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“Pt’s husband and father deported. Pt doing ok.” The message came from a colleague who had seen my patient for an urgent visit. My heart drops every time I get this kind of message, which happens all too often for primary care providers like me at community health centers. In an instant, my patients’ lives are turned upside down – they become single parents, they lose critical income, they begin endless wonder about the fate of their loved one. But perhaps what haunts me more are the faces and names of patients who have disappeared from the clinic schedules, who previously came religiously to their visits, and now we do not see. Patients like Maria, a middle aged Brazilian immigrant who I last saw for insomnia and palpitations a year ago. During our visit, she recounted an episode a few days earlier when the car she was driving was rear-ended by another car. Though clearly not at fault, she was nonetheless fearful that police may come, so she fled the scene. She developed insomnia, palpitations and extreme anxiety, fearful that she may now be deported as a result of the accident she did not cause.  When Maria did not come to our follow up appointment, I called her at home, and she did not answer.  I wondered whether she had been deported, or whether she, like so many of our patients, no longer answer the phone.  I think about the conversation I overhead in urgent care weekend clinic the other day: worried about a lab result, a physician tried to call a patient. When no one answered, the physician shared her concern at not having reached the patient. A medical assistant volunteered  “let me call him”, the assistant offered, “when patients hear me speak their native language, they often answer” – indeed, this patient answered the phone when the Portuguese-speaking team member called back, and the patient got the care he needed. Sadly, my patient Maria never answered the phone even when a native Portuguese speaker called. In fact, her phone is no longer working, and I fear her worst dreams have come true.

At the Institute for Community Health, we have long worked with social service and healthcare organizations that provide support to vulnerable populations such as immigrant communities. Through research and evaluation, we help organizations understand how their outreach and engagement efforts are working with this and other vulnerable populations. We work with organizations like Community Catalyst’s Center for Consumer Engagement in Health that are supporting grass roots organizing and mobilization to increase the voice of low-income communities and communities of color in health systems transformation efforts (see the recently released interim report of their Consumer Voices in Innovation program).  Our support helps organizations not only improve their services but also demonstrate to funders the impact of their work, so that they can continue to grow.  We have  documented the impact of immigration policies on health care access, showing how fear of deportation leads to less health care seeking.  And we have done research highlighting that immigrants contribute into healthcare – and contribute more than is spent on their behalf in one of the largest sectors of healthcare, Medicare, thus subsiding the care of others. This is especially true of undocumented immigrants like my patient Maria. At a time when immigrants’ rights are under attack, we at ICH are more committed than ever to supporting vulnerable populations and the organizations that serve them through data-driven insights.