Patients participate in a culturally inclusive prenatal care model that integrates prenatal visits with mindfulness therapies and more.
From balconies in New York City to the National Assembly in Kenya; across Spain, Italy, Turkey, Singapore, India, and many other nations around the world—some of the most inspiring images from the pandemic have shown leaders, celebrities, and everyday people clapping, ringing cowbells, and banging on pots to recognize and give gratitude to the health workers on the front lines of the COVID-19 response.
From Philanthropy to the Front Lines
Corporate philanthropies must double their commitments to address social and health inequities in the face of COVID-19 and other crises. This collection of articles discusses how to reach and partner with underserved communities to provide the care they need. Sponsored by the Medtronic Foundation.
This global acknowledgment was heartening to see, considering that frontline health workers too often go unrecognized. Yet, they are playing a critical role in caring for those communities most effected by the pandemic, while at the same time risking their own lives. Especially in underserved communities, frontline workers like community health workers (CHWs) are helping vulnerable patients to reduce their risks by understanding symptoms and seeking testing and treatment early.
In the United States, the need for such support is greater for people who live in communities of color, which have been disproportionately exposed to the virus and are more likely than people in white communities to not receive care they need or to experience severe disease or death. According to the Centers for Disease Control and Prevention (CDC), Black Americans are 2.1 times more likely to die of COVID-19 and 4.7 times more likely to be hospitalized than white people. Hispanic Americans have a 4.6 times greater risk of hospitalization and 1.1 times greater risk of death than white people as well.
When the coronavirus hit the United States in early 2020, health officials in Minneapolis, Minnesota—including the clinical staff at the People’s Center, a Federally Qualified Health Center (FQHC)—had concerns about the potential for the virus to spread in the city’s Cedar-Riverside neighborhood. This area is home to the largest Somali population in the world outside of East Africa, and it includes many refugees who live in public housing. In fact, one high-rise building in the neighborhood has more than 4,000 residents, making social distancing a challenge and placing residents at higher risk of exposure.
But even with higher risk of contracting COVID-19 in their densely populated neighborhood, People’s Center staff discovered many residents didn’t want to get tested. Based on their experiences with health care in Somalia, staff found some local residents weren’t used to seeing a doctor for preventive care. In Somalia, they would only see a doctor on rare occasions, and only when they could afford it. Instead, people typically would rely on their community’s support and home remedies. Some feared they couldn’t afford to see a doctor or, if they did test positive, they would be taken to the hospital against their wishes and separated from family. Others were afraid to see a doctor due to fear of being mistreated.
Social and cultural barriers like these aren’t unique to Minneapolis and its Somali American residents. Across the world, some of the most important factors contributing to poor health are rooted in social determinants of health, including the cost and affordability of care, language barriers, lack of experience with health systems, transportation needs, childcare, safety, and other social issues. Traditional health systems are often ill-equipped to address these barriers. So, now more than ever, CHWs are playing a significant role in bridging these gaps and helping underserved people access the healthcare they need.
Surmounting Barriers to Better Health
For Minneapolis’ Somali American community, mental health needs have created a significant barrier to better overall health. Many patients carry scars from their experiences in Somalia that have only been exacerbated since the pandemic and its economic effects began. The country was formed in 1960 from former British and Italian colonies, but it collapsed into civil war in 1991 when the military regime of then-President Jaalle Mohamed Siad Barre was overthrown.
In Somalia, mental health isn’t a widely recognized health condition, even though it affects a significant portion of the population. The World Health Organization estimates that one in three Somalis is affected by some type of mental illness. That compares to one in five US adults who live with a mental illness, according to the National Institutes of Health. And a study of adolescent Somali refugees resettled in the United States found a history of trauma and acculturation challenges directly diminishes well-being. At the People’s Center, many of the patients treated have never heard of post-traumatic stress disorder (PTSD), and far fewer know it can be treated. Left untreated, mental health conditions like PTSD can affect other areas of a patient’s health. The patient may forget to take their medication regularly, visit their clinic for a checkup, or steadily manage chronic conditions.
When patients arrive at People’s Center with mental health concerns, it’s the staff’s goal to meet these needs alongside the patient’s other health needs. For example, an elderly patient visits the clinic on a weekly basis just to have a chance to socialize. The clinical staff checks her blood pressure and asks her if she’s keeping up with her medication, but rarely is there a medical issue. After chatting for an hour or two with the staff, she’ll say goodbye, and the staff knows they’ll see her again in a few days. Even during the pandemic, CHWs continue to visit with her, using masks and appropriate precautions. Like a lack of exercise or unhealthy eating habits, loneliness caused by social isolation is considered to be a significant health risk.
Similarly, another People’s Center patient is working to lower his high blood pressure and manage his glucose levels to avoid diabetes, but high rent and financial challenges have led to anxiety and depression. The CHWs learned he wasn’t able to afford his rent, which increased his risk for serious health issues. When our CHW identified these health challenges, the People’s Center was able to connect him with a local case manager, who helped him find a more affordable apartment and access rent support programs that could help him bridge his financial gaps without fear of being evicted. With rent and financial support, he was able to focus on his health again. He started on a path to better health by resuming his diabetes and blood pressure medications and better managing his anxiety and depression.
In partnership with the Medtronic Foundation, the People’s Center is extending its reach into the community with a new program “Project CARE” (Community Action to Reach Empowerment) that aims to help more people manage diabetes and improve their cardiovascular health. Additional CHWs make regular home visits to build trusting relationships with their patients so we can identify concerns early and maintain a focus on better health. CHWs also bring tools and support directly to patients, with in-home blood pressure and blood sugar checks, wellness classes in the community, regular exercise sessions, and healthy cooking demonstrations.
The People’s Center is also working to reduce the incidence of COVID-19 in the local community by contacting more people in South Minneapolis and encouraging them to feel comfortable seeking COVID-19 testing. The center is bringing testing closer to where they live to reduce potential access barriers by establishing mobile testing units in public housing buildings within South Minneapolis. The project was coordinated with support from several Medtronic employee volunteers who have expertise in managing complex projects, such as bringing new medical devices from research and development to market. Anyone in the neighborhood can access testing just steps from their homes at mobile People’s Center testing sites. People’s Center staff also provide education and tips on social distancing, wearing masks, and isolating for those who have symptoms so they can avoid spreading the virus. The goal is to build greater trust within the community, so People’s Center staff can identify and end outbreaks quickly before they take hold in the neighborhood.
Building Capacity Through Trust
Successful CHW-led programs often rely on building trust and having a deep understanding of the local community’s needs, culture, and history. When the COVID-19 pandemic required the People’s Center to move many medical visits online to slow the spread of infections, our CHWs discovered that patients didn’t trust virtual care or consider it a “real” doctor’s visit. Many thought they had to see the doctor in person, and they would often arrive at the clinic at the time they were supposed to sign on to the virtual-care platform. Some thought online care would be substandard if they didn’t sit face-to-face with their doctor and leave the clinic with a prescription after the visit. The People’s Center CHWs guided patients through the process, from making a virtual appointment to accessing the technology on their personal devices to meeting with their doctor and determining a treatment plan. They also ensured patients had the right technology and were comfortable using it on a regular basis for their health-care needs. Ultimately, with help from CHWs and more experience with telehealth, patients understood that meeting with a doctor online could help them address their health needs without risking exposure to COVID-19 during an in-person visit.
CHWs who are also members of the local community can bring a deep understanding of issues like these and quickly build trust with patients. They can help learn about health-care options and treatments that they might not have heard of or could even fear. For patients who are immigrants, CHWs can help translate differences in health systems, such as how to navigate them, how to make appointments, and what to expect during a visit. And when a patient’s symptoms or concerns are difficult to diagnose, CHWs are trained to ask more questions, probing further to understand the root of a problem and identify the right support services—at the clinic or in the community—to address challenges and concerns. They are a tremendous asset to confronting and addressing racial disparities in COVID-19 infection and recovery.
Serving Those Who Serve Us
In communities large and small, some of the same people who have experienced higher infection rates are often frontline workers—those our communities rely on to serve us in grocery stores, restaurants, packing plants, farms, childcare, home care, or other critical operations that have remained open throughout the pandemic. These are the people who have taken significant risks to keep essential parts of our economies open.
CHWs are often shoulder-to-shoulder with these other frontline workers, yet they may be underappreciated and undervalued as they help their communities manage risks and reduce the spread of the virus. While the global and national debate about health workers accelerates, rarely are CHWs explicitly referenced. They should be. As much as ever, they deserve our support as we work to overcome this global pandemic.
Support SSIR’s coverage of cross-sector solutions to global challenges.
Help us further the reach of innovative ideas. Donate today.
Read more stories by Ahmed Sougueh & Jokho Farah.