Minority healthcare as it relates to the COVID-19 pandemic and vaccine has been a topic of conversation recently because of the higher numbers of minorities getting the virus but the lower numbers of minorities getting the vaccine.
In Clark County, for example, black individuals only make up about 5 percent of the vaccines given even though they disproportionately make up about 7.2 percent of deaths from the virus, says Rocking Horse Community Health Center Chief Medical Officer Dr. Yamini Teegala.
The disparities there, says Dr. Teegala aren’t because COVID-19 as a virus is seeking out minority hosts.
“It sometimes is the pre-existing disparities that people struggle with that make their outcomes disproportionate when it comes to certain health issue,” she says. “People live in their cultural bubbles and, for example, this group could not even fathom why somebody didn’t get their mammogram, and this other group cannot understand why somebody would go see a doctor when they’re not sick.”
These differences in cultural interpretations of healthcare are one reason many preventive services are more accessible to the majority, she says, attributing how someone grew up to how they may gain many of their opinions about healthcare.
“If your grandma and your mom went every year to get a mammogram, then you’ll go every year to get a mammogram,” Dr. Teegala says. “It’s very generationally habitual.”
Healthcare disparities also stem from greater differences in social determinants of health, including socioeconomic status, housing status, family unit structure, education and more.
“I mean, if you have unstable employment and unstable housing, and you don’t know how to make ends meet, and then on top of it all, someone tells you that you have diabetes – I think that’s my last priority,” Dr. Teegala says. “Because I have kids that I have to feed and get them to school and keep the lights on. And I really think that’s where it starts getting problematic.”
For Rocking Horse Community Health Center, facing those problems along with each patient’s physical health is just as much a part of providing care.
“I really think what we have realized is that people don’t care how much you know until they know how much you care,” Dr. Teegala says. “If you don’t talk to them about how they’re not having three meals a day, they could care less about their hypertension.”
She continued, “For anyone who is interested in health equity for minorities, I think we should just take the ‘health’ off and just say ‘equity’ – equity for education, equity for housing, equity for other things because health does not drive health, other things drive health.”
Rocking Horse has taken a strong hold of this approach. The health center is open to anyone in the community seeking care from a primary care provider, dental care, chiropractic care and more, says Stacy Lee, the center’s director of operations.
Unlike an urgent care or a walk-in clinic, Rocking Horse patients are asked to commit to receiving medical care there and transfer past medical information, as needed, to maintain a continuity of care, Lee says.
Though services are not free, patients are not required to have insurance. A sliding fee scale is available based on income, and some services are offered at a discount for patients who quality.
“We will work with everyone,” Lee says, adding that the center also has programs to help with diapers, clothing, medical assistance and more, as needed by patients.
Many patients who visit Rocking Horse are in need of more than what can be fixed with just a quick prescription.
“We’ve had people come in, and they don’t have transportation. Within one hour we can get them a bicycle so they can get to their appointments,” Rocking Horse Director of Nursing Christy Detrick says. “All our providers are very in tune that health is about the whole picture. It’s about where you’re living, it’s your transportation, all in one. I think we do a very good job of that.”
Looking outside the center’s walls, Dr. Teegala says making bigger changes to minority healthcare will take a systematic overhaul of investing time in working on the many social determinants that affect minority health.
She says Rocking Horse will be using Community Health Workers (CHWs) to continue this kind of outreach, but that it will take more than just their CHWs to start seeing the necessary changes.
CHWs, according to the National Institutes of Health, are trained members of the community who “usually share ethnicity, language, socioeconomic status, and life experience with the community members they serve.”
Using CHWs as building blocks within a community has, according to the NIH, been proven to:
- Improve access to healthcare services
- Increase heath and screenings
- Enhance communication between community members and providers
- Increase use of healthcare services
- Reduce the need for emergency and specialty services
Dr. Teegala says increasing the use of CHWs is a statewide issue, because while Rocking Horse trained all its advocates as CHWs, Ohio does not classify CHWs as a paid position but rather as a volunteer position. This leads to many organizations not using CHWs within communities in need.
“We need to embrace the Community Health Worker model,” she says. “They look like and talk like and know the needs of our minority community.”
Rocking Horse is located at 651 S. Limestone St., making it more accessible than some other healthcare options to patients from the southwest side of the city. Dr. Teegala says the center has always worked to establish a diversified group of providers, which she thinks has also helped build community confidence.
Showcasing minority healthcare – both in general and as it relates to COVID-19 – has also been a positive of the center.
One of the responsibilities of Nettie Carter-Smith, the center’s director of community relations, is to manage Rocking Horse’s social media. She’s made a point to highlight people of color getting vaccinated.
“When you see real people on social media getting it, and those people in your own community can say ‘I’m fine,’ – it can help break down those fears,” Carter-Smith says.
She also shared how Rocking Horse jumped at the chance to organize pop-up testing centers starting in June 2020 that ran twice a week through October. They paused for a bit, but they are now back up and running again to continue providing accessible testing for residents on the Southside of Springfield.
People receiving COVID-19 testing and vaccines through Rocking Horse are not required to be patients, Lee says.
Dr. Teegala says people getting or not getting the vaccine comes down to an individual’s personal choice of wanting to get protection by way of the vaccine or wanting to take their risk of getting the virus.
She and Carter-Smith also encouraged people who register for the vaccine to each personally encourage another friend or family member to register with them. They say spreading a message from person-to-person about the benefits of being vaccinated can have a positive effect, especially among minority communities.
“Everyone needs a buddy,” Carter-Smith says. “If you get the vaccine, you need to make a deal of getting one more person to get it also.”