The holiday season barely slows the bustling activity at South Philadelphia’s Puentes de Salud (Bridges to Health), a clinic where no patient is ever turned away and treatment is often accompanied by a generous dose of moral support and access to much-needed community services. Founded in 2004, Puentes thrives on the energy of student volunteers, dedicated medical staff and health educators. In order to create this unique health services model for an urban, immigrant Latino community, “myself and my mentor, Steven Larson, M.D., the dean of Global Health Programs at the University of Pennsylvania, attended many neighborhood events and began talking to people about their health needs,” explains Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2007-2010) Matthew O’Brien, M. D., the founder of Puentes de Salud.
O’Brien and his team quickly learned that Philadelphia’s severely over-taxed health care safety net was failing to meet the needs of the area’s rapidly growing, uninsured Latino population. “People told us, ‘we don’t have access to care. We are turned away by clinics and we get bills for thousands if we go to emergency rooms,’” O’Brien said. Realizing that a traditional biomedical health care model would not work in this environment, O’Brien and Larson drew on their years of experience working with diverse populations, to “design a comprehensive immigrant health center that would address a broad range of the social determinants of health as they affect South Philadelphia,” O’Brien said.
As a result, Puentes is run by a team of bilingual student volunteers who do administrative work, nurses and clinicians who provide care and community organizers who conduct classes on everything from literacy to how to apply for nutrition assistance, practice preventive health care or protect the health of infants and new moms.
Clinical nurse liaison, Annette Silva explains, “we fill the tremendous gap left by area health centers because we serve people whether or not they have health insurance. We bridge language barriers and help people obtain any additional care needed, even if we have to walk them through the process.”
For Elena Carrera, Puentes de Salud’s comprehensive care may have saved her life. A diabetic who had gone without medical care for two years after immigrating to the United States, Carrera heard about Puentes through word of mouth. “She had no insurance or personal physician,” Silva explains, “and she came to us in crisis—her blood sugar was out of control. It took about a month to get her stabilized, but then she and her husband were willing to come in to learn more about her disease. Taking injections carries a huge taboo in the Latino community, so that gave us an opportunity to explain to her husband why it was important for her to take injected medication. This made it possible for her to take care of her diabetes without being alienated from her family and community.”
“Elena is very typical of our patients, we are seeing more and more cases of diabetes, we see a great deal of hypertension and digestive disorders as well and of course we sometimes discover possibly undiagnosed cancers or other serious illnesses. No matter what the situation, we make sure they get additional care or emergency medical assistance if we can’t provide complete care,” said Silva, who has seen the weekly patient load grow from 20 to 50 in the months since the recession began.
In addition to providing primary care and education programs, “the third arm of our organization is focused on research,” said O’Brien, an internist and director of clinical research at Puentes de Salud. “We’ve investigated the effectiveness of preventive interventions in cervical cancer and we are currently looking into obesity prevention programs.” O’Brien credits his experience as a Robert Wood Johnson Foundation Clinical Scholar for his unique approach to care at Puentes, “the Foundation has inspired me not only through what I’ve learned in the Scholar program, but also through the principles of the Commission to Build a Healthier America. I got some incredible ideas about how to seek help and funding as a Scholar and the Commission’s recommendations were extremely helpful in teaching us how to focus on the social determinants of health in the design of Puentes de Salud.”
“Now, we hope that Puentes will provide a replicable model for other health care providers and institutions that want to satisfy not only a community’s medical needs, but also confront the larger social factors that impact population health,” O’Brien said.
The Robert Wood Johnson Foundation Clinical Scholars Program focuses on training physician scientists to collaborate with the public and learn the requisite skills of conducting Community-Based Participatory Research.