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On talking with people about their personal health

On talking with people about their personal health

Picture of Farida Jhabvala

My fellowship project changed dramatically from what I initially proposed to what I ended up writing about. The general topic remained: the Affordable Care Act law and Latinos. This law promises to make some big changes for this ethnic group, and some of those changes are already happening in California.

The full implementation of key parts of the law, such as that most individuals must have health insurance, aren't scheduled until 2014. And until then, things might change because of the pending decision by the Supreme Court on whether the law can stand as is.

But in any case, most counties in California have started expanding public health insurance coverage to low-income adults ahead of 2014. A presentation by Noam Levey from the L.A. Times during the USC fellowship meeting in November of 2011 was a first inspiration to look deeper into this. Is the program – called Medicaid Expansion - working? How many people are newly insured through this effort? What kind of services are patients looking for?

Last time I checked with the California Department of Health Care Services, all counties in California except for Fresno, were aboard with this program to insure more residents. The federal government promises to reimburse half of the costs of new enrollments until 2014, and then, most of the cost for a couple of years after. Sounds like a good deal. There have been glitches in the counties actually getting the money, but in general, county governments have incurred the extra expenses to cover more residents with the idea that it's a good investment for the health and prosperity of their citizens.

When I found out that Fresno was the only county that had applied, but then withdrawn its application to participate in this program, the question became: why?  The Fresno metropolitan area had the highest poverty rate in the state in 2010, according to the Census.  Many residents could benefit from better access to healthcare. My first radio story in the series explored this question, which then led to the other stories in the series.

With a subject matter abounding in bureaucratic sounding stuff and statistics that threaten to turn a radio listener off faster than you can say "Medicaid Expansion," one of the challenges was to be able to tell the stories of people affected by this. As the stories on this series are in Spanish, and sometimes things can get lost in translation, I was looking for testimonies in Spanish.

Full disclosure here:  my news organization, Radio Bilingue, prides itself on having reporters working within the community they are covering, and in general, that's the goal. Great stories abound in our newsroom about reporters just having to step out of their home onto the street, and turn on their microphone for full coverage of some major and historic event, say the Rodney King L.A. riots.

Alas, that wasn't my case. I wanted to report on Fresno and then subsequently on Kern (a county that did go ahead with this insurance business) but I live in the Bay Area. So a lot of calls and emails preceded my finally heading out to interview sources there.

For one story, help came from someone who said ‘I have a cousin who lost her health insurance, let me see if she'll speak with you.' For another story, it was the county hospital staff that helped me contact patients, something that just didn't happen in other counties I considered writing about.

In all of the cases,  it was interesting that none of the individuals knew enough about the Affordable Care Act to see how it could impact them, or in the case of recently insured patients, how it was benefiting them. It goes to show how little information about this major piece of legislation is actually getting out to Spanish-speaking Latinos, which also points to the need for more stories on this subject.

The weeks-long search for sources turned up two personal testimonies that I featured for this series. One woman had an easy to treat infection that turned into an emergency, life-threatening situation because she lacked health insurance and waited to see a doctor. But being bed-ridden for days and in serious pain was not what she regretted the most. What she regretted the most was not being able to see her elderly mother who became ill at the time, and died.

It sounds obvious in retrospect, but their honesty about their health situation and how their health needs impacted the rest of their lives, made the series more compelling for our listeners. On speaking with interviewees, I wholeheartedly agree with Rachel Dovey's recent post on interviewing seniors here. I also found that asking tough questions is hard, but key. Equally important is meeting face to face with people you want to talk to, and spending enough time with them to really understand the context, details and complexity of their stories.

This might also be obvious for many, more experienced reporters out there, but it's really the personal, this-happened-to-me stories (more than stats or quotes by secondary sources) that stick the most in a listener's brain. These stories can lead to wider impact. A listener called in the other day to say that he had paid attention to one of the stories in this fellowship series. He questioned the decision by authorities in Fresno County to wait out on expanding health access and services among low-income, uninsured residents, and regretted the real consequences for thousands in the county. My first reaction was relief that someone other than my dad listened to the story. But on deeper thought, it feels good to help inform.

This fellowship project led me to new story ideas that I plan to tackle in the coming months, and for that, I'm also grateful. 

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