South Philadelphia's immigrants have a bridge to better health - and life

Thousands of uninsured Latino and other immigrants in South Philadelphia’s low-income neighborhoods go to Puentes de Salud (Bridges to Health) for health care, wellness – and hope of a better life.

Since 2003, Puentes has provided low-cost primary health care, plus a range of social and educational services for a primarily Latino immigrant population. It’s relied on more than 200 volunteer doctors, nurses, medical students and interpreters – augmented by just a handful of paid employees – to run part-time clinics for vulnerable residents.

In April 2015, Puentes settled into its first permanent home. The University of Pennsylvania Health System (UPHS) donated a 7,000 square foot clinic and education center – part of the UPHS campus – to the nonprofit organization and helped to fund the renovation of the clinic.

“We’ve been embraced by a health system to bring greater visibility to this model of health care and that is exciting,” says Steve Larson, M.D., Puentes’s co-founder and executive director, and Hospital of the University of Pennsylvania-Penn Medicine’s associate professor of emergency medicine.

“It’s given a home to the community,” says Annette Silva, Puentes’s clinical nurse liaison. “When people walk through our doors they know no one is going to ask [for documentation] and they can ask for assistance and we will do the best we can for them.” 

Puentes’s goal is to break the cycle of poverty for its vulnerable populations through customized programs and services. It provides everything from dental care to family-planning advice to oncology referrals for as little as $10 per visit to patients.    

“We are evolving into being a true medical home that is able to not only respond to the daily medical needs of patients, but also to complement our services and our reach into the community,” says Larson. As a young physician, he spent time in Central America and observed community health workers focusing on prevention. He wondered about the prevalence of immigrants who came to the United States and developed chronic illnesses.

“You had to think about health care in a totally different fashion than what we traditionally teach in the U.S.,” he says. “It made sense to implement interventions that made people healthy and kept them out of the emergency department.”

He and co-founder Jack Ludmir, M.D., started Puentes as a “shoestring” operation in various clinics and offices in South Philadelphia. In the early days, Ludmir identified a shortage of prenatal and general medical care among the city’s undocumented Latino immigrants.

“I was frustrated that these women, because they unauthorized, could not get prenatal care,” says Ludmir, who served as the 2011 chairman of the AHA’s Maternal and Child Health Constituency Section, and is chairman of Pennsylvania Hospital-Penn Medicine’s obstetrics and gynecology department.

Puentes showed costs are lower when women get treatment that prevents problems during pregnancy, rather than waiting for them to arise, he said. “We are a model of care that is truly integrated with the community” and improves outcomes for pregnant women and newborns, Ludmir says.  

The organization cares for nearly 5,000 patients, with plans to double that amount over the next year.

It addresses the underlying causes of illness, like poor nutrition, illiteracy, unemployment or urban violence that affect peoples’ health. Puentes partners with local public schools, universities, governmental institutions, non-profit organizations and community-based agencies to extend its reach deeper into the communities it serves.

For example, Puentes started Puentes Hacia Futuro (Bridges Toward Future), an after-school program for kindergarteners and other children up to 8 years of age. The program includes tutoring and mentoring, a computer coding program, art classes and a summer literacy class.

Through Puentes, immigrants seeking legal advice can get free consultations from volunteer law school students. The Penn Graduate School of Education designed a curriculum in English as a second language and a summer reading program. The university’s Wharton School offers investment classes to Puentes clients.

“We give you the platform and now my community benefits from those services,” says Larson, who likens the partnerships to a Thanksgiving table. “Everybody is invited to share, but you don’t come to the table empty handed. You bring a jar of cranberry sauce or a loaf of bread or a turkey. Everything gets put on the table and is used and appreciated.”  

Typical of the patients seen by Puentes is Justina, an undocumented mother of two who came to the U.S. from Puebla, Mexico seven years ago. She has obtained medicine for her daughter’s thyroid condition for only $20 a month. Through the program, she took art classes from an instructor who encouraged participants to express their feelings about the experience of coming to the United States, and has an interpreter service for English-language letters that arrive at her South Philadelphia home. 

Justina’s native tongue is not Spanish, but Nahuati, an indigenous language spoken by many in Puebla. Today, she teaches a language revitalization class in Nahuati – through the Bridges Toward Future program – to other immigrants from Puebla.

“It is just one example of all the things that happen at Puentes that are very much related to long-term wellbeing and unrelated to direct health,” says Esther Morales, who head Puentes’s educational and social services.

Calling Puentes a “disruptive innovation,” Larson said the program shows that community-based health care can be inexpensive and effective. Adds Ludmir: “Our dream is that this model can and will be applied not just to the vulnerable Latino community in Philadelphia but to vulnerable people in vulnerable communities everywhere.”