A colleague has vanished from my workplace. Her name is Estefanny Casas. We worked together at a clinic in Richmond, in the Bay Area, until a cavalier snip from the federal budget gutted the AmeriCorps volunteer program.
Casas was one of 10 AmeriCorps health fellows in the organization where I care for patients and teach physicians-in-training. In our chronically underresourced and overenrolled clinic, Casas took on dozens of tasks from blood pressure checks to reminder calls — tasks that often went unnoticed by me and my busy colleagues, but made a world of difference to our patients. Now that she’s gone, we all feel the loss.
The AmeriCorps website states that my organization received $250,000 for this year’s funding cycle to cover the $20,000 annual stipend for each volunteer and the cost of a program supervisor. In other words, a sum equivalent to a typical Bay Area corporate salary funded a year’s worth of service, education and career development for 10 young people and their supervisor. Hardly a boondoggle. Nationwide, AmeriCorps supported the work of more than 32,000 volunteers each year.
“I am still in shock,” Casas told me when I reached her at her home several days ago. She had been preparing for a typical workday when word came in from her site supervisor that their AmeriCorps program had been terminated, effective immediately. “None of us were in it for the money,” Casas said. “We were all in it to serve.”
I am becoming numb to the daily announcements of radical cuts to our healthcare system. Billions of dollars gone from research, layoff of thousands of public health workers, entire divisions eliminated within the Centers for Disease Control and Prevention and the National Science Foundation, proposed rollbacks to Medicare and Medicaid benefits. But the overnight disappearance of Casas really hits home.
The secretary of Health and Human Services, Robert F. Kennedy Jr., who campaigned on a promise to “Make America Healthy Again,” often uses war metaphors to describe how he plans to address our epidemic of chronic disease. To me it’s clear: Casas and her peers were the foot soldiers in this war.
Casas grew up in the Iron Triangle of Richmond, Calif., a largely working-class neighborhood that surrounds our clinic. She went to local schools where she discovered that she loved community service and biology. She was the first in her family to graduate from high school and then college, majoring in biology at Sonoma State. During college, Casas had a number of health challenges. Several family members were also diagnosed with chronic health conditions. “All of this made me want to work in healthcare,” she said. But with few role models or connections, her professional path was hard to envision.
“AmeriCorps solidified my dream and opened doors for me that I could not open on my own,” said Casas. Inspired by seeing at our clinic how regular care can change lives, she now hopes to be a family nurse practitioner to help her patients prevent or reverse their chronic health conditions.
In our clinic, Casas helped nurse midwives and family physicians set up and facilitate groups for pregnant women. She enrolled patients for essential services like SNAP and WIC and routinely dispensed random acts of kindness. (I watched her help one elderly patient find veterinary services for her support dog.) She collaborated with other colleagues to survey health providers and patients about their wellness needs and will be presenting her findings this month at UCSF’s Department of Family Medicine annual research colloquium.
She also credits AmeriCorps for her own health improvements: “I never had fruit and veggie bowls before.” She started implementing the changes we recommend to our patients and noticed a positive difference in her blood sugar.
By my tally, Casas was generating a lot of health for that $20,000-a-year investment.
Ivan Iniguez, one of the family medicine residents I supervise in our training program, also got his start in AmeriCorps. Like Casas, he was the first in his family to go to college and served as AmeriCorps health fellow in his neighborhood clinic in South Central Los Angeles. He too credits the program for opening doors and directing him toward primary care.
Given the growing shortage of primary care clinicians, Iniguez wonders who is going to take care of the “Silver Tsunami,” the millions of baby boomers with growing health needs.
“AmeriCorps was a pipeline program for me and for other people entering the healthcare workforce. They go to places where we need them,” Iniguez told me. “Why are they taking it away? If they really want to solve this country’s healthcare problems, they should be putting more money into AmeriCorps.”
Clinicians and staff who work in community clinics for underserved populations either burn out or become hardcore optimists. We show up each day to celebrate our patients’ victories, however small, and to dispense a big dose of hope along with our more standard prescriptions. Since Casas’ disappearance, it’s this same stubborn positivity that has kept me hoping that President Trump and his administration will reverse course and bring back our AmeriCorps volunteers. We all depend on them to help make America healthy again.
Daphne Miller is a family physician, an author and a clinical professor at UC San Francisco.
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