Barriers to booking shots
Families face hurdles in getting vaccines for immigrant parents
Edith Sorto is used to taking care of her parents’ medical needs.
The 40-year-old mother of three often takes time off from work to drive her parents to doctors’ appointments. Her father has poor eyesight, so if he does drive, it’s usually only around their southeast Houston neighborhood.
When COVID-19 vaccines were made available for anyone over the age of 65, Sorto quickly jumped into the technological, and often infuriating, process of finding an appointment for her parents.
“If it was up to them, they wouldn’t have gotten the vaccine,” Sorto said. “They don’t know technology; the phone numbers provided, no one answers, so they just give up. It’s time consuming.”
As vaccine supply increases, adult children of immigrants are desperately trying to book shots for their older relatives, manag
ing technological hurdles and language barriers, in their battle against a pandemic that has hit immigrant communities particularly hard.
After many tries, Sorto, who emigrated from El Salvador with her family, was able to find appointments through the medical clinic Centro de Corazón.
Their appointment was scheduled at the Capitol Street location — 13 miles away from the Scarsdale Family Health Center, a partner of Centro de Corazón, which her parents typically visit. Again, Sorto had to take time off from work, pick them up and drive them to their appointment. Thankfully, Centro de Corazón had Spanish speakers on site to explain the vaccine’s ingredients and side effects to her parents, who are in their late 60s.
“It’s a lot of jumping through hurdles,” Sorto said. “A lot of people who haven’t been able to get the vaccines do finally get an appointment, but once they do, they don’t know how to get there. Once they do get there, they don’t know where to go. They don’t know the process.”
Help needed
About 39 percent of adults who have been vaccinated were aided by another person when booking the appointment, according to a Kaiser Family Foundation study. And it’s likely the rate is higher among immigrant families; children of immigrants feel a sense of unity and responsibility driving them to find the vaccine, said Dr. Melba Vasquez, an Austin psychologist who studies immigrant trauma.
“Most families of color have close connections,” Vasquez said. “They care, so they want the best for their families. Those families that believe vaccines save lives will be motivated to get services for their elders.”
Erika Garfias, an elementary school teacher, called her parents for pictures of insurance and ID cards as soon as she found appointments at an urgent care clinic in Missouri City.
Her parents, Juan and Maria Gomez, and grandmother, Julieta Gomez, emigrated from Mexico in the 1960s. Her parents’ technological skills aren’t good enough to catch a vaccine appointment. It’d be faster, Garfias rationalized, to do it for them.
She registered her parents for a vaccine the weekend before last month’s deep freeze. Take a jacket, Garfias advised her mom over the phone, in case they had to wait outside the clinic.
When she called to check in after the appointment, she learned her grandmother decided against a vaccine at the last minute.
“What do you mean?” Garfias asked. “This isn’t an option.”
Her grandmother was scared about potential side effects, her parents replied. But Garfias, whose visits mostly consist of conversations through a window, fretted about never seeing her inperson again.
A week later, her grandmother changed her mind.
“She was very sad people weren’t coming to see her,” Garfias said. “(My aunts and uncles) had to explain to her it’s not that they don’t want to, it’s that they can’t. So I think she weighed her options and decided it was better to have the vaccine so we can come around and not be afraid to get her sick.”
Burdens on communities
ZIP codes with primarily Hispanic and poorer populations tend to have a lower vaccination rate per capita than their whiter, wealthier counterparts, according to a Houston Chronicle analysis of state data. Issues of access, coupled with concerns about data collection and eligibility, create multilayered barriers.
Dr. Gary Sheppard, president of the Harris County Medical Society, serves patients in southwest Houston, a dense and diverse area where English is not the primary language. During the pandemic, he has noticed fear, disbelief and distrust in his longtime patients. He worries they don’t know if they qualify or where to go.
“We base so many things on signing up with websites and being communicated with electronic devices,” he said. “Older patients have problems getting help from children and grandchildren.”
About 21 percent of immigrants who speak a language other than English have no computer experience, according to the Program for the International Assessment of Adult Competencies, which surveys adults’ skills.
The pandemic put a magnifying glass on responsibilities felt by first generation Americans, said Dr. Amelia Averyt, an associate medical director for family practice at Legacy Community Health. Ordinarily, she can go over risks with them to make decisions for their parents. But COVID restrictions limit how many people are allowed in exam rooms, separating older patients from younger relatives who usually help them, she said.
“Not being able to have those discussions with families in the room has been an obstacle,” Averyt said. “You’ll talk about the vaccine with older patients, and they say, ‘Sure, I’ll get the vaccine, but how do I do it?’ ”
Sorto is one of five children, and the only daughter. In her family, it’s her responsibility to help her parents pay their bills, fill their medications and keep their medical files handy. If they have an appointment, she goes with them.
“I cannot choose — I have to go,” Sorto said. “It’s just on the women mainly. My brothers will help if I ask them, or their wives will go with them. But I know their medical history, and that’s something my brothers don’t really know.”
At Legacy Community Health, Averyt’s older patients often bring a younger family member with them. Averyt speaks both English and Spanish but has noticed her patients need additional reassurance from loved ones.
“No matter what I say to them about this vaccine being great, (my non-English-speaking patients) worry about how fast it was developed,” Averyt said. “Until they hear it from someone they love, their decision around the vaccine won’t change.”
Being in the community
Community health organizations need to remove as many barriers as possible, families said. When Rosana Lin Keleher, who grew up in Houston and now lives in Maryland, tried to book an appointment for her mother, Josephine Lin, it took several calls and texts to track down an inoculation site where someone spoke Mandarin Chinese.
What should have taken just a few minutes over the phone stretched into days. Lin’s family physician at Memorial Hermann called two days after they began the search, offering a first dose the first week of January.
Lin Keleher said the experience showed her how difficult it can be to find a vaccine for seniors and immigrants who don’t have a support system like her mom does.
“Having to get on the computer and even calling is beyond her,” Lin Keleher said. “We don’t have anything translated. What are they supposed to do, press ‘one’ and wait forever? It’s worrisome.”
Community organizations such as HOPE Clinic and the Association for the Advancement of Mexican Americans believe establishing vaccine sites in immigrant communities will help with equitable distribution.
In recent weeks, HOPE Clinic, a nonprofit that works with patients who speak more than 30 languages, has quietly run weekend vaccination sites geared toward Houston’s Asian American communities. Some weeks, they receive 500 doses; other weeks, they find 100 on their doorstep. Because the safety-net medical provider’s vaccine supply varies week to week, its staff opted to call patients and book appointments rather than advertise on social media, said Dr. Andrea Caracostis, the clinic’s CEO.
Many immigrants are essential workers who are motivated to work hard and establish financial stability in their chosen country. Further, some immigrants, particularly those who are undocumented, are hesitant about data collection and eligibility. COVID-19 vaccine providers say they need to build trust with those communities to hit herd immunity. In the last few months, AAMA, which serves people from 32 Latin American countries in expanding voter engagement, food insecurity, health care and employment, has worked to connect Latino communities with vaccines.
“With our population, they don’t have the time or the ability that a lot of professional people have to get on these lists, watching and waiting and responding as soon as they have a link with an opening,” said Debbie Ortiz, AAMA’s chief development officer. “Our people are out working and getting a living, and they’re the ones who need it the most.”
Fixing the problem
Vaccine providers are optimistic they’ll reach more of Houston’s immigrant communities moving forward. Expanding eligibility and culturally sensitive advertisements on social media will help, said Carol Paret, chief community health officer at Memorial Hermann.
“The more open it can be, the easier it’ll be to get 75-year-old grandma there now that her 50year-old daughter can get it,” Paret said. “Hopefully we can get households pretty quickly this way.”
It worked for Garfias’ family. When she signed up for her vaccine, she also booked appointments for her husband, parents and grandmother and sent the link to her sister-in-law.
After receiving their second shots the first weekend of March, Garfias feels a mix of relief and stress: Relief they are now fully protected against COVID-19, yet stressed she and her older brother must make hard decisions to protect the health of the people who raised them.
“It’s a weird shift,” Garfias said. “They’re looking at us for advice because they feel we are more knowledgeable on these things. I don’t know if I’m ready, but here we go.”