How Portland's healthcare institutions are working to build back trust with Black Lives Matter protesters

In the beginning, it was thoracic injuries. Cate Krieger remembers caring for protesters whose backs were injured by less-than-lethal munitions shot by Portland (Ore.) Police Bureau officers and federal agents.

As summer faded and the Black Lives Matter protests persisted, the injuries shifted to more long-term concerns, like emotional trauma or repeated damage to joints, according to Krieger, an organizer with the street medic group Portland Equitable Workers Offering Kommunity Support, or EWOKS. Among the more than 1,000 demonstrators the EWOKs have treated, effects from tear gas remains the most common ailment, she said—despite the city promising to halt its use.

“Portland has stayed spicy here and we keep working on it here,” Krieger said. “If we can’t create proof of (a progressive care) concept in a city like Portland, so many large metropolitan cities that are struggling with just this thing are gonna have a hard time finding out what the answer is for them.”

Portland’s reputation as the whitest big city in America may seem at odds with the intensity of the Black Lives Matter protests that erupted after the killing of George Floyd in Minneapolis. But the city’s progressive activists have a long history of violent clashes with police. In 1990, a staffer to President George H.W. Bush referred to the city as “Little Beirut,” after tensions burst between officers and anti-war protesters.

The city has seven major street medic teams that serve as the most immediate, and sometimes primary, point of care for protesters. While these groups are run mostly by healthcare workers volunteering their spare time, they specialize in everything from emergency care to mental health services. At the start of the protests, Oregon Health and Science University operated its own street medic team, although the group was later disbanded after police arrested one of its members. The EWOKS continue to collaborate with OHSU, Rosehip Medic Collective, Portland Action Medics and others to serve Black Lives Matter protesters’ needs.

“No one in our city trusts calling 911, and so any service that is tied into that emergency response is as good as useless,” Krieger said.

In 2020, Portland reported the most incidents of police brutality across the nation since the start of demonstrations in May, with nearly three times as many reports compared with second-place New York City, according to 2020PoliceBrutality, an open-source project that tracks officer violence in the U.S. Even as loud activists demanded institutional change, wildfires burned across Oregon and the COVID-19 pandemic raged, with both factors disproportionately impacting minority communities.

In September 2020, wildfire smoke created the most hazardous air quality conditions the Portland area had ever experienced, resulting in an 88% surge in visits to hospitals and emergency departments by patients with asthma-like symptoms during this time.

The trifecta of emergencies has magnified the need for culturally sensitive providers conscious of the social determinants of health in the city. In the wake of Black Lives Matter protests, healthcare providers are rethinking how they connect with the community.

“As much of a dumpster fire and awful as 2020 was, it also taught me a lot about the power of mutual aid,” Krieger said. “I’ve never been so excited to be in street medicine and street mental health. It feels like there’s possibility here.”

The EWOKs represent the only street medic teams in the city integrating physical and mental health services, according to Krieger, who works as a crisis therapist and supervisor at a local not-for-profit. But the city is aiming to implement a similar service.

In June 2020, the Portland City Council voted to direct $4.8 million from the police budget to a program called Portland Street Response, which will send trained mental health providers to certain 911 calls instead of law enforcement officers.

By tending to the full spectrum of a person’s health, officials hope to bridge racial health inequities in the city, said Sam Diaz, a senior policy adviser in Portland Mayor Ted Wheeler’s office.

In 2014, a report by Portland State University and the not-for-profit Coalition of Communities of Color found that Black families lag behind whites in the area in health outcomes and law enforcement engagement, like many areas across the country. In these instances, hospitals and healthcare systems often pay for much of the cost of treatment. A 2020 study by the American College of Surgeons found that gunshot wounds cost the U.S. healthcare system $170 billion a year, with hospitals spending $16 billion on operations alone to care for patients.

In Portland, between 2003 and 2007, Blacks were more than six times as likely to die by homicide and twice as likely to die from diabetes as whites, according to the report. Black residents in Multnomah County, where Portland is located, were more than three times as likely to be represented in the criminal justice system than the population as a whole, according to the analysis. In 2019, the county’s Black residents had an average annual income of $46,500, while whites’ income averaged upwards of $80,000, according to U.S. Census data.

“This isn’t new,” Diaz said. “We have report after report after report showing us the data, and it continues to be unacceptable.”

After the protests erupted in May, the city issued a 19-point plan for reforming the police department, with plans to cut the department’s budget, recruit minority officers, remove police from schools and more. In October, the city also launched its first public racial equity support hotline, where individuals can call in to report racial profiling and receive emotional support.

Health department officials prioritized giving minority communities most impacted by COVID-19 the digital tools they need to conduct telehealth visits and rental assistance support, said Ebony Clarke, interim director of the Multnomah County Health Department. According to county data, Hispanic individuals make up 11% of the population but represent 28% of the city’s COVID-19 cases as of Jan. 24. Clarke said the county also prioritized free testing for this population.

“At the core of our effort is really trying to rebuild trust with our BIPOC communities and owning and recognizing the role that bureaucratic systems have played in the disparities,” she said.

Officials for local hospitals and the state hospital association either declined comment or didn’t respond to multiple requests for comment.

Multnomah County has also compiled a public list of culturally sensitive health providers. Kaiser Pemanente Center for Health Research launched an anonymous, voluntary survey asking protesters exposed to tear gas to share their healthcare experiences.

And healthcare organizations like OHSU and Portland-based Cambia Health Solutions are also enlisting equity consultants to examine the biases that exist in their operations.

Peggy Maguire, who serves as foundation president and senior vice president of corporate social responsibility and palliative care solutions at Cambia, said the insurer is working with a consultant to review its grant-making process. Cambia, which operates Regence Blue Cross and Blue Shield in Oregon, recently invested $11.5 million in 17 community organizations focused on immediate crisis relief, healthcare access and public health projects. The group also invests in federally qualified health centers like Virginia Garcia Memorial Health Center, a network of 17 clinics in the Portland metro area that provides low-cost care to a primarily Hispanic patient population.

“My thinking about addressing social determinants of health has changed over the last year,” Maguire said. “I’m just really seeing many more connections between things and thinking about the need to address change at the roots to get at the cause of some of these issues.”

By staffing clinics with employees who look like their patients and speak their language, Virginia Garcia aims to build trust within the community. The clinics accept almost all forms of insurance and, for those who are uninsured, offers a sliding payment scale based on income. The organization offers bilingual behavioral health and primary-care services at a single site.

Dr. Eva Galvez, a family physician who is Mexican-American, said her patients’ needs directly intersect with many of the social issues fueling the Black Lives Matter movement, such as access to healthcare, safe housing and healthy food.

As protesters’ calls for institutional change were heard across northwest Oregon, Galvez found herself having more conversations with patients about how their race could impact their health, talking to some of the 10,200 individuals who received free COVID-19 tests from Virginia Garcia about how their income status, work settings, underlying health conditions and other racial issues put them at a greater risk for contracting the virus.

“For me, it’s just more of an acknowledgment about how racism ties into health,” Galvez said. “I’m not taking my patients off the hook. I still want to try to help them make good choices. But I think that if I acknowledge (systemic racism) within the room, that also opens up trust, and then it makes me more effective.”