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The unseen barriers to good health.

Some months ago, I phoned my 84-year-old grandmother on a quiet Saturday afternoon after enduring a torrent of pleading from my father. I hadn’t spoken to her in two or three years, and she was lonely, he said. It was nothing personal; I just couldn’t really communicate with her in Spanish anymore, my command over my native tongue having become so rusty as to be virtually unusable.

I had a drink before I called her, so that my Spanish was at least restaurant quality (“Dos tacos de pollo, with artichoke hearts and sundried-tomato salsa, por favor”) and dialed her number, which hasn’t changed in more than 40 years.

When she answered, I was taken aback at how small she sounded and how old-world her Spanish had become. She blessed me in Jesus’ Holy Blood and told me, as usual, how she keeps me in the Virgin Mother’s prayers, in place of saying she loved me.

I tuned out her blessings and her current list of maladies until she told me about her terrible arthritis. I shouldn’t worry, she said, because, between the power of prayer and WD-40, her joints were working fine. I asked her, in my halting Spanish, to repeat what she had just said, especially that bit about the WD-40. “The spray stuff, that we used on the trucks, Gramma?” I asked. “El es-sprayo por los truckos?”

“Yes, that’s the stuff,” she said (en español). “I just say a prayer over it and spray my knees and my elbows, and, in the name of Jesus, the heat from the WD-40 loosens my arthritis.”

“What are you now, a robot?” I yelled at her (in English). She didn’t understand me. But she laughed.

My grandmother’s not dumb or losing her mind. Like many immigrants faced with problems that demand solutions beyond their resources, she looks inward, and backward, for help—or at least delayed consequences—resorting to superstition, old wives’ tales, or illogical assumptions. Anything, so long as it does not cost money. Seeking medical advice is the last option, akin to giving up hope and faith. This is how poor people have learned to cope in South Texas.

MY GRANDMOTHER has always been fanatical about work: In her teens and twenties, she picked vegetables in Mexico; through her thirties and into her sixties she ran a trucking company in Texas. She attacked any job with suicidal enthusiasm, right into her seventies, when she cooked in a restaurant. Now, at 84, she is no longer capable of working, and so she loans money to people in the neighborhood who can’t go to banks. They hock pistols and rifles for small loans, and Gramma charges a weekly interest. Because of the steady income, she’s actually considered a bit more well-to-do in her circles—a doña, a sort of upper-lower-class matriarch. Her benefits as a widow of a Korean War veteran also pad her modest income. Still, she avoids doctors, except in the most serious of cases. She does have access to Medicare and Medicaid, and has relied on them to cover treatment for two heart attacks. But, even to the extent that these programs make health care somewhat more affordable, there are additional barriers to her use of the medical system—namely, cultural isolation and fundamental lack of understanding. She comes from a community, after all, that depends on others to translate everything from state and federal policy to the weather.

Health insurance was rare where I grew up, in Brownsville, Texas, on the border with Matamoros, Mexico. Many families there lived a dual life, on both sides of the border—like the middle school kid who was recently shot and killed by the Brownsville police, when he brought a pellet gun to school and the police mistook it for a real gun. His mother lived in Matamoros while he stayed with relatives in Brownsville and attended school. When I was growing up in the early ’80s, the school district understood that the free lunch program was the only guaranteed meal many of the kids would have. I felt an unusual resentment and superiority that I had to pay for my cafeteria meals and that I had a grasp of English before I started kindergarten.

There was no encouragement from either the immigrant culture or the culture into which we were trying to assimilate to seek out any kind of preventive care. If an emergency arose, then it was off to Mexico to see a pharmacist and ask for a free consultation. Simple ailments could be treated with household products: On first-degree burns, the application of toothpaste (it cools, you see?) would set you right in a couple of days. Or you could try rubbing an egg on it while saying a Hail Mary, which would absorb the evil that would otherwise infect your wound. My brother, Dan, knew a kid whose grandmother made him eat Vicks VapoRub when he had a fever. The only insurance he and I remember having as children was the $15 paid to our school’s football program in case we got our necks broken or, as once happened to a kid I knew, our pinkies ripped off. But visit a doctor? Never. If you’re not hemorrhaging or suffering from an embolism, then you don’t get to see a doctor. That’s what we knew.

Cameron County, where my grandmother lives, boasts one of the highest ratios of uninsured in the state; one in three people have no coverage. In Texas as a whole, one in four people live without health insurance, the worst percentage in the country. (In theory, this situation should at some point be remedied by the Affordable Care Act, but—between the pending Supreme Court challenge and the prospect of a Romney administration committed to repeal—it’s far from certain that the law will ever take full effect.) Over the past ten years, infant mortality rates have risen by about 10 percent. Under Governor Rick Perry, the Texas legislature has already successfully passed a law cutting most of the funding to a program that offered loan repayments to doctors fresh out of medical school who started their careers in towns and counties with large numbers of uninsured. Meanwhile, he’s made noises about trying to undermine Medicaid—on which my grandmother and father depend. (They get their diagnoses in Brownsville but buy their prescriptions in Mexico, where they are far more affordable.) Both are deeply concerned about losing Medicaid coverage and live in fear that Perry’s reforms will affect them directly.

“You don’t think he’s going to win for president, do you?” my father asked me recently.

“Dad, he dropped out in January,” I said.

My family is not exactly illiterate: There’s a Ph.D. in the family, and my brother is a nurse in San Antonio. But even he only begrudgingly pays for his health insurance and is loath to take preventive measures. My stance is similar, maybe because we’re both childless. This attitude toward insurance is not singular to our own failings; we inherited it from the place we grew up. So perhaps I’m not the best advocate for regular blood pressure checks or arthritis medication that isn’t bought at the hardware store. But come a cold spell, I worry that I’ll have to figure out how to keep my grandmother from drinking anti-freeze. And how can I convince my father that lighting a candle to the Virgin Mary won’t help him keep his Medicaid? Few people who speak their language have the time or inclination to try to persuade them—and even fewer are willing to pick up the phone and call.

Domingo Martinez is a 2013 Pushcart Prize nominee and the author of the forthcoming memoir, The Boy Kings of Texas (Lyons Press). This article appeared in the March 1, 2012 issue of the magazine.