SPOTLIGHT

Dr. Marina Del Rios is a researcher and advocate focused on achieving health equity. She is an Associate Professor of Emergency Medicine at the University of Illinois at Chicago College of Medicine, the Community Sphere Physician Leader of the Illinois Heart Rescue Project and an active member of Illinois Unidos, an organization focused on eliminating the disproportionate impact of COVID-19 on the health of Latinx communities. 

In her interview with Nicole Blum, a fourth-year medical student at the University of Illinois College of Medicine, she shares her motivations for choosing to work in health equity, her experiences working to eliminate disparities in cardiac arrest survival, and her work on addressing health inequities during the COVID-19 pandemic.

How did you initially become interested in Social Emergency Medicine and health disparities work?

I grew up in a family where my parents were poor. My dad had been a janitor, and my mom had been a stay-at-home mom—not really by choice, but more out of necessity. I remember counting pennies so that we could pay for my dad’s medication. I remember also all of the expenses related to hospital costs and the disjointed care he received—that turned me towards medicine. And then, at some point during college, I started to take an interest in more of the social determinants of health and understanding how poverty, racism, and sexism play a role in peoples’ health and their access to health care. The final epitome of that for me was when I had the chance to do a research project with an epidemiologist who was looking at the impact of education level on stroke mortality compared across different countries. I had this hope that maybe with more universal healthcare access we wouldn’t see much of a difference [in mortality between education levels], but I found that still was the case. So that’s how it has informed that piece, recognizing that universal access to healthcare is a start, but it’s not the be-all and end-all. That sort of led me towards this path.

We need to go beyond just access to healthcare and really talk about what makes people sick and how we can improve the quality and conditions of their life. 

In medical school, I had a chance to work with a community clinic, and, again, I learned about people’s challenges getting medication. I would talk to patients, if they were obese for example, and say, “You could just start by walking around your neighborhood,” and the response would be, “Well, Doc, the neighborhood is not safe so what else can I do?” The same thing with, “You can change your eating habits.” Well, how do you do that if you live in a food desert, and it’s really difficult to get to a supermarket with fresh foods? So fast forward to when I get to the University of Illinois at Chicago (UIC). The mission of the department as a whole revolves around addressing health disparities, and I found myself with the group that started thinking about the Illinois Heart Rescue project. It started with Illinois Heart Rescue, and it branched out to the CHAMPIONS NETWork (Community Health and Empowerment through Intergration of Neighborhood-specific Strategies using a Novel Education and Technology-leveraged Workforce) and doing work with high school students to turn them into community health advocates. Through Illinois Heart Rescue, I got in contact with the Puerto Rican Agenda and started doing more work out in the community related to health education and also school advocacy and workers’ rights. That has sort of rolled into now my roles in the COVID-19 pandemic and my work with Illinois Unidos. It’s been a long trajectory, but it really starts with my experiences at home.  

Can you talk about Illinois Heart Rescue, and how the project evolved since its inception in 2013?

Illinois Heart Rescue is an organization that seeks to increase rates of bystander CPR and out-of-hospital cardiac arrest survival rates in Illinois. By leveraging community partners, hospitals, and EMS agencies, the initiative aims to reduce health disparities in cardiac arrest by identifying and intervening in communities with the highest incidence of cardiac arrest and the poorest outcomes. 

One thing we realized as soon as we were planning the Illinois Heart Rescue project was the importance of engaging the community. The cardiac arrest survival rate drops so precipitously in those first ten minutes after cardiac arrest. It doesn’t matter how much state-of-the-art care you provide someone on the hospital side or even from EMS if there’s not enough empowerment from the person who is witnessing the cardiac arrest to recognize what they’re seeing and be willing to have the tools and feel safe in acting in the moment. In realizing that, we understood it was very important to create community partnerships from early on, and it took a lot of community asset reconnaissance. I spent a lot of time getting to know the community-based organizations in Chicago. I learned about where they were located, what communities they served, and what they envisioned would be a good partnership—meaning what they thought we could provide them and what assets they had also that we could leverage. 

One of the things we have tried to do throughout Illinois Heart Rescue was to try to let the community take the lead and define what they need to get their community to a point where they’re ready to act when they see a cardiac arrest. Depending on where you go, with some people the concerns are more about calling 911—maybe they’re actually willing to do CPR, but what happens when they call 911? Who’s going to show up at their doors? And what does that mean in terms of their safety? For others, it’s more that they don’t know what a cardiac arrest is—they want to help, but just don’t have that information. Others may have the tools but then have this concern of harming the individual. A lot of it has been trying to figure out how to tailor our educational programming to fit the specific communities that we’re serving. It’s been an interesting process in recognizing how all community-level interventions have to be hyperlocal to some extent. Yes, you can have a blanket instruction piece, but you also have to consider what the unique challenges are in each neighborhood, in each community, and in each person you’re approaching. It’s trying to meet people where they are in their mindset and in their comfort in acting when they see an emergency. 

What trends have you seen regarding CPR rates and cardiac arrest survival in Chicago neighborhoods? How has Illinois Heart Rescue addressed this?

The trend from 2013—which was when Illinois Heart Rescue was started—to 2018 was that we were able to triple the rates of bystander CPR in Chicago. We started in 2013 at a barely 10% rate, and then by 2018, we were a little bit over 30%. We’d love to see that 100% of our cases get bystander CPR, but considering all of the challenges of a city with a large proportion of folks that may not have had bystander CPR instruction ever in their lifetime, I think that this is huge. Of course, I don't think it's just been Illinois Heart Rescue, it's been it's been a combination of multiple factors like dispatcher-assisted CPR instructions and the mandatory CPR requirement for high schools that I'm sure has also been able to permeate some in the neighborhoods. With that, we've also seen an increase in cardiac arrest survival from 2% in 2011 to a close to 10% survival rate last year. 

When you breakdown bystander CPR rates by neighborhood though, there's still some pretty significant disparities that we need to address. This is where I think that the dispatcher-assisted CPR program has probably played a larger role than we realize. Overall, CPR rates in the city have gone up. The rates in Black neighborhoods have gone up very nicely, and probably more so than what we've seen in white neighborhoods. Now, that’s not to say that Black neighborhoods have higher CPR rates, but proportionately, they have seen a larger increase. [Black neighborhoods] are starting to come closer to the CPR rates that we've seen in white neighborhoods for most of the time that Illinois Heart Rescue been up and running. But we haven't seen the same increase in Latino neighborhoods. In fact, there was a kind of worrisome trend that we saw at one point where there was a little bit of a dip in 2017 [in Latino neighborhoods], and I don't know if that has to do with maybe some hesitancy from people from Latino neighborhoods to act because they worry about their own kind of legal repercussions or if it's maybe a communication disconnect. A lot of this increase in bystander CPR has been related to dispatcher-assisted CPR, so what happens when the person doesn't speak English? I don't have a way of looking at that because I don’t know who called 911. I don’t know what the language barrier was, if there was any, and so that's something that I would like to investigate further. It is worrisome that we're not seeing the same uptick in all neighborhoods equally.

You’ve taken a very active role in advocating for the Latinx community in Chicago during the pandemic. Can you speak to the work you are doing with Illinois Unidos? 

The ultimate goal of Illinois Unidos is to try to mitigate the effects of COVID-19 in the Latino community. When we talk about the effects, we’re not talking only about the health effects—the fact that the most recent data from the CDC has shown that Latino community, when you do age-adjusted mortality rates is dying in higher numbers than any other community in the U.S. When you look at the city of Chicago specifically, the mortality rate in Latinos is four times that of whites and double that of the Black population, which is already very high. It’s heartbreaking. There's the issue of how to limit the spread and also ensuring that those that are getting sick get the care that they need so that they can survive COVID-19. But, also, the most recent job reports talked about how, over the month of December [140,000 jobs were lost and the most affected were] women, and especially Latina women. When you think about what COVID-19 has done to the economy, the places that currently are shut down are the service industry—restaurants, hotels, bars—and a lot of them employ Latino workers, a lot of them women. I'm not sure how soon the community is going to be able to recover from that economic impact, because, to add to that, a very large portion of the Latino population is undocumented. They don't qualify for a lot of the federal relief programs that have been put out. You have a community that has had disproportionately higher job loss rate and, on top of that, many of them will not be able to benefit from the few relief dollars that are out there. 

Through my links with Illinois Heart Rescue, I have been in touch with the different community-based organizations in the city since early on in the pandemic when it was very clear that Latinos were being left out of the narrative of COVID-19. I thought that it was important to lend at least my expertise as a clinician and share what I was seeing on the frontlines in my own emergency department. I made myself become an expert in the data and understand how different neighborhoods were being affected in an unequal way in the city of Chicago and also the rest of the state. When you start saying things enough people start listening. I've been lucky enough that, because of my role in Illinois Unidos, I've been called to be a part of the Illinois Department of Public Health COVID-19 equity task force. I also work with Lieutenant Governor Stratton and the Restore Illinois group which is sort of planning what comes next after COVID-19. I have almost every other week meetings with city officials thinking through different strategies to address this this disproportionate burden of COVID-19 in the community. We've been able to advocate for the increased availability of testing sites in the Latino community. You can see the map of where people are getting tested versus where people are getting sick, and there's a huge difference there in that the shaded areas for testing are completely opposite to the shaded areas for illness. We still have a lot of work to do, but we’re certainly at a better point than where we were back in April and May when we didn't even understand how much COVID-19 was affecting the community. Now, with vaccine rollout, a lot of what we're trying to do is first advocate so that our essential workers are being included early on—essential workers meaning not just frontline workers, but people that really are making our economy run which are many Latino and Black individuals. I think one of the success stories might be the fact that Illinois is one of the few states that has reduced the age for the 1B vaccination category to 65 years. This has a lot to do with advocacy.

How have you dealt with political adversity during the COVID-19 pandemic?

What’s kept me grounded is realizing that all politics is local. I have an opportunity to at least talk and see some action at the local level, and it's the thing that kind of keeps me going.

I may not be able to fix what's going on in the rest of the country, but maybe I can make a small contribution and makes things a little bit better for my community—that's a start.

I feel very fortunate living in a place like Illinois and working in a city like Chicago. You can go to the Illinois Department of Public Health or Chicago Department of Public Health websites, and they are completely transparent as to what they're doing, who's dying, who's living, who's getting hospitalized, and where the outbreaks of COVID-19 are. I'm also grateful that, although there are certainly policies that I disagree with both state and city officials, for the most part I recognize that they listen and really try to compromise in a way that is safe for as many people as possible. I appreciate that Mayor Lightfoot has given Illinois Unidos the platform that we've gotten, and that she's put city officials at our disposal to talk, brainstorm, and provide ideas that are coming from the community. One thing that is very unique of Chicago and of Illinois is that they’re not listening to just the experts that are crunching numbers, they are also trying to listen also to the community. In meetings, it is not just me as a physician sitting there having a conversation with them, but we have leaders of workers’ groups, teachers, community health workers, and people who work at FQHCs providing their perspective as people on the ground seeing day-to-day the effect this pandemic has had, not only on their patients, but on their families and their communities. I'm there more to speak alongside as opposed to on behalf of the community.

I think it is very important for anyone who does work in social emergency medicine to be clear that you're not the community’s voice, but that you're giving them a voice.

Do you have any projects or plans post-pandemic? Anything else you would like to add or share?

I don't know how soon I'm going to be done with COVID-19 work. One of the things that we've been discussing in Illinois Unidos is that there's a good portion of our population that is going to need access to health care for the chronic conditions like cardiomyopathy and lung disorders because of COVID-19. We're also working on using this pandemic as an opportunity for job training and workforce development. I'm hoping that that is something that will become more long-term and more sustainable.

 There's always something else. Cardiac arrest is still one of the primary reasons for death in the U.S. I expect that I will still continue to be doing work in resuscitation and addressing health disparities, bystander CPR, hospital access and all of those other topics that I'm passionate about. I have flirted with the idea of and maybe getting at some point an appointment at a public health department. I've been in the advocacy side for a long time, but I think at some point I'd like to transition into more of those positions of having the ear of the governor the mayor or anyone else who is actually developing budgets. One thing I've learned is that our public health infrastructure has been slowly defunded over the period of decades. The model of public health has changed over the years from something that was universally accessible and paid for through federal and state funding to one that is largely outsourced into private organizations. I would like to be a position where I can start advocating for steering away from that [privatized] model to one where we have more of a central infrastructure and more resources directed for the greater good.