UNDERAPPRECIATED AND OVERLOOKED

When Cedric Bautista was a child, dengue fever hit his community in Eastern Samar, Philippines. The nearest hospital was a 45-minute drive away, and unpaved gravel roads made it nearly inaccessible. Bautista watched as his neighbors, family and friends fell ill with fevers and rashes, hoping someone with power would step in to help.

Now a fourth-year physiological science student at UCLA, Bautista continues to see barriers stopping the Filipino community from accessing health care, but, for the first time, he also understands the forces behind these obstacles.

“My perspective on health disparities shifted from ‘The government is very incompetent, why are they not doing enough?’ as a child, to ‘There are these -isms – capitalism, racism, neoliberalism, colonialism, imperialism – ingrained into our current systems and institutions,’” Bautista said.

In California, Filipinos make up the second-largest racial group in the nursing workforce. Yet, they often struggle to receive the care they need. The COVID-19 pandemic only exacerbated these disparities: The Filipino community makes up 20% of Asian adults in California, but 42% of the state’s COVID-19 deaths in the Asian community were Filipino patients.

For Ninez Ponce, eliminating health care disparities starts with properly collecting data. In her role as director of the UCLA Center for Health Policy Research, she has dedicated herself to collecting data specific to Filipino communities.

“I think the most pressing issue is this juxtaposition of fairness of being and serving in frontline health care occupations, … but at the same time, (there’s) this invisibility of this population, as a racial-ethnic group, in statistics on health care access, health care views (and) health care quality,” Ponce said.

Finding the balance between presenting collected data and preserving respondents’ privacy can be difficult, Ponce explained. The most common solution is to aggregate the data – grouping it into categories distinct enough to notice trends but broad enough that individual responses are not revealed.

This does not come without real-life consequences. Aggregating data of Asian Americans and Pacific Islanders has historically erased the visibility of smaller ethnic groups, including Filipinos, Ponce said. Compared to other Asian communities, Filipinos are more likely to be diagnosed with diabetes, heart disease and hypertension. But when data is aggregated from specific ethnicities to Asian and Pacific Islander, this finding becomes hidden, Ponce explained.

“You can’t get at health equity until you get at ways where the populations you purport to represent and serve are with you in the data production process, in the knowledge generation process and in the interpretation of the insights,” Ponce said.

The problem, then, is that many don’t realize there is a problem at all. But the young professionals Ponce works with are determined to shed light on these disparities. Through writing papers, talking to the media and getting the word out in any way possible, Ponce sees a hopeful future in the world of data reform – a hope that is only possible with the younger generations’ drive to make a difference.

“Awareness is fueled by social movements,” Ponce said. “It’s fueled by advocacy, by students.”

Karen Madamba, president of Pilipinos for Community Health at UCLA, is one such student.

On a typical Saturday morning, Madamba can be found outside supermarkets in Historic Filipinotown and East Hollywood, providing free health screenings to shoppers. The prime location allows PCH volunteers to screen a large number of people without inconveniencing customers, explained Madamba, a fourth-year psychobiology student.

“A lot of folks talk about how fun our volunteers are because they have a blast on site every time,” Madamba said. “Volunteers are hopefully creating that welcoming space for them and encouraging them to get screened.”

Madamba joined PCH during her first year at UCLA. Attracted to the organization’s holistic view of health care, Madamba found PCH to be a departure from the competitive atmosphere of other health-related organizations. Now spearheading the operations at PCH, she aims to continue this focus on physical, mental and emotional health through the organization’s projects.

At its pop-up health clinics, PCH provides multiple services, including blood pressure and body mass index screenings. These services can help lower the risk of hypertension, diabetes and other chronic health conditions common in the Filipino community, Madamba explained.

Bautista, who currently serves as PCH’s co-medical outreach director, emphasized the importance of creating safe spaces for the local community when working at these clinics. The key to this, he said, lies in culturally relevant care or tailoring medical services specifically to the communities targeted. For Madamba, culturally relevant care starts with seeing a patient as an individual, not just a statistic.

Something as simple as understanding patients don’t always speak the same language as their health care providers is important when volunteering at PCH health clinics, she said. While Madamba might not be able to speak every patient’s first language, she can make their experience as comfortable and smooth as possible with humility and compassion.

“Access (to health care) is one issue. … But when you are in a hospital or clinic, there are difficulties with that interaction too.” Madamba said.

But language is an important aspect of health care accessibility, especially considering the amount of jargon used in medical appointments. Danielle Mangaliag – a third-year human biology and society student and co-medical outreach director of PCH – speaks Tagalog, a commonly used language in the Philippines. This enables her to communicate with a greater number of patients, both in the Los Angeles area and in the Philippines, where the organization goes on a mission trip each summer.

Mangaliag is originally from the Philippines but moved to the United States at a young age. When she began studying at UCLA, joining PCH felt like a way she could reconnect with her culture while also supporting the Filipino community. She noted how her relatives back in the Philippines struggled to access resources during the COVID-19 pandemic, with test kits priced around $100.

“They have to pay $100 for a test, whereas here (we) can just take it for free,” Mangaliag said. “And if not here on campus, we can also get free test kits from our insurance.”

Now in her third year at PCH, Mangaliag aims to ensure PCH has the resources it needs to continue its work even after she graduates. She feels lucky to be able to communicate with the Filipino communities PCH supports on its mission trips, both for the sake of the patients and the volunteers.

Despite the advances PCH has made the past few years, the organization’s work has not gone unscathed by the turmoil of the pandemic. It only further emphasized the importance of culturallyrelevant care, Madamba said. Many Filipino health care workers served on the frontlines at hospitals and assisted living facilities before returning home to multigenerational households, Ponce said. As a result, health care workers faced the constant fear of exposing their older family members to COVID-19, she added.

Yet, these struggles often went unrecognized. Although health care workers were eligible for priority vaccinations, family members of health care workers were not. Because a large number of Filipino frontline workers live in multigenerational households, Ponce explained, their family members were more at risk.

“Given this historical legacy of labor Filipinos provided in the nation’s health care sector, there was underrepresentation in terms of policies like vaccination equity and vaccination priorities,” Ponce said.

However, Ponce explained, the exacerbation of health disparities in the Filipino community during the pandemic spurred greater activism surrounding health equity. Stories of Filipino health care workers who had died of COVID-19 circulated the Internet and raised awareness of the pandemic’s impact on the community, Ponce said.

Using this newfound exposure to its cause, Madamba wants to see PCH keep cultural humility as the foundation of its health care services. Instead of a top-down approach to health care, where health care providers work for their patients, Madamba and PCH focus on working with the community. Building upon values of holistic health, humility and cultural understanding are top priorities for Madamba. Without these values, PCH wouldn’t be the organization it is today, she said.

“Service is grounded in humility and solidarity,” Madamba said. “We have a horizontal view of service. We are not working for the community, we are working alongside (them).”

Ponce doesn’t think the work of activists like the members of PCH will go unnoticed forever.

“At some point, policymakers are going to listen,” she said. ♦