Episode 2: REACHing for Vaccine Equity Guest Multnomah County Health Department

Dr. Yabo Beysolow 00:00

Welcome to REACHing for Vaccine Equity. We are your hosts. My name is Dr. Yabo Balo.

Lisa Jacques-Carroll 00:09

And I’m Lisa Jacque Carroll. In this limited series podcast hosted by the iReach team at the nonprofit Association of Immunization Managers, learn how individuals living with chronic health conditions can thrive with the preventative power of getting vaccinated and adopting healthy behaviors, including nutrition, exercise, and smoking cessation.

Dr. Yabo Beysolow 00:33

Meet REACH community leaders who have success stories to share, the challenges they have met, and the health inequities they’re working to overcome in the diverse communities they serve. We’re glad you’re here. I’m Dr. Yabo Balo, the host for today’s show. At the top of each episode in this podcast series, we like to explore how individuals who are living with chronic health conditions can continue to thrive through the preventive power of getting vaccinated and by adopting healthy behaviors.

On today’s show, we’ll be discussing how health promotion activities, such as good nutrition and exercise, can prevent heart. And we’ll also talk about how vaccination in adopting healthy behaviors can help those with heart disease thrive. I am so excited today to welcome our guests, Cindy and Jasmine from the REACH program at Multnomah County Health Department in Oregon.

I’ve worked with them and their team over the last two and a half years, and I’m so glad to have you both on the show. Welcome. So I’ll start with you, Cindy. Please tell our listeners just a little bit about your organization, what your role is.

Cindy Shepherd 01:48

So, my name is Cindy Shepherd, and I’m the communications specialist for the REACH program for the Multnomah County Health Department.

And REACH stands for Racial and Ethnic Approaches to Community Health. So our program works to address health disparities in chronic diseases for the Back and African communities of Multnomah County.

Dr. Yabo Beysolow 02:11

Awesome. Thank you. And Jasmine?

Jazmine Bowles 02:14

Hi, my name is Jasmine Bowles. I work with REACH under the Public Health Division with Multnomah County Health Department.

I’m the community immunization Program manager and nursing development consultant, and I have the pleasure of being able to stand up the vaccine clinics within our BIPOC, our Black, indigenous, people of color communities within Multnomah.

Dr. Yabo Beysolow 02:34

Excellent. And you both mentioned a little bit about the communities that you work with. Cindy, you mentioned some of the communities that you work the most with. So, what are some of the unique cultural aspects of the community that affect your work?

Cindy Shepherd 02:49

So some unique aspects about our work are that we serve not just English-speaking people, but we serve people who speak multiple languages. We have a lot of immigrants and refugees. Some of the languages we have are Swahili, [LANGUAGE]. We also deal with people from West Africa, so there are many languages and people who we need to consider anytime we are creating messaging and programming so that they have access to our programs and our resources.

Dr. Yabo Beysolow 03:17

Great. So a lot of work there, but I’m sure also very rewarding work to be able to work with people from so many backgrounds. So, you know, I’ve worked with both of you and have been really inspired by your work on two projects in particular, and one is the Community Immunization Project. And so Jasmine, can you just share some of the goals for their community immunization program?

Jazmine Bowles 03:39

Yeah, so the Community Immunization Program works to bring families into the clinic to be vaccinated. So we work pretty closely with REACH to do flu clinics annually, from like September until March, as well as providing COVID vaccines and boosters to adults and children who are coming into those clinics as well.

Dr. Yabo Beysolow 04:04

Very good. And also, with Cindy, could you shed some light on another program, I believe it’s the Heart Health Initiative.

Cindy Shepherd 04:10

Yes, so the Heart Health Initiative right now, we actually have a Healthy Heart Ambassador program that we’ve rolled out in February that will run through June. And this is a culturally specific program run by a facilitator from the Black community. And what’s unique about this is that we’ve taken a national program, but we’ve tailored it.

So a lot of times when we package information, when we receive packaged information, it’s hard to implement. So, this program actually is made for the Black and African community and it’s tailored to them. And this is something we are promoting during the month of February, specifically, to get people enrolled so they can, you know, work on improving their heart health.

Dr. Yabo Beysolow 04:52

Great. And what are some of the specific activities this month that you’re pursuing?

Cindy Shepherd 04:57

So for the month of February, we are focusing on heart health, particularly heart disease. It affects the Black and African community at much higher rates. We’ve rolled out, uh, two Healthy Heart Ambassador classes run by the same facilitator, and it is culturally specific, meaning it is tailored to the Black and African community, and it is facilitated by someone from the community.

So this program will run through June, and this is what we’re trying to promote. It also includes a physical activity portion. We are organizing community walks every month, starting from April until late fall, until September, and this starts with the Healthy Heart Ambassador Program, but it actually continues past that because we do want to capitalize on that momentum. And there’s also a nutrition element to this program. So, people will learn how to eat healthier, cook their favorite foods in a healthier way, and they’ll receive individual training and support.

Dr. Yabo Beysolow 05:55

Great. And why is this so important in the African-American community? You know, is there’s something regarding the rates of disease and so forth that you wanna share or expand upon?

Jazmine Bowles 06:04

So I can kind of talk about heart disease and how we want to prevent it within our communities. From a nursing perspective, I think that it’s important that we provide education to our communities, specifically around some of, just the way that we can, you know, prevent these diseases from happening. And just healthy activities that we can do to really help aid ourselves during these practices.

So I think, you know, really working within communities, talking about exercise, talking about diet, talking about nutrition and ways that we can change our perspective around some of that, right? Like some of this is passed on from generation to generation, and I think it’s important that we address some of the slave syndrome, right, that folks experience across a diaspora. So I think, um, yeah, just having conversations and providing education.

Cindy Shepherd 06:48

Thank you, Jasmine. I would like to add that the other thing we’re trying to focus on is, we’re trying to come from a perspective of understanding. And not push the narrative that chronic diseases like heart disease are an individual failing. These statistics are also, like these rates, the incidences of chronic diseases in the Black and African community are also a result of systemic racism and lack of access to resources and safe spaces to exercise, you know, limited access to fresh food – to address those aspects instead of just telling people to go out there and exercise and eat healthier. We’re gonna actually provide people with resources like access to a CSA program, a low cost or no cost. CSA program. We’re going to organize community walks, which are safer than walking by ourself if you live in an area with, you know, really bad traffic and no sidewalks, which is very common for Portland. So we’re trying to come at this from a lens of, okay, what do you need to be successful?

Dr. Yabo Beysolow 07:49

Yes, yes. You both have touched on some very important aspects and, um, a lot of work that you’re putting into this. So, I wanted to ask you how the two projects really got started in your communities. How did you build relationships and foster partnerships?

Jazmine Bowles 08:06

Yeah, so the Community Immunization Program was born out of the pandemic, and so we started off with our testing sites, but we really built relationships within the communities and with our community-based organizations. And, so one of the things that I was tasked with is going out and meeting with folks within the community, and I was able to stand up two clinics at a community-based organization that was reoccurring every single week. And so it became a trusted space where folks in the community knew that if they needed to be tested or they needed to get a vaccine, that they could come to those locations and get those services. And so really what it it was is, is being able to engage with community leaders, build trust within community, and maintain that.

And so as we continue to expand our efforts, our program specialist within the community or immunization program work with the Oregon Health Authority, another program within the public health division, the Community, uh, Capacitation Building program, and then as well as with REACH, so the Racial Ethnic Approaches to Community Health really continue to maintain those relationships, but also to partner with other community-based organizations, which we may have not been able to establish relationships with. So that’s how we actually came to be.

Cindy Shepherd 09:21

Just as Jasmine said, really, it’s just finding out trust in the community. CBOs sometimes even, you know, community hubs. We’ve worked with barbershops, salons, community centers, and we help them with resources and they help us with legitimacy and access. So what that looks like is we might plan, fund, and host a community of, for a local organization that’s well known, and we’ll have food, we’ll have music.

It’ll be a community building space and a chance for people to decompress and experience a little bit of joy, and then we will be there so that we actually are a presence in the community instead of just being an arm of the government trying to tell people what to do. So, this way we can actually do to foster partnerships with them, and it’s a mutually beneficial partnership.

We get access to the community, and we become trusted messengers, or we become a trusted source of medical advice. And then we use trusted messengers like CBOs, and we train them so that they have the capacity to get the information out there as well.

Dr. Yabo Beysolow 10:24

Excellent. I heard a lot about mutual respect and trust, and you mentioned CBO. Could you expand on what I, what does that mean?

Cindy Shepherd 10:31

Yes, a community-based organization.

Dr. Yabo Beysolow 10:34

Oh, okay. So, those are some of your partners that you mentioned earlier. Okay, great. And what about utilizing social media? Is that something that you’ve done as well?

Cindy Shepherd 10:42

We definitely use social media. We have a Facebook, our REACH doesn’t have its own Instagram, but we do use the Multnomah County Health Department’s Instagram when we need to promote something.

And Facebook is actually very helpful because even though it looks like maybe people aren’t so engaged with it, it is a place that people come for information when they need something. So it’s important just to have a landing page and some sort of page where people can come when they need to know what’s happening or they need the latest guidance on something. So we do utilize social media and we also use social media for advertising. So we might pay to reach people that we might not otherwise be able to reach. So social media is a, a big tool that we use.

Dr. Yabo Beysolow 11:25

Excellent. And I’ve had the opportunity to speak at a couple of your events, and I remember a lot of music, a lot of good, good music, and just fellowshipping. So tell me about what, you know, some of those activities that you actually are part of in your community.

Cindy Shepherd 11:39

Two specific meetings I would say that are really, really instrumental to our work are the Black COVID Response Meeting. That was, I think, the meeting you spoke at, and that meeting was initially designed just for COVID to give people, specifically the Black and African community updated information on the pandemic and guidance.

So this is a biweekly meeting, and we’ve kept it going, and we still give people information on COVID-19 because it’s not over. And there are many changes now happening, but now we’ve added another part where we focus on a chronic disease or some affecting the community that can range from, um, diabetes. Like this month, it would be heart disease, things like mental health. So we just start with our COVID updates and our influenza and RSV updates, and then we move into another topic that is affecting the community. The other meeting that is really, really helpful to connect with community-based organizations and our partners is the Achieve Coalition meeting.

So this meeting is a collection of local organizations and community members, and sometimes businesses and just people with a vested interests that come and meet monthly to discuss anything that’s happening in the community. Updates, resources, programs, and REACH helps facilitate this meeting.

Dr. Yabo Beysolow 13:01

Excellent to see that, you know, you really have grown and expanded the program based on the needs of the community, and now addressing not only vaccination but chronic disease prevention as well. So we applaud you all for that. Jasmine, I just wanted to find out, are there any challenges that you’ve come across in your work the community immunization?

Jazmine Bowles 13:19

Yeah. So like I mentioned, this program was born out of COVID, and so one of the biggest challenges was navigating systems, um, you know, pre-COVID, there was no telework, Pre-COVID, there were a lot of policies and procedures that were really set in stone, and so it really challenged the systems, right? Like being able to think outside of the box and think creatively around how we may be able to navigate communities, how do we access communities in a different way, right? With a respiratory disease, it made it challenging in a lot of ways. Like, how do you bring people into a clinic and space them out and still, you know, and show compassion, but also vaccinate as many people as possible? So yeah, I would say systems, navigating, um, policies and structures was a big challenge that we had throughout. Um, and still with, with our response.

Dr. Yabo Beysolow 14:13

That is so true, Jasmine, were there some non-traditional settings where you had to administer vaccines that you yourself were surprised at?

Jazmine Bowles 14:19

Yeah, so we administered, uh, vaccines in a houseless camp underneath one of the highway underpasses. We’ve done vaccines in schools, we’ve done them in parking lots, we’ve done them outside when it’s raining, we’ve done them, you know, extreme heat. We’ve navigated multiple different types of environments to provide these vaccines, but with the commitment of just like leadership, with the commitment of the staff that we had, we were able to make that happen.

Dr. Yabo Beysolow 14:50

Yes. What are some challenges, um, perhaps, that you’ve come across, and how you worked to overcome those?

Cindy Shepherd 14:58

I think we faced a couple major challenges. One of them is definitely with working with communities that have medical trauma and have been historically wronged. So the Black and African community that there are still people alive who remember some of the things that the government had done before. So, it is difficult to now tell people or try to give people medical advice when they remember that.

So there’s definitely some medical trauma there to overcome. And then the other challenge is with messaging. Because things were changing so quickly, people were getting frustrated, and so we are trying to give the most updated guidance we can, but a few people felt like they were being told one thing and then they were being told another thing. So trying to stay on top of a consistent message is a little difficult, especially when there’s so much disinformation out there.

Dr. Yabo Beysolow 15:48

Exactly, exactly. And you all have touched on, again, so many, um, very, very important issues. You mentioned trying to overcome those challenges. How do you build trust in the community again?

Cindy Shepherd 16:01

The only way to do that really is to be consistent. So, you just have to keep showing up. It’s unlikely you’re going to convince someone the first time, but if you keep showing up and you’re also leading by example and you’re providing messengers that look, uh, like the community and that represent the community that you’re working with, that’s really important.

So another one of our communication vehicles is the Ask a Black Doctor Podcast. So we actually brought in medical professionals to discuss the ins and outs of the vaccines and why the CDC might be providing guidance on certain things and why we have, you know, why do we need to wear a mask? Why does that work? So we actually have medical professionals from the community and we ask them to volunteer some of their time to dispel myths and to build confidence.

Dr. Yabo Beysolow 16:53

Great. So culturally specific messaging and programming. Excellent. You both mentioned, you know, just building, and you’ve shared some examples of fostering partnerships in your community. What surprised you about working with some of the trusted leaders or messengers in your community?

Jazmine Bowles 17:08

I think, um, just how willing everyone was to jump in, you know, COVID lasted much longer than what we anticipated originally with flu. Right? And so you started to see exhaustion over time, but folks continued to show up, right? Those leaders continued to show up in spaces to make decisions. Our community-based organizations were wonderful and just welcoming us into their spaces, right? So it was just the way that people showed up, the way that people continued to understand the importance of the work. That was really amazing to see.

Dr. Yabo Beysolow 17:44

Awesome. Awesome. Both of you are probably midway in your projects now. Are you starting to see some outcomes, some results? How’s it going?

Jazmine Bowles 17:52

Yeah, so some of the outcomes from our, you know, some of the work that we’ve done is we now have standing clinics. So originally, we had a model where we were just going out into the community, but we now have standing clinics. To date, we’ve done about just shy of 600 clinics out in the community. But we have a standing location downtown that we’re able to see patients at as well. And that has been really nice to, you know, kind of have some steady ground. Um, so that’s really, really nice. We also have an emergency response component to our program, so we are able, you know, if and when the next emergency comes about, we’ve been able to take some of our lessons learned and really put that together for our emergency response. And the next big piece that the Community Immunization Program is working on is health education. So being able to get back out into those communities and, again, continue to build that trust.

I think Cindy was really talking about the mistrust of healthcare and government within communities, and so allowing folks to have information to make informed decisions about their health, and so that is something that we’re working on as well. So we’ve hired a full-time health educator to help with that as well.

Dr. Yabo Beysolow 19:04

That is incredible. So really making some ground rules. And Cindy, would you also, um, like to share, you know, the progress so far with your…

Cindy Shepherd 19:14

Definitely. We’ve, for example, for February, we already have quite a few people signed up for our Healthy Heart Ambassador program classes. And I would just say that we’ve become a lot more flexible also in responding to anything that comes up.

We know how to put on a clinic very quickly. So one of the outcomes is just that we’ve become much more efficient if we are going to have an event somewhere, we know exactly what we need to make sure that people have access to vaccines. But the other thing is that, uh, anytime we have an event, we still see a little steady stream of people coming in to get vaccinated.

And we know that just having the clinic there sometimes is what you need to do, even if you know it starts to slow down a bit as it has recently. Getting people vaccinated is becoming a little bit more difficult, but just having the clinics there and and on hand we’ve noticed is really helpful. People will be like, well, I’m at this event, and I’m just gonna go ahead and do it. It’s like running an errand now. So I’d say one of the outcomes is that getting your booster or in preparing for school in the fall, this is another thing that you also should be doing.

Dr. Yabo Beysolow 20:21

Wow. Yes. Normalized that whole experience. Exactly. Both of you have mentioned partners. Please bring some shine to some of the partners that you’ve worked with in your area.

Jazmine Bowles 20:32

We’ve worked, um, with faith houses, so churches, we’ve worked with, schools, we’ve worked with the Latino Network, ERCO. Africa House. There’s a long list of them, but we’ve worked with quite a few different populations of folks and tried to reach as many folks within the BIPOC community. So again, that Black indigenous people of color communities,

Cindy Shepherd 20:54

I would add Playgirl Learn. They’re a local community-based organization that helps families. We’ve worked with Highland Haven Christian Center a lot, one of our faith-based community-based partners. We’ve also worked with, um, some people for our CSA program, which is the Community Supported Agriculture, like farms. So we even have black people growing vegetables for the Black community. So those are, for example, three partners that we’ve worked with. Afro Village they’re trying to address homelessness in the Black and African community among other things. So yeah, there are a whole list of things. A whole list of, you know, CBOs, individuals, it’s hard to remember all of them at once.

Dr. Yabo Beysolow 21:39

Those are great examples, and I’m sure you’re glad that you have that mutual working relationship with them and things are going very well, as it seems. So how do you plan to sustain the great work that you’ve done thus far in your communities?

Cindy Shepherd 21:52

I’d say that. We just have to keep showing up and keep providing things that people need. And I see this a lot as community building. It’s unique in Portland because we do have a really, really low percentage of Black and African people here, at just around 6%. So there aren’t a lot of spaces for people to feel safe and to feel like they have community.

Everyone is spread out. So, providing that space for people to be happy and to be with their families and to be with the community is really important. And I would say that is the biggest way that we can actually maintain trust and partnerships and, um, you know, have people trust us as a source of medical advice is by providing other things that they need as well.

Dr. Yabo Beysolow 22:42

Awesome. And Jasmine, anything to add to that?

Jazmine Bowles 22:45

Yeah, the Community Immunization Program will continue to, um, do the work that we’re doing, right, providing a couple of pop-up clinics a week out in the community, so in partnership with our community-based organizations, but we’ll also provide webinars and participate in health fairs, provide written information and multiple languages to community-based organizations to disperse within their communities as a trusted location.

We’ll continue to maintain our emergency management in the event of the next emergency, and like I said, really highlighting that health education piece to allow for folks to make informed decisions.

Dr. Yabo Beysolow 23:20

Very good. And Cindy, you had mentioned social media and messaging before. How has your message changed, or will it change as we move forward?

Cindy Shepherd 23:29

Yeah, so like we were talking before about normalizing COVID vaccines, I’ve started pretty much pairing COVID vaccination messaging with flu messaging, trying to just make it something that people should be doing, trying to avoid any language that looks at the pandemic as, um, a solvable thing. Focus on messaging that talks about it, you know, as being part of the new daily reality because I do think that there are some people who are just sort of waiting for it to end and it’s not going away. And so we need people to know that this is here to stay, and you still need to protect yourself even if this state of emergency goes away. And the other thing I’m trying to focus on is to make sure everyone knows where they stand with regards to insurance once the state of emergency does end so everyone can be prepared and knows where to go for resources if they need them.

Dr. Yabo Beysolow 24:21

Yes. Excellent preparations there and wanted to just pivot for a minute what one message or story has really inspired your own confidence in vaccines?

Jazmine Bowles 24:33

I think just being able to be on the ground and be in the clinics to see like the smiling faces of the community. But I will just say really quickly as an African American nurse being in the clinic, being able to answer questions from folks who may be unsure about vaccines, but trust my opinion as a Black woman has been one of the most empowering experiences that I’ve been able to have within the clinics and it has felt as though, you know, the community has really appreciated that as well. You know, I think Cindy brought up the population here is about 6% of African American folks. Representation matters. And so that has really been one of those moments that’ll, they’ll stick with me for a long time.

Cindy Shepherd 25:19

I remember this was actually something that happened when we’re at an event, and there was a person talking about how they had been against vaccines and then they got COVID, and they said it was really, really bad, really debilitating, and then the moment they were covered and they were able to, they went out, and they got the vaccine, and they were telling other people. That was really, I think that was a unique moment because a lot of people don’t like to admit when they’re wrong. It just shows that like people are willing to to sort of change their messaging when they have updated information.

Unfortunately, this person had to go through it. But to see someone going and telling other people, everyone around them, go get vaccinated. Go get vaccinated. I thought that was really powerful.

Dr. Yabo Beysolow 26:03

Yes, both of you have definitely shared some inspiring stories. What do you wish everyone knew about managing heart disease as well as COVID and flu, but you know, with a focus on heart disease?

Cindy Shepherd 26:16

People need to know that it is not something that just happens, you know, immediately. It builds up over time. And something that struck me recently when I was looking into it was that the rates for things like heart disease, diabetes, and high blood pressure they’re pretty much the same across most communities when people are young, right? And so something happens as you age and it’s sort of a cumulative effect. So that means that it is never too late to start improving your health, but you also wanna make sure that you do it early because it does accumulate over time, and it’s so much easier to prevent these chronic diseases like with heart disease because really there isn’t a proper cure for this. It’s, it’s more about lifestyle. And so that’s the biggest thing I would like to get across,

Dr. Yabo Beysolow 27:06

Thank you. And Jasmine, anything to add?

Jazmine Bowles 27:08

We know that COVID and flu can impact both the heart and the lungs, and I think that it’s important that folks understand taking those preventative measures up front, particularly, right, if you are already down the path of heart disease or lung disease, for that matter, and so just taking those preventative measures upfront to prevent further damage to both of those organs, it’s just really important. And so, just finding information, finding trusted sources to provide that information to you so, again, that you make those informed decisions.

Dr. Yabo Beysolow 27:40

I just really wanna thank both of you. You’ve shared so much valuable information. Again, I wanna say thank you, but I also wanted to give you an opportunity. Are there any last-minute words of advice or things that you meant to share? So I wanted to give you both an opportunity to wrap up with any last-minute, um, words.

Cindy Shepherd 27:59

Another thing we’re doing is trying to pair COVID messaging with other conditions like heart disease, for example. Because of what Jasmine said, it’s all connected. It’s not just one thing affects one part of the body. We know COVID affects so many different systems and organs, and we don’t even know in what ways fully. And so, a big part of our tactic is to pair health observances with COVID messaging. We need people to understand that there are interactions between these conditions, and so anything you can do, like Jasmine said, to protect yourself is really, really important.

Jazmine Bowles 28:35

I mean, the only thing I would just say is I would just encourage people to find trusted sources within your communities to gain access to information. I know that REACH is one of those programs that has information translated in multiple languages, and the community immunization tries to do the same.

And we also have interpreters that we are able to bring in to help with any services that folks are looking for. And so I just wanna emphasize the importance of getting the information, accurate information from reliable sources and trusted members within communities. Again, I just can’t stress enough to make informed decisions about your health.

Dr. Yabo Beysolow 29:12

Well, there you have it. We have two experts here who’ve shared some wonderful information with us. We’ve had a wonderful time chatting with both of you today, and we thank you for your participation today.

Thank you for listening. If you want to get all the episodes as we release them, please subscribe to the podcast on your favorite podcast app or visit the AIM website to join our mailing list. The Association of Immunization Managers, or AIM, is dedicated to establishing a nation free of vaccine preventable diseases.

Visit our website at immunizationmanagers.org to get resources to help your community thrive. REACH, or Racial and Ethnic Approaches to Community Health, is a national program administered by the Centers for Disease Control and Prevention or CDC. To reduce racial and ethnic health disparities. AIM has partnered with CDC to engage in support participating REACH organizations in their efforts to address racial and ethnic disparities related to COVID-19 and flu vaccination coverage.

This content was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention grant number. 6, N like Nancy, H like Henry, 23. I like India. P like Paul. 9 2 2 5 6 9 dash zero five dash zero three. The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services, or HHS.

The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government. The views expressed by the guests are their own and do not reflect those of AIM or iReach. AIM controls all content on this podcast. All episodes were recorded and produced in 2023.