Professional Service | A firsthand account of the rewards and rigors of advocacy work
How did you first become involved with health care literacy working at Lenox Hill Neighborhood House (LHNH)?
During my undergraduate career I was drawn to internship experiences in the realm of public advocacy. I knew when I graduated that I wanted to continue advocacy work. For the most part, my undergraduate experience involved work with Massachusetts constituents who were immigrants, which I really enjoyed, but I wanted to branch out and gain knowledge in a different area. I was particularly drawn to a job opportunity at LHNH because the description emphasized direct client services in the health care field; a field I was interested in but knew very little about.
Why did you choose to do health care literacy work?
I initially chose to do health care literacy work because the idea of communicating with clients on a daily basis to help them navigate public health care seemed like an ideal way to make a tangible impact in the lives of many low-income New Yorkers who needed health care services. My work as a health care advocate was incredibly rewarding because it afforded me the opportunity to learn about the public health care system in the US, and to effectively use this knowledge to help those who (rightfully) had a great deal of trouble navigating the system. The more I learned through my job as a health care advocate, the more I understood that most people who are dependent on our public health insurance programs are in great need of someone who is literate in public health care policies and regulations, and who can act as an intermediary between the individual and the insurance plan/provider to ensure that the client has access to and obtains the health care coverage s/he deserves.
You worked with the Immigrant Children’s Assistance Project over the summer in Texas, can you give some examples/generalities about who the children you worked with were and what their situation was? What you were helping them do?
ICAP is a sub-department of the South Texas Pro Bono Asylum Representation Project, a legal services organization that offers free legal services to detained, undocumented, individuals in the Rio Grande Valley. The Children’s Project collaborates with the Office for Refugee Resettlement (ORR), which operates shelters for detained unaccompanied minors. Detained unaccompanied minors are children under the age of 18 who come into the US without proper documentation and without parental supervision. The children detained in the shelters in this particular area are typically of Central American origin (Honduras, Guatemala, El Salvador), and come to the US to reunite with family members, continue their education (due to the fact that in many of the rural areas in the aforementioned countries children may not have access to education beyond middle school grade levels), flee mistreatment or persecution, or all of the above. I worked in a team with an accredited representative and a paralegal this summer to deliver ‘Know Your Rights’ workshops in these shelters, and to conduct individual legal screenings for the children to identify those who may be good candidates for legal relief.
What were the biggest difficulties or most frustrating parts of that work and how did you overcome them?
There were two aspects of the work that I found incredibly frustrating:
The first aspect is probably a common frustration for many types of organizations that offer free or low cost services: resources were limited. We had a team of about 10 individuals working to deliver the aforementioned services, as well as (in some cases) legal representation for thousands of unaccompanied minors every year. Naturally, when resources are limited, attorneys have to make difficult decisions when they consider taking on a single difficult case, because this may mean that s/he can not take on three additional cases that may require less time and may be less difficult to win in immigration court. We had to make decisions on how many times to return to a shelter and follow up with a single child to see if s/he might have a compelling case for legal relief, because more often than not, extra time spent with one child meant less available time to do new intakes and potentially identify new cases that may have particular urgency.
The second frustration specific to this job was that far fewer children were eligible for legal relief under current US immigration law than we would have liked. This frustration is a result of legislation and the current structure of US immigration policy that has very strict eligibility requirements for visas and high thresholds for different statuses that unaccompanied minors must meet in order to be strong candidates for these forms of legal relief. What compounded the harsh nature of this reality was that we had the responsibility of telling children and their families that (according to our assessment), they did not meet the requirements necessary to qualify to stay in the US. Additionally, it was extremely frustrating when the staff identified a child who they believed had a strong case for relief and would work on the case, only to have the case denied several months or years later, resulting in the deportation of the child back to his or her country.
Because of the nature of these challenges, means of overcoming them was rather limited. However, the best way that I and many other staff members attempted to overcome the limitations in our work was through our spirit and commitment to the work we were doing. Winning cases and being able to give some children hope that making the dangerous journey was worth it; that they might in fact be able to access protection and opportunity here in the US was what often kept us moving forward. These victories reminded us that despite the failures and frustrations, our successes were just as valuable and for the people we helped, it probably mattered more than we could have imagined.
What was the most rewarding part of your work in Texas? In terms of specific occurrences or aspects of the job or both?
Despite the aforementioned frustrations and many other challenges, a general reward of working at ProBAR was the wonderful community of people who welcomed me into the organization and whose passion and determination to make a difference in the lives of unaccompanied minors was inspiring, to say the least.
A second reward was interacting with children on a regular basis. As one can imagine, working with detainees can be an incredibly challenging and emotionally draining experience, due to the difficult situations and backgrounds these individuals tend to come from, as well as the harsh realities they may face. Working with child detainees made the process appear somewhat less severe and difficult than it was in reality. I was constantly amazed at the resilience of the children despite the fact that many of them endured hardships most of
us could not imagine, and yet they continued to believe that things could get better, that if they just made it over the next hurdle—whether it be reunification with parents, an appearance in immigration court, or actually winning a case—that everything would be okay. As adults I think we tend to abandon this will to hope and to persevere—justifiably, at times—but in this particular line of work it was encouraging, heartbreaking, and necessary in order not to give into despair on difficult days, when success of any kind or standard seemed impossible.
I particularly enjoyed coauthoring a brief for the asylum application for a young girl who was at one of the shelters I visited regularly. As a learning experience, it was a wonderful opportunity to watch the process of a case unfold and to tangibly help a child file an asylum claim. In addition, considering the fact that my educational background is more policy oriented than law oriented, I learned a great deal about the standards and intricacies of writing legal briefs on behalf of asylum applicants.
What were some of the commonalities between doing the health care literacy work in Spanish Harlem in New York and advocacy work in Texas? What were the biggest differences in the work/location/community?
A common factor in both child immigrant advocacy in south Texas and health care advocacy in New York City was that both of these populations had limited knowledge, power, and agency to ensure that they could access protection and exercise rights that were delineated for them within laws and regulations specific to their individual situation. As a result, I think both of these populations benefited immensely to have an agent who was knowledgeable, willing, and able to act on their behalf.
One of the fundamental differences between these two populations is age, and therefore, difference in ability to give consent and make decisions. Although I had a few clients who were minors when I worked as a health care advocate in NY, the majority of my clients were adults who possessed a level of cognitive maturity that allowed them to perceive and judge their particular circumstances. This enabled them to ask questions and make informed decisions about their health care options. Naturally, minors could not do these things nearly to the same extent as their adult counterparts. Working with unaccompanied minors required a great deal of patience, constant assessment and reassessment of cases and facts, and because of their exceptionally vulnerable state as minors without parental protection, compassion.
In terms of location, Harlingen, TX, and NY, NY are worlds apart, as one might imagine. When considering the impact of the location on the work that I did, the difference in working in a large city in the northeastern US vs. in a remote small town on the Texas-Mexico border, I would say that the greatest difference was probably that of culture. Having worked in both of these locations, I think the greatest advantage was the ability to experience two polar opposite cultures within the territory of a single country. There are people in every part of the US and all over the world who benefit from some form of advocacy in order to effect change in their living conditions, access social and political benefits and protections, and many other categories which I won’t go on to enumerate. By working in a single location, in a single field, one develops an invaluable level of expertise. However, changing fields, learning to live in different locations and among different cultures reminds us that it is important to remember to adapt, to try and see things from a different perspective and, most importantly, to remember that most of what we know to be absolute is actually relative. I always try my hardest to learn about the location and culture during every professional and academic experience that I have (I have done this with varying rates of success and failure) because this allows me to understand how to benefit the most from that experience and how best to help the population at hand.
How have those work experiences affected your schoolwork and your future goals?
During my relatively short career as an advocate in the fields of health care and immigration I learned more than I expected about decision-making in public policy at the federal and state levels, and the implementation and execution thereof. In the US specifically, health care and immigration reform are two vigorously debated topics due to the underlying reason upon which most people agree: both are in desperate need of reform. Learning about the theory behind immigration policy in a graduate program (i.e., the concerns of the government devising the policy and the populations that different aspects of the policy are intended to target) and then experiencing how the implementation of these policy affects the population on the ground (i.e, immigration enforcement and control as well as access to different kinds of protections under US immigration law) drove me to consider the various levels of analysis that should occur, but rarely do in practice, when a policy is implemented or considered for reform. My research this academic year focuses on analyzing negative consequences of US immigration reform in the mid-1990s and how that reform contributed to many of the problems that resulted in a large influx of undocumented immigrants from Central America into the US today.
You are working on your Masters in Law and Diplomacy, how does that degree/educational experience help your work or future work? What kind of position/work are you hoping to move into after?
After I complete my degree at Fletcher I hope to pursue a career path in immigrant advocacy. I am open to pursuing this path through two main routes, although I expect these will be revised over the next several years… Thus far my work in the immigration field consists mainly of direct client and constituent services, which I enjoy and find very rewarding. However, I have not had a chance to work for a think tank or a similar organization that is responsible for policy analysis and recommendation, which is something that I would like to do if I have the opportunity to do so in the area of immigration legislation and reform. However, I am also interested in continuing on the path of direct client services and working with refugees abroad who are trying to gain access to and find resettlement in the US. We shall see…
You can find out more about Lenox Hill Neighborhood House here: http://www.lenoxhill.org/content/home
and the work of ProBAR here: http://www.abanet.org/publicserv/immigration/probar.shtml
