Latino USA 1520 Take Care >>MARIA HINOJOSA, HOST:

From NPR and The Futuro Media Group, it's Latino USA. I'm Maria Hinojosa.

>>RAY LEON: But when I would take a deep breath, at the very end of the breath, I'd feel a pinch in the lung, then I'd cough. You know, it's like what the heck is this?

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>>HINOJOSA: Today, we talk about taking care in different ways -- a story about an insidious disease that lives in the ground and young moms facing challenges caring for their kids.

>>KAYLA WILSON: You know, you're in there with a pump that makes noises and, you know, it's just -- it's not a comfortable, relaxing, clean environment for a mom to pump. Like, a mom should not have to pump on a public toilet in a bathroom.

>>HINOJOSA: Plus, how Cuba does health care and how that might change. Will they go from plants to pills? All this and more coming up on Latino USA. I'm Maria Hinojosa. No se vayan.

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>>MARIA HINOJOSA, HOST:

Welcome to Latino USA. I'm Maria Hinojosa. In parts of the American southwest and northern Mexico, there's a mysterious disease that lurks in the dirt. It's called valley fever. There's no cure and little funding for research. And for those who do get sick, having the disease can be a lifelong battle, sometimes even leading to death. We begin our program in California, where residents of the south Central Valley are most at risk for valley fever. Latino USA's California Endowment reporting fellow, Vanessa Rancano, introduces us now to some people trying to figure out how to take care of themselves in the face of danger.

>>VANESSA RANCANO, BYLINE:

The west side of Fresno County is home to small farming towns separated by huge swaths of agricultural land. Some fields are green with rows of garlic and tomato; others are dry and bare. Tractors cut through the fields, throwing up plumes of dirt as tall as skyscrapers. Sometimes the wind whips up clouds of dust so vast the sky dims and the surroundings disappear.

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>>RAY LEON: When big, old storms come through over the hills from the coast, they just kick it up hard, and everybody goes inside.

>>RANCANO: Ray Leon grew up here.

>>LEON: Well, you don't want to be outside 'cause you will get dirt on your teeth, in your eyes.

>>RANCANO: It's more than just uncomfortable. The dirt here is teaming with a fungus that can be deadly.

>>JARED RUTLEDGE: Valley fever is a fungal organism that lives underneath the soil.

>>RANCANO: That's Dr. Jared Rutledge.

>>RUTLEDGE: I am one of the epidemiologists for Fresno County Department of Public Health.

>>RANCANO: People can get infected when they inhale the fungal spores, the microscopic part of the fungus that allows it to reproduce, like a seed to a plant. Once the spores are airborne, the wind can carry them for miles.

>>RUTLEDGE: If you are doing any activities that would disturb the soil outside -- gardening, digging holes, you know, playing in the dirt, any type of yard maintenance -- you are going to disrupt it.

>>RANCANO: Between 1998 and 2013, there were about 140,000 reported cases of valley fever; most of them in Arizona. In California, the vast majority of cases are here in the Central Valley. Over 3,000 cases showed up in 2013, nearly a third of them among Latinos. Most people who are exposed have very mild symptoms or none at all. But about 40 percent do get sick with anything from a mild flu to severe pneumonia and painful sores in a very small number of cases, an estimated one to two percent. Valley fever wreaks real havoc.

>>RUTLEDGE: This disease, in certain populations, can spread, like, almost like cancer.

>>RANCANO: It can attack bones, skin and organs. In some cases, it reaches the nervous system, leading to life-threatening meningitis if it's not treated.

>>RUTLEDGE: It grows and leaves these little balls of fungus in your lungs. And those little spores can spread throughout your body, and that's when we get disseminated infection.

>>RANCANO: Researchers know that anyone with a compromised immune system is at increased risk for that. And that for some reason, black and Filipino patients have a much higher chance of becoming seriously ill. Here in Fresno County, Dr. Rutledge says the biggest risk factor is living on the west side because it's mostly open farmland.

>>RUTLEDGE: So when we move some place, we pave everything. We pave it. And we, you know, make sure that our lawn is watered. And we make sure our plants are watered. And all of that is going to keep the valley fever cases down. There, it's just open fields.

>>RANCANO: The fields Ray Leon grew up around.

>>LEON: A lot of folks in my family have had valley fever -- my brother, my sister-in-law, cousin -- and she was in the hospital for a while -- my cousin's nephew, another cousin on the other side of the family.

>>RANCANO: But Leon says he never really thought much of it until he experienced it himself almost 10 years ago.

>>LEON: OK, so check this out. How about we take the route to Hanford?

>>RANCANO: This was Leon's commute for months.

>>LEON: So I was taking this route. And I had a little Toyota Corolla, but I didn't have an AC.

>>RANCANO: So he'd leave the windows open.

>>LEON: Windows being down would allow the dust coming in.

>>RANCANO: And that's when he started to feel like he was coming down with the flu, so he went to the doctor and got a prescription for antibiotics.

>>LEON: A week, maybe two passed by -- finished the pills. I'm still coughing, and so I went back. He gave me stronger pills.

>>RANCANO: Those helped.

>>LEON: But when I would take a deep breath, at the very end of the breath, I'd feel a pinch in the lung, then I'd cough. You know, it's like what the heck is this?

>>RANCANO: A specialist finally diagnosed Leon with pneumonia caused by valley fever and put him on antifungal medication, the only treatment for the disease and one that's brutal.

>>LEON: You know, my tongue was all white. One of my toes looked like a white mushroom because I was so white and, you know, killed like every fungus inside and out.

>>RANCANO: Still, Leon is lucky. He hasn't had any symptoms since. Recurrences are fairly common. And people with severe disease often have to stay on medication for the rest of their lives. Diagnosing valley fever can be tricky. That's a problem because getting the right diagnosis early can make a huge difference.

>>LEON: Between life and death. It's between a good quality of life and a life of suffering and inconvenience.

>>RANCANO: Leon says valley fever doesn't discriminate, but judging by his own family...

>>LEON: I would venture to say that Latinos and farmworkers are disproportionately impacted.

>>ALBERTO AGUILAR: My name is Alberto Aguilar. I'm Ray's cousin.

>>RANCANO: In high school, Aguilar spent summers working in agriculture. His job was to empty huge burlap sacks of onions into a machine that cleaned them.

>>AGUILAR: As you're doing that, all kinds of dirt's going everywhere.

>>RANCANO: He started feeling sick, but he kept working.

>>AGUILAR: And I would tell my mom, Mom, I feel sick. And my mom thought I was just being lazy.

>>RANCANO: Eventually, he got too sick to work, and he lay in bed, getting worse and worse.

>>AGUILAR: Finally one day, my body just gave out, and she took me to the hospital. And I just remember walking in there and then -- it's like being in a cloud, you know? My whole brain was full of fluid, and I felt really -- I was out of it.

>>RANCANO: Doctors told him he had valley fever. It took him a long time to recover.

>>AGUILAR: Just remember being sick, sick, sick. All I wanted to do was sleep. I slept like 20 hours every day. Literally, I had no life for, like, a whole year.

>>RANCANO: Before Aguilar got sick, he didn't know anything about valley fever. Neither did the other people he worked with. Besides, he says, they were afraid to speak up.

>>AGUILAR: And nobody ever wanted to go to my herdomo, you know, and tell him, hey, you know, this guy's sick. We think it's from this because not only would they fire you, but your whole family, your whole crew that backed you up.

>>RANCANO: Even today, farmworkers don't know much about the disease.

>>LEON: We are currently heading westbound on 198 en route to Huron, Calif.

>>RANCANO: Ray Leon.

>>LEON: Farmworker community close to a hundred percent Latino, about 7,000 population. It's been identified as the poorest city in the state of California.

>>RANCANO: We're driving near a labor camp in the city.

>>LEON: There's a lot of dust. I mean, you can't have a car here in Huron for more than a day without it getting full of dust.

>>RANCANO: It's not just dust; it's really windy. Leon spots a couple of guys he recognizes and pulls over.

>>LEON: (Speaking Spanish).

>>RANCANO: He asks if they know what valley fever is.

>>UNIDENTIFIED MAN: (Speaking Spanish).

>>RANCANO: They say they've heard of people getting it.

>>UNIDENTIFIED MAN: (Speaking Spanish).

>>RANCANO: One man says he knew a woman who got it and ended up in a wheelchair. Leon asked if they know what causes it.

>>LEON: (Speaking Spanish).

>>UNIDENTIFIED MAN: (Speaking Spanish).

>>RANCANO: They say they're not sure, but rumor has it fertilizers cause it or pesticides.

>>UNIDENTIFIED MAN: (Speaking Spanish).

>>RANCANO: At a nearby clinic, it's easy to see why information on valley fever is hard to come by and tracking cases is so difficult.

>>TEMISTOCLES BATARIO: I am Dr. Temistocles Batario. I have been working here for 14 years.

>>RANCANO: Dr. Batario is Filipino. His Spanish isn't fluent, but he says it's good enough to communicate.

>>BATARIO: I understand the patient. I speak Spanish maybe 50 percent, 60 percent.

>>RANCANO: Valley fever is commonplace here. Dr. Batario says most of the cases he sees are in the early stages and treatable, but patients don't always finish their treatment.

>>BATARIO: Yeah, I saw one patient with infection here in the finger.

>>RANCANO: The disease had attacked the man's bone.

>>BATARIO: Unfortunately, there was no follow-up. Maybe he went back to Mexico.

>>RANCANO: Researchers know farmworkers are especially vulnerable because they're constantly exposed to dust, but they don't have the data to show it.

>>RUTLEDGE: We just don't have the information to make that argument.

>>RANCANO: Epidemiologist Jared Rutledge.

>>RUTLEDGE: That this population is not only suffering disproportionately in terms of disease, but also death as a result of infection.

>>RANCANO: Which, in turn, makes it hard to get funding for research and outreach. Even, so Dr. Rutledge and his team are doing what they can to educate people about valley fever. They're writing pamphlets to teach prevention methods, like staying indoors when it's windy or wearing protective masks when working in the dirt. There's also an effort to develop a vaccine for valley fever. Scientists have been working on it since the '60s. But again, funding is scarce.

>>RUTLEDGE: It does come down to an economic argument.

>>RANCANO: The question, he says, is whether there are enough cases of valley fever to justify drug research and clinical trials, especially because the disease only affects people in certain parts of the country.

>>RUTLEDGE: The local organizations here in the Central Valley are trying to save and raise enough money to get to that level.

>>RANCANO: Driving through the valley, Ray Leon says the low number of cases is just part of the problem.

>>LEON: So I think if goes most impacted by valley fever -- if they were upper-income Anglo-Americans, there would be a significant difference in the attention that valley fever would be getting from foundations, policymakers and the like.

>>RANCANO: Looking forward, Dr. Rutledge is worried. He's expecting a spike in valley fever cases if California's long-running drought eases.

>>RUTLEDGE: Valley fever likes to eat dead things. The more things that are dead in the soil, the more fungus grows. In long periods of drought, as you have areas not getting touched with water, you will have rodents dying, plants dying and more spores.

>>RANCANO: Eventually, when the fields are tilled again, he warns even more fungal spores will be released. For Latino USA, I'm Vanessa Rancano in Fresno County, Calif.

>>HINOJOSA: Coming up on Latino USA...

>>LUIS ZAYAS: Everything in family court is done -- what's the best interest of the child when parents are separating, divorcing, custody disputes and so on? In immigration court, it's all about the undocumented immigrant and getting that person out of the country.

>>HINOJOSA: The mental health consequences when families are separated. Stay with us. No se vayan.

(SOUNDBITE OF SONG, "CRAZY")

>>CEE LO GREEN: (Singing) I remember -- I remember when -- I remember when I lost my mind. There was something so pleasant about that place. Even your emotions have an echo and so much space. And when you're out there without care, yeah, I was out of touch, but it wasn't because I didn't know enough. I just knew too much. Does that make me crazy? Does that make me crazy?

>>SPONSORSHIP: Support for NPR comes from NPR member stations and from Inada, maker of the Dreamwave massage chair; Japanese crafted with shiatsu-point detection and 16 preprogrammed massages, including morning, night and full-body sessions. Learn more at dreamwavechair.com. And Americans for the Arts, for more than half a century, committed to building better communities and better lives through arts, in partnership with local, state and national leaders. Learn more at americansforthearts.org.

>>MARIA HINOJOSA, HOST:

Welcome back to Latino USA. I'm Maria Hinojosa. Conversations at the doctor's office aren't always easy. There's always a chance of getting some upsetting news or just misunderstanding what the doctor is saying. So for limited-English speakers, language problems can create some serious barriers to get good care. Federal and state laws require translation or some other plan for non-English speakers. But even with translations, some patients have mixed success communicating with health care providers. Pauline Bartolone of Capital Public Radio has more from Sacramento.

>>UNIDENTIFIED DOCTOR: I'm going to work with you a lot on your balance.

>>UNIDENTIFIED INTERPRETER: (Interpreting to Spanish).

>>JAIME URENA: (Through interpreter) I'm tired.

>>PAULINE BARTOLONE, BYLINE: Jaime Pena Urena is recovering from head trauma from a bike accident he had more than a month ago. He's getting cognitive and physical therapy at UC Davis Medical Center in Sacramento. Right now, he's having a hard time putting together a complex puzzle with different sizes and colors.

>>UNIDENTIFIED DOCTOR: Is it the right direction?

>>UNIDENTIFIED INTERPRETER: (Interpreting to Spanish).

>>J. URENA: No.

>>BARTOLONE: With a Spanish translator in the room, his care is somewhat of a team effort. Jaime's wife Felicitas says she's happy with the services and the medical translation they're getting at the hospital.

>>FELICITAS URENA: (Through interpreter) They come and explain what the doctors need to tell me. The service is really good.

>>BARTOLONE: Under California law, hospitals and insurers are required to provide interpretation. A federal law requires providers to have a service plan for non-English speakers, which often includes translation. But the experience of California Spanish speakers at health facilities is certainly not uniform.

At the Mexican consulate in Sacramento, Isabel Flores Ventanilla de Salud, or Health Window, a program that refers about a hundred people a month to regional health care.

>>ISABEL FLORES: So sometimes just to make the initial appointment can even be a challenge.

>>BARTOLONE: Flores says the clinics where she refers people have Spanish speakers. But when she checks back in with patients after a doctor's visit, it's hard to tell how much they've understood.

>>FLORES: Partially, it could be a language barrier. And the other part could be medical terminology. I mean, we go to the doctor sometimes, and we're like, what does that mean exactly? But we know how to ask those questions. Sometimes they -- it could be they're intimidated, they don't know that they can ask these questions or they forget and blank out on the spot and later have all these, you know, wondering exactly what does this mean. So...

>>BARTOLONE: Twenty-year-old Maria Medina is sitting at the consulate waiting for service. She says sometimes people at clinics speak Spanish; sometimes they don't. She says she translates for her husband and that can be uncomfortable.

>>MARIA MEDINA: Not pleasant. There are certain things that a woman should not know about a man so like it's -- (laughter) it's really complicated trying to translate that stuff.

>>BARTOLONE: Her husband Rubin Solis is sitting next to her. He says he doesn't mind her knowing his health information.

>>RUBIN SOLIS: (Through interpreter) We're a couple so I'm not embarrassed because she's my wife. If it were another person, maybe I would be.

>>BARTOLONE: Near the Health Window, Blanca Valdes looks at brochures. She's been in the country for about a dozen years and hasn't had any luck getting Spanish-speaking providers.

>>BLANCA VALDES: (Through interpreter) It would be great if the doctor spoke Spanish, but I know that in the United States English is the language so I can't say, oh, why wouldn't they speak my language?

>>BARTOLONE: Valdes also relies on her family to translate. In this case, it's her kids. But she says the doctor may explain a lot of things, and her kids will only tell her two or three things. That's exactly one of the problems, says Dr. David Hayes-Bautista. He's director of the Center for the Study of Latino Health and Culture at UCLA's School of Medicine. He says if a sip facility lacks resources, it may not have a professional a medical interpreter. A clinic worker may be pulled in to translate and may or may not have formal training. Other times, Hayes-Bautista says, a translator may be brought in by phone.

>>DAVID HAYES-BAUTISTA: All of these, however, make the quality of care a lot less. It increases the chance for medical error for the patient not understanding, for the physician or provider not understanding things. It restricts the flow of information.

>>BARTOLONE: He says the larger problem is a shortage of Latino doctors in California.

>>HAYES-BAUTISTA: Given that most Latinos physicians speak Spanish and most non-Hispanic whites do not, clearly it's an issue when Latino patients go out seeking services.

>>BARTOLONE: That's an experience Blanca Valdes knows well. And she says it can make her feel helpless.

>>VALDES: (Through interpreter) Because you don't know how to explain to them what's going on with you. And even after you leave, you still don't know what you had.

>>BARTOLONE: One way to improve doctor-patient communication, says Hayes-Bautista, is training more Latino or Spanish-speaking medical students or bringing in more Mexican and Latin-American doctors. For Latino USA, I'm Pauline Bartolone in Sacramento.

>>MARIA HINOJOSA, HOST: We know now that immigrants face plenty of challenges when it comes to health and accessing care. But what about their children -- their U.S. citizen children? Dr. Luis Zayas at the University of Texas at Austin says that the children of immigrants are part of a mental health crisis that no one is talking about. Many of them are suffering from psychological problems related to anxiety and depression. Zayas catalogs the mental health consequences of U.S. immigration policy in a new book, "Forgotten Citizens: Deportation, Children And The Making Of American Exiles And Orphans" And he joins us now to talk more about his research. Luis, welcome back to Latino USA.

>>LUIS ZAYAS: Thank you very much, Maria. It's a pleasure being back and talking to you.

>>HINOJOSA: So, Luis, you start off your book with the story of Virginia. She's a little girl who essentially stops talking. What happened?

>>ZAYAS: Well, Virginia was actually the very first case that I was called on. And two attorneys asked me to evaluate this child, six years old, and see how we could show that there would be this exceptional and extremely unusual hardship if her father was deported to Mexico. So I met her, but she wouldn't talk. She had gone for over an entire semester, even a school year in pre-K and kindergarten, not speaking. And over the course of time, she did open up a lit with me in speaking, but mostly through drawings, that she held this family secret. And the family secret was that her parents were undocumented immigrants. And she had been told you've got to keep our status quiet. And consequently, she really internalized what her parents had told her, and she stopped talking.

One of the things we found in our research was that there were two rules that were imposed on children -- parents told them don't talk, meaning, don't talk to anyone about our legal status. The other rule is behave -- sit still. They live with that day-in and day-out. So we heard stories of children who would watch -- would be going on a family outing in the car and watch their parents with great anxiety as their parents anxiously looked for police cars. In psychological terminologies, we call it hypervigilance, right. And what we do from neurobiology that with so much ongoing anxiety and stress, the brain development is affected. It creates stresses that can lead to psychological problems. We also know that high levels of stress in childhood do lead to chronic illnesses -- physical illnesses -- as adults.

>>HINOJOSA: So in your book, Luis, you talk about, essentially, two groups of kids. One are a group of kids that become orphans, essentially, when their parents are deported and they're left behind in the United States, but they're American citizens. And the others are kids who are taken with their parents once they're deported. So essentially, they're growing up American exiles in another country that isn't the United States. So what are their mental health issues?

>>ZAYAS: Well, let's talk about the orphans first. We have -- we see an awful lot of negative self-esteem that, in some way, the child feels that they are sometimes to blame or feel that they had something to do with their parents' deportation. We see a lot of anxiety. Among the exiles that we studied in Mexico, we saw much more depressive symptoms -- depression, there were sad moods, physical symptoms, complaints about headaches and stomach aches that weren't a medically related. We hear about these children feeling hopeless. These are children who are U.S. citizens who have been speaking English -- have been throughout their lives. And they are kids in American schools. And to go somewhere else, that is damaging. And we've got to consider why are we relegating a group of our citizens -- our most vulnerable citizens -- to this exile?

>>HINOJOSA: What's the long term for them, and in the broader sense, for people who are saying, well, this has nothing to do with me?

>>ZAYAS: The long-term is damaging for both the child and for ourselves. So let's think about the child for a moment. He or she is left behind or is in another country having to live out a life getting less than adequate education, perhaps living in some remote village in Mexico. Their life opportunities are reduced. In the past eight, 10 years, over 3 million -- about 3.2 million people have been deported from the United States. And demographers say that for every two adults that is deported, one U.S. citizen child is affected. So if you do the math, that's about 1.5 million children.

>>HINOJOSA: We like to think of ourselves in this country that if you're a citizen, you're a citizen and there's equality for citizens. So can you be very specific in the ways in which you're saying that these American citizen children of undocumented immigrants are treated, in fact, differently?

>>ZAYAS: Well, we see it in the way that immigration court works. It abrogates the rights that a U.S. citizen has. We have a right to walk freely, speak freely and so on. However, in immigration court, the child's rights do not matter. We do not have the best interest of the child at heart. In family court, that's how we operate. In immigration court, it's all about that the undocumented immigrant and getting that person out of the country. And that is a way that we are taking away many aspects of the Bill of Rights that our citizens have.

>>HINOJOSA: Dr. Zayas, thank you so much for your work and for speaking with us on Latino USA.

>>ZAYAS: Thank you very much.

>>HINOJOSA: Dr. Luis Zayas is the dean of the school of social work at the University of Texas at Austin. He joined us from the studios of KUT in Austin, Texas.

>>MARIA HINOJOSA, HOST:

So U.S. citizen children of the deported face mental health issues, but what about children who are themselves undocumented? They grow up, and they have their own dreams and goals, but they don't know if they'll be able to access resources to make those dreams into a reality. For some undocumented

youth, their goal might be becoming a doctor. Now, President Obama's executive actions on immigration have opened doors for students who otherwise wouldn't have had access to med school. In California, Ali Budner has our story.

>>ALI BUDNER, BYLINE: Midi Del Rosario and Denise Rojas are chatting with a couple of friends on the campus of UCLA. They all have two things in common -- they're undocumented and they want to be doctors. But finding someone who's made this happen is so rare. It's like searching for a unicorn.

Wait, so who's the unicorn?

>>DENISE ROJAS: I guess I am.

>>MIDI DEL ROSARIO: People who have done it.

>>BUDNER: That's Midi.

>>DEL ROSARIO: It just seemed like it was completely impossible to be an undocumented student going into medical school. Like, the barriers were so high, it was just so, like, seemingly insurmountable, rights.

>>BUDNER: But along the way, they managed to meet people like them who had made it to med school.

>>DEL ROSARIO: And it was like, oh, my God. This is possible.

(LAUGHTER)

>>BUDNER: Midi's friend Denise doesn't consider herself one of the unicorns, but she is used to feeling like an outsider.

>>ROJAS: Probably as far as I can remember, I've known that I -- about my immigration status, I think in stages, I've learned what that means. But since I can remember, I know that I was different.

>>BUDNER: Denise was born in Mexico City. And when she was less than a year old, her family moved to Fremont, Calif. Even though her parents were open with her about their status, they had to be careful who they told.

>>ROJAS: Also, you know, you're not safe. You're not secure.

>>BUDNER: Denise learned that firsthand when she was 10 years old and her aunt died of cancer. Her aunt was afraid to go to a doctor because she had little money and no papers. When she was finally diagnosed at the emergency room, it was too late.

>>ROJAS: When she passed away, I felt like that was an injustice.

>>BUDNER: Then when Denise was a junior in college, her mother needed surgery for uterine fibroids but couldn't get coverage. So she moved to Canada.

>>ROJAS: You know, it's so hard to see someone get on a plane and not knowing when you're going to see them again.

>>BUDNER: Denise's mom got the surgery she needed, but she hasn't been able to return to the U.S. since.

>>ROJAS: When my mom, you know, left, I think that's what really gave me the fuel to not only know that I wanted to do medicine but that I need to overcome all the obstacles that come along the way.

>>BUDNER: And she's done that. For one thing, she graduated from college with a pre-med degree. She does have a Social Security number and work permits thanks to President Obama's executive order known as Deferred Action for Childhood Arrivals or DACA. But that doesn't mean she can apply to just any med school.

>>ROJAS: Yeah, so some schools don't take international students. Some schools will only take U.S. citizens and permanent residents.

>>BUDNER: DACA students aren't eligible for federal financial aid. And for them, commercial loans are hard to come by. On top of that, the laws about whether they can even get a license to practice medicine vary from state to state.

>>ROJAS: Unfortunately, none of my pre-health advisors could help me.

>>BUDNER: So Denise turned to her peers. She made friends with other undocumented students who also dreamed of careers in health.

>>ROJAS: I mean, we would talk to people in admissions offices, we would talk to people, you know, all around the country.

>>BUDNER: And that was the beginning of Pre-Health Dreamers, an online community that links over 400 undocumented students in 32 states. The group lobbied the Association of American Medical Colleges to publish a list of schools that would accept applications from DACA students. Out of 141 med schools in the U.S., there are currently only 16 on that list. Even so, Denise and her friends are on their way.

>>ROJAS: And now you're in med school and you're going to med school.

>>JIRAYUT LATTHIVONGSKORN: I'm going to med school. That is crazy.

>>ROJAS: We got what we asked for.

>>BUDNER: That's Jirayut "New" Latthivongskorn. He was born in Thailand but has lived in the San Francisco Bay Area since he was nine. Like Denise, New was inspired to become a doctor when his mother got sick.

>>LATTHIVONGSKORN: I was, again, the main person trying to coordinate everything, whether it's through insurance paperwork or going with her to doctor visits and pre and post surgery and all of that.

>>BUDNER: New was only a junior in high school at the time. But last year, he became the first openly undocumented student to attend medical school at the University of California, San Francisco.

>>LATTHIVONGSKORN: It's very exciting to have that privilege really. But I think on the one hand, many folks look to me, whether I like it or not, as sort of the student and how is he going to do now that he's here?

>>BUDNER: For Denise, the road has taken more turns. She was waitlisted at her dream school, UCSF. She got in to UCLA, but without enough financial aid. Then, the Icahn School of Medicine at Mount Sinai

in New York offered her scholarships that cover nearly 80 percent of her education. Going there will allow her to practice medicine in Spanish with new Latino patients.

>>ROJAS: I've never felt that I represented just me. It's always been a lot of people who I represent. And so that's exciting. I think that's exciting that we made it this far.

>>BUDNER: So Denise Rojas may be a unicorn now, but she'll keep working so that what she's achieved will not always be so rare. For Latino USA, I'm Ali Budner in San Francisco.

(SOUNDBITE OF MUSIC)

>>HINOJOSA: Coming up on Latino USA...

>>UNIDENTIFIED WOMAN: So lucky they had embargo such a long time. They developed their own system and using more for the natural medicines, natural substances and a natural way of healing themselves.

>>HINOJOSA: As the relationship between the U.S. and Cuba changes, what will happen to health care? Stay with us. No se vayan.

>>SPONSHORSHIP: Support for NPR comes from NPR member stations, and from the Annie E. Casey Foundation, whose every kid needs a family report highlights state child welfare system policies and practices. More information is available at aecf.org. And Lumber Liquidators, a proud sponsor of NPR, offering more than 400 styles, including hardwood, bamboo, laminate and vinyl, with floor specialists in hundreds of stores nationwide. More at lumberliquidators.com or 1-800-HARDWOOD.

>>MARIA HINOJOSA, HOST:

Welcome back to your Latino USA, everyone. I'm Maria Hinojosa. So the U.S. spends about $9,000 per person each year on healthcare. Cuba, though, spends only about $400 per person, according to the World Health Organization. And yet, the two nations have nearly the same life expectancy -- 76 years old for men and 81 for women. Cuba is poor and medical resources are limited there, but it does have the highest doctor per patient ratio of any country in the world. And the labor there is cheap. Doctors make only $30 a month. But Cuba can't afford many prescription drugs, so Cubans often use herbal medicines, and health stats show that the system seems to be working. The U.S. stopped to trading medical supplies with Cuba over 50 years ago when they set up the embargo. But now the U.S. government is deciding whether to start trading with Cuba again. And if the embargo ends soon, could Cuba switch from plants to pills? Katie Manning reports now from Havana.

>>KATIE MANNING, BYLINE: Ten-year-old Carla Resla is picking up dead leaves around oregano plants. She's in Habana Vieja at a half acre garden that's surrounded by peeling pastel-colored colonial buildings. Carla visits these rows of fruit and vegetables every Friday. There's horseradish, tropical beans and chamomile. She's here to learn about medicinal plants. She wants to be a dentist, and she's kind of a teacher's pet.

>>JULIO SENERO: (Speaking Spanish).

>>UNIDENTIFIED STUDENT #1: (Speaking Spanish).

>>MANNING: Her teacher is a gardener named Julio Senero. He asked his four students what they know about oregano. Carla's quick to answer. It's for cooking and headaches. Julio asks what else?

>>SENERO: (Speaking Spanish) (Coughs) (Speaking Spanish).

>>UNIDENTIFIED STUDENT #2: (Speaking Spanish).

>>MANNING: "A cough," a classmate says. He has a bushy mustache and runs a tight ship. Mostly he lectures, and the students listen quietly. But he stops class whenever a customer comes. A woman in a spandex leopard print dress leans over the counter at the front gate. She asks Julio for a plant to help her lose weight. Julio plucks a leaf of a chia bush and shows it to the students then sells it to the woman.

>>SENERO: (Through interpreter) The plants that we eat are also medicine. The kids take in all of this knowledge and moreover, they can teach what they learn here to other kids and adults.

>>MANNING: Carla says she's used her newfound expertise of herbal remedies to heal her parents.

>>CARLA RESLA: (Through interpreter) I've told them that when they have a headache they can use sage and cook with oregano. Also when they have a bad cold, they should make chamomile tea. They got better after drinking it.

(SOUNDBITE OF PUBLIC RADIO PROGRAM)

>>UNIDENTIFIED MAN #1: (Speaking Spanish).

>>MANNING: Cubans can also learn about natural medicine on government TV stations and public radio programs like this one.

(SOUNDBITE OF PUBLIC RADIO PROGRAM)

>>UNIDENTIFIED MAN #1: (Speaking Spanish).

>>MANNING: In Cuba, plants come cheaper than traditional medicine, and they're more available. That's partly because the U.S. trade embargo keeps some medicines out of Cuba and partly just because the country is so poor it can't afford to buy a lot of medicine from places like Europe. But world-famous Japanese healer, Dr. Kazuko Tatsumura thinks that's a good thing.

>>KAZUKO TATSUMURA: And it's so lucky that they had embargo, so lucky they had embargo for such a long time. They developed their own system and using more for the natural medicines, natural substances and the natural way of healing themselves.

>>MANNING: Dr. Kazuko is best known for developing an alternative therapy that uses heat to improve the body's immune response. She now works closely with the Cuban government, hosting yearly alternative medicine conferences in Havana. Dr. Kazuko says the embargo has actually been a blessing. Ending it could allow U.S. pharmaceuticals to edge out natural medicines.

>>TATSUMURA: That is not necessary. They are doing very well, but I hope that Cubans will not be so quick to adapt the American way. The whole Western medicine field is so conceded. They have forgotten 6,000-year-old medicine.

>>MANNING: But even Dr. Kazuko says that in emergency situations having Western medicine like antibiotics or anesthesia can mean life or death. Medicine and hospital supplies are scarce at Hospital Comandante. It's an hour west of Havana in the Artemisia province, mostly known for its farming and factories. That familiar hospital smell of antiseptic cleaning products doesn't exist here. Patients in the emergency room sweat in the 90 degree heat. There is no air-conditioning. Gray stains line the bed sheets. Dr. Nicholas Delgado checks on a young man. He is hooked up to an IV hanging from a rusty pole. Delgado says over his 40 year career, he's made do with limited medical supplies. But his job would be easier if he had more resources.

>>NICHOLAS DELGADO: (Speaking Spanish).

>>MANNING: "We've achieved a lot so far," he says. "But couldn't we collaborate better without the embargo," he asks?

Just down the hall from the emergency room is another cramped room covered in broken tiles. An elderly woman named Elena waits here with her daughter and son in law. She's here for a follow-up visit after knee surgery a couple months ago. Physical therapist Humberto Marcellino introduces himself. Humberto says the hospital doesn't always have what they need.

>>HUMBERTO MARCELLINO: (Speaking Spanish).

>>MANNING: ...And he blames the embargo for that. But despite the limitations, Humberto says he'd still rather work in Cuba than anywhere else.

He's strapping magnets to Elena's leg to help solidify the tissue around her knee fracture. He puts his hand on her shoulder and asks her if she's worried. She says she's afraid of falling if she walks. Feel your strength, and you can do it, Humberto says. He sits close to his patient and leans into the conversation. In Cuba, no matter what ails you, rest assured that doctors are going to check on your mental health.

>>MARCELLINO: (Through interpreter) I see my patients like a family, not as a sick person who I'm better than because I'm a doctor. We're just as human as the patient. We try to interact a lot with the patients. If the patient is unwell, he is the one in pain and knows what he feels. Sometimes love cures more than medicine.

>>MANNING: Humberto says he didn't feel the love so much when he worked abroad in Venezuela.

>>MARCELLINO: (Through interpreter) In the rest of the world, doctors have a higher social status than other people, like someone superior -- not us.

>>MANNING: Humberto earns as much as his brother, who works in a factory. In Cuba, everyone officially makes about the same amount of money. And Humberto says that keep egos in check.

>>MARCELLINO: (Speaking Spanish).

>>MANNING: "We're all alike," he says. "We're all the same."

Back at the garden, Julio Senero is checking in with a butcher who's come to buy chamomile for a neighbor. Julio asks about her sore throat. Embargo or no, medicine only counts as part of what makes Cuba's health system different. And whatever changes come as the U.S.-Cuba relationship evolves, Cuba's we're in this together mentality isn't likely to change. This is Katie Manning for Latino USA.

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>>MARIA HINOJOSA, HOST:

And now a story about nursing in the United States where finding a place to breast-feed can be difficult for any mom. When you're running errands or even spending time with friends and family, a clean, welcoming space can be hard to come by. So imagine the obstacles for a teen mom in high school. What if there isn't a safe, private place at school to nurse or pump breast milk? In California, a proposed state assembly bill could offer a solution. KQED's Alice Daniel has our story.

>>NORMA ACKER: Oh, Gracie. Let me see. Give it to mommy. Go wash your hands.

>>DANIEL: Norma Acker's 3-year-old daughter Samantha Grace has opened a bottle of bright-red fingernail polish without anyone noticing and now it's everywhere.

>>ACKER: Go wash your hands in the bathroom.

>>DANIEL: Just another reminder that parenting is hard, and being a teen parent is even harder. Acker was 15, a Mexican-American high school student in the Central Valley town of Reedley when she had Gracie. She wanted to breast-feed, but even the other young mothers at school thought she was crazy.

>>ACKER: They were like, girl, why aren't you out eating your lunch? And I'm spending my lunch time breast-feeding the whole time, well, breast pumping.

>>DANIEL: Teachers and counselors gave her a list of the cons.

>>ACKER: You will lose school time. You will lose class time. You will lose, and maybe you won't even get the credits for that class because you're missing out on so much trying to make me realize that it's going to be harder than I thought.

>>DANIEL: They told her it would be easier to breast-feed at a continuation school, an alternative program for at-risk kids. She finally agreed, but regrets the decision because the school wasn't challenging.

>>ACKER: Everything there is just toned-down easy.

>>DANIEL: Teen mothers who want to breast-feed are often forced to make that kind of sacrifice. There's no accurate estimate on how many high schools in California have breast-feeding accommodations. But it's safe to say the overwhelming majority do not. In Los Angeles County, for instance, just a fifth of the high schools have a policy to allow for breast-feeding space. Statewide, the number could be even lower. That bothers Angelica Salceda.

>>ANGELICA SALCEDA: They shouldn't be making decisions specifically because it's where they can breast-feed or where they can express milk.

>>DANIEL: Salceda is a lawyer with the American Civil Liberties Union of Northern California. It's cosponsoring a breast-feeding bill to help teenage mothers in the state.

>>SALCEDA: The bill would guarantee that pregnant and parenting students have a private, secure place to be able to breast-feed or express milk, the ability to bring a breast pump school, the ability to be able to store the breast milk

>>DANIEL: Salceda says California has some of the strongest laws in the country to support working mothers who breast-feed.

>>SALCEDA: And I think that is now time to be able to do that for students as well.

>>DANIEL: More than 20 organizations have signed on in support of the bill. But it's opposed by the Association of California School Administrators, which says the requirements for creating a breast-feeding space are too restrictive and should be left to local discretion. The ACLU and the association are in talks to see if they can arrive at a resolution. Kayla Wilson is one of the bill supporters. She's a consultant for the Fresno County Office of Education and often directs teen parent programs on high school campuses. Some young moms stop breast-feeding, she says, because the only place to pump is the school bathroom.

>>KAYLA WILSON: You know, you're in there with a pump that makes noises, and you know, it's just not a comfortable, relaxing, clean environment for a mom. Like a mom should not have to pump on a public toilet in a bathroom.

>>DANIEL: She says fixing the problem wouldn't take much.

>>WILSON: We're not asking them to build new facilities, but to be able to provide a private location.

>>DANIEL: It's what Norma Acker wishes she had when she went to high school.

>>ACKER: Want strawberries in it? (Speaking Spanish).

>>DANIEL: She's proud to say she breast-fed her daughter for eight months, and she would've done so no matter what the cost.

>>ACKER: If it meant me dropping out of high school just to make her well, then I would do that. If it meant to that I would fail as a person, myself, but be the best mom I could be for her, I would do that.

>>DANIEL: But Acker didn't fail. She's now in her second year of community college, and she's still making sure her daughter eats well.

>>SAMANTHA GRACE: Bye-bye.

>>ACKER: Good job.

>>DANIEL: For Latino USA, I'm Alice Daniel in Reedley, Calif.

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>>MARIA HINOJOSA, HOST:

And now, from taking care of the youngest among us to the importance of taking care of yourself. Zarela Martinez is one of the most celebrated Mexican chefs in the United States. At one time, she owned restaurants, wrote cookbooks, hosted a PBS series, and she helped introduce many Americans to the richness of Mexico's many regional cuisines. Then in 2004, Zarela was diagnosed with Parkinson's disease. It's a neurological disorder that causes the loss of fine motor skills and, in its later stages, dementia. Now, this diagnosis might have devastated some people, but not Zarela. Her philosophy of self-healing is today's Sabiduria, or words of wisdom.

>>MARTINEZ: The way that they found out that I Parkinson's is because I got hit by a cab. And when they did the MRI, they noticed that I had a tremor. And I must tell you that it never once occurred to me that I would be disabled. I knew that I was going to fight. I try to do everything that people say -- people with Parkinson's can't do. Three times, I do water aerobics a week. But I also do boxing. I design jackets. I'm constantly writing articles. I go out to all sorts of events, you know, like for instance, you know, I was taking voice therapy because, as you can tell, there's a little bit of difficulty enunciating and everything with Parkinson's. But it was so boring. It was like -- ma, ma, ma, ma, ma, me, me, me, me, mo, mo, mo, mo, mo. So I started taking singing lessons.

(SOUNDBITE OF SONG)

>>MARTINEZ: (Singing in Spanish).

I sing all day, every day. I love it. The most satisfying thing that you can imagine, you know, it's just so empowering. You can do anything. I mean, I really feel that you choose the way you feel. That's part of my philosophy, too. I mean, it's -- you have to empower yourself. I mean, you have no idea how many people I know with Parkinson's that just -- they get the condition, they don't even want to tell people. I force myself to do stuff. I mean, even if I don't feel like going to workout and even if it's like five degrees, I mean, I get up and go to the gym. I mean, no matter what. And then when I get done, I feel really good. You know, and I think you have to -- I mean, you have to take the bull by the horns. You can't just let the disease conquer you. You've got to do everything possible to not let it progress.

(SOUNDBITE OF SONG)

>>UNIDENTIFIED MAN: (Singing in Spanish).

>>HINOJOSA: The unstoppable Zarela Martinez. To find out more about Zarela's many projects, visit us on the web at latinousa.org.

(SOUNDBITE OF SONG)

>>UNIDENTIFIED MAN: (Singing in Spanish).

>>HINOJOSA: And that's it for this week, mis queridos y queridas. Latino USA is produced by A.C. Valdez, Leda Hartman, Daisy Rosario, Marlon Bishop, Michael Simon Johnson, Camilo Vargas and Antonia Cereijido. Our engineer is Cornelius McMoyler. Nadia Reiman is our music consultant. Nancy Trujillo makes it all happen. Special thanks to Sarah Lu at WBEZ in Chicago and Julia Shu for her production help. Our show was founded at the University of Texas at Austin. I'm your host and executive producer Maria Hinojosa. Join us again next week. And in the meantime, find us on Facebook, Twitter and Tumblr. And I'll see you on Instagram. Hasta la proxima.

>>SPONSORSHIP: Latino USA is made possible in part by the John D. and Catherine T. MacArthur Foundation, and by the Marguerite Casey Foundation, dedicated to achieving a more just and equitable society for all. The Ford Foundation, dedicated to working with visionaries on the frontlines of social change worldwide. Funding for Latino USA's coverage of the Culture of Health is made possible in part by a grant from the Robert Wood Johnson Foundation and the California Endowment, building a strong state by improving the health of all Californians.

>>SPONSORSHIP: Support for NPR comes from NPR member stations and from the George Lucas Educational Foundation, creator of Edutopia, an online source for what works in education, dedicated to empowering education changemakers every day to improve the learning process. Learn more at edutopia.org. And the Pew Charitable Trusts, driven by the power of knowledge to solve today's most challenging problems at pewtrusts.org. This is NPR.