Friday, December 15, 2006

Katrina Begets a Baby Boom by Immigrants

Photo credit:Lee Celano for The New York Times
Sara Alvarado, a Honduran immigrant, with her son, Jackson Antonio, who was born in New Orleans.

Lee Celano for The New York Times

In the latest twist to the demographic transformation of New Orleans since it was swamped by Hurricane Katrina last year, hundreds of babies are being born to Latino immigrant workers, both legal and illegal, who flocked to the city to toil on its reconstruction.

The throng of babies gurgling in the handful of operational maternity wards here has come as a big surprise — and a financial strain — to this historically black and white city, which before the hurricane had only a small Latino community and virtually no experience of illegal immigration.
“Of all the myriad things that have changed after Katrina, this wasn’t high on anybody’s priority list,” said Dr. Mark Peters, chief executive of East Jefferson General Hospital in Metairie.
Because many immigrant mothers cannot afford to pay for prenatal care or delivery services, New Orleans’s newest citizens are adding an unexpected load to the decimated health infrastructure in a city abandoned by many of its doctors. Much of the state-financed Charity Hospital system, which before Hurricane Katrina provided the bulk of care to New Orleans’s uninsured and indigent population, remains closed.

Lacking health insurance and barred from most government assistance, expectant immigrant mothers can go to only the handful of charitable clinics that are still operating and that do not question a woman’s immigration status when offering low-cost prenatal care.
“Prenatal care is our daily nightmare,” said Shaula Lovera, the program coordinator for the Latino Health Access Network, an outreach service operated by Catholic Charities.
The two health units providing prenatal care run by the Louisiana Department of Health and Hospitals saw more than 1,200 pregnant women from January to mid-November. Virtually all were Latino immigrants.

“Before the storm, only 2 percent were Hispanic; now about 96 percent are Hispanic,” said Beth Perriloux, the head nurse in the department’s health unit in Metairie.
There are so many pregnant women that the clinics have reached capacity. Dr. Erin Brewer, the department’s medical director, said, “We’ve gone from having a maternity clinic two to three days a week to five days a week.”

Many immigrant women are forgoing prenatal care and showing up, ready to deliver, in hospital emergency rooms, where they are required to be seen even if they are in the country illegally.
“When I felt the pains I just went to the women’s and children’s hospital,” said Noemi, an illegal immigrant from Oaxaca, Mexico, who arrived in New Orleans right after the storm as part of a cleaning crew from North Carolina. She left the city but then returned in October, a month after giving birth to her daughter Alejandra in Lake Charles, 200 miles west.
“If they hadn’t received me, my girl would have been born in the hall,” Noemi said. (She asked that her last name be withheld to protect her identity.)
There has been a small Latino population in New Orleans for several decades, mostly Hondurans who came after Hurricane Mitch battered Central America in 1998. But that population has started to grow.

According to the Louisiana Health and Population Survey, released in November, the number of Latinos living in households in Orleans and Jefferson Parishes has increased by about 10,000 since 2004, to 60,000, even as the total population has fallen by about a quarter, to roughly 625,000.

Last summer, researchers at Tulane University estimated that there were 5,000 to 7,000 illegal Latino workers in Orleans Parish alone, excluding nonworking relatives. But some community workers estimate that tens of thousands have arrived since the storm.
Immigrants can be seen working on roofs, installing Sheetrock and laying tile all over town, from the up-market Lakeview neighborhood in the west to East New Orleans. At the Lowe’s home improvement store in the city’s Bywater neighborhood, clusters of day laborers mill about in the parking lot every morning, waiting for jobs.

Most are not new to the United States. They come from Texas, Florida or California, seeking construction work that can pay $150 a day. But there are some newcomers, including Sara Alvarado, a 26-year-old Honduran, who arrived in the United States in August after a monthlong odyssey through Mexico with her partner, Tony, 32.
When Ms. Alvarado finally got to New Orleans, brought into the country by coyotes, or smugglers, who charged $6,000, she was more than six months pregnant. The last time she had seen a doctor was four months before.

“The coyotes wanted to charge me more and bring me across in a car,” Ms. Alvarado said, sitting in her cramped room in a shotgun shack in the Upper Ninth Ward that she and Tony share with four other people. “But I didn’t take a single vitamin, and I came across that desert jumping fences and all that, and look, here is this boy.”

She cradled a plump bundle: Jackson Antonio, an American citizen who came into the world at Tulane-Lakeside Hospital 12 days early on Oct. 17, the day the 300 millionth American was born.

At Tulane-Lakeside, doctors are delivering 215 to 240 babies a month, which is 60 percent to 70 percent more than before Hurricane Katrina, said AndrĂ© du Plessis, the hospital’s chief operating officer.

Some of that increase is because of the lack of hospitals. But the numbers also reflect the new population. “Approximately 20 to 25 percent of the babies are Hispanic,” Mr. du Plessis said. “Pre-Katrina, we largely didn’t have a Hispanic population.”

Dr. Kevin Work, an obstetrician who started a private practice a year before the hurricane, decided to focus almost exclusively on the Latino population when he saw the abundance of immigrant women at the maternity clinics run by the Department of Health and Hospitals, where he works two and a half days a week.

“The demographics of the health units used to be 85 percent African-American, who had Medicaid, and 15 percent other,” Dr. Work said. “When the clinics reopened, I started seeing the faces changing. Now 85 to 90 percent are Hispanic undocumented, and only 10 to 15 percent have Medicaid.”

Dr. Work has been offering a low-cost prenatal care package, charging about $800 for the full term of a pregnancy, a small fraction of the typical bill. He also runs advertisements on the two local Spanish-language radio stations.

The boomlet of Latino babies in New Orleans poses particular challenges. Nonemergency Medicaid is not available to illegal immigrants or even to legal immigrants who have been in the country less than five years. Virtually none of the immigrant mothers-to-be have private insurance. They are mostly poor. Many fear being deported.

Hospitals will deliver these women’s babies only if they arrive in labor through the emergency room. There, emergency Medicaid pays for up to a 24-hour hospital stay for a vaginal delivery and a 48-hour stay for a Caesarean section, Dr. Work said.

Most of Dr. Work’s patients do not speak English. At the Department of Health and Hospitals’ unit in Metairie, where he sees patients Tuesday mornings, he relies on the “language line,” a phone-based translation service. Sometimes women arrive with one of the Latina translators who prowl the clinics and charge the patients $60 per session.
Dr. Work said he delivered 50 to 70 babies a month, most born to Latino immigrants. He even delivered Jackson Antonio, though he could not remember doing so, the memory lost in a blur of births.

The new population is having a tough time in New Orleans. Jackson Antonio was required to stay 48 hours in the hospital. But Ms. Alvarado had to leave after 24. “If I stayed longer they would charge me,” she said. She spent the next day looking for a car safety seat, which hospitals require to discharge new babies.

Health workers at Catholic Charities eventually found a car seat. They also gave her a crib, so her baby would not have to sleep on a mattress on the floor. Volunteers at Common Ground, a nonprofit assistance organization that opened a health clinic after the storm, have been trying to help Ms. Alvarado apply for assistance for her child.

Still, Ms. Alvarado’s life is mostly an endless hustle at the limit of subsistence. She started Jackson Antonio straight off on baby formula because she expected to go to work as soon as she recovered from the delivery. But she cannot leave home, because there is nobody to care for the baby.

Her partner, Tony, who declined to provide his last name, spends most days waiting with the day laborers at a Shell gas station near their home. But with demand for workers slackening, he is having a hard time finding a job. Just before Thanksgiving he worked 10 hours on an apartment building, but the woman who hired him disappeared before paying him his promised $120.

Meanwhile, bills are piling up, starting with repayment of the $6,000 they borrowed to pay the coyotes’ fee. They have repaid only about $1,300, Ms. Alvarado said. And they need $350 a month just for their share of rent and utilities.

Ms. Alvarado must also send money to Honduras for her two daughters, ages 7 and 9, who live with her mother. Tony has three daughters in Honduras, too, living with their mother.
Because Jackson Antonio is a United States citizen entitled to Medicaid, Ms. Alvarado gets a monthly ration of nine cans of baby formula, as well as powdered milk, canned juice, and eggs and cheese for her. But the staff at the food stamp office told her they were required to report any applicant who was an illegal immigrant to the authorities, so Ms. Alvarado did not apply.
She said she might return to Honduras because there was no point to staying if she could not work. “I came to make a future for my mother and my girls,” she said.

But if she can work, she will probably stay. And the baby boom may even provide an opportunity. She said she might go into business taking care of the babies of other Latino mothers.

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