Many of the nation’s essential workers – who didn’t have the option of working from home during the pandemic — rely on Community Health Centers for health care. Virginia Garcia Memorial Health Center in Oregon is the medical home for these workers, with a long history of serving agricultural workers and their families. By design, federal rules require health centers to be located in lower-income rural and urban areas and offer care to everyone, regardless of ability to pay or citizenship status. Protecting migrant workers from COVID through vaccination is the job of health centers, like Virginia Garcia.
As one of the first health centers in the state to receive vaccines directly from the federal government, Virginia Garcia took vaccines to the migrant worker camps and partnered with community groups to vaccinate other marginalized populations, including their largely Latinx patient community. To overcome barriers their patients faced to getting vaccinated, the health center experimented with running late night and weekend clinics and partnering with other community-based groups.
In the third episode of the NACHC podcast, Health Centers on the Front Lines, we talk with Virginia Garcia’s Laura Byerly, MD, Medical Director, and Kasi Woidyla, Public Relations Officer, about what’s working and what challenges remain in their effort to close the vaccination gap between the Latinx and Hispanic community and the rest of the population.
NACHC: The people who toil long hours harvesting and processing the nation’s food already live on the margins. The pandemic has increased the danger these workers face, putting them at greater risk of Covid-19 infection. In many parts of the country, it is community health centers that serve as the medical home for these workers. By design, health centers offer care to everyone, regardless of ability to pay or citizenship status. Protecting migrant workers from Covid through vaccination is the job of these health centers.
Today, we’re talking to the Virginia Garcia Memorial Health Center in Oregon, which has a long history of serving migrant workers and their families. As the threat of the more contagious Delta variant grows, how is Virginia Garcia doing in its effort to ensure the largely Latinx and Hispanic migrant worker community has equal access to Covid vaccines? I’m Alexandra Walker with the National Association of Community Health Centers and today we’ll answer this question and more in this episode of Health Centers on the Frontlines Fighting Covid.
Today I’m joined by Dr. Laura Byerly, medical director, and Kasi Woidyla Public Relations Officer for Virginia Garcia Memorial Center. Thanks for your time today. We know you’ve got a lot going on. We really appreciate it. I want to just start with hearing a little bit about the community that Virginia Garcia serves and a little bit about the history of the health center, specifically why you have the name that you do. Dr. Byerly, if you’d like to start?
Kasi Woidyla: Yes, this is definitely my part, I love telling this story. So, for those who may not be familiar with the organization, Virginia Garcia Memorial Health Center was founded 46 years ago. We actually just passed our 46th birthdays on the 6th of this month; in response to the death of a six-year-old girl of migrant farm workers who were making their way up from Mission, Texas, following the harvest. And while traveling, her farm worker parents and Virginia cut her foot and by the time they reached Oregon, it had become infected and due to economic language, cultural barriers and health care Virginia Garcia died from what should have been an easily treatable wound.
Moved to action by Virginia’s unnecessary death, there was a community of individuals who rallied quickly to open the first Virginia Garcia Memorial Health Center just three weeks after she died. The clinic was located in the three-car garage in Cornelius, Oregon. Flash forward, 46 years; we now have 17 clinics in two counties, we serve 52,000 individuals every year. They are highly diverse, speaking more than 60 different languages, and 62% of our patients are Latin X, 48% are under the age of 18. 98% of them fall below the poverty line, 14% are migrant and seasonal farm workers, and our patients come from all different areas of the world and of the state where we’re really proud of how resilient they are and how dedicated they are and how amazing they are to be healthy and to partner with us in their health care.
NACHC: Thank you. We know that over the past year, during the pandemic, Oregon had some hot spots, multiple Coronavirus infection clusters in the state were linked to agricultural and food processing work sites. Did this affect your patient population? And more broadly, I guess for Dr. Byerly, how has Covid affected your communities in the past year?
Laura Byerly: Yes, so those outbreaks that happened early on really raised our alarms because they were in similar populations but in different parts of the state. We didn’t have such huge outbreaks that we happened to serve, but we’ve had this steady higher level of positive tests than the rest of the state did. So, when we were hearing about those outbreaks, we did some work with the CDC and the public health to go to some of our farm worker migrant farm worker camps and provide testing;
And see what we could find that we never we never had the same positivity rate in their migrant farm worker camps. So that was good. But in our more settled Hispanic population, our rate has been three to five times the state average of positive tests all along. And early on, I said we can’t use the same criteria that the state is. I feel kind of bad about this, like don’t tend to be a rule breaker, but the state we were trying to use, you have symptoms or you have an exposure. We will do a test. But we said no, you want to test you’re one of our patients and you want to test we’re going to give you a test. And we still get three to five times a positive rate as people who had symptoms and exposure. So, I think that allowed people to know and take the precautionary measures more than they would have otherwise. But our community was just really hit by this ranges. Just that many people do work to work in places where they can’t be separated and they had to work or they could not work. So, their exposure just was more likely to happen and did. I think fortunately, we didn’t have a lot of loss of life, but just a lot of loss of income and health rather than a permanent loss of life.
NACHC: Well, you’ve just touched on this topic, but it’s been pointed out widely that the pandemic has laid bare the rampant inequality in the country experienced by marginalized communities. How have factors like unequal access to health care, well-paying and safe jobs, housing, affordable housing and food affected the patient population of Virginia Garcia?
Laura Byerly: It’s one of these questions like this should be obvious to everyone, but I think one like a telling place where this really plays out is in our vaccination campaign. So, one big reason that is kind of easily solvable, if it’s not an ideological or a belief that I don’t know, how come you believe that about vaccines? Like where did that come from? But just the fact that if I get a really sore arm or have more severe in the normal side effects and I can’t go to work, I can’t afford that. So, there’s a significant chunk of people who are choosing to not get vaccinated because they cannot afford an unpaid day that they would have worked. So that is one place where that just having a job that doesn’t give you sick leave is keeping people at risk, and that we really designed our farm worker jobs. There’s a systematic, institutionalized approach to not have benefits in farm work or jobs. And I don’t want farmers to go out of business, but everybody has to eat. So, we should realize our systems are messed up if they are depending on keeping workers in a state where they can’t take a day off or a vaccine for a pandemic. So, that’s one.
Kasi Woidyla: Exactly. And I’d like to add to that none of the government programs that were rolled out during covid-19 included most of our farm workers and most of our patient base. So, the things that were designed to help relieve the effects of having to take off time to be sick or the extra financial burdens that were put upon our farm workers they weren’t allowed to take part in. So, the protections that our government put in place didn’t include a lot of our patients.
Laura Byerly: And then, like the historic distrust in health care, that one is hard for me to see because I’m in the middle of a trusted health care provider, so I don’t see that generally because people who are already coming to see us are those are mainly the people I’m talking to. But as I was helping run one of our vaccine’s afternoons in our McMinnville site;
Some folks who were patients but were supporting a patient, they were going to bring in a man or meeting them or I ran into like, are you crazy? I’m not going to do that. That’s like a government conspiracy. So, I don’t know where that is out there. And it’s in our English-speaking population and it’s in our Spanish-speaking population. And it’s fluky. So, we have two of our migrant farm worker camps, one where we showed up to provide vaccines to those who wanted them. And people kind of went inside and lock their doors on their cabins. And then another 40 people got vaccinated and people weren’t hiding. So, it’s like whoever there’s an influencer in the groups and that we have to figure out how we help.
NACHC: What strategies are you using to overcome that reluctance or uncertainty or simply just lack of knowledge and access to information about the vaccines?
Kasi Woidyla: Well, we started a while ago with ask the expert sessions on radio both on Zoom and on the phone so people could call in. And we had provided early on for the English-speaking version. We had another provider on for the Spanish version and we really just gave the community an opportunity to get on the phone with a provider and ask questions and get answers straight from what they considered a trusted source. So, our relationship with the community and the trust that we have worked so hard to develop over 46 years has played a key role in our ability to be able to reach out to these communities and talk to them about not only covid-19 and how to stay safe, but also the past six months and the vaccine and why they should get it. We’ve used a lot of radio and public service announcements, Spanish radio. We’ve used a lot of Spanish television, social media and dispelling rumors and misinformation that are spread on Facebook and Instagram with the younger generation. We understand that the younger generation influences the older generation in a lot of ways. And so, we are working to provide relevant and factual information at our school base levels, as well as through traditional radio and TV.
Laura Byerly: One thing that I think will help is that when the state relaxed, you must never open a vial of vaccine unless you can use every last dose. That really inhibited our ability to merge the vaccine into our clinic visits because we couldn’t know that we would have 10 more people that day who wanted that vaccine, but that we’ve been able to relax a little bit on that. And so now we can have the conversation with the known primary care provider. And that will be another way to get people who are teetering to fall on the side of going in and getting the vaccine. It’s a tricky thing. They’re all under an emergency use authorization. So that in and of itself is a message to some people that I’m just going to wait until it’s properly authorized by the FDA. And it’s hard to say, okay, but now we have millions and millions of people who have had it, which is many more than usual in a before that authorization happens. So hopefully there’ll be another chunk. There was people were frantic for getting the vaccine early on and we adapted our service to be available to do that for those people initially. And it’s really tapered down and we’re getting little groups. So now we have to change our expectations to a slower dribble. But we’re just going to keep pushing on that. Our population is still at high risk of having a severe infection, so we don’t want to stop.
NACHC: Well, speaking of early on, Virginia Garcia is one of the few health centers in March in Oregon tapped by the Biden administration to receive direct shipments of the Covid vaccines. What difference did that make to your ability to protect your patients in your community with the vaccine?
Laura Byerly: We could meet that friend and meet the people who frantically wanted their vaccine. We couldn’t meet it, we couldn’t ramp up, we couldn’t plan, okay, we’re going to dedicate staff to doing this many vaccines on this day because we didn’t know if we’d have that many vaccines. We could see there at the beginning that we have that much demand. But it’s like we better we should do something. We ought to keep doing primary care because we don’t know if we’ll have the vaccine. So once that happened, then we felt we could really respond to that need. And we shifted. We started doing a lot less primary care and a lot of activity. And we’re having to shift back because now we have catch up to do. But without that, it will be much more frustrating for much longer. We were very appreciative of that.
NACHC : Have there been barriers that the seasonal agricultural workers have confronted in trying to access the vaccine in terms of registering or documentation issues and how have you helped overcome those?
Kasi Woidyla: The barriers that they’ve experienced have not been around documentation or registration because we don’t require any of those things. So, the barrier was actually making sure they knew we didn’t require any of those things. But I think the biggest one was access. When they first started rolling out vaccination events, the state did and all of the larger hospitals did. They were running these very large vaccination clinics in large venues in Maine, Portland area. And most of our patients are 45 minutes outside of the Maine Portland area. And they were running them from eight a.m. to five p.m. And so, the barrier was getting there. And our patients don’t have and most of the community doesn’t have the ability to take three hours off of work to drive downtown if they can’t even drive downtown to get a vaccine.
The biggest step we took was to start holding the vaccination events near them that were from four p.m. to eight p.m. or on the weekends for an entire day. A lot of our patients work sixty to seven days a week. So even a Saturday event, if it’s not held with reasonable hours, they’re not going to be able to make it to it. So, I think the barriers came around to access them before they came around, fear of requiring documentation or how to fill out the registration forms. We were familiar with that. We’ve been doing that for a long time. We know how to help them fill out the registration form. We know how to make sure they understand the documentation requirements. So, I think it was more access. And that even took us a little bit of time to realize that was once the first initial push of everybody who wants one. Once that calmed down, we started to look at the people that we were really trying to reach and why weren’t they coming to us? And I think that’s when we realized it had more to do with access.
NACHC : We often talk about the importance of culturally and linguistically appropriate care as one feature that sets community health centers apart. How is that making a difference in the vaccination campaign that Virginia Garcia has been involved with? That attention to culturally and linguistically appropriate care.
Kasi Woidyla: We’ve spent 46 years doing it. Go ahead Dr. Byerly.
Laura Byerly: Yes, I was going to queue up, so Spanish language and English language where we’ve got really good grip on. But we’ve been working with community-based organizations and partners and maybe you Kasi can talk about our work with a Korean group. So, I think you’ve got more details in your head.
Kasi Woidyla: Yeah, we have been. It’s not only the Korean community-based health centers, but also Muslim and based health centers or community-based health organizations. We did a lot of community-based organizations out there that we are working hard with to make sure that we’re reaching all different communities of color versus just one or two that we are used to working with. And that’s kind of been the linchpin for everything, is that I sit on a lot of committees and a lot of advisory councils where;
The communities come together to really collaborate and to talk about how they can get care to their communities and to everyone. So doing that, like I said before, we’ve been doing this for 46 years. So, we understand that on some level the challenges that exist and we want to do our part to help.
NACHC : And so, when there’s a language that a patient speaks or a patient population speaks that you don’t have staff on site to address, you seek out that community-based organization to.
Laura Byerly: Yes, the Korean group was one group. We said, okay, let’s have interpreters or I don’t agree with one on site and let’s schedule your group all together so that we’ll know that the interpreter will be there and work. So, we worked with the group to get that arranged ahead of time. We have a lot of bilingual staff in Spanish, but not in the other 50 or so languages. So, we use interpreter services either in person or on iPads or over the phone, and we just have a contract with the interpreter service that we use regular basis.
NACHC: So, the Delta variant is quickly becoming the dominant variant around the country. How is that affecting your center’s approach to vaccination or your day-to-day vaccination work? What does that look like?
Laura Byerly: Well, I think it’s doing is telling us that we can’t relax and as we make our plans to try to normalize, go back to our normal set of services and try to catch up on the primary care, that we couldn’t get the preventive care. We’re making plans to do that and keeping in the back of our mind that we may need to regroup and go back into the individual. We’re still having to be physically distance wearing face masks at work. I’m giving myself permission to not wear one right now because we’re doing this. But I am in a little room, so I’m not get anyone infected. But I think it’s just hangs out there as a potential problem that we just need to keep our awareness on. Our staffs are pretty well vaccinated. And it seems that the modern of vaccine, which is what most of us have, is working. So that might not be the variant that causes us the most problems.
NACHC: Right. But so it means that as you get back to providing routine care that maybe people have put off for a year or not, they’re more comfortable coming in for appointments. You can’t let up on the vaccination efforts. So, more than six months in, the vaccination effort is slowing as people have had easy access to the vaccine, were eager to get it or now vaccinated, what is keeping unvaccinated people in your community, your patient population, from getting the shots?
Kasi Woidyla: I have my own observations, I’m sure Dr. Byerly has hers as well, but mine is basically that there’s a group of people, like I mentioned before, who are still struggling with access. And so that is a percentage that we’re working very hard on right now to reach. I think there’s obviously a percentage that are hesitant but still haven’t decided that the vaccine is for them and that they need a little more urgent and a little more discussion and a little more time to process if it’s right for them. And then there’s just those that are just not going to get it. So, I think we are working on providing access and providing information in order to get that small group of people that we want over the finish line to get vaccinated.
Laura Byerly: So, I think there’s the timing of the access, we’re going to keep working on for sure and trying to find the way. We can map out where pockets of people or who are not vaccinated are, and we’re going to try to do things like take our mobile van to that place and handle the area and see who will show up. We’re going to be frustrated that we are doing 50 instead of 500 vaccines.
But that’s kind of where we are, I think. And then the influenceable out of those hesitant group, there’s like a spectrum to the never going to get it in there. So, as we’ve been collecting information from people, their opinions and worries or concerns, I think we’ll keep working on getting that and trying to figure out like what can we say to address some of those fears? It’s hard to know when people say, I just don’t know enough about it. I don’t trust it. We’ll have to just try telling them different sets of information, all of it true information, but like how to frame it, that it’ll be a different argument for different groups of people. So, we’ll just keep trying new things. I look forward. I think if we have to do a booster and then we’re going to do this whole thing again.
NACHC: I think I’m hearing from you, though, that the issue is really more one of the disparities in the vaccination rates among different racial and ethnic communities is more and issue of access than hesitancy at this point. There’s still more to be done that you’re working on in terms of getting the vaccine to people where they are.
Laura Byerly: Out of all the remaining people, I would say a significant chunk is access for our people particularly in that they are worried about getting it and not being able to go to work. If we can call that an access thing, then I would say it’s a meaningful chunk of the remaining part of our population is unvaccinated. It is access. But yeah, I don’t know if it’s more than half, but it’s not like one percent.
Kasi Woidyla: We are seeing as we start to get into the communities, like Dr. Byerly said, and take a mobile clinic into neighborhoods that have a high un-vaccination rate and take out mobile clinics that were vaccinating 50 people, 70 people. It’s a small amount, but it’s significant when we’re doing it five days a week. And I think we’re going to see small amounts of progress at a time versus where we started, which we were vaccinating several hundred people at a time. But I think the need is still there.
NACHC: In the process, have you learned about any unexpected partners or influential messengers that have been helpful and in spreading the vaccination message to your patient population?
Kasi Woidyla: We’ve always had really good relationships with our elected officials and with community-based organizations. I think what we’ve really tried to do is partnering has been really key with other community-based organizations in the area. So, I think that has been key for us and in the partnerships that we’ve formed with people that we already had partnerships with, but they weren’t as strong as they are now. And we definitely are reaching out and gathering as a community to work together. So, I don’t know if there’s anybody new, but different people work for different groups. So, some people like the elected officials and trust the elected officials. Some people look to the news, some people look to their community leaders. So, we’re trying to involve the law.
NACHC: And are these partnerships that you forged during the pandemic going to inform, support your work going forward out outside of vaccination Covid efforts?
Laura Byerly: Absolutely. We really are hoping to leverage this stronger relationship into having access points that we can get health care to places we haven’t been able to. Some people are calling up, making appointments and going into the clinic and other folks just don’t want to do that. But they still could use the primary health care. So, we’re hoping to expand our accessing the people that way.
NACHC: Wrapping up, 16 months into this, we know that you and your staff must be tired. As you say, the vaccination effort has slowed, you’re still running lots of different programs at the same time. How are you holding up? And what has kept you going during this year, each of you? I’d like to hear your thoughts on that.
Laura Byerly: Okay, I’ll start. Outside of work, being able to see friends again has really replenished my heart. I was definitely tired and beaten down, feeling and then looking and seeing that the fear among our staff is less. They were really scared and we did have some positive staff, but as far as we can tell, came from their known positive family member. So, we didn’t seem like that’s dangerous source of infection for them. But the everyone feeling safer is really helps me and it helps me just feel better. And then it also helps us do our work. Is just getting harder and harder to do the work with the oppressive pressure of this fear and seeing the injustice more highlighted than usual. Or it was just more like, oh, my gosh, we don’t need to work on social justice in this country so badly, so obvious now, that hasn’t gone away, but it’s not combined with fear of everyone’s being alive. So, I feel better. But I get that, like you mentioned, the Delta are like, oh, please don’t have another spike.
NACHC: Kasi, your thoughts?
Kasi Woidyla: Well, my job for the past 16 months has been supporting the organization and supporting the staff. I’m grateful for a family who’s able to support me because it’s been a really long road, but I’m feeling hopeful and I love doing what I do. And the mission of our organization keeps me moving forward because I know without Virginia Garcia Memorial Center, the people that we serve would not have the care that they have. And so that keeps me motivated and keeps me moving forward. And it’s really nice to see a light at the end of the tunnel.
NACHC: Thank you.
Kasi Woidyla: Knock on wood. Sorry.
NACHC: Well, thank you both very much for your time today, joining us on Health Centers on the Frontlines.