1 &0&Z. FIELD NOTES - MARIA CUBILLOS (compiled April 3, 2011) Interviewee: MARIA CUBILLOS Interviewer: Makani Dollinger Interview Date: Sunday, April 3, 2011 Location: Coffee shop, Garner, NC THE INTERVIEWEE. Maria Cubillos has been living in the United States for twenty-six years. She first lived in Miami, FL where she and her family migrated from her home country of Columbia. After eleven years, she, her husband, and her daughter moved to Greenville, NC. After three years, they moved to Clayton, NC where she currently resides. Maria currently works as an endodontic assistant in an office in Raleigh. Although she obtained little dental assisting experience in Columbia, however, she was able to find a job working as a general dentist's assistant in Miami. Upon her move to North Carolina, she first worked for three years as an assistant in a dental clinic for jailed persons. Through her experiences as an assistant in the dental fields, she had much light to shed on access to dental care for Latin American immigrants living in the United States. THE INTERVIEWER. Makani Dollinger is an undergraduate student studying chemistry and Spanish at UNC-Chapel Hill. As a student in Dr. Hannah Gill's international studies course Latin American Migrant Perspectives: Ethnography and Action, she is interested in researching the differences in access to medical and dental care for Latin American migrants living in Chapel Hill. In March of 2011, she traveled to Guanajuato, Mexico where she investigated access to medical and dental healthcare in extreme rural conditions, conditions many immigrants claim as those in which they lived in their home countries. With the knowledge she gained from this course and this trip to Guanajuato, she is well qualified to interview Latin American migrants currently living in or near Chapel Hill and to get the most out of her discussions with them and her classmates. DESCRIPTION OF THE INTERVIEW. The interview was conducted outside of a coffee shop at a small table. It was located near a highway and there was an occasional noise interruption from louder vehicles, as well as conversation from other individuals. Although Maria maintains a busy schedule during the week she was very relaxed and unhurried. Maria and I had never met before this interview, and I was glad she was so comfortable to share her experiences with me. Maria was warm and pleasant, and seemed to enjoy discussing the topic of interest, as well as providing some background information about her life. I did not feel any hesitation in her answers to my questions despite the fact that no restrictions were placed on access to the interview.
2 CONTENT OF THE INTERVIEW. The interview was organized around the major theme of medical and dental care access in the United States compared to Maria's home country of Columbia. Every effort was made to investigate reasons as to why or why not Latin American migrants were utilizing access to healthcare in the United States. Themes explored include who is taking advantage of healthcare, who can afford it, and who is knowledgeable of its accessibility. NOTE ON RECORDING. I used the Apple ipod Touch Voice Memo application. The quality is good.
3 fvtyz TRANSCRIPT - MARIA CUBILLOS (Compiled April 4, 2011) Interviewee: MARIA CUBILLOS Interviewer: Makani Dollinger Interview Date: April 4, 2011 Location: Garner, NC Length: 25 minutes 53 seconds START OF RECORDING 1 Makani Dollinger: My name is Makani Dollinger and I am interviewing Maria Cubillos in Garner, NC. It is April 3rd, :10pm and we are outside of a coffee shop. Ok, Maria. Where are you from? Maria Cubillos: I am from Columbia, South America. MD: And how long have you been living in North Carolina? MC: In North Carolina for about fifteen years now. MD: And did you come from Columbia to North Carolina? MC: No, no. We emigrated from Columbia to Miami, Florida. Stayed there for eleven years, and then we moved up here. MD: And we is your family? MC: My husband, my daughter, and myself. MD: From Miami, did you move to your current residence now? MC: No, we, we actually moved to Greenville, which is east of, you know, ECU. East of here. And then we lived there for about three, four years, and then we moved to where we are now, which is Clayton MD: Ok. Tell me about where you have worked and where you're working now.
4 Makani Dollinger 2 MC: I worked on, in a dental field in Miami for a couple of dentists. General dentists. Dr. G and Dr. A and then I worked for, in Greenville I worked an endodontist, which is the people that do root canals. For Dr. M. Then I moved here and I worked for the state, for the department of oral surgery that works for inmates that only do~i worked at a prison, a central prison, and they had a hospital. I worked for the state for about three years, and then I met my current boss. He took me out of prison. (Laughter). Yeah I worked there for, you know, I worked there with the endo students. When you go to endo, as an endodontist, you have to practice in North Carolina three years and, and people actually do root canals. So they have this clinic at the CP, and every inmate that needs a root canal has to come here. So I worked with them. MD: And that made you qualified to work with the endodontist? MC: Well, yes. And in also what I did in Greenville I learned, and I learned more often here than I used to be for because I never really did. General dentists here they mostly don't do root canals. So that's what helped me learn a little bit, and then in here I learned oral surgery and endodontics when I worked with the CP. MD: Did you have any experience as an assistant or hygienist in Columbia or only Miami? MC: Actually only in Miami because in Columbia when I just got married one of my good friends was a dentist, she was a dentist, and I worked with her like before I got pregnant with Laura for a little bit, and she taught me a little bit of what I. Back then, you know, this is at the beginning of the 80s so back then we didn't even use gloves. You know, so, so it's a long time ago.
5 Makani Dollinger 3 MD: And your dentist in Miami allowed you to work there with the experience that you had? MC: Yes, yes. They did, and then they sent me to school too. Yeah. MD: Oh. MC: I had to go to school and get certified, you know, to do things in the office and get x-ray certification and all that you have to go to school so. MD: Did they compensate you for that? MC: They did, they paid for my classes, yes. MD: Wow. MC: Yes. And the reason why is I used to babysit for Dr. A.'s children you know. He, so nobody wanted to work on Saturdays, he used to work on Saturdays, and nobody wanted to assist him on Saturdays, so, and he needed somebody that would be bilingual too. So he asked me if I would help him and they would teach me a lot of it. And I said, "Well, I'll try." And that's how basically got into this field, you know. MD: Did you, by the time that you moved to Miami were you fluent in English? MC: No, no. No because see in Columbia from the point I start elementary school they teach you English, but the English when you come here is like, it's another language so what I had to do is I had to come to Miami and I work mostly with English-speaking people and then I had to go to school at nights, you know. MD: Were the classes taught in English? MC: The classes were taught in English, but it was a different levels of people. Like, I had people that were grandparents and me and then other. Also, the education that we all had was different, so sometimes I knew more than the teacher for some things, you
6 Makani Dollinger 4 know. But then they, they taught me how to pronounce things and read the English. Because, you know, it's difficult. English is a difficult language compared to Spanish. MD: Have you personally, away from work, had any health experiences in a hospital or dentist office? Any medical issues or, tell me about your access to healthcare and how you perceive that in the United States. Whether it's in a hospital or in a dentist office or in an emergency room. MC: Like in what sense? Like MD: Just any experiences that you've had. Maybe problems that you've run into from the doctors not speaking Spanish MC: I see. MD: Or not being able to access that from where you were living. MC: Right, right. Well personally, I see it many times, you know. Like when the doctors don't speak the, the language of the patient is very difficult because you can't communicate well. So, I, what I had, like when I was working at CP, which it was a hospital, it was for inmates, but it was a hospital, I many times had to go to translate at the, the psychiatric area, which is very interesting to me to translate for somebody that is being interviewed by a psychologist, for example. I mean, can you imagine? Because I can't transmit, I can transmit words but not feelings, you know. So that was, you would think that they would have at this time and age somebody that would a doctor bilingual, right? When it comes to that. And also in the clinic where I was working, I had to translate sometimes for some inmates that were Spanish-speaking, but it was, you know it's easy for me to do that part more than to translate for psychologists.
7 Makani Dollinger 5 But, like where I am right now one of the doctors is pretty much fluent in Spanish. The other one is not, but one of the things he has done is he's done and I appreciate on him is that he would probably mimic things for you if he has to, you know. So, he may not be able to speak the language, but he wanted to make the patient comfortable, and he would do any kind of mimic. So that to me it's, it's meaningful in the sense that he, you know, he doesn't like when people don't understand him, but he tries, you know. But, some people, I don't think they care, you know. Some doctors that I know of, they don't care, you know, if the patient understands or not. So that's not, to me that's not healthcare, you know. MD: Do you think that the doctors that do come off like that, that they don't care about that patient population coming into their office, that they're not advertising to them at all? MC: I think they don't think they need them as patients, you know. So, it boils down to whether if they are in like a public healthcare its like an assembly line, you know. I hate to use that word but...but if they are in a private practice then I've seen doctors that either look for assistants that are bilingual, or they learn some words or they have something that the patient...or they tell the patient please bring somebody (motorcycle) Or they tell the patient 'Please bring somebody that can translates for you,' you know. Because ultimately but, you know, this is an English-speaking country, you know. I, I think I understand that, but like in North Carolina because we have so much Spanishspeaking people, if you are in private practice, and if you wanted to accommodate that population, you need to have somebody in the office or, or at least somebody that they can call and say 'Can you translate this for the patient?' you know.
8 Makani Dollinger 6 MD: Do you see new doctors and new dentists emerging in North Carolina that are reaching towards being bilingual and reaching towards that patient population or have you seen--? MC: I, I haven't seen that no. I see like, I see like in Raleigh I know a few doctors that are Spanish, a couple of dentists that I know that are good and they're Spanish. But, I haven't seen like new students trying to... like, like one of my bosses he's trying to learn Spanish and he's, he, he even, last year he was taking private lessons, you know. Going through the trouble to do that, it means that the person cares for the population. And, hey, it's in his interest, you know. I mean, he's going to be known as a bilingual and sometimes they call our office and they ask us if we're bilingual and I said, "Yeah." You know, even if you great the person in their language, even if you do that, that means a lot for them. MD: Does your dentist that you work for now want that patient population or is it that that patient population wants him? So I guess what I'm asking is do you think that dental care or endodontics is becoming more accessible to native Spanish-speakers because they can either afford it? MC: Right. MD: Or do you think it is your dentist and other dentists reaching out to these people? MC: I, I think it's both ways. And one thing is that you see sometimes, you know, Spanish people they may have gold earrings and gold chains and...and they don't want to save their teeth, you know. Some do that. So they do have the money to pay for a treatment, and so some of them want to do that, some of the Spanish people want to do
9 Makani Dollinger 7 that. And some of the doctors want to reach out to them. So, I'm thinking that it's both ways in that sense. Because obviously, if you had, if you're, if you're learning the language it's because you want to attract that people too, and you want to help them, you know. So... MD: And, from what you can remember from your experience in Columbia, what were, what was access to dental care like there compared to MC: It, it's very, it's very good actually. And it's very reasonable to compared to here, you know. Lets, if I wanted to say prices, you know, I just want to say, well what I know about root canals, you can pay for a $100 root canal down there, and how much is a root canal here, you know? So it is very...1 mean you can have access to a lot of dental care there, if you want to have good dental care. MD: Do you see a lot of your friends or family members at home, did they reach out to that access or...? MC: Some, yeah. My family does because we, we were taught that way. Some others don't (laughter). Because they're not, you know, like, I have a cousin, she's a dentist, and she says some people want to come here and then get their teeth out when I can save the teeth, but they don't want to spend the money on that, you know. So, there's still that level of education that people don't, some of them don't understand that you need to save. But most of the Columbians, most of them, they do want to save their teeth this time and age, you know. So... MD: Is that because they haven't had dental hygiene education or is it that their families don't?
10 Makani Dollinger 8 MC: They didn't have it years ago, but now its different, you know. Now you know that sugar is bad for your teeth and all this stuff You know now people wanted to, well, they're better educated now and then they're more dentists spread out, you know. Like when my parents grew up, which it was not like that, so... MD: So the education is definitely MC: It's much better. Definitely, yeah, yeah. MD: And what about the access? Is it still the same as far as cost? It's much less still? MC: Yeah, I mean it's definitely...you mean compared to here? MD: Compared to here. MC: Oh yes, definitely. Yeah, it's much, much less, yeah. MD: Would that prevent immigrants from Columbia, for example, who saw that easy access in Columbia and could get a root canal done for $100? Would they avoid doing that here? MC: A lot do, yes. I mean I have had patients at the office that are, you know that I, they come and say, you know, I say, "You need a root canal to save this tooth," and they'll say, "Oh, can I have a prescription so I can buy me time to go home and get it done?" And this is what I said, I said, "Okay, it's fine, you know, you can have prescription and you may become, you may get in a lot of pain in the meantime, and not have time to go back. Or, you cannot find a good dentist down there that do it well. And then you come back in here, and then a year later you're going to have a problem, and who's going to fix it? You're going to have to come back to us and it's going to cost you
11 Makani Bollinger 9 more." So that's what I said, you know. Everybody has a choice, they have to make their own, you know. But sometimes you can also have bad quality and there is good dentists and there is bad dentists too, you know. You have to be careful who you choose. MD: Is that because of the various routes of education that they take to be dentists? MC: That is correct. Also products, you know. We do definitely have money to buy very good products here, and then the, the quality of the products that you buy there maybe not, they may be not as good as it is here. In that place it would be ( ). When you have cosmetic work and things of that nature, too. MD: Do you, or you dentist, or anybody that you know in the dental fieldwork in any of the free clinics that they offer? MC: We do actually. We work, this is how, actually this coming weeks I have a patient from Wake Smiles. And one of my dentists, my doctors goes to dental society meetings so that's how they get, you know, their names out, and then they call us and they ask can you do a root canal for this and that person and we actually have a patient in a couple of weeks coming that is Spanish. So, yes we do, that's how we do it. But, also they do a lot of, sometimes I know people. Like in my congregation that cannot literally afford root canals and they've done it not once, but many times, like that. But I know that they can't afford it. So they're very nice about people like that so... MD: Tell me more about the...wake for Smiles? MC: Wake Smiles.
12 Makani Bollinger 10 MD: Wake Smiles. Is that directed towards patients that can't afford different procedures? MC: Yeah, and it, I think what they do is they look because they go to the dental society meetings and they find different specialists, you know. Let's say you need a crown and a root canal. So we do the root canal and then Dr. B does the crown or whatever, and they call those doctors and set them up with the patients. That's how they do it. Which I think is really good. MD: Yes. MC: You know, because like when the patient I work on is missing a front tooth, imagine if you're of ( ) and missing a front tooth and if you're a woman, that's terrible, you know. So that's what we have. And, yeah I think it's great. So that's how it works. I think the patient has to go to the Wake Smiles and qualify for that. MD: Do you see a lot of Hispanic patients and Spanish-speaking patients reaching out to that program? MC: Yes, a lot. MD: Do you have any idea how they become knowledgeable of the program? MC: It could be I, it would, I'm not sure. So I don't know if I should answer the question or not, but I think it has to be when they go to their clinics, like when the go to WakeMed clinic and they don't have any obviously insurance so that's how they've been told go to this place and, you know, see if you can qualify. MD: I have volunteered as a dental assistant in various free clinics that we offer. One of them is the Dental SHAC in Carrboro, and it's put on by the dental students, UNC
13 Makani Bollinger 11 Dental students, and I work there as an assistant, and a huge percentage of our patient population is Spanish-speaking. MC: Spanish, yeah. MD: And often times they run into the language barrier between doctor and patient, and on nights when I'm there it's really helpful because they don't have that bilingual aspect with the dentist. And those patients that come in don't...it's not that they don't care about they interaction, it's just that they want, they think that the dentist knows best so they'll let them whatever. MC: Whatever, uh-huh. MD: Do you ever get that attitude? MC: Not, no, not many times. You know, because where I, where I, what I'm doing right now, it's very expensive, so they definitely want to inquire, like is this going to last, is it worth it, what are my options. So, and we definitely wouldn't want to do anything on a patient unless they're aware of what's going on. So, mostly of the ones that we have, they wanted to know, you know, what are they're options, and what is done, and what else do they need after that. MD: And, I've also experienced that these patients were not ever knowledgeable of different diseases and how to prevent different diseases. In one of the motives I've made towards that is a pamphlet written in Spanish of, you know for example, Baby- Bottle Syndrome that mothers with newborns don't know now to put their child MC: To sleep. MD: To sleep with the bottles and I see that reoccurring over and over.
14 Makani Dollinger 12 MC: Sometimes I think that the population that we have in Raleigh, in North Carolina, and sometimes the population that immigrates here from, from border countries, not that I, because I have friends from Mexico myself that are well, well educated and very, very, you know, smart, and it's some of the immigrants that come here come from like village or little towns and they don't get to, they don't, sometimes they don't even know how to read. So that's a lot of the population that we have here. Not all. And by no means I don't mean that they are not smart or anything they just didn't have that chance to get educated. So sometimes they just, you're right, they don't know many things that are, and sometimes obvious, you know. MD: Do you have any friends that are, that have taken advantage of either going to the UNC Dental School for dental work or the free clinics? MC: Yes, I have, yes. I have, actually, I sent a friend of mine there a couple of weeks ago to get an extraction done at UNC because she's new here and she doesn't have any insurance and she's a diabetic and she needed an extraction. We can't do that for her so she, she went to the, the UNC clinic and they did it there. MD: Have any of them shared their experiences with you? MC: She did (laughter). Did you want to hear it? (Laughter) MD: Yes, please. MC: Well, she said that they were the first time that she went she was actually scared because she, her blood, her blood level was like in 300 or MD: Blood pressure? MC: Not her blood pressure, the sugar. MD: Oh.
15 Makani Dollinger 13 MC: She thought it was too high for her to have an extraction. Because she kind of, I mean, you know, she's knowledgeable of that. So she told the student and then the student says, "Oh no, it's not a problem." And she goes, "Please make sure!" So the student asked the doctor in charge and then he didn't do the extraction that day because of the sugar level was too high. So then, of course, they send her home, make sure that goes down and then come back. Then she goes back, they do the extraction, but I think the doctor in charge, the student had a lot of struggle doing it so they, he had to call the doctor again and get it out. Yeah. MD: Was the doctor, the student, bilingual? MC: That's a, I don't know, I don't know. But the first one, I know it was. And the second one I don't know. She doesn't speak English. So, I didn't ask her that. But the first doctor that saw her, and then the second one...she said they were all very, very nice to her, but she knew that he was having a hard time taking out that little piece of tooth out. So, no I don't know if he was bilingual or not to be honest with you. I didn't ask her. MD: Has she, was she pleased with the rest of the services? MC: She was, yeah, she was, yeah. She was happy that, you know, that it was done. She said that it was a lot soreness after that. But she was happy that it was done. And she actually wanted to get involved so they can do like a treatment plan for her because she needs on the weekend ( ). MD: Does that happen often where you'll get patients in your office and then refer them other places? MC: We refer them when they can't afford it. Sometimes we send them to UNC clinic. Yeah, we do it often. Actually I these last weeks we have done once every week.
16 Makani Dollinger 14 We have a patient from Brazil because there is a student from Brazil that is doing the endograd program and my doctors knows him and we send him to him. MD: Well that's interesting that they are taking advantage of the access to you, and then going from you. MC: And we did this lady from Brazil, we had already done a root canal on her, and then my boss had given her a little discount, but she's going to need another one. And she says she cannot afford it. So that's why we sent her to the UNC clinic. And then because of he knows that doctor there is Brazilian so its just, you know, we think it's perfect for her. And that way she can get treated and it's, it's not as expensive as coming, it's a lot less than coming to us. MD: So from what we've talked about it sounds like Spanish-speaking patients are becoming more and more knowledgeable of access to dental care that is provided in North Carolina and you're seeing...over the years can you say from your experience that you've seen a greater amount of that population accessing your services? MC: Oh yes. Definitely, yeah. MD: Well I don't have any more questions. Did you want to add anything else? MC: No, it's okay I mean MD: Okay. END OF INTERVIEW END OF RECORDING 1 Transcriber: Makani Dollinger April 4, 2011