There are so many...so many. As healthcare providers and as a nation, we have been acutely aware of the impact of COVID-19 on communities of color and, more specifically, on the African-American community. In April, nearly three-fourths of patients who died from COVID-19 in Chicago were African American. But what I have been seeing more and more at my hospital is a shift toward a different (but also often marginalized) demographic: Hispanics. Sadly, these numbers are likely to be even higher since race and ethnicity are not always reported accurately. This is of personal importance to me because I am Hispanic, and I am one of a few Latina physicians at my hospital who is also fluent in Spanish. For my colleagues who do not speak the language, we typically have in-person translators available. But, because of the nature of COVID-19’s transmissibility, hospitals are limiting not only visitors but also non-essential in-person services such as translators. This means many of my colleagues are left to use an extremely impersonal method of communicating—an interpretalk phone.
Typically, I can manage to seek-out and admit the bulk of the Spanish-speaking patients but that for the past few weeks has not been the case, as the volume of Spanish-only speaking patients has become terrifyingly high. I want to be that familiar face that can communicate and connect with them, make them feel understood, and feel heard. A hospital is a scary place for patients to begin with, but especially now, and especially for patients who do not speak English, when there are multiple nameless, faceless strangers in their rooms, completely covered from head to toe in gowns, gloves, masks, and face shields. And when these patients start to decline, an additional wave of blue and yellow gowns enters the room, with alarm bells going off—and I want so badly to let them know that a familiar voice is there, one that they can understand, one that will explain what is happening, one that will communicate with their family. But there are simply too many of these situations, and I feel helpless.
When COVID-19 impacts a specific community of color so deeply, we talk about the socio-economic issues that factor in—broadly, we call these the social determinants of health that include things like the following:
- How many people live in the house with the patient?
- Does the patient have a job where they have the ability to work from home?
- Does the patient have access to health insurance, medications, and nutritious foods?
- Does the patient have pre-conceived or cultural misconceptions about certain disease processes or the healthcare system in general?
What I keep hearing from these patients is: “I’m undocumented, I thought ICE would know I was here.” “I don’t have insurance.” “I heard this is where you get the virus and you don’t come out.” “I don’t have internet so I don’t know where to go.” Generally, the Hispanic community faces many of the same access and healthcare challenges that the African-American community faces, but with additional unique obstacles, such as fears of deportation, living in a foreign country, and speaking a foreign language. I have heard many messages of caution in the Spanish-language media, for example, “things not to do” in order to stay safe. But I feel the message that needs to be emphasized is one of hope and reassurance. All of our patients, but especially our most vulnerable Spanish-speaking patients, need to hear concrete, meaningful, and practical instructions on how to care for each other when they live in large multi-generational families, and positive stories from people who have successfully managed infection with COVID-19. They need to hear that, as their physicians, we are here for them.
I want them to know that when they are sick, their immigration or insurance status is not my concern. My concern and my oath are to the patient in front of me and to the community I love.