Alaska Health Policy Review

Recently we had the pleasure of interviewing José Luis Cuevas of the Mexican Consulate in Alaska. The interview was conducted in the spacious and recently remodeled Consulate at 610 C Street, Suite A-7 in Anchorage between 6th and 7th avenues. This candid and wide-ranging interview covers topics such as the health issues of Mexicans in Alaska, the history and work of the Consulate in Alaska, the nature of Mexican communities in different areas of Alaska, and how health care issues for Mexican communities in Alaska differ from their counterparts in other cities in the United States. Mr. Cuevas stressed repeatedly that he is interested in communicating with health care providers or others who work with Mexican communities anywhere in Alaska so that Mexican residents can have their health and other family needs effectively met. This interview was conducted February 3, 2010, and has been edited for clarity and length.

AHPR: I wonder if you could tell us how long your consulate has been here, and why there would be a Mexican consulate in Alaska?

Cuevas: The consulate was established a year and a half ago, the middle part of 2008. It was determined that a Mexican consulate should be up here for the simple reason that Mexico thought that -- with Mexican migration coming into the United States, and finding residents in specific states of the United States -- considering Alaska was so far away from the Lower 48, it was necessary to have an office to be able to serve Mexicans up here. We also serve American nationals and foreigners, in order to be able to provide them visas to travel to Mexico.

Compared to our colleagues from Canada, Japan, and Korea, this is a full-fledged consulate. In other words, you can get passports, you can get consul identification cards, you can get visas, powers of attorney, register your child for dual nationality, and many other things. It was determined based on the fact that their studies indicated that there might be a great population of Mexican nationals here. Curiously enough, because of the distance of Alaska, the Mexicans that we have found up here, most of them already have their documents and most of them, or half of them are already U.S. citizens. That has, kind of lowered our expectations as to what our workload would be.

AHPR: Lowered your expectations because you were assuming that more of them would be undocumented?

Cuevas: No. If they weren't American citizens, they would come in and obtain a Mexican passport, but already being U.S citizens, then they get a U.S. passport. If they are legal residents here then they can get a passport for up to six years, and if they get it in Mexico they can get it [for] up for 10 years. Consequently, we wouldn't be able to see them until every sixth or seventh year, once those passports expire.

"There are a lot of nationalities from Central or South America that do reside in the state of Alaska, ... but Mexican nationals, curiously enough, you wouldn't find as many as you would in other states of the Lower 48s."

AHPR: I happened to run across a newspaper article, I think it was from when you first came to Alaska, or at least first set up this consulate. And, I think the estimate at the time was something like 40,000 Hispanics in Alaska, and of those maybe 15,000 Mexicans in Alaska. I may have those numbers incorrect. What is your current estimate of how many Mexicans may be residents here in the state?

Cuevas: In the whole state probably 15,000. Being realistic, and taking note of different counts that they've been taking, obviously the 2010 census will be important in that respect because it will give us a very specific number. I think it was [the Pew Hispanic Center] in Washington D.C. came out with a study indicating that they didn't expect more than 15,000 Mexican nationals to be living within the state. There are a lot of nationalities from Central or South America that do reside in the state of Alaska, like [from] Guatemala [and] Peru. It's a little bit varied, but Mexican nationals, curiously enough, you wouldn't find as many as you would in other states of the Lower 48s.

AHPR: Are there Mexican consulates in every state in the United States?

Cuevas: No, no. This is the 50th consulate, [or] the 49th consulate, and the 50th consulate was Boise, Idaho, but we don't cover all states. Certain states, like the state of California, you'll find that it has thirteen consulates because of the amount of Mexican nationals living there. The state of Texas has eleven, also because of the numbers. But you might find that in North and South Dakota, you wouldn't have a consulate, [and] in Montana you wouldn't have one. So you have other consulates, like the one in Montana is covered by the one in Salt Lake City. You pretty much cover from the spectrum from north to south, east to west.

AHPR: Did we get a consulate here in Alaska because, primarily, we are so distant from other consulates that might serve us?

Cuevas: Yes, even though before we used to cover it with a mobile consulate. In other words, the consulate in Seattle would come in on a twice-yearly basis, to come to the state of Alaska to be able to provide services to Mexican nationals here in Anchorage, or in Juneau. I think they went to Juneau once, but they did come to Anchorage a couple of times, and it was serving a purpose. Just send ahead advanced notice that you would be coming, and let people sign up. We've had already three mobile consulates from this consulate. We've gone to Dutch Harbor, we've gone to Kodiak, and we've gone to Juneau.

AHPR: In Dutch Harbor and Kodiak, would that primarily be cannery workers?

Cuevas: Yes, it would. We did issue new passports to people that had their passports expire, and we did issue Mexican birth certificates to children born in the United States whose parents are Mexican Nationals and are entitled to dual-citizenship. Just like you would if you were in Mexico and you had a child, you could go to the U.S. Embassy or U.S. Consulate and register your child there for U.S. citizenship.

AHPR: Before I turned on the recorders, we were talking about this: It never occurred to me to interview you here, based on health issues, until I ran across one of your staff, a Mr. Pedro Rodriguez, at a meeting I attended two or three months ago, I think. That meeting was a planning meeting for an Office of Minority Health that the state is considering establishing. It was very interesting to me why a staff person from the Mexican Consulate would be at that meeting. I wonder if you could explain what your interest is in that office or those issues.

Cuevas: Basically, it's an interest of all consulates -- to try to provide as much service to Mexicans residing here, and it's also an idea that has carried well in the Lower 48. If you're talking of specific health issues, this bi-national health program that Mexico established with the Unites States has provided services to Mexican nationals living here who might not have the time or are somewhat short of money, or skeptical of going to a doctor, so they come to something that's organized and coordinated by the Mexican Consulate so that they can get at least primary information regarding health.

And that is something that Mr. Rodriguez went there to find out -- exactly what the state of Alaska was doing, and to see if we could somehow launch that. However, because of the lack of Mexican nationals, we still haven't. Here in Anchorage, we don't see that they live in a specific community. They sort of live all over the place. In Chicago they literally live in South Chicago, and in Omaha they live in South Omaha, and so on and so forth. They do have specific places of residence, but here it's kind of spread out. Basically, the only way of communicating with them would be through television, which would be, maybe.

It was an idea that has been carried out well in the Lower 48, and it's a program that's carried out every year. Now, it's not only bi-national, it's tri-national because Canada is also included in the program. They are establishing the same procedure by Mexican Consulates in Canada to be able to provide those essential meetings to Mexican nationals living there. [This] is not something that the American taxpayer pays, not at all. It's something free of charge, and it's something that doctors or nurses or professionals give their time, and are able to evaluate the people that go in.

"Some consulates, where there's a huge amount of Mexican nationals living in that particular community, they might have within the consulate a specific aisle, or specific place, where they can get that information like 'What is high blood pressure?' 'What is cholesterol?' What have you."

AHPR: So, is this a clinic that would be sponsored by the consulate? I'm not exactly sure what form we're talking about.

Cuevas: Yes, if you're talking of the bi-national program, it's held once a year. Some consulates, where there's a huge amount of Mexican nationals living in that particular community, they might have within the consulate a specific aisle, or specific place, where they can get that information like "What is high blood pressure?" "What is cholesterol?" What have you. Things they might not be familiar with. And the person being there would be able to explain to them what exactly it is, and how it can affect your health.

AHPR: I ran across this very interesting document that was published by the Consejo Nacional de Población in Mexico City. It was published in conjunction with the University of California. This document discusses how recent Mexican immigrants to the United States have a whole range of problems having access to health care, having higher rates of diabetes, and so forth. It did say that recent Mexican immigrants are more likely to use Community Health Centers than, for example, for-profit private physicians. Is that something you've noticed up here, and I wonder if you've had any discussions with, in Anchorage for example, the Neighborhood Health Center?

Cuevas: We kind of have noticed that up here, and we have touched base with some health centers. Possibly because of the lack of being able to coordinate, [we have not been able to say] "Hey guys, we're going to have a specific health clinic or a program running from Friday and Saturday of this week of this month," and we haven't been able to do that for the lack of communication in the Spanish language, and the lack of Mexican nationals living up here. Why? Because most of them already have their documents in hand and in order, so that they won't need us until they require something. If they do, they just call and we're here.

AHPR: I imagine another issue, in terms of this consulate, would be the fact that Alaska is so big, and transportation is so difficult.

Cuevas: So big and so difficult, that's right. With the possible exception of Fairbanks, you have to fly everywhere else. Yes, it's huge.

AHPR: Moving on to specific policy issues, this document that I mentioned earlier noted that recent changes in immigration law in the United States, have made it more prohibitive, or scary, for undocumented Mexicans -- and even documented ones -- to go out and seek health care, particularly from the public sector where they might qualify for services otherwise.

"We're here and we're available. Anyone that calls, we can provide them with the appropriate information in the right language. ... I believe that for emergency purposes, if you are going to an emergency room -- whether you're a legal or an illegal -- you'll still be able to receive the appropriate health care, at least as is necessary so that you won't pass away."

Cuevas: I think it's because lack of understanding, or word of mouth that gets around, "You know, this is going around, and unless you really need it, don't go." That's possibly it, but I think it's probably lack of knowledge. We're here and we're available. Anyone that calls, we can provide them with the appropriate information in the right language. But yes, it's getting to that, and some people, as I said, by word of mouth interpret it their own way. I believe that for emergency purposes, if you are going to an emergency room -- whether you're a legal or an illegal -- you'll still be able to receive the appropriate health care, at least as is necessary so that you won't pass away.

AHPR: But I think there may be a fear that someone in the emergency room would call immigration. Is that...?

Cuevas: That's also a possibility, but that doesn't happen. There again is where we can help out in providing information and letting people know that basically, they are just concerned with your health issue. They're not concerned with your legal status.

AHPR: Do you have any stories regarding Mexicans in Alaska obtaining health care, or obtaining help about health care?

Cuevas: This was sometime last year, that they were inquiring as to where they may be able to get some type of, not initial health care, but secondary health care for this or that ailment, and we had been able to refer them to appropriate physicians. [That occurred] possibly because of the fact that they didn't know exactly who to contact, and we can also try to help them out in that respect.

AHPR: Are there physicians or other health providers you can refer to that speak Spanish?

Cuevas: Very few. Very few. In the Lower 48 you find that some physicians there have gone to Mexico, and that some of them have even taken their medical studies in Mexico, so their fluency in Spanish is a lot better than you might find up here. I particularly have not found any physician that speaks Spanish here. That they try, sure. That they have their best opinion as to how to deal with them, yes.

My wife is a professional interpreter and a translator for a health system in the Midwest of the United States. She translates from English to Spanish, [but] here we don't see that there's much of a need for that, but down there almost every form is translated into the Spanish language just for the purpose of a patient understanding what's going on and what he has to do. Up here, correct me if I'm wrong, but I haven't seen that. Then again, I haven't gone to the hospitals that often. [However,] as I said, we have not received any inquiries into the subject for the simple reason that there's not that many people here. That there are Mexicans here, yes. And our estimate continues to be around 15, 000.

"We would be more than willing to work with anyone. We have been working with state agencies already, or are in the process of working with state agencies, health and human services, child protective services, etc."

AHPR: Are there any organizations you work with in Anchorage or in Alaska, or would like to work with, in terms of the health of Mexican residents in Alaska? I'm thinking of maybe professional organizations, the major hospitals, the health clinics, something like that?

Cuevas: We would be willing to work with anyone. We would be more than willing to work with anyone. We have been working with state agencies already, or are in the process of working with state agencies, health and human services, child protective services, etc. We'd be willing to work with any hospital in that respect, in the event that we might be able to establish that, but we haven't seen much of a need to make a full launch of the bi-national health program here for the simple reason that there are not that many people for them to be able to take care of.

On a Friday and Saturday in the Midwest, the bi-national program, if you publicize through the radio and through the Spanish newspaper, you might have somewhere in the range of maybe 1,000, 1,300 people, 1,500 people walk in and go to different sectors of the fair. [They would] be able to determine their blood pressure, their blood type, and what their heart rate is, and what have you. Up here, there isn't that much of -- not lack of interest -- but there isn't that [many] Mexican nationals to be able to take care of that. There is a great Hispanic community. There might be, maybe 40,000, 50,000 something to that effect, considering all nationalities. But we only represent Mexico.

AHPR: I wonder if you could say anything else about your trip to Dutch Harbor. I've been to Dutch Harbor, and I've seen the huge processing plants there, and the fishing fleet. I understand that Hispanics are very involved in those industries.

Cuevas: Very.

AHPR: I wonder if you could say anything more about how their needs are being met, their health needs, and maybe how you have helped?

Cuevas: We arrived on a Friday and we left on a Sunday morning, and we worked on Saturday. My initial impression -- and [that of] the people that I was speaking to over there -- was that yes, there is a great need. They do work in the fishing and canning industry over there, which we did take a tour of. And, apparently they have, like the meat packing industry in the Midwest, they do have health clinics that surround the canning industry. First aid might be provided there. In the event that it cannot be dealt with on a first-aid basis, then they fly them to Anchorage in order to be able to provide the additional health [care]. As in the Midwest, we have found that -- or we believe because of certain cases that have been brought to our attention -- what things might be considered first-aid cases are not necessarily just first-aid, it should be [classified as something more serious]. In that respect, we are working with OSHA [Occupational Safety and Health Administration].

AHPR: And you mentioned you went to Kodiak also. How did you find that situation there, in terms of Mexican residents, and health issues?

Cuevas: Pretty much the same as [Anchorage]. Nobody complained regarding Kodiak. Nobody complained in [any] of the three places that we went to. Nobody complained regarding health issues. They might have indicated to me, once or twice, in Dutch Harbor, regarding the possible health, that they didn't feel it was a local situation, that it was something that might have required [additional care outside Dutch Harbor].

AHPR: Just one last question on, along these lines. This document I mentioned before, prepared by this Mexican institute, it implied that female Mexican nationals might have even more problems accessing good health care in the United States, than males. Is that an issue you've found, or do you have any comments on that?

Cuevas: I haven't seen that. I have not seen that problem anywhere. I stand to be corrected, but we haven't seen that either here, or anywhere else. And they all receive the same treatment.

AHPR: This might be an awkward question to ask you, but I feel compelled to ask it anyway. Are there any United States or Alaska policies that you feel maybe adversely affect the health status, or the ability to get health care of Mexican residents in Alaska?

Cuevas: We haven't seen that in the state of Alaska. I know that certain states within the United States have taken certain measures that, unless you have a green card or social security number, usually for some reason, initial health service might be denied. But obviously the doctor usually takes into account what he swore to when he became a physician, you know, that the health of the individual is first. So, we haven't seen any type of legislation here in the state of Alaska, that might affect them. But as I've said, I'll stand to be corrected, but we haven't seen much in that respect. Obviously, the Department of Motor Vehicles does require that you present a green card or permit to show that you are legally in the state of Alaska or the United States in order to be able to obtain a driver's license, but for health reasons it hasn't gotten to that yet. I know that someone in Congress didn't quite agree with what the president was saying in that respect.

" ... in Mexico, yes, the people do have more access to physicians down there and professional health [care] of different forms, than they do here. ... in certain communities they kind of ["delay"?] going to a doctor for the simple reason they might foresee or think that they can take home remedies and get it better, and that [isn't] always necessarily the case."

AHPR: It is my understanding that the health care system in Mexico is much more heavily reliant on the public sector so that working class Mexicans may have much better access, to at least primary health care in Mexico, than they do here. Is that correct, would that be a correct assessment?

Cuevas: It probably might be. Well, that's the same case as here in the United States. If you need health [care], or because of a health issue, and if it's a grave health issue, you'll get health here or there, or anywhere. But in Mexico, yes, the people do have more access to physicians down there and professional health [care] of different forms, than they do here. But also in certain communities they kind of ["delay"?] going to a doctor for the simple reason they might foresee or think that they can take home remedies and get it better, and that [isn't] always necessarily the case.

AHPR: Mr. Rodriguez mentioned that. I forget exactly what he said, but it was something like an issue here in Alaska might be Mexicans self-treating rather than say, seeing a physician. Is that an issue that you've found or you've heard about?

Cuevas: I have heard about it in other States, yes. They'll try to take home remedies first. Here we might have heard a couple of cases, and that's about it. I mean, it's not really overflowing. But some people do rely on home remedies, or "this is what we used to do." But obviously here, the problem is we can't find the necessary herbs, but I do understand that you do have those types of stores here, where you can find that particular type of medication. I don't know what the [Alaska] Native people might do. Do they rely on physicians, or do they rely on their own health [remedies]?

AHPR: I would say the health care they receive is primarily Westernized treatment from physicians and hospitals and so forth. But there is often, particularly I think for the older Natives, there's often a traditional component together with the Western medicine. That's my impression.

Cuevas: Yes, that's possible. You might start here, finish up here, and then somewhere in the middle they'll unite and go together. But, in general, I think that the health system here has been very open and approving to Mexican nationals or Hispanics in that respect. I have not seen many things in the Spanish language for better understanding [by] the patient, but other than that, I think the health system here is [welcoming] to everyone.

AHPR: Well, that's good to hear.

Cuevas: That's my impression. As I said, I stand to be corrected. But usually, those type of comments get to you very fast, and they haven't, so I find that that's probably the case.

AHPR: I would like to ask you, before we terminate the interview, if there are any last statements that you would like the readers of to know, or to hear?

Cuevas: You know, as I said, I find that the welcoming hands of the Alaskans, and Alaskan physicians to the Mexican nationals or Hispanics is there. And that's something to be applauded, and I appreciate that, and so does, I'm sure that, most of the people here.

AHPR: Thank you very much, Consul Cuevas, it's been a pleasure indeed.

Cuevas: Thank you sir.

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