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Community health workers are a ‘lifeline’ to pregnant people with COVID-19

A nationwide patchwork of women workers has become indispensable to immigrant parents.
Tina Vasquez September 2nd, 2020
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In New Jersey’s immigrant community, doula Teresita Carrasquillo is considered a godsend. Families call her at all hours—pregnant people have questions about something they learned in their childbirth education class; new mothers want additional tips on breastfeeding or help getting diapers; and women who gave birth months prior just want to remain connected. Carrasquillo becomes a friend and confidant to undocumented women navigating one of life’s biggest transitions in a country that is increasingly hostile to immigrants. But as the COVID-19 pandemic continues to ravage Latinx communities, trained community health workers like Carrasquillo have also become lifelines.

According to data from the Centers for Disease Control and Prevention, nationwide Latina mothers make up nearly half of the coronavirus cases among pregnant women. As The Washington Post reported, information about the impact of the coronavirus on pregnant people continues to be limited. A report from the CDC in June found that infected pregnant women may be more likely than infected nonpregnant women to be treated in an intensive care unit or need a ventilator, and pregnant women who are Black or Latinx appear to be disproportionately affected by the coronavirus during pregnancy.

As a certified doula and the supervisor of the Children's Home Society of New Jersey’s community-based doula program Apoyando Madres/Armando Redes (AMAR), which means Supporting Mothers/Creating Networks, Carrasquillo is providing in-person support to COVID-19-positive pregnant women—including undocumented Indigenous women from Guatemala.

In 2019, 250,000 Guatemalan migrants were apprehended at the U.S.-Mexico border. Many of them were asylum-seekers and at least half of them were Mayans who spoke little or no Spanish, the New Yorker reported. Mam was the ninth most common language used in immigration courts last year, and three Guatemalan Mayan languages made the top 25: Mam, K’iche’, and Q’anjob’al.

Language barrier presents major challenges when it comes to accessing health care. Many hospitals fundamentally fail to provide language services to people who speak Indigenous languages, and hospital staff cannot communicate with patients or offer Indigenous patients forms and other paperwork in their language.

Two of Carrasquillo’s recent COVID-19-positive clients were Indigenous women from Guatemala who spoke Qʼeqchiʼ, which presented challenges for Carrasquillo, whose primary language is Spanish. While one birth was mercifully short, the other was “very, very long,” Carrasquillo said—both for the first time mother and the doula.  

Doula Teresita Carrasquillo in the hospital with a new mother. (Photo credit: Teresita Carrasquillo)
Doula Teresita Carrasquillo in the hospital with a new mother. (Photo credit: Teresita Carrasquillo)

The hospital in New Jersey where one of her clients gave birth had strict guidelines regarding COVID-positive pregnant people, namely that whoever is in the room during labor cannot exit and re-enter the room. This meant that if Carrasquillo wanted to remain with her client during the duration of the labor and birth, she could not exit the room to get food, for example. Carrasquillo stayed as long as she could—18 hours. The doula purposefully waited until her client was in active labor, feeling confident she was leaving her in good hands.

“Wearing a N95 mask for 18 hours was very difficult and it made me so upset that I could not leave the hospital, get some rest, and come back to be with the mom in her room as part of postpartum,” Carrasquillo said. “She had to stay alone during postpartum and it was heartbreaking, but I did the best I could.”

The ‘magic component’

As the first Spanish-language doula program serving Trenton, New Jersey, AMAR has quickly become an indispensable resource to the immigrant community. Part of its success is due to its adherence to the community-based doula program model created by HealthConnect One, an organization focused on peer-to-peer support for pregnancy, birth, breastfeeding, and early parenting. The community-based doula program model prioritizes employing women who are trusted members of their community.

This model has become particularly crucial for building trust in undocumented communities, who have valid reasons to fear accessing health care. Clinics have called law enforcement on undocumented immigrants seeking reproductive health care, and as Prism recently reported, hospitals can unilaterally choose to medically deport undocumented patients who are unable to pay for their care. In New Jersey where Carrasquillo works, undocumented pregnant people can access emergency Medicaid for labor and birth. In fact, the first point of connection Carrasquillo makes with her undocumented clients is when they come in to take a pregnancy test. From there, she helps them access the prenatal care clinic and AMAR’s prenatal education program, among other programs.

As of June, AMAR had two dozen undocumented clients. If it weren’t for the organization, these families would have nowhere to turn for culturally competent support.

“There are a few essential components that lead to better birth outcomes for low-income communities of color, meaning a decrease in maternal mortality, in anxiety rates, and an increase in breastfeeding. For me, one of the most essential components of HealthConnect One’s model—the magic component—is employing women who are trusted members of the target community. If the community is mostly Hispanic immigrants who speak Spanish, you must hire women like that. We understand them because we are them; we are in community with them,” said Carrasquillo, who is from Puerto Rico.

Community connectors

Carrasquillo is one doula in a much larger nationwide network of community health workers anchored by HealthConnect One that provide pregnant people with social and educational support during pregnancy, birth, and postpartum—often bridging the gap between them and their medical providers. This work was never easy, but community health workers who spoke to Prism said they feel like they’re “treading water” during the pandemic—especially because so many of their clients are undocumented, uninsured, and in need of basic services.

Maria Briseño says she loves her work, but the lactation counselor and breastfeeding peer counselor finds herself increasingly frustrated by the lack of resources available to undocumented people in her community. She said she works hard to fill the gaps so that community members have what their families need, but people are still falling through the cracks.

It’s not unusual for Briseño to receive messages near-daily on Facebook from members of the community asking for help or resources related to her work as a community health worker. In Merrillville, Indiana’s immigrant community where she was born and raised, Briseño is lovingly referred to as “the chichi lady” because she’s spent more than 20 years tirelessly teaching new mothers the basics of breastfeeding. But as COVID-19 cases have surged across the state—including more than 7,300 people testing positive for the coronavirus in Lake County where Merriville is located—the social media pleas for help are now coming from families she’s never worked with, and they are dire.

A few weeks ago, Briseño said that a mother frantically messaged her on Facebook. She was undocumented, uninsured, and just tested positive for COVID-19. Without any real instructions, the hospital sent the woman home and told her to isolate in her apartment, but she lived with her children. She called Briseño on Facebook Messenger crying, and Briseño could hear the woman’s children crying from the other room. They were hungry, but the mother was afraid to leave her bedroom and she didn’t have funds to stock up on food. Responding to these kinds of desperate calls go above and beyond Briseño’s work as a lactation counselor, but she does what she can because she knows that there are few organizations in Merriville willing to help undocumented community members.

“I’m a connector in the community, that’s how I see myself,” said Briseño, who was able to connect the family to a regular source of food and use her relationship with HealthConnect One to get the mother some rental assistance. “I understand the barriers that these families experience, but it’s very frustrating to hear someone crying on the phone for food because it makes you realize that we have really failed women of color and immigrant women in our community.”

While they may not be seen as essential workers during the pandemic, community health workers are proving to be vital. Brenda Reyes told Prism that supporting community health workers as they shift to working more online has actually been the easy part.

Reyes is a registered nurse and a certified lactation counselor who has more than 15 years of experience creating and implementing peer support programs for new moms and families. She began her work with HealthConnect One in 2001 as the organization’s peer counselor program coordinator. She is now a board member and serves as the organization’s representative to the United States Breastfeeding Committee, while also supporting on-the-ground community health workers access the resources they need to serve families. Reyes said community health workers have adjusted to the pandemic—they are conducting consultations with clients over WhatsApp and hosting webinars on Facebook to get face time with the community and answer any questions they may have. But they are spread thin, Reyes said, and feel “overwhelming” pressure to find resources for families in their communities where sometimes there are none.

“Many of our community health workers are documented and bilingual and they know how to navigate the system, but it’s still really hard to juggle all of this—the pandemic, their own families, and the stressful work that they do. On top of it all, the families in their communities need more help than ever and the regional organizations [these workers are employed by] are under-resourced and the hospital systems they’re working in have very different COVID policies depending on the region,” Reyes said. “Doulas are struggling with their emotional and mental health, but they feel like they have to keep pushing because they are the go-to source for undocumented families; they are the bridge for the resources that families need and trust.”

‘Badass women’

Lorena Quiroz-Lewis, who identifies as a “rogue doula,” admits “it’s been a grind.” The Mississippi resident wears many hats. She’s the leader in HealthConnect One’s Birth Equity Leadership Academy, an organizer with Working Together Mississippi, and the founder of Immigrant Alliance for Justice and Equity of Mississippi. In all of these roles, she advocates for undocumented Mississippians, a community that last year was hit by Immigration and Customs Enforcement’s (ICE) largest single-state workplace enforcement action in U.S. history. ICE detained nearly 700 people during the raids, many of whom were parents.

These were families Quiroz-Lewis knew, both as an organizer and birth worker who has lived, worked, organized, and raised her children in the Mississippi Delta for around 20 years. Now she’s helping these same families access PPE and other basic resources to fight COVID-19—and that’s part of the problem.

Quiroz-Lewis says that government and health department officials are fully aware that Mississippi has a sizeable undocumented population, with many of these Mississippians doing “essential” jobs at poultry processing plants where they are at high risk of getting the coronavirus. But few efforts have been made to aid or help protect this population. Quiroz-Lewis said that every time there is a public health crisis—whether it’s COVID-19 or ICE “terrorizing the community”—it’s like she’s starting from scratch all over again, scrambling to address families’ most immediate needs while educating government officials on what they could be doing to help undocumented Mississippians that they don’t seem to understand they have an obligation to.

In other words, she spends her days hustling to get pregnant poultry plant workers proper PPE, for example, or trying to get food for entire families sick with COVID-19.

“It pisses me off because when I take a minute to think about it, I see how all of this is an example of all of the systems that have failed these communities,” Quiroz-Lewis said. “But when you’re with the community, you are on the frontlines for what they need and I’m happy to play that role. I’m a cultural broker with my feet in different worlds and if I have to yell at the health department on their behalf, I will.”

But the birth worker is also giving local mothers the skills and tools they need to feel empowered and begin organizing mutual aid in their own communities. Many are Indigenous women from Guatemala who work in the poultry plants. Quiroz-Lewis is helping them learn how to use Gmail and Google Docs so that they can stay in touch with families sick with COVID-19, and collaborate with each other by compiling lists of community needs and available resources. Many of these women have expressed interest in becoming doulas, so now Quiroz-Lewis is trying to figure out how to get them doula training in their languages.

The organizer told Prism that it’s strange to her, the backwards ideas that Americans have about immigrants. Her presumption is that many would look down on the undocumented mothers toiling away at Mississippi’s poultry processing plants, assuming that because they don’t know English or they are stuck in a low-wage job that they are somehow less intelligent.

“These badass women have sometimes traveled a thousand miles to get here with nothing on their back but an infant. These women speak more languages than Americanos because when they get here they have to learn English and Spanish and they already speak dialects their people have been speaking for centuries,” Quiroz-Lewis said. “I can’t tell you how beautiful it is to see them in their Guatemalan dresses, sometimes going door-to-door to ask what their community needs so that they can write it down on a little piece of paper and figure out how to put it in a [Google] doc. This is the resilience I want people to understand about our communities. These women are powerful and they figure out how to thrive even when the shit is piling up around them.” 

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