• Beyond Charity: FP Empowers Communities, Sparks Change

    August 17, 2020, 3:17 p.m. David Mitchell -- Faced with a choice between her full-time academic position as a professor of clinical family medicine and a volunteer position at a homeless shelter, Evelyn Figueroa, M.D., chose the role where her skills as a family physician were needed the most.

    headshot of Evelyn Figueroa, M.D.

    In addition to stepping away from the University of Illinois at Chicago College of Medicine and eventually transitioning out of her role as program director at the UIC Family Medicine Residency in May, Figueroa self-isolated from her family while working six or seven days a week at the Pacific Garden Mission, the Midwest's largest shelter for people who are homeless, where she had been the volunteer medical director since 2016.

    "It was the right thing to do," said Figueroa, who led an emergency COVID-19 medical response at the mission from late March through June. "A large outbreak was in place. We had to lock things down."

    Figueroa worked with the city's public health officials and a coalition of health care and emergency shelter workers to develop and implement treatment protocols and facility modifications, converting four dormitories into COVID-19 isolation units as part of a shelter-in-place containment strategy. The mission had a cumulative COVID-19 infection rate that exceeded 70%. Figueroa, public health nurses, family medicine residents, UIC medical students, and other health professions students provided on-site care to more than 230 people in the units.

    Figueroa had been the UIC family medicine residency program's associate director for four years before serving as director for the past six.

    "I had accomplished my vision for the residency, and it felt right to find another leader to bring fresh ideas to the program," said Figueroa, who remains a professor of clinical family medicine at her alma mater. "I have pivoted into community organizing work, and it was time to transition from this academic role."

    Throughout her two decades in family medicine, Figueroa has maintained a broad-scope practice with outpatient and inpatient care, including maternity care and women's health procedures. She also supervises fellows, residents and medical students. Although she has treated thousands of patients and delivered hundreds of babies, two particular interactions with patients experiencing homelessness left their mark on her career.

    Figueroa was a resident in 2000 when her hospital treated a man who was living in a nearby forest. Although his condition was treated, his homelessness was not addressed. In the end, he was "discharged to previous living arrangement."

    "Social services were separate from what we were doing," she said. "We didn't understand what social determinants were and focused on medical care without connecting his social wellness to his overall condition. It was completely siloed. We didn't do anything about it because it 'wasn't our problem.' I was complicit in something that was not appropriate. That's stamped in my brain. I knew I wasn't advocating for the patient, and I didn't know how to address it."

    Figueroa said she had always been "really good at the charity part" of giving back to her community, but she didn't yet know how to empower communities and influence system-level change. Although she has long held interests in health equity and social justice, two events in 2017 pushed her to do more.

    For nearly two years, Figueroa had supervised a young boy's well-child visits with her residents. She got to know the child’s mother (or so she thought), who was a law school student. During a visit in which it became clear that the toddler was failing to make progress on the growth chart, the mother appeared uncharacteristically disheveled. Figueroa finally put the pieces together: This small family was struggling with homelessness.  

    "I missed it," Figueroa said. "That was it for me. I had to change the way I asked questions and become more intentional. I reframed questions. Instead of asking people if they were eating healthy foods, I asked, 'Do you have access to fruits and vegetables?' I started getting very different answers from patients."

    Later that year, she had another "aha moment" when Hurricane Maria devastated Puerto Rico. Figueroa, who has family on the island, was eager to help, but that didn't go exactly according to her plan.

    "I thought I would be needed as doctor," she said, "but they didn't need me as a doctor. They needed public health support and logistics. The experience in Yauco (in southwestern Puerto Rico) gave me a better idea of how I could help a large community during a horrible disaster."

    Figueroa and her husband, family physician Alex Wu, M.D., launched a nonprofit foundation aimed at helping people struggling with poverty. The foundation delivered food, medical supplies, water filters and solar lanterns to the island.

    Just a few months after Figueroa took that mission trip to Yauco, she launched a longer-term initiative closer to home. The Pilsen Food Pantry has grown steadily since January 2018 and now processes more than 17,000 pounds of food per week, including frozen products, shelf-stable items, fresh produce, eggs and dairy products. The pantry helps about 50 families a day, five days a week, and, to date, has served more than 22,000 visitors. Although the pantry was originally located on UIC property, it has always been open to the entire community, not just patients.

    The Greater Chicago Food Depository supplies 70% of the food, and the pantry works with grocers and other community partners to obtain additional items and prevent food waste.

    "We want the right food to get into the right bellies," said Figueroa, who serves as director for the pantry, which has two full-time employees and is supported by about 35 volunteers a week (including medical students and residents).

    Figueroa said she considers herself a lifelong learner and works to recognize her own biases and assumptions. This approach is the foundation of the service learning she offers to health professions students and residents.

    "People think you look a certain way when you're poor, but that's not true," she said. "My staff, volunteers and learners see people who look just like them at the food pantry. Poverty is stigmatizing, so people do their best to look like everything is fine. On TV and in movies, homeless people are portrayed as dirty and wearing old clothes, but it  doesn't usually look that way in real life. I ask students and residents, 'What do poor people look like?' and challenge that construct. We need to look at things differently. We are in a position to provide more dignified care for people experiencing poverty."