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 Republican 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, or ICE, 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 recalled. Bavis said she felt a little guilty, wishing she could do more to relieve her anxious patient.
“‘Right now, I just am so afraid. I can’t go anywhere,’ ” she recalled the patient saying.
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 person’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 Wednesday, when CommunityHealth’s main clinic around the West Town neighborhood on the West Side is typically bustling with patients. That was a few days after Trump was inaugurated and people were bracing for deportation.
“It was very surreal and actually reminded me of what it felt like to be on site during the pandemic,” Willding said. “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.”
Not every clinic or hospital is having the same experience as CommunityHealth or is tracking how many patients aren’t showing up for appointments, WBEZ found. Some medical facilities slide another patient into a slot when someone doesn’t come.
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 can’t be handled via a phone or computer, like getting a vaccine.
There are other signs of the chilling effect of the Trump administration’s deportation plans. 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 around 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.
More than half of the health center’s patients have at least one chronic condition that needs consistent care, Willding said.
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 that any paper trail back to the family could raise the suspicions of immigration enforcement. They also are shying away from applying for help to pay hospital bills, advocates say.
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 trickled 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.
ICE agents have detained at least 100 people in the Chicago area, Chicago Police Superintendent Larry Snelling has said, including in Lake County, where Mano a Mano has offices.
Researchers at the nonpartisan Migration Policy Institute documented the chilling effect on immigration 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.
“The fear is still there, ever since the new president was elected,” said Luvia Quinones, senior director of health policy at the Illinois Coalition for Immigrant and Refugee Rights.
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 live-streamed show where they invite different partners, such as hospitals and nonprofits, to talk about what’s going on, educate people about their benefits and their rights when interacting with immigration officers, 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 with everything from affordable housing to legal services. Willding said this would help cut down on travel times for some patients, possibly enticing them to keep getting their regular check-ups. It can take about an hour on public transit to get to CommunityHealth’s main clinic near West Town from Back of the Yards.
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. Immigration officers typically need to show a warrant signed by a judge or probable cause to arrest someone. Willding is also looking into ways to buzz people into the clinic, like with a doorbell camera on homes and businesses.
Back at the main clinic, in between patients, Bavis tries to keep perspective. During COVID, there was a vaccine on the horizon to look forward to. When thousands of migrants arrived in Chicago, providers at CommunityHealth and other clinics took care of them.
“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.