Across Los Angeles, the Inland Empire and the Coachella Valley, one community health center is extending its services to immigrant patients in their homes after realizing that people were skipping critical medical appointments because they’ve become too afraid to venture out.
St. John’s Community Health, one of the largest nonprofit community healthcare providers in Los Angeles County that caters to low-income and working-class residents, launched a home visitation program in March after learning that patients were missing routine and urgent care appointments because they feared being taken in by U.S. Immigration and Customs Enforcement agents.
St. John’s, which offers services through a network of clinics and mobile units across the region, estimates that at least 25,000 of its patients are undocumented, and about a third of them suffer from chronic conditions, including diabetes and hypertension, which require routine checkups. But these patients were missing tests to monitor their blood sugar and blood pressure, as well as appointments to pick up prescription refills.
Earlier this year, the health center began surveying patients and found that hundreds were canceling appointments “solely due to fear of being apprehended by ICE.”
President Trump came into his second term promising the largest deportation effort in U.S. history, initially focusing his rhetoric on undocumented immigrants who had committed violent crimes. But shortly after he took office, his administration said they considered anyone in the country without authorization to be a criminal.
In the months since, the new administration has used a variety of tactics to sow fear in immigrant communities. The Department of Homeland Security has launched an ad campaign urging people in the country without authorization to leave or risk being rounded up and deported. Immigration agents are showing up at Home Depots and inside courtrooms, in search of people in the U.S. without authorization. Increasingly, immigrants who are detained are being whisked away and deported to their home countries — or, in some cases, nations where they have no ties — without time for packing or family goodbyes.
The Trump administration in January rescinded a policy that once shielded sensitive locations such as hospitals, churches and schools from immigration-related arrests.
In response to the survey results, St. John’s launched the Health Care Without Fear program in an effort to reach patients who are afraid to leave their homes. Jim Mangia, chief executive and president of St. John’s, said in a statement that healthcare providers should implement policies to ensure all patients, regardless of immigration status, have access to care.
“Healthcare is a human right — we will not allow fear to stand in the way of that,” he said.
Bukola Olusanya, a nurse practitioner and the regional medical director at St. John’s, said one woman reported not having left her home in three months. She said she knows of other patients with chronic conditions who aren’t leaving their house to exercise, which could exacerbate their illness. Even some immigrants in the U.S. legally are expressing reservations, given news stories about the government accusing people of crimes and deporting them without due process.
Olusanya said waiting for people to come back in for medical care on their own felt like too great a risk, given how quickly their conditions could deteriorate. “It could be a complication that’s going to make them get a disability that’s going to last a lifetime, and they become so much more dependent, or they have to use more resources,” she said. “So why not prevent that?”
On a recent Thursday at St. John’s Avalon Clinic in South L.A., Olusanya prepared to head to the home of a patient who lived about 30 minutes away. The Avalon Clinic serves a large population of homeless patients and has a street team that frequently uses a van filled with medical equipment. The van is proving useful for home visits.
Olusanya spent about 30 minutes preparing for the 3 p.m. appointment, assembling equipment to draw blood, collect a urine sample and check the patient’s vitals and glucose levels. She said she has conducted physical exams in bedrooms and living rooms, depending on the patient’s housing situation and privacy.
She recalled a similar drop in patient visits during Trump’s first administration when he also vowed mass deportations. Back then, she said, the staff at St. John’s held drills to prepare for potential federal raids, linking arms in a human chain to block the clinic entrance.
But this time around, she said, the fear is more palpable. “You feel it; it’s very thick,” she said.
While telehealth is an option for some patients, many need in-person care. St. John’s sends a team of three or four staff members to make the house calls, she said, and are generally welcomed with a mix of relief and gratitude that makes it worthwhile.
“They’re very happy like, ‘Oh, my God, St. John’s can do this. I’m so grateful,’ ” she said. “So it means a lot.”
