La Maestra has been providing services and programs
available to all low-income residents in the community
it serves. Many of its patients are immigrants and
refugees, many of whom are in the country legally and
were forced to leave their native countries due to
conflict or other upheaval. La Maestra also places a
high value on the support of the family and provides
comprehensive programs that strengthen both the children
and adults. Many other patients are second or third
generation families from the communities they serve.
Most are struggling to survive but are learning to build
their knowledge of the community and its resources to
become more self-sufficient. All of these residents rely
heavily on La Maestra Community Health Centers not only
for their health care but for their non-medical needs as
Annual State and Federal reports provide excellent data on the characteristics of La Maestra patients at all locations: 64% are women (83% of those are of child bearing age). 96% are non-white and 80% say they prefer to be served in a language other than English. An astounding 98% of them are below the Federal definition of poverty (double that of all of San Diego County, the state of California and the United States as a whole). The vast majority (92%) are either uninsured or rely on public insurance programs for partial coverage. The City Heights, a part of the Central Region of San Diego is a federally designated MUA/MUP- Medically Underserved Area / Medically Underserved Population.
The community serves as a microcosm of inner city challenges of poverty, unemployment, and poor access to health care or social services. Linguistic and cultural barriers compound these problems.
There are no County hospitals in San Diego and the small network of community clinics, like La Maestra, provides the only existing safety net. County statistics for the region report startling problems: a poverty rate of 19.22% (200% above the countywide average), highest teen birth rate, lowest prenatal care utilization rates, lowest health insurance coverage rates, and highest rates of reported child abuse. El Cajon City in East San Diego County, although in a more rural desert setting, experiences similar problems to those of City Heights. In El Cajon, the majority of the population is Latino although “official” census numbers report only 26%. Because of the high cost of housing in coastal areas, there is a migration of middle income, working people buying homes in El Cajon and commuting west.
From outward appearances household incomes seem to be rising. This development masks the fact that there is still high local unemployment, underemployment and poverty. Many Hispanic refugees and Chaldean immigrants, who escaped from Iraq, live in El Cajon and struggle with linguistic and cultural barriers that continue to exist. The problem is so well recognized that the Medical Director from La Maestra (who is Chaldean himself) was asked to establish the El Cajon Center.
Although many of the patients being served at the main clinic in City Heights walk and push their strollers to the clinic (an informal study showed 62%), there are over 37 separate census tracts served by this overburdened facility on Fairmount. The primary service area has a population of 199,230. City Heights is a small part of a larger extended area that includes the entire Central Region of San Diego County with a population of approximately 488,205. Similarly, the El Cajon facility is easily accessible by public transportation and is available to over 29 different census tracts with a total population of 118,902 (according to the 2002 Census). All of the East Region of San Diego County has a slightly less dense population of approximately 448,750.
Commented Dr. Almansour, “Our patients experience lack of access to appropriate medical care. They have no insurance coverage from their minimum wage job employers. They do not know where or how to shop, they practice unhealthy behaviors (smoking, drinking alcohol and soda) encouraged by marketing, stress and culture and they therefore suffer from their poor diet/nutrition and lack of adequate physical activity and substance abuse. Frequently we see escalated rates of chronic disease and mental health problems. We have learned that women typically seek medical and dental services for their children. Men are more likely to come for enabling services like housing assistance, and job training/placement programs. For many reasons, these adults often fail to recognize or acknowledge their own health problems and obtain care only in later stages of illness or disease. Co-morbidities and symptoms are oftentimes identified when individuals come to the Center for unrelated assistance and timely referrals are made”