Health is essential, but services are scarce in many underserved communities, and healthcare remains a luxury that some just can’t afford.

With the pandemic as an ever-growing issue, the idea of telehealth is not only becoming the norm but changing the way that healthcare is being provided in the city. The benefits of telehealth are easy to enumerate — limiting staff and patient exposure to those who might be sick; and preserving the use of personal protective equipment (PPE), are at the top of list.

But digitally delivered healthcare isn’t without challenges.

“Telehealth is a growing concept. The COVID-19 pandemic indicates that telehealth will be on the rise,” said Dr. Eric Edi, chief operating officer of AFRICOM, a coalition of African and Caribbean communities that is headquartered in the Paschall neighborhood in the city. “But let us not forget that there are prohibiting factors: digital illiteracy, fear of being exposed, [lack of] trust in the system caused by the constant attack on immigrants.”

According to Edi — who focuses on health in the African immigrant community of Southwest Philadelphia — immigrant communities rely on smartphones and social media for everything, including health information. Given that some communities don’t have the necessary access to computers, however, telehealth can be a challenge.

Formally known as Kingsessing Township, what we commonly call Southwest Philadelphia encompasses not only Kingsessing, Paschall, Bartram Village, and Angora (among others), but also parts of Grays Ferry — otherwise a western South Philly community. The area is majority Black — both African American and African immigrant— and the rowhome-lined neighborhoods are underserved when in comes to healthcare. In Kingsessing-Paschall, for example, there are 3,590 residents for every physician; the city average is 1,460 per physician.

The digital divide, and lack of digital literacy, has also long been an issue in the Southwest. The Centers for Disease Control says that restricted access to technological devices such as cell phones, tablets, and computers may make the practice of telehealth challenging.

(Infographic by S. Vourvoulias)

“I agree with [the CDC] simply because access to the internet is a challenge for many families,” Edi said. Second, where I may disagree with the statement is the question of limited access to technological devices. For instance, we know that immigrant communities rely a lot on smartphones to access social media and stay connected with family members. Many use their phones to access the internet.”

In Paschall Kingsessing, according to a map of broadband subscriptions compiled by Comcast in 2019, 39% of households do not have broadband internet. And it’s worse in other parts of the Southwest: in Kingsessing it’s 42%; in Grays Ferry , 46%; in Bartram Village, 52%.

“In addition to the lack of basic computers for many, there is the culture of ‘in-person’ appointments with doctors, which makes people feel more secure and cared for,” Edi said. “But, still, I do not think that we should shy away from telehealth completely. Digital literacy is a must-have skill. The same as we invest in language and English classes, we should invest much more in digital literacy classes.”

According to a 2019 community health assessment completed yearly by the City of Philadelphia, factors such as social and economic condition, accessibility of healthy products, the behavioral choices people make, and the medical care system can all affect the “health” of a neighborhood.

Edi points also to other challenges in the Southwest, such as language access, employment, poverty and housing, among other. The impact of COVID-19 has exacerbated these issues.

There have been some significant problems concerning health within the African immigrant community in the area. He lists lack of knowledge about health centers, men’s reluctance to go to the doctor, alcohol, and some substance abuse as issues the community continues to confront.

“Today in Philadelphia, the gun violence epidemic is another cause of trauma that is yet to be addressed properly,” he added. “African immigrant communities in the Southwest have had their shares of victims. Families have lost loved ones to gun violence.”

And then there is the lack of insurance — 15% of residents of Kingsessing-Paschall are uninsured.

“It costs too much to be healthy in the U.S.,” Edi said. “The healthcare system needs a culture-overhaul.”