Bill Klaproth (Host): This is a special episode of Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership, recorded live at the AONL 2024 conference. I'm Bill Klaproth, as we talk about A Port in the Storm, healthcare for asylum seekers in Chicago. With me is Beth Vaclavik, Associate Chief Nurse Executive of Ambulatory Services at Cook County Health. Beth, welcome.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Hi. Thank you, Bill. It's great to see you here at AONL.

Host: Thank you. It's great to be here. I love this conference, and it's just a great conference for learning and everybody coming together. Just wonderful. So thank you being here, and thank you for your session as well, talking about health care for asylum seekers in Chicago. So tell us about that. Why you wanted to bring this to AONL 2024, and how did you address this issue, health care for asylum seekers in Chicago?

Elizabeth Vaclavik, DNP, RN, NEA-BC: Thank you. So, a lot of this is about social determinants of health and health equity for those marginalized populations. And so, Cook County Health has always held that we will take care of anybody. If you are in need, if you suffer, you can come to us and we will help you and that's all that we need.

Back in 2022, when Chicago as a sanctuary city started receiving the refugees coming to us from Texas, we had to come up with a plan. And so we had 48 hours to create a plan as to how we were going to address this population, understanding that they were coming from South America, primarily Spanish speaking, and had suffered some very vigorous terrains in coming through the Yucatan to make it to Texas.

So in looking at that and trying to level the playing field with health equity and inclusion, we identified one of our clinics that is primarily Spanish speaking called in the Belmont Kragen neighborhood. We had a facility where we had a clinic on the first floor, and we had a second floor we were going to be building out.

So we had a space. We had to create a team, and it's really important that you have a team. No one person can do this alone. This included purchasing, it included medicine, it was nursing, and operations. So there were a lot of meetings to build this team, and within a 48 hour time frame, we had our operations team with busloads of people bringing them to our clinic.

We had the staff that was able to register them, welcome them, and bring them into our clinic. We had nurses and clerks, medical assistants and physicians and APRNs. And so we had to build an instant migrant health clinic and address the needs that they were coming in with.

Host: That is amazing. So kind of a four pronged attack within 48 hours. You mentioned purchasing, medicine, nursing, and operations. You quickly had to put this plan together.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Absolutely. And we included within that, nursing scope and medicine, we also had behavioral health and care management. We recognized that these individuals were coming to us, and we'll call them new arrivals. They were coming to us with nothing but shorts and t-shirts, no food. And this was September in Chicago, so we knew what lie ahead.

So, we needed to address all of their needs that they were coming to us with. First and foremost, we were able to get donations of things like diapers, baby formula, diaper bags, backpacks for those children going to school. We needed to address our youngest population. And we needed to get them ready for school.

So we had school forms ready, we had vaccinations, we made sure that all of our children came in, if they didn't have current vaccination records, and this is really important, if they don't have proof of that vaccination and they don't know when they happened, we were restarting them. And then putting them into eye care.

So wherever they may end up, the next place, if it's not us, will be able to access those vaccination records. So that was critical.

Host: Really, really important. So I want to ask you for anyone listening to this podcast now, there's lot of cities struggling with this. Can you talk about the, I know you talked about purchasing, medicine, nursing operations. Can you talk more about the plan? How you got this thing rolling? What are the necessary steps to do what you're doing?

Elizabeth Vaclavik, DNP, RN, NEA-BC: Yes, sure. So the first thing we had to look at was people who were coming from another country into the U.S. What kind of screening needed to be done? Who was able to do it? So we were looking at things like TB screening, infectious disease screening and then healthcare for those children. We also needed to make sure that they could communicate effectively with this group of people that were coming across to us.

And since they speak, primarily Spanish, and we didn't run across anybody who actually spoke English, we made sure that our entire staff was Spanish speaking. So our RNs, our clerks, and our MAs all had to be bilingual Spanish. To do that, above and beyond what we currently have in our system, we had to engage our partners to have agency staff coming in who were competent in bilingual Spanish.

Then we had to create an orientation for them to that included the trauma informed care because there were many people coming across the Yucatan and had endured quite a bit during their journey. So they were able to recognize those individuals who were at need. We had behavioral health on site, walking around, just to identify if there was anybody that the nurse or the MA thought might need a little bit more assistance.

And so they were readily available. We had a dentist who was on site because a lot of these children are, cutting their teeth or have their teeth. And the dentist was there to hand out toothpaste and toothbrushes and to do the basic routine that all of our children do when they're starting school.

We had an HIV screener who came in who spoke with each of the adults who were sexually active to offer at no charge, an HIV test. Cook County Health is one of the leaders with HIV care. We have both primary and specialty care services. And so to engage them early on to test and identify those at risk and bring them into our system was really important for the quality of their life. And so we engaged them as well. So it was important that we had a multi pronged approach to this. And all of this process, putting together, we had to purchase machines to take blood pressures within 48 hours. And so we had to find locations and get all of our resources, filling up a supply room.

Our operations team was phenomenal. And then they were giving us a text at night saying, a bus is coming in. We expect it at such and such time tomorrow. And we had to make sure we had enough staff and that we could leverage them coming off of the bus. It became apparent when they were coming off the bus, some of them hadn't eaten in a long time.

So we then had donations of food. We had our fruit, juices, tuna, all kinds of things. And there was a couple of occasions where individuals from within the clinic were purchasing meals for the children who were coming because they hadn't gone, or they hadn't been able to eat in a while. And they were going to be facing labs.

And so when you're going to stick a child. You want to make sure that they've eaten something and that they're steady. So we had to encounter all of those types of issues with them as well. And then they went to see care management after that to talk about what lie ahead for them. What options do they have? What resources do they have by staying in the U.S.? And then we gave them a brochure that said if you are planning to stay in Chicago, we welcome you and we are happy to be your primary care provider if you decide to stay with us.

Host: Amazing.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Yes, that was the first of three.

Host: Wow, that first of three, that's a lot of moving parts. So before you get into part two and three, I just want to say editorial for a minute. This is a hot button issue across the country, but when I hear you talk about how we're taking care of these people, I'm proud of us.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Yes, we did a great job. And you know, we had to be really flexible with them as well. What we started with on day one was not what we were doing on day nine. The first day, when we were set to open, we opened at 10 AM. Our plan was to be closed by 10 PM. And we didn't close until midnight. Everybody stayed.

We had a couple of people who needed to get transferred to the hospital. And we needed to take care of them. And so everybody just stayed and took care of them. We listened to people's stories. They all have stories.

Host: I do want to ask you about that. So I want to ask you, and maybe I'll just jump into it right now before we get to two and three. We hear about this in the news, and we hear about the top line problem of where we're going to put these people, and people are complaining, and I get it, this is a hot button issue, I don't want to get into that, but I would like to hear from you, because we never hear from them.

Are they appreciative of this? Are they like, thank you, America. Thank you for what you're doing for us. What did they say to you? We never hear from them.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Right. So, we've heard some of the stories. They've really connected. They appreciated that they were treated with respect and dignity. We treated them the way we treat every single patient. The staff spoke their language. They listened. They held their hand. They walked them through each step of the process.

When somebody greeted them at the door, they walked them to the scale to weigh. They walked them into the room. The providers were there. The providers met with them. We kept the family in one room to keep them together. The stories that we heard of having to pay as they went through each person's territory, and many of them were lucky enough to pay with money. But if they didn't have money, they paid with women and children. And so, predominantly what came across were men, initially, for the first couple of months, between the ages of about 21 and 50. And so, they had already endeared a lot. And coming to us for a while we bought boxes of chips. It was kind of a funny thing.

We would buy boxes of chips because these were young men, or, you know, men. and we would just put out boxes of chips. And we could put out three or four boxes, and they'd be gone within hours.

Host: You said they were so hungry. A lot of them haven't

Elizabeth Vaclavik, DNP, RN, NEA-BC: Absolutely.

Host: eaten in days, you said.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Right? And then as they were coming through with families, they weren't necessarily the nuclear family. It might have been a sister who wasn't a blood sister, but a sister that they had acquired along the way because she was traveling alone. And they stayed together. And so when these families came in, they weren't separated. We had a situation with a man who was there with a child and had lost his wife.

He was not going to leave the child alone, was having chest pain. We coordinated with the ED over at Cook County, how can we get father there and taken care of with the child. And so we were able to do that. We were on the phone every step of the way in getting them to the appropriate care and keeping the family intact.

And some were larger than others.

Host: Yeah. And it, it sounds like they're appreciative of the efforts that people like you are providing. The care that they're receiving when they get here. I know this is, again, a hot button issue, but when they get into your hands or people like you, I would imagine they're very appreciative.

Want

Elizabeth Vaclavik, DNP, RN, NEA-BC: And this is a group of people and I know you don't hear from them but they very much want to be in the U.S. And they want to pull their weight. And they come across, we had men that didn't want to come into the clinic because they were out looking for a job. And it was very important for them to be able to support their family.

And so, a lot of times the wife would come in with the children and there'd be a husband somewhere, but he was looking for a job. And then they would get that job, and then they couldn't come in because they needed to go to work every day. And so they want very much to be part of our society. They want to help, and they want to work.

They very much appreciate what we're doing. For we think about Maslow's Hierarchy of Needs. If we can't address the needs of food, and safety, and security, and clothing, we had donations. We had an Amazon wish list, and when people would ask, what size do you need? It says underwear. What size? We'd say yes. Everything. Everything from the smallest to the largest. And so we had what we called a boutique, and so after patients were seen for their medical needs and their screening and their vaccinations, we would bring them over to the boutique where they were able to get sweatshirts, long pants, boots and wears for their kids as well.

Only when you help patients to achieve that level can you go into the safety and the health care and say, now your child needs to come back, they need that next round of vaccines, we're happy to do it. We even provided transportation to our clinics. So if they had to come back in three weeks for another vaccine, we provided the transportation with a car seat for the entire family to come in for that visit.

Host: Right. So you said this is a multi pronged approach. You said it's kind of a three step approach. So you kind of went through step one. Can you quickly take us through two and three?

Elizabeth Vaclavik, DNP, RN, NEA-BC: Absolutely. So we had seen several thousand patients and had a significant number of visits from 2022 to December of 2023. In December of 2023, we seemed to have an influx of people that were coming to us from Texas. And they were living in the shelters and they weren't getting into our clinic fast enough.

So, again, the city reached out and said, is there some way that you can help, can you screen, can you go into the clinic, into these shelters and screen? So we started to have a presence of nurses and MAs going into the shelters, setting up a shop, and having the people living in the shelters come to us where we were doing vital signs and a basic screen.

At this time we were seeing a lot of chicken pox, and so we were talking to the shelter managers and talking to them about anybody who was itching, scratching, had a rash, and so they would go and they would pick them out and bring them in, and it was open, some people walked in on their own, and we were coming to them.

And so it was a lot easier than them getting on a bus and coming to us. So we reached out to them, and we were doing a lot of screening, and then we had a provider who was available virtually, who was able to look at rashes talk with the person who had a fever. We sent some people to the emergency room, some people had the virtual visit, and some people were just scheduled for a visit within the next 72 hours at Belmont Cragun.

So that was phase two, and really that was intended to screen. It was additional screening in those shelters. And we had a presence, I think we had a presence in about 10 different shelters, and we moved from shelter to shelter. After a couple of thousand people going through that process in December of 2023, recently we received a phone call saying that they've seen some measles predominantly in our new arrival populations living in the shelters.

And so we had had a significant number of measles cases and mostly they were in children. And so our thought was, well, we need to get these babies and these little kids vaccinated as quickly as possible. We partnered with our infectious disease team and our Chicago Department of Public Health team and we met to talk about what that would look like.

The ask was to vaccinate right at the point where people are coming into the city. So that means that we just this week started sending a team of nurses to the landing zone, which is kind of like a bus stop, ground zero, where people are coming off of the buses either from other shelters or from Texas

and we are doing a screening and vaccination right on site. And so all children are getting the varicella vaccine, age 12 months and up. And then children and adults are both getting the MMR.

Host: And it seems like that's working. I live in the Chicago area, so I hear and see all of this. And it sounds like the measles rates are coming down.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Yes, yes. And they say, so Dr. Welbel has been our infectious disease contact. She's been our, go to person. And she's identified that after that first vaccine, the immunity is well into the 90 percentile. And so, yes, we are seeing that.

Host: That's good. So, Beth, thank you for your time. This has been great. Can you tell us about the results? So far, it sounds like what you are doing is working for the people you see.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Right. So, we have, to date, about 110,000 visits from new arrivals coming from that region and coming to us specifically from Texas. We have been able to impanel close to 30,000 patients who've stayed in the Chicagoland area and are becoming our patients. We've had roughly less than 4,000 that have had to go to an emergency room for an emergency room visit.

But we've integrated them into our specialty clinics, our primary care clinics. We have gone out to their shelters. The shelters are shifting. People are coming out of the shelters. They're finding homes. They're finding permanent locations out into the community. They're finding jobs. And we do continue to have those care coordinators to help assist with that transition of care.

And so if they've come to us and they've been screened for something, we have somebody who can reach out to them to give the results and if any further treatment is needed.

Host: About everything you're doing in Chicago and hopefully some of your wisdom and strategies will help other people that are in the same situation as well. As we wrap up, Beth, anything else you want to add?

Elizabeth Vaclavik, DNP, RN, NEA-BC: I would say that it's been difficult to cross the nation and it's been difficult to be sanctuary cities and sanctuary states, and I've heard very much the same thing from others that have received the new arrivals. Know that we're not alone. There are so many people out there to use as resources.

And if we were to think about the situation where we would be in a location where nobody spoke our language, and we were trying to come across what we needed, the difficulties that we would have. And put that into perspective when they're coming to us. They're not asking for us to hand everything over to them.

But how can we treat them with the dignity and respect that we treat each other?

Host: Yeah, very well said, and I'm happy for people like you that are doing just that. So thank you for all of your efforts in this. I know this is, again, a hot button issue and a lot of people are struggling with it, but thank you for what you're doing in Chicago.

Elizabeth Vaclavik, DNP, RN, NEA-BC: Thank you Bill, and thank you for having me.

Host: Yeah, absolutely. Once again, that is Beth Vaclavik.

And for more information, please visit aonl.org. And if you found this podcast helpful, please, I ask you share this on your own social media platforms. We would appreciate that. And you can check out the full podcast library for topics of interest to you@aonl.org. This is Today in Nursing Leadership. Thanks for listening.