Poor and Immigrants’ Ignorance of Medical System Can Be Deadly

When a 5-year-old Fullerton girl died of complications from chickenpox on March 28, many people were shocked.

But those who work with the poor--from her school principal in Fullerton to several doctors to a vicar in the Catholic Church--say that untold numbers of indigent people in Orange County have the same problem as the parents of Sandra Navarrete: They do not know how to deal with Orange County’s medical system.

Father Jaime Soto, the Diocese of Orange’s episcopal vicar for Hispanic communities, estimated that thousands of Orange County’s newly arrived immigrants from Mexico or Central America would be “at a complete loss” as to what to do or where to go in a medical emergency.

Also, he said, “there are cultural and social gaps” so that new immigrants might prefer to use folk medicine, including a herbal healer called a curendaro, rather than seek out a hospital.

But even well-educated, middle-class parents sometimes badly misdiagnose the severity of a child’s illness, be it chickenpox or croup, and risk death by delaying needed medical care, some doctors said.

“Today, (even) with our medical technology, there are still children dying because they don’t know how to receive that technology,” said Dr. Floyd R. Livingston, pediatric director of the UCI Medical Center’s North Orange County Community Clinic. “It happens every day in America.”

No Money, Parents Said

Sandra’s parents, Emilio and Florencia Navarrete, had said that they did not immediately seek medical care for their daughter because they had no money and did not know where to go.

Livingston, who examined the Navarrete’s other three children after Sandra died, said he knows “a lot of stories” similar to Sandra’s situation, where a child had a high fever, was not taking fluids, got dehydrated, went into shock and died within 24 hours.

It happened during a recent measles epidemic in Orange and Los Angeles counties, Livingston said. He added that he has also seen children die of a fast-moving bacterial disease, meningococcemia, which begins with a rash that doctors who are not pediatricians sometimes misdiagnose as minor.

On Wednesday, Orange County’s public health laboratory determined that Sandra died after a severe and fast-moving streptococcus infection affected her brain in a rare complication of chickenpox.

Though Fullerton police were continuing an investigation into her death and whether her parents contributed to it by possible negligence, Orange County’s public health officer, Dr. L. Rex Ehling, suggested that the autopsy findings indicated that negligence charges were not warranted.

Ehling urged sympathy for the Navarrete family. And even as he spoke, parents of Sandra’s schoolmates at Richman Elementary School were showing their concern. By Thursday, they had contributed more than $310 to start a savings account for the remaining three Navarrete children.

Richman Principal Minard Duncan, who is administering that account, estimated that about 50 families at his heavily minority, 700-student school in southwest Fullerton are as needy as the Navarretes--and also as ignorant of the medical system.

That is nothing new for the administrators at Richman Elementary, Duncan said.

“They call us . . . for everything,” Duncan said. “You name it: welfare, food stamps, shelter (sometimes they don’t have a place to live), child abuse, used clothes.”

He recalled one situation in which a mother whose child had a bad toothache and infected gums called the school, not for the name of a clinic, but for cash to pay the dental bill. The school contributed about $15, the amount she needed. And later, when the dental bill was a few dollars less than expected, the woman gave the school a refund, he related.

Duncan said he was sorry that the Navarretes had not called. “Mrs. Navarrete might not have known she could ask us. Also it happened so fast.”

But childhood illnesses are like that. Common childhood diseases such as chickenpox or croup “can slip up on you,” said Ehling, a pediatrician.

“Things can turn sour in a big hurry with a child. Children both get well and get sick in a hurry. It’s a very nervous time when you’re a parent.”

And because “a child can become ill extremely fast,” there are cases of “misjudgment” in terms of assessing the severity of a disease, sometimes even by doctors, Ehling said.

He recalled working in a Denver hospital when a child with croup, whose parents were both physicians, died in the emergency room.

Childhood illnesses such as chickenpox are usually treated as routine and “that’s the way people handle it,” Ehling said. But rare complications can occur, so “second-guessing the way people went wrong is often fallacious,” he said.

Dr. Barry Behrstock, chairman of pediatrics at Hoag Memorial Hospital in Newport Beach, said he lives with the knowledge that “horrible things can happen to anyone at anytime. You don’t have to live long to realize complications can occur (with) any disease (that are) beyond anyone’s control.”

Still, “the main rule of thumb in pediatrics is good common sense,” Behrstock said, urging parents to contact their doctor quickly when a child is ill. “If the physician isn’t contacted, nobody has an opportunity to do anything. I’d hate to call that (not contacting a doctor) child abuse, but there are complications of chickenpox that are lethal.”