Diego Chaves-Gnecco, MD, planned to spend about a year in western Pennsylvania when he first arrived 25 years ago.
Instead, he found his mission: helping to remove health care barriers for families who speak other languages or come from other cultures.
Dr. Chaves-Gnecco, a pediatrician at UPMC Children’s Hospital of Pittsburgh, created southwestern Pennsylvania’s first bilingual pediatric clinic in 2002. Today, that clinic is known as Salud Para Niños (Health for the Children).
The program works to address barriers families may face, such as speaking a different language or not having health insurance.
“One of our objectives is to address health disparities, and the way that we address health disparities is by addressing barriers to health care access,” Dr. Chaves-Gnecco says. “There are many barriers that families can have in terms of health care access.”
Since its creation, Salud Para Niños has provided health care and other services for thousands of children and families.
And though the program began as an initiative to help Latino families, it now helps families from countries all over the world.
“It has been an interesting journey,” Dr. Chaves-Gnecco says. “I don’t know that I was able to picture that the program was going to grow that much, that it was going to be that big.”
‘An Invisible Community’
A native of Colombia, Dr. Chaves-Gnecco graduated from medical school there. He came to western Pennsylvania in 1998 as a visiting instructor at the University of Pittsburgh School of Medicine. He completed a master’s degree in public health at the University of Pittsburgh and began a pediatric residency at UPMC Children’s in 2002.
The UPMC Children’s Residency Program had an initiative known at the time as Community Oriented Residency Education (CORE). The CORE program allowed doctors to address the needs of underserved communities. As part of CORE, Dr. Chaves-Gnecco proposed the creation of a bicultural, bilingual pediatric clinic for Latino families.
“By then, I had been in Pittsburgh for four years, and I realized that the Latino community was, first, an invisible community,” Dr. Chaves-Gnecco says. “And second, because of this invisibility, an underserved community. There were no pediatric clinics for the Latino community. There were no bicultural, bilingual programs.”
About one-third of the Latino population in western Pennsylvania is under 18, says Dr. Chaves-Gnecco. That made a pediatric clinic especially necessary.
The clinic launched in summer 2002. In its earliest days, Dr. Chaves-Gnecco worked to get the word out to the Latino community — getting creative at times.
“I joke that I made so many announcements in church that at some point people thought I was the priest,” he says.
He also partnered with La Mega Nota, a Spanish-language newspaper, to advertise programs and services. He still writes a monthly column for the paper about health topics.
Word of the clinic began to spread quickly after its launch. And with that, the clinic began helping more people from a wider and wider array of countries. Dr. Chaves-Gnecco remembers treating his first family from a non-Hispanic country and feeling amazed they had heard of the clinic.
Today, that sort of thing is common. Although Salud Para Niños treats mostly Latino families, they see patients from many other cultures, too.
“We see families from all over the world,” Dr. Chaves-Gnecco says. “We have seen families from Ukraine, Afghanistan, Denmark, South Korea, Indonesia.”
‘Culturally Sensitive Care’
From the beginning, Dr. Chaves-Gnecco looked to partner with different organizations and facilities to provide services. As the years went on, Salud Para Niños’ offerings continued to increase.
Today, Salud Para Niños’ services include:
- A bilingual pediatric primary care and immunization clinic three times a week at UPMC Children’s Primary Care Center in Oakland. (Appointments and insurance required.)
- A bilingual, free pediatric primary care and immunization clinic on the second Saturday of each month at Birmingham Free Clinic. (Appointments required, though not insurance.)
- A bilingual, free pediatric primary care clinic at Casa San José in the Beechview neighborhood. (Appointments required, though not insurance.)
- A bilingual literacy program.
- Car seat checks.
- CPR clinics.
- Health reading materials and information in Spanish.
- Injury prevention programs.
- Participation in fairs and events related to health promotion and prevention.
- Spanish phone line.
For the clinics, Dr. Chaves-Gnecco and nurses travel on UPMC Children’s Ronald McDonald Care Mobile. The mobile unit includes two exam rooms, a waiting room, and a nurse’s station. He praises the work of the entire staff of people he’s worked with over the years, from the “loving, caring nurses” to the “amazing drivers” of Care Mobile.
The clinics account for about 1,800 patient visits per year. More than 350 of those patients don’t have insurance.
Health insurance and cost are two major barriers for many of the families that Salud Para Niños helps. Because of that, many of their services are free or do not require insurance.
“This is free care that we provide to a community for patients who don’t have health insurance,” Dr. Chaves-Gnecco says. “We try to screen for the possibility that these kids might qualify for health insurance. And as a matter of fact, many of them end up qualifying for health insurance.
“So, once they get health insurance, first we see them at the free clinic, and then we transfer their care to our clinic for kids with insurance in Oakland.”
Salud Para Niños also provides interpretation services for families to help them through the care experience. And Dr. Chaves-Gnecco strives to provide a welcoming environment for all cultures.
“We also put a lot of emphasis on culturally sensitive care, making sure that we are sensitive to cultural needs and understand the needs of these families,” he says.
“Of course, some of those cultural traits I might share because I’m Latino myself. But for many families in Latin America, cultures can be different. It’s not the same to be from Mexico as to be from Colombia or from Venezuela. And obviously, the program has grown so much that we see people from all over the world.”
The services continue to expand to meet community needs. During the COVID-19 pandemic, Salud Para Niños worked to address food insecurity and provide COVID-19 vaccines.
“We were very satisfied to report the Latino community in southwestern Pennsylvania had a higher rate of immunizations compared even to a general community in terms of COVID,” Dr. Chaves-Gnecco says.
Dr. Chaves-Gnecco’s work is spreading in other ways, too. Salud Para Niños was the first specialty clinic to partner with Birmingham Clinic and Casa San José. Since then, many other UPMC specialty clinics have followed suit.
‘The Numbers Keep Growing and Growing’
Dr. Chaves-Gnecco is proud of the work done so far at Salud Para Niños. But there is still more he wants to see.
He began the clinic in part to help the Latino population of southwestern Pennsylvania, which he saw as an “invisible community.”
Twenty years later, he still sees that invisibility.
Part of that invisibility is because rather than congregating in specific neighborhoods, the Latinos in western Pennsylvania are more spread out. And Latinos make up about 2% of the population, but it’s a growing population. As of the 2020 U.S. census, there were more than 26,000 Hispanics in Allegheny County, 45,000 in southwestern Pennsylvania, and thousands more in surrounding counties. The population has steadily increased over the 21st century.
“You still hear today in Pittsburgh that people say there are no Latinos in Pittsburgh,” he says.
“In total, we are 1% to 2% of the population. But we have increased over the last three decades by about 300%. So, the numbers keep growing and growing and growing.”
The invisibility isn’t the only problem that remains. Though Salud Para Niños has worked to address barriers to health care, some of those barriers still exist today.
One of the biggest barriers is insurance. A total of 24,000 children in Pennsylvania do not have and won’t qualify for health insurance.
“I am amazed myself about how much we have grown, but I always think about: What can we do better?” Dr. Chaves-Gnecco says. “How can we continue growing? How can we do more?
“My dream would be to have those children in Pennsylvania have health insurance. That will solve a lot of problems. And also, to make sure that people understand that there is a community that exists, that has needs, and that we need to provide for them.”
Addressing barriers to health won’t just help the people in need, Dr. Chaves-Gnecco says. It will help the community at large.
“People don’t realize that by serving this community, we’re actually benefiting the entire community,” he says.
Although he’s always striving to do more, Dr. Chaves-Gnecco says he is proud of the work he’s done so far. He considers it a good day when he can help solve a family’s problems.
Some of his proudest moments come when his former patients bring their own children to him. It means the mission of Salud Para Niños can continue for future generations.
“Every single day is a way to rejoice and to celebrate,” he says. “And every little thing we do is a step moving forward.”