A Bhutanese refugee has been holed up in his southwest Houston apartment for months, downing pain killers. This isn't the new life he had in mind.
Rubber sandals cover the mat outside the spare, dim apartment. The man is embedded in an easy chair. He periodically winces and grabs his stomach.
The man, who is 40 with a delicate frame and thin black hair, asked not to be named. He and his family are of Nepali origin. They fled Bhutan in the 1990s during unrest over assimilation and spent 18 years in a refugee camp in Nepal. The man was a guard at the hospital; his younger brother, who also lives in Houston, taught math.
In 2007 the United States and other countries agreed to resettle many of the refugees. About 60,000 were approved for a move to America.
It took the man some time to get settled. His first job was fixing coils at a manufacturing company a three-hour bus ride from home. The stomach pains started after a couple of weeks, so he took a job at a nearby carwash. He had been working there about a week when he collapsed and started vomiting. That was in March.
Houston is one of the largest refugee hubs in the country, thanks to its relatively healthy economy and low cost of living. Between 3,000 and 4,000 arrive a year, according to Shirin Herman, one of two
directors outreach workers of the refugee program for the Houston Independent School District. The majority now comes from Iraq and Myanmar, but there are also large communities of Bhutanese, Burundians, Somalians and Sudanese, among others.
Refugees receive eight months of Medicaid. After that, they're expected to be working and able to take care of health insurance on their own. Many, especially children, suffer serious health problems from years of malnourishment and poor living conditions. And for some, the eight months isn't enough.
"In this situation, very often refugees are not getting those kinds of jobs [that provide health care]," Herman says. "It becomes an issue."
In the Bhutanese man's case, the problem has been a pair of relatively massive kidney stones, including one that is impossible to pass.
On March 12 an ambulance took him to the emergency room. He was discharged two days later with a prescription for vicodin and the name of a urologist. That's when he entered what Quynh-Anh McMahan, a refugee support volunteer who is helping with the man's case, calls the "rabbit hole" of the health care system in Houston.
Charles Begley, a professor at the UT School of Public Health, says the problems here are similar to those of big cities across the country: "We do have some resources, but not nearly enough. And so it's rationed by queueing, by waits, by red-tape paperwork."
McMahan called the recommended urologist, but, like a growing number of doctors nationwide, he no longer accepted Medicaid. After five more tries she finally found one who did. Then that doctor refused to see the man because, like many immigrants, he tests for a latent form of tuberculosis. With the man vomiting and in pain, McMahan brought him back to the ER.
Finally, on March 31, the man visited a urologist. He learned that only invasive surgery would remove the stone. But the doctor declined to perform it, because the man's Medicaid was up at the end of April, which would be in the middle of the process.
Harris County provides health care to people making up to 250 percent of the federal poverty level. McMahan and the man applied for a Gold Card on April 15, which would grant him access to it. The hospital district outreach worker they dealt with told them everything was in order. Then she dropped out of touch; when McMahan called the hospital district a week later, she learned that nothing had been filed.
The man finally completed his Gold Card application on May 12 and received it that day.
Jean Kegler runs a charity called ECHOS that helps immigrants with Gold Card applications. She says they face a number of barriers -- language and unfamiliarity with how to proceed, but also a system that struggles to prevent people from getting lost in the shuffle.
"It's not that nobody cares. There's just not a lot of people to go around," Kegler says. "They're doing the best they can. It's a tremendously overburdened system. If you don't understand the appropriate way to act, you are going to fall between the cracks."
Bryan McLeod, a spokesman for the hospital district, says the man's application appears to follow a standard timeline.
"The delays are usually on the applicant's side," he says. "Unfortunately, I think people only come to us when they have a [pressing] health issue."
There are between 1.2 and 1.5 million uninsured in the county, far more than the hospital district is sized to handle, according to McLeod. The district services more than 300,000 uninsured people a year, which can lead to lengthy waits for appointments.
Gold Card in hand, the man was able to schedule a consultation for surgery. It's set for September 1.