Key Takeaways

  • The pandemic emphasized how an individual's and community's social determinants impact health care and access to care
  • The conditions in which many in underserved communities are living make it difficult or impossible to truly self-isolate
  • Community health workers are available at clinics and by phone to connect people with help right away

In the city of Chelsea, Massachusetts, high housing density, a large proportion of essential workers and lack of resources combined for a perfect storm that built a coronavirus epicenter in the state. However, this sanctuary city is home to many immigrants and refugees who have remained strong throughout the pandemic, even while facing longstanding inequities such as limited resources, systemic racism and chronic health conditions.

"Chelsea is the most amazingly resilient community," says Sarah Abernethy Oo, MSW, senior director of community health improvement at MGH Chelsea HealthCare Center. She has been working in Chelsea for 23 years.

"It is the most loving, kind, compassionate and strong community," she says.

Immigration-related Challenges during COVID-19

The pandemic emphasized existing disparities in health care. While many Boston-area neighborhoods have been able to hunker down and isolate at home, Chelsea and other underserved communities simply do not have that option.

Social Determinants of Health

"We have long seen how the social determinants of health impact health care," says Oo. "This pandemic highlighted this fact again, as so many lost employment and were caring for sick family members.” 

These challenges include:

  • Food insecurity
  • Housing conditions
  • Literacy and health literacy
  • Low job security
  • Lack of childcare and eldercare
  • Substance use disorders
  • Domestic violence
  • Lack of access to public health benefits

Difficult to Quarantine in Close Quarters

With insufficient financial resources, it is common for families in Chelsea to rent out rooms or share an apartment with other families. Moreover, many buildings are not up to code, so they have poor ventilation and are not wired for the internet. Living conditions such as these can make it difficult, even impossible, to truly self-isolate in the home.

Public health announcements have suggested that families should avoid unnecessary contact with seniors during the pandemic. However, many families who are immigrants live in tight-knit, multigenerational households. Not only is it impossible to avoid contact with people in small spaces, but they are also unlikely to leave each other if they get sick with COVID-19.

"Some of the systems that were created to try and help people were really hard for patients to access," Oo explains. "For example, when we create a hotel where essential workers can go to self-isolate, many are not able to take advantage of this as it would mean leaving their children and elderly parents at home alone."

Misinformation and Fear

Many people are afraid to seek care because of misconceptions about the safety of health care settings during the pandemic.

In addition to fears about being exposed to and contracting the virus at the hospital, undocumented immigrants also experience fear and mistrust of authority figures. As such, they are hesitant to provide their names to organizations such as food banks and the National Guard, which was deployed in Chelsea to help with the pandemic. However, the City of Chelsea and Mass General worked hard during the peak of COVID-19 to create an environment where all—regardless of circumstances—felt safe to seek care.

"Chelsea has always done an amazing job of reducing stigma when it comes to school and the health center," says Oo. "The sanctuary city efforts that have gone on in Chelsea for years now to make immigrants and refugees feel safe are amazing."

Resources for Immigrant Communities

Oo manages a team of 45 community health workers and medical interpreters who work hard with patients to make health care more accessible. They typically split their time and effort on three main issues:

  • Addressing social determinants of health
  • Managing chronic health conditions
  • Resettlement for newly arrived immigrants

When the MGH Chelsea HealthCare Center became a respiratory infection clinic (RIC), many of Oo's team shifted to responding to the frontlines at the clinic. A diverse team of community health workers who speak a combined 25 languages became available on-site or by phone, seven days a week, to provide support by connecting community members with food pantries, childcare resources, legal support for evictions and support for domestic abuse or substance use disorders.

The team also participates in proactive outreach by calling residents to find out if they need help acquiring food, housing and any other essentials.

Looking Toward Recovery

Oo explains that while addressing urgent needs during the pandemic is not easy, the hardest work involves repairing the inequitable system that puts the health of people of color and people at economic disadvantage at risk in the first place. Community health services are even more essential now that COVID-19 rates are starting to decline and people are starting to leave their homes and return to work. Many patients need to catch up on primary care needs that paused during the peak of the pandemic, such as standard pediatric vaccines and treatment for chronic conditions like high blood pressure, substance use disorders and obesity.

"Our work will ramp up significantly," says Oo. However, her team—and all others at Mass General—is available and ready to provide safe care to all patients.