Putting Community First

By Tad Vezner

Across nearly two decades of family clinical work in Chicago’s Pilsen neighborhood, Esther Sciammarella (M.S. PSYC ’80) has garnered a mixed appreciation for partnerships.

There was a lot of talk among nonprofits for “joint ventures,” or relying on other nonprofits to collaborate and split services proportional to where the needs are. But there was also an equal amount of competition.

And so, in the 1990s, she took a job as the primary community liaison for the Chicago Department of Public Health’s Commissioner for Hispanic Affairs, doling out funding to educate, train, and pay community health workers who were employed by neighborhood nonprofits. And, in some cases, getting those nonprofits to work together.

While she still speaks with some skepticism about cooperation in the coordination of services, those who know her well say Sciammarella has worked wonders.

“One of her strengths is to build a Hispanic coalition, an effort to put together what was thought impossible with very little data. Her significance in that has been tremendously important,” says former Illinois State Board of Health member Patricia Canessa, who is now a consultant with the Latino Health Initiative in Maryland.

Perhaps that’s why Sciammarella was appointed in 2022 to sit on the State Board of Health herself.

For more than six decades across two continents, Sciammarella has tried to understand, teach, and treat people in the Hispanic community for a variety of mental and social ills—particularly clients who are coping with cultural change in an unfamiliar country.

“I’m concerned that people [in the United States] focus on behavioral actions, and not enough on what happens subconsciously [without action],” she says. “I work with immigrants and refugees who have different experiences. You need to understand how people were raised in their culture to reach and help them.”

According to the United States Census Bureau, Illinois’s Hispanic population in 2023 reached nearly 2.4 million people, a roughly 60 percent increase from the 1.5 million Hispanic population in 2000. According to the most recent census statistics, 14 percent of Illinois households now speak Spanish as their primary language.

Sciammarella’s focus on cultural differences stretches back to her dissertation in India, where she compared children from the U.S. to those in India.

“Many problems arise from [the U.S.’s] addictive culture. There are many addictions to many things: substance abuse, work, food,” she says, adding that she found that the culture tended to be individualistic and not holistic when treating and healing families.
After teaching high school psychology and philosophy in Buenos Aires, the capital of her native country of Argentina, Sciammarella arrived in the U.S. and eventually settled in Chicago in 1972, counseling families as a clinician at what was then the Pilsen Mental Health Center.

Therapy, she says, is about simply allowing people to “ventilate.” Often, when placed in an unfamiliar environment or culture, or when old identities are subverted by new ones, people tend to internalize or withhold their problems— as well as any psychological effects.
She left the Pilsen Mental Health Center (now called the Pilsen Wellness Center) and took a job at the Chicago Department of Public Health under Chicago Mayor Richard M. Daley. There, she put together the Door to Door program for community health workers.

Says Sciammarella, “The community health workers are the glue for the system, between the community and health systems, integrating health and mental health. But there’s a competition for funding between the institutions; it is sometimes difficult to work together. Nobody’s working together, nobody talks to each other. If you don’t create a model of integration for everybody, the system becomes fragmented.”

In 1991 Sciammarella founded her own social service organization in Illinois, the Chicago Hispanic Health Coalition, which is currently funded by the National Alliance for Hispanic Health. The organization offers training programs for community health workers based in the Pilsen Family Health Center Lower West, part of the University of Illinois Hospital and Health Sciences System. According to the organization’s records, it now trains and informs roughly 30,000 people annually through its different programs.

She accepted a position on the State Board of Health in 2020 because she saw the need for a Hispanic voice there—especially one who has known the community for decades.
“The only way you learn is you put your hands in the dirt. The tendency for intellectual people, public health experts, is to be insular. You need to listen to people in order to create systems,” Sciammarella says. “The bureaucratization of the intellectual world, the stagnation of systems…no matter from where, it fleeces things.”

“The only way you learn is to listen to the community,” Sciammarella adds. “You need to be in the trenches and put your hands in the dirt. The tendency in public health is to create models without taking into consideration the community’s needs. You need to listen to people in order to create systems.”

Adds Canessa, “She has never given up on the community health care worker. If she cannot find a door to get things done, she will find a window.”