau of Immigration and Customs Enforcement. That's comprised of people who were formerly immigration special agents, deportation officers, detention and removal officers, as well as the contingent of customs enforcement officers who are now under the single umbrella for interior enforcement. And then finally, we have the service bureau. That's known as the Bureau of Citizenship and Immigration Services. This is probably unique in the fact that it's comprised now essentially of the very same personnel that were conducting adjudications in the old INS. Here we have the officers who screen the application for residency, citizenship, political asylum and refugee status. "

>>" Feliciano: What's been the largest impact of the realignment thus far since it's occurred? "

>>" Russell: I think we would properly conclude there has been a larger impact on the enforcement side than on the service side. For the reason I previously stated, the benefit bureau is intact in terms of how it's comprised. On the other hand, when you look at the enforcement bureaus, we now have a coalescing of personnel that used to be United States customs inspectors, immigration inspectors, customs patrol officers and border patrol officers. This is a melding of many different groups and organizations into a single enforcement bureau at the border, and a single enforcement bureau in the interior. So a lot of times, we've got attitudes, beliefs, habits that are throw overs from things that we used to do and jobs we used to have. This is something that hasn't really manifested as something major. Human beings being what they are, we see service loyalties to old agencies that still manifest. In general, we've had a tremendous degree of unity and a sense of mission. And, of course, our mission after September 11, at the very top of our priorities is to prevent further terrorist activity in the United States, and the legacy customs officers and the legacy immigration officers are dedicated to that. "

>>" Feliciano: Has the funding picture improved now that they no longer have to compete with the enforcement side of the bureau? "

>>"Russell: Well, it's too early to say that it's immediately improved, for a number of reasons. You have to remember that budgets are written several years in advance. What we're contending with now is still a legacy INS budget, but we anticipate that the budgetary picture is going to improve in the very near future. There is a very good reason for that. In the legacy INS, we had the service side of the house competing with the enforcement side for a slice of a single budgetary allocation for one agency. Now we've got enforcement and service separated out and each is going to have its own dedicated budget to address its own needs, and there won't be this competition among two sides of the house or between two sides of the house for a budget anymore. We view that as something extremely positive. "

>>" Feliciano: Does reduced competition mean that mean there is going to be a decrease in the backlog of cases processed by the service side? We actually had a viewer who sent in a question wanting to know why it was taking so long for her visa to be processed. "

>>" Russell: Yes, I'm aware of that message. I've forwarded it to the attention of the director, and he assigned me to get in touch with this person and give her some explanations for what's going on in her case. There is some good news, and for those who would ask for evidence of progress in how we've reduced the backlog, I would point to pretty dramatic evidence. Going back to April of 2001, here in Phoenix, it was taking about 42 months to process an application for residency. For citizenship, it was taking 39 months. Here we are in July of 2003, and I can report that those processing times respectively are down to 29 months and 11 months. So there's been a dramatic turnaround that began long before either the onslaught of the aftermath of September 11th or the creation of the Department of Homeland Security. We've taken steps to streamline processing. We've introduced computer application now, on-line application for various categories of applications. We've got a larger staff than we had back in April of 2001, and I think there is a very realistic chance that we are going to achieve the goal that's been outlaid for us by the president and the administration and director and that's to have every category of processing and adjudication down to six months in the very near future. "

>>" Feliciano: So Arizona will remain a competitive place in terms of processing their applications? "

>>" Russell: It's beginning to become competitive. We intend to make it competitive. "

>>" Feliciano: Great. Thank you, Mr. Ahr. "

>>" Russell: My pleasure. "

>>" Feliciano: For many Latinos, there are numerous barriers to health services. Language, cultural and economic barriers and the lack of insurance are just a few. It is for reasons like those that clients of Phoenix nurse managed health clinic "Breaking the Cycle" have nowhere else to turn for care. 98% of the clients at Breaking the Cycle fall below the federal poverty level and 90% speak only Spanish. The clinic sponsored by the ASU college of nursing depends on federal funded grants and public donations. Merry Lucero gives us a look at Breaking the Cycle. "

>>" Reporter: Ana Bautista comes to the community health clinic knowing she will be treated well. Breaking the Cycle provides free or low cost family planning and related healthcare for the uninsured and underserved. [ speaking Spanish ] "

>>" Bautista is here for a refill of her contraceptive prescription. Nursing assistant and ASU student Lourdes Bejar makes comminication possible through translation. "

>>" Lourdes Bejar: I think having someone translate for them is a big advantage for them, because it's a way that they can communicate and express themselves and I can translate what they are saying. "

>>" Reporter: Here, Bejar gets important practical experience. She hopes to enter ASU's nursing program next semester. Under the supervision of a certified nurse practitioner, Bautista's vital signs are being checked by ASU nursing student Andrea Casillas, who is getting to put into practice what she is learning in school. "

>>" Andrea Casillas: I've had hospital experiences and community experiences, and definitely being in the community is something that I look forward to doing. It seems very different from working with really sick people to coming and working with more people who are well on the most part, and doing education and family wellness. It's not just about the one person, it's the whole family. "

>>" Reporter: That educational experience benefits both the students and the patients, says supervising nurse practitioner Eileen Doench. "

>>"Eileen Doench: I think the ideal is the patient is able to get a better education because the student is taking the time. I mean, where in the world does a student take 30 minutes to 45 minutes to sit with a patient and just educate them? "

>>" Reporter: Kari Mao went through the advanced nursing program and is a certified practitioner at another practice. She still volunteers at the clinic. "

>>" Kari Mau: As a nurse, I worked in an acute care setting. Coming here I saw the community side which started the passion for me in the community. I never thought I wanted to do anything in the community until I came here. I enjoy working with underserved and underinsured or uninsured. They seemed very appreciative of what we gave them, and it just -- I really enjoyed this as a nursing student being able to spend a lot of time with them and do a lot of education. It really helped me with my graduate work. "

>>" Reporter: Reaching out that to that community is Crissy Calfee. She provides triage, student training and a big part of what she does, follow-up home visits with patients who have abnormal test results. "

>>" Crissy Calfee: Family planning, of course, is what we primarily provide. They come in the door and receive those services, but in the meantime they get a lot of information that they didn't have about calcium and folic acid, breast exams, testicular exams, education. Some of them are just really profoundly surprised by the information that they are getting. It's very new. They might not have had any health care services in 5, 6, 7 years. "

>>" Reporter: So taking down the barriers to health services and providing preventative healthcare helps to break the cycle from poverty to poor health. That is why questions are never asked about immigration or employment status. "

>>" Eileen: Again, we're talking barriers, okay? And there are no barriers for that, and I think that maybe that makes them feel safer, I don't know. I mean, it's not an issue to healthcare. That should never be an issue. We should never be put in that political situation of -- because you don't have papers, we can't treat you. And that, again, comes down to Breaking the Cycle, the inability to get healthcare, sometimes we shouldn't have that. "

>>" Feliciano: Joining me now to talk about health issues in the Hispanic community are Gail Petersen, director of Breaking the Cycle, and Sylvia Echavestock, president and CEO of Mountain Park Community Healthcare. Gail, welcome. Sylvia, welcome.

>>" Gail Petersen:Thank you. "

>>" Feliciano: What are the major barriers to accessing healthcare for your clients? "

>>" Gail: Primarily, the clients we see do not qualify for Arizona's Medicaid system. They can be here with a green card. They have to be here for five years with a green card to qualify under AHCCCS, or if they are here with a work permit, they don't qualify for services either, and we see the undocumented. "

>>" Feliciano: Sylvia, how do clients find out what kind of services they can access at your facility? "

>>" Sylvia: It's almost a mystery how they find out, except that one person who is satisfied will tell a friend or a relative, and then suddenly they come. It sometimes -- I think if we build it, they will come. In Glendale two years ago we opened a new site. We thought we would see 5,000 visits the first year, and we've had 15,000 visits without advertising anything. "

>>" Feliciano: So what are some of the other barriers to healthcare, cultural barriers that folks may not realize exist to accessing healthcare among Latinos? "

>>" Sylvia: I think one of the things is the fact that there is a feeling that you don't want to necessarily reveal everything to the provider. A woman may not want to expose her body to a physician, a male physician. That may be a situation that keeps her from going to the doctor. Sometimes it's the idea that maybe someone will find out if that person is undocumented that they are accessing the healthcare system. Some of it is not knowing that there are people who can speak Spanish that will talk with them. Some of it is, I don't necessarily want to know what's wrong with me because it might scare me. Lack of money. There is tremendous pride among the Hispanics. By and large, we don't want to have something free, and we don't provide free care, but we don't deny care if someone can't pay for it. So I think pride gets in the way sometimes. Lack of knowledge that it's there. Just various things. Gail may have more that I haven't mentioned. "

>>"Gail: I agree with Sylvia. We do see embarrassment concerns. It takes time to get our clients to reveal their issues and concerns during the health history process. And we need to schedule more time for each client. The trust factor is something that we have to build with each individual over time, and that's one of the barriers that I think is the trust of the system. "

>>" Feliciano: Beyond language, what are the elements of providing that cultural competent service besides having Spanish speaking service providers. "

>>" Gail: It's respect for cultural traditions, it's respect for how the client expresses their health needs. A woman can come in and if she has a bad Pap smear or abnormal results, they blame themselves. It's because I did this three weeks ago that I'm having this abnormal test result now. So we listen, and we counsel and we explain. "

>>" Sylvia: We've had some interesting things happen. I was talking to one of our obstetricians before I came, and he said one of the things that surprised him was that when he went to examine Hispanic women, some of them had safety pins in their underwear, and he thought gee, I wonder why they have a pin, did the elastic break, and it has more to do with the belief that their baby will be born healthy or the gender, and then when a female baby is born, many times they will shave the head -- the hair off because there is a belief that it will grow more healthy, and -- that it will grow thicker, and you have to have respect for that, and not become appalled that someone has done something that you think, oh, my gosh, what are you doing shaving this baby's head. We had a doctor who couldn't figure out why the babies all had dandruff. It was that they were putting salt in the fontanel, and this is just -- you have to find out what are the things that the person is doing and just make an assessment that -- whether or not those things will impact or adversely affect the treatment that a traditional physician might prescribe. "

>>" Felciano: Gail, it's interesting to note that in many areas, in many health areas, Latinos have better performance indicators than Anglos. What can that be attributed to? "

>>" Gail: We were discussing this before the show, Sylvia and I. I don't think you can pinpoint any one thing. It's a mix of genetic background. It's a mix of diet, culture, family support, emotional support. We have tremendous emotional support from family members in our Hispanic community. It is a positive benefit to health overall. "

>>"Feliciano: Is that changing as the Latino population acculturates to life in the United States? "

>>" Gail: We see some issues between men and women that are -- we see primarily recent immigrants. We see very traditional families in our practices, but we do see changes over time with diet, fast-food and things that aren't healthy for the family. "

>>" Feliciano: Gail, thank you. Sylvia, thank you. "

>>" Sylvia: Thank you. "

>>" Feliciano: If you would like to see a transcript of this show or get information about upcoming "Horizonte" programs, please visit our web site at www.kaet.asu.edu and click on "Horizonte" in the lower left of the screen. Join us next week for more in-depth coverage of Hispanic issues on the next "Horizonte." Thank you, and good afternoon.