“What are you now, a robot?” I yelled at her (in English). She didn’t understand me. But she laughed.

My grandmother’s not dumb or losing her mind. Like many immigrants faced with problems that demand solutions beyond their resources, she looks inward, and backward, for help—or at least delayed consequences—resorting to superstition, old wives’ tales, or illogical assumptions. Anything, so long as it does not cost money. Seeking medical advice is the last option, akin to giving up hope and faith. This is how poor people have learned to cope in South Texas.

MY GRANDMOTHER has always been fanatical about work: In her teens and twenties, she picked vegetables in Mexico; through her thirties and into her sixties she ran a trucking company in Texas. She attacked any job with suicidal enthusiasm, right into her seventies, when she cooked in a restaurant. Now, at 84, she is no longer capable of working, and so she loans money to people in the neighborhood who can’t go to banks. They hock pistols and rifles for small loans, and Gramma charges a weekly interest. Because of the steady income, she’s actually considered a bit more well-to-do in her circles—a doña, a sort of upper-lower-class matriarch. Her benefits as a widow of a Korean War veteran also pad her modest income. Still, she avoids doctors, except in the most serious of cases. She does have access to Medicare and Medicaid, and has relied on them to cover treatment for two heart attacks. But, even to the extent that these programs make health care somewhat more affordable, there are additional barriers to her use of the medical system—namely, cultural isolation and fundamental lack of understanding. She comes from a community, after all, that depends on others to translate everything from state and federal policy to the weather.

Health insurance was rare where I grew up, in Brownsville, Texas, on the border with Matamoros, Mexico. Many families there lived a dual life, on both sides of the border—like the middle school kid who was recently shot and killed by the Brownsville police, when he brought a pellet gun to school and the police mistook it for a real gun. His mother lived in Matamoros while he stayed with relatives in Brownsville and attended school. When I was growing up in the early ’80s, the school district understood that the free lunch program was the only guaranteed meal many of the kids would have. I felt an unusual resentment and superiority that I had to pay for my cafeteria meals and that I had a grasp of English before I started kindergarten.