Some public health problems are so extensive that they can only be solved with a coalition of support from health care professionals and the community at large. Dinah Ramirez, RN, president of the Illinois Hispanic Nurses Association, a local chapter of the National Association of Hispanic Nurses (NAHN), believes that gangs in her community are one such public health problem, and she is using her role as a nurse to help solve it.

Dinah Ramirez, RNDinah Ramirez, RN

Ramirez is co-chair of the Southeast Chicago Anti-Gang Initiative (SECAGI), a coalition of over 30 neighborhood agencies and organizations. She also serves as coordinator of the Healthy South Chicago Coalition (HSC), a consortium of local health care facilities, community service agencies, churches, schools, businesses and other neighborhood groups formed in 2001 to promote access to expanded community health services, promote healthy behavior and foster a positive community environment.

About three years ago, Ramirez helped HSC distribute over 400 surveys to nearby residents. The purpose of the surveys was to identify and assess community concerns so that HSC could develop appropriate resources and services. The coalition initially sought community input to help plan routine services such as after school programs. But the information they received from the surveys made it clear that there were deeper issues to address.

“Most people were concerned about youth, gangs and youth violence,” Ramirez explains. “We did not have [any programs] that dealt even minutely with gang members.”

Turning Exclusion into Inclusion

As a nurse, Ramirez was also struck by the health care aspects of the survey results. They revealed a lack of access to medical care for young people most likely to be affected by gangs.

“[Social service] agencies usually exclude these high-risk teenagers,” she says. “That includes health care, any outreach for HIV, STDs, teen pregnancy, etc.”

Of course, health care facilities have a right to make sure that their environment is safe and orderly. “You don’t want gang members to be fighting inside your lobby,” Ramirez admits. However, she finds that health care providers’ fear of gangs often has the result of penalizing young people who need treatment. The tactics medical facilities use to exclude gang members are subtle.

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“Access to care has a lot to do with customer service,” Ramirez believes. For instance, if a person is made to feel out of the loop or disenfranchised, they may not seek care, especially in non-emergency situations. High-risk Hispanic youths in urban areas like South Chicago face other barriers to care as well, Ramirez continues. “Language is the biggest one, but also attitude,” she says.

As a result, some gang members use the emergency room as their primary source of health care, with no preventive measures taken at all. This poses problems for the larger community, which may then have to deal with higher instances of teen pregnancy and a potentially higher HIV/AIDS rate.

For Ramirez, this is unacceptable. She reasons that gang members cannot be excluded from health care facilities–or from schools and other social services, for that matter–without consequences. “They’re going to be back in your neighborhood,” she warns. “If you expel them, then they’re out on the streets full time. They don’t go away.”

Ramirez aims to help restore good customer service to health care and to help all populations in the community feel welcome. Beyond just treating patients’ physical ailments, she and her colleagues at Healthy South Chicago try to express an attitude of involvement. For example, they refer medical services to patients who may not otherwise know how to navigate the health care system.

Working on a Larger Scale

Another officer of the Illinois Hispanic Nurses Association who is helping to serve at-risk minority youth in South Chicago is Loraine Moreno, RN. She works at Chicago Family Health Center, a federally funded non-profit community health center that is a member of HSC and serves about 18,000 patients annually. A few years ago, Moreno and her colleagues discovered that local teenagers in high risk groups did not know where appropriate medical facilities were located and or what health care services might cost. She also found they needed to seek care without worrying if the color of their clothes would offend a rival gang member.

Loraine Moreno, RNLoraine Moreno, RN

The health center came up with a solution to these problems by opening a site adjacent to a local high school. Moreno discovered that this had the positive effect of her being able to offer the kids more information on drug intervention programs as well as help dealing with family issues and other pressures of teenage life. “Now they can get info about drug use, stress management and domestic violence,” she says.

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Ramirez and Moreno have also amplified their outreach efforts by partnering with other SECAGI and HSC members. After the coalition received its alarming survey results, representatives of its member organizations met monthly to brainstorm ways of reaching kids who were most at risk to join gangs.

The group encouraged communication between schools and law enforcement officials in order to determine the right grade level to target with their anti-gang efforts. They learned that students coming into the ninth grade were often already affiliated with gangs, and some had years of experience by that time. So the coalition decided to target sixth to eighth graders. Their first major project was to host a daylong youth conference for these students.

Reverend Doctor Zaki L. Zaki, pastor of the East Side United Methodist Church–which is another member of the coalition–worked closely with the nurses in organizing the conference. “We started setting up dialogue groups,” he recalls. “We met with school principals and sent them applications to enroll students. We specifically asked them to invite students who have a history of violating the [school discipline] code.”

The first conference, held during a regular school day, was attended by just under 200 students. SECAGI presented speakers from law enforcement agencies, hosted workshops, facilitated discussion groups and served lunch. “It was very successful,” Rev. Zaki reports. “Some [students] confessed that they are active in gangs, which is quite a confession to make.” Others students spoke of their parents’ or grandparents’ involvement in gangs.

“[Having the participation of] a broad consortium of groups actually helps recreate a sense of community that the youths need and that gangs give the illusion of providing,” Rev. Zaki continues. “One of our challenges is the fact that there’s an intergenerational divide within many communities, including ours.” This divide, he says, makes it more difficult for youths to relate to older residents in the community, and vice versa.

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In Southeast Chicago, the generation gap is exacerbated by the fact that there are ethnic tensions in the area as well. This part of the city was once populated mainly by people of Eastern European and Central European descent. More recently, Mexican immigrants settled in the community, followed by African immigrants, Asians and African Americans. “The area around the east side is predominantly Hispanic,” says Ramirez, “with the south side having a more mixed population.”

In addition, the area’s economy has had a difficult time recovering after once prominent steel mills closed a few decades ago. These hardships have increased tensions in the entire community.

The consortium is making inroads into healing these tensions by focusing on the community’s youth. “Three years ago we purchased what used to be a union hall and we converted it into a youth and community center. We call it The Zone,” says Rev. Zaki, who serves as chairman of The Zone’s board of directors. He works with health care professionals and other community leaders to hold a special program at The Zone called Youth Night.

Kids from across the community attend these events. “It typically starts at 6 p.m. and ends at 10 p.m.,” says Rev. Zaki. The program offers the usual fun activities: dances, sports tournaments and entertainment. However, there is also a motivational speaker to address issues like dating violence, gang violence and drugs.

Introducing Kids to Health Careers

All of these efforts have yielded positive results, and Ramirez is happy to see how her work with SECAGI and HSC has affected her community. In a more recent HSC survey, students indicated that they are learning the downside of gangs. The nurses are gaining better access to high-risk kids and are providing them with health education.

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Moreno is also pleased with the results, including the fact that more at-risk youths are now able to find adequate health care. “We don’t address them as gang members,” she says, explaining that she and her colleagues instead address each patient as an individual. While Moreno does not work directly with programs that help students leave an active gang life, she does have an extensive referral network. “We work with anti-gang agencies and the police,” she explains. “We play a part in helping [gang members find alternatives].”

The nurses have also discovered another upside to making medical care more accessible to these kids: It exposes them to the possibility of pursuing health care careers. Because many of the local medical centers in the coalition have racially and ethnically diverse staff, the students see health care workers “who look like them,” Moreno says.

Chicago Family Health Center regularly hosts a Health Career Day, which gives students the opportunity to explore the full spectrum of possible health care professions besides just doctors and nurses. “They learn that ‘I can be a medical assistant’ or ‘I can be a phlebotomist,’” says Moreno. The coalition also works with organizations that offer scholarships to encourage more Latino and Latina students to go into nursing.

The nurses’ efforts have also helped increase the overall community’s awareness of healthy behaviors and lifestyles. According to Ramirez, “Four years ago, out of 28 area grocery stores, only eight were selling vegetables and fruit!” In addition, most of the restaurants in the area carried fried foods, but only two had salads on the menu. “Now, everybody offers some type of salad,” she says.

The community is also growing some of its own healthy food. Two city lots have been developed into a community farm with a vegetable garden. Although it is located in one of the toughest sections of the district, it has never been vandalized. “People have been able to work together,” says Ramirez.

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Advice for Others

What advice does Ramirez have for other nurses in urban areas who see a similar need for anti-gang initiatives in their communities? Her number one recommendation is to partner with other local health care facilities, social service agencies, the police and the schools. “It has to be a coalition,” she emphasizes.

Pooling resources with a number of other organizations can also help with another challenging area: obtaining funding for programs and services. Ramirez helped write the grant to fund the Healthy South Chicago Coalition, then applied for her job there. However, the Southeast Chicago Anti-Gang Initiative operates with an all-volunteer staff. “The agencies have picked up the parts that they can,” says Ramirez. For example, one community resource center is able to offer free pregnancy tests.

Nurses are also ideally positioned to be proactive in looking for additional solutions, Ramirez believes. “If you’re a nurse in a health care setting, there are things you can do to open up the doors and be welcoming to the high-risk youth population,” she explains. For example, this could include encouraging young people to come back to your facility for regular visits, offering information on where to find additional health care options and encouraging them to pass the information on to their family members and friends.

Ramirez advises nurses to identify young patients who might be recruited by gangs and then find ways to reach out and offer alternatives. This is where a coalition approach will be helpful. “There might be a church that’s already working with them,” she points out.

Rev. Zaki agrees. “I feel this is the main strength of our initiative,” he says. “Where my competency and strength ends is exactly where somebody else picks up.” And who better to be that “somebody” than a neighborhood nurse?

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