For now the refugee health screening program in Uptown, hailed by local refugee-assistance organizations as one of the country's best, remains in operation. But its survival isn't certain. Each year the program, which operates out of the city's Uptown Health Clinic at 815 W. Wilson, provides free medical care and interpreters for some 3,000 refugees, most of them from Africa, Russia, and Southeast Asia. But over the last six months the interpreters, who speak 18 different languages, have been threatened with pink slips as a result of local budget cuts and proposed changes in federal law.
At one point in December several interpreters received layoff notices. But then, in the face of protests by activists from a coalition of refugee organizations, city officials rushed forward with assurances that the interpreters would not be laid off and that the Uptown screening program would continue. "It's an excellent program," says Tim Hadac, spokesman for the city's health department. "It's absolutely not under any threat. Anyone who thinks so is in need of some serious updating."
Despite the reassurances, the activists remain cautious. "I'm happy to hear that the city recognizes this as a successful program, but I still won't feel secure until we get some kind of written or even verbal guarantee from the city of its intention to keep this program," says David Marzahl, executive director of the Chicago Coalition for Immigrant and Refugee Protection. "We still don't have that. In fact, they still haven't even met with us to talk about the program at all."
The screening program was started in the mid-70s as part of a federal effort to help thousands of newly arrived refugees from Vietnam, Cambodia, and Laos. By law the refugees were given access to free medical treatment at local health clinics for at least eight months. The clinics were also supposed to hire interpreters. "It is difficult to provide health care for someone if the patient and the doctor do not speak the same language," says Ha Nguyen, executive director of the Vietnamese Association of Illinois. "There is always the chance that the doctor will not be able to find out relevant information about the patient."
Resettlement workers also point out that it's important that the interpreters be professional. "We had a situation at one clinic where doctors gave a refugee a medicine that his body could not tolerate," says Lien Du, a supervisor at Travelers & Immigrants Aid. "The man broke out into a rash. Later they discovered that he should never have received the medicine because he had only one kidney and his body could not handle the medicine. But the interpreter did not know the terminology to say the patient only has one kidney. There are also embarrassing difficulties with men translating for women."
In an attempt to avoid such problems, the Uptown clinic employs 15 interpreters. Under the city personnel code they are classified as clerks, and according to city officials, their pay averages about $20,000 a year. Some of them are fluent in four languages. "Initially most refugees were from Southeast Asia. Now there are many from Africa," says Erku Yimer, executive director of the Ethiopian Community Association of Chicago. "Ethiopian refugees probably speak one of several languages, including Amharic, Tigrinya, Oromigna, and Arabic. There is one staffer at the clinic who speaks all of those. These are diverse languages too. It is like being able to speak Russian, English, Spanish, and French."
Late last summer word surfaced that all of the interpreters might be let go as a result of changes in the refugee-resettlement law proposed by the Bush administration, which intended to privatize refugee health care. "The screening program was to be changed from one that is operated by public facilities, like our Uptown Health Clinic, to a managed-care arrangement to be handled by resettlement groups, social-service agencies, and other private contractors," says Patrick Lenihan, deputy commissioner of the health department. "This is something the city opposed, and I'm not sure what the reasoning was that was behind it. Many of the social-service groups that would get the contracts are the ones in Chicago who are most supportive of the Uptown clinic."
The Bush administration's proposal, which was adopted by Congress last fall, gave the city a difficult choice: lay off the interpreters, or pay their salaries with city funds, which would be difficult given a budget crisis that has already forced the Daley administration to hike property taxes and cut such popular services as the Municipal Reference Library. And it wasn't clear how much the city would have to pay. According to Lenihan, city funds account for at least half of the screening program's $1 million budget. However, state health officials say the budget is closer to $800,000, of which the city pays a small fraction.
"Layoff notices were never sent out, but we informally let people know at Uptown that they were possible," says Lenihan. "This all happened sometime in the fall." Yet resettlement workers say several translators did receive layoff notices. In fact, Yimer wrote a December 28 letter to Health Commissioner Sheila Lyne asking that the clinic's Ethiopian interpreter not be let go. "We regrettably came to know that [the Ethiopian interpreter] will be laid off effective December 31, 1992," Yimer wrote. "This will definitely result in reduced access to appropriate and effective health services due to communication barriers." (The interpreter was not laid off.)
In an attempt to prevent the layoffs, Wendy Siegel, a policy specialist for Travelers & Immigrants Aid, appeared at a City Council budget hearing and requested that the city provide more funding for the Uptown clinic. "Since these translators are classified as clerks, they were going to be let go or reassigned on the basis of seniority," she says. "That meant you could have a translator in Uptown sent to another clinic somewhere in the city where her language services wouldn't be used. You would be wasting a needed talent."
As Siegel and others see it, it's irresponsible for the government to encourage or even permit refugees to settle here unless they're provided essential health care. "There is also the question of legality," says Siegel, "since the civil-rights law guarantees that any agency receiving federal funds has a responsibility to provide interpretive services. If care is denied or delayed then the law has been violated."
For the most part, city health officials agree with resettlement workers on the importance of the translators at the Uptown clinic. The city also opposes efforts by the Bush administration to privatize the program. "We opposed these proposals from the start," says Lenihan. "Our office of intergovernmental affairs in Washington lobbied against them." The city even filed a supporting brief in a lawsuit by the state of Washington, which seeks to prevent the federal government from privatizing the refugee health program.
In December a federal judge ordered an injunction against implementing the privatizing regulations until this case is settled. City officials say the injunction has saved the translators at Uptown, at least for the time being. "We are not in immediate danger of losing our federal funding, but we are not completely out of the woods," says Lenihan. "We have the injunction, but we have to make sure this doesn't happen again. We also hope that the new Clinton administration will abandon the plans to privatize. We are certainly working with the incoming Clinton administration toward that goal."
But resettlement workers are less than reassured. They wonder why city officials didn't meet with them early on to discuss Bush's proposals and how they would affect Uptown. "It's a strange thing: the health department tells a reporter that they support the Uptown clinic, but they don't tell us," says Marzahl. "I'm glad to hear that they agree with us on the importance of the translators, but I wish we could have heard it from them. I would think that if they really wanted to keep the program going they would have called on the refugee community for support. Together we would have made a much stronger force. It would certainly have saved us a lot of aggravation."
Art accompanying story in printed newspaper (not available in this archive): photo/Jon Randolph.