Stories: Voices from the frontline

Nwando Anyaoku, M.D., MPH, MBA

Nwando Anyaoku, M.D., MPH, MBA

CONNECTING COMMUNITIES TO THE VACCINE

The COVID-19 pandemic disproportionately struck communities of color. Yet those same communities struggle to access vaccine. We recognized that disparity, and moved quickly to address it. Thanks to the philanthropic support of our community, on Jan. 26 we were able to launch the first phase of our Mobile Health Equity Clinic to bring vaccines directly to those populations. In that phase we administered vaccines to 1,825 eligible people in nine locations with the help of community-based organizations. And this week, we began phase two of the outreach, with plans to vaccinate as many as 2,400 people at another eight locations.

We spoke to Nwando Anyaoku, M.D., MPH, MBA, our new chief health equity officer, who led the effort, to learn how it came together and how it fits into our goal of reducing disparities in healthcare so that all patients receive the care they need, when they need it.

Where did the idea for the mobile vaccine units come from?

Early on, when we got our vaccine supply, we made a commitment to use a portion of our allocation to support the community. As we got past Phase 1A and started to review who we were serving, it became apparent that we needed to have a particular strategy to reach minorities and marginalized populations, because the systems that were in place would not necessarily serve them well.

We started thinking about how best to do that and quickly arrived at building a fully mobile option that we would take the vaccine from place to place.

How did we decide which communities to visit?

We wanted to make sure that our efforts were directed by data. So we identified zip codes and populations that were particularly affected by COVID-19 and had difficulty accessing the vaccine. From there we decided that the best way to distribute the vaccine would be by partnering with community-based organizations. When you want to serve people, you have to figure out where they live, where they go, who they trust.

The definition of community-based organization is very vast. Some of them are churches, some are nursing homes, some are federal qualified health centers, some are just groups that get together around some common bond or affinity. We knew that working with them would give us two things: a trusted partner that the people in those communities already knew, and access to those particular communities in a way that would be more efficient and targeted than if we were to do a blanket outreach.

There’s a well-founded distrust of healthcare among communities of color and marginalized populations. How did we overcome that?

We went into this with the assumption that we were going to have to do a lot of work to convince people to get vaccinated. But it turned out that that wasn’t the case. There were so many groups interested in working with us that one of our biggest tasks was deciding who to work with.

We still put a lot of thought into how to begin these conversations and gain community members’ trust, though. For instance, our first location was at the Ethiopian Community Center in South Seattle. The week before our clinic, the community center held a webinar for their constituents and answered lots of questions—and they got tons of people to sign up. As it turns out, there was hesitancy, but there were also a lot of people who just needed information—which was understandable, considering the newness of the vaccine. People wanted to know if they could take it, given their own particular diagnosis or medications. So having those information sessions and being able to address people's concerns was extremely helpful.

We also asked each community-based organization to provide us five to eight volunteers to be part of the workforce on the day of the clinic. And those people would help with wayfinding, translation, mobility assistance and generally supporting their people.

Philanthropy was integral to this project. Can you describe a couple examples?

We were very lucky at the time to have generous donors—particularly CellNetix—who wanted to support Swedish in any work that we were doing to foster health equity. We thought that this would be a great use of that support, and we used that funding to allow us to rent tents and to actually fund this program.

And then we had community partners like T-Mobile, which offered us our own mobile hotspot so that we had regular, stable Wi-Fi at each location. And Denali donated trucks and personnel to help us with setup and take down. Having these gifts in hand allowed us to package this fully mobile solution so we had our tent, tables, chairs—everything—that we could load up in a truck, go to a given location and set it up.

You were recently named Swedish’s first chief health equity officer. How does this project fit into our larger health equity efforts?

It fits right in the middle. The work of health equity is to reduce disparities in care. People are marginalized for all sorts of reasons, from race to ethnicity to sexual orientation and gender identity.

In order for you to achieve equitable care, you need to be looking at how you're delivering care to all those different groups. The big challenge is that a lot of people think that the difference is due to a biological construct. But race or ethnicity most often are really a proxy for several social determinants of health that affect the ability to effectively deliver or receive healthcare.

In the case of this vaccine outreach, for instance, people aren’t having trouble accessing the vaccine because they’re elderly, African-American or allergic to the vaccine. It's because they can't readily navigate the mostly tech-based scheduling process, due to a well-documented digital divide. Nor can they easily get into a car and get to a mass vaccination site, due to mobility issues. Elderly BIPOC populations are disproportionately poor or lower income. They have tech challenges. They can't afford to take a day off, or their children can't afford to take a day off from work to take them.

Ultimately, we need to sustain these channels over time as we work on reducing health disparities in other areas beyond COVID. We are hyper-focused on managing the relationships and the experience of these community based-partners, building and maintaining trust with the recognition that the relationships will be crucial to allow us to come back and talk to them about high blood pressure and diabetes or any other health challenges faced by their communities.

Where do we go from here to improve health equity?

When you walk the length and breadth of Swedish, I promise you will never find a more dedicated and committed group of caregivers. They are extremely passionate about what they do and how they care for their patients. And they’re committed to giving their very best to everyone equally. But the truth is, not all patients need to be treated the same.

You always have to be asking, "Who am I serving? Am I reaching the people that I need to reach? Am I getting everyone served in the way that they need to be served?" My goal is to have health equity be the way we do business.

Our Mobile Health Equity Clinic is only possible with the support of donors like you. For more information about how you can ensure more members of underserved communities can access the COVID-19 vaccine, please contact Adria Alhadeff at 206-215-3256 or [email protected].