Maria first learned about the Phoenix Urban Health Collective (PUHC) in the middle of one of her many car washes. She was hosting these carwashes as fundraisers in the hopes of raising $22,000 to pay for a surgery that she otherwise would not be able to afford, without health insurance, on her tamale-vendor income.
Then somebody stopped her and told her there might be another way. He took out his phone, and started dialing. His friend, Jason Odhner, a registered nurse with PUHC, answered.
"I was told that there was a woman who had a tube in her stomach," Odhner said. "They didn't know any details past that. Just that she was very sick and they requested that I go and visit."
When he did, he found Maria – who asked that her last name not be used – who had been living with this tube for months after an emergency surgery. She didn't pay for the surgery because the doctor determined her situation – a swelling gall bladder that might have quickly gone septic – was a medical emergency. But when she went back to the hospital to get the tube taken out, she was told the tube-removal was not an emergency and she would need to pay up front. Only when the tube inevitably infected could she come back for another emergency operation.
Confused yet? So was Maria. Which is why when PUHC stepped in to help, it seemed to her almost cinematic.
"It was like a movie," she said, in Spanish. "Like a beautiful movie...because they just told me to get ready, nothing else. Just: 'Let's go.'"
PUHC's network of doctors and nurses were able to move Maria through the system quickly and quietly. They do this when they can't resolve a patient's issue at home or over the phone; a situation Odhner said is rare.
"A lot of times, all people need is a nurse. A lot of issues can be dealt with without using pharmacological interventions," Odhner said. "For example, I had a woman recently who had a cut on her hand that wasn’t healing..."
Sometimes it’s this simple: Odhner suggested that the patient stop pouring hydrogen peroxide on the wound and instead use a sterile saline solution, cheaply found in contact lens solution. Other times, PUHC see patients with diabetes or serious infections, as with Maria's emphysematous cholecystitis, that require their expertise in navigating America’s healthcare bureaucracy.
Initially, PUHC was just meant to provide medic support to protesters at rallies against Sheriff Joe Arpaio's immigration enforcement tactics in late 2009. While there, Odhner met other activists, who later called and asked if PUHC would do home visits too. Many migrants feared that healthcare, even 911, was now off limits to people without papers. Diana Perez Ramirez is with the migrant advocacy organization Puente.
"It doesn't occur to a lot of people anymore – they don't feel comfortable, they don't feel safe," Perez Ramirez said. "They don't know if it's going to lead to something worse, like contacting other agencies."
One reason why undocumented migrants may justifiably fear this is because the Arizona legislature considered making it law earlier this year. SB 1405 would have required hospitals to track the numbers of unauthorized immigrants seeking care and to report them to law enforcement. Right now, hospitals don't even ask.
"Now, when we ask [hospitals] next year, how many illegals did you treat? Instead of the same 'I don't know!' they can give us an answer!" said State Senator Steve Smith, who introduced SB 1405. "And now we can put a legitimate hard value cost to what we spent on them."
The bill didn’t make it into law this year, but Odhner said the threat did bring more medical professionals into the immigration conversation.
"There's no question," Odhner said, "that the attempt to pass SB 1405 and the attempt to essentially forcibly conscript medical professionals into basically this de facto immigration army did a lot to upset medical professionals."
Currently, Odhner says PUHC has over 30 volunteers, and growing. He said their call volume is growing too as word of mouth from patients like Maria spreads.