Co-Founder and Executive Director of Puentes De Salud/ Emergency Room Physician/ Associate Professor at University of Pennsylvania Medical School
I drove to South Philadelphia on an October morning to meet Dr. Steve Larson at Puentes De Salud (“Bridges of Health” in Spanish), a free clinic that he co-founded. He was legendary in the community for his outstanding volunteerism and contribution to the South Philadelphia community where growth in its immigrant population exploded in the past decade.
I was pleasantly surprised walking into Puentes two hours before its opening time. It was inviting, spacious, colorful and clean. It felt like a community center. The front lobby had vibrant decorations hanging from the ceiling as if a party were recently hosted. It was not what I expected to see at an inner-city free clinic. Dr. Larson was chatting with people at the reception desk when I walked in. He had such warm and friendly aura.
Hazel: Hello Steve. Thank you for letting me come visit Puentes. What a beautiful place you’ve got here!
Steve: You are welcome. Yes, it’s quite nice. We just had some celebrations in this lobby space.
Dr. Larson walked me through various spaces at the clinic. There were administrative offices, and rooms for patient triage, outpatient, legal counseling, family planning, and dental exam. Dr. Larson showed me the current renovation to expand the dental services at the clinic. They were going to launch a full-fledged dentistry practice with bells and whistles such as an x-ray machine. Their launch date was January 2020. Dr. Larson was beaming with pride when showing me the new dentistry area.
Finally, we sat down at a conference room near the lobby to chat.
Hazel: Dr. Larson, what made you start Puentes?
Steve: In order to answer that, I need to tell you a bit of background story about Philadelphia. Currently, 15% of Philadelphia population is foreign born. Up until about 2008, Philadelphia was stagnant in both economy and population. But the change started to happen. The immigrant population escalated rapidly.
Hazel: What brought on that change?
Steve: During the Clinton presidency, the country experienced a period of economic growth that was historically unprecedented. Whether in the agricultural industry, light construction, or the service industry, this growth was dependent on cheap labor. In the mid-90s Philadelphia’s restaurant industry experienced a renaissance fueled by the availability of an immigrant labor force from Mexico. The restauranteur Stephen Starr is reported to employ nearly 800 in his restaurant empire, staffing the “back of the house” as prep chefs, dishwashers, and busboys. Interestingly, prior to 9/11, migrant workers would come north to work for 8 months a year; returning to be the with their families in the cold months of winter. Post 9/11, crossing the Border became more dangerous and difficult; workers grew frightened to leave the country in fear that they would not be able to re-enter. And so young men and women came north for jobs and stayed. Soon families began to grow in South Philadelphia as it offered affordable housing and easy access to work on bikes.
Hazel: What year did Puentes start? Were you the original founder?
Steve: Puentes got started in 2003 but didn’t see patients until 2006. It took a few years to get to know the community and build relationships with them. Peter Bloom, the founder of Juntos, the first organization in Philadelphia dedicated to organizing and defending the human rights of Latino immigrants, approached me in 2003 to receive help in addressing the community health care needs. Peter asked if I was willing to help create a solution to address the growing healthcare needs for South Philadelphia community. Jack Ludmir and I soon met after that and discovered that we shared a mutual interest in the community; we were later joined by Matt O’Brien, a young resident at Penn who was interested in Latino health care issues. The three of us officially became the co-founders of Puentes. Together we worked to map out the specifics of the organization we were to build.
Hazel: How did Peter know you would be the right person for the challenge?
Steve: I was already working at a free clinic called Project Salud in Kennett Square serving a community of migrant workers at nearby mushroom farms. I was out there one day out of the week taking interested Penn (University of Pennsylvania) Medical School students and residents with me for their training. I’ve been a faculty member at Penn since 1991. I worked at Project Salud from 1993 until 2006.
Hazel: That’s amazing. So you knew what it took to run a free clinic.
Steve: Yes. I had the good fortune of landing in one of the area’s first nurse-managed models for community health for the next thirteen years. My mentor was a nurse practitioner who founded the clinic; she taught me much of what I know about under-resourced community work. As I began to conceptualize the framework for Puentes, I knew that I didn’t want Puentes to become just a free clinic. I realized that we had to address the root cause of health disparities in under-resourced communities.
Hazel: Could you elaborate on that?
Steve: The majority of South Philadelphia’s Mexican immigrant community work in low-paying jobs without benefits. Most lives below the poverty level, many have less than 6 years of formal education, most have limited English proficiency, and all live with the stigma of being in the country undocumented and fearful of Immigration and Customs Enforcement (ICE). As an Emergency Medicine (EM) doctor, I’ve seen too many 17-year old boys shot and too many 14-year old girls giving birth. I knew I could not wait for the next trauma patient to come in. I knew I had to engage the community beyond the four walls and prevent things from happening. And that required that I try to break the cycle of poverty, and ensure the creation of a foundation for the community that could sustain and nurture its growth.
Philadelphia is the poorest city in the nation. The Philadelphia school district’s 50% black males and 45% Hispanic kids never finish high school. Even the ones who do, most of them are poorly prepared for college and job. The inequity is so big from the start. One of the wealthiest districts, Lower Merion, gets $27,000 per head from the local government whereas Philadelphia city proper gets $15,000 per head. The former has 5 to 8% economically disadvantaged kids on average and the latter has 99%.
Hazel: It’s upsetting to hear about the great disparity in the numbers between the privileged and the underprivileged. The gap I feel is compounding.
Steve: Precisely. There is an organization called Common Hope in Guatemala. They help the community in the form of education. Kids in the community are allowed to continue education while their families get subsidized for lost labor.
While we work to ensure the wellness of the first generation of immigrants through the direct provision of health care services, we consciously have put the lion’s share of our resources towards nurturing the next generation of young community members. With the Common Hope model in mind, we have worked to establish the infrastructure of Puentes centered around education and empowerment. Education is the most effective way to break the cycle of poverty. Ensuring that the children in the community are able to realize their full potential as young productive members of society, ensures the long-term health and wellness of the community.
Hazel: I agree with you wholeheartedly! Also, going off on a tangent, I feel that while the spirit of affirmative actions in college admissions is well-intended, it’s too late to address these inequities of education by that stage. The intervention has to start much earlier. Can you tell me if Puentes is addressing this issue?
Steve: In the 90’s, I was concerned about the need for passionate young under-represented minorities to have a visible presence in medicine as role models. One of the reasons I invited students and residents along for the ride down to Kennett Square clinic was to talk about health disparities in their communities and value and address their concerns and interests. Over time, I realized the need to create a pipeline for talented students interested in this work; building Puentes in South Philly was a huge bonus for me! Over the years we have mentored hundreds of college, medical and nursing students and residents interested in under-resourced community health and wellness. This pipeline serves in the recruitment and retention of these kids at Penn.
But taking it a step further, along the lines of what you describe, we knew we had to go way upstream in the education process and so in 2010, we initiated an afterschool program for 2nd and 3rd graders with 12 kids. Also that year, a young pre-med student and now fellow emergency room physician and Penn faculty member, Daphne Owen, created the pilot for our Puentes Hacia el Futuro, After-School Program at Southwark Elementary School.
In 2011, she wrote a grant and received a grant that allowed us to expand the program to have 35. A year later, the success of the program allowed us to obtain more funding that allowed enrollment to increase to 75 kids.
We then realized that the education intervention was needed for even earlier age. Kids in the community were not doing well in kindergarten. So we extended the program to kindergarteners to facilitate their kindergarten to 1st grade transition. Then, early child development program was added in 2016. We have partnered up with Barnes Foundation and were able to enroll 22 pre-school aged children in the program during its first year. It has been a big success and growing every year!
Also in 2016, we started to focus on the other end of the K-12 education continuum. We started a college readiness and career development program for high schoolers.
Hazel: It’s so neat to see that Puentes has programs for kids from pre-school age all the way to ones about to graduate from high school. It’s truly a full circle.
Steve: Yes. But there’s more for me to share! Currently, our biggest afterschool program is being held remotely at Southwark School, a public K-8 school in Philadelphia Public School District 2 miles southeast from Puentes. The school’s demographic is very diverse. 40% South Asian, 40% Hispanic, 5% White and 15% African American. 100% of the school population is identified as economically disadvantaged. We started out there 4 years ago with STEM program, a computer programming afterschool course for 11, 12 and 13 year olds. Since then we wrote a grant and the whole school of about 850 kids now get afterschool program access. We have partnered up with Drexel University where their Education majors get training opportunities by working with these kids.
Hazel: Steve. The more I talk to you about Puentes and the work you and your team have done, the more humbled and awed I am. It’s astounding the amount of change you’ve brought and how many people you’ve enabled and involved in this whole process, not to mention community members who have benefitted from all that Puentes offers. Are there more projects I’ve not heard about at Puentes?
Steve: One of the biggest projects at Puentes has been raising 1.5 million dollars to renovate the space and medical equipment to serve the needs of the community to the fullest. During your tour earlier, you saw the dentistry wing being renovated. That is part of where 1.5 million dollars is going to. In order to receive money, we first had to earn our non-profit status in 2009. Then, we raised half of the 1.5 million dollars, $750,000, by writing grants and being awarded. The other half came from Penn Medicine’s now CEO Kevin Mahoney who has been a big advocate for Puentes. He persuaded LF Driscoll Construction, who is currently building the new Penn Medicine hospital building set to open in 2021, to provide $125,000 worth of pro bono work. Kevin also led the effort to successfully convince the architecture firm Ballinger, who has designed several Penn Medicine affiliated buildings, to provide free services to Puentes.
Hazel: That’s amazing! Once again, you’ve succeeded in involving more great people to get behind your vision and cause. It’s like building a community of helpers to help out another community! Since I have finance and accounting background, I cannot help but to ask how big the operating cost of Puentes is and how it is funded.
Steve: So we keep the operating cost at a minimum. It’s only 12% of the whole budget. 98% of Puentes’ workers are volunteers. We have 392 volunteers! We have currently 6 full-time staff and 18 part-time staff that are being compensated through grants and donations. We also receive a generous contribution from Penn Medicine, who is the owner of the building Puentes resides in. We pay one dollar per year for rent.
I also want to acknowledge other great partners of Puentes.
UPHS (University of Pennsylvania Health System) has been a huge supporter of Puentes in many intangible ways. In 2009, we hired our Community Nurse Liaison through the emergency department at HUP. She spends 100% of her clinical and administrative time at Puentes. While we pay her salary and benefits, being able to access UPHS Human Resources as a staff member is a huge gift to a small non-profit such as Puentes.
The Penn Dental School has provided us education and health promotion services for children since 2010 and will be expanding their services full time in January 2020 after renovations are completed. They will be providing a full time faculty member to oversee senior student training as well as a hygienist to oversee clinic operations.
Penn’s School of Nursing has been a great partner as well. The Dean is on Puentes’ Board of Directors and we have worked to provide their students the opportunity to come to Puentes to train. Equally important, our Medical Director, a nurse practitioner specializing in women’s health and a faculty member of Penn’s School of Nursing, spends 100% of her time at Puentes; again, we benefit from the ability to access Penn’s Human Resources.
Our partner HIAS (Hebrew Immigrant Aid Society) provides all immigration related legal services to the community. As you may guess from their name, they were established originally to Jews from Eastern Europe in immigrating to Philadelphia. In 1980s, they expanded their services to help other cultural groups such as refugees from Bhutan and Iraq.
Our affiliate Justice at Work handles all other, non-immigration related legal issues for our community members such as housing rights. For our legal partners, we write grants and receive funding and pass onto them while they provide services. So it’s a win-win situation.
In a similar fashion, our Director of Education is hired by Haverford College (which pays for her benefits) and provides Haverford College’s Center for Global Partnerships with a front seat at Puentes, where its faculty and students can begin to understand foundation for responsible and respectful academic-community partnerships.
There are several other partners whose names I might be omitting as there are so many. Without generous donations of time and resources by so many individuals and organizations, Puentes cannot exist.
Hazel: Yes, indeed! What’s next? What is your vision of your role in Puentes in future years?
Steve: I’ve already started transitioning responsibilities to the future leaders at Puentes. Esther Morales, the Managing Director, has started to take the lead in overseeing finance and development. My goal was never to be the Executive Director but to build the integrity and structure of the organization and hand over the reigns to the next generation. It is crucial for the health and growth of the organization to have a solid foundation and also have timely transition of leadership.
Hazel: As a last question, I want to ask how do people become like you… community-minded, altruistic and giver of society? I want to raise my children to be a contributor in our society like you.
Steve: (chuckles) I think it’s pretty simple. How many eggs can one man eat? I’m content with what I have. What more can I want? I think it also has something to do with growing up in the 60s. There were lots of idealism and hopes. We all dreamt of a Utopian society. The idea of community has always resonated with me. It doesn’t make sense to stand on someone’s shoulder so you can be above the water. We are all in this together. I also come from a multi-racial, bi-cultural family. My dad’s side came from Sweden and my mom’s Puerto Rico.
I was always cognizant of the world out there but taking a momentous trip to Vietnam and Thailand during my gap year in medical school with my wife really shaped my mind and perspective about life. It gave me a chance to learn the current events on a global level.
Hazel: What made you choose Vietnam and Thailand specifically?
Steve: My wife and I chose to go to Vietnam and Thailand because Americans had done a lot of damage there not long ago. The consequences of our actions were still fresh when we got there. We really tried to absorb and understand the culture and food of the region also. We travelled frugally. We rented a motorcycle and rode around rice paddies. Just as back home, grandparents in Vietnam and rural Northern Thailand loved their grandchildren. Everyone there also wanted to have shelter and food. It was clear to see there were unifying characters among everyone regardless of heritage. It made me want to capitalize on similarities among people rather than focus on differences. I think that sentiment started my motivation to serve the communities in need.
Dr. Larson saw me out to the front doors of Puentes and I took my last shot of the humblest man who had become the source of hope and light to the underprivileged immigrants. He stood there in front of the façade of the pillars of the community he had founded with his heart and soul.
As I wish the continued success in Dr. Larson’s mission to help others in dire need, I truly hope that many individuals read this interview and get inspired to become great beacons of society as he has. I’m profoundly touched by your humanity, altruism and positivity, Dr. Larson. Thank you for what you’ve done for our society and persuading so many others to join your crusade and share your vision!