NEW YORK - As the death toll from the COVID-19 pandemic continues to rise, a new initiative is helping Mexican immigrants living in the United States deal with issues of end-of-life planning.
Hispanic Americans are 18% of the U.S. population, but account for 25% of COVID deaths, adding extra urgency to things like advance directives for end-of-life care.
Patricia A. González-Portillo is National Latino Communications and Constituency Director with the organization Compassion & Choices. She says the collaboration with a national health outreach program from the Mexican Consulate should help reduce disparities in end-of-life planning and health care that negatively impact the immigrant community.
"We can catch this horrible virus that can kill us," says González-Portillo. "Are we going to wait 'til that happens before we have the conversation with our family about what I want in case I die from this illness?"
Compassion & Choices has assembled a free, bilingual COVID-19 toolkit, which is available online at 'CompassionandChoices.org.'
Maria Otero, Compassion & Choice's national constituency manager, points out there are Hispanic cultural values - such as the importance of family involvement and the influence of religion - that affect behavior at the end of life. And there are cultural barriers, too.
"There's not a word in Spanish about advance directives. We don't have a word for 'hospice,'" says Otero. "So, often we are perceived like we are not very assertive to what we want at the end of life."
She adds that the pandemic represents an opportunity to start important conversations among families about a topic that most people prefer to avoid.
Because COVID-19 is so contagious, currently incurable and the symptoms can advance quickly, González-Portillo stresses that everyone should complete an advance directive.
"That clearly details what the person wishes for at the end of life," says González-Portillo. "So that family members are not left with this task of guessing, 'What would my brother want?'"
She says without an advance directive, hospitals often are forced to make decisions about medical interventions and treatment that may not be what the patient would want.
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Immigrants and the agencies that help them are preparing for what could happen when President-elect Donald Trump returns to office. In Wyoming, a "Know your Rights" training is being offered this weekend. Trump has said he'll take fast action when he steps into office to launch a "mass deportation program." There are limitations to the power and funding he has to immediately do so, but experts say they expect to see "significantly more" arrests by U.S. Immigration and Customs Enforcement, or ICE, during his presidency.
Antonio Serrano, advocacy director of ACLU of Wyoming, will host a workshop in Jackson this Saturday to help people understand their rights in case they do interact with immigration agents.
"Don't be like somebody who thinks, 'Well, this is never going to happen to me.' We just want to teach people their rights, so that way, we can hopefully make folks feel a little more empowered," he said.
Serrano added that the training will explain different kinds of warrants and address various scenarios including if ICE comes to a person's home or workplace, or stops someone while driving or walking.
Immigrants make up just over 3% of Wyoming's population, or about 19,000 people, according to the American Immigration Council. Serrano advises people to learn their rights in advance, so there's no need to try to understand them "in the moment." He hopes knowledge will help alleviate some fears.
"When you know that you have people in community who can stand with you, who can support you, who can have your back, it makes those things feel a little less scary," he continued.
Serrano noted there is also information on immigrant rights available on the ACLU website, including for students and families.
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By Antoinette Grajeda for The Arkansas Advocate.
Broadcast version by Freda Ross for Arkansas News Service reporting for The Arkansas Advocate-Winthrop Rockefeller Foundation-Public News Service Collaboration.
A Pacific Islander and his family left the Marshall Islands more than a decade ago in search of better education, health care and job opportunities in the United States.
Similarly, a mother and her four youngest children moved to Arkansas from Mexico 25 years ago, joining two children and their father and hoping to improve her family’s circumstances.
Like thousands of people who come to the U.S. looking for a better life, these immigrants and their families often encountered challenges, including low-paying jobs, language barriers and navigating complex systems. And despite working one or multiple jobs, they, like many immigrants, found themselves struggling to make ends meet.
The Marshallese man and his family eventually landed in Northwest Arkansas — home to one of the largest concentrations of Marshallese in the continental U.S. — where he worked in the local poultry industry.
He added his wife and two children to his health insurance plan until he received a paycheck worth about $100 and realized he couldn’t afford it.
“I had to cancel and take everybody off, because I couldn’t afford to pay rent, bills and even provide food,” he said.
The Mexican mother said her focus has long been her children instead of herself, so to support them, she’s always worked multiple jobs — cleaning homes and offices and making food. She practically only arrived at her house to sleep, she said.
These Northwest Arkansas immigrants’ stories place them solidly in what’s known as the ALICE population, which stands for Asset Limited, Income Constrained, Employed. In other words, people who work hard, yet find their incomes and limited assets keep them struggling.
A 2024 ALICE report found rates of financial hardship differ by race and ethnicity in Arkansas, due to systemic racism, discrimination and geographic barriers. In 2022, 59% of Native Hawaiian and Pacific Islander households and 51% of Hispanic households, as well as half of the households led by biracial Arkansans were below the ALICE Threshold in the state, compared with 43% of White and 33% of Asian households.
ALICE advocates describe a financial survival threshold as the average income a household needs to afford the basics, defined as housing, child care, food, transportation, health care and a smartphone plan, plus taxes and a small contingency measured by county. The survival budget for a married couple with two school-aged children would be $72,120 in Benton County and $68,652 in Washington County, according to United for ALICE.
While the Marshallese father no longer works in the poultry industry, he advocates for Marshallese community members who do through his current employer. As the sole provider of his family — his pregnant wife recently left a job that didn’t offer paid maternity leave but will start another job soon — he said he is stressed about not being financially stable.
“For now we’re just trying to survive,” he said.
Housing challenges
Housing is particularly challenging for low-income Northwest Arkansas residents because prices have skyrocketed due to the region’s rapid growth. In Bentonville, for example, the median listing home price increased from $460,000 in July 2021 to nearly $600,000 in June 2024, according to Realtor.com.
The Marshallese immigrant rents a duplex in a smaller town but said it feels like they’re “just not making enough,” and he’s not alone in that. At 32%, the Native Hawaiian and Pacific Islander population had Arkansas’ highest poverty rate reported in American Community Survey census data released in 2022.
A soft-spoken, small-statured man with big hopes for the future, he admitted things are “pretty difficult right now,” but he’s committed to supporting his loved ones.
“I will try whatever I can to provide for my family because I’ve been through so many moments where I got kicked out, my electricity went off and that’s when I hit rock bottom and I learned from that,” he said.
Employment challenges
A calm demeanor and positive outlook on life offer a sharp contrast to the many difficulties the native Mexican faced as an immigrant worker in the U.S.
The mother of nine initially juggled multiple jobs because she had so many mouths to feed. As her children got older, she kept working because her priority was for them to continue studying, not work. She herself only received one year of education in Mexico.
In addition to daily expenses, she also needed money for lawyer fees to obtain immigration documents for her family — an expensive 15-year process, she said.
As she gets older, the 65-year-old is concerned she won’t be able to keep working two or three jobs, though her children have offered to help support her.
Early in her career, she endured bosses who treated her poorly and stole her wages because she wanted to support her kids, she said. Eventually she decided she’d had enough and started working for herself.
She said she felt helpless witnessing the abuse of other employees, including a woman who seemed stuck in a bad situation because she didn’t have immigration papers. Employees could complain to supervisors, but no one did anything because it was in their best interest to keep abusing workers, she said.
Through his work with poultry workers, the Pacific Islander said employees often don’t know who to speak to about issues with sexual harassment, unfair treatment, racism and wage theft. There’s also mistrust and a language barrier, the latter of which he said contributes to a lack of understanding about company policies and payroll deductions.
“Just because you don’t have the language doesn’t mean you don’t have the rights,” he said.
The importance of frontline workers was highlighted during the pandemic, but companies’ treatment of employees “really showed these companies don’t care about individuals,” he said.
“People were risking their lives to go to work just for the goal of the company, and now we have lost so many of our community members [to COVID],” he said.
Although Marshallese and Hispanic residents represented about 19% of Northwest Arkansas’ population in mid-2020, they accounted for about 64% of COVID-19 cases and 57% of associated deaths in the region, according to a U.S. Centers for Disease Control and Prevention report.
He said poultry workers need higher pay, but if companies are unwilling to raise wages, they could provide training to help employees advance to higher-paying jobs within the industry.
In 2021, Tyson Foods increased starting wages from $12.50 to $15.20 per hour for Northwest Arkansas poultry processing workers, according to the Arkansas Democrat-Gazette. Tyson, George’s and Simmons Foods did not respond to requests for current starting pay figures.
Arkansas’ minimum wage is $11 an hour.
Health care
The Mexican mother’s dark brown eyes welled with tears as she recalled how sad and helpless she felt when one of her sons became so sick that he required dialysis three times a week, and the hospital expenses added up.
“Gracias a Dios” — “Thank God” — he was placed on a waiting list and received a kidney transplant, she said. He’s alive today because “soy una mujer de fe”— “I’m a woman of faith.”
Health care access can be challenging for immigrants because of cost, especially when, due to a lack of education about the system, patients access more expensive urgent or emergency care for a non-emergent illness or injury.
A 23-year-old Marshallese immigrant works at a Northwest Arkansas clinic where he helps other Marshallese community members access health care services, including breast cancer screenings. At the age of 18, he migrated from the Marshall Islands with grandparents to seek medical care for himself.
“I don’t trust those doctors over there,” he said.
The Marshallese community has a complicated history with health care and the United States, which conducted 67 nuclear weapons tests on and near the Marshall Islands from 1946 to 1958, devastating parts of the Pacific Island nation and sickening its people. More than half of all cancers on the Marshall Islands’ Rongelap Atoll might be attributed to nuclear fallout exposure, according to the National Cancer Institute.
The United States signed a Compact of Free Association (COFA) with the Marshall Islands that allows the U.S. to operate military bases in exchange for security guarantees and economic assistance. Under COFA, Marshallese migrants can live and work in the U.S. and were promised access to Medicaid. They lost that access when Congress omitted their unique immigration status in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Congress restored access in 2020, and around 4,000 Pacific Islanders and Native Hawaiians in Northwest Arkansas got health coverage from 2020 to 2022, according to Axios NW Arkansas. About 12,000 Marshallese lived in Arkansas in 2020, according to the U.S. Census.
The young man said his clinic works to increase access to health care by meeting Marshallese migrants where they are. Many patients work for local poultry companies, he said, so the clinic schedules events for things like clinical breast exams after work. Additional patient challenges include language barriers, transportation and a lack of education on how insurance works, he said.
While Northwest Arkansas does have several amenities like health care facilities, it’s an expensive place to live, especially for people earning minimum wage or just a little more.
“With the economy that we’re living in now — a lot of people are moving here — it’s really expensive. Especially for those who are underserved communities, it’s really hard,” he said.
Brighter future
Education and finding a support system can help immigrants overcome the financial obstacles they face in the U.S. as they try to move upward economically.
At his job, the Marshallese father educates migrant workers about their rights and connects them with resources, but for himself, he’d like to have more financial literacy. For his children, he stresses the importance of education and said he’s proud of his bilingual students for advancing in school.
Likewise, the Mexican mother emphasized education to her children and is equally proud of their successes, such as graduating college and owning a cafe.
While she has her own struggles, she said there are people with less. Over the years, she gave money to people in need, taught a friend to cook so she could earn money for family and cared for a dying woman who was alone in her final days. It’s satisfying helping others expecting nothing in return, she said.
Besides relying on family and friends, immigrants can also find assistance through local nonprofits like Arkansas United, an immigrant advocacy group that helps connect newcomers to community resources. The native Mexican connected with the organization through its English classes.
Soon she’ll be part of Arkansas United’s new support group for Northwest Arkansas moms that will provide a place for women to share the stories about their challenges with things like domestic violence and depression, and learn about resources from guest speakers, Navigator Coordinator Elizabeth Perez said. Meetings will also include fun activities so participants can set aside for a while what they’ve been through, she said.
The Mexican mother will be a good example for other moms, Perez said, because of her resilience in finding ways to support her children and her compassion for helping others.
“Su bonda es grandiosa” — “Her goodness is great,” and we need more people like her in the world, Perez said.
Antoinette Grajeda wrote this article for The Arkansas Advocate.
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