Mario’s family was kicked off Medicaid this year.
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When he reported a new income source, he learned that his family — including his two children — no longer qualified for health insurance through UPMC for You, a Medicaid managed care plan.
And buying marketplace coverage is out of the question: Most plans would cost him up to $300 per family member. That works out to more than $1,200 per month — a cost he can’t afford on top of his mortgage and other expenses.
“It’s too much money, you know?” he said, shaking his head.
PublicSource is withholding Mario’s last name because he comes from a mixed-immigration status household. His daughters, 13 and 5, were born in the U.S. They’ve been without health insurance for most of the year.
Despite their lack of health coverage, Chelsea, his eldest daughter, was sitting on a doctor’s exam table. Mario had brought her to a mobile clinic in Beechview for a free COVID booster and exam for her school health record.
The best part of their experience? The doctor attending to Chelsea, Dr. Diego Chaves-Gnecco, is a Spanish speaker. Mario — who knows English, but prefers to speak his native Spanish — was able to directly communicate with a provider about his daughter’s health.
“It’s just better because he speaks in my own language,” he said. “I feel comfortable,” he added, gesturing to his daughter. “I think she feels comfortable as well.”
Asking questions and advocating for yourself or your loved one is an essential part of receiving healthcare. Some take it for granted, but it’s a process that many people with limited English proficiency, including many immigrants, struggle with.
Lea esta historia en español: En Beechview, una clínica bilingüe gratis atiende a hijos de inmigrantes
Experts say it’s hard for non-English speakers to navigate the byzantine American healthcare system — especially if they’re used to universal coverage in another country. And if they’re undocumented, they won’t qualify for public health insurance in Pennsylvania without proof of a serious health condition. The state excludes at least 10,000 undocumented children from its Children’s Health Insurance Program, according to an estimate by child advocates.
In Beechview, doctors from Salud Para Niños — a bilingual pediatric clinic at UPMC Children’s Hospital of Pittsburgh — have teamed up with staffers from local nonprofit Casa San José to provide primary care to uninsured kids. Many travel from all over Western Pennsylvania to access the free, bilingual and bicultural pediatric care they bring to the South Hills neighborhood that’s become a hub for Spanish-speaking people in the region.
An ‘invisible’ community
Every Tuesday, a mobile medical van pulls up outside Casa San José on Broadway Avenue. It was parked across the street from the nonprofit’s office on a rainy morning in November.
Described by staff as “the care mobile,” the van is operated by Children’s Hospital, but was paid for by the Pittsburgh Penguins Foundation and the Ronald McDonald House Charities. It has a tiny nurse’s station, two cheerfully painted exam rooms, and a patient waiting area in the style of a four-seat arrangement on a passenger train.
There was enough room to accommodate the team of four — Chaves-Gnecco, a nurse and two drivers — working that day. They attended to several families with children, who arrived for their appointments between 9 a.m. and noon.
There was Alba, who moved to Beechview in February from Santa Marta, a city on Colombia’s Caribbean coast. She brought her 11-year-old son, Edward, who has asthma, for a check-up and free inhaler supplied by the clinic. Joselyn arrived next with her son, Justin, 8, who needed childhood immunizations. Chelsea was the last patient on the schedule.
PublicSource is withholding their last names to protect patient privacy.
Chaves-Gnecco is the driving force behind the operation. He’s a pediatrician from Bogotá, Colombia who came to Pittsburgh for specialty training in the late 1990s. He planned to leave after a year, but changed his mind and did a pediatric residency at Children’s Hospital, choosing a track that would help him understand the social and environmental factors that drive health outcomes. It was training that would prepare him to serve communities of color like his own, which he described as “invisible” in the region.
There are more than 13,000 Latinos in the City of Pittsburgh and more than 31,000 Latinos in Allegheny County, but “you’re still hearing that there are no Latinos” here, said Chaves-Gnecco. That’s partly because the county lacks traditional barrios — a term for American neighborhoods with concentrations of Spanish-speaking immigrants, he said. The group makes up just 2.5% of the county’s population, compared to Los Angeles County’s 49%, according to census data.
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But it’s an important and fast-growing population, he added. Latinos in the county grew by more than 80% between 2010 and 2020 — far more than the 2% total population growth, according to a county report. Latinos here also tend to be younger: Just 7% are 65 or older, compared to 19% of all people in the county.
Chaves-Gnecco founded Salud Para Niños — “Health for the Children” — to meet the healthcare needs of those young people. It opened more than 20 years ago as a bilingual clinic at Children’s Hospital in Pittsburgh’s Oakland neighborhood. He was helping a lot of kids, but wasn’t reaching the undocumented ones, some of whom, he said, “will never qualify” for subsidized health insurance under current Pennsylvania law.
“And that’s kind of sad because that’s not the case for other states,” he said, pointing out that California, Washington and others have expanded coverage to include undocumented people.
Immigrants and people who face language barriers are more likely to be uninsured and less likely to seek primary care, said Drishti Pillai, the director of immigrant health policy at KFF, a San Francisco-based health policy research organization. Without access to preventative services, they might develop a health condition that goes untreated for a long time, which could lead to a trip to the emergency room.
“By then the situation could likely have gotten much worse, much more expensive to treat, and it theoretically could incur more costs to the healthcare system,” she added.
To keep that from happening to uninsured kids, Chaves-Gnecco and his team took the care mobile to Beechview in early 2020, just as the world was shutting down to prevent the spread of COVID-19. That year, Salud Para Niños cared for more uninsured kids than ever. Now the program does about 360 uninsured patient visits per year.
‘Linguistically affirming care’ for families
“Oh, no!” yelled Justin, the third-grader, when he spotted the nurse carrying a tray of syringes toward him.
Rose Wise laughed over Justin’s antics in the exam room. A longtime pediatric nurse at Children’s Hospital, she loves her shifts on the care mobile because “it eliminates the barriers to healthcare,” including cost, transportation and language barriers.
Justin and his mother, Joselyn, are uninsured. She had been taking him to a low-cost clinic in Squirrel Hill, but heard from staffers at Casa San Jose that a Spanish-speaking doctor was treating kids right where she lived in Beechview.
That day was Justin’s first appointment with Chaves-Gnecco, who gave him a physical and caught him up on his vaccinations. He told Joselyn in Spanish that her son was healthy and in good shape to play sports at school. She plans to bring Justin back to the care mobile.
“Thanks to this type of clinic, we have the possibility to access a doctor,” she said, speaking through Chaves-Gnecco’s translations. “This clinic is very valuable for the community. It’s very important.”
Joselyn and Justin’s experience is what pediatrician and assistant professor Dr. Maya Ragavan calls “linguistically affirming care.” It creates a safe, supportive environment in which patients and their families can express their identities. Affirming care started as a framework for treating LGBTQ+ patients, but it can be applied to immigrants, people of color and other marginalized groups.
Ragavan speaks Spanish and occasionally treats patients on the care mobile. She’s also a health equity expert whose research shows that affirming care can help improve health outcomes for immigrants. Too often, families don’t get that kind of care, she said, adding that it’s bad practice to expect family members to interpret for their loved ones. That leaves the burden on the family to advocate for a certified interpreter.
Chelsea, Mario’s daughter, said she had to translate for her parents in other healthcare settings.
“That’s really hard and really unfair,” said Ragavan. “… It’s the healthcare system that does that [to immigrant families].”
Chaves-Gnecco, on the other hand, built a system that ensures families receive affirming care “from start to finish,” she said, from a Spanish-speaking scheduler to fully translated health manuals.
“I love the way that he can communicate with my parents,” Chelsea said. “Anything that I shouldn’t [have to] know to explain, he explains it for them.”
Non-Spanish-speakers are also welcome at the care mobile, which is equipped with a tablet that provides virtual interpretation services for more than 100 languages, said Chaves-Gnecco. And the team is working with community partners like Casa San José to better accommodate Latinos whose first language is indigenous — a growing population here, according to a county report.
A trusted community partner
Across the street from the van, Constanza Henry was helping people who were crowding into Casa San José’s tiny lobby. Some had only been in the U.S. for one week, she said.
Henry is Casa San José’s community health and wellness coordinator. She works with providers to hold free clinics in or near the nonprofit’s office. Her efforts helped bring vaccines, mammograms and primary care to adults and children in Beechview.
Nearly a third of immigrant adults said a community health center is their usual source of healthcare in a recent survey. That jumps to about two-fifths among immigrants who are uninsured, undocumented or have limited English proficiency, said Pillai, the KFF researcher.
Of all the doctors who donate their time to Casa San José’s programs, only the ones from Salud Para Niños can speak Spanish, said Henry. She often has to translate for patients and providers at the other clinics. It’s why Chaves-Gnecco is one of the most beloved doctors in the community, she added, and in such demand that he sometimes has to turn patients away.
“It’s also very frustrating, not having all of the resources you would like to have,” said Henry, an immigrant herself from Mexico City. “Or just thinking that in our countries, if you go to the dentist, they won’t charge you so much and they will help you immediately.”
Chaves-Gnecco said Colombia provides healthcare to immigrants, refugees and unhoused people. He dreams of universal coverage in the United States — of a system that doesn’t punish uninsured children.
“It’s no secret to anybody that if you don’t have health insurance in this country, sometimes you might end up losing your car … [or] your home,” he said. “That is a really huge problem. And I feel that we should do better for our community in general, for all Americans … and provide health insurance for everybody.”
Back in the care mobile, the team wrapped up with Mario and Chelsea.
Wise, the pediatric nurse, said Chelsea could have her pick from the clinic’s supply of blankets. She chose a cozy-looking fleece one in a butterfly pattern. It shielded her as she climbed down the clinic’s steps and stepped out into one of the coldest, wettest mornings this fall.
The locations and hours of operation for Salud Para Niños can be found here in English y aquí en español.
Correction: Tom Skemp’s name was misspelled in an earlier version of this story.
Venuri Siriwardane is PublicSource’s health and mental health reporter. She can be reached at venuri@publicsource.org or on X, the platform formerly known as Twitter, @venuris.
This story was fact-checked by Ladimir Garcia.
Translation by Zulma Michaca, a bilingual professional living in Riverside County, Calif., with family ties in Pittsburgh. She can be reached at z.michaca123@gmail.com.
This reporting has been made possible through the Staunton Farm Mental Health Reporting Fellowship and the Jewish Healthcare Foundation.
