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Meeting people where they’re at

Community leaders guide OHSU efforts to vaccinate hard-hit communities with an urgency that is only intensifying as the state re-opens
Five members of a family gather with Dr. Donn Spight from the OHSU Vaccine Equity Committee outside Emmanuel Church, showing off the Band-aids on their upper arms after the family members got vaccinated.
As a teacher, Luretta Tinnon (striped skirt) got vaccinated when her kindergarteners returned to her classroom. When OHSU and Emmanuel Central Church partnered on a vaccine clinic, she brought her family. From left, husband Tim Tinnon; sister Alice Marie Biggs; Donn Spight, M.D., co-chair of the OHSU Vaccine Equity Committee; and Lurettas daughter and son, Tionna and Timm Tinnon. I would love to inspire more of my friends and family, Tinnon said. Show our community of color that this is OK and necessary! (OHSU/Erin Hoover Barnett)

When COVID-19 began spreading in early 2020, Pastor Levell Thomas and Assistant Pastor Mark Jackson of the Oasis of Praise International Ministries in Southeast Portland focused on learning about and educating their mostly African American congregation: What is this virus? What are the risks? What is needed to stay safe?

Soon they heard about local relatives, friends, community members as well family members down South falling ill and dying, driving home the seriousness.

Meanwhile, a few neighborhoods to the northeast, the mostly Indonesian and Vietnamese American members of the Portland City Blessing Church and the nearby Living God Church, respectively, faced not only illness but fear of xenophobic attacks. The Spanish-speaking congregation that shares space with Portland City Blessing Church was equally distressed.

Young man gets vaccinated by an OHSU staff member at a community clinic.
Josh Chavarria, 26, who is on the worship teams at Portland City Blessing Church and the church that shares space with it, Iglesia doe Cristo de Santidad, led by his father, became an enthusiastic partner and promoter of the clinics. (OHSU/Erin Hoover Barnett)

“For a lot of people, we were in shock,” said Josh Chavarria, son of Pastor Obdulio Chavarria of Iglesia de Cristo Camino de Santidad (Church of Christ Pathway to Holiness). “We were a little scared.”

With good reason.

The virus’ toll has been devastating, especially in racial and ethnic minority communities. It laid bare and cruelly exploited the impacts of structural racism such as disproportionately high levels of obesity and chronic respiratory and circulatory ailments due to racism-induced stress, environmental injustices such as poor air quality, lack of neighborhood trees and access to parks, and inadequate care and mistreatment by the medical profession, as well as a higher likelihood of working in front-line jobs, using public transit and living in higher density and/or multi-generational households.

Communities whose first language is other than English were not only imperiled by the virus but by insufficient multilingual health information or culturally informed providers to bridge linguistic and cultural gaps.

When the vaccines rolled out in late fall, even as the country reeled with another surge in cases, many of the same factors meant that these communities once again were miles behind the starting line. And most health systems were no better prepared to make up the distance.

Now, the resulting slower rate of vaccination in these hardest-hit communities means that the reopening of Oregon and states across the country creates yet another threat as the Delta variant is getting a foothold. Among age-eligible Black, Native American and Latino Oregonians, between 43% and 45% are vaccinated compared to white residents at 59 percent.

State, community and OHSU leaders drove home the continued urgency June 30 at Gov. Kate Brown’s announcement of the state’s reopening.

“We must ensure every Oregonian has access to a COVID-19 vaccine,” said Judy Guzman-Cottrill, D.O., professor of pediatrics (infectious diseases), OHSU School of Medicine. “Vaccine availability does not mean vaccine access. We cannot let up now. The mission is not yet accomplished. Let me say that again: This mission is not accomplished."

 

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Pastors Thomas and Jackson of Oasis of Praise remember when the vaccines were approved amid the political firestorm accompanying the 2020 U.S. presidential election, and the rapid roll-out commenced.  The whole process only raised more questions.

“We just heard about this virus a few months ago and now you’ve got a solution?” asked Thomas. “So, we didn’t rush; we didn’t run. We were like, ‘Let’s see how this plays out. How will people react to the vaccine?’”

The big fear, said Jackson: If people have underlying medical conditions, will the vaccine be as deadly as the virus?

Yet many health systems – thrust into standing up public vaccine clinics because they were the recipients of the biggest vaccine allocations from the federal government – did what they do best: They went big.

OHSU partnered with the Port of Portland and the American Red Cross on the mass vaccination site at the Portland International Airport Red Economy Lot and partnered with other metro-area health systems at the Oregon Convention Center. Soon, the volunteers directing traffic, checking in patients, administering vaccines and monitoring patients could see that most of the people showing up were resourced and white.

Making an appointment and figuring out eligibility was complicated, even if you had a computer or a smart phone. Having to give a Social Security number or proof of insurance were at least discouraging and at most fear-inducing, especially for people who lack a path to citizenship. Getting to the airport or navigating the convention center was challenging for some and alienating for others. And where were the medical experts with cultural humility and knowledge who would listen and answer questions?

“OHSU had to realize that one size did not fit all,” said Derick Du Vivier, M.D., M.B.A., OHSU senior vice president for diversity, equity and inclusion and co-chair of the OHSU Vaccine Equity Committee that OHSU formed in January. “It is our job to vaccinate people. That means tailoring opportunities so that everyone can feel supported to get the vaccine.”

But OHSU is a sophisticated academic health center on a hill above downtown and less enmeshed in communities than smaller hospitals. As an elite biomedical research institution, OHSU also bears the responsibility of historical abuses in medical research elsewhere. Yet to restore health to all communities amid the pandemic required not only trust but humility – acknowledging past injustices and structural racism and centering equity.

“To reach communities most harmed by the virus, we couldn’t just go in cold,” said Donn Spight, M.D., professor of surgery and co-chair of the OHSU Vaccine Equity Committee. “We needed to partner with trusted messengers like pastors and other respected leaders. The responsibility they feel for the well-being of their communities is deeply personal and when they speak, their communities listen. With such high stakes, these community leaders gave us a chance. We could not do this without them.”

Pastors Thomas and Jackson from Oasis of Praise had met Spight and his School of Medicine colleague Christopher Evans, M.D., M.P.H., assistant professor of medicine and an infectious disease specialist, early in the pandemic when the Bridge Pamoja and the Coalition of African & African American Pastors organized a call with the Oregon Health Authority.

The pastors could sense the doctors’ genuineness. They also knew of the COVID-19 community testing clinic that Donna Hansel, M.D., Ph.D., professor and chair of pathology, OHSU School of Medicine, and colleagues had set up with Principal Nichole Watson at Prescott Elementary in Parkrose.

Through the two organizations, the pastors connected Spight and Evans with Emmanuel Central Church Lead Pastor, Bishop C.T. Wells. Emmanuel, on North Sumner Street in Portland’s historically Black neighborhood, has a large community space and significant parking, perfect for a clinic.

Spight, Evans and the rest of the OHSU Vaccine Equity Committee mobilized along with many staff and leaders from health care, nursing and pharmacy. Partnering with the Multnomah County Health Department’s REACH program and the Consulate of Mexico, the first vaccine clinic was March 28.

A lot went right. But there were bumps.

OHSU advertised the clinics as not requiring insurance information or Social Security numbers yet volunteers who were checking in patients at those early clinics faced an electronic health record that required those fields, discouraging some who showed up for their vaccines. When people dropped in without an appointment or family members with different appointment times wanted to be get vaccinated together, volunteers hesitated.

“We had to deconstruct and reconstruct our systems and approaches,” said Jeanine Smith, a practice manager at the OHSU Family Medicine Clinic, South Waterfront who is managing operations for the vaccine equity clinics. “We take care of patients for a living, but health care isn’t often known for being user friendly. We had to pivot quickly or risk losing our chance at reaching all of our communities. Community leaders were our greatest teachers, and our team is so committed to getting this right. Our motto is ‘Let’s have fun, and get it done.’”
 

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Two young women flex with their Band-aids after getting vaccinated at Portland City Blessing Church.
From left, Harina Aimaga and Desty Inas got the shot at the Portland City Blessing Church clinic in April. (OHSU/Erin Hoover Barnett)

Oscar Surjadi, pastor at the Portland City Blessing Church in Northeast Portland, was worried. His congregation was isolated and suffering. Yet it was spring and few had gotten the vaccine.

So when Pastor Thomas of Oasis of Praise approached him about doing a clinic, Surjadi was interested. He joined a call with the pastors, Spight and Evans. He shared with Spight his congregation’s concern about whether people who are undocumented could get vaccinated without fear.

Spight said yes.

“The moment Dr. Spight said that, I knew: This is my man,” said Surjadi, born in Indonesia and educated in Singapore and the U.S. before eventually settling with his family in Portland where he and his congregation bought and renovated their building at Northeast 78th Avenue and Glisan Street themselves.

Surjadi invited Spight to speak at Portland City Blessing Church on April 11.  

“He shared with beautiful language. He said, ‘Come. It is an opportunity,’” Surjadi said.

Surjadi paid attention to the reaction after the service. Congregants began to talk among each other.

“What I see is the trust of the people,” Surjadi said. “I believe that relationships and trust penetrate the wall of disbelief.”

Surjadi teamed up with Living God Church, Iglesia de Cristo Camino de Santidad and Oasis of Praise to offer the Northeast 78th Avenue church for the clinic. Church members showed up. And neighbors did too: the man next door who had never been into the church, the workers from the nearby car wash.

“A bridge formed,” Surjadi said. “They come in their car wash uniforms. They come for the vaccine. And it is melting my heart.”

Josh Chavarria of Iglesia de Cristo applauded Spight and team’s approach, setting up tables in the lobby where people could talk privately with health care workers, with the assistance of interpreters where needed, and get their questions answered before deciding to get vaccinated.

“A friend of mine was very concerned,” Chavarria said. “He did take the shot, but he had a lot of questions. He stayed behind in the lobby for five minutes to get questions answered.”

When the first- and second-dose clinics were over, they had crossed over. Nearly all members of all the congregations were now vaccinated.

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Community partners and OHSU’s Vaccine Equity Committee have held nearly 40 unique, culturally and linguistically specific clinics all over the metro area – at schools, places of worship, community centers, the Hillsboro Stadium and more.  Partners have included Centro Cultural, Mujeres, Asian Health & Service Center, North by Northeast Community Health Clinic, Salud, the OHSU Transgender Health Clinic, Prescott Elementary School and others.

Immigration Counseling Services brought their legal team to offer guidance; major grocery stores offered gift cards; and the Portland Trailblazers provided T-shirts and tickets to pre-season games.

Two OHSU staff members and two women who own an ice cream truck talk outside the truck, which is parked outside a church where a clinic was held.
Far left, Rosita Cortez talks with Leslie Garcia, OHSU Vaccine Equity Committee member, while Latisha Aguilar, an OHSU medical assistant, (second from left) talks with Felipa Begines. Cortez and Begines helped promote the OHSU-St. Peters Church vaccine clinic as church members left mass and stopped at their truck for ice cream. (OHSU/Erin Hoover Barnett)

“We wanted the clinics to feel safe, even celebratory, and to include supportive resources beyond just the vaccines,” said Leslie Garcia, M.P.A., assistant dean for diversity, equity and inclusion in the OHSU School of Medicine and a member of the OHSU Vaccine Equity Committee. “Taking a community-centered approach and engaging communities to incorporate their voices and needs was key.”

So far, more than 6,600 vaccines have been delivered at the OHSU community clinics, with 64% of the recipients identifying at least in part as Black, Latino, Asian, Pacific Islander and/or Native American. Outreach is now intensifying in Portland’s large Russian and Ukrainian communities, where the barriers are often overlooked.

Community leaders say this must be only the beginning.

“Based on relationships that we have now, we must learn to extend this,” Surjadi said.

Jackson put it another way:

“We said from the beginning: We are not interested in a helicopter experience where OHSU comes and drops in relief and then goes away,” he said. “There has to be a sustained effort to address the disparities we have; COVID-19 today but high blood pressure tomorrow. The impact of this virus on our community did not just happen. It is our hope that this partnership can be sustained in a really systemic way.”

Young woman who just got vaccinated shows the Bandaid on her upper arm in front of a multilingual sign congratulating patients.
Maribel Sanchez brought her elderly mother to the clinic at St. Peters Catholic Church in Southeast Portland, where her mother attends mass. Sanchez was grateful for a clinic where her mom, who speaks mostly Spanish and has mobility challenges, felt comfortable coming to get vaccinated. This is everybody coming together for everybody else, Sanchez said. (OHSU/Erin Hoover Barnett)

 

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