You are rotating in the emergency department and are evaluating Ms Tran, a 60-year- old, uninsured, Vietnamese American woman who presents with a breast lump that she is worried may be serious. Ms Tran noted the lump several months ago but de- layed seeking care due to lack of insurance and concerns for her ability to pay. She had been told about a free clinic several towns away, but she doesn't have a car and she has mobility issues that limit her use of public transportation. Based on the 4- level conceptualization of racism, what level of racism does this part of Ms Tran's story most reflect?