“Our case manager is very helpful in getting patients on prescription
assistance programs. Because there's a lot of prescription
assistance programs here … But a lot still don't accept
applications for people without a social security number. So,
when it comes to things like that we have to try hard to make
partners with the pharmacists in town or the doctors who may
have donations of medications.”
Requiring a U.S. social security number bars eligibility from
many immigrants. Immigrant patients are especially challenging
for community clinics because clinics have to piece together alternative
means for obtaining prescription drugs. Considering such
eligibility issues, many low-income immigrants employ one of the
other three strategies discussed, although some do find inroads to
aid programs.
Navigational capital on the part of the patient, or their social
network (as is the case for Louria's grandmother discussed earlier),
is needed to find community clinics and determine which offer
prescription programs for unauthorized immigrants. Especially for
unauthorized immigrants, but also for any patients lacking insurance
and unwilling to travel to Mexico or use illicit means, using
CHC to navigate community clinics and prescription aid programs is
crucial for accessing drugs.
4.5. Limitations of CHC in marginalized communities
The use of CHC described in the previous strategies is often
successful in delivering basic health maintenance drugs to patients,
but it is not a panacea. Problems that can arise from strategies
described in these findings include: improper pharmaceutical use,
exhausting resources in social networks, and unreliable access.
These may be due to participants not having enough (or the right
kinds of) CHC to manage healthcare in any context, including the
marginal spaces described above. These shortcomings indicate that
the CHC in Mexican American border communities, like dominant
forms of CHC, may be unequally distributed and offer differential
utility depending on factors like social network composition, citizenship
status, experience with U.S. bureaucracies, and bilingual
language capabilities. Future research should focus on understanding
how CHC in marginalized communities is developed and
differentially distributed.
For the most part, participants agree that these local strategies
for accessing prescription drugs are inferior to mainstream avenues
for prescription drug access like health insurance with low or no
co-pays or enrollment in Medicaid and Medicare. Serious structural
barriers to mainstream healthcare resources necessitate the use of
navigational, social, linguistic, and familial CHC. As long as
healthcare marginalization persists, the CHC developed in
marginalized communities offers valuable resources to low-income
and immigrant communities of color for accessing healthcare. But