Despite offers from a local hospital to provide life-saving treatment, an undocumented immigrant from Guatemala has chosen to return to Central America knowing once he is home, he may not receive further medical care.
Thomas Rivera, 36, of Davenport, said he has achieved the dream that brought him into the United States. Now his goal is to be with his family.
Tomorrow, Mr. Rivera leaves for Chicago. On Wednesday, he will board a plane to Guatemala City, where his wife, Petrona, and children, Maria, 5, and Pedro, 3, will be waiting to care for him.
According to hospital documents he provided, Mr. Rivera has a heart condition; his kidneys are not functioning properly, and he needs dialysis.
Nevertheless, Mr. Rivera said he is content with his decision to go home. "Eventually I hope to have some tranquility," he said through a translator.
Mary Ann Garcia, a volunteer with Palomares Social Justice Center in Moline, has befriended Mr. Rivera and will drive him to Chicago. "I understand the cohesiveness of family," she said. "I told him I understood his decision. There is no price for being with family."
"We can give you life"
Ms. Garcia got a phone call April 17 about Mr. Rivera's illness. She spoke with him, then made an appointment for him at Community Health Care in Davenport.
Mr. Rivera said CHC examined him and said they were not equipped to care for him. He was directed to go immediately to the Genesis East emergency room.
There, hospital staff put him into a wheelchair and took him to the third floor, he said. After eight days and a battery of tests, he was transferred to Genesis West.
Mr. Rivera said he was diagnosed with pneumonia, a heart condition that is affecting his circulation and that his kidneys are not functioning. He said he was asked to consent to an operation needed before he could begin dialysis.
"I did (consider) the decision to do this at first," he said. Then he was told he needed dialysis three times per week, and it would be a four-hour procedure each time.
Mr. Rivera asked how long he would need dialysis. "They told me, there is no ending," he said.
He declined the operation and treatment.
Mr. Rivera said he didn't know if his employer would work around the dialysis schedule, and he might not be able to find another job. Without money, he couldn't pay rent or eat or continue to support his family in Guatemala.
"They interrogated me, asking, 'Why don't you do this? We are trying to give you life. Why won't you accept?,'" he recalled hospital staffers saying.
Mr. Rivera said he was told once he started dialysis, he could get placed on a donor list and eventually -- perhaps in 10 or 15 years -- get a transplant.
"I was very, very sorrowful," Mr. Rivera said. "I told the doctor, if I accept this (treatment), I know I have to pay."
He said hospital staff assured him the doctors were not asking for one penny. "'We can give you life. There is help for you. Accept this,'" Mr. Rivera said he was told.
Again, he declined.
Instead of medical advice, Mr. Rivera was listening to his heart and his family.
Mr. Rivera said he talked to his mother on the phone while he was in the hospital. She was crying and begging him to return to Guatemala, he said. "Come back. We will take care of you. God has blessed you. It is better you come here rather than dying there," he recalled his mother saying.
His wife made similar pleas and reminded him he achieved the goal that brought him into the U.S. "God is going to help us. God has blessings for all of us. You went there for the necessity, and you abandoned me to better your family. You did what you set out to do," he recalled her saying.
"What we have accomplished, I am sure we can go further," she told him. "Let me take care of you."
He left the hospital May 4.
"I am going to get there"
Before coming to the U.S., Mr. Rivera worked the fields in Guatemala and was paid very little. "It was only enough to pay for tomatoes," he said.
He and his family lived in a home smaller than some walk-in closets. Made of aluminum, it leaked when it rained, and the ground turned to mud. In this community, the toilets and all washing is done outside, he said.
About four years ago, Mr. Rivera told his wife -- who was pregnant with their second child -- they couldn't live like that forever. He wanted his family to have a home."I know here in this country you earn a little more," he said. "I told my wife, I am going," he said.
He paid a coyote to smuggle him into the United States. Mr. Rivera said his journey took 32 days, and he only made it, initially to Cedar Rapids, with help from American strangers who offered him places to rest, water and food.
"Someone was guiding me, telling me not to stop and to move forward," he said.
He spent six months in Cedar Rapids and lived in the Quad-Cities the past three years, working for a janitorial service cleaning a local big-box store, he said.
Mr. Rivera said at times, he worked a second job, too. He earned enough money for his family to buy a small home in Guatemala.
"I want to live"
Mr. Rivera said he is grateful for the medical care he received in Davenport. "The people who attended to me, attended so well and with their arms open," he said.
He said he may try herbal treatment recommended by a friend and available in Guatemala. He is hopeful he can receive medical care once he gets home.
However, challenges exist. According to the World Health Organization and Global Health Initiative reports, the public medical system in Guatemala is underfunded, there are few doctors and the area is fighting many health crises, including high child mortality and chronic malnutrition.
Mr. Rivera said he decided to return to Guatemala for his family's sake. Having accomplished his first dream -- to provide his family a home -- he now wants to watch his children go to school, to receive the education he never got, he said.
"I am not thinking I am going to die. When I get there, I will figure out a way," Mr. Rivera said. "If I feel better when I get there, I will work. For the minute, I want to live," he said.
Care for everyone
Not-for-profit hospitals are legally obligated to provide care for everyone.
"Whether you have health insurance or not, or whether you can provide documentation of citizenship or not, we provide care," said the Rev. Becky David, spiritual and mission director of Genesis Health System.
"We can figure out ability to pay later. In some instances, we cannot provide the level of care a patient needs, and they may be transferred, but we provide the medical care necessary for everyone who needs us," Rev. David said.
Dr. Jim Lehman, M.D., vice president of quality management for Genesis Health System, said providing care to everyone is the right thing, morally, for the hospital.
"It feels right," he said. "We focus on our mission. Compassion is one of the core values of our organization. How would we want to be treated or have a loved one treated? We want to treat everyone with that in mind," Dr. Lehman said.
Genesis provides about $10 million in charity care, which is provided to patients meeting income guidelines. There is no expectation of repayment.