Nurse practitioner Margaret Bavis isn’t used to her “rock-solid” patients not showing up at CommunityHealth, a free medical center in Chicago that mostly treats Spanish- and Polish-speaking patients.
But about two weeks ago, when President Donald Trump was sworn into office amid a promise to deport millions of people in the U.S. without legal status, some of Bavis’ regulars started skipping their appointments.
In the days since, U.S. Immigration and Customs Enforcement made a high-profile appearance in Chicago but released limited information about the people it detained.
Many patients have continued to stay away from CommunityHealth, where nearly all the patients are uninsured. Many of the staff are from immigrant communities too, not only witnessing the trauma that their patients are experiencing but feeling it at home, CEO Steph Willding said.
Delaying care, even for a short time, can have grave medical implications, health care providers say.
Bavis said many of her patients need help managing high blood pressure, type 2 diabetes and other chronic conditions, illnesses that can set a person back for months if left untreated. Bavis saw this during the COVID-19 pandemic, when people stayed away from hospitals and clinics to make space for the critically ill, but then got sicker from delaying medical care.
The health center had a huge backlog of people who missed preventive cancer screenings during COVID — Pap smears, mammograms, colonoscopies — and when people did return, some were diagnosed with cancer at a later stage, Willding said.
Bavis recalled a longtime patient who came in for lab work recently after skipping her appointment the week before out of fear she could be caught up in raids and separated from her family. The patient was in tears, she said.
“‘Right now, I just am so afraid. I can’t go anywhere,’ ” the patient told Bavis.
Bavis said it’s been “heartbreaking to hear that kind of despair. I think we’re just only at the very beginning of what’s going to be a really horrible time for our patients.”
A chilling effect
CommunityHealth treats more than 4,000 people a year, with around 50 employees and 1,000 volunteers helping take care of patients. Like a lot of hospitals and health centers, CommunityHealth doesn’t ask a patient’s legal status.
Still, in the first two weeks after Trump took office, nearly 30% of patients didn’t show up or canceled their primary care or specialty appointments or lab tests without rescheduling, translating to more than 300 missed visits, Willding said.
She described how quiet it was on a recent Wednesday, when CommunityHealth’s main clinic in the West Town neighborhood on the West Side is typically bustling with patients.
“Several times, I walked into the clinic and it was silent, no noise, and when I checked on the waiting room, twice we had no patients in our waiting room,” Willding said.
Several clinics, including CommunityHealth, have shifted to virtual visits at the request of patients who don’t want to leave their homes. But that’s not a long-term solution, Willding said. Some medical needs have to be handled in person.
There are other signs of the chilling effect of the Trump administration’s deportation policy. During a recent visit at CommunityHealth, two shelves in the pharmacy were packed with small brown paper bags filled with prescriptions that hadn’t been picked up for about 10 days. Patients had yet to get insulin to treat diabetes or medication for blood pressure, high cholesterol and rheumatoid arthritis.
“Depending on how much they have at home, they definitely need these meds,” said Elsa Bishop, assistant director of pharmacy at CommunityHealth, as she combed through the bags.
In other cases, some people aren’t renewing food assistance or medical benefits; some are ending health insurance coverage for their children, even if their kids are U.S. citizens, fearing any paper trail back to the family could raise the suspicions of immigration enforcement.
At Mano a Mano Family Resource Center, a north suburban nonprofit that helps around 12,000 mostly Latino immigrants a year enroll in public benefits, among other services, program manager Irma Barrientos said case managers typically receive about 50 to 60 calls a day to apply for benefits.
That’s dropped to three to five calls a day.
“The fear is so great that it’s preventing people to seek life-saving treatment, preventive treatment,” Barrientos said.
She points to the Illinois health insurance programs for immigrant adults and seniors regardless of their immigration status, lauded as a lifeline for people who don’t have legal status in the state. If people don’t renew every year, they lose coverage.
“We’re going to have this vicious cycle of people having to go to the ER as their last resort and having these huge medical bills that everyone in America has,” Barrientos said.
Researchers at the nonpartisan Migration Policy Institute documented the chilling effect on immigrants during Trump’s first term, when there was a steep decline in low-income immigrants signing up for financial aid, food assistance and health insurance they were eligible for.
Glimmers of hope
With many immigrants afraid to leave their homes, health advocates are turning to social media to get their messages out. Mano a Mano hosts a weekly livestream to educate people about their benefits and try to ease concerns.
CommunityHealth plans to open a “micro-clinic” next month in the Back of the Yards neighborhood inside The Resurrection Project, a nonprofit that helps immigrants. Willding said this would help cut down on travel times for some patients, possibly encouraging them to keep getting their regular checkups.
In the meantime, to help protect patients, Willding won’t allow immigration officers or people other than patients to linger in the waiting area or lobby. She is also looking into ways to buzz people into the clinic, possibly using a doorbell camera.
Back at the main clinic, in between patients, Bavis tries to maintain her perspective.
“In this moment, I just feel I’m looking for the hope,” Bavis said. “I want to be strong for my patients and for my community, but I think right now, today, it just feels really hard.”
Kristen Schorsch covers public health and Cook County for WBEZ.