Sarita, one of the 20+ pregnant women we have helped access prenatal care, car seats, WIC, and health insurance, was strongly advised by phone to go to the hospital to be induced out of concern for the health of her baby. She and her husband have struggled to find stable housing for their growing family since they arrived a few months ago and work for her husband has been inconsistent. He is a day laborer at the whims of weather and job contracts. Without a way to communicate with her husband or her child at school, no public transportation in her rural town and with limited English skills, Sarita wondered out loud if it would be ok to wait until tomorrow to go to the hospital. The medical provider explained that, though rare, fetal death was sometimes associated with her condition. I heard an audible gasp as Sarita processed this information that I shared via a WhatsApp call (the only communication method available to her at the time) and decided she would to go to the hospital right away. I reached out to a professional contact who had offered to help with last minute transportation needs. She was unavailable but shared that another friendly neighbor was around and willing. Sarita was dropped off at the hospital alone. At check in at labor and delivery, Sarita called me to interpret as she signed some forms. When asked to sign a consent to bill, she paused and asked aloud how she was going to pay for the costs. I stepped out of my role as interpreter to remind her that her health insurance was in process and we hoped she would be notified of enrollment very soon.
We were in touch into the evening with labor progressing slowly. Unsure when the baby would arrive and concerned that her husband wouldn’t get enough sleep to work the next day, he stayed home with their other young child. I woke up at daylight just after receiving a picture of her healthy baby, born earlier that morning. I thought about my time in the hospital after giving birth and the many family and friends who checked in – the comfort I had in knowing that through the exhaustion I was fully supported and could ask for whatever I needed or wanted. I offered to stop in and help coordinate additional supports as needed. Sarita said she would welcome a visit. When I asked if she had a craving for anything Sarita responded “Could you help me buy a pastelito?” Luckily I clarified as I first thought she meant a savory turnover-like stuffed pastry. What she actually wanted was a vanilla cupcake.
Two days after the birth of her health baby, she was discharged, returning home to a packed 2 bedroom household of 6 adults and 7 children. Two days later, over the weekend, Sarita reached out saying she had a fever and wanted to go to the hospital. We called the on-call provider who went through a series of question about abdominal pain and other symptoms. The provider wanted to how high her fever went and Sarita said she felt really hot. She didn’t have a thermometer so the provider recommended getting one – a nearly impossible task due to living far from any store with a thermometer and a lack of transportation. The provider reviewed reasons Sarita should go to the Emergency Department – sustained fever, heavy bleeding, abdominal pain… She made a note in the chart for a nurse to reach out on Monday to check in. In the meantime, I reached out to a Spanish speaking friend who happened to be nearby. She was warm but had no fever when the friend showed her how to use the digital thermometer.
Early Tuesday morning, Sarita wrote me from the Emergency Room. She had arrived by ambulance after a rough night of fever and chills – she said she just knew something was really wrong. She was ultimately diagnosed with a blood infection connected to the birth a few days earlier. The recommendation was to be admitted for intravenous antibiotics but when Sarita was told she could not get admitted with her days old baby, she asked about getting discharged. With all adult family members working in unstable jobs that often come with fear of getting fired for missing work and no social network, Sarita was facing an impossible choice – her health vs caring for her newborn. Behind the scenes, we began conversations about whether an informal network of Spanish speaking moms I knew could take turns in the hospital helping take care of the baby in a way that would allow Sarita to stay with him and continue to breastfed. In the meantime, a fantastic social worker/patient advocate from within the hospital and I reached out to a medical provider in a leadership position at the hospital who fully understood the complexities and health risk that lay at the center of this case. Ultimately, Sarita was allowed to keep her baby at her side for the duration of her multi-day hospital stay.
Sarita’s health and the health of the family, like so many of the families we work with, continues to be impacted by the intersection of multiple social determinants of health: economic stability, safe housing, social and community context, transportation, and language access. The family is recovering from a parasitic infection that ultimately impacted the all families in the small apartment building due to close living quarters. Insurance covered the cost of treatment for the children while the most of the parents who are ineligible for insurance paid out of pocket. Sarita recently cancelled a well-child check for her kiddos due to needing to take on the responsibility of caring for another baby in the household while the parents worked. All while Sarita is at risk for mental health issues as she is socially, linguistically, and culturally isolated in a rural community while sleep deprived, caring for her own infant.
Sarita has demonstrated significant strength, calm, and determination in the face of so many challenges over the past few months. While both she and I recognize the important role our program has been able to play in helping her and her family navigate some of the health challenges in the short-term, there needs to be resources dedicated to ensuring newly arrived immigrants can acquire the knowledge and skills needed to set the family up for successful integration in the long-term through orientation about and access to transportation, secure housing, stable employment, affordable childcare, English classes, community connections, and health services.