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Caring for the Most Vulnerable a “Moral, Ethical, Medical Responsibility”

Standing outside the exam room door, Blima Ludmir warns her husband, Jack Ludmir, MD, that the patient inside is skittish and shy. She quickly relates the young woman’s story: She arrived from Honduras just four weeks ago, somehow making it across the border into the United States with her five-year-old daughter. She speaks no English. She doesn’t know exactly how far along she is in her pregnancy. She only knows she had to escape the violence in her country.

Ludmir nods, motions to the two medical students with him to follow, then throws open the door with a jovial, “Hola!”

Inside, 26-year-old Ingres sits on the examination table nervously toying with the paper pink-orange hospital gown, her daughter, Sandra, by her side. Ludmir immediately starts speaking to her in Spanish, making conversation to put her at ease. He asks her about her previous pregnancy, her family, and then he asks about leaving Honduras.

Speaking softly, she tells Ludmir why she had to leave her country. It was dangerous there for her—so much brutality. They had killed her brother, they had killed many of her friends—for no reason. She feared for her life and the life of her daughter. She risked the dangerous journey to join her husband in Philadelphia.

“And this is why we do this,” Ludmir says, turning to his students.

Mother and daughter came with only the clothes they were wearing. They had no identification documents, no money, and certainly no medical records from Ingres’ first pregnancy.

“Do you think we can get any medical records?” the doctor asks the students. He answers his own question with a shake of the head and weary smile, “Welcome to my world.”

That world consists of the most vulnerable of humanity—pregnant, frightened, and often undocumented immigrants in need of someone to trust. These poverty-stricken members of society find their way every Tuesday to the Jefferson Latina Women’s Clinic where the OB/GYN, his wife, and the dedicated volunteer staff offer medical care and kindness.

“This could be the only time they will be treated with dignity and respect,” Ludmir says. “That is why it is so important to take time, give them some TLC. They are used to being abused by everyone in society—they will not be abused here.”

Jefferson Latina Women’s Clinic

The Jefferson Latina Women’s Clinic, which just celebrated its first anniversary, is on the bottom floor of 833 Chestnut Street in Philadelphia. It is a comfortable space with a cheerful waiting room and four exam rooms. Here, providers deliver prenatal and postnatal care for women with no money, no support system, and nowhere else to turn.

While the clinic is the brainchild of Ludmir, he says the “backbone” of the center is his wife, Blima, the volunteer patient navigator, translator, and 24-hour on-call advocate for the disenfranchised.

Both Jack and Blima Ludmir are children of Eastern European Jewish immigrants who first came to the United States, and then settled in Peru. They grew up together, moving back to the United States so that Jack could attend college and the Temple University School of Medicine. Throughout their lives they have shared a common belief that they were put here to do some good in the world.

After medical school, Ludmir trained at the Hospital of the University of Pennsylvania in OB/GYN with a specialty in high-risk maternal-fetal medicine. He served on Penn’s faculty for several years, and then moved to Boston in 1992. After a six-year stint at Harvard, he returned to Philadelphia as chief of the Department of Obstetrics and Gynecology at Pennsylvania Hospital.

Around 2003, he started to notice an inordinate number of Hispanic women showing up on his labor and delivery floor who had never had prenatal care. “Most were from Mexico, and I was really concerned and wanted to find out what was going on,” he said. What he found was the history of Hispanic migration to the United States.

Over the years, the regions of origin of the Hispanic population in Philadelphia has shifted. In the 1940s and 1950s the majority came from Puerto Rico; in later years, immigrants from the Dominican Republic settled in the United States, and in 2000, an influx of Mexicans sought to build a life working in the restaurant industry as dish washers and line chefs.

Wanting to learn more, Ludmir sought out Steven Larson, MD, an emergency department physician at the University of Pennsylvania, who had been working with the migrant population in the city for years. The two spoke about undocumented immigrants and the need for low-cost or free healthcare; they came up with a plan for a patient-centered clinic that served the Hispanic community.

The nonprofit they created was Puentes de Salud (“Bridges of Health”), with an extra component called Latina Community Health Services that specifically catered to women. Puentes de Salud in South Philadelphia continues to serve as a multidisciplinary, community-based collaborative that promotes health and wellness through low-cost, high-quality healthcare, innovative educational programs, and community building.

Philadelphia Collaborative for Health Equity

In 2016, Ludmir decided it was time to take a sabbatical—a working sabbatical. He and Blima traveled to Colombia to work toward reducing maternal mortality rates. However, while they were there a new challenge in the region developed—the Zika virus. Ludmir was contacted by Colombia’s Minister of Health to help write national guidelines on how to deal with Zika during pregnancy. Once the unexpected assignment was completed, the Ludmirs turned their attention back to the United States.

“It was then I realized something: You don’t have to go overseas to encounter misery and poverty—you can find it here in our own neighborhoods,” he says. Although the city boasts areas of great wealth, Philadelphia is overall the poorest big city in the United States. More than 25 percent of its residents live below the poverty line; it has the highest obesity, smoking, HIV, low-birthweight babies, and maternal mortality rates of any of the country’s 10 major cities; more than 20 percent of the population do not have access to inexpensive, nutritious food; and there is a serious lack of available healthcare in many of its poverty-stricken neighborhoods.

Because of these staggering statistics, Ludmir sought a new opportunity to help on a “glocal” basis—global and local. That opportunity came in a phone call from Stephen K. Klasko, MD, MBA, president of Thomas Jefferson University and CEO of Jefferson Health.

“He gave me the task of creating an initiative that will narrow the health disparities gap and improve conditions in Philadelphia,” Ludmir says. “And that is where the Philadelphia Collaborative for Health Equity (P-CHE) originates.”

P-CHE is a new citywide initiative Jefferson is helping to launch that addresses the social determinants that contribute to the health disparities in so many communities within Philadelphia. The grassroots approach seeks to build trust in the communities and create an alliance of government, business, philanthropic and nonprofit organizations, and citizens to address challenging issues that contribute to the complex social problems of Philadelphia and its residents.