Undocumented workers often function with quite different goals and aspirations. They have left or escaped oppression and poverty in their own country. Their access to work and education may have been very limited.
Their earning capacity was below the poverty level in most nations. The conveniences to which we have long grown accustomed are unknown, novel and/or merely the things of fantasy.
They often come to America with modest manual skills. They seek employment that does not demand language from them.
They may cluster together in settings occupied by transplants from their own country, perpetuating the lack of English skills, slow acculturation and lack of adaptive goals and values we see as unique to our country.
Very important in understanding the undocumented injured worker is their sense of obligation to those whom they left behind. They ran the risks inherent in coming to America through indirect channels with the tacit agreement that monies generated would be sent home to support families left behind. The families rapidly become dependent upon these contributions, but when the worker is injured, the flow of such funds decrease or cease.
What is most concerning to clinicians treating such patients is the lack of shared language, shared values and underlying goals.
Even with an interpreter, one cannot be certain that the patient understands the injury, treatment rendered, the nature of rehabilitation an/or whether medication is taken or taken correctly.
Additionally, while those treating the undocumented worker may believe that s/he shares the goal in returning to their job, the worker’s goal may to amass enough money to return home and establish her/himself in a better socio-economic position than that which prompted their coming to America.
The treatment of an undocumented injured worker requires a more expanded diagnostic approach in which the background, motivation and future goals are more clearly understood.
American Academy of Pain Management