It’s a Wonderful Life

It’s probably been 12 years since I sat in the cafeteria of UNC Hospitals and met a young psychiatry resident who would become a very important community collaborator and friend.  He was still in training but was the only Spanish-speaking psychiatry resident in the hospital at a time when North Carolina’s demographics were shifting rapidly and the state was struggling to catch up.  This young man from Arkansas identified a need and, even though he was not “prepared” to take on the task of developing an agency to serve new immigrant and Spanish-speaking families in need of mental health services, he did it any way.  Although it was a long time ago, I knew I was in the presence of something special and have been a cheerleader and occasional collaborator with El Futuro, the organization he founded ever since.  Over the years, I’ve watched former students join the effort becoming champions and leaders for these new North Carolinians.  We’ve started new programs together that have become some of the most meaningful efforts of my career thus far.

Last Friday, the organization held a retreat/planning session to think about how best to make decisions for the organization, and how to nurture and sustain the incredible people that work there.  These are tasks any organization must attend to but El Futuro is doing this in the face of a complicated and often hostile policy and payment environment.  In the midst of great food and fellowship, there was also great concern – concern that staff were seriously over-extended compromising their ability to be the clinicians they wanted to be.

Now, having followed this group for a long time, there have been lots of ups and downs.  Times when the director was not sure he could make the payroll, times when particular programs looked unsustainable, and grant applications that were due yesterday were flooding his and others’ desks.  But today was different.  Today there was real fear, fear that because of draconian policies by payment entities, services provided to individuals without social security numbers would have to be cut. (Here’s a link with more information on this issue.   How could such a choice square with a long-standing mission that provided services to everyone in this population with or without documentation?  What would it mean to the integrity of everyone involved to change that mission and serve only documented clients?  (There is a complaint in the Office of Civil Rights about these policies that is awaiting a ruling on this point.  Depending on the outcome, the payment entity may be required to pay.  The other alternative is that other payment entities may take up the same policy as this one if they are clear they can get away with it.)

At first, my impulse was to minimize and cheerlead.  This organization has been existence for nine years against all odds.  Surely it can weather the current storms.  Then I listened some more and moved into problem-solving mode.  Let’s contact so and so, partner with this group, tell the organization’s story in a new way, mobilize faith communities, etc.  All good things to do and I will contribute to doing  them in any way I can.  But eventually, I quit avoiding and confronted the very real discouragement and worry that was in the room and on my friend’s face.  This is a different storm and it will take big efforts from all of us that care about this population to get through it.  But it will also take courage and faith, a belief in things unseen.

Like many people, my favorite Christmas movie is It’s a Wonderful Life.  George Bailey who works tirelessly for the people of the community he loves becomes discouraged in the face of evil and loses his faith that anything he has done makes a difference.  Through mystical means he is given a chance to know all that he has done by seeing briefly what the world would be like without him.  The analogy is obvious: What would this community be like without El Futuro?  Three clinics providing evidence-based bicultural/bilingual mental health services would not exist.  Multiple schools would not have bicultural/bilingual on-site services provided to their new immigrant or children of immigrant kids.  There are mothers, fathers, grandparents, aunts, and uncles, people who work two and three jobs in our communities, who would remain depressed, ridden with anxiety, burdened by post-traumatic stress, and addicted because there was not an agency that could provide services that would help them.  (El Futuro’s success rates are quite impressive.) UNC’s and Duke’s emergency room and crisis services would be over-burdened causing other patients not to get the quality of care that they need.   Teachers can teach all children more easily when children in need are having those needs met.  To quote Clarence Odd Body, Angel Second Class, “Strange isn’t it, how every life affects another…”  Not to mention the classic scene when there’s a run on the bank and George has to explain how a community only functions well when it recognizes its interdependence and the consequences of giving that up. The story of course doesn’t end with George having a realization and feeling better.  It ends with friends pitching in and coming to his aid.  So if you’re looking for a worthy cause this holiday season, if you want to do something that will, in the spirit of the season, ‘welcome in the stranger,’ then check out the good work of El Futuro and throw some money in George Bailey’s basket.



  1. Luke and Caroline, I thank God you are following His dream. You keep doing your part. God will provide. Yours is to be the light, the tool and the Savior will save. All the best. Love. Terry and Charlotte Smith

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