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The healthcare system in America is a mangled web of bureaucracies that, for incoming immigrants, can be very daunting to approach. The Senegalese, like many other immigrantgroups survive within this crazy system by meeting the challenges as a community, rather than on an individual basis. Organizations such as The African Services Committee and the Senegalese Association clarify legal matters and minimize the confusion that often occurs as a result of trying to understand the United States healthcare approach. These associations also provide social services and housing help, and the African Service Committee in particular has a huge outreach program to educate people about HIV and AIDS. For more information on what this organization does, go to their website.

Legal and Financial Problems

Immigrants, especially those unfamiliar with Western medicine, are often reluctant to seek medical attention when they are ill for a variety of reasons. One prominent reason is their distrust for government programs. According to the New York State law, immigrants who arrived before August 22, 1996 are eligible for Medicaid, while those who arrived after that date are subject to a five-year bar on public health insurance (link). Although all Senegalese would be able to seek emergency treatment, not all of them would be eligible for treatment of chronic conditions. The Medicaid brochure provides a lot of information about eligibility, but that does not help new immigrants because they do not know enough English to understand it.

Older immigrants have formed organizations to help new Senegalese (and other West African) immigrants get the care they need. The aforementioned African Services Committee, for example, provides people to go to hospitals with immigrants that act as guides and translators. This way immigrants can access low-cost healthcare even if they are not familiar with the system.

Cost is a major concern when it comes to healthcare. Private facilities charge large sums that a new immigrant simply can not afford. Even public hospitals now require co-payments for insurance and non-insurance holders that can be between twenty and forty dollars a visit.

Immigrants are fearful of a hospital visit because of the legal documentation required for patients. Medicare and Medicaid are programs funded by the US Government and therefore eligibility depends on a legal immigration status (citizen or legal resident). In fact, this rule applies for all services funded by tax-dollars, such as welfare and food stamps. Major hospitals, although they require documentation for treatment, are not allowed to refuse treatment to the seriously ill. These hospitals are also prohibited from reporting undocumented immigrants to the Immigration and Naturalization Services Bureau.

Cultural Barriers

Medical Wellness Center

Another reason immigrants may resist American healthcare is because of a distrust of Western medicine. Western medicine has a long history of being to long-held practices of people from other parts of the world. Coupled with a language barrier, an immigrant can sometimes feel trapped by a doctor or pressured to take medicine he is suspicious of. Because immigrants tend to group together through country of origin, language, dialect etc., hospitals need to respond to the communities they serve. A New York Times article dating back to 1994 talks about internist Dr. Francesca Gany, at Bellevue Hospital who, though being unfamiliar with Senegalese culture, began to learn more about the community at 116th Street.

Healthcare in Senegal

The final difficulty for these West African immigrants may be unfamiliarity with the healthcare system in America. In the U.S., traditional healers are an important part of health care. In many villages, the healers provide as much if not more medical assistance to the ill. Healers practice indigenous medicine which combines science and Divination. They are usually trained by other healers, often family members.

In Senegal, the state does not have the money to cover everyone, so many private providers have emerged (link). Churches, for example, provide care for relatively low fees, and people create community insurance where everyone contributes money to a general pool, and when one person is sick, he can dip into that fund to receive treatment. This behavior is indicative of the way networks operate within Little Senegal. If someone cannot produce documentation to be treated at a public facility, members of the community will pool funds in order to pay for private care. (For more information about the importance of networks in immigrant communities, specifically the Sengalese, see Money Has No Smell, by Paul Stoller.)