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June 7, 1995

Crossing 'Line on the Map' In Search of Hope

JAMA. 1995;273(21):1646-1648. doi:10.1001/jama.1995.03520450014006

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WHEN ROSA SANCHEZ first came to the Presbyterian ministry—run clinic Project Vida in El Paso, Tex, she did not know she had diabetes. She did not even know what diabetes was. Her blood glucose level was above 33.3 mmol/L (600 mg/dL)—near coma level.

Jean Gowen, the clinic's physician assistant, tried to persuade her to go to the hospital. Sanchez (not her real name), a 35-year-old mother of five children, would not go. There was no one to look after her children.

The woman's husband lives in Houston, where he was able to find work. She and the children came to El Paso from Ciudad Juárez, Mexico, about 3 years ago. All in the family are undocumented aliens and are extremely poor even by the standards of El Paso, the fourth poorest city in the United States (JAMA. 1995;273:1478-1482).

"Little by little, we got her help," Gowen says. "We bought her

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