TGen Health Surveys in Avondale


>>José Cárdenas:
Tonight on "Horizonte," proposition 200 is intended to stop undocumented immigrants from receiving government benefits, but is it affecting the health and educational needs of children and families? And photographer Howard Buffet shares his experiences with poverty around the world.
Plus, a health survey targets Hispanics in the West Valley. Up next on "Horizonte."

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>>José Cárdenas:
Since proposition 200 was passed, at least one valley organization is concerned about the impact the law is having on families in the community. Joining us tonight is Laura Walker, early childhood development director for Chicanos por la Causa. Laura, welcome to "Horizonte." I should mention that I'm on the board of CPLC, but I don't participate in this program. Tell us first about the head start program generally and then I want to talk specifically about the one that you are on.

>> Laura Walker:
Head start is a federally funded program to serve low income children and their families, and in particular, to serve children and provide educational opportunities, also to provide comprehensive social services for those children, like medical, dental, nutrition, and mental health. So we provide a comprehensive array of services. Our program in particular serves the migrant seasonal farm workers and their families, and those families to be eligible for the program must work 50% of their income in agriculture and hit the 100% poverty guideline or under set by the federal government.

>>José Cárdenas:
You mention it was a federally funded program. Does that mean it was not covered by proposition 200?

>> Laura Walker:
Correct. That deals with particular state benefits. Because we are federally to locally funded, Prop 200 is not covered by this.

>>José Cárdenas:
Did you see any impact of the passing of proposition 200?

>> Laura Walker:
Immediately. The day after elections, attendance in our programs statewide, all of the head start programs was near 37%. In our program, we saw anywhere from --

>>José Cárdenas:
That was a dropoff 37%?

>> Laura Walker:
A dropoff 37%.

>>José Cárdenas:
What are the total numbers we are talking about?

>> Laura Walker:
In the State of Arizona. We serve 21,000 families on any day.

>>José Cárdenas:
And the day after election, 37% didn't show up?

>> Laura WaLker:
Correct.

>>José Cárdenas:
What other impacts have you seen in terms of proposition 200 and the use of services?

>> Laura Walker:
It's a fear factor. Our families are not accessing the services that we are referring them too, particularly in the medical area.

>>José Cárdenas:
Did that 37% drop continue or did it pick back up? What happened?

>> Laura Walker:
No, with a lot of hard work and communication, fliers going out to the families, phone calls, we reassured them that they were safe within our program, that the proposition 200 did not affect those children and their families.

>>José Cárdenas:
Despite those efforts, have you seen any dropoff in terms of accessing of services?

>> Laura Walker:
Absolutely. Again, receiving services that we have referred them to, like medical, and dental, is part of it, also accessing insurance for their children. All of these families are eligible for the service that is we refer them to.

>>José Cárdenas:
As I understand it, you just talked about referrals. The program provides some services directly, and then there's a referral to outside providers; is that right?

>> Laura Walker:
Correct.

>>José Cárdenas:
Have you seen any impact there in terms of accessing of the referral sources?

>> Laura Walker:
Absolutely. Again, in our particular program, 23 families have either refused after referral, not shown up to their appointments, or, again, have refused to seek out eligible services like medical insurance.

>>José Cárdenas:
It's purely -- they are not being denied these services; right?

>> Laura Walker:
Correct. As far as we know, they are not being denied. It's what -- the factual data we've been able to gather from our parents that are telling us why they are not doing this is because of Prop 200.

>>José Cárdenas:
Just one point of clarification, as I understand it, the direct services that head start provides are just for the children; is that right?

>> Laura Walker:
Correct.

>>José Cárdenas:
Have you seen any instances where children who are U.S. citizens and would be eligible even for state services, but their parents may be undocumented, their parents aren't taking them for these services?

>> Laura Walker:
That's correct. Head start does not require any type of documentation whether undocumented or not. We don't ask them if they are legal or illegal. We require a birth certificate. Whether that's from the State of Arizona or say Mexico or California, all we're asking for is just so that we know that there is a birth certificate on file.

>>José Cárdenas:
For identification purposes?

>> Laura Walker:
Identification purposes only.

>>José Cárdenas:
Have you seen any difference in terms of the way the referral resources are treating the people that you've been sending to them?

>> Laura Walker:
Absolutely. As I said, because we're an agricultural program, we are obviously in the rural areas, and the community is not -- because it's such a vague law, is self-interpreting what the law is, and they are requiring much more documentation, further information, that they've required in the past from our families, and we think that it has to do with proposition 200, and these parents have very little access as is in these rural communities. We depend on these providers to be able to help these children and these families, especially in need.

>>José Cárdenas:
You talked about the need for educating the parents as to what Prop 200 does and doesn't cover. Does this suggest there is a need to educate the providers as well? Are you finding that to be the case?

>> Laura Walker:
That is absolutely the case. We need to have the community understand what the law affects, what programs it affects, and that without that information, once again, they are making their own determination of what the law means. So it's not only a fear factor within our families, and within citizens, but also the providers that are there to provide services to these families, which creates undue hardship.

>>José Cárdenas:
We had the attorney general come out with an opinion that was fairly comprehensive telling people what was and was not covered by Prop 200. Did that have any impact at all?

>> Laura Walker:
It had some impact, but because most of that information stays within the urban area -- areas and is not really translated and given to these certain populations that don't seek out that information, they go by basis of talking within their own community, and so everybody is doing their own interpretation of what the law means. So many of what the attorney general has presented helps, but again, reaching out to these very rural communities, we need to have more impact on.

>>José Cárdenas:
What do you anticipate going forward that we're going to be seeing as further consequences of the passage of Prop 200 in terms of the people that you serve?

>> Laura Walker:
Well, I think that part of this is when we have -- in our population, we screen our children, and we have noted that there happens to be a tendency rate of identifying tuberculosis, TB, within our children. Then we find that it's in the family itself. We request that they -- that the needed medication to the cure or to be able to subsidize no passing of the disease, and what we are afraid will happen, is that they won't reach out for these services, and which will eventually possibly start an epidemic. It's not about them, it's about us as a community.

>>José Cárdenas:
There is a higher incidence of TB in the populations you serve and your concern is that these people will not get care that they would otherwise get?

>> Laura Walker:
Absolutely.

>>José Cárdenas:
What other types of impacts do you anticipate that Prop 200 may have as we go forward.

>> Laura Walker:
Not only medical services but economic impacts of areas of needing to have services provided to the citizens will be less and less, which might eventually cost more and more. I think it's going back to once again, it's not about them, it's about us as citizens, and the inhumane aspect of this law.

>>José Cárdenas:
What about the costs? When we were off screen, you were talking about some of the costs in terms of emergency medical care.

>> Laura Walker:
Well, when you have parents who refuse to apply for access, which is not under Prop 200, but because, again, the vagueness of the law leads them to believe that it is, they would have coverage. If something was to happen and they were to go into an emergency room, they would be covered. The bill comes out if they are covered 200 to $300. If they refuse these services and go into the emergency room and the hospitals must provide their care, the bill eventually costs $4,000 to $5,000.

>>José Cárdenas:
That's state money rather than federal money?

>> Laura Walker: It's state money, insurance money, we all know from hearing from the reports that have been given on that situation as is.

>>José Cárdenas:
Laura, thank you for joining us on Horizon.

>> Laura Walker:
Thank you.

>>José Cárdenas:
Howard Buffet is the son of billionaire Warren Buffet. His new photography book "Tapestry of Life," has recently been released. He's just returned from a journey tracing and photographing the steps taken by immigrants who enter the country secretly. He visited ASU last week to talk about world poverty.

>>José Cárdenas:
Mr. Buffett, thank you for joining us today. You've written six box on photographer fee, a 7th on the way. I'd like to talk about "tap percent industry of life." Tell us about that.

>> Howard Buffett:
"Tapestry of Life" is a combination of 40 international trips and a few domestic trips. It's an effort to kind of show through photographer and images what's happening around the world and what some of the challenges are for different people, different cultures, different traditions, and, you know, some might be very different from what we would see here in the United States and then there might be some that are similar in certain specific areas.

>>José Cárdenas:
Some of those pictures are in a booklet put together for a visit to ASU that brought you here. You talked about their and I think about N your book about your start in photography, first wild wildlife and then people. Tell bus that.

>> Howard Buffett:
I started my photography mainly when I -- I also farmed back home both when I was in Nebraska, now I'm in Illinois, but I started photographs when I was on the farm. You just see these great moon rises and sun sets and coyotes and dear and fox and so I started taking photographs on the farm, and then I kind of graduated where I wanted to go beyond that, so I started traveling around the world photographing all sorts of animals and that, then, eventually led me into the discovery of how interrelated all of the issues that you think of in terms of poverty and lack of health services and how that all integrated with impact on the environment, and then obviously impact on animals. So really, the last four, five years, I've spent a lot more time photographing people than I have animals.

>>José Cárdenas:
But you have the power to shape public opinion started in a very young age. You mentioned in your introduction to this ASU piece, your experience s in Czechoslovakia. Tell us about that.

>> Howard Buffett:
We had a foreign exchange student staying with us when I was growing up in Omaha, Nebraska, and she invited us to visit her at home. I argued with my mother for about two hours saying I wanted to go and finally my dad was sitting over on the couch reading the paper and he put the paper done and he says Susan let him go, it'll be a good experience for him. So with a little support from him I got off, and the first trip I ever made internationally and it was the first international trip by myself. I got to -- with a few little hiccups, I made it to Czechoslavakia. It was the first occupation by the Soviet union at the time. It gave me incite into the change that can take place with families and the hardship that can come with the result of that activity. It made an impression on me in terms of, you know, how other people's actions really impact, you know, what can happen socially and what can happen just to this family that I was staying with. I mean, you couldn't -- I had a difficult time getting groceries, and electricity was gone and off most of the time. Didn't have hot water. That was a new experience for me.

>>José Cárdenas :
You mentioned one experience that you had there watching the landing on the moon with your Czechoslovakian friends.

>> Howard Buffett:
Yeah, this big apartment building, they called them flats. They had a black and white TV that didn't have great reception but it worked and it was the only TV in the building, so all of these people crammed into this little apartment, and I'm standing there and they show Neil Armstrong take his first step on the moon and no one in that room believed that he was on the moon. The Soviets were covering the -- they were providing the coverage and so they were basically implying that it was all a hoax and it was all propaganda and all of these people believed it. And I just -- it was amazing to me. I thought, now how can you -- of course they are on the moon. And so it had a tremendous impact on me in terms of realizing that the truth may not be perceived as the truth, and how easy it is to manipulate people, and so it was a -- it had a huge impact on me.

>>José Cárdenas:
In addition to the commentary that you have in the booklet prepped for your ASU visit, there are a number of photographs that I would like to chat a little bit about. One of them is a gentleman saluting the American flag. Can you tell bus that one?

>> Howard Buffett:
That's Everett. He is in West Virginia in the Appalachians and I saw him out getting his newspaper. He's just about one of the thinnest individuals I have ever seen. His ribs were showing. You could tell he was malnourished. I was on a busy street and I was wanting to get his photograph and my colleague went up to talk to him and I yelled across the street and I said ask him if he's a veteran, and he immediately saluted the flag there on the porch, and he then -- we went over and visited with him. He wanted to get out his medals and talk to us. It was amazing to me. It was a great example of somebody who spent their life serving his country and had gotten very little back. He lived in a home with basically no furniture, almost nothing in his cupboards. We tried later after that to help him a little bit. I was going to go back -- he had actually asked the gentleman we were with to have -- he said have that guy, that guy that took those pictures come back and see me, I want to take a picture in my uniform, and we tried to find him, and we could not find him. It was only about 6 months later. He had gone into the hospital and no one could tell us where he went.

>>José Cárdenas:
You also have pictures of poverty in other parts of the world that are here, particularly striking one of a young child covered with flies.

>> Howard Buffett:
And that's such a -- I've used that photograph here in an effort to try to convey more than just the fact that there is a single issue. I mean, you have hepatitis A and hepatitis B, and typhoid and meningitis and all of these various different diseases that are dealt with on a daily basis, losing tens of thousands of individuals and suffering in a really difficult way and a difficult environment, and this kind of photograph usually gets people's attention.

>>José Cárdenas:
You also captured the horrors of the Rowandan massacres in another picture that's here.

>> Howard Buffett: I've gone back -- I have a difficult time pronouncing this woman's name. She is in a genocide site in a church where the priest actually participated in getting about 5 to 600 people into this church. This is a common thing that would happen during the genocide. They would fill the church up with people telling them that it was a safe haven, and then they would lock the doors behind them, put semi-automatic weapons in through the windows, fire at will, throw a few grenades in and then go in and finish any of the survivors off with machetes. There were close to 600 people killed in this church. That photograph shows how the church was left. It's undisturbed. With the bodies, the bones, the skulls are all still there. They are just now starting to clean it up this past year, and this woman was under her dead husband and dead three children, and didn't come out for a full day and that's how she survived, one of four survivors.

>>José Cárdenas:
Your visit to Arizona is in conjunction with yet another book that you are preparing. Tell us about that.

>> Howard Buffett:
Well, my mother, when I came out of tap press industry of life, she said you've got to try to do a similar book of images of the United States and some of the same similar type challenges that we have here, which in some ways is probably more interesting because we have the resources to deal with these issues here and it's usually a choice or it's politics or whatever it is that gets in the way.

>>José Cárdenas:
You've been traveling throughout the state?

>> Howard Buffett:
Yes, on the trip to Arizona, we were able to go up and spend a couple of days on the Navajo reservation, which was a great education for me, and exposure to some of those issues. We went down into Mexico and actually went up on the Mexican side of the border where they have about 5,000 immigrants crossing every day, and we were able to see these -- we saw the living conditions and we were able, then, to go on up to what they call the brick yard which is on the other side of the U.S. border where they transfer thousands of people into basically it's like herding cattle, but it's herding people, and then they go in and obviously attempt to cross the desert and the one thing that really stuck with me is these people, as you interview them and talk to them, they know that some of them face certain death, but they are absolutely determined, and many of them said, if I don't make it this time, I'll -- you know, I'll try five times, ten times, 15 times, I'm going to make it across the border.

>>José Cárdenas:
Mr. Buffet, my last question is for you is one you ask in your introduction, and that is do these images really have impact.

>> Howard Buffett:
Well, you have to have a little faith that they do, because sometimes it's hard to see, but I will tell you that in different times, different presentations, I have had a lot of people walk up and say, how do a drill a well for somebody in Ghana and help eliminate the kind of disease that you showed in your images. How do I help a child caught in this cycle of prostitution, and I've directed them to places and I've actually seen a lot of people write checks and, you know, writing a check doesn't always solve the problem, but every organization working on it has to have money, and so I guess at least in that sense, the images have moved some people to action and that's all I can hope for.

>>José Cárdenas:
Mr. Buffet, thank you for joining us on our show. We look forward to your next book.

>> Howard Buffett:
Thank you.

>>José Cárdenas:
As part of the healthy Avondale partnership, the Translational Genomics Research Institute known as TGen started conducting health surveys in Avondale as part of an initiative to target cardiovascular disease among Hispanics in that community. With us tonight is Minerva Romero, the study director for the Epidemiological Survey Diabetes and Obesity Research unit at TGen.

>>José Cárdenas:
That was a mouthful. Tell us about yourself first and then about the unit that you work in at TGen.

>> Minerva Romero:
I'm a native of Mexico city. I've lived in the United States more than half of my life, and I graduated recently from Arizona State University. I'm currently completing classes for a master's of public health. I'll be enrolling in the college of medicine at the University of Arizona next fall.

>>José Cárdenas:
What was your undergraduate degree in?

>> Minerva Romero:
Cellular biology and physiology.

>>José Cárdenas:
Tell us about TGen for some of our listeners.

>> Minerva Romero:
TGen is the new nonprofit research institute here in Arizona. We're focused in the study of the genomics, and translating those discoveries into bed side therapeutic remedies.

>>José Cárdenas:
And how did this particular project, the healthy Avondale partnership, what's the Genesis of that?

>> Minerva Romero:
Well, the Hispanic community is probably second at highest risk for diabetes. That's the unit where I started my internship, about a year ago.

>>José Cárdenas:
With TGen?

>> Minerva Romero:
Exactly, with TGen. My project was to develop a program that focused on the Hispanic community, and so I sought out several communities here and finally decided on Avondale because of the high population of Hispanics that live there, nearly 50% of the residents are Hispanic. It's also a manageable size population for research, and they have a healthy Avondale initiative that was very welcoming to our project and so they are part of our partnership as well as sun health and the American Heart Association.

>>José Cárdenas:
So this is your baby. It developed out of your internship project.

>> Minerva Romero:
Right.

>>José Cárdenas:
The healthy Avondale initiative predated the development of your project then?

>> Minerva Romero:
Exactly. We developed the project separately and joined forces once we realized that we could benefit from each other's presence in the city of Avondale.

>>José Cárdenas:
Tell us about the survey itself. What does that consist of?

>> Minerva Romero:
Basically, we're going out there to seek out specifics on behaviors that may increase or may not increase the risk for people to develop chronic diseases like diabetes or cardiovascular disease.

>>José Cárdenas:
The two are related as I understand?

>> Minerva Romero:
Exactly. Being diabetic puts you at a higher risk of developing cardiovascular disease than the general population. In fact, diabetes is considered one of the major risk factors for heart disease now.

>>José Cárdenas:
And how far into the project are you and how many people? What's going on?

>> Minerva Romero:
We're actually about nine months into the funding, however, we only recently began the survey. We started at the beginning of 2005, and we're looking to finish it by the middle of the year or July.

>>José Cárdenas:
You mentioned funding. As I understand it, you submitted a grant to obtain the funding? Can you tell us about that process?

>> Minerva Romero:
Exactly. We submitted a proposal to the Arizona Department of Health Services, and the proposal funded not only our survey, but also several projects undertaken by the other organizations I mentioned in our partnership.

>>José Cárdenas:
These are tobacco fund monies being used?

>> Minerva Romero:
Right, from the proposition 303 is that.

>>José Cárdenas:
Now, the actual survey taking -- you are going door-to-door?

>> Minerva Romero:
Yes.

>>José Cárdenas:
And what's the process? Give us a description of that?

>> Minerva Romero:
Basically, our interviewers are going out there and explaining to people what the survey entails. If a person decides to participate, they go ahead and conduct the survey, take some body measurements and refer them to allow for a blood draw. We will then mail the people their results so that they can analyze the results with their doctor or if they don't have a doctor, a clinic in the area that may provide services to people who are not insured or underinsured.

>>José Cárdenas:
How are they selected, the actual survey participants?

>> Minerva Romero:
It's a sampling strategy that basically -- it's on a voluntary basis, so even if the person -- even if our interviewers come to your door, it is not mandatory to participate.

>>José Cárdenas:
Are you getting good results?

>> Minerva Romero:
Yes.

>>José Cárdenas:
Have you seen any impacts of Prop 200? There are some suggestions that people are afraid to answer questions from anybody who licks a little official.

>> Minerva Romero:
Yes, people do ask the interviewers are you with the police or with the government, is this going to affect, you know, is this going to affect the care I receive, you know, does this have anything to do with Prop 200. So there are several questions that we have had to field because of the effects of Prop 200.

>>José Cárdenas:
Are all of your surveyors Spanish-speaking?

>> Minerva Romero:
Right, they are all actually Hispanic and bilingual.

>>José Cárdenas:
They've been able to get past these impediments?

>> Minerva Romero:
Uh-huh.

>>José Cárdenas:
Now, exactly how are the results going to be used?

>> Minerva Romero:
Well, what we hope to do is produce a report and then not only produce a report and let it sit on the shelf, but we're actually going to have focus groups with our partners and other health agencies, public health agencies that work in the city of Avondale, and basically, first of all, develop modifications to programs so that they can address the needs that are identified by our survey, so that they can make their programs more culturally relevant, if that is one of the needs that they find, and also, we really hope to make this a model, a pilot program for other communities to follow.

>>José Cárdenas:
Minerva Romero, good luck in medical school.

>>> Minerva Romero:
To see transcripts or information on upcoming shows, visit our web site, AZPBS.org and click on "Horizonte." Thank you for joining us tonight, I'm José Cárdenas. Have a good evening.

The Translational Genomics Research Institute (TGen) in cooperation with Healthy Avondale Partnership is fighting back against cardiovascular disease among Hispanics. Join TGen Study Director Minerva Romero to get the facts.

Sponsor message:

In this segment:

Minerva Romero: Director, Epidemiological Survey Diabetes and Obesity Research unit, TGen;

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