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By JULIE MINDA

It was an encounter in the emergency department about four years ago that convinced Sr. Christine Mura, DC, of the need to shift her focus as a Hispanic outreach and pastoral care worker with St. Mary's Healthcare in Amsterdam, N.Y.

Called to assist a patient who knew virtually no English and who was in crisis, Sr. Mura found her lying on a gurney, bereft and crying. She spoke Spanish to the woman, whose name is Martha. "I learned that she'd just had her second miscarriage in a year and couldn't communicate with the health care providers. She couldn't ask whether she could have more children."

Sr. Mura comforted Martha, whose last name is not being used at her request. Over the ensuing months Sr. Mura got to know Martha and her husband — both of whom are undocumented residents of the U.S. — and she found her a Spanish-speaking provider who was taking uninsured patients. Based on test results, the doctor reassured Martha, who was in her late 30s, that she could conceive children. Sr. Mura has since helped her navigate the health care system during two subsequent pregnancies, and served as her labor coach when she gave birth to two daughters — the 3-year-old is Sr. Mura's godchild. Her baby sister was born June 11. (Martha has a 16-year-old daughter who lives in her native Mexico with Martha's mother, sister and other relatives. Martha crossed the border in 2008 to join her husband and brother in working in Amsterdam's dairy farm industry. She said she feared for her daughter's safety in the crossing, and so she left the girl at home with relatives.)

Before meeting Martha, Sr. Mura's outreach to the Hispanic community had principally consisted of providing general and medical translation and pastoral care to Spanish-speaking Puerto Ricans living in downtown Amsterdam. (The city's now-downsized carpet and textile industry had attracted Puerto Ricans decades ago; they've since maintained a strong presence.) Through her experience with Martha, Sr. Mura realized she also needed to seek out the most vulnerable Hispanics in the region — undocumented immigrants laboring in the dairy farm industry and living on the outskirts of Amsterdam. She now also assists these workers in navigating and accessing the health care system.She links them to social services, dental care, legal services, and spiritual support — whatever they require.

Hidden population
St. Mary's, which was founded by the Sisters of St. Joseph of Carondelet, created the Hispanic outreach and pastoral care position nearly six years ago at the urging of then-Vice President of Mission Integration Sr. Danielle Bonetti, CSJ, who wanted St. Mary's to bridge the language and culture gap between the hospital and Amsterdam's large Puerto Rican community. Sr. Bonetti traveled in the same circles as the leaders of Sr. Mura's congregation, the Daughters of Charity, and she asked those women if the Daughters had a Spanish-speaking sister available to work with the Puerto Rican population. They recommended Sr. Mura, who was serving in pastoral ministry for Spanish speakers at several Philadelphia parishes at the time, and had just taken a health care interpreter course. The opportunity with St. Mary's was a perfect fit, said Sr. Mura. Her congregation donates her services and funds some of her clients' medical and other expenses. The Sisters of St. Joseph of Carondelet and the Daughters of Charity are among the congregations that founded facilities that are now members of Ascension Health. Ascension Health is the parent of St. Mary's.

Julie Pierce, St. Mary's director of community benefit and outreach, explained that at first St. Mary's leaders thought Sr. Mura would concentrate on outreach to Amsterdam's Puerto Rican community. As U.S. citizens, most of them have access to some type of health care benefits, however, for various reasons, they may have trouble accessing appropriate health care.

After meeting Martha, Sr. Mura familiarized herself with the lives of the immigrant farmworkers and she reported back to the hospital on their unmet health needs. "We realized the greatest need was this whole different world with the dairy farm population," Pierce said, and Sr. Mura expanded her focus to include both Hispanic groups.

In rural Amsterdam and the surrounding area, there are dozens of dairy farms that employ workers from south of the U.S. border, primarily Mexico and Guatemala, according to Sr. Mura. Sr. Mura does not know how many immigrant workers there are locally, but she estimates she has linked about 60 immigrants to health care or social services.

Sr. Mura said foreign laborers who lack work visas and their families "live in fear — they are hidden." They do not know who they can trust; and because of the threat of deportation, and because they are poor and have no right to health insurance, they avoid health care institutions. The vast majority only seek health care services for births and work accidents, said Sr. Mura.

Patience and trust
Since she began making inroads with immigrant workers about four years ago, she has earned trust, one family, or even one individual, at a time. Those clients vouch for her and encourage other families to contact Sr. Mura when they are in need.

"It must feel risky to them when they call me for the first time, so I'm always concerned that I need to establish a relationship out of a sense of solidarity and service," Sr. Mura said.

Sr. Mura said she begins by getting to know each immigrant as an individual. She assures her clients that she will only connect them with providers and partners who will respect their privacy. She promises that neither she nor any of the providers or agencies she refers to will report them to immigration authorities.

"I receive the gift of trust. And, besides facilitating access to services, I think what people appreciate most (from me) is being able to share their stories and being heard. (As undocumented immigrants), they can feel invisible and feel like nobody. When I am responsive to them, they feel like people again. They feel they can share their life stories and have someone available to them in their challenges."

Sr. Mura said in most cases the children of the immigrants are eligible for New York's Child Health Plus, a state health insurance program for underserved children who do not qualify for Medicaid.

Sr. Mura has built up a network of St. Mary's providers, nonprofit agency partners and others who will work with adults who are uninsured and unable to pay much for their health care. (Most of her immigrant farm family clients qualify for charity care at St. Mary's.) If her clients wish, she makes appointments and provides translation at the meetings.

Sr. Mura's clients have her cell phone number; she is available to them around-the-clock.

"She's a modern-day missionary," said Sr. Joan Mary Hartigan, CSJ, St. Mary's vice president of mission integration.