A diabetic's dilemma

When Fe Del Carmen Trinidad's children sponsored her application for permanent US residency several years ago, it seemed the right thing to do. At the time, Trinidad, now a 69-year-old legal immigrant and Lawrence resident, was living alone in her native Santiago, Dominican Republic. Her 17-year battle with diabetes had taken a turn for the worse. Her blood pressure was skyrocketing. And she had developed osteoporosis. While her children had been sending home $50 per week to support Trinidad, they figured they could care for her more easily by bringing her here.

"We thought it'd be better to have our mother with us," says Dulce Valentine, one of Trinidad's three children living in Lawrence.

Yet soon after Trinidad arrived in Massachusetts last April, she and her family discovered just how expensive it would be to meet her health-care needs. For starters, there was the price of her six prescription drugs, which consist of injected insulin and pills to control her blood sugar, as well as pain, calcium, and blood-thinning medicines. The total cost per month: $353. And that doesn't even take into account the cost of regular medical appointments to manage her glucose and blood-pressure levels.

For the first month, Valentine and her siblings paid for their mother's health care, but just barely. So they helped Trinidad apply for full-coverage Medicaid, for which she was eligible as an elderly, legal immigrant earning no income. She received her Medicaid card in the mail last June.

By early September, things had improved. Trinidad had gone from a dangerously high blood sugar to a more stable one. She had gone from visiting her doctor twice a month to once a month. "I was managing my diabetes," Trinidad says. But by early September, she had also gone from insured to uninsured. When she tried to renew her prescriptions that month, the pharmacy informed her that her Medicaid benefits had been terminated.

"I thought, 'Oh, Dios mío,'" recalls Trinidad, speaking in Spanish through an interpreter. Trinidad is a squat, bespectacled woman who tends to laugh boisterously, anxiously, when talking about her predicament, as if to hide her pain. She adds, "It meant everything to me that I had this coverage. I'm alive because of it."

Since Trinidad lost her Medicaid benefits, her three children have bought her insulin, pills, and supplies, which cost about $200, because, as Valentine says, "she'll die without it." But they've had trouble financing all her medications. As a result, Trinidad has begun rationing her health care. She has stopped visiting a doctor. She has cut back on her daily dosage of insulin and blood-pressure medications. And she has cut out her osteoporosis medicine altogether.

But such drastic measures have consequences. Just last month, Trinidad noticed that her heart has begun to beat faster. She gets dizzy more often. She shakes. To calm herself down, she has taken to chewing garlic cloves - an old wives' remedy. But garlic doesn't do anything for the pain associated with osteoporosis - her aching legs, her numbing feet, her swollen ankles. That she cannot seek preventive health care any longer has left her frightened. "I don't want to die," she says. Indeed, she knows all too well what can happen when she messes with medications. In Santiago, she once reduced her insulin by half in order to stretch the prescription and save money. Within days, she collapsed and had to be hospitalized for four days.

"It's depressing," says Trinidad, who is considering a return to Santiago if her medical condition continues to deteriorate. "I feel like I'm in the middle of nowhere. I'm in limbo."