Episode 4: REACHing for Vaccine Equity Building Trust and Vaccine Access – CAI Global and Buffalo Center for Health Equity

Dr. Yabo Beysolow 00:48

Hello! Again, I’m your host, Dr. Yabo Beysolow. In today’s episode, we are gonna explore how individuals can continue to thrive with the preventive power of getting vaccinated in adopting healthy behaviors. I wanna welcome our guests, Stan Martin from Cicatelli Associates, or CAI, and also Ebony White from the Buffalo Center for Health Equity.

I’ve had the pleasure of working with both of you over the last couple of years during this COVID-19 pandemic with the iReach Project. I’m so excited for you to share today all of the great work that you’ve been doing to promote flu and COVID-19 vaccination, as well as your focus on tobacco cessation among your communities in the Buffalo, New York area.

So Stan and Ebony, welcome. I am so glad to have you on the show.

Stan Martin 02:34

Thank you. Thank you for having us.

Ebony White 02:25

Thank you.

Dr. Yabo Beysolow 02:27

Wonderful. So, Stan, we’ll start with you. Can you just tell our listeners a little bit about your organization, CAI, and how you work really to impact the lives of people in your community?

Stan Martin 02:41

Thank you. Thank you. Well, CAI, you know, our mission, we utilize the transformative power of education and research to foster an aware, healthy, compassionate, and equitable world. We actually partner with the Buffalo Center of Health Equity on the REACH grant and I truly believe that that’s the reason why we were able to, you know, receive the award and receive funding.

Our demographic area that we serve is primarily African American and those who identify with the Black diaspora. And also when you look at some of the data, some of the information Ebony will probably talk about later on, has some of the greatest health disparities and needs in terms of healthcare and to also address inequities.

Dr. Yabo Beysolow 03:24

Great. That then leads me right to Ebony to tell us a little bit about your organization and then some of the health inequities that Stan mentioned that you see in your community.

Ebony White 03:35

So the Buffalo Center for Health Equity has been a champion and was birthed out of a coalition called the African American Health Equity Task Force, which still exists, which is comprised of academia, healthcare, community-based organizations, and just everyone that has a great stake in the outcomes of our community members.

We have focus points that look at our neighborhoods, community advocacy, also community engagement, and also research and how we are a critical part about that, but really honing in on the impacts of the social determinants of health which made our relationship as organizations just purposeful and aligned perfectly with Cicatelli & Associates, cause overall we wanted to impact — in a positive way — our community members to make sure that our health outcomes were not determined by our zip codes as they currently states right now.

Dr. Yabo Beysolow 04:33

Great. And I’ve really just been inspired by all of the work that both of you have done with your organizations to help meet your community’s needs. And you mentioned partnership with regards to the vaccination efforts. Stan, how did you build this partnership with Ebony’s organization and foster that partnership?

Stan Martin 04:54

One of the things that we utilize and, you know, you and our listeners or those tuning in might be familiar with, is collective impact. Having a shared agenda, mission and, you know, bidirectional communication and conversations and utilizing the science and data, et cetera, things of that nature really made this, you know, a no-brainer in terms of our collaboration and we also both utilize community-based participatory research. So, really engaging those with lived experience, you know, not just the content, but the lived experience, as a part of the solution, not seen as a part of the problem. So that being said, you know, we were able to collectively develop and disseminate a community needs assessment that allowed us an opportunity to gather information from the community and then, you know, utilize the data and the information to inform our strategies, to inform our activities, to inform, you know, the different things that we heard from the community, you know, to bring to fruition.

We quickly learned who some of the trusted messengers were, you know, who some of those, trusted sources are, whether it’s doctors, whether it’s, you know faith-based leaders and, and what have you. So it was those type of things that we learned that not only what would work, but also what wouldn’t work.

Dr. Yabo Beysolow 06:10

Okay. Great. So, Ebony, Stan mentioned trusted messengers. For those of you listening who may not, you know, be as familiar, how important was that to your work, and how did you work with trusted leaders and messages in your community? How did you find them?

Ebony White 06:27

So it, it’s critical to your work that you are in partnership with the trusted messengers. So those trusted messengers varied from your faith leaders to your everyday local businesses, from your black club leaders. It just varied. But it was important that we evaluated who was in this space, what their needs were when we, you know, conducted our community needs, but how could we walk alongside of them? How can we help and support what they were doing? Never a takeover, but really, “I wanna walk with you because we’re going in the same direction.” So it was critical for us to do that. So, whether it was your food pantries, there were hosts of places where there are leaders coming in all shapes, sizes, colors, and spaces, and we sought out to make sure we engage with them appropriately.

Dr. Yabo Beysolow 07:20

I like that – walking with you. Really like that. When we talk about this work with enhancing flu and COVID-19 vaccination efforts. How do you feel your community has accepted flu and COVID-19 vaccines?

Ebony White 07:37

I would say, initially with the flu vaccine our, elderly population operated more on that health promotion and preventive that they were more responsive. It was when we got to our 18 to 30, our 30 to 45, where we got a little bit of hesitancy, but it also was not surprising because we understood that there is a large population who was not engaged with the healthcare delivery system.

Whether it’s not having a primary care provider. And that played a major role and that’s why our education had to be around that health promotion. Not just the the vaccine itself, but the relationships between my community members and healthcare at large because this is something that we wanted them to not just get the vaccine, but we wanted them to build relationship and rapport.

And that comes with time because we have not always had uh, historically and still to date, really good relationships and building those relationships that they were trusted. So, it took some work, but at first, you know, it was slow and steady. Sometimes it was a pause where we felt like we weren’t making any headway, but we were. And I think we’ll be able to kind of talk about some of those highlights later on in the show.

Dr. Yabo Beysolow 08:55

Thank you. You brought up some great points such as access to care and trust and building that trust between the healthcare system and community so thank you for sharing that. So, we’ll move into perhaps some of those highlights or shiny moments of your work during the pandemic. And Stan, I’ll turn to you and ask you to share some of those.

Stan Martin 09:18

One of the things that I would like to highlight and share with everyone is that one of the lessons learned that the messenger is just as important as the message. You know, and it was very important that not only that we have spokespersons and trusted messengers that were from the community, but also reflective of the community that looked like the community and you know, provide opportunities for our residents to see themselves in our, you know, advertising, in our promotions. One of the things Ebony and I really try to embody is we wanna amplify community voices, not our voices.

We want to amplify their voices or your voices and they actually were involved in the production of a video that hopefully we have queued up that we’re gonna be able to show where, so you’ll see them, you’ll see their energy, you’ll feel their vibe. You’ll, you’ll see and hear their excitement in terms of being involved at every level of implementation.

Sometimes we didn’t get it right. They say, “Nah, that’s not it.” And then sometimes when we did, they say, “Yeah, now that’s it!” you know. So we are very excited and more importantly just very excited for the community, cause they’re the ones who actually developed this and it was their idea and we were just alongside to help bring it to fruition. So this is from our Community Vaccine Champions.

Dr. Yabo Beysolow 10:35

This is an awesome video and you know, we just really see the impactfulness of it and also as you shared that is sharing the voices of the community. People can relate to who’s in the video, they may be able to see a neighbor or someone else that they know from the community. So thank you for sharing that. And I know you’re really proud of the campaign and the results.

Stan Martin 10:59

Absolutely.

Dr. Yabo Beysolow 11:01

And where could someone watch that video if they wanted to? What’s your website or link?

Stan Martin 11:07

They can go to our website, I would say www.caiglobal.org. And I believe that is also available on YouTube for folks as well.

Dr. Yabo Beysolow 11:17

Great, and we’ll have it in the show materials for the podcast as well. So Stan, um, wanted to ask you again, you know, the work you’re doing to prevent COVID-19 and flu in your community…all of this work we’re doing extends beyond vaccination efforts. Can you tell us about a project perhaps that you’ve conducted just regarding health promotion in general?

Stan Martin 11:40

In terms of health promotion, I would really go back, I would really go back to when COVID first started and a lot of people were, you know, sheltering in place. And one of the things I didn’t mention earlier about our community is that, you know, Buffalo, um, is one of the poorest cities in the country. You know, we have high child poverty rates as well, and one of the things that, you know, for those might not be aware, like when you look at life expectancy, people in our area, our catchment area the life expectancy is 10 to 12 years less than whites in particular who live outside of our zip code area, our catchment area. So there’s a lot of health inequities and disparities that exist.

However, these are people who are on the front lines. You know, they’re the ones who are driving the buses. They are the ones who are delivering foods, Uber drivers, you know, what have you. They’re the ones who taking care of those who are sick…who are in the hospitals, you know, so who are really on the front lines working in grocery stores. So when COVID first hit they had to go to work. They couldn’t stay at home. Many of ’em say, I gotta work, and you should never have to choose in terms of being able to provide for your family or having to earn a livable wage, you know. I mean…that’s just not fair in terms of equity.

So I think that in terms of health promotion, being able to work with the Buffalo Center Health Equity Ebony, and, you know Pastor George Nicholas, who’s a respected leader in the community, and mobilized other faith leaders, health providers, you know, hospitals, large macro systems, including transportation, which is an issue in our area, in our community to really come together and provide access to vaccinations, to provide access to food, you know, to other essential items that you might not think of when it comes to health promotion. But they are essential, especially to those with the greatest needs.

So, just being there at that time when we didn’t have a lot of information early on about COVID there was a lot of uncertainty, a lot of hesitancy and et cetera. Being able to work in that capacity to reach those with the greatest needs was, in my opinion, a health promotion strategy that impacted every level – at the individual, the community including creating systems and policy change as well to promote health and wellness.

Dr. Yabo Beysolow 14:00

Thank you so much for sharing light on that, not just that individual-level change, but also things that impact someone’s ability to get vaccinated that you were addressing through the system-level changes that you mentioned. So thank you for sharing that. One of the projects I remember you focusing on was tobacco. Can you shed some light on that tobacco cessation?

Stan Martin 14:21

Yes absolutely. You know, these are, when we talking about tobacco, when we talk about chronic disease, diabetes, et cetera. But you know, I’m, let’s deal with tobacco. There are, there are correlated factors, you know, and we know that when we look at the African-American community, we look at communities of color, that there are, you know, high rates, prevalence rates of tobacco use, you know, within the community, alright, within households.

And we learned quickly early on that a lot of people, because they were at home, that they were smoking in the home. You know, not necessarily taking it outside and not, and exposing a lot of other family members, loved ones to secondhand smoke, and we know that there’s no safe level of exposure to secondhand smoke, period, alright.

So that being said, one of the things we did to try and reach, you know, some of those gaps or other populations was to promote, at the time, tobacco cessation, to promote ’em in particularly in multi-unit housing complexes, to promote them through the use of door hangers that, once again, our Community Vaccine Champions and Tobacco Action Group members, they created the flyer, they created the door hangers. They created the design, and with their mask and with their uniforms, you know, things of that nature, they went door to door and they didn’t have to have face-to-face contact, they could just leave the door hangers outside of the of the door within each complex in our five complexes throughout our catchment area.

And that was a way to getting the information out, you know, for people who was at home about the harmful effects of smoking. But also if you need help to quit, for them to call the New York State Smokers Quit Line, which is here in our backyard, for assistance with access to gum, access to lozenges, access to patches. Cause not everyone can quit cold turkey. So, that was just another way that we tried to perhaps bridge the gap or address correlated factors that exacerbates health conditions in particular, COVID, you know, to reach people where they were at. And once again that was something that our community residents came up with, you know, that particular strategy and the activity, you know, so and we had tremendous success with that as well.

Dr. Yabo Beysolow 16:25

Definitely sounds very impactful. Very impactful. So, let’s switch gears a little bit Ebony. Stan has shared some of the great work that you’ve been doing. What will you remember most about the last two and a half years?

Ebony White 16:50

It’s so much, but I’ll say that outreach was critical for us and we had to have organizations and partnerships that had the courage at a time when no one wanted to touch anybody and we were very isolated, to go door-to-door to knock, to go back again for us to properly engage and equip our community members.

So, these past two and a half years showed the courage of my community, even with all of the despair that was happening around us, there was still the troops, the boots on the ground I refer to as, that we’re willing to go door-to-door. Every door, you know, all the way with flu vaccines and making sure, and then working and finding partners that turned healthcare on its head.

No more was it coming to the brick and mortar and them saying “we’re willing to go out.” Those mobile units were not just parked at selective places, but those mobile units said “You tell us where we should be” versus us making a plan and hoping you’ll come. The importance of canvassing a community, knowing this part of the town is a little upset, or this part of town feels like they’ve been neglected.

However, when you bring that vaccine, bring some food. When you bring that vaccine, bring some toiletries because we have a need in regards to toiletries. So, we, we took all of those things into account, but it’s the courage of my community to keep going. When we were doing trainings and everything was hybrid, right? So everything is virtual. They don’t know us, but they knew the person that knocked on the door and they trusted the person that knocked on the door that then in turn trusted us to impart information into them. Those providers that are medical students that said, “Hey, we’re willing to come and hear what you have to say, because you have the, the voice of what the community has shared” and how they feel like that there’s a split and there’s a miscommunication.

So we played a major role in translation to healthcare what we needed and vice versa. So we operated as a bridge back and forth but never got tired of treading, but we continued to strengthen that bridge, and that bridge got wider and it got stronger over these past two and a half years. So there’s so many things to remember, but the courage..the courage.

Stan Martin 19:27

Yeah. Yeah.

Dr. Yabo Beysolow 19:29

Thank you. That courage and addressing those insecurities, and you said bridging those gaps, so you definitely shared a great deal there. I wanted to ask you one of your favorite moments when you felt that you may have connected with someone on an individual level to help them feel more confident about flu and COVID vaccines.

Ebony White 19:51

I’ve done outreach, I’ve done door-to-door, I’ve done, you know, different locations in my community, and over a time span, you hear so many people say, “Absolutely not.” And then you get the phone call four months later, five months later, six months later, “Can you help me?”

And when I go, will you be there? And me saying, absolutely, I’ll be there. I have held hands. I’ve been pinched a little bit. I won’t name who pinched me. And it wasn’t a baby, it was adults. And they said, do you trust them? Yes. Did you get your vaccine? Yes, I’ve waited purposely when it was time to get the next booster until it was one of the events because people were coming and they wanted to ensure that I would be there and I trusted them, that they had the willingness to do it.

So the delayed response that, you know, the, the hesitancy wasn’t a no. It was strictly hesitancy, and us being able to give them that it was always their choice. Never wanted to say, “I’m telling you” to do anything, because it was about people maintaining their autonomy and there were so many things that kind of stripped that away from them, um, that, you know, we didn’t have anything to do with, but it was important for us to maintain the integrity and relationship with our community. So I’ll say just being able to get those folks that had no desire to get a vaccine that were willing to go, because you said you’ll be there. And I’ll hold your hand. So that meant a lot.

Dr. Yabo Beysolow 21:19

Great.

Stan Martin 21:19

Certainly, you know, there are those um, some of those stories at the individual level, and over this time period I’ve seen that expand to the community response. Whereas they’ll reach Buffalo and you know, we’ve experienced a lot of trauma, you know, in our community over the past two years. And however, when the community says “Why are they here?” Not REACH, but when they are saying, why are others out here when REACH has been here, you know, all along… That right there said a lot to us because they see not not only us, but they see each other REACH their, their familiar faces and voices. As Ebony mentioned, they’ve built rapport. You know, our Community Vaccine Champions have that trust, you know, they have integrity, they have that respect, you know, so that, whether it’s, whether it’s for the vaccination of COVID or flu, or even to be boosted if they have a issue or situation that they can go to them as a trusted source, which then opens the door up for future conversations about whatever it might be. So I think that is something that I’ve seen over the past few years that have grown…just the confidence of our Community Vaccine Champions, you know, from someone go from being shy in terms of doing outreach or speaking, or who, who’s just comfortable with passing out the flyer, which is fine, to now not only passing out the flyer, now they’re, you know, they’re giving their pitch.

They’re utilizing their skills and talents on a platform on a higher level than they ever had a opportunity, you know, to do so, or even imagine. And I guess that speaks to sustainability as well. We don’t oftentimes think of it in that light, in that framework. However, those are the type of things that will go beyond any funding source.

Dr. Yabo Beysolow 23:19

That’s right, that’s right. You mentioned a couple of things that I wanted to um, you know, go further, if I may, and ask you about. You mentioned resilience in your community and trauma, and if you feel comfortable sharing, is there any particular event or events that you wanted to talk about?

Stan Martin 23:38

When you know the Tops massacre occurred here in Buffalo, you know, it was at that time when the community responded because there was a plethora of resources that, you know, and outside sources that came into our community. And the community knew quickly that those resources were gonna be gone within a week or so. The news coverage was gonna be gone within a day or two, and that, you know what, people were gonna be forgotten and left behind. Nothing would’ve changed to a degree.

So the community was very, in my opinion, my experience was very, you know, keen to that and really wanted to take ownership of connecting with each other and identifying who they can trust, where they can go for assistance, where they can go for resources, you know, not just for vaccination, but for food. Cause we are on a, we do live in a community that’s food apartheid. And maybe one pharmacy, I think, Ebony, within our, within our catchment area?

So, you know, and then you talk about limited transportation as well. So it’s one talk about the social determinants of health, you know, where you work, where you live, play, learn, and even pray, shop as well, had a rippling effect. And the community in particular, you know, was resilient in that regard. And it’s still dealing with today. So that’s why I think those trusted messengers, those, you know, having the ability to build rapport and trust, you know, is so important.

Ebony White 25:12

I agree.

Dr. Yabo Beysolow 25:13

Yeah. Thank you both for sharing. I know it still is and must have been a very traumatic time for your community and we continue to pray for healing for everyone.

Stan Martin 25:25

Thank you.

Ebony White 25:25

Thank you.

Dr. Yabo Beysolow 25:27

And you mentioned you started to touch on sustainability and all the efforts are not just for now, but what do we look forward to? How can we sustain all this great work that both of your organizations have done during the pandemic? How are you planning to sustain that?

Stan Martin 25:46

Once again, you know, looking at the way that we’ve built the capacity of our Community Vaccine Champions, you know, when the time comes for reapplication, that is something that we will highlight, in terms of the outcomes that have been accomplished, achieved, you know as a result of that. I think also you know, Ebony is, is very humble. She’s been able to create a lot of systemic changes, you know, in terms of systems creating, systems change. Working with clinical providers, you know, working with pharmacies, you know, things of that nature.

We don’t oftentimes think about or hear about or see those systems changes that are necessary, you know that needs transformation. Cause the environment has to support the behavior change that we want to see. So to be comprehensive, I think that we will continue to lean in the poor and some of the work that Ebony has done, you know, in that area with, you know uh, clinical linkages, diabetes, also addressing some of the other areas that we’ve been trying to link as well surrounding sustainability.

And also looking at, you know, what are the policies that need to change, not just systemically, but what are the policies that, that impact social norms? That impact the social determinants of health? We have endured, this community has endured, you know, for generations, for decades, but we can’t do that without the input of the community, you know, and prioritizing, you know, that application or those things with them.

Dr. Yabo Beysolow 27:10

Thank you, Stan. Ebony? Anything else to add to what Stan said?

Ebony White 27:13

Not to be repetitive, but the CVCs, the Community Vaccine Champions have been critical for us because they come with a host of skills that they already had, right? So we have from university librarians, we have teachers, educators, we have clinical staff, you have individuals in banking and real estate.

So we have this robust group that has a shared interest in their community getting better. So I think it’s been, even though their focus has been on vaccines, COVID, and flu, but it’s just so much to them, they’re just too rich. Right? They did, this is a rich group, but it comes from a rich community, right? That has all of these skills that, you know, we’re working to tailor and they’re cross-pollinated that they have such a great impact on various areas.

Raise the volume. Amplify if you will not just our work, but all of the work cohesively. So most people can’t see how it all connects. I’m a person, I see how it all connects. So even though we’re talking about vaccines, I know this applies to insurance, this applies to healthcare relations, this applies to housing, this applies to who sits in your government. This applies to policy. It’s all connected. And getting people to see that it’s all connected gets people more involved. So these times when we do Lunch and Learns, it connects them. Most people didn’t recognize when we talked about tobacco that there was some messaging they just thought they sell tobacco here. That’s why it’s all the signs and they pay. But there is messaging and how that messaging impacts our behavior.

So the more and more that we hone in, it’s an awakening, right, for our community members, and I’m just really glad to be a part of it. But the Vaccine Champions will be champions for their community throughout and they’ll continue to do so and they feel good, especially when you have a person that you want to maximize all your gifts and talents, but when you line them up with other people who want to maximize all their gifts and talents, they don’t grow weary, right? In doing good things not just for themselves, but their community at large. So, we don’t want them to ever grow weary or believe that it is them by themselves.

We’re doing this all together and you know, I get a little tired. Stan got my back, and if Stan ain’t got my back, those CVCs got my back and all of the people around me. So that’s critical for us.

Stan Martin 29:48

All right.

Dr. Yabo Beysolow 29:49

Awesome. Just that collective power that you both shared and the um, plans for sustainability. Definitely, definitely grateful to you and to both of your organizations. You mentioned the focus moving forward. Just wanted to narrow down into that focus on the importance of vaccinations. Once the pandemic is over, how do you think that will play out in your community?

Ebony White 30:14

I think it’ll play out well. So we’re in a season of, we still are getting some who had never had the first series, are just getting the first series. So one person, three years, almost three years in just getting their first series, it was well worth it, right? It’s slow, but it’s steady progress, you know? Discussing boosters because now this is a part of health promotion and all of it has always been a part of health promotion, and I just think for sustainability will continue to go forward promoting good health and what that looks like for people individually and the choices that everyone as individuals have to make. And when we make really good choices, how overall we win as a community against all of the preexisting comorbidities and all of the other things that ail us that we don’t have to live with, but we kind of make a choice to live with and we can choose the other way too.

So, I’m just very optimistic about our work going forward.

Stan Martin 31:15

Yeah. And I would, I would just add to that in terms of certainly we would want to sustain and replicate our, you know, community engagement strategy that Ebony described so eloquently. And also I would want to hope that for those who are listening, you know, I would want to sustain the relationship that we have with iREACH.

Having a repository, I think that’s the word, yeah, of resources and that will allow us to not only build our capacity but to also share with our community, you know, has been invaluable. So I can’t underscore enough in terms of having, you know, having that support and access to resources, tools, you know, information in a timely manner, in real-time, you know has been a tremendous asset to our community.

Imma say for our community, not just Ebony and I, and something that we rely on and, and utilize on the regular. So, thank you.

Dr. Yabo Beysolow 32:15

Well, no, thank you. You are the ones doing all the work on the ground, and we’re happy here at Iris should be able to provide you that support any way we can. And I’ve just really enjoyed today hearing about all of the incredible work in the systems. And provider level, individual level changes that your organizations have made to build trust and improve health in your communities. Any last parting words for our audiences, and I’ll start with you, Ebony. Any last parting words?

Ebony White 32:46

This is good work. This is great work and I think I reach for, again, for all of the space, the safe space, the subject matter experts to really help us in our setting and how all of this is very transferrable to other communities that look similar to ours. So I just hope that everyone still feels encouraged to keep going and staying motivated to do this.

Dr. Yabo Beysolow 33:12

Thank you. And Stan?

Stan Martin 33:14

I would say many hands make light work. You know? And to really, in that same spirit, you know, to be authentic, to be genuine, to provide opportunities for success, you know for engaging the community, meeting them where they’re at, you know, that amplifies their skills, their talents, their interests, their knowledge is invaluable to doing this work. So thank you for the opportunity to be with you and to speak with you all today.

Dr. Yabo Beysolow 33:45

Excellent. Excellent. Well, it has definitely been my pleasure chatting with both of you today. And again, we thank you for all of the work that you’re doing in your community. So with that, we’ll say goodbye. Thank you.

Ebony White 33:57

Thank you, Dr. Yabo

Stan Martin 33:58

Thank you.