No Walls, No Barriers

July-August 2017


Miguel is a local pizza delivery man in his late 30s or early 40s who has brought orders to the Community Wellness Program office at Saint Anthony Hospital in Chicago. One day, he walked into the office without a pizza — coming to us because he had severely infected thermal and chemical burns on his hand.

Our community wellness nurse saw that the burns were severe enough for Miguel to need immediate care, but not so severe that he could lose a limb. Because the Emergency Department wait time was running long that day, the nurse called our urgent care center. In 10 or 15 minutes, Miguel was receiving the medical treatment he needed.

Miguel told us he had suffered the burn at work and tried to treat it himself with mustard, toothpaste and Pomada de la Campana, a common over-the-counter ointment. His home remedies made it worse. Much worse.

Still, Miguel said, he was afraid to go to a doctor because he is an undocumented immigrant. He was acquainted with us at the Community Wellness office, though, and by coming to us, he got the medical help he needed and also received assistance from our urgent care staff in completing a workers' compensation claim.

"We need to stand together," Cardinal Blase Cupich wrote in a letter distributed to Chicago priests in February 2017, "and clearly make it known that the Archdiocese supports the dignity of all persons without regard to immigration status…. We will continue to provide services to those who seek assistance, such as food, shelter and legal aid… regardless of the person's national origin, religion or immigration status."

Saint Anthony Hospital has been fulfilling that mission — meeting the health needs of persons regardless of their nationalities, denominations, religious affiliations and ability to pay — for 120 years. Located between the Eisenhower and Stevenson expressways, about five miles southwest of Chicago's Willis Tower, Saint Anthony Hospital is faith-based, nonprofit and "community-centric." It has been independent since 2009, one of only three remaining independent hospitals in the Archdiocese of Chicago.

The hospital was founded in 1898 in a neighborhood populated by Czech and Bohemian immigrants. In the mid-20th century, when the Czechs were leaving the neighborhood to move further west, Polish immigrants were moving in. Chicago poet and author Stuart Dybek was born at Saint Anthony in 1942.

Beginning in the 1980s, the neighborhood ethnic composition gradually changed again, and it was beginning to be called La Villita, Little Village, the "Mexico of the Midwest." In 2016, more than 90 percent of the 1,500 students at nearby Hammond and Saucedo elementary schools were Latino, as were almost 90 percent of the 800 students at Farragut High School. St. Agnes of Bohemia, the largest parish in the community — and perhaps in the entire vicariate — has nine Masses in English and Spanish on Sundays, one every 90 minutes from 7:30 a.m. to 7:30 p.m.

From 2005 to 2008, through Section 1011 of the Medicare Modernization Act, the federal government allocated $250 million a year to reimburse hospitals across the country for the emergency services they furnished to undocumented immigrants. Illinois, one of the six states with the largest undocumented populations in the United States, received $10 million a year. Saint Anthony received $2 million a year, reportedly more than any other hospital in the state. Although the Section 1011 "sunset" has passed, ending the federal allocation, Saint Anthony continues to be a trusted provider of emergency room services to Chicago's undocumented population.

In 2006, a community hospital near the Eisenhower Expressway was converted into a long-term care facility, which orphaned a three-year-old program for mostly African-American older adults and seniors. Saint Anthony adopted the program and, in 2011, with a seed grant from the Chicago-based Retirement Research Foundation, one of the country's first private foundations dedicated exclusively to elder issues, Saint Anthony's senior wellness program hired a bilingual community resource coordinator. She helps seniors who prefer to speak in Spanish understand the services and benefits they may be eligible for, based on their immigration status, to improve their health and well-being.

In 2009, after separating from a national health network, Saint Anthony rechristened itself a "hospital without walls." At that time, as it continues to be today, access to health care was an issue for far too many residents in the surrounding community. So staff stepped outside the hospital walls to attend health fairs in parks and schools, to provide screening services at church halls and food pantries, and to make presentations on managing diabetes and high blood pressure at senior housing and senior services centers.

Developed over two decades, the hospital's Community Wellness Program has become a refuge for members of the marginalized groups to which Saint Anthony ministers, serving their social-emotional needs through five free initiatives: health care navigation, community nursing, community organizing, family support and mental health services. Each of these initiatives provides much-needed social support delivered in collaboration with partner organizations at a variety of locations throughout the community.

The five program areas were designed to develop integrated, wraparound care that has a positive impact on the lives of adults and families and adds value to the partner organizations' work. To better leverage resources for collective impact, Saint Anthony's Community Wellness Program prioritizes its work with coalitions to increase awareness of local resources and to support initiatives that respond to the community's unique needs.

The Chicago Tribune estimates there are 183,000 undocumented immigrants in Chicago, of which 20,000 are living in Saint Anthony's community. Many have lived there for years; they are the hospital's neighbors and have accessed a variety of the hospital's community wellness services.

Maria, for example, completed prenatal classes in 2011 at Saint Anthony. After her child was born, Maria felt isolated without family members close by, so she and her child enrolled in Little Explorers, a weekly program at Community Wellness that promotes unstructured parent-child play time for infants and toddlers, organizes structured parent-child activities and offers individual coaching on child development concerns.

While at Little Explorers, Maria noticed that her child was not as active as the others. After making their own observations, the Community Wellness staff suggested to Maria that she request a diagnostic evaluation for her child. Staff members accompanied Maria and her child to the evaluation, and they were with her when she learned that her child has autism.

Maria was unfamiliar with what services were available for her child and unclear about what they were meant to do. She relied on Community Wellness staff to explain the benefits of speech and occupational therapy, and ultimately they helped her gain access to the services. As her child got older, Maria completed Adults and Children Together (ACT), a parenting class designed by the American Psychological Association that the Community Wellness Program offers in Spanish.

Traumatic experiences, unfortunately, are not uncommon within the immigrant community. When Maria felt overwhelmed by her life, her child's disability and keeping up with the special education needs, she was referred to free mental health services that offer childcare along with trauma-focused, long-term care. The fact that Maria is an undocumented immigrant has never been a barrier to her and her child receiving services from Saint Anthony.

In February 2017, at the 23rd Annual Chicago Neighborhood Development Awards, Saint Anthony's Mental Health Services Program received the Blue Cross and Blue Shield of Illinois Healthy Community Award. This award celebrates the work of a successful initiative that is improving the health of residents and the environment of a community in a way that contributes to an improvement in overall community health. Saint Anthony's mental health services program partners with a strong set of neighborhood organizations to serve nearly 300 adults a year with a team that has doubled in size over the last two years. The team now has four full-time therapists and one supervisor.

Immigration status is a significant risk factor that contributes to the vulnerability of community residents. The demand for services increased in the months following the 2016 U.S. presidential election. Saint Anthony spearheaded a community-based participatory research project designed under the guidance of Arturo Carrillo, PhD, who is the hospital's family support and mental health program manager. Saint Anthony partnered with various neighborhood-based organizations, local residents and a variety of mental health providers for the project. The group made three key findings: 1) Depression was the leading self-reported mental health need in the community; 2) The community reported an overwhelming desire for mental health services; and 3) Cost — not stigma — was by far the biggest barrier to care.

These findings speak to the larger structural challenges facing the immigrant population in Saint Anthony's community and in low-income communities throughout Chicago. In convening the Southwest Side Mental Health Collaborative, Saint Anthony will develop solution-oriented research which will bring together stakeholders to create better health systems that provide the necessary support for vulnerable immigrant communities, regardless of their nationalities, denominations, religious affiliations and ability to pay.

Saint Anthony Hospital continues its mission to serve the most vulnerable community residents by being embedded within the community to provide essential health and social supports and to drive change that can improve systems to allow for healthier adults and families.

JAMES A. SIFUENTES oversees mission, government and community relations as well as the Saint Anthony Hospital's Pastoral Care Department and its Community Wellness Program in Chicago.

ARTURO CARRILLO is family support and mental health program manager for Saint Anthony Hospital's Community Wellness Program in Chicago.



No Walls, No Barriers

Copyright © 2017 by the Catholic Health Association of the United States

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