Battling Breast Cancer Alone: One Uninsured Immigrant’s Story

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FRESNO -- When Georgina González learned she had breast cancer, she focused only on the first three letters of her disease.

C-A-N. As in, she can survive. As in, yes, it can be done -- a phrase the 54-year-old immigrant from Puebla, México, repeated multiple times in Spanish one Thursday in early December.

"What am I going to do?" González said, as she waited in the lobby of the California Cancer Center for a routine checkup. A small pink ribbon was pinned to her pastel blue sweater vest, and in her lap she clutched a black tote bag inscribed with a pink heart and the phrase "Keep hope alive."

"I'm not going to cry," she said. "I must continue forward. 'Sí se puede.' "

But González, a petite woman with short, dark hair, who warms a room with her bright smile and easy laughter, has not survived her battle with breast cancer with strength and optimism alone.

With the support of state health programs, she underwent an operation, physical therapy and six weeks of daily radiation last year, all in a country where she has no immediate family and does not speak the language.

González is thankful for such safety-net health programs -- lifesavers for her.

But some of those programs have been targeted for cuts, according to Gov. Jerry Brown's proposed state budget, which was released Monday morning.

That prospect made González turn somber.

"If it weren't for (those programs)," she said, "I truly don't know what I would have
done."

More than three years ago, González left her three sisters, three children and three grandchildren in Puebla and traveled to the United States in search of the American dream that so many people chase.

"One wants to do something that in her own country she cannot do," she said.

González's goal was to build a home in Puebla. But as a single woman with an
elementary school education, who worked her whole life cleaning houses, it would be impossible to make enough money to construct a house.

"In México, it's impossible to save money, because you're living by day," she said.

Since arriving in Fresno in 2007, González has worked toward her goal. She has labored in a taquería and cleaned houses and now works at a chain restaurant.

She started a new, simple life for herself, renting a central Fresno apartment with a co-worker. The apartment is cozy -- her twin bed, below a portrait of the Virgin of Guadalupe, is steps from the tiny kitchen -- but it is clean and festive, thanks to a small Christmas tree with colorful lights and music that streams softly from a radio.

A Fresno Area Express bus stop is right outside her apartment. She takes the bus to English classes every morning at the César Chávez Adult Education Center in downtown Fresno and to her job in the afternoon.

On some afternoons, she hops off the bus and walks along Barstow Avenue, over the State Route 41 overpass, to FoodMaxx. She buys basic groceries -- milk, oatmeal, tortillas, eggs, flour and yogurt -- then pushes the grocery cart back along the overpass to her apartment complex.

This simple routine was thrown into disarray in April, when she felt a lump in her left breast.

She visited Clínica Sierra Vista, where she received a free mammogram through the California Department of Public Health's cancer-detection program, Every Woman Counts, a program that ensures that low-income women age 40 and older who are uninsured or under-insured can receive free clinical breast exams, mammograms, pelvic exams and Pap tests.

After multiple tests, González got the news: She had breast cancer, the leading cause of cancer death among Latina women, according to the federal Centers for Disease Control and Prevention.

This was not the American dream she sought.

Or was it?

"I have seen that God brought me to this country to be cured," González said, as she sat on the worn, cream-colored couch in her apartment. "It's possible that, in my country, I would not have had that opportunity."

The cancer-detection program also funds case-management services, so health care workers at 900 provider offices statewide can follow up with patients and guide them through the system.

"The whole goal of the program is to save lives by identifying breast and cervical cancer early enough that it can be treated successfully," said Dr. Linda Rudolph, deputy director of the California Department of Public Health's Center for Chronic Disease and Health Promotion. "We focus on low-income, uninsured, underserved women who unfortunately still have the worst outcomes."

The state delivered a blow to the program last January, when it froze new enrollment in the program and raised the eligibility age from 40 to 50. But the state reinstated the program in December, and Gov. Brown has not proposed cuts to the program for 2011-2012.

“In this budget climate, that is a huge win" for community clinics and the women who rely on that program, said Kevin Hamilton, deputy chief of programs at Clínica Sierra Vista.

Last June, just a few days before González was scheduled to undergo surgery, she asked her children and their families to gather together and participate in a rare video conversation via Skype.

It was the first time she had seen her whole family since she emigrated to California, so the conversation started off jovial. But then González broke her news.

"I'm OK, don't get worried -- but they are going to operate on me," she said. "It's OK, it's not serious."

Despite her rosy efforts, her family broke into tears -- "from smiles to serious," she recalled. González, though, remained strong throughout the conversation.

As she sat in the booth of a downtown Fresno taquería in late December, and recalled the conversation with her family, she curled her fingers into a tight fist. Her gaze was far from the plate of carne asada tacos on the table, as she recited the phrase that sustained her through that experience: "I am not going to cry."

Days after informing her family of her illness, González went to a Clovis hospital for her operation. Though her family was on the other side of the U.S.-México border, González said she did not feel alone.

Her friends and co-workers in the San Joaquín Valley had become family in this country, she said. They, combined with her family in México, became her "prayer warriors," she said, and prayed for her throughout the surgery.

"The friends I have here made a pact that at 2 p.m., everyone was going to do a chain of prayers, from México to the United States," she said. "The power of prayer is divine."

After her surgery, González's boss, Claudia Jímenez, and Jímenez's mother, nursed González back to health. For one month, they bathed González, who could not move her own arm, fed her, and brought her breakfast in bed.

Claudia Jímenez said González was a delight to have in the house.

"We had someone to take care of, and at the same time, even though she was recuperating, she was a joy to have in the house with us," Jímenez said.

It was due to the kindness of friends, co-workers, and health care workers -- "pure angels," as she often calls them -- that González said she suffered little as she battled cancer outside her native country.

"I'm not alone," González said. "Maybe if I were alone -- really without anybody -- then I would feel much sadder."

Once she recovered from surgery, González began six weeks of daily radiation treatment. Each day, she would ride the FAX bus to the Cancer Center, for what seemed like two to three seconds of radiation.

During that time, González's spirit never wavered, said Lupe Briceño, a medical assistant at the California Cancer Center.

"She would come in every day, and she would travel by bus, and the way she is now with that beautiful smile -- that was the way she would come in for the whole six weeks," Briceño said. "You wouldn't even think she was a cancer patient."

González's surgery, physical therapy and radiation treatment were completely covered through the state's Breast Cancer and Cervical Cancer Treatment Program, which serves eligible state residents who, due to income or immigration status, do not otherwise qualify for adequate or affordable insurance coverage.

Through the program, González was able to temporarily enroll in Medi-Cal benefits, which cover her cancer-related treatment as well as her medications, which cost about $343 each month. But the benefit will expire on November 30, and Georgina’s physicians have told her that she will need to continue her medications and treatment for 5 years.

Nevertheless, González said she was surprised and grateful to learn services like this exist.

"I was even more surprised when they told me it would be free," she said. "I hope they never get rid of these programs, because they are a great help."

Hamilton, of Clínica Sierra Vista, also emphasized the importance of these safety-net programs.

"Regardless of what we do with primary care at the community health center, we can't offer cancer treatment -- we don't have the capacity to do something like that," he said. "We really need help from these various programs to ensure that these women don't die unnecessarily from these diseases."

According to the budget proposal released Monday, the Breast Cancer and Cervical Cancer Treatment Program has so far emerged unscathed. However, the temporary Medi-Cal benefits González receives through the program could be impacted by the governor's proposed budget, which recommends an increase in certain costs for Medi-Cal recipients: $100 per day for a hospital stay, $50 co-payment for emergency room visits, and $5 co-payment for prescriptions, and doctor, clinic, and dental visits. The governor's proposed budget would also reduce Medi-Cal provider rates.

If approved by the legislature, those proposed changes would go into effect on July 1.

Today, González is cancer-free, although she continues visiting the cancer center for checkups. She is grateful for the assistance of Clínica Sierra Vista, and programs like Every Woman Counts and the Breast Cancer and Cervical Cancer Treatment Program, all of which allowed her to receive health care she never could have obtained otherwise.

"Here, they treat you without worrying about your immigration status," she said. "If they get rid of these programs, what will happen to us?"

The only thing that could have improved González's experience with cancer, she said, would be to have had her children, nieces, nephews, and grandchildren at hug's reach. But she drew comfort, she said, from something her daughter and niece said to her.

"When somebody serves you soup, when somebody bathes you, when somebody covers you with a blanket, pretend that it is us, tía," González recalled them telling her. "Our hands are dressing you, our hands are bringing you a plate of food and a cup of hot tea -- pretend it is us, tía."

It was almost 4 p.m., and González had changed from her pastel blue sweater vest into her black and red work uniform. In place of the pink ribbon pin, she attached her name tag, which identified her by a longtime nickname, 'Koka.'

González prepared to get back on the bus, and head to work.

"I wanted to return to my country for my children -- to be close to my children, to hug them, to hug my grandchildren," she said. "But God brought me here for something. As long as God gives me strength and health, I will continue in this country," she said.