Confianza: COVID care at the intersection of kinship, community, and biomedicine

Photo by Jesús E. Valenzuela Félix
VIDA Outreach workers distribute free toys, as well as COVID-19 information and PPE, at an event in front of La Princesa grocery store in the Salinas Valley of California.

When Yesenia Mendoza and her family contracted COVID-19 in November 2020, they quickly relocated to the county-provided isolation housing available to farmworker families in the Salinas Valley of California. Few were availing themselves of this service, and it was rumored to be poorly resourced, but she insisted that they leave their crowded home to prevent others around them from catching the virus. Her family, and the extended Mendoza clan, are a relatively typical family in Salinas: Mexican-American, variably involved over generations in Sureño gangs and informal agricultural labor, semi-engaged in community projects, rarely drawing on their state-provided Medi-Cal coverage, and closely entwined in each other’s lives. I’ve known them for nearly a decade through Yesenia and her sister Sara’s participation in a now-defunct group called La Colectiva de Mujeres, the Women’s Healing Collective, of which I was also a member and ethnographer. Alongside other community groups oriented to health equity in this city, the Colectiva’s short but impactful tenure imparted a strong sense of health as social, spiritual, emotional, and physical. It built on thick relations of kinship and care, already so important in this working-class Latinx community, to underscore the importance of confianza to each other’s health and wellbeing.

Confianza, in Spanish, refers to a relational and durative formation of trust and mutuality; it is about familiarity, reciprocity, and an ongoing attendance to one another. Codeswitching in Spanglish, one has confianza ‘with’ another rather than ‘in’ someone or something. Confianza is key to understanding how Yesenia and Sara, and others in Salinas, could collectively acknowledge COVID as a lethal risk, yet take unique and sometimes contradictory approaches to its mitigation. As this essay shows, at the intersections of kinship and community infrastructure, Salinans often prioritized ongoing relation with and care for each other rather than trust in the institutions claiming to offer safety or respite from the risk of COVID. When they did intersect with those institutions, they were often compelled by their ongoing relations of confianza.

Yesenia’s kids and partner recovered quickly from COVID, but her condition took a serious turn. She spent the next two months on a respirator, in and out of consciousness. She was plagued by nightmares (or were they?) about being sexually assaulted by her doctor—the same doctor who told her family she was unlikely to survive. She eventually learned how to breathe, walk, and live again, and reentered the fray of family life. Amidst subsequent virus surges, Yesenia was exposed to COVID numerous times through her kids (who contracted it at sports practice and work) and nephew (who was living on the streets, and would show up high and maskless at her house). This all made her anxious, but she could not cut herself off from her loved ones. What could she do but mask up, pray, and keep the Clorox flowing—even as her husband derided this constant cleaning as “not trusting God”?

The Mendozas treasured Yesenia’s recovery as miraculous. Still, it was almost another year after this close call before Yesenia’s sister Sara opted to get vaccinated. Even then she chose the Johnson & Johnson single shot, what Yesenia described as “the cheapest one” (and, I would add, the riskiest for her demographic). Sara told me that she chose the single shot to minimize her engagement with medical infrastructure, which made her uncomfortable. This wasn’t a problem of access. In Salinas, Sara saw vaccine clinics “everywhere, at the libraries, in parking lots, everywhere.” She knew many of the people organizing and promoting these clinics from her years with the Colectiva, which had been one of many community groups funded through the local Building Healthy Communities (BHC) infrastructure intended to meet the health equity needs of a mixed-migration status, working-class population. In 2020, BHC and other community leaders quickly organized, along with agricultural trade associations, to lobby the county government to provide an initial $5M for a highly successful collective effort known as The VIDA Project, which made that multitude of community vaccine clinics in Salinas possible. VIDA, “Virus Integrated Distribution of Aid” but also Spanish for life, calibrated the efforts of ten different local community organizations in a highly successful approach to COVID-19 outreach with familiarity and “already-trusted people” as its “essence.” Sara had confianza with many BHC and VIDA organizers but nevertheless contended for months that she did not need the vaccine, since she had almost certainly contracted the virus when Yesenia became infected and been asymptomatic.

In fact, Sara was exceedingly careful, staying at home for much of the pandemic and keeping her daughter in virtual learning even when she could be back at school. She didn’t trust the school to keep her daughter safe. But her workplace had finally issued a vaccine mandate, and she absolutely needed her job. Sara had been housing insecure, living in shelters, through much of 2018, and in no way would risk losing the small apartment where she and her daughter lived. Plus, she liked her job and didn’t want to find another one. She found a VIDA-run vaccine clinic close to home that fit her schedule and went to get the jab, thereby maintaining her family’s precarious and hard-fought housing security. As a bonus, on visits to see her partner, locked up at a state prison, she would have another measure of solidarity with the incarcerated—forced to be vaccinated early on, yet surrounded by guards and staff who often refused the dose themselves and brought the virus inside the facility.

The Mendozas’ tangle of accommodations to each other, maintaining care and relation, illustrates how confianza has shaped people’s engagement with the threat of COVID-19 in working class Latinx families and communities in the US. These practices do not equate to trust in medical institutions. Where people like Yesenia and Sara do intersect with these systems of knowledge and power, it is clear how they are compelled by relations of confianza. Shifting next to that intersection with particular attention to the VIDA Project, I argue that the same ongoing commitment to care-full relation is at the core of community-led endeavors in Salinas to keep each other healthy. The same relations of confianza, scaled up and professionalized, have arguably driven the remarkably successful vaccine campaign in Salinas in 2021-22, which achieved among the highest rates of vaccination in the state.

This success deserves careful interpretation. As I have written elsewhere, Salinas is a profound example of the intergenerational impacts of systemic racism, structural poverty, and mass incarceration among Latinx people in California and the US. Due to collective histories of medical racism and discrimination, and concerns about collusion between medicine and immigration enforcement or state surveillance more broadly, many Latinx people in the region have little engagement with, or trust in, the healthcare system. Nationwide, there has been much concern about Latinx populations’ vaccine hesitancy as well as their susceptibility to misinformation. And yet, high vaccination rates in Salinas have long sat well above the state average, in large part due to community groups like VIDA. VIDA was able to build on existing relations of confianza to provide COVID information and vaccines to residents—despite many people’s longstanding and profoundly felt lack of trust in the medical system and state institutions. VIDA’s efficacy was due in large part to the work of residents-turned-staff who have mobilized their confianza with members of this community to create a strong network of accessible and relevant programs, services and events, practices of care for residents whose realities they deeply grasped.

Watching VIDA’s Instagram stories, one could quickly learn of a vaccine clinic being held in the parking lot of a McDonalds, where people received free Big Macs after getting their dose. On another day, another clinic around Christmas is a family event, held outside of La Esperanza grocery store. Here, people could bring their children to receive one toy per child, and also receive COVID information and PPE. Or they could be tested, sponsored in part and hosted by a local ranchero radio station. Another VIDA video was filmed by an outreach worker, providing conversational instruction in Spanish on how to administer an at-home test just before the district’s schools were set to reopen. These events were designed to accommodate the realities of widespread local food insecurity, poverty, and an abiding concern for their children’s education in a city with a noted digital divide. VIDA’s staff were not simply translating epidemiological information to community residents, they were mediating a relationship between individuals and institution in ways that prioritized resident wellbeing. This wellbeing was recognized as spanning ethico-social, affective, and economic domains, in addition to physical health, with a timeline well exceeding getting shots in arms.

Screenshot from @VidaProject831 on Instagram
A flyer advertising a vaccine clinic, with free Big Macs to all who register. 

Those employed by VIDA live in the same neighborhoods, attend the same churches, and follow the same school schedules as those lined up for toys, burgers, and vaccines. They have family members who have avoided medical attention for fear of attracting unwanted scrutiny by immigration or justice authorities. Or have gone for treatment but been saddled with surprisingly huge medical bills. They are the ones who have learned that the Medi-Cal system can be navigated to their advantage and are eager that others realize the same. VIDA’s staff mobilized existing ethical imperatives to maintain caring relations and to keep each other healthy, thus building on confianza they already had with others in this community to open a safe and accommodating conduit for biomedical information and services.

Shifting focus from transactional trust in institutions or supposed biomedical panacea, to relational confianza with others, can help all with concern for public health outcomes to realize the primacy of localized ethical formations and social relations in navigating profound societal challenges. It provides an important corrective to public health strategies that aim to patch the “trust deficit” with marginalized communities by plying them with more biomedical knowledge or an assumption that there is one clear pathway to health. Prioritizing actual, ongoing relations and the many, messy ways they are maintained decenters the acclaimed exceptional urgency of the pandemic and recenters sociality in a way that transcends the particularities of the period, acknowledging and accommodating the other ongoing crises that many marginalized communities endure daily. Ongoing and constant threats posed by the prison industrial complex, migrant “illegality,” and food and housing insecurity in an increasingly unaffordable state are no less dire threats to the health and wellbeing of many working-class Latinx people in California and the US. Relations of confianza, rendered into care-full accommodations in community settings, can be a potentiated arrangement for health equity. And health equity, in a country where racism is the underlying cause of a vast panoply of illness and mortality, can also open onto racial equity, especially if achieved on a community’s own terms.

About the Author

Megan Raschig is an Assistant Professor of Cultural and Medical Anthropology at California State University, Sacramento.