Join us for our newest blog series Pages with Partners, where Health Forward staff select a book to discuss with a community partner. If you have a book recommendation, fill out the form at the end of this post.
Maid: Hard work, low pay, and a mother’s will to survive
By Stephanie Land
In Stephanie Land’s memoir Maid: Hard work, low pay, and a mother’s will to survive, Land chronicles her own experiences as a young single mother and survivor of intimate partner violence. She sheds light on the seemingly endless challenges she confronts as she supports herself and her daughter with a low-paying job that does not provide health insurance or paid time off.
She details the complex process to prove that she needs public assistance; the lengthy wait times at social services offices that keep her away from her hourly job; the physically demanding work that takes a toll on her body; the high rent costs and unhealthy living conditions in the home she can afford; the difficulty accessing and affording health care; and the judgement and stigma she faced as a mother living in poverty.
Land’s narration outlines the factors and forces shaping her reality while also communicating the stress, anxiety, loneliness, and desperation she often felt. But just as importantly, she also shares the opportunities and kindnesses that allowed her to have hope and eventually pursue a college education and greater economic stability. Land draws important connections between her own circumstances and the larger systems and policies at work, in a way that is personal and compelling to the reader. On Oct. 1, Netflix released a 10-episode mini-series of Maid.
Maid was recommended to us by Anne Rauth of Mercy and Truth Medical Missions, and we had a great discussion about the book. Mercy and Truth is a safety net clinic that operates in both Wyandotte and Johnson counties. You can read more about Mercy and Truth’s work on our blog.
Editor’s note: The following interview has been lightly edited for length and clarity.
Cori: Anne, when did you first read this book, and what about it made such an impression on you?
Anne: I came across the book a few years ago, and I found the story so moving. When you read about what she was going through, it is clear that Stephanie Land is such a good mom and was trying so hard just to make it work and take care of her daughter. When she experienced hardships, she just didn’t have the sort of support system in her life that she needed. She didn’t have someone to come alongside her and show her how to navigate the system and access what she needed.
She struggled so much. This book changed the way I think about the need for wrap-around services for women and children: how can Mercy and Truth and other safety net clinics and governmental agencies walk alongside these women?
Cori: The book outlines a number of frustrating interactions the family has with the health care system. After Stephanie makes a trip to an urgent care center for suspected meningitis, she receives a bill for $200 after speaking with a doctor for only a few minutes. She calls the hospital to negotiate, and recounts, “By filling out several forms, I finally convinced them to lower my bill through a program they offered for low-income patients. All I had to do was call and ask. It always struck me that programs like that were never mentioned. Billing offices only said to call for payment options, not to lower your bill by 80 percent.” Health care costs are a huge barrier to care for low-income families.
How does Mercy and Truth work to create transparency around costs? How do you work to keep care affordable and accessible?
Anne: Mercy and Truth uses a sliding fee scale to make services affordable and accessible for families. Most of our patients without insurance pay $40 for a visit. Each visit costs us approximately $120, which is why we fundraise to cover the rest of our costs. We also will work with our patients who can’t afford to pay the sliding fee. For example, we recently had a woman who received care through Early Detection Works—a women’s health program. She needed follow-up care after an abnormal test result. We wanted to see her right away to get to the bottom of what was going on and get her the additional care she needed to stay healthy. But she failed to show up for multiple appointments. As our team talked with her, it became clear she felt like she couldn’t afford it. We never want that to be the barrier for care, because we know our patients are constantly making monetary choices: paying for utilities or going to the doctor. We’ll always work with them.
There are also times in the book when Stephanie delays getting care or goes without medication for herself because she feels like she can’t afford it. She needed a clinic like Mercy and Truth in her life. She would have gotten better care sooner and been able to stay healthy. It was heartbreaking to read about how she needlessly suffered. I want to do everything I can to make sure people know about us and will come to us instead of going without the care they need.
Domestic workers like maids don’t have insurance, which makes it harder for them to get care when they are paying out of pocket. Folks like domestic workers and those in the service industry have also been among those hit hardest by COVID-19, and that will have long-term consequences for them and the community. But a clinic like Mercy and Truth is a great place for them to go for care. I was recently in a restaurant with a colleague, having a working lunch. Our server overheard us and told us about getting care at Mercy and Truth. She said Mercy and Truth had saved her life! It was a humbling moment for me, but I’m so glad she came to us when she needed care. Having that sort of real impact on people’s lives is why we do what we do.
Cori: Land also speaks of the judgement she frequently felt from others for needing public benefits. More than once, she overhears conversations about people who access SNAP (food stamps) or WIC being lazy and a drain on taxpayers. “Without food stamps, we would have frequented food banks or free meals at churches. Without child care assistance, I wouldn’t have been able to work. The people lucky enough to remain outside the system, or on the outskirts of it, didn’t see how difficult those resources were to obtain. They didn’t see how desperately we needed them, despite the hoops they made us jump through.” For those who have never experienced poverty, it can be difficult to understand.
How can we work to increase understanding around these realities and the importance of benefits such as SNAP and WIC, and for that matter, Medicaid?
Anne: I’m a big believer in the power of telling stories. That’s part of why I found Maid so powerful, and why I’m glad it’s also a Netflix series now. People don’t really understand what Mercy and Truth does until they hear some of the stories of our patients. Your average Kansas City resident may not really understand what people go through when they are living in poverty — how hard it is and how much work it is to get help. If they did, they would offer a more compassionate response.
People in power also need to hear the stories of those who are struggling to understand how the system works. That’s why Mercy and Truth makes it a point to attend Advocacy Day in Topeka, to thank our legislators for their support and to continue to show our support for Medicaid expansion in Kansas. Our patients might not be able to take a day off work, travel to the Capitol, and speak to our legislators. So we make sure we are there representing their interests in places of power. We feel like that is part of our job.
Mercy and Truth and our many partners are working together so that all the “Stephanie Lands” of the world can receive the quality health care and other benefits they deserve. Increasing awareness of our patients who work hard, receive low pay, but are still surviving, and one day will be thriving, should encourage us all.