The Hennepin County Medical Center has been the hospital of choice for the huge immigrant population of Minneapolis and on Saturday, in an article entitled ‘Foreign Ways and War Scars Test Hospital,’ the New York Times told us all about the good, the bad and the ugly of treating patients there. Please read the whole article, often couched in touchy-feely terms, to see what medical professionals are up against.
Many arrive with health problems seldom seen in this country — vitamin deficiencies, intestinal parasites and infectious diseases like tuberculosis, for instance — and unusually high levels of emotional trauma and stress. Over time, as they pick up Western habits, some develop Western ailments, too, like obesity, diabetes and heart disease, and yet they often question the unfamiliar lifelong treatments these chronic diseases need.
Some also resist conventional medical wisdom or practices, forcing change on the hospital. The objections of Somali women to having babies delivered by male doctors has led Hennepin, gradually, to develop an obstetrical staff made up almost entirely of women.
Doctors here say that for many of these newcomers, the most common health problems, and the hardest to treat, lie at the blurry line between body and mind, where emotional scars from troubled pasts may surface as physical illness, pain and depression.
The article goes on to tell readers about the mental and cultural problems the staff must cope with in a hospital that spends $3 million a year on interpreters alone.
The Times reporter works so hard to tell us that the negative aspects are balanced by rewards, but as you wade through to the end, even the good natured Dr. Pryce has his limits.
The Personal Care Assistant racket
Calling the Somalis entrepreneurial, the reader has to go over this a couple of times to grasp how the Somalis have figured out how to game the system.
Somali patients have been asking them to fill out forms stating that they need personal-care assistants. Some do not need the help, Dr. Pryce said, but are being egged on by Somali-run health care agencies that want to collect insurance payments for the services.
Somalis in Minneapolis, often entrepreneurial and business minded, have opened the agencies to take advantage of relatively generous rules in Minnesota that were originally meant to help keep the elderly and chronically ill out of nursing homes.
Tricia Alvarado, director of home care for the Minnesota Visiting Nurse Agency, which evaluates requests for home help, agreed that there had been an explosion of Somali agencies, with 100 or so opening in just the last three years. Many are run by people without any medical training. And Ms. Alvarado confirmed that the agencies were putting a hard sell on potential clients.
” ‘Diabetes?’ ” Dr. Pryce said, relaying what he said was a typical conversation between a sick Somali and a Somali-run agency. ” ‘You need a personal-care assistant. Here’s a form. Give it to your doctor.’ “
Dr. Pryce turns down requests that he thinks are unwarranted, but patients argue and sometimes even act sicker than they really are.
The whole thing leaves him “hopping mad,” Dr. Pryce said. “I want to be a good steward of our resources, the tax money we’re all paying.”
The State of Minnesota is looking into the fraud.
The current situation with the Somalis is part of a larger problem in Minnesota: the number of clients, and the costs of personal care, more than doubled from 2002 to 2008, and the number of agencies more than tripled. A report in January by the state legislative auditor said, “Personal care services remain unacceptably vulnerable to fraud and abuse”; the state is drawing up plans to tighten its control of the services.
“I love the Somali people and their culture,” Dr. Pryce said. “I like taking care of them. It’s rewarding and interesting. They don’t drink, they don’t smoke much, they’re living the American dream, they need our help. Then you have this other side that’s really painful, this contentious issue of who gets what.”
Endnote: I wonder what Dr. Pryce thought of the Somalis when shooting victims were brought to Hennepin over the weekend, victims of Somali men shooting up a trailer because they were not invited to the party.
For new readers: Here is a post I did in September of last year which shows how many Somali refugees we have taken in the past 25 years or so. For some reason it is getting lots of readers lately so it reminded me to post it more frequently.
While I’m at it, here is another old post about how the State Department has had to shut down family reunification because of fraud in the Africa refugee program.