The doctoral program in Behavioral and Social Health Sciences (BSHS) is the only Ph.D. program in the School of Public Health that requires original data collection of its students. Most often, students in public health work to interpret existing public health data sets in original ways that shed new light on a problem or population. BSHS doctoral students, however, collect original data themselves as a part of their training. Kira DiClemente and Ashley Gomez are meeting this challenge by collecting qualitative data on local populations of marginalized women who have experienced a disproportionate share of COVID-19 risk and mortality.
Gomez, a Robert Wood Johnson Foundation Health Policy Research Scholar, is studying the pandemic’s impact on the health and socio-economic status of Latinas in Providence and in New York City, many of whom are direct care workers. “I focus on areas where Latinas are overrepresented—home health care and entrepreneurship,” Gomez said. “Home care is one of the fastest growing occupations in the U.S., where Latinas bear the greatest workforce burden.”
DiClemente is conducting her doctoral research in partnership with Women’s Refugee Care, a Providence organization that supports Rhode Island refugees from Africa. The organization’s leaders “have been active partners in my dissertation,” she said, “which is trying to better understand the mental health experiences of African refugee women.”
Kira DiClemente: Building Bridges
You work closely on your dissertation research with Women’s Refugee Care. In fact, its founders will be listed as co-authors on your papers. How did you find out about WRC?
I have always done global health, but heading into the second year of my Ph.D., I realized that I wanted to do global health, but I wanted to do it locally. So, I Googled “immigrant women empowerment, Providence, Rhode Island.” The first thing that came up was Women’s Refugee Care. Their mission statement, I read, is to help empower women who come to Providence from the Great Lakes region of Africa as refugees to live the kind of lives they want to lead in the U.S. And I thought, they’re doing exactly the kind of work I am trying to do!
So I signed up to be a volunteer. When I met with WRC’s co-founders, Aline Binyungu and Clemente Shabani, in person, we bonded over a vision of how women deserve to live in society, and how they deserve to be equipped with resources to help them live the kind of lives they want to lead. And so together we developed my dissertation project.
How has this population and your work been impacted by the pandemic?
So much of what makes their community special and what helps people, I think, feel as welcome as they can in the U.S. as refugees, is their sense of community: being able to be together, share spaces, share food, go to religious services, and see their community. Weddings and other celebrations are a huge part of their cultural practices.
In addition to fears of getting sick and having your family get sick, and losing their jobs—because they often work in housekeeping and hotels—the loss of being able to see each other, I know, has taken a huge toll. But WRC is resilient. They’ve conducted food drives, they’ve had volunteers deliver masks. Last week we did a talk on the COVID vaccine to try to get people together and just help dispel some of the concerns that were floating around. They’ve adapted to everything that’s come to them, and I have tried to step back and take their lead on how the research should change in accordance with the new priorities of their community. I see my role as applying what I have learned in school to better understand what they are interested in understanding.
What have you learned about refugee mental health?
I find that women’s mental health is best right before they arrive in the U.S., as they are filled with hope for a new life. However, once they arrive in the U.S., they are met with challenges they never anticipated, including overwhelming bills, needing to find employment and learn English, and encountering racism often for the first time. Life is not at all what they thought it would be, which leads to a drastic decline in mental health experiences upon resettling in the U.S.
Community organizations like WRC must play a vital role in helping women to resettle.
Social support from a range of community members can help newly resettled refugees navigate the intricate landscape of U.S. norms and systems. Public health practitioners and initiatives should partner with community-led organizations to leverage the powerful community connections that already exist to support refugee women as they transition to life in the U.S. You brought WRC’s co-founder Clemente Shabani to Brown as a guest lecturer in the Introduction to Public Health course. Clemente gave an incredible lecture on refugee health and what life is like in a refugee camp, and the stress that refugees commonly experience. Seeing the students’ interest in his story was amazing. It’s so easy for someone at Brown to pass the mic, and the reward is just incredible. Any chance we get to bring the community to our classroom is a win-win, especially for our students.
What has been most rewarding about your collaboration with WRC?
From the School of Public Health, it’s 10 minutes in the car down Broad Street to the WRC office, but without that initial outreach to them, we might as well have been a million miles apart. All it takes is building one little bridge. Once you build the one bridge, anyone can walk over it, back and forth from either end. And being able to do that with WRC has been the greatest pleasure of my experience at Brown, and in getting a Ph.D. Truly, they have made me into a person who deserves to get a Ph.D. This is a lifelong partnership now, and I will always be grateful for them.
Ashley Gomez: In their Own Words
Your research examines the health of immigrant Latinas.
I’m interested in hearing about their everyday lived experience and how their occupation interacts with other social determinants of health, such as access to health care and other economic opportunities. Latinas are overrepresented in home health care and entrepreneurship and a majority of home care workers live in poverty. It’s no surprise that many home care workers also have second jobs, some entrepreneurs, in order to provide for their families.
This is especially important because the women who work in these areas are at increased risk of COVID-19, where they are not able to work from home. The 1-on-1 interviews I conduct explore how COVID-19 has impacted immigrant Latinas’ health, businesses, and work conditions in their own words.
You’re a Los Angeles native, but your dissertation project grew out of work you did in New York City before coming to Brown.
Prior to Brown, I launched a community health workers program in New York City that predominantly serves immigrant Latinas. This left me with a strong local network. Since arriving in Providence, I interact with the Spanish-speaking community on a daily basis. My familiarity with Latinx neighborhoods in both cities allowed me to build meaningful relationships with community members, leaders, and businesses that could spread the word about my research, which they, themselves, inspired. I do not engage with the Latinx community because of my research needs, but rather, because I am a member of the community, I research.
The pandemic has had a disproportionate impact on Latinx communities.
Latinxs continue to account for a majority of COVID-19 infections, hospitalizations, and deaths. This disparity is not due to biological difference, but rather the socio-environmental conditions Latinxs are subjected to, one of which is work. I am very interested in seeing how the lived experiences compare across New York City, the nation’s most populous city, and in Providence, capital of the smallest state.
My findings indicate that there are many more similarities among the experiences of immigrant Latinas living in Providence and New York City than there are differences. All of the women I interviewed proudly care for others through their job as home care workers and/or by providing food, cleaning, and other services to the general public as entrepreneurs. Yet, when asked who takes care and provides services for them, they say themselves. They often prioritize the needs and care of their clients and families over their own.
Amongst entrepreneurs, several Latinas noted having to shut down their businesses due to the government restrictions. This inevitably had a negative financial impact on their business, household, and employees. Other entrepreneurs continued offering goods and services while taking all the safety precautions they could and changed their business models to include online services, where possible.
Among home care workers, there’s a general consensus that not going into work was not an option. Agencies that employ them give them the “choice” on whether or not to take on certain clients, often not stating if the client has COVID-19. For most home care workers, it is not viewed as a choice, but rather a risk deemed necessary for survival.
Has the pandemic impacted your ability to conduct this research?
I began my research after the start of the pandemic. My strategy in New York has largely been remote and I’ve relied heavily on snowball sampling, word-of-mouth. I’m looking forward to being able to travel to do direct recruitment in New York City soon. My recruitment strategy in Providence has mostly consisted of flyers, direct recruitment, and word-of-mouth. All of my interviews to date have been conducted over the phone.
I was afraid that engagement would be low due to the disproportionate economic and health impact of COVID-19 on Latinxs. So far, the interviews have turned out to be just the opposite. The women I’ve interviewed have expressed gratitude for having their story and opinions documented and often said they felt the interview was “therapeutic” or provided “relief.”
What policy proscriptions would the women you are learning from recommend?
Regardless of migration status, every woman I’ve interviewed, to date, has mentioned a pathway to citizenship for immigrants as a top priority. My research adds further evidence of how migration status creates drastic differences in wages, access to capital, and health care among immigrants in the U.S. I recommend investment in women- and minority- owned businesses to vitalize economies in communities of color that have been devastated by the pandemic, and protection for the occupational health and safety of home care workers as frontline health workers on behalf of the Occupational Safety and Health Administration.