Accessing Healthcare During COVID-19

Dr. David E. Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at UCLA Health. He recently published a study that found Latino households are unable to afford the high costs of COVID-19 treatment.

By Peter White

NASHVILLE, TN — The essential workers who harvest our food and stock grocery store shelves are helping us survive the pandemic. We would starve without them. They are largely underpaid and uninsured. Many frontline workers and their families can’t afford the high cost of treatment for COVID-19.

Last March, first responders got PPEs. They got tested. But nobody thought about meatpackers, bus drivers, gardeners, truck drivers, construction workers, food industry workers, and farmworkers. They were taken for granted and largely forgotten. For

Because they rarely have health insurance, in order to pay for such a course of treatment, a California farm worker would have to go entirely
without meals, housing, and transportation for two months. Most people will starve to death by around 40 days without food.

them, accessing healthcare during the pandemic can be a crisis in itself. And begs a serious question: Who Shall Live?

About 90% of farmworkers in California are Latino immigrants and 60%-80% are undocumented, according to Dr. David E. Hayes-Bautista, director of the Center for the Study of Latino Heath and Culture at UCLA. Although essential workers, they are not covered under Obamacare. And unlike some jobs, you can’t do farm work from home. 

“After all, you can’t grow strawberries in your front yard,” Bautista said. “They have to go out in the fields; they work in packing houses; they work in large crews shoulder to shoulder, they are rarely offered health insurance,” Bautista said. Stoop labor is low-paid back-breaking work. 

You can’t afford to get sick if you are a migrant. Even a single office visit can be unaffordable. During the first months of the pandemic you had to visit a doctor to get a referral to get a test. Without insurance, that could cost anywhere from $100 to $2000 for one test.  Even at $100 each, a family of six simply couldn’t afford it.

“Because many populations of color tend to work in these occupations and industries that expose them to coronavirus with less access to care for testing, for treatment, for follow up, not surprisingly Latinos have one to the highest rates of exposure and mortality in the State of California,” Bautista said. That is also true of Latinos in SE Nashville around Antioch. City leaders ignored the COVID outbreak there for months.

Bautista compared a farm worker with acute COVID-19 going to an emergency room with President Trump’s visit to Walter Reed Hospital a couple weeks ago. 

Forget about the airlift by helicopter that costs about $60,000. Let’s assume our farmworker had a buddy drop him off at the ER.  And let’s not count the cost of the President’s medical team or his security, the cost of an intensive care room, or the cost of setting up a hospital inside the White House. Let’s just talk about how much a course of remdesivir costs.

“It’s $3,120,” Bautista said. 

“Your average farmworker household income is $1,500/mo. So that course of treatment of remdesivir that President Trump got would have been two months salary for a farmworker. To pay that he would have to forego all food, housing, all clothing, all transportation for two months. If you go without food your average person dies in about 40 days,” Bautista said. (see graph) 

Community Health Workers are essential workers who strengthen the public health response to COVID, particularly in under-served communities. Paradoxically, CHWs are not part of the health care system: CHWs are lay workers, usually women, and do not practice medicine. Rather, they are trained to provide basic health education in the communities where they live and work. As a rule, they are not state or federally funded. They exist primarily on private philanthropies that fund short-term projects. 

Australian researchers studied CHW programs in various countries and discovered that without steady funding they cannot sustain themselves for long. On the other hand, CHW programs would not be successful without the intimate community connections CHW workers have.

“CHWs are a precarious workforce,” said Denise Octavia Smith, executive director of the National Association of Community

Denise Octavia Smith is executive director of the National Association of Community Health Workers (NACHW). She said CHWs in 46 states help underserved communities get access to health care and the network has distributed more than 100,000 masks during the pandemic.

Health Workers.

“We have deep cultural origins that extend throughout the world,” she said. In Latin America CHWs are called “Promotoras de Salud”.  Their origins grew out of the writings of Paulo Friere, a Brazilian educator and philosopher, whose book, Pedagogy of the Oppressed (1968), discussed not only education but also community empowerment in line with Catholic liberation theology. Friere’s theories have been applied in many developing countries for more than 50 years.

In the United States, the National Association of Community Health Workers (NACHW) promotes healthy communities with programs in 48 states.

That is no easy task in the U.S. where healthcare is an industry controlled by private insurance companies. Their primary objective is to make money, not provide quality healthcare at a reasonable price. The U.S. has the dubious distinction of spending more than any other country on healthcare (17% of GDP) but leaves millions of people outside its healthcare system. 

‘This year in the United States you will find us working around community violence prevention, helping new immigrants and refugees navigate a new health system, conducting home visits, or working with families to ensure immunizations,” Smith said.

She noted that community health workers have a calling for compassionate service and speak peoples’ native language as well as English. ”We walk alongside, we partner with, and engender trust with our community members .We often live in the community or we are peers with the same lived experience. If you’re living with a chronic disease like cancer, we are cancer survivors. We are from the reentry community, we were once migrant workers,” Smith said. CHW’s cultural competence is key to effectively organizing in underserved communities.

CHWs are the lowest paid frontline public health workers but vital because they run programs that help marginalized populations counter structural racism and promote equity. 

During the pandemic CHWs screened communities for social and behavioral health needs. They found community members to train and work on COVID testing and contact tracing in Navajo country. In Pittsburgh’s Black neighborhoods CHWs are recruiting volunteers for COVID-19 trials. In the process, they are building trust by confronting historic barriers to preventive medicine like vaccines. 

“We are working in under-resourced communities in a variety of different settings. You will find us working on education and working around housing and workforce development as well as working in hospital settings and with primary care providers. We are bridge builders. We are navigators. We are health educators. We are also community organizers and advocates and social workers,” Smith said.

This article was brought to you by Ethnic Media Services and the support of the Blue Shield Foundation of California.