If you look at a map of confirmed coronavirus cases in Chicago, the Southwest Side is very clearly suffering. Neighborhoods such as Pilsen, Brighton Park, Little Village, and Back of the Yards are colored in a deep, dark blue—on the South Side, both case rates and number of confirmed cases are the highest in the city, according to the Illinois Department of Public Health. Many of these neighborhoods are over eighty percent “Hispanic,” following the national trend of hard-hit Latinx communities.
Citywide, almost thirty-five percent of those who have tested positive are Latinx, the largest of any racial demographic. The South Side Weekly tracker, based on data from the Cook County Medical Examiner’s office, shows Little Village is the Latinx neighborhood with most COVID-19 deaths, and ranks third among all neighborhoods. ZIP code 60632, which covers the Brighton Park and Archer Heights area and is eighty-eight percent “Hispanic,” has an overall positive test rate of thirty-seven percent, with sixty-five percent of those cases in the “Hispanic” demographic, according to IDPH.
Nearby ZIP codes such as 60623 (which includes Little Village), 60629, and 60804 (in west suburban Cicero), have similar positive rates and numbers of confirmed cases and are found in majority-Mexican areas. One predominantly Latinx zip code in the North Side, 60639, which covers Belmont-Cragin, is also dark blue on the map. Meanwhile 60654, a ZIP code in the Loop, has a positive test rate of fourteen percent.
For those who provide healthcare to Southwest Side communities, the data is not at all surprising—they have seen the same numbers before. Dr. Evelyn Figueroa—a professor of Clinical Family Medicine at the University of Illinois at Chicago, the executive director of the Pilsen Social Health Initiative, and the founder and director of the Pilsen Food Pantry—said, “You see the same map over and over again in Chicago. It’s the same infographic for food insecurity, allocations per child per school, violence—the South and West Side have the worst of whatever the condition is.”
Health outcomes are often a result of structural social inequalities. As many Southwest Side residents are immigrants who may not speak English, they are more likely to have lower paying jobs and less likely to have health insurance. Chicago’s extensive history of redlining also limits access to health resources for Southwest Side residents. To reach Esperanza, the health center doing the majority of the Southwest Side’s coronavirus testing, half of the patients served at their Little Village location travel all the way from south of the I-55 Stevenson Expressway.
So although no one was prepared for the onslaught of COVID-19, the Southwest Side, long affected by poverty and well known as a ‘health desert,’ was even less so.
After its first week of coronavirus testing, Project Vida, a community health organization in Little Village, found that eighty percent of those tested did not have insurance, with ninety percent of those tested identifying as Mexican or Latinx, they said. Lack of insurance, a large barrier to healthcare, is usually due to a second barrier: namely, legal residency, which prevents many immigrants from qualifying for public benefits such as Medicaid, or the act of seeking medical care itself, due to prohibitive costs and fear of being identified as undocumented.
As the political climate under the Trump administration worsens, undocumented immigrants have become even more reluctant to address their medical needs. Esther Corpuz, CEO of Alivio, a community health center in Pilsen founded to address the needs of undocumented immigrants, said, “With the public charge issue, [those in our immigrant communities] aren’t accepting any kind of public benefits because that could impact their path to citizenship. When Trump got elected we immediately saw our visit numbers go down. People stopped coming—even after many years of coming to Alivio, they were just very fearful.”
The language barrier is another structural issue that exacerbates health disparity. Figueroa once volunteered during storytime at a CPS grammar school on the Southwest Side and was shocked to find that the learning was conducted entirely in Spanish, as the school could not afford an ESL curriculum. Although Chicago-born, the students were monolingual Spanish speakers. “This is systematic. This was at a CPS grammar school. It was mind-boggling,” Figueroa said. Being unable to speak English limits the opportunities for Latinx Chicagoans, including access to health resources. “When people talk about navigating systems, they don’t understand how much you have to be able to read and speak to accomplish that.”
Structural inequalities feed health disparity and further cause chronic illness. Some of the most common conditions health centers like Alivio and Esperanza see are diabetes, heart disease, obesity, hypertension, anxiety, and depression.
The distribution of health resources across the Southwest Side is, beyond structural imbalances, also limited in number—according to Figueroa, insurance lapses, social issues affecting health, and English fluency make it difficult for healthcare providers to stay afloat. Health providers that do choose to serve the Southwest Side are challenged by administrative burdens influenced by poverty and lower payments from public insurance such as Medicaid, as well as costs incurred by serving undocumented immigrants and hiring bilingual staff, interpreters or translation services.
Saint Anthony Hospital’s senior vice president of Mission and Community Development, Jim Sifuentes, said that finances are especially difficult for Saint Anthony as a safety net hospital, committed to serving anyone in the community regardless of their insurance status. When asked what Saint Anthony’s biggest challenge was, he said, “It’s not the people. It’s not the clinic. It’s not serving these people. It’s getting paid.”
While the revenue of an average hospital in the U.S. is around sixty-seven percent commercial payer private insurance payouts, Sifuentes said Saint Anthony’s is only four percent private insurance and nearly eighty percent Medicaid or Medicare, with the remaining patients uninsured or undocumented. Saint Anthony filed a suit last month against the Illinois’ Medicaid program, saying that as of mid-February, the state’s six managed-care organizations—private insurers that are delegated to reimburse healthcare centers who see public insurance patients—owed the hospital $22 million. “We had to use all our money to pay the bills because we’re not getting reimbursed,” Sifuentes said.
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Federally Qualified Health Centers (FQHC) such as Esperanza and Alivio receive funding from the federal government, and can more easily accommodate their Latinx patients by charging for services on a sliding scale—those who are uninsured don’t pay at all. Even so, Esperanza still engages in private fundraising and applies for grants in order to cover uninsured patients. Furthermore, establishing new FQHCs and access points is extremely competitive and regulated, said Alivio CEO Esther Corpuz. And smaller healthcare providers such as Project Vida have even more trouble meeting funding prerequisites like administrative guidelines.
What is most frustrating to hospital administrators is that many of the Southwest Side healthcare providers are technically and culturally competent and well trusted by the community they serve, yet funding does not easily come their way. “You can’t imagine the quality of the nurses, physicians, and even ancillary people,” Sifuentes said. “They could be working in other places. They choose to come here because… they believe that serving people that don’t always get a break is number one.”
Sifuentes said that while other safety net hospitals have been forced to close up services like pediatrics and speech therapy to make ends meet, Saint Anthony is extremely money-conscious and does whatever it can to keep services available. “Look at the needs of the community. There’s no way we can close [these services]. We not only kept the pediatrics department open, we have a neonatologist, which is rare—you would never see that in a community hospital, let alone in a safety net community. But that’s how our commitment is.”
The coronavirus pandemic has placed the healthcare challenges of both residents and healthcare providers on the Southwest Side, as well as the structural inequalities that produced them, under a magnifying glass. In many ways, COVID-19 has exacerbated the hardships of living in a low-income, marginalized community at the center of a health desert, resulting in the explosion of confirmed cases among Latinx residents of the Southwest Side.
Because many Southwest Side Latinx residents are essential workers—overrepresented in job sectors like construction, food service, and transportation and material moving—they are at a higher risk of contracting COVID-19. Some continue to go to work because they need the income, as many undocumented immigrants cannot receive relief checks and unemployment benefits, or because they fear eviction and other financial consequences. Others work because they feel pressure from employers. Jerome Montgomery, the CEO of Project Vida, said, “We’ve had individuals that have told us they tested positive and that their employers are requiring them to come to work, which is against every Department of Public Health guideline I’ve ever been familiar with.”
Furthermore, cultural factors prevent Latinx Southwest Siders from adhering exactly to social distancing guidelines. As many live in multigenerational homes in close quarters, self-isolation is not always realistic. It may not be possible to sleep in a room alone or have one’s own bathroom. Sifuentes said that it’s not uncommon to have three or four people from the same household be hospitalized for COVID-19.
Other challenges seem mundane, but are significant. “Some of our front desk people actually asked us if they could not wear their uniforms to work because they didn’t want to go to the laundromat as often because they were worried about getting COVID-19 there,” Esperanza CEO Dan Fulwiler said. “So little things like that, that people don’t necessarily think of when they have more money, are real stressors in our community.”
Communicating information to individuals about testing sites, health resources, and pandemic best practices is proving to be a great challenge in tackling COVID-19 in the Southwest Side. Misinformation inspires fear and endangering behavior. Figueroa said price gouging on items like plastic gloves misleads people into practices that don’t actually assure safety. “If you hear about hand hygiene, everything says wash your hands or use hand sanitizer, and yet when you’re in the store… person after person, they’re wearing gloves, and that does not offer protection. COVID lives for three days on plastic.”
And it is difficult for Latinx in the Southwest Side community to understand and access accurate information. “Highly educated people don’t understand COVID,” continued Figueroa. “So how are you going to tell someone who has a low literacy level to begin with, in Spanish, and then translate it into health information?”
At the same time, news that Latinx residents are most impacted by the virus continues to drive fear. “A patient will come into the ER like ‘Oh my God, I’m positive, I’m gonna die.’ And they believe it,” Sifuentes said. Saint Anthony Hospital’s wellness program is connected to about one hundred community organizations and tries to keep communication channels as open as possible in order to educate and reach people in need.
Media is an effective tool, and Corpuz said that Spanish-language media is likely the most powerful way to educate people, along with word of mouth. At Alivio’s testing site, healthcare workers patiently address fears and provide educational information on follow up calls with those who get tested.
Organizations like Esperanza, Alivio, Saint Anthony Hospital, Project Vida, and UI Health are providing coronavirus testing sites in majority-Mexican communities. Although practice at each site varies, typically those who wish to be tested make an appointment, fill out necessary forms, and undergo a nasopharyngeal swab that is sent to a lab. The sites are drive-thru or walk-in, and are equipped with Spanish-speaking staff. Tests are free or completely covered by insurance, even for undocumented people who are not covered under the CARES Act, which waived all coronavirus-related healthcare costs. Results come back within anywhere from twenty-four hours to two days.
The testing sites see varying demand and each conduct between thirty and 150 tests a day. Most organizations have not had to turn people away, though Alivio reported frequent test kit shortages. Still, access to test kits is a common challenge. Esperanza has had to source different test kit components from different suppliers, which Fulwiler attributes to the lack of a single, unified response to the pandemic. Saint Anthony Hospital recently received technology from a donor for a more accurate test that takes only fifteen minutes, but has not been able to obtain the necessary testing reagents to use it. The struggle to obtain crucial resources for underserved areas even in the midst of a pandemic continues.
Some of the consequences of COVID-19 have yet to play out for health providers on the Southwest Side. Fulwiler believes that the CARES Act did not allocate enough money to reimburse healthcare providers for the cost of testing and caring for uninsured COVID-19 patients. Corpuz worries about billing challenges with insurance companies and Alivio’s financial health. And Figueroa said that even though the CARES Act covers coronavirus-related costs for those who are uninsured, some hospitals are still billing patients, perhaps out of habit, feeding the uninsured population’s pre-existing fears of being charged.
For now, these community health organizations are focusing on how best to serve the Southwest Side during this crisis, actively reaching out to educate residents and provide crucial care.
There could be a silver lining to an otherwise devastating pandemic. As community health centers begin to tear down the barriers to healthcare for residents in the Southwest Side, they may be building a future where those barriers stay down. In light of present circumstances, healthcare workers can now get paid for telemedicine down to its most basic form of a voice call, reducing costs like time and transportation associated with healthcare visits. Figueroa said that anecdotally, patients really enjoyed phone-based visits with doctors they already knew, although there are still barriers such as owning a phone or computer.
Additionally, healthcare centers like Alivio keep track of those who get tested, their medical history, and their primary care provider or lack thereof. Although Alivio has stopped general visits, it has transitioned to telehealth, provides home delivery for pharmacies, and actively checks in on seniors over sixty-five years of age, a group particularly vulnerable to the virus. “Rather than just swabbing them, we’re asking them, “Do you have a medical home? Do you have a doctor? If no, then consider keeping us as your medical home,” said Corpuz. “And then we start to know the health issues that they may have.”
Beyond the new connections healthcare centers are making with patients, Latinx residents of the Southwest Side may become more proactive about their health concerns post-pandemic. “I think that [COVID-19] has frightened people to the point where they’re taking care of their healthcare issues with greater concern and trying to address them rather than putting things off,” Corpuz said.
During the crisis, state and local governments have also become more aware of disproportionately affected groups and the need to reckon with the structural inequalities that fuel their current hardship. “The mayor had a press conference recently about COVID-19 among Latinx communities,” said Fulwiler. “And I was really heartened…They’re actually moving to provide housing to vulnerable people [to] allow them to self-quarantine outside the house with their family, which is a huge cost. That’s really responsive.”
When asked how he thinks the pandemic will change the future of the Southwest Side, Montgomery said, “You know, I have my hopes. If I had it my way, it would draw more attention to the need for universal healthcare, regardless of citizenship status. It would give rise to understanding of the increase of minimum wage and for there to be a basic household income.
“It would bring more attention to the importance of the immigrant population to the very existence of the United States, and not only to our economy but also to who we are in the fabric of the United States. I would like to see that after COVID, people care more about each other and how their actions impact others. But in reality? I don’t know.”
Correction, May 29, 2020: This piece has been updated to reflect the correct title of Saint Anthony Hospital’s Jim Sifuentes.
Susy Liu grew up in Boston and is currently an undergraduate student at the University of Chicago studying economics and sociology. She last wrote in the Weekly about medical students practicing street medicine in the South Side.