In Central Oregon, Latinos struggle with health care access

For many immigrant families, health care is just out of reach

By Tara Bannow (@tarabannow) and Ryan Brennecke

Published May 12, 2014 at 12:11AM

Latino populations in Deschutes, Crook and Jefferson counties

Deschutes County: 7.6 percent

• Bend: 8.2 percent; Redmond: 12.5 percent

Crook County: 7.5 percent • Prineville: 10.1 percent

Jefferson County: 19.8 percent • Madras: 38.5 percent

Oregon overall: About 12 percent

Source: 2010 Census data

Health insurance status

Among Central Oregon Latinos served by the Latino Community Association:

82 percent are uninsured; 18 percent are insured.

Clients served by the Latino Community Association in 2013

Total people served: 1,634 (1,411 adults, 223 children)

Total services provided: 2,933

36 percent make between $10,000 and $20,000 annually. 19 percent make less than $10,000 annually. 22 percent do not work. Less than 2 percent make more than $40,000 annually .

76 percent lived in Deschutes County.

20 percent lived in Jefferson County.

2 percent lived in Crook County.

2 percent lived elsewhere.

90 percent were born outside of the U.S.

10 percent were born in the U.S.

Source: Latino Community Association survey

In the Hidalgo household, the chairs surrounding the kitchen table are covered in plastic in case of spills. Nearby, a wooden cabinet displays the fine china used on special occasions. Fruit sits in wire baskets. Next door in the living room, the walls of this modest ranch home in Redmond are covered with the faces of loved ones come and gone.

It’s a happy household. Alive with the giggles of 2-year-olds and the wide smiles of their parents. But even though they’re surrounded by the comforts of family, Ignacia and Rogelio Hidalgo can’t shake a pervasive fear that lingers beneath the surface of their outward security.

The couple, who moved to the U.S. in 1992 from Guanajuato, Mexico, seeking treatment for their son with autism, are undocumented immigrants. It’s a highly politicized term that creates an invisible divide between the Hidalgos and their neighbors and places them in the company of an estimated 6.1 million other undocumented immigrants in the U.S. from Mexico who, for the most part, can’t get driver’s licenses, home loans, food stamps or unemployment assistance.

Although recent data from the Pew Hispanic Center shows immigration into the U.S. from Mexico is at a standstill, Mexicans still represent the largest group of immigrants in the U.S., at 12 million of the country’s current 40 million.

Undocumented immigrants also can’t participate in the sweeping set of federal reforms designed to improve the nation’s health care system. Undocumented immigrants are prohibited from buying insurance through the federal and state health insurance exchanges, including Oregon’s state-run exchange, Cover Oregon.

In the coming years, undocumented immigrants will comprise the largest group of uninsured in the U.S. By 2024, 9.3 million of the estimated 31 million uninsured nonelderly adults in the U.S. will be undocumented immigrants, according to an estimate by the Congressional Budget Office.

A lack of access to health insurance is just one among a long list of obstacles that keeps members of the undocumented Latino community from seeing doctors and getting the care they need when health issues arise. That contributes to higher rates of diabetes, obesity and cardiovascular disease in the Latino community compared with other populations.

An obvious barrier — the first one most people tend to think of — is language.

But that’s a small obstacle compared with bigger things, like cultural barriers, said Laura Pennavaria, the medical director for Mosaic Medical’s Bend Clinic. When she moved to Central Oregon from Southern California nearly two years ago, Pennavaria said, the homogeneous population and comparatively small Latino population was a major culture shock.

“Culture is the very essence of who we are,” she said, “and if you don’t have a lot of exposure to someone else’s culture, you may not recognize the subtle things that come with that culture. I think that’s a big barrier for Latino patients.”

For Ignacia and Rogelio Hidalgo, whose household includes their three children and one grandchild, their undocumented status comes with a whole lot of worry.

“You’re always thinking, ‘If this happens, what would I do?” said Ignacia, 48. “It’s something that I think we have to live with every day — just thinking, ‘We just can’t get sick.’”

The Hidalgo family, from left, Ignacia, 48, Guadalupe, 2, Rogerlio, 50, Jose, 2, and Antonia, 23, play together in their living room.

Ryan Brennecke / The Bulletin

Not getting sick was the goal, but it’s proved far from reality. Three years after the couple moved themselves and their two young children to the U.S., their then-4-year-old daughter, Antonia, was diagnosed with leukemia and underwent three grueling years of being driven back and forth to Portland for treatment.

Then just last year, 50-year-old Rogelio was diagnosed with Type 1 diabetes, which he’s managing it on his own.

And as careful as she had learned to be, Ignacia moved an 8-foot ladder last spring without noticing the drill on the top rung. It fell square on the top of her head. She went to sleep, hoping it would heal on its own. The next morning, a terrible headache forced her to see a doctor, who told her she was fine and sent her home. The next day, the pain forced her to return, and X-rays revealed internal bleeding.

Sitting at her kitchen table on a recent evening, Ignacia, a slight woman with her dark hair tightly pulled back, recalled months of not being able to work because of the headaches, which persist today.

Food or insurance?

In many cases, the barriers to insurance extend even to those who are in the U.S. legally.

Children of undocumented immigrants who were born after their parents arrived in the country are citizens and thus legally eligible to benefit from state-funded programs, such as the Oregon Health Plan, but many of them don’t.

That’s partly cultural. Many within the Latino community are private and averse to the idea of seeking help from publicly funded programs, said Alberto Moreno, executive director of the Oregon Latino Health Coalition.

But there’s a bigger issue, too. Determining a child’s eligibility for such assistance requires a significant amount of information from the parents — incomes, proof of residency — just enough to make some people too nervous to go through with it out of concern that their information could be passed along to U.S. Citizenship and Immigration Services and ultimately get them deported.

“They’re afraid of placing their entire families at risk by seeking out services for those children, even when those children qualify,” Moreno said.

That’s proved to be a hindrance to getting Latinos signed up for health insurance under the Affordable Care Act. In addition to U.S. citizens, anyone with legal residency is allowed to purchase insurance from the state and federal exchanges.

Officials with Cover Oregon declined to provide the number of Latinos who have enrolled in plans, but misconceptions have been rampant across the country that undocumented individuals who try to enroll their children will be deported.

President Barack Obama spoke on the topic at a March event promoting Latino enrollment in health insurance that was broadcast on Spanish-speaking media outlets such as Telemundo and Univision. He promised that information provided for the purpose of signing up for health insurance will not be given to immigration officials.

A host presented Obama with the scenario of an undocumented mother who was afraid signing up her children for insurance would put her at risk in a country that sees more than 1,000 deportations per day.

“Of course I understand the fear,” Obama said.

For others, the focus is much more immediate than health insurance. In a lot of immigrant households, the focus is simply on getting by. The estimated 160,000 migrant farm workers in Oregon have annual salaries of less than $10,000, Moreno said. He estimates an average of $7,200 of that is spent on rent, leaving about $2,800 for food, clothing and school supplies for the kids.

“Many of these families are then faced with a real and painful decision of whether or not to put food on their children’s table or purchase a health insurance policy that they may or may never need,” Moreno said.

It’s a phenomenon that the Latino Community Association — an organization with offices in Bend, Redmond and Madras that helps connect Latinos with legal, educational, health and other services — is intimately familiar with. For its clients, 90 percent of whom are immigrants and 82 percent of whom are uninsured, health insurance is a luxury that’s simply not on their radar.

“The focus becomes very much just money, money, money — economic,” said Brad Porterfield, the LCA’s executive director. “The focus as an organization is just on helping people survive and get by.”

Out of the woodwork

Aches and bumps go unchecked. Coughs persist. Until, months or years later, they become something far more serious.

In one case, Pennavaria said she recently saw a Latino patient on the first day his insurance kicked in. She admitted him straight to the hospital with a serious respiratory infection — a side effect of not having seen a doctor for quite some time.

“It’s been impressive,” she said. “People are coming out of the woodwork.”

Castillo, a 48-year-old Bend resident who asked to be referred to only by one of his two last names because he is undocumented, had a similar experience about three years ago with his wife, who is also undocumented.

One day Castillo, who spoke with a reporter through an interpreter, said he rushed her to the emergency room because of severe pain in her head and neck. Her blood pressure had gotten so high, it sent her into a one-day coma.

Castillo, who moved to the U.S. from Mexico in 1989, also struggles with high blood pressure and high cholesterol, which he maintains with help from providers at Volunteers in Medicine in Bend, a clinic that provides services to uninsured Central Oregonians regardless of their ability to pay.

Castillo first learned about VIM when a friend gave him a pamphlet. The clinic provides more than medical care — they’ve helped him sort through medical bills and connected him with programs to help pay them.

That help was especially important four years ago when his stepson got in a car accident that required four ambulance rides, transports to three hospitals and an airlift to Portland. He died from his injuries.

Castillo, who works as a cook, said the naturalization process is extremely complicated, but he’s just months away from the finish line. Like most people he knows, he’s had to hire a lawyer to help navigate the paperwork at a price tag of $5,000.

Patients like Castillo, once they become citizens and obtain insurance, no longer will be able to go to VIM for care, as the clinic only serves uninsured patients.

VIM’s executive director, Katherine Mastrangelo, expects undocumented immigrants will comprise a much larger proportion of the clinic’s patient population after the implementation of the Affordable Care Act, although — as with most medical providers — immigration status is not a question they ask.

VIM has been aggressive in getting eligible patients insured under the ACA, even requiring that everyone go through the eligibility determination process.

Since many of the patients are low-income, they gained coverage under OHP — and almost immediately began making appointments with Mosaic Medical, a provider with clinics in Bend, Redmond, Madras and Prineville that accepts Medicaid recipients and offers services on a sliding fee scale. Leaders at Mosaic expected an uptick, but the number of new OHP patients who called the clinic in January exceeded their predictions for the entire year.

“It felt like a tsunami,” Pennavaria said. “It would be patient after patient, VIM transfer, VIM transfer, VIM transfer because they suddenly have insurance.”

Castillo has been trying to get appointments outside of VIM but said other clinics are too busy to get him in. In response, VIM has decided to allow patients to keep coming even if they have insurance until they can see a different provider, said Jennie Davis, VIM’s referral coordinator and interpreter.

“Once you’re in, it’s a little bit easier,” she said, “but your first appointment can be months out just because the clinics are super jammed.”

Getting mom to the doctor

For years, Carmelo Felix and his family have focused nearly all of their attention on his younger sister’s battle with cancer.

When she passed away last October at age 16, Felix’s mother, Leodegaria Cervantes, a native of Mexico who has residency in the U.S. but is not a citizen, took it the hardest of all. A diabetic, she stopped taking care of herself and wasn’t eating much for a while. Cervantes has long gone without the health insurance that used to pay for her blood glucose test kits.

“I keep telling her to go get checked out,” said Felix, 24, who lives in Culver, “to go get a checkup to make sure everything’s OK.”

The recently released findings of the largest study to date on health disparities among Latinos in the U.S. found that half of the participants ages 65 to 74 had diabetes, with rates decreasing with age.

Among the men and women with diabetes, half had their condition under control.

The National Institutes of Health’s three-year study into Latino health disparities included more than 16,000 people living in four major U.S. cities. Participants were between 18 and 74 years old and self-identified as being of Central American, Cuban, Dominican, Mexican, Puerto Rican and South American background.

Of those studied, 80 percent of men and 71 percent of women had at least one risk factor for cardiovascular disease, such as high cholesterol, high blood pressure, obesity, diabetes or smoking. Obesity was high among all groups, but was highest — 48 percent — among women ages 45 to 74.

Latino immigrants actually tend to be young and healthy when they move to the U.S.; it’s only once they’ve been in the country for several years that their eating habits and lifestyles tend to become increasingly unhealthy, said Mary de Leon Siantz, a nursing professor at the University of California, Davis.

Part of that stems from the belief that to become more American, they need to eat fast food and processed food, she said.

“They really think, especially the kids, that by eating pizza they’re going to be just like everybody else,” she said.

Oral health is another major area of disparity that tends to be overlooked, said Kristi Hammerquist, VIM’s dental coordinator. Although free or low-cost dental services exist for uninsured children — often such services are provided in schools — programs like that don’t exist for adults.

“They’re ignored,” she said.

Among the Latino population, it’s not so much cavities Hammerquist sees causing health problems — it’s gum disease.

“They don’t know why their gums are bleeding or they don’t know why their teeth hurt,” she said, “There’s not a cavity there. It’s just the periodontal (gum) disease, and they do go to the ER for that.”

Emergency physicians tend to simply send such patients home with antibiotics, which actually don’t help in cases of gum disease, Hammerquist said.

Infections in the mouth can cause blood sugar spikes, which can be dangerous for diabetics, she said. One way or another, dental problems tend to spill over to the rest of the body, Hammerquist said.

“Because they can’t see that periodontal disease, they let it go and then pretty soon they’re losing teeth,” she said. “And pretty soon their chewing ability is not there, so they’re not eating properly.”

Latino immigrants also face a higher risk of accidental injuries than the general population given the large proportion that end up working in fields, on construction sites or in meat processing, Moreno said. Ironically, those jobs tend not to offer health insurance.

But for many immigrants, it’s still preferable to the environment they came to the U.S. to escape.

More than half of the LCA’s clients came from Michoacán, a southwestern Mexican state plagued with violence and economic inequality. Some people still struggle with extortion plots against them even after they’ve moved, Porterfield said.

“Michoacán seems to be one of the worst areas right now,” he said.

Health care reform has brought positive changes for many Latino families. Felix and his parents, with help from the LCA, recently were enrolled in OHP through Cover Oregon.

Now, Felix said, he will try to see a bone specialist who can treat the knee injuries he sustained playing soccer years ago that still hurt today.

But first, he’ll make sure his mom, who also suffers from kidney stones and had tumors removed in the past, sees a doctor.

“Now I can take my mom to get checked out and make sure everything is OK with her after everything that’s been going on,” Felix said. “I can go and get my mom checked out and make sure she’s healthy.”

Isolated families

For a long time after Ignacia and Rogelio Hidalgo arrived in Redmond with their two young children, they didn’t talk to anyone.

“At that time, we didn’t see a lot of Hispanic people around,” Ignacia said. “We almost didn’t see any. It was pretty hard.”

The family first lived in California for eight months after moving to the U.S. while they pursued treatment for their son, Mel, who was 2 years old at the time. They moved to Central Oregon so that Rogelio could donate a kidney to his brother, who was suffering from a deadly kidney disease.

After the surgery, Rogelio constantly urged his wife to move the family back to California. Or Mexico. Anywhere where people spoke Spanish and would understand them.

But Ignacia persisted. She began taking English classes at Central Oregon Community College, hopeful that she eventually would be able to get help for Mel, who is now 24 years old.

“I did care, but I was more focusing on finding help for my son,” said Ignacia, who now speaks English fluently.

The Hidalgo family, clockwise from left, Ignacia, 48, Rogerlio, 50, Guadalupe, 2, Antonia, 23, Jose, 2, Mel, 24, and Daniel, 13, pose for a family portrait in their Redmond home.

Ryan Brennecke / The Bulletin

That fear and mistrust is common among new immigrants to Central Oregon; many of whom feel they don’t belong and, as a result, don’t hold much hope for the future, said Miguel Angel Herrada, who worked with the LCA to enroll Latino individuals in health insurance through Cover Oregon.

“That’s a very human concept that is important to our welfare,” he said. “If you don’t trust the organizations, if you don’t trust your government, if you don’t trust other people, if you don’t trust your community, you feel isolated.”

But Ruth Zambrana, a women’s studies professor at the University of Maryland and director of its Consortium on Race, Gender and Ethnicity, said placing the blame entirely on the immigrants is an uninformed perspective. The bigger problem, she said, is a public that is generally unfriendly toward immigrants, especially in predominantly white, English-speaking areas.

“The greatest issue I think the Latinos and Mexican immigrants in particular face is the lack of welcoming from a society which then pushes them not to interact,” said Zambrana, who has studied Latino populations for decades. “I mean, who wants to be rejected and given looks?”

Too often, research into Latino health disparities places too much emphasis on the Latino culture and not enough on their socioeconomic status and longstanding patterns of unequal treatment, Zambrana said. She advocates for increased research into the institutional barriers and structural inequalities that contribute to such disparities.

Residents of many small, predominantly white communities in the U.S. quite simply haven’t been exposed to people who look different from them, which naturally creates a “your way is the only way” mentality, said de Leon Siantz, the UC Davis professor.

“If you don’t have high levels of education that have opened your mind to thinking more broadly, that tends to color the lens that you’re looking through when different people come in,” she said.

The U.S. is currently experiencing a second immigration boom that involves more people of color, whereas the first wave at the turn of the century involved Western Europeans, de Leon Siantz said.

“Central Oregon is a microcosm of what’s occurring in small communities around the United States,” she said.

By 2050, de Leon Siantz says the Hispanic population in the U.S. will increase by 188 percent. Within the same time frame, the non-Hispanic white population will increase by just 7 percent.

That means promoting education among the Hispanic children in the country today must be a priority, she said. Currently, about 50 percent of Latino children do not graduate from high school, de Leon Siantz said. They also experience a higher rate of teenage pregnancy and depression.

“There’s really a strong need to focus on how can we promote the academic achievements of the children of these documented and undocumented immigrants,” she said, “because on their shoulders rests our economic success and our scientific future.”

Bridging the language gap

In both her job and in her personal life, Gabriela Hernandez gets a close look at the barriers Latinos face to seeing doctors.

The 21-year-old COCC student works part time as a medical interpreter. She sees and hears about the intense fears patients harbor. Those who are undocumented often believe if they go to the doctor’s office, the staff will turn their information over to immigration officials, ultimately resulting in their deportation.

“Once I interpreted for a patient that did not want to give me any information,” Hernandez said. “She didn’t want to give me her address, Social Security number. She didn’t want to show me her ID. … The Hispanic community is afraid. They’re afraid they’ll give up the information and it will separate their families.”

Gabriela Hernandez, 21, is a student in the medical assisting program at Central Oregon Community College and also works as a medical interpreter for Spanish-speaking patients in various clinics in Central Oregon.

Ryan Brennecke / The Bulletin

Hernandez, whose parents moved to the U.S. from Nicaragua more than two decades ago, was born in Los Angeles. Her family moved to Redmond about seven years ago, and to Bend three years ago. She is studying to earn her medical assistant certificate and hopes to graduate in June. Both of her parents are legal residents, but they’re not yet citizens.

For Hernandez’s mother, who doesn’t speak English, language is the primary barrier that keeps her from seeing a doctor. For others, it’s cultural. Hernandez knows many Latinos who prefer using home remedies over prescription drugs. Then there’s the invincibility factor present to some degree in all communities.

“Especially the males — since most of them have a very dominant role — they feel they don’t need to get checked out,” she said.

That’s true for Hernandez’s father, who works as a merchandiser for a wine and beer distributor. Even though his job provides insurance — which also covers Hernandez and her mother — he very rarely goes to the doctor. In fact, he’s only been to the doctor once since coming to the U.S.

“It’s just because he doesn’t like it,” Hernandez said.

He’s not alone. U.S. Census Bureau data in 2010 found that 42 percent of Hispanics said they didn’t visit a doctor once in 2010, almost double that of white and black respondents. In the same survey, 73 percent of Hispanics said they never used prescription medication.

Jennifer Fuller, a nurse manager at Volunteers in Medicine, said she’s noticed a tendency among Latino patients more than other groups to stop taking their medications once they start feeling better, even if they’re supposed to keep taking them.

“A lot of education goes into, ‘OK, you have this diagnosis of diabetes. It’s very important to keep taking this medication until the doctors say,’” she said.

The patients Hernandez talks to say they would feel more comfortable seeing a doctor who speaks Spanish rather than one who speaks English and using an interpreter. For most patients in Central Oregon, though, that’s not an option.

Mosaic Medical does allow patients to choose whether they prefer to see a Spanish-speaking provider or use an interpreter. If they don’t speak English, most prefer a Spanish-speaking provider, but there are a small number who prefer an interpreter if a friend or family member recommended a specific provider who does not speak Spanish, Pennavaria said.

Mosaic has the most providers in Central Oregon — around 100, half of its total staff — who are at least proficient in Spanish, said Elaine Knobbs, Mosaic’s director of programs and development. The clinic also has full-time interpreters on staff and another staff member who trains others in health literacy and cultural competency, she said.

For scheduled visits, St. Charles Health System usually arranges to have an interpreter in the room with the doctor and patient. St. Charles does not track which of its providers speak Spanish.

For emergency room visits, St. Charles Bend in March implemented a new video interpreting program called InDemand Interpreting, a laptop on a cart that’s wheeled into the room with the patient and doctor. The program works a lot like Skype in that the interpreter can see the patient and the doctor, and vice versa. The provider specifies the language and gender that the patient prefers in an interpreter (often female patients prefer female interpreters, for example). St. Charles Madras was the first to implement the video interpreting service about three years ago, and Redmond and Prineville followed suit in fall 2013.

Before that, St. Charles’ ER interpreters worked on an on-call basis. If a patient needed one, he or she had to wait between 15 and 20 minutes for one to arrive at the hospital.

Porterfield, of the LCA, said he thinks St. Charles, particularly in its Madras hospital, should have bilingual providers who are able to work with patients rather than using interpreters.

“It blows my mind that Madras doesn’t have more Spanish-speaking staff at their hospital,” he said.

Nearly 39 percent of Madras’ population is Latino, according to 2010 Census data. In Bend, that number is about 8 percent, compared with 12.5 percent in Redmond.

Moreno, with the Oregon Latino Health Coalition, said interpreters are not the most culturally competent way to provide care to Spanish-speaking patients. Ideally, clinics would hire bilingual physicians rather than employing physicians in addition to interpreters, he said.

“Not only does it make service sense, but it makes financial sense to make use of and hire providers who are bilingual and bicultural,” Moreno said.

In other parts of the state, Moreno said he’s seen situations in which male interpreters were called in for a female patient’s visit, a situation that could make some female patients uncomfortable. In other cases, patients’ children were used as interpreters, a practice he said is “grossly inappropriate.”

“Imagine a 9-year-old child or a 12-year-old child having to tell their mother that she’s pregnant all of a sudden or that she has cancer,” he said.

‘He’s a miracle’

After she finished her leukemia treatments, doctors warned Antonia Hidalgo that future pregnancies would come with a high risk of going into early labor due to the damaging effects of the chemotherapy and radiation.

A little more than two years ago, Antonia — Ignacia and Rogelio’s 23-year-old daughter — learned the hard way that they were right. After she became pregnant, she had two bleeding episodes. After the first, she went to the hospital and commenced months of worrying whether her son would be OK.

Antonia went into preterm labor at 16 weeks of pregnancy and spent more than three months in the hospital before the delivery. Her son, Jose Loreto, was born more than 21⁄2 months premature and spent the first month of his life in the neonatal intensive care unit.

Today, he’s a healthy, energetic 2-year-old.

“He’s a miracle, he really is,” Antonia said.

Antonia was able to have the expenses from her pregnancy and delivery covered under OHP, which saved the single mom from what would like have been insurmountable debt.

Antonia, whose parents moved her to the U.S. with them as a 1-year-old, lives in the U.S. legally under Deferred Action for Childhood Arrivals, a policy implemented through a June 2012 memorandum issued by President Obama. It doesn’t allow her to get federal student financial aid, but she managed to land two private scholarships that have helped her become trained as a nursing assistant. She first attended classes at COCC and, more recently, at Regency Pacific, a senior care provider that also hosts a nursing assistant training program. She has completed the coursework, but has yet to take the final exam.

Antonia’s legal residency depends on her staying employed. She works as a secretary at a nonprofit organization called Recursos Latinos, which advocates for equal access to education, health care and economic opportunities for Latinos in Central Oregon.

Not all of her siblings are so lucky, though. Her older brother, Mel, who is severely impacted by autism, lost eligibility for services three years ago when he turned 21. Mel, who graduated from Redmond High School in 2008, previously was able to attend different camps and benefited from various disability programs. Antonia still drives him to the Opportunity Foundation, a nonprofit organization in Redmond that serves people with intellectual disabilities, every Wednesday to interact with other clients.

“He likes to go there,” Antonia said. “He loves people, he really does. But that’s another worry. If he gets sick, he doesn’t have health care, either.”

Mel is not eligible for the same legal status as Antonia because his disability renders him unable to work.

Antonia’s younger sister, 2-year-old Guadalupe, and two younger brothers, 13-year-old Daniel and 20-year-old Miguel, all were born in the U.S. and are thus citizens. Still, Antonia said they don’t qualify for OHP and her parents can’t afford to buy private insurance for the kids while supporting the family on one income — Ignacia cleans houses but Rogelio is out of work. Fortunately, unlike their family members, the kids have thus far remained healthy.

Guadalupe Hidalgo, 2, and Jose Hidalgo, 2, play with members of their family in their living room.

Ryan Brennecke / The Bulletin

Although it’s not possible to get an official count on the number of undocumented individuals living in Central Oregon, Ignacia said, there are many mixed-immigration status families like hers, and everywhere they go, people ask for identification. Many of them have lived in the U.S. for decades, and they’ve spent that time trying to build a better life for their families, she said.

“People that I know work really hard and they don’t deserve not to have what they need,” Ignacia said. “That’s sad. For me, that’s sad.” •

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