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NEW HAVEN — At the New Haven Museum last Thursday, Jessica Cerdeña, a Middlesex Health resident physician, shared the story of Célia, a pregnant Ecuadorian immigrant treated at the Yale-New Haven Hospital Women’s Center where Cerdeña was working.
According to Cerdeña, Célia arrived at the hospital one day with severe pain and bleeding, but was turned away due to a lack of hospital beds. The hospital called her back that evening and gave her medication to induce labor, but the baby remained stuck. Only hours later did the hospital staff realize that a wound from a previous cesarean section had reopened, tearing Célia’s uterus and both the major blood vessels in the area.
In her new book “Pressing Onward: The Imperative Resilience of Latina Migrant Mothers,” Cerdeña uses Célia’s story as just one example of how racial bias can affect the medical treatment that pregnant Latina and Hispanic women receive.
The book, published in 2023, is the outcome of Cerdeña’s doctoral dissertation in medical anthropology. She presented it Thursday as part of the museum’s NewHaven250 programming, in anticipation of the U.S. semiquincentennial celebration in July.
New Haven has a decadeslong history of welcoming Hispanic and Latino migrants. According to Cerdeña’s book, the first Hispanic residents in the New Haven area were Puerto Ricans, who came to Guilford in the 1930s to pick tobacco and harvest vegetables. They later moved into New Haven, settling mainly in the Hill neighborhood. According to the 2020 Census, just over 30 percent of New Haven residents identified as Hispanic, the largest demographic group in the city, including 103,000 immigrants, half of which are undocumented. In the Fair Haven neighborhood, about 62 percent of residents identified as Hispanic.
As a medical student at the Free Clinic at Yale, Cerdeña said she encountered numerous women expressing frustration with their care and staff making presumptions about their intelligence. She noted that non-English speaking women often felt demeaned, and health care providers would further exacerbate the issue by addressing the interpreter rather than the patient directly. While assisting patients dealing with depression, Cerdeña also listened to their worries about the potential effects of migration-related trauma on their children. The topic piqued Cerdeña’s interest.
Cerdeña told CT Examiner she originally planned to study the cortisol levels of migrant mothers who had experienced trauma and their babies at the time of their vaccinations. But when the pandemic shut down opportunities for in-person research, she shifted to a narrative-based project.
Cerdeña said she then interviewed 65 women from various Latin American countries, discussing their experiences with childbirth, motherhood and obstacles such as financial struggles, lack of health care coverage, isolation and job loss during the COVID-19 pandemic.
Cerdeña has co-authored papers and articles on the negative effects of using race as a factor in estimations of kidney function, and looking at the prevalence of Black patients in clinical trials for pain management interventions. In her writings, Cerdeña discussed the need to detangle genetic mutations that have a connection to a particular ethnicity — such as the one that causes sickle cell disease or Tay-Sachs disease — from diseases that are more common in certain ethnicities due to socioeconomic factors.
During her first year of medical school, Cerdeña said she was shown bar graphs demonstrating the rates of heart disease and diabetes in White Americans versus Black and Hispanic Americans. She said she remembers worrying that her classmates would believe that race predisposed certain people to these conditions, rather than considering the environmental factors behind them.
Cerdeña said she also constantly thinks about environmental racism, and the effects of exposure to certain toxins on physiology, epigenetics, gene transcription and protein synthesis.
“In Fair Haven, you literally are up at the river junction. You have the big oil tankers right there. You have big salt piles … [that] they use to salt the roads in the winter. You have people who are parking their cars on the dirt using their leaded gasoline that’s leaking into the soil. And then mom or dad walks in, kicks off their shoes. Then baby walks around and crawls all over and then puts it in their mouth. And then [the] kid tests positive for lead — that’s environmental racism right there,” she said.
In Célia’s case, Cerdeña hypothesized that her delayed admission to the hospital was partly a result of her being a Women’s Center patient — meaning she lacked insurance — and her inability to speak English. She noted that Celia’s complaints of severe pain were dismissed by providers, and that at one point she was given a less efficient medication for her labor pain.
Cerdeña said she was in awe of the women’s ability to adapt and persevere in their circumstances — a trait she characterized as “imperative resilience.”
But Cerdeña also said that resilience could cause misleading results on tests that behavioral health professionals use to identify post-traumatic stress disorder. When she performed formal mental health inventories with the women, Cerdeña explained, nearly all of them screened negative for PTSD but described symptoms of the condition in subsequent interviews.
“People would talk about not being able to trust anyone … or being like, ‘I still think about the things that happened to me in detention,’ or feeling a general uneasiness or that like nothing is safe in the world. And those are all symptoms of PTSD,” she said.
Cerdeña emphasized the importance of physicians adopting a personalized approach and allowing patients to guide their own medical care, rather than solely relying on screening tools.
She said physicians should also recognize the imbalance of power inherent in the doctor-patient relationship, and strive to give patients — especially those with fewer resources — more control over their health care.
“A lot of times we steer patients toward a choice that we think is best. But even thinking about … the amount that we let our patient talk before we redirect the conversation,” Cerdeña said.
In terms of potential policy changes, Cerdeña wants the HUSKY health program available to all immigrants in Connecticut, a food stamp expansion or a universal basic income for undocumented families, and an updated migration registry, which would open a pathway for undocumented people who have long resided in the U.S. to become citizens.
“No woman should be forced to rely on her own intrinsic abilities to survive and build a life for herself and her family in a hostile environment,” Cerdeña said. “She deserves to be supported and to have enough capacity to grow her self-worth and invest in her dreams.”
Cerdeña is currently seeking funding for her next project, which explores how individuals utilize direct-to-consumer genetic testing platforms such as 23andMe and the impact on their sense of identity.
“I find that really interesting, the supremacy of the gene or the primacy of the gene … [and] how these unexpected results change how we think about ourselves and our relationships and where we fit in the world,” she said.