Bitter Pill
A scene from Clinica de Migrantes, an HBO documentary about a Philadelphia clinic struggling to care for undocumented immigrants
Healthcare is a seriously complicated thing for undocumented Latino immigrants, many of them facing coronavirus exposure when they go to their essential jobs on the front lines of the pandemic
By Andrea Arzaba
As the United States reopens in spite of the pace of infection and death, cold statistics show that Latinos and African Americans are being disproportionately affected in the runaway COVID-19 pandemic.
Every day, thousands of new patients report to U.S. hospitals and clinics -- more than 1.6 million since late February, when the nation saw its first COVID-19 death and community spread of the virus was declared in Washington state.
Since then, fighters on the front lines against the coronavirus have been the thousands of doctors, nurses and healthcare professionals managing surges of infections.
U.S. media have thoroughly documented the healthcare community’s fight to save the sick and deal with insufficient coronavirus test supplies and shortages of protective equipment care. What’s less in the spotlight is the heroic work of clinic workers and doctors who are dedicated to helping undocumented Latino immigrants -- many who work at jobs with virus exposure and often lack adequate insurance coverage.
Consider the plight of farmworkers who have been designated as "essential" to the nation’s food supply. Yet, some two-thirds of them are undocumented immigrants. And, because of their immigration status, these workers face tall barriers to obtaining medical care.
In California, Pennsylvania, Illinois, and Wisconsin, palabra. found professionals in clinics and hospitals, risking their lives to help people who are especially vulnerable during the pandemic.
Dr. Steven Larson, founder, Clinica de Migrantes in Philadelphia. Photo courtesy of David Suro
Pennsylvania: The Mobile Clinic
Dr. Steven Larson recently had to make one of the most difficult decisions of his career: As the COVID-19 pandemic hit the city of Philadelphia, he closed the clinic he has run since 2004.
With graying hair and a welcoming voice, the doctor has become a recognized figure in the care of immigrants since the nationwide airing of “Clínica de Migrantes”, an HBO documentary that focused on the challenge of bringing medical care to the community of undocumented and uninsured Latino immigrants in and around Philadelphia.
The city of Philadelphia is home to approximately 50,000 undocumented immigrants. For many of them, it is impossible to buy health insurance. For this population, free community clinics provide the only care available.
"It was difficult, but we decided to close our physical doors at the Puentes de Salud clinic during the pandemic since we have very few resources, so right now we cannot give people proper attention," Larson said.
While the clinic is physically closed, Larson has found other ways to provide health services. "Now we are using telemedicine techniques, we have volunteers remotely monitoring patients with coronavirus-related symptoms and soon we will be doing tests."
Although undocumented immigrants cannot receive unemployment insurance, some clinics and civil society organizations are working to meet the needs of the most affected families.
“We have a partnership with food banks and other organizations. We have helped raise funds and have had a good response,” Larson said. “Immigrants make our city more diverse. Philadelphia is a city richer in culture thanks to them. Although I am officially retiring from the clinic this year, I will not leave it entirely. I want to continue contributing to build a fairer and more inclusive city for all.”
Larson, who is retiring from his medical practice later this year, said a shortage of tests has caused much uncertainty among Latinos in Philadelphia. This has not stopped the medical staff of Puentes de Salud. Instead, clinic workers have been delivering healthcare in the homes of immigrants.
Annette Silva is one of the pillars of the clinic. Trained as a traditional nurse, she says her work has taken a 360-degree turn.
"Now I am a mobile clinic," she said.
Silva drives from house to house in the city, making sure her patients are well or continuing treatments during the pandemic.
"Patients need medicine. Many of them, if they don't take them, will end up in emergency rooms. The last thing hospitals need is people in emergency rooms. Especially those cases that can be prevented," Silva says.
Silva was born in Los Angeles, to Guatemalan and German parents. She said most of her patients are immigrants from Central America, Mexico, and Ecuador.
“Something that has caught my attention is that every time I bring medicine to patients' homes, they express their gratitude. They always want to offer me something, at least some water and a sandwich,” she said. “Sometimes they even welcome me with a few dollars in hand. I never accept them of course.”
Annette Silva, Community Nurse Liaison, Clinica de Migrantes in Philadelphia. Photo courtesy of Annette
Looking for the cough
"Have you had a cough, or a fever in recent days?" This has become a mandatory question on each of Silva’s home visits. She always makes sure to wear gloves and a mask, since many people with COVID-19 have no visible symptoms.
Silva has seen a clear difference in the impact on men versus women: "pregnant patients are very concerned." For example, pregnant women are considered a risk group. In the third trimester, they suffer alterations in their immune and pulmonary systems.
She said the disease also has had a greater impact on single mothers, in large part due to the lack of balance between work and family.
“On Tuesdays I volunteer at a local prenatal clinic. The women I see arriving at the clinic, who are about to give birth, feel very distressed. They are afraid of going to the hospital. I understand them and try to explain that they must have faith in the system, that they will not be placed near sick people.” she said.
Silva does not know when things will return to normal, so she decides to stay grounded: “I don't know when the pandemic will end. I can only assure you that at Puentes de Salud, we are doing everything we can, with our own means. Nurses, doctors, everyone is trying to end this nightmare. We all have to do our part. ”
Dr. Javier Rodriguez, Chief Medical Officer at La Maestra Community Health Centers, San Diego, California. Photo courtesy of Dr. Rodriguez
California: It’s not business not as usual
For Dr. Javier Rodriguez in San Diego, California, the word “routine” no longer exists.
Rodríguez is the Medical Director at the La Maestra family clinic and has been working there for over 15 years. And almost every day, he would drive his car to the clinic. Each day he would walk up the stairs, enter the same office, and take out his stethoscope before reading the list of incoming patients.
Now, in one hectic day, Dr. Rodriguez hears most of his patients on the phone or in a teleconference. Many of them are afraid of getting the virus if they leave their homes. For the few patients who need to be seen in person, he receives them well protected - with disposable gloves and masks. Rodriguez makes sure to greet them by touching elbows.
"Despite the social distancing, I try to smile or make a joke to make my patients feel at ease," Rodríguez said, leaning on his energetic voice that changes constantly from English to Spanish. He was born in San Diego to immigrants from the state of Jalisco in Mexico, a profile that underscores a life influenced by both countries.
Given the current uncertainty and the number of positive COVID-19 cases in the area, his medical staff is living through anxious days.
"Some medical staff refused to come to the clinic for fear that they could catch the virus and endanger their babies or their families," Rodríguez said. "Despite this, many others agree to see people with a cough and fever, obviously with the right equipment to protect themselves."
But obtaining the right equipment has not been easy, said Zara Marselian, president and co-founder of La Maestra family clinic. "We have had to be very firm and fight like crazy to get enough equipment."
In the hunt for adequate personal protective equipment, Marselian said she is impressed with how the clinic’s staff and community has stepped up: During the pandemic, a group of women participating in a microcredit program have produced thousands of cloth face masks, which help protect and extend the life of N95 face masks.
But for every good thing that has happened during the pandemic, there seems to be a few things that go bad, Marselian said.
As the nation started staying home, the all-important border between Mexico and the United States was closed to non-essential travel.
"Some of our staff who work at the clinic and live in Tijuana are concerned that [border officials] might not let them pass," says Marselian.
To avoid problems, Marselian asks workers who cross the Tijuana-San Diego border daily to carry a letter with them at all times, indicating where they work and why they need to come to work.
Cristina Vieyra, Interpreter, Community Health Care Inc in East Moline, Illinois. Photo courtesy of Cristina Vieyra
Illinois: New tools for a new disease
Cristina Vieyra is a 22-year-old interpreter at Community Health Care, Inc., a community health center in the town of East Moline, Illinois.
Vieyra is a translator, a job she said helps her ensure that non-English-speaking patients are treated with dignity and understand vital instructions.
She is studying to become a social worker, saying “I would like to contribute even more to the community. I am proud of my Mexican heritage and to represent the Latino community in Moline and in the Quad Cities.”
Like most healthcare workers in the nation, Vieyra has had to adapt to a new way of working. Today, outside of the building where the clinic is housed, staff now must first ask would-be patients “if they have traveled, if they have been in contact with someone who has COVID-19. And when they come, we evaluate them outside the building or in the car, where we have a nurse and a medical assistant who sees them outside,” Vieyra said.
Another new tool for Vieyra is telemedicine, which has a limit in the undocumented immigrant community, given that some patients don’t have stable Internet connections. "But yesterday we had two patients with telemedicine appointments and everything worked and I was surprised that it turned out so well."
On top of the new challenges, Community Health Care staff is also preparing for exposure to COVID-19. Vieyra, who lives with her sister and mother, said she already has a plan to avoid infecting her family: “If I get COVID-19, I would have to inform my supervisors, and my family would go to my uncle's house for about 14 days. We have already discussed it and everyone agrees."
Interpreters at Community Health Care Inc in East Moline, Illinois. Photo courtesy of Cristina Vieyra
Wisconsin: They must work to eat
On the south side of Milwaukee, a community clinic on 16th Street caters each day to patients who speak very little English. That’s where Dr. Jorge Ramallo, pediatrician and internist, spends his work days.
For his patients, not working means a difficult choice between food, bills and healthcare, especially since most do not qualify for unemployment benefits or bailouts.
Ramallo says several people with COVID-19 symptoms have called the clinic asking what to do. It is then that, depending on the symptoms, they may be asked to come to the clinic for a test and/or to be isolated for about 10 days.
Dr. Jorge Ramallo and team, at 16th Street Community Health Clinic in Milwaukee, Wisconsin. Picture courtesy of Dr, Ramallo
"Many times it is the employers who see workers with symptoms, and ask them to stop working," says the doctor.
Clinic social workers are constantly seeking to inform undocumented patients about the services available to them. That means healthcare augmented by information about food banks, organizations that can provide childcare, or how to solve problems with electricity or water bills.
Ramallo and his staff work with the constant fear of finding themselves infected. "There is a lot of pressure,” he said. “Doctors can easily get the virus, and in that case, continue to spread it".
Today, there are doctors and nurses who are staying in hotels and rented houses, he said, to decrease the risk of spreading the virus to loved ones.
While healthcare personnel are experiencing difficult times, Ramallo said his "greatest concern" is for undocumented families. He’s hoping things will change after this pandemic. High on his wish list is being able to offer all of his patients effective treatment and free COVID-19 testing.
"There are not enough economic and social benefits for these communities, which are the most vulnerable."
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Andrea Arzaba is a freelance journalist currently based in D.C. She holds a master’s degree in Latin American Studies from Georgetown University. She’s reported from throughout Latin America for Transparency International, Proceso, Animal Politico, 100Reporters and palabra.