Being an undocumented immigrant, my family and I had no health insurance or understanding of the healthcare system. We did not think there were affordable healthcare facilities for us. My parents did not want to be burdened with medical debt and thought a medical visit would cost hundreds of dollars out of pocket. Our option then was to wait and hope our pain would subside. Due to this, my family and I never went to yearly physicals or made appointments for sick visits. Preventative visits were not an option, so my family resorted to ignoring aches and pains . After working at a Community Health Center, I've learned that there are resources and facilities that assist underserved communities like the one I come from. It is a safety net for those who have fallen through the cracks in the healthcare system. A new refugee family would arrive every week to establish medical care. They had difficulties navigating the healthcare system because of the language barrier, low socioeconomic status, and cultural differences. We were the first transition into establishing a new life here in America. Grants allowed for health professionals to provide quality primary care for uninsured patients. Although the clinic charged based on a sliding fee scale, the cost for services was still expensive for those who are low income. Some couldn’t afford to take time off work, find childcare, or had difficulties with transportation. It is essential to acknowledge the challenges patients face when providing health care and offering a safety net for those who fall through the cracks. I easily relate to the difficulties of the patients. English was a second language my parents struggled to master. Anxiety loomed over us as we entered spaces with only English speakers. My parents either talked through a phone interpreter or used me as an interpreter. Some places preferred my mother's broken English to communicate, but it often left my mother confused. I tried to fill in the gaps, but with low medical literacy, how could I say the word in Spanish if I needed help understanding it in English? In moments of confusion, I have learned to be patient and compassionate as I know what it feels like to be in their shoes. There are additional difficulties that come with being low-income, and it is essential to acknowledge them when providing health care and offering a safety net for those who fall through the cracks. I acknowledge that these feelings are not exclusive and are felt by many people who have difficulties in healthcare settings due to their socioeconomic status, low medical literacy, or cultural differences. When people seek medical help, they want to be seen and heard. I want people to have a sense of autonomy in their health decisions without the fear of not being understood. My experiences are a guiding force for my goal to be a physician assistant.

When my friends asked me if I was born in the US, I would say yes to avoid the additional questions that came with it: How did you get here? What is Mexico like? In grade school, I knew these questions came from a place of curiosity, but later they felt more like an interrogation. I worried they would learn of my legal status, so I chose the safer route: say Yes, I am just as American as you. This is not far from the truth; Mexico is a place my family yearns for, yet I have no living memories of my birth country. I wanted nothing more than to be American as I associated it with wealth, prosperity, and education. I dreamed of blending in and hoped people wouldn’t notice my differences due to being Mexican. I felt a sense of shame because I feared they would associate me with being poor and unintelligent. I refrained from sharing the struggles I experienced as an immigrant because I assumed they were exclusive to undocumented immigrants. Although, my desire to identify as Mexican or American caused turmoil within myself, I navigated these two cultures in a way that allowed me to create a new definition of the American dream. Instead of shame, I have learned to have pride in my upbringing as it shaped my dream. My parents expressed affection through unwavering sacrifice for others. I am familiar with the hard work necessary to reach my goals. From a young age I worked with my mother, a housekeeper, during school breaks while my father toiled six days a week on farms. Because of their legal status, working long hours without benefits or legal protection was their only option. Their work ethic instilled a resilience in me not easily deterred by the obstacles I encountered because of my undocumented status. The roadblocks I experienced discouraged me from envisioning a future path to higher education. I first saw doors close for my older brother as he started to navigate the system with no way to work legally or go to college. Luckily, DACA offered us a lifeline. There was a legal pathway for my brother and I to work towards the future our parents dreamed for us. However, DACA has always been a temporary solution, with my legal status coming into question every two years. However, I continue to push forward despite the instability. When my parents reflect on their life in Mexico, I remind them of the life they have built for us here. I have seen the toll unconditional sacrifices have taken on my family, and I don’t take them for granted. Their work ethic has motivated me to advance through obstacles. America has always been a mix of ideas and values. The greatness of this country is one of new beginnings and flexibility, with people taking pieces of their history, experiences, and environment, and creating something new for themselves. I, much like the country I now call home, am a mixture of values and outlooks. I have taken my upbringing from my Mexican household and have confluenced it with new things I learned in this country. I no longer must grapple with the two ideas I had of being exclusively American or Mexican. I created a New American Dream for myself: live a life worthy enough to share and inspire others. My family inspired me, but I have also been inspired by ordinary people I meet. Everyone lives different experiences that come together to form their story and our many stories together make America a canvas to live vibrant dreams.

“Preguntale, Diana." My cheeks felt hot. The seconds that passed felt like an eternity. “Es que no se como decirlo en ingles.” "Preguntale!" They both looked at me while my brain arranged the words in one language to the other. "My mom asks how much this will cost." This skeleton conversation was one carried out in multiple settings: grocery stores, school, and in healthcare settings. I was the walking dictionary, even a language creator when I didn't know the equivalent word to interpret. This responsibility often came with embarrassment and annoyance: the embarrassment of my parents or family members not knowing English and the annoyance that I had to mediate the language barrier. Ultimately, the responsibility became a reason for indignation as I interpreted for my aunt during the beginning of the COVID-19 pandemic. While echoing the oncologist's words, I informed her over the phone that her cancer had metastasized and about thirty tumors had spread throughout her digestive system—English, Pause, Spanish, English, Pause, Spanish. I explained the treatment plan and apologized for the news in the same tone the doctor had. I pushed back the sorrow I felt and worst-case scenarios running through my head. The worst-case scenario I feared was eventually our reality. I spoke out my aunt’s death sentence when I interpreted the new medical diagnosis, at least that’s how I remember it. I should never have been put in that position, and my aunt deserved to have the resources to speak with and understand the provider. Unfortunately, my experience is not unique; language barriers are present in many settings, but I have directly seen the danger in health care, which is why I want to be a Physician Assistant. At Health Brigade, my training as a volunteer interpreter involved a PDF of general medical terminology and joining a video call to observe another volunteer. When I interpreted for a gynecological exam in person, I realized I knew very little about reproductive health in Spanish. When I shadowed a provider, the video interpreter lost signal multiple times, causing miscommunication. I then questioned the efficiency of some interpreting services. After my internship there, I knew I wanted to be a provider to diminish patients' barriers when communicating about their health. Doing so will empower patients with autonomy in their health decisions and help reduce the anxiety of meeting with healthcare professionals. As I reflect on the moments with my family members, I realize they experienced fear and shame—the fear of not being understood and the shame of not being able to speak for themselves. Those who need an interpreter give up their independence and trust another person to speak for them. Being an immigrant, I understand the shame and guilt of language barriers. I acknowledge that these feelings are not exclusive and are felt by many people who have difficulties in healthcare settings due to their socioeconomic status, low medical literacy, or cultural differences. When people seek medical help, they want to be seen and heard. I want people to have a sense of autonomy in their health decisions without the fear of not being understood. I can do this as a Physician Assistant.

When I graduated from college, I searched for a job that served those in my community. The Community Health Center's (CHC) first mission was to help farm workers in the Bluegrass area. It has now expanded to serve multiple underserved populations across various counties in central Kentucky. The clinic provides comprehensive health screenings to refugees who come to Lexington, offers mental health services and treatment for those with substance use, and provides primary care for uninsured/underinsured patients. It has become a safety net for those who have fallen through the cracks in the healthcare system. A new refugee family comes to CHC every week to establish medical care. Refugee patients have difficulties navigating the healthcare system because of the language barrier, low socioeconomic status, and cultural differences. I remind myself to be patient with them and explain procedures or instructions multiple times to ensure they understand. We are the first transition into establishing a new life here in America. CHC provides health services for individuals in nearby recovery homes. I listen without judgment as they share the reason for the visit. Many apologize for the scars on their veins from using IV drugs when I draw their blood, but I assure them everyone at the clinic will do their best to care for them. For some, their recovery can be three steps forward and one step back, but we remind patients that they are still moving forward. We celebrate their progress, whether it's been five years or one week. CHC receives grants to provide quality primary care for uninsured patients. Although the clinic charges based on a sliding fee scale, the cost for services is still expensive for those who are low income. They can't afford to take time off work, find childcare, or have difficulties with transportation. It is essential to acknowledge the challenges patients face when providing health care and offering a safety net for those who fall through the cracks. I easily relate to the difficulties of the patients. English was a second language my parents struggled to master. My family struggled with the language barrier and the lack of medical literacy. Anxiety loomed over us as we entered spaces with only English speakers. My parents either talked through a phone interpreter or used me as an interpreter. Some places preferred my mother's broken English to communicate, but it often left my mother confused. I tried to fill in the gaps, but with low medical literacy, how could I say the word in Spanish if I needed help understanding it in English? I have seen BCHC support its mission statement by hiring bilingual and even trilingual staff who speak Spanish, Swahili, Arabic, and Kinyarwanda. As a clinical assistant, I see patients' relief when they can express their native language. In moments of confusion, I have learned to be patient. Patience is necessary as it takes more time for patients to understand medical information given to them, and compassion as I know what it feels like to be in their shoes. My work experience at CHC has allowed me to serve members in the Commonwealth of Kentucky. I have learned to be patient and show compassion in moments of heightened worry. Many patients share their life story with me in the short ten minutes we are together. I encourage them with my spirit with words of empathy. I help foster an atmosphere where they feel comfortable and safe. CHC has allowed me to give back to my community by allowing me build relationships with those marginalized around me.