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Mixteco Project in Oxnard: Profile of Sandra Young

Sandra Young FNP
There was no recognition that this was a separate culture -- and language. [Mixtec patients] had a very fundamentally different concept of health that was not the same as Western medicine… There was a huge cultural divide that existed.
Mixteco Project in Oxnard: Profile of Sandra Young

It’s likely that we all have a connection to a Mixtec farmworker. That’s because the indigenous population, from impoverished and ecologically devastated areas of Southern Mexico, make up a high percentage of the workforce that picks much of California’s berries: If you pick up a strawberry from a plastic clamshell package at the store, the worker who picked it is likely Mixtec. It’s also very likely that the worker came to the US without English language skills -- and possibly without Spanish language skills as well. This was what clinicians like Sandra Young, FNP, discovered in the late 90s, when Mixtec workers began to arrive in California in large numbers.

Young did not come from a migrant family, but she did come into medicine with the intention to serve the underserved. “I was a social activist long before I was a medical provider,” explained Young. “When I went into medicine, it was really a natural for me to work with an underserved population.”  

In 1997, upon completion of her Nurse Practitioner’s degree, Young joined the staff at Las Islas Medical Clinic, a community health center in Oxnard, a warm Southern California town outside of Santa Barbara, famous for its just-about-year-round berries. “That was the beginning of this migration from Mexico of indigenous farmworkers from southern Mexico, who largely didn’t speak English or Spanish, but only their indigenous language, Mixteco,” Young explained. “There was no recognition that this was a separate culture -- [or] language.”  There were no interpretation services for the language. Additionally, Young found that the patients had a “very fundamentally different concept of health that was not the same as Western medicine… There was a huge cultural divide that existed.”

Young struggled in particular with her pregnant patients. “Women were coming in really late for prenatal care,” and being labeled as “noncompliant” when they didn’t follow instructions that weren’t presented to them or explained in their own language. Plus, due to cultural differences, “they didn’t get, or believe, or accept a lot of the things we were saying,” she added. 

Young decided the first step was to find interpreters. This was more troubling than it sounds. “There weren’t people around -- and there are still very few people around -- who are trilingual [in] English, Mixteco, and Spanish,” she noted. Even fewer were sufficiently well-versed in Western medicine -- or had the personal drive and dedication to learn it on the job --  to interpret complicated medical terminology, she said. After some tough false-starts, she managed to secure an interpreter. “Within a couple of months, that became a full-time position,” she said, due to demand. Today, Las Islas has four full-time native speakers in the clinic; three are interpreter/outreach workers, and one is a registration clerk. “That reflects the large population that is in our clinic, that we serve,” Young stated. 

MIXTECO PROJECT

Young recognized that these new immigrants would need more connection outside of the clinicians’ office; they would need an outreach program to help them navigate the health care system and to educate them on the community resources available to them. In 2000, she wrote an outreach program proposal to her medical director.

“His response was, ‘That’s great, Sandy, but I have no time. If you want to do it, go ahead,’” she said. After initial disappointment, Young realized, “Wait a minute -- he said yes!” On a Friday night not long after, she organized her first volunteer-run community meeting in the clinic waiting room. It was a word-of-mouth meeting, to “get people to come together and just talk about real basic survival things, like how to get Medi-Cal, why you should take a bus instead of a taxi, how to get a birth certificate for your kid… Just basic stuff,” she said. Twelve people showed up. “At the end of the meeting, everyone asked ‘When is the next meeting?’  That became the community meeting that still goes on to this day,” Young said joyfully. There are now two monthly meetings in Oxnard, drawing roughly 250 to 300 families a month. The community itself determines the content, and invites speakers every month. 

Young recognized that there was a growing need for promotores, community health workers from the Mixtec community, in addition to the outreach programs through the clinic. In 2001, she decided to form a nonprofit, apart from the clinic, which became the Mixteco/Indígena Community Organizing Project. “The very first grant money we got was to train Mixtec women who were bilingual in Spanish and Mixteco in some basic concepts around the importance of the basic prenatal care,”after which the newly trained promotoras did outreach within their communities, Young explained. From there, the Mixteco Project has expanded. Its hands-on, nonliterate Bebe Sano (Well Baby) classes were picked up by Ventura County’s First Five program, and replicated at Las Islas, as well. Its diverse programs offer training and education, community organizing, youth groups, interpreting, and special community events.

COLLABORATION

Young still fields calls from other parts of California on how to replicate services for indigenous populations in other communities. “Ventura County was way ahead of the ball in terms of finding solutions,” she said. Fifteen years after her first work with the indigenous groups, “there’s [still] lots of networking and trying to help people develop their own models and organizations,” she said. She continues to work in “professionalizing the role of interpreters and outreach workers,” and treating them as medical professionals, as the training programs within the Mixteco Project does. Such collaborations, between clinics, and between practitioners and outreach workers, make stronger programs.

ACCESS, ACCESS, ACCESS

Young believes that the biggest issue in health care today is “access, access, access,” she said, and she fears for undocumented peoples’ health. “If you’re undocumented, you have no security in your life, period,” she noted. While the Affordable Care Act was a good step, it doesn’t cover undocumented people. She added, “Our Federally-Qualified Health Centers theoretically serve everybody, but we don’t, in reality,” because patients are confused by sliding-scale options.

“We know people don’t get health care. Farmworkers don’t come for preventative health care. Somehow, even though we have some systems in place, the systems that exist are overwhelmed and they are not outreaching to people to really draw them into real health care.” she continued. Currently, she sees mostly women and children, but she wants to see health care available to “Mixtec men, Mixtec older women, gay and lesbian clients that don’t have kids, to be able to bring those people into having access to the system,” she said. In terms of the greatest needs in health care, she emphasized, “I think that’s the biggest.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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