By ContraCOVID NYC Team
“I feel unseen, unheard, and constantly at the margins of the U.S. healthcare system. I’ve thought about going back to my country where I can ask questions and manage my health in Spanish without having to deal with so many barriers.” Such were the sentiments of Irma*, an undocumented New Yorker trying to navigate the healthcare system during the COVID-19 pandemic. Frustrated with the care she was receiving at an institution that supposedly served one of the most ethnically and linguistically diverse communities in NYC, Irma contacted ContraCOVID NYC – a student-run, community-based organization that provides bilingual navigation and translation services – for support finding an OB/GYN who would actually listen to her and take the time to explain her particular diagnosis and prognosis.
After an initial intake in which Irma went over the many inconsistencies and inadequacies with her healthcare, her ContraCOVID NYC Navigator was able to refer her to Grand Rounds, a digital healthcare company that provides free, remote medical advice from high-quality specialists. With the help of ContraCOVID NYC and Grand Rounds, Irma was able to gather and send her full medical record, along with her detailed questions, to a healthcare specialist in Grand Rounds’ network. Irma received a written expert opinion in Spanish and her ContraCOVID NYC Navigator ultimately helped find her an affordable health clinic with a more culturally competent OB/GYN for further care.
Irma’s case is not unique. Sadly, similar situations have only increased, in numbers and in severity, over the past year due to the COVID-19 pandemic, particularly for vulnerable populations like undocumented limited English proficient (LEP) immigrants. The pandemic has taken a devastating toll on members of these communities and made it even more difficult for them to seek medical attention. This is because many of the free and low-cost clinics who serve them were forced to reduce or close operations, no longer accept new patients, or implement months-long waitlists. Like Irma, most clients managed by ContraCOVID NYC face numerous challenges in accessing healthcare and social services in the U.S.
Although difficulties in healthcare access, health literacy, and health insurance attainment have been exacerbated by COVID-19, the reality is that our healthcare system was never designed to be inclusive of LEP and/or immigrant populations. A gap continues to exist between knowledge of available resources and utilization of those resources. COVID-19 has only widened this gap and further revealed the health inequities that disproportionately affect marginalized communities, but these health inequities have always been present in the U.S. due to a poor investment in social services.
Social determinants of health (SDOH) are complex factors that are part of the built environment which determine one’s health outcomes, based on the conditions s/he was born into and where s/he grew up, lived, and worked. SDOH includes socioeconomic status, education, neighborhood and the physical environment, employment, access to health care, and social support networks. The interplay between these factors affects individual and a community health, both directly and indirectly, because of a lack of services or barriers to accessing those services.
Like in Irma’s case, the simple act of scheduling a medical appointment is often stressful: a person must first know how to successfully navigate through automatic messaging systems in English, connect to the appropriate department, endure long wait times and transfers, only to eventually learn that the next appointment is many months out. For someone with a chronic health condition, the outcome is often a matter of life and death. Before the pandemic, this process was already problematic for undocumented LEP immigrants. COVID-19 has only made the situation worse, especially for individuals who rely on public transportation to obtain healthcare. Irma, for example, now faced limited access to care because she 1) wanted a free clinic that 2) was closer to her home in order to 3) minimize her exposure to the virus and 4) reduce her risk of infection. Many free clinics that have historically served as “safety nets” for undocumented individuals closed because of the pandemic, leaving vulnerable NYC residents like Irma without care.
COVID-19 has highlighted and further increased the disparities that exist in undocumented LEP communities. In fact, ContraCOVID NYC was born because its members saw an increased need for one-to-one assistance with navigating the complex healthcare and social services systems. Our Navigators and Translators seek to connect these populations to culturally appropriate medical and social services information and resources to reduce health disparities while bridging the gap between our clients and the available resources. Our ultimate goal is to build community resilience among marginalized communities in NYC by providing our clients with the knowledge to empower themselves and tools to gain what they need to survive these unprecedented times.
*Pseudonym used to ensure client’s anonymity