Dr. Eva Galvez’s (Biology ’99) family background and passion for holistic care have led her into migrant labor camps, radio stations, mobile clinics, and the world of public policy. She is adamant about the necessity of culturally appropriate health care — a need which is ever more urgent as migrant communities face disproportionate challenges due to the COVID-19 pandemic.
“If we are going to bring health equity and reduce disparity in health, we must take into account those social determinants which are relative of culture, people’s language, and people’s beliefs,” Eva said.
When reports of COVID-19 cases in Washington state began surfacing in January, Eva knew it was only a matter of time before the novel virus reached her community. As a family physician at the Hillsboro Clinic of Virginia Garcia Memorial Health Center, Galvez cares for a community that closely resembles her own.
Galvez and her identical twin sister, who is also a physician, grew up east of Portland, Oregon. As daughters of a Mexican immigrant and with both parents employed as seasonal farmworkers, Galvez’s family lived in farmworker housing in a community made up of people with backgrounds like their own. Most community members came to the United States to participate in the highly sought-after opportunities to create a better life for themselves and for their families back home.
“If we are going to bring health equity and reduce disparity in health, we must take into account those social determinants which are relative of culture, people’s language, and people’s beliefs" — Eva Galvez.
Galvez’s parents had the same philosophy. Instead of working in the fields, she and her sister were expected to focus on school. What she wasn’t aware of, however, was how her upbringing compared to that of her classmates. In middle school, Galvez realized her community faced challenges like racism, discrimination, and poverty, that were largely unfamiliar to her peers who did not come from migrant farmworker communities.
“It was that backdrop of seeing a community that was working so hard to try to make a better life, but also seeing the challenges that they faced, that inspired me to go into medicine,” she said.
Achieving equity in healthcare
With clinics spanning Washington and Yamhill counties, Virginia Garcia Memorial Health Center generally serves a patient base that relies on Medicare, lives in poverty, and largely consists of migrant and seasonal farmworkers and others with barriers to receiving health care. Given the population they serve, Galvez knew COVID-19 had the potential to disproportionately impact her community. Virginia Garcia set up one of the first drive-through testing centers in March but found that there was still a gap in patient understanding of COVID-19. Most of the resources explaining the virus were in English, which left a significant portion of Galvez’s patients without information. So, she took to the radio waves.
“I was given a script in English and that night — and I’m grateful that my parents always said ‘don’t forget your Spanish’ — I was able to quickly take something from English to Spanish and then by the next morning we were at a radio station.”
Galvez recorded public service announcements to be aired on three Spanish radio stations and Univision, a major Spanish TV channel. Around the same time, the clinics began to have their first confirmed cases and partnered with local food banks to provide resources to patients who were unable to work.
“Farmworkers have always been victims of substandard living and working conditions. If you’re getting paid to pick cherries by the hour, who’s going to stop doing their work so they can go across the field to wash their hands? Especially if you find there’s no soap there.”
While mobilizing quickly to identify and care for patients should have helped to TRACE and mitigate spread, unfortunately, that was not the case. Confirmed case numbers continued to rise and Galvez continued to search for a cause.
“After about 2-3 weeks, what I found was that my patients did understand how COVID spread and how to prevent spread of COVID-19. This is more about the conditions that my patients are working in and living in.”
Through conversations with patients and others in the community, Galvez found that migrant and seasonal farmworkers especially were not receiving support at work. Most operations were continuing as if there was not an ongoing global pandemic: no personal protective equipment, people packed elbow to elbow at factories, and multiple families sharing living spaces at labor camps. Even if workers did get sick, there was little incentive to get tested for COVID-19.
“About 70% of our farmers, if not more, are undocumented. Therefore, if they’re sick and can’t go to work, they’re not going to get unemployment and they're not going to get sick benefits.”
Galvez realized that the health of her community was dependent on more than the care she could provide. Social determinants, like where people live and work, greatly impact our health, which is especially significant during a pandemic as they can give insight to how a single virus can have such drastically different effects on a broad range of cultures, she explained.
“Much of our society has this belief that health is something that we have control over — that if we as individuals can just eat the right food and exercise the right amount and take the right medications you will be healthy. And this would be nice, but that is not the reality. Health is actually the sum of many factors. The reality is only about 20% of our health is determined by healthcare and our individual choice. And the rest is shaped by social factors, otherwise known as social determinants of health, and those include cultural beliefs and your values.”
Social determinants also include the culture of your work and living environment. For many farmworkers this includes close quarters and the lack of sanitation, both of which spell trouble amid a respiratory-transmitted viral pandemic.
“Farmworkers have always been victims of substandard living and working conditions. They have handwashing stations that are a mile away,” noted Galvez. “If you’re getting paid to pick cherries by the hour, who’s going to stop doing their work so they can go across the field to wash their hands? Especially if you find there’s no soap there.”
Galvez partnered with the Oregon Law Center (OLC) to petition for temporary rules in the fields to improve sanitation and living conditions, and expand benefits for farmworkers, such as sick leave and unemployment. This was Galvez’s first step into the world of public policy, however, she felt prepared to advocate for her patients due to her previous experiences both as the daughter of farmworkers and her community involvement in college.
“There are many things that contribute to poor health that are beyond medicine. Once you get at the root causes, then you realize that you must start pushing for change at a policy level. So those experiences in college where I got to interact more with a different group of students who were not scientists but were still social activists, I think really has made me a better physician.”
Advocating for essential workers
Though she did have support from her advisor and professors, courses like Organic Chemistry and Cell Biology often felt lonely. Galvez’s sister was one of her few Latina classmates. So, she sought out community beyond the bubble of pre-medicine. She was an active member of the Hispanic Student Union and a frequent presence at the Centro Cultural César Chávez, both organizations that worked to support Latinx students and promote diversity on campus. Little did she know, these communities of support also equipped her with invaluable advocacy skills that would serve her well as a physician.
Galvez and the team at the OLC were successful in petitioning the Occupational Safety and Health Administration (OSHA) to enact emergency rules that would help protect farm workers during the upcoming harvest season, but there is still more work to be done.
“It was really exciting for me when OSHA did agree to make some changes in the rules. Obviously, we didn’t get everything that we asked for, and it’s an ongoing battle. Something that I will continue to fight for during this pandemic, and even when this pandemic is over, is ensuring that these farmworkers who are essential workers have access to these benefits that all other essential workers have.”
Galvez does see a silver lining in these difficult conversations: The unsafe conditions are being recognized and addressed. No longer does healthcare have to stop when patients leave the clinic. Galvez and other physicians who build relationships with their patients and take the time to understand how their cultures affect health are able to push for holistic, culturally appropriate care. By teaming up with experts in law and public policy, physicians can share their patients’ stories and make changes that will have long-term benefits for the health of many.
“Science is really rigorous, and you definitely need a very strong science background to go into medicine. But while we are pursuing that science degree, let’s not forget to learn about the lives of the people that you will be taking care of. Whether you’re a physician or you have a Ph.D. in biochemistry or you’re a scientist, that gives you a platform to speak on their behalf.”