San Antonio Express-News (Sunday)
AT-RISK OUTREACH
Underserved groups are the most impacted by COVID but remain reluctant to take the vaccine
For the past two weeks, San Antonio residents have scrambled for a chance to get one of the nation’s approved COVID-19 vaccines, made by Moderna or Pfizer-BioNTech. Thousands of appointments were filled within minutes.
But public health workers say they fear that those who aren’t clamoring for the shot may need it the most.
Health care providers already tasked with the difficult job of administering a limited number of vaccines also need to appeal to residents living in underserved parts of the city, especially those most at risk of infection and severe illness.
COVID-19 is disproportionately killing Blacks, Latinos and Native Americans in the United States. Research shows that people in these racial and ethnic groups are four times more likely to be hospitalized than those who are white.
“There’s a lot of people that are scared. They don’t want to be used as guinea pigs,” said Ludivina Hernandez, 63, who lives and works on the city’s West Side as a “promotora” — a Spanish word for someone who advocates and educates within the Hispanic community.
Still, she says, some are buying products in Mexico that falsely promise to ward off the coronavirus.
Many others rely too much on Facebook posts. One widely shared post said gargling with warm salt water kills the virus. The U.S. Centers for Disease Control and Prevention says there’s no evidence this works.
“What I want to do is bring them information from the right sources and then let them decide,” said Hernandez, adding that a big part of her job is establishing trust. “All I have is my word.”
She has served as a bridge to the health care system for more than 30 years.
Her title is community outreach coordinator, and she works for UT Health San Antonio’s Research to Advance Community Health, or ReACH, Center and the South Central Area Health Education Center, where she’s involved in grantfunded health campaigns.
Recently, she recruited men for an educational program called Diabetes Garage. The idea is that they should manage their health just like they do regular maintenance of their cars.
She also oversees a team of community health workers in the Rio Grande Valley connecting patients to free treatment for Hepatitis C, a virus that attacks a person’s liver but that can be cured with medication.
Government-mandated quarantines to control the spread of coronavirus have made it harder to see people in person, forcing Hernandez to get creative. Some of her usual meetings are going virtual.
Hernandez enlisted her grandson’s Christian rock band, InDisguise,
to create a song for a local campaign called “Cover 4 Covid.”
The music video, which has been distributed on social media as a public service announcement, urges people to “think of all the lives you’ll save” by always wearing a mask, washing your hands and staying 6 feet apart from others.
She’s working with the Archdiocese of San Antonio to bring a campaign called United Against COVID-19 to Catholic churches, including San Martin de Porres near the San Fernando Cemetery. The campaign is intended to support informed decision-making by first trying to understand community perspectives on the crisis.
During a meeting about that, Hernandez got a call from a community health worker asking if she’d be willing to make calls to people who’d had trouble registering for appointments at a city-operated vaccination hub at the Alamodome. They ended up scheduling 60 appointments.
Sharing own experience
She’s prepared to share her own experience about taking the first dose of the vaccine and how she was able to sign up her husband, too. He is head custodian for Harlandale ISD. Her second shot is scheduled for Wednesday.
A San Antonio Metropolitan Health District spokeswoman, Michelle Vigil, said the city/county health department employs more than 20 community health workers who plan to concentrate their pro-vaccine efforts in ZIP codes deemed most vulnerable.
They will distribute information, leave materials at homes and keep clients currently enrolled in health care programs updated about the vaccination process, she said.
But there is no task force or
comprehensive outreach plan to ensure disenfranchised residents are reached.
Amelie Ramirez, director and founder of the Institute for Health Promotion Research at UT Health San Antonio, said public health messages will need to be consistent to counter misconceptions about the vaccine’s safety.
She stressed that the science behind the vaccine can be trusted and she plans to get the vaccine herself soon.
“I feel that the messenger really needs to be the individual who lives, works and worships in the community with them,” she said. Not necessarily local celebrities, but pastors and respected city leaders.
Ramirez investigates the causes of health disparities among Latinos in South Texas, and her work with Salud America! drives national health policy to help level the playing field.
Latinos are more likely to live paycheck to paycheck and to live in areas that lack access to health care facilities and healthy food options. That means underlying health conditions such as diabetes, obesity and chronic heart problems are more prevalent in these communities, studies show. Many also lack health insurance.
In a city such as San Antonio, where the majority of residents are Latino or Hispanic, this poses a problem.
Many have jobs that require them to work on the front lines in restaurants and grocery stores and hotels. These essential jobs put them at higher risk of contracting the virus.
The novel coronavirus first emerged in the United States a year ago and has since killed 384,277 people.
As of Wednesday, Metro Health reported that 1,685 people in Bexar
County had died from COVID-19; 65 percent were Hispanic.
There are other barriers that could lead to vaccine hesitancy, said Luz M. Garcini, assistant professor at UT Health San Antonio’s Joe R. and Teresa Lozano Long School of Medicine.
Garcini’s research focuses on trauma, loss and grief among Latino immigrants, particularly the complex health needs of undocumented Mexican immigrants and deportees.
Many immigrants are concerned about how their personal information will be used if they sign up for the vaccine. They fear it could adversely affect their efforts to become citizens. She said partnering with established community agencies could help assure them that their personal information will be protected.
“A lot of the Latino community have been victims of financial scams,” she said. “They are terrified that they will go in for a service said to be no cost and somehow be stuck with a large bill they cannot afford.”
In her research, she’s seen how often they end up signing contracts for home mortgages and car loans that are good at the beginning, but backfire over the longterm.
‘They never come back’
Hernandez, the promotora, said she’s seen a reluctance among people on the West Side to trust people they don’t know. Sometimes, she said, health research needed to attract more funding for social services can feel disingenuous to the people under study.
Researchers often submit the data found in the community to medical journals for publication and then walk away when the grant funding runs out.
“They never come back and report to them,” she said.
She remembers working as a patient navigator at a local hospital. She had been hired to recruit patients who qualified for free medical treatment. She was told to follow a script and if they didn’t answer after three tries, she needed to move on.
But after a while she learned that many of these patients needed more immediate help before they could even think about treating a chronic condition. She hooked them up with the food bank and enrolled them in other assistance programs — in turn saving the hospital money.
Hernandez said some of the investigators didn’t understand why people would turn down free medical care, but often these patients did not have bus fare to get to the free care or could not afford to take a day off work.
Precinct 2 County Commissioner Justin Rodriguez, who represents the West and far West Sides of Bexar County, hopes that vaccine providers can mitigate some of these barriers.
In a Jan. 6 letter to University Health CEO George Hernandez, Rodriguez reminded him of COVID’s disproportionate impact on Hispanic communities and asked for an equitable distribution of the vaccine — one that supplied community clinics and pharmacies rather than just mass vaccination sites.
“We must ensure we do not deepen this disparity, exacerbate existing obstacles, or create new barriers for the marginalized in our community,” he said, calling on the county health system to help ensure all communities have easy access to the vaccine.
Last week, San Antonio City Council members partnered with health care provider WellMed to open mass vaccination sites on the West Side and South Side.
The plan is to administer 1,500 free COVID-19 shots per day, six days a week, at the Elvira Cisneros Senior Community Activity Center at 517 S.W. Military Drive and the Alicia Trevino Lopez Senior OneStop Center at 8353 Culebra Road.
Signing up for the vaccine doesn’t require internet access; in fact, the only way to schedule an appointment is to call 311 or 833968-1745.
All appointments have been booked. When more vaccine doses are received, the phone lines will open again.
Councilwomen Rebecca Viagran of District 3, Adriana Rocha Garcia of District 4, Ana Sandoval of District 7 and Shirley Gonzalez of District 5 said they wanted to ensure that a lack of internet access would not be a barrier.
Rocha Garcia said many people in her district don’t own computers or tablets; hence the reliance on the phone to make vaccination appointments.
“The South Side will not be left behind,” she said.