COVID-19: How US healthcare is failing vulnerable immigrant communities

by Melissa Nix

Amizade alum Nicole Silva offers her perspective on COVID-19 from her work on the front lines with a vulnerable community. In the picture above: Nicole (left) with other Ironbound Initiative team members.

My name is Dr. Nicole Silva, and I am a recent graduate of Rutgers New Jersey Medical School, in Newark, New Jersey. I have participated in a few Amizade trips to Santarém, Brazil, as well as help organize a trip for medical students to Santarém every year. In Newark, I started the organization called Ironbound Initiative as a first-year medical student. Our goal, throughout my four years at NJMS, was to provide blood pressure screenings, medical education, access to preventative cancer screenings and act as liaisons to our institution’s hospital for Portuguese-speaking immigrants who lacked the ability to get insurance or access to care in this country.

Since the COVID-19 pandemic began, it has impacted the New Jersey and New York areas, more so than anywhere else in the country. Ironbound Initiative’s function quickly changed as a small group of senior medical students and Brazilian nursing students began a program to connect with community members for support during this time. Not only does the NJ-NY-PA Metropolitan area have the second-largest Brazilian community in the country, but COVID-19 has been severely affecting marginalized groups in this area.

March 14 was the last day we were able to provide our blood pressure checks and medical education to the Brazilian community-based organization (CBO), Mantena Global Care. It was a somber day. We were wearing masks and gloves. The nurses doing blood draws were gowned in PPE. We spent the majority of our time handing out information about COVID-19. At that point, there were only a few confirmed cases in New Jersey, but we knew more were yet to come.

Members of the Ironbound Initiative in action.

Since March 14, it’s been a month of the influx of COVID-19 positive patients, “probable cases”, and concerned community members. My day usually consists of navigating a broken US healthcare system and immigration system to get vulnerable Portuguese-speaking immigrants the best information and care needed. This is a usual day for me and my colleagues from the Ironbound Initiative who are functioning solely as a COVID-19 response team for the community. And as a team, we have noticed barriers that we feel need to be addressed in the US healthcare system, barriers that are even more apparent with COVID-19.

8:32 am: A healthy, young Brazilian has some symptoms: feverish, slight cough, headache and body aches. This one is a simple case, because we can recommend, based on CDC and DOH guidelines: stay home, isolate, and supportive care. Although we attempt to find a drive-thru for testing, the person does not have a car, no fever when measured, and will be turned away for not meeting criteria.

10:15 am: This community member has asthma and is experiencing symptoms, with direct contact to a COVID-19 positive person. She just ran out of her inhaler yesterday and has no insurance in this country and no primary care doctor. If she has an asthma attack because of possible COVID-19 symptoms, she could end up not being able to breathe well. This situation is harder to fix. We have to find a federally funded clinic–that takes uninsured patients–and an appointment QUICK to get a prescription for an albuterol inhaler. She needs an albuterol inhaler as fast as possible.

11:38 am: This community member is worried about her family’s wellbeing. She and her husband are out of work. They can’t apply for the stimulus package benefits because they don’t have social security numbers, even though they’ve paid taxes to the IRS with their ITINs for years now. They want to know how we can help.

2:17 pm: A community member we have been following has worsening shortness of breath; he can’t take breaths and talk at the same time. He’s been fighting COVID-19 for over two weeks now with breakthrough fevers even with Tylenol, so I am calling an ambulance on his behalf. He’s one of the community members I’ve been most worried about. I have to translate for EMS when they get to his apartment. EMS are exhausted, you can hear it in their voices.

5:00 pm: I receive another call from a community member in a high-risk group, having diabetes and asthma, who had direct contact of a COVID-19 positive patient, and now is showing symptoms. I want to get that person a COVID-19 test, but I can’t find a place to do it. He doesn’t have a car, so he can’t do the drive thru. He has no insurance, so he can’t go to a private walk-in clinic.

Vulnerable immigrants, especially of Hispanic/Latino communities, face severe hardship during the COVID-19 pandemic. Even prior to this crisis, they were less likely to have chronic medical problems appropriately managed. This came into play because COVID-19 is impacting those with comorbidities more so than healthy people. Unfortunately, CDC, DOH and other reliable information was not disseminated to non-English speaking communities in their native language, impacting social distancing orders and the ability for medical providers to give proper advice and guidance during this time. COVID-19 Hotlines may have Spanish-speaking options, but rarely, if ever, Portuguese-speaking options. Moreover, fear of even reaching out to government or state departments has created hesitancy in immigrants, with the new USCIS public charge rule stating that those who use government assistance or seek treatment during this time will not be able to successfully become permanent residents (i.e. receive green cards) or citizens one day. Finally, many immigrant communities feel more comfortable reaching out to their local CBO, church or other community organization than any local health officials or even hospital.

So what have we done to combat this and help vulnerable communities? Our team works with every community member reaching out to us, and we follow them daily, monitoring symptoms and providing guidance. We make appointments with them with the Federal Qualified Health Center (FQHC) in the Newark area, a clinic for those who are uninsured or socioeconomically disadvantaged, to speak to a doctor through telemedicine. Every day, we monitor updates provided from major reliable health information sources and post them, in Portuguese, on our Instagram @ironboundinitiative. We monitor our Instagram and email every day, for those who wish to reach out to us with questions.

Our roles are constantly evolving, as we navigate a broken US healthcare system and a subpar response to a global pandemic, yet we do our best every day to work with the community to achieve solutions to their needs.

Members of the Ironbound Initiative team.

Thank you, Nicole, for sharing your story with us, bringing light to these issues, and for all of your hard work to help the community combat COVID-19!


Support our community partners around the world by making a donation to Amizade’s COVID-19 Relief Fund.