The Proyecto SALUD team of researchers, volunteers and dental care providers pose at a recent health fair in Belgrade. Credit: Proyecto SALUD

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BOZEMAN — Buried in Montana State University’s Mark and Robyn Jones School of Nursing, right next to the campus duck pond, is a laboratory with no microscopes, no latex and no goggles. The space is called the Moyce Immigrant Health Lab, also known as Proyecto SALUD — “Scientists And Latinos United against Disparities.” In Spanish, it also means “health project.” 

The lab was created by assistant professor Dr. Sally Moyce and includes an interdisciplinary group of researchers working to address health disparities in the Latino community in Gallatin County, a population that has increased dramatically in recent years. According to the census, Gallatin County saw a 138.7% increase in Latino or Hispanic residents between 2010 and 2020.

When Moyce moved to Bozeman, having worked with Latino immigrants before in Oregon and California, she saw a need. 

“When I moved here, I noticed a real absence of Spanish-language services and resources,” she said in an email. “And I knew the community needed basic preventive health care and access to health services. I thought the Immigrant Health Lab could be a place where students and other researchers interested in the same things could work together to find solutions.”

Through health fairs, surveys and community advisory boards, the MSU researchers are gathering data on health needs in the Latino immigrant community. 

The hope is to use the data to work with health care providers Community Health Partners and Bozeman Health, as well as other organizations in the area, to create more health awareness and access for Spanish-speaking immigrants. 

“We work with [immigrant] representatives of the community to inform us, ‘What do you want us as researchers to focus on? Where do you want us to put our time, energy and resources?’” said Danika Comey, the lab’s lead researcher. “We don’t want to come in as researchers, especially white researchers, and be like, ‘Hey, we know what you guys need.’”

Carlos Medina is a community representative on the Bozeman Community Advisory Board. He and the other board members meet monthly to discuss, in Spanish, the health needs of the Latino community and report back to Comey and Moyce. Originally from Mexico, Medina and his family moved to Bozeman in 2020.

“I have five years living in the U.S., and I have seen that the Latino community is afraid to approach the hospitals due to a lot of barriers: language, culture, knowledge of rules and high insurance costs,” he said in an email. “This project is important because we help people to receive free medical and dental check-ups, and also, they have the opportunity to participate in health programs that may help them to have a better quality of life no matter what country they are from.”

The lab’s work started in 2019 with quarterly health fairs. Comey said 40 to 50 participants attend each health fair. At the fairs, Proyecto SALUD partners with Smiles Across Montana, a mobile dental clinic, which Comey said is a big draw.

“Every time we have a health fair now people are waiting before we open, and we fill up all of the dental slots within the first hour,” Comey said.  

While at the fair, Comey said, the participants can get tested for diabetes and high blood pressure, get vaccines from the Gallatin City-County Health Department, and learn about the local food bank. Attendees are also given a survey — part of the lab’s data intake — which asks about their home situation, employment, comfort with English, education level and, critically, health insurance.

According to the surveys, 83% of health fair attendees do not have health insurance. Genesis Chavez, a lab volunteer who is originally from Nicaragua, said there are a variety of reasons for the lack of coverage. 

“Insurance in the country is pretty expensive, and that’s not something everyone can afford. There’s so much involved in it,” Chavez said. “So if there are ways we can support and provide free health care for those that really need them, then let’s do it.” 

Comey said there is a unique fear for migrants who don’t have documentation to be in the country legally.

“There’s fear as you’re going into a more bureaucratic system,” Comey said. “Are they going to report you if they find out that you are not legal to work in the United States? Are you going to face discrimination? When you get there, are the front desk staff going to roll their eyes at you when you start speaking Spanish?”

A lack of health care providers who read or speak Spanish poses another large obstacle for migrants whose first language is Spanish. Proyecto SALUD’s surveys showed that 64% of participants self-reported their ability to speak English as “poor.”

“There’s fear as you’re going into a more bureaucratic system. Are they going to report you if they find out that you are not legal to work in the United States? Are you going to face discrimination?”

Danika Comey, the lab’s lead researcher

“It’s challenging throughout the whole process,” said Comey, who used to work at Bozeman Deaconess Hospital. “From the minute people walk in the door, having language barriers left and right, like even directional signs, even knowing where the office is.”

Comey said health care providers in the area are working to increase their Spanish resources, but, she said, “it’s slow.” A spokesperson from Bozeman Health said the hospital averaged “18 interpretation calls per day in Spanish” in 2022. The hospital last year began using iPads capable of translation, is working on a designated Spanish number for its call center, and awarded grants to Proyecto SALUD for the health fairs, among other efforts. 

For Proyecto SALUD’s part, everything is in Spanish. Volunteers even read the surveys out loud for those who aren’t comfortable reading.

Yet another barrier to accessing health care is transportation. More than half of survey responders at health fairs said they work in construction, and many of those jobs are in Big Sky, an hour’s commute.

“If you are working, your only day off is Sunday, and you are working six days a week for 12 hours a day, you can’t go into traditional health care services,” Comey said. For that reason, health fairs are always on Sundays.

Besides the fairs, Proyecto SALUD has launched several other initiatives, in part to broaden its efforts to include mental health.

“We asked the community advisory board what their priority issue was, and they said mental health,” Moyce wrote. “So we did a root-cause analysis into the causes of poor mental health in the population and found that the lack of Spanish-speaking providers combined with a general stigma around seeking mental health care were the problems.”

To address these obstacles, the researchers are trying two different projects. One is a study involving health workers who use a technique called “motivational interviewing,” counseling that guides more than instructs and helps immigrants make changes in their own lives, mindset and health.

“That intervention, delivered over the phone, did work, so now we’re looking to secure funding to test it in a larger group,” Moyce wrote. 

The other project, instituted last fall, is called Mujeres Unidas — “Women United” — and consisted of a cohort of 10 women who met regularly to learn and talk about different elements of health.

Isabel Romero, a graduate student from Peru who is working towards her masters degree in counseling at MSU, led the mental health-oriented sections of the group.  

“The part that I developed was how to manage stress, and how to understand what is stress, what happens inside of our body,” Romero said. “It was basically a conversation with them.”

Romero said the informal, collaborative nature of the meetings is intentional.

“There is a lot of healing in just talking,” Romero said. “Just listening to other peoples’ stories and being able to relate to other women created a sense of community. And I have the belief that the community is the first mental health support that you will get.”

Chavez, a volunteer who was recently hired as a resource coordinator for Community Health Partners, also noted a unique challenge with mental health for some immigrants coming from South American countries.

“The reason why [some] people immigrate is because there are no opportunities where we live,” Chavez said. “So we experience so many challenges that we come here, and there’s this mindset: We should not complain because we were living in a worse situation.” 

The researchers hope to continue to combat stigma and increase awareness with the Mujeres Unidas project with two more cohorts of women. They are also collecting feedback at the next health fair on what participants like and would like to see more of. That event will be held at the county fairgrounds on Sunday, Feb. 12, and the researchers are always looking for volunteers who speak Spanish. 

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Mardy Harding is a freelance journalist and audio producer based in Bozeman. She adores meeting, talking to and learning about people and the issues they care about. Before Montana Free Press, she wrote for OutdoorsNW magazine and several small local papers in her home state of Washington. She also interned for the WNYC podcast "Death, Sex and Money," and now produces a podcast about Animation and animated movies.