Telling the stories of those seeking health care south of the border

When I came across survey data showing that 10 percent of local adults were driving south to Mexico for health care, I knew a story about why they do so would be the story of health care in the Coachella Valley and, to some extent, in America.

The inland desert region of Southern California where I live is something of a microcosm of the nation. We have three hospitals and myriad more care providers, yet few doctors and dentists serving poor communities. The health care is good if you can afford it and don’t have to sacrifice a day’s pay to make an appointment.

The valley is ethnically and economically diverse, and survey data has shown different groups seek care in Mexico to varying degrees. No one would be surprised to read that one in four Latinos head to Mexico for care; the fact that 6 percent of white adults did as well seemed like an unexplored phenomenon.

I conceived of the project as an effort to look at two sides of the same coin. Why would a white middle-class Californian seek care in Mexico, and how was that any different from a working-class Latino? Obviously, cost is a motivator for everyone. I also knew from past reporting that some people felt it was just easier to see a doctor in Mexico than have to navigate the bureaucracy of the American health care system.

My initial goal was to make at least two trips to Mexico with different patients representing two angles of medical tourism: an older white person traveling south to save money, and a Latino going because of better access and familiarity. The first subject was easy to arrange. A Palm Springs man I already had met had talked about his experience in Facebook. He was happy to have us join him on his next trip.

With that major piece of the reporting sorted out, I was left with two remaining challenges, one concerning people and another concerning numbers.

The language barrier

I don’t speak Spanish, a fact that made my editors somewhat hesitant to send me to Mexico for this project. Despite only speaking English, I had already managed to cover health issues in the Spanish-speaking community thanks to the help of bilingual coworkers and contacts in the field. In many instances, bilingual family members or health care workers are happy to serve as translators when asked.

What I’ve learned is that I shouldn’t let my lack of Spanish stop me from reporting as I normally would. And as is typically the case, I found during this project that face-to-face interactions with people led to the best information.

I initially hoped that some local social service agencies helping poor Latinos with health care would connect me with interview subjects. Despite some efforts, nothing panned out. What did work was going directly to a senior center in Coachella and talking to people as they played cards and Wii bowling. I took a bilingual coworker to translate and we got several good interviews with people who talked about how they and their friends consider going to Mexico to see a doctor or get a tooth fixed a normal practice.

The second thing that worked was putting out an online survey in English and Spanish asking people to weigh in on Mexican health care. The survey seemed to draw more attention than a call-out online or in the newspaper asking people to write or call with their stories. The survey allowed me to ask more specific questions. I wrote the English version and a coworker translated it into Spanish. I also gave the Spanish survey to a local clinic that provided paper copies to patients. Both versions led to sources who were willing to be interviewed, including a young Latino woman who believes seeing a Mexican doctor while she was pregnant saved the life of her child. She completed the survey in Spanish but was comfortable doing an interview with me in English.

I was lucky to have coworkers who were willing and able to lend a hand when I needed it, but the bigger lesson is that a language barrier shouldn’t be seen as an automatic roadblock to getting a story.

The data hunt

An important question I had set out to answer is how the Affordable Care Act had changed this pattern of seeking cross-border health care in Mexico. And for that, I wanted numbers. I found that academics who had published papers on pre-ACA medical tourism had not yet updated their research. In some cases the researchers had moved on to other areas in the intervening years, and so I often got anecdotal observations and theories instead of hard numbers.

I talked with medical tourism trade publications and found there’s little agreement on how big the industry is and no agreed-to authority on estimates. The Department of Health and Human Services, which administers the ACA, told me they weren’t looking into the question. Attempts to contact similar agencies in Mexico led nowhere.

Some online research led me to a short paper by a researcher with the federal Bureau of Economic Analysis, which led me to their annual estimates of how much Americans spent on foreign health care annually, going back more than a decade. It was clear from the steady annual rise that major reforms under the ACA had done nothing to slow the gradual increase in how much money Americans spend on health care in foreign countries. But how much of that care is happening in Mexico, the bureau couldn’t say.

After talking to many experts in government and academia, I felt confident in reporting that no one has a clear understanding of how the ACA has affected medical tourism to Mexico. That’s an important statement to be able to make, and one that I wove into a story about how area Latinos seek care in Mexico.

Both challenges lead to adjustments in my original project plan. Instead of following a second person on trip to Mexico, we combined personal stories plus interviews with pharmacy and health workers on both sides of the border to look at why many Latinos see Mexico as a preferred option for health care. Instead of a story looking exclusively at the impact of the ACA, what little was known about the law’s impact was folded into a story that touched on the role insurance was playing in people’s decisions.

Knowing that I’d explored all avenues for sourcing and research left me confident that my final reports were still an authoritative and informative look at the topic that ignited my journalistic curiosity when I saw those survey numbers more than a year earlier.

Read Barrett Newkirk’s fellowship stories here.