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(acoustic guitar music plays)
(jet passing overhead)
(indistinct chattering)
(man speaking Spanish)
(woman speaks indistinctly on phone)
♪ ♪ (indistinct chattering)
(speaks Spanish)
Mm-hmm, mm-hmm.
Mm-hmm, mm-hmm, mm-hmm.
Yeah.
Mm-hmm, mm-hmm, mm-hmm.
♪ ♪ (indistinct chattering)
(Juan speaks)
(Annette speaks)
(Juan speaks)
(Annette speaks Spanish)
Oh, okay.
♪ ♪
(breathing deeply)
Okay.
(speaking Spanish)
Steve: Immigrants aren't a popular subject politically.
That's a population that doesn't come up under the Affordable Care Act.
There's just no private insurance for these guys.
(beeps)
Ninety percent of the immigrant community
that we work with is undocumented.
Almost 100% are below the poverty level.
In many communities, they're invisible.
(laughs)
Steve: We take care of the Dream Act kids.
Kids who came across when they were maybe one or two years old
and they're now 13, 14, need healthcare.
We're here for them.
What you have to do is come up with a comprehensive program
that acknowledges the presence and then finds ways of funding the cost.
Louis Olivera?
You're talking immigration reform,
and that's mired down in the politics...
on both sides, you know?
And... it-- it's-- it's not ready to be brought up.
♪ ♪
(indistinct chattering)
(woman groans)
(Daphne Owen speaks Spanish)
Daphne: She came in for substernal chest pain
that radiates to her back. She works in house cleaning,
so when she's leaning over, cleaning stuff,
and then stands up, she gets this pain,
so she went to Thomas Jefferson.
She got a bill.
She's very concerned about how she's gonna pay the bill,
because it's... pretty big.
(speaks Spanish)
Mm-hmm.
So this is her trap, her trapezial muscle,
so I'm suspecting that she's just got a lot of overuse.
(speaks Spanish)
(woman speaks Spanish)
Okay, okay.
(speaks Spanish) (woman speaks Spanish)
(woman speaks)
(crying)
Yeah.
(crying)
(speaking indistinctly)
(speaking Spanish)
Annette: Mm-hmm.
♪ ♪
Steve: It was around 2003, and we were asked
by a mutual friend to help come up with a solution.
It became really clear that nobody really wanted to take on this population.
There was a need, and it just would manifest itself
by showing up in an emergency room,
when that's the least cost-effective way of managing a person's care.
So we just said, "You know what?
We're just gonna do it, so."
♪ ♪
(receptionist speaks Spanish)
(speaks Spanish)
So, today is a routine day,
and we have only 52 patients to see.
Just pulling her-- you start seeing the uterus, right?
You see it? Very clearly. Mm-hmm.
How about here? (thumps)
More tympanic. Why?
Air. Air.
(ultrasound whooshing)
(people chattering)
(Jack speaks)
(mother speaks) (Jack speaks Spanish)
(mother speaks) (Jack speaks)
(mother speaks, laughs)
(Jack speaks Spanish) (mother speaks)
(Jack speaks)
Daughter: Yeah, I'm fine.
Jack: I don't have to worry? No, you don't.
I'm fine. (Jack speaks Spanish)
(speaks Spanish)
(Jack speaks) Mm-hmm.
Yeah. (speaks Spanish)
(Jack speaks)
Yes. Mm-hmm.
Jack: Okay. Thank you.
(Jack speaks)
(laughs, speaks Spanish) Cooking.
We were frying meat, and then...
she was, like, I guess she dropped the meat, like,
too fast... (Jack speaks)
...into the frying pan. Diane: Oh, the--
(speaks Spanish) 20 week-- 20 days ago.
(Jack speaks)
(laughs) Yeah.
I'm telling you, you don't have to worry when I'm doing that.
(speaks Spanish) No.
Mother: Si. Yes.
No. No.
Jack: Promise me. Yes, I promise.
I'm doing it for you, not for me. I know.
I haven't self-harmed in, like, a year and a half already, so.
But you understand why I'm concerned? Yes, I understand. Yes.
So, just give her a minute. (people chattering)
S-so... you know,
um, this kid has a history of suicide attempts.
Diane: Yeah, I noticed that on the records.
So that's the reason I always pay attention to everything.
You see? Diane: Yeah.
That huge mark, and I don't know to believe it or not,
that it was an accident, a hot something.
You know, 'cause whenever I hear the story of someone that has a story of abuse
or that and I see marks and all that,
and the excuse is, "Something hot fell onto"-- Fell on you?
You always have to be concerned if that's real or not, okay? Mm-hmm.
Was she able to get follow-up care
with a psychiatrist or therapist?
Well, probably not, but...
♪ ♪
(speaks English)
♪ ♪ (chatting in Spanish)
(door creaks) (woman speaks on P.A.)
And it's been probably six months since our last staff meeting
just because of the transition and the summer.
Are we okay with trying to reinstitute monthly staff meetings?
That's going to be important in anticipation of this new space...
Yeah. ...so everybody's on the same page.
And we can shore up, put resources where they need to be.
Annette: What you missed a little bit earlier, Steve,
was we're having between eight and 12 new patients,
plus our established patients, plus the walk-ins.
Yeah. No, I crunched the numbers about... a month ago
looking at, you know, the patient flow and the volume,
and it's-- it's dramatic, the increasing visits.
It-- it just keeps rising. Annette: Yeah. Mm-hmm.
Annette: Mm-hmm. We just have to tread water for a little bit longer.
(people chattering)
(sighs)
(beeps)
So he has a colostomy bag now,
that he's had for three years. Right?
Mm-hmm. And so I asked him what they told him
in terms of when he needs to come back,
and he said they haven't told him anything
because he didn't have insurance.
(sighs) Do you know anybody at Jefferson with GI surgery?
Well, the problem is going to be getting him in to get an operation...
if he's uninsured without it being em-- an emergency.
(nurse speaks Spanish)
Si. Okay.
(mutters) All right.
Steve: What I'm gonna do is make a phone call
to some friends to see what we can do.
I know some folks that are supportive
and sensitive to the cause...
Okay. ...so maybe we'll be able to get it.
Okay.
Listen, so-- so this is a tough one,
'cause the guy is healthy, looks great, 33, you know.
Has a fricken colostomy bag, and it's like, "Dude."
♪ ♪
I know.
Nah, you can't, you can't. No.
No, the health system has to-- you know.
It-it-- it can't happen.
Nah. All right, man.
All right, boss. Thanks. Yup. Bye.
(phone clatters)
♪ ♪ (exhales sharply)
That's not gonna happen.
Medicine's changed.
When students go into medicine,
there's this idealism.
There's this sense of, "I want to do well
by communities and individuals."
You know, the idealism is great,
but if there's nothing to sustain that,
then it gets washed out pretty quickly.
♪ ♪
What is this? So the patient had a headache, right?
Yeah, so she had a very bad headache that wouldn't go away,
so she went to the emergency room,
and the bill is for... $3,856.
Yeah. And what did they give her? A Tylenol, right?
They gave her two aspirin, acetaminophen, caffeine pills,
one urine collection kit,
one PET-U visit, and one observation.
Jack: Mm-hmm.
(woman speaking Spanish)
Jack: This is the thing that kills me, okay?
"Good luck."
"Good luck," huh?
Okay, so we really need to follow up on this one, okay?
(speaks Spanish)
(woman speaks) Honduras.
(woman speaks)
♪ ♪
(screeches)
(indistinct chatter)
Steve: In the '90s, what you had was
a distinct demand for cheap labor
coming out of Central America.
The urban sprawl, you know,
that's taking place in what was once farm country,
it's now being converted into these two-acre plots with a mansion on it.
That's happening in parallel with the demand for nannies,
the demand for landscapers, the demand for cheap labor to work in restaurants.
They're in this country
because, in a way, we've invited them.
(woman speaks Spanish)
(man speaks Spanish)
(Daphne speaks)
(man speaks)
(Daphne speaks)
Okay. (speaks Spanish) No.
Okay.
Yeah, okay. (speaks Spanish)
(both laugh) (speaks Spanish)
(speaks Spanish)
(man speaks)
(speaks Spanish) Ah. Okay.
(man speaks)
Woman: Oh! Okay.
♪ ♪ (people chatting)
Steve: I think we're short-sighted.
We'd rather not even open the door
to embrace that they're human in a way.
Because once you open the door and admit that they're real,
they're live, they're palpable, they're part of my community,
it's like driving by a car accident:
You're either gonna stop and help or you're not.
(people chattering)
(clattering)
Over the past 10, 15 years,
there's been a very large influx,
a predominantly Mexican labor force
directly involved in many of the restaurants
up and down the-- the corridor here.
We have gone into the backs of some restaurants
just to talk with workers, and, you know, it's amazing
the number of patients that show up the next week.
We now have a physical space
that you can actually see and touch.
And the community will, you know, have access to,
and that's really exciting for me
to be able to house all of these programs in one-- one area.
You know, the result of it is, though,
that there are gonna be ongoing, you know,
needs and costs and money and budgets,
and things like that that I have to pay attention to.
It's an absolute no-brainer
that we as a restaurant community should be involved in this,
and should help our people out and help Steve out.
And for myself and my staff,
we've used Puentes quite often.
Um, Steve has personally saved
at least two people's lives on my staff.
How about we do an event one night a year?
Plates for Puentes.
We each give a third or we--
we're figuring a third of our proceeds to Puentes.
You can't. It's too much.
Man: What do you mean too much? Too much work?
It's a lot of money at a certain point to some people.
Like, if Parc participates in it,
Parc is going to do $40,000 that day.
Man 2: Is this the primary fundraiser for the year for you guys?
Is this-- is this-- Yeah, I mean...
What's the tagline though? How-- what-- what's capturing the people's--
I mean, many people are becoming familiar with "the back of the house"
and the reference of that. Woman: I like "back of the house."
"The people who prepare your food at your favorite restaurants,
give back to them," or something like--
something like that. Woman: And they're gonna say, "Why don't you, asshole?"
Excuse my language. We are. We are.
Woman: But they're gonna say, like, "Why don't you just pay them more?"
Man: Do you need that? Woman: Nope.
(speaks Spanish)
Ehh...
(Jack speaks)
Honduras.
(Jack speaks) What?
Jack: She just arrived.
(Jack speaks)
(mutters, chuckles)
Jack: This woman doesn't even know.
She just arrived 20 days ago.
(Jack speaks)
So... (speaking English)
(doctor speaks) ...ultimately.
Yes. So...
That's...
...or someone that-- Mm-hmm.
Mm-hmm. Mm-hmm. Right?
♪ ♪ Yeah.
Steve: When we started laying the foundations for Puentes,
we kind of kept things on a low burner,
you know, just slowly moving forward.
♪ ♪
I don't think up until probably the last election
that there's really been a palpable sense of the inevitable,
that immigration is real, that political parties
are going to have to address it.
The change is already happening.
It's just a matter of time until they realize
that this is the new face of America.
These are the, uh, exam rooms.
This is gonna be one of our bathrooms.
Jack Ludmir had a specific request
for two bathrooms, particularly for the pregnant women.
♪ ♪
You know, now the fun begins...
getting the long-term funding to sustain operations.
When I first showed up here six years ago,
you guys were still in a basement at Saint Agnes...
Yeah. with like two tiny closets that you were seeing patients in.
I never would've thought--
I mean, I know you say you had a master plan,
but like I never would have thought that this would actually happen.
Steve: Hello, guys.
Hey, what's up?
♪ ♪
Daphne: You know, I told you last time after I went to see her,
that she didn't look very good, you know? Yeah.
The plan had been that there was going to be several rounds of chemo and...
So, we you know, when she finally told me that--
she called me and said that they were going to discharge her from the hospital,
'cause they had decided there wasn't much else to do.
I was just surprised because...
it wasn't the original plan, I guess.
(sighs)
(speaking Spanish)
Okay. Yeah.
Steve: Mery was in house cleaning.
About a year a half ago, she was diagnosed with leukemia.
We put her into the system where she started getting chemo.
You know, as we started talking to her,
I remember she just started breaking down.
She was just adamant that she had to get back to work.
She was in a really bad situation, because she didn't have a lot of support here
and had stopped being able to work.
She was so sick, and so she really felt
that there was some resentment towards her also,
you know, in the hospital, yeah.
Insurance or just-- No.
But it's hard 'cause what, you know, can the hospital do?
They say, like, "All right, we're done, go home,"
but, like, how's she gonna get home?
(scoffs) Like, how's she gonna go back?
Steve: She would have to go around the coast. We want one stop.
(Annette speaks Spanish)
How about this: Her kids are in Roatan.
Does she just want-- would it be easier
to just take her from San Pedro Sula-- a charter-- to Roatan?
Gracias.
(speaks Spanish)
(laughs)
(both laugh)
Okay.
Well then...
(speaks Spanish)
Mmm.
Yeah? Okay. Okay.
(people chattering) (keyboard clacking)
Steve: You okay?
Bless you. Steve: Why don't you guys chat?
Here's your passport back.
Daphne: Yes. We'd love to come.
(Daphne speaks)
(coughing)
♪ ♪
(Mery speaks)
Si? Si.
(Mery speaks)
(coughing)
Steve: Hey, Daph. Steve. Hey, what street was
that, um, Honduran restaurant you were telling me about?
(people chattering)
(Mery speaks)
♪ ♪
(sighs deeply)
There are a lot of single women
who, um, have come north to work,
and they leave their children behind.
And, I mean, what a sacrifice.
Mery's been here for eight years, nine years.
Her oldest son's 18. Her youngest son's 14.
She hasn't seen them in 10 years.
♪ ♪
(Daphne speaks)
(both speak Spanish)
(woman speaks)
Woman: Puebla.
(woman 2 speaks) Puebla, Puebla. Okay.
(woman 2 laughs)
(both breath deeply) Again.
(speaking Spanish)
No.
Okay. Okay.
(laughs) Sí.
(woman speaks)
Daphne: Okay.
Mm-hmm.
Okay.
Mm-hmm.
♪ ♪
Steve: With many of the people that we deal with,
they're working very long hours in the shadows of society,
always worried about something
that reveals who they are or exposes them.
You know, it's a tough way to live your life.
♪ ♪
Hola, Mery.
(continues speaking Spanish)
♪ ♪
(Daphne speaks)
(Mery speaks)
(Daphne speaks)
(Mery speaks)
♪ ♪
(people chattering)
(speaks Spanish)
Umm...
(Mery speaks)
(laughs)
Umm...
Si.
Si. Si.
♪ ♪
Yeah. Thank you.
Daphne: Hey.
(Mery speaks, crying)
Daphne: Si.Okay.
♪ ♪
(crying)
(woman speaks indistinctly on P.A.)
(indistinct chatter on phone)
Hey, man, you did-- you did right by her,
and, like, you know this is a thing I've said before,
but, like, whether it's me or, like, other students,
you guys really like-- you know you guys have had such a big impact on like--
on helping me understand how I wanna--
you know, like how-- what kind of doctor I want to be. So, thank you.
♪ ♪