About a dozen people gathered in a windowless conference room at a South Philadelphia health clinic last week as an intense physician with a shock of tousled hair discussed what the national debate about deporting undocumented immigrants might mean for the patients right outside the door.
"We don't want to just cower and live in fear," said Steven Larson, executive director of Puentes de Salud health clinic. "We're all very concerned. But our mission takes on greater priority."
That mission: Ministering to the health needs of some 6,000 patients a year, most of them low income Latino immigrants, most of them undocumented, with no insurance.
"It's important that we not make assumptions" about what Donald Trump's presidency will mean, said Larson, 56, an associate professor of emergency medicine at the Hospital of the University of Pennsylvania who started Puentes with a Penn colleague 13 years ago in a church basement in South Philadelphia.
Larson and Penn ob-gyn Jack Ludmir acted out of frustration with continually encountering patients with preventable health problems. For Larson, it was people piling into the emergency room with gunshot wounds or drug overdoses. For Ludmir, it was women who showed up about to deliver who had received no prenatal care.
"After about a year and a half of trying to work the safety nets, we realized nobody wanted to do this," Larson said. "We were stomping out little fires here and there … we realized we'd have to start from the bottom up."
Larson, a Woodbury, N.J. native, had a long-standing interest in Central America and many contacts there, so a clinic for Philadelphia's Latino immigrant community was the logical step.
Puentes de Salud – "bridges to health" – now has three full-time and six part-time staffers, dozens of volunteers and an annual budget approaching $1 million.
About half its patients come through the main clinic office at 17th and South Streets, a newly renovated building on Penn's Rittenhouse campus. The other 3,000 come through the prenatal clinic at HUP operated by Ludmir.
In certain situations such as deliveries and emergency room visits, many immigrants are eligible for the state's Emergency Medical Assistance program.
But in other cases, Puentes winds up patching, filling and scrounging so that care can be provided at little or no cost to patients.
An HBO documentary on Puentes to be released next year, shows Larson, his face etched with frustration, hanging up a phone after unsuccessfully trying to arrange major surgery for a patient.
"Our health system," he said in the interview, "is skewed toward those who can afford medical care."
Puentes goes beyond basic care to also help clients with education, behavioral health, legal advice and even financial counseling classes.
"We have a comprehensive eyeball on the community," Larson says. "We don't have to advertise. People know we're here."
Puentes started its after-school program , Larson said, because "health-care outcomes are in a linear relationship with education and socioeconomic development."
At Southwark Elementary School in South Philadelphia, 65 children in grades 1 thru 6 receive individual tutoring, mentoring and homework support every day. More than 20 others are on a waiting list. Principal Andrew Lukov estimates that about 60 percent of the school's 790 students come from families where English is not the main language at home.
Puentes education director Alexandra Wolkoff has brought in physician assistant students from Drexel University to discuss topics such as stress management and mindfulness, and Penn Dental School students to lecture on dental hygiene and nutrition. But the emphasis remains on literacy in a school where most of the third graders read below their grade level.
Wolkoff started a girls' support group after one girl failed to show up at school after spending the night with an older man. More recently, she got a call from a mom whose husband illegally took their children out of state. Puentes connected the woman with legal assistance.
"When we need to think outside the box," Lukov says, "we turn to Puentes."
Like Wolkoff, Susana Pimentel is on duty 24/7. "My phone is ringing nonstop," says the volunteer "promotora," or health education worker. "I can be at the laundromat and women come up to me and ask for things."
On a recent morning, she was working with women considered at risk for diabetes.
With fellow promotora Fabiola Carrasco, she lectured on diet and nutrition and deciphering food labels to look for transfats, saturated fats, cholesterol and protein.
"Now they can get healthier things, not just because they're on sale," said Pimentel, who makes her living as a medical translator on top of a full load as a volunteer. The yearlong program counts among its successes participants like Beatriz Torrez, who watched the presentation while her 2 ½-year-old son played with blocks. She went from 180 pounds to 151 in six months.
Monica Posada, recently hired as the agency's new behavioral health specialist, gets frequent referrals from the promotoras who meet community members dealing with problems of alcohol, domestic violence or simple exhaustion from holding down multiple minimum-wage jobs.
Helping vulnerable clients with such stress "is not easy," the Colombia native said, "especially now when Donald Trump is our president."
At the meeting last week, Larson urged staff members and community partners to stay alert but not to panic about the new administration. He said that his staffers were already hearing unfounded rumors, such as immigrants' bank accounts being seized to pay for a wall on the Mexican border, a campaign promise Trump already has backed off from.
Larson says he hopes that anti-immigrant sentiment will be tempered by the realization that America has always had, and always has needed, its immigrants.
"There are enough people out there," he said, "who realize this is the future."