SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I'm Sarah Hexem Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium. As part of our housing as health series, we're going to spend this episode learning from two registered nurses who specialize in community health work with public housing residents in Chicago.
They'll share with us how they've implemented a streamlined COVID-19 vaccination system at six different sites within the city's public housing communities, and how now they're adapting to meet the growing demand for COVID-19 testing. Joining us are JoAnne Ivory and Dora Loya. They work together at TCA health, which has been a longtime fixture on the Chicago south side. Dora is the Director of Clinical Services of JoAnne is the Clinical Manager for TCA health.
The health organization started out in 1970 as a private clinic at one of the city’s public housing developments. And by the early 1990s, TCA had become a non-profit health care center and a Section 330 Community Health Center and Public Housing Primary Care grantee. Since then, TCA Health has significantly expanded with other locations, but still runs its main clinic and administrative offices next to the Altgeld Gardens-Murray Homes.
Welcome JoAnne and Dora to At the Core of Care.
JOANNE: Hi, how are you, Sarah?
SARAH: Great to have you.
DORA: Hi Sarah.
SARAH: We'd love to hear first about each of your journeys into the field of nursing and what led you to the position where you are now. So Joanne, can you start us off?
JOANNE: So yeah, my journey, my passion for being becoming a nurse started I think when I was in seventh grade, and I think it's just because I liked the lab coat that my science teacher was wearing. Then when I go home, my sister was a candy striper. And I was like, Oh, that's pretty neat. So that's when I first thought about being a nurse, to be honest, but from then on, it just kind of stuck in my mind. I liked helping people I know that's so cliche. That's what all nurses are people in health care, say, but I was really more passionate about killing people, I thought I had the power to heal. I really had a passion, I think more so for outpatient nurses, nursing, which is been my forte, and my nursing career. Because I like seeing people helping people to be able to get on their feet, and barrel through life, I should say, with maybe some of the medical conditions that they have, making sure that they are able to control and maintain their illnesses, and not really seeing them lying in a hospital bed. So that's pretty much been my journey through nursing, of course, I entered on into management. So I'm not so much on the floor anymore, but it gives me an opportunity to teach the newcomers, the new medical assistants, the new nursing students, and everyone the, the process and the ability to help people so and that's where I’m at today.
SARAH: Great. And how about you, Dora?
DORA: So yes, my recollection that I have, as I'm wanting to become a nurse, started at a federal funded clinic as well. My parents came here from Mexico, and that was how we obtained medical care. And we had this nurse that was just so giving and loving to us who we hardly spoke English. And I just couldn't understand why was she so nice? Why was she taking care of us, and we weren't even paying for services. So it was, it was just hard to understand as a little girl, thinking, and so as I grew up, went to college, and started exploring different ways of four different ideas of what I really want to do. It kind of just brought me back to back then. And I said, I want to really do something that is going to affect or change someone's life, or I want to be part of a memory like that. I don't know where that person is, or what happened to her. But, I mean, it's still well, 40 years later, and I still can think of her. So I think that's what I wanted to do. I wanted to do something that was challenging, and something that I knew that was going to change or impact someone's life in some way or another.
SARAH: And before the current pandemic, have you ever experienced working as a nurse during another major public health crisis?
JOANNE: Well, the only thing that comes to mind for me is the swine flu. I don't know if you remember that. I think that was somewhere back in 2009, the h1N1 where everyone had already received their seasonal flu vaccine, but then all of a sudden, we got this new variant that just started the swine flu. So there was this influx of people rushing back in to get this second shot for the flu vaccine. So but other than that, I've been fortunate not to have lived through another pandemic, maybe but I don't remember, I won't tell my age. But way back when I'm sure there was another pandemic smallpox or what was it? I'm not sure but I'm too young to remember that. So the H1N1 is the one that comes to mind for me
SARAH: How about you, Dora?
DORA: I would say this swine flu too as well, and SARS back in 2004. It was it was kind of a big deal back then. Because it was it was kind of new, it really was giving this respiratory, upper respiratory infections and it wasn't as big of course as COVID. But it was definitely affecting a lot of people. And at the beginning, people didn't know what was going on what was happening. So that alone just makes everyone so scared.
SARAH: Can you take us back to the early days of when TCGA health finally acquired the COVID-19 vaccines and your organization started to administer vaccines in the community? Can you describe for us the first vaccination clinic you set up in a public housing site in Chicago? What were the considerations you took ahead of time to plan and what did that look like? That first vaccine clinic?
JOANNE: We can start when we first received the vaccine here at TCA. So of course, all the nurses here and all the medical staff, we were all the quote unquote, guinea pigs, like you get it first, you get it first, or you get it for years before I get it. And then it kind of went out in phases. So we received the bags, I think the vaccine started in January, or a little before that, I believe TCA we received it in January, like the mid to late January. So and it came out in phases, so everyone wasn't able to get the vaccine. So we didn't really do a lot of outreach for the Housing Authority, because all of our patients, of course, as everyone knows, they were coming from everywhere, because only limited clinics had the vaccine. So people came from all over the city of Chicago to get the vaccine, they didn't care, you know, where they live. But about March, I would say, we started reaching out to our community, of course being here in Altgeld Gardens, we kind of, you know, reached out to the residents. Because they of course, were experiencing the barriers to receiving the vaccine, because they didn't really have anywhere to go. So we kind of partnered with the CHA health team to make sure that we were able to host an on-site or inside the garden community building for the residents to come and get the vaccine. So that was our first vaccine clinic, we did have that at the Altgeld Murray homes where we kind of we have a wonderful outreach team. They kind of reached out, we able to go through our medical records and kind of see where people live their demographics and reach out to them via text message and say, Hey, we're going to have a clinic, come on by and where it was put out flyers, those kind of things. So that was our first CHA housing event for the vaccine.
SARAH: I was going to add one clarification of for listeners, just that CHA stands for Chicago Housing Authority. And about how many people did you have at that that first clinic?
JOANNE: So the first clinic, we did pretty well. We tried to have people register first. So I think we had maybe 15 people registered. But then when we got there of course we accepted walk in so we wound up with something like 30 people which we thought was really great because vaccine hesitancy is rampant. So it was kind of like wow, you know, we have people out and trying to encourage people to come on in and get the shot. So I would say about 30 people at the first clinic.
SARAH: And then what would you say became some of your best practices. So that was that was the first clinic you went on to do many more? What did you learn from that first time?
JOANNE: And so I'm thinking back, word of mouth was really helpful. Because you know, once you see that your friends received it. It kind of helped with the hesitancy. It's like oh, it didn't hurt. Oh, You know, I didn't fall out, Oh, I didn't, you know, all the crazy things that people have been hearing on social media. So you know, I survived, you should come and get it. So they would go back and they would tell their friends and sometimes their friends even followed us to the next clinic, like say, for instance, that we finished up early, like we finished at three and they were late to the party, they were you guys going to be next. And then they would come over to the, to the next housing, housing project to get the vaccine so that word of mouth helped a lot.
SARAH: And how about you, Dora? What else did you observe in this experience?
DORA: So I think just learning from all the first time events, learning how to, you know, schedule prep for the timing, just trying to figure out how much staffing do you need? How much time do you need? How many vaccines do you need? The bringing of the vaccine if the vaccines is so important, because you know, they have to be refrigerated, certain temperature. So I think that JoAnne and the nurses learned so much from those first events, because they were the ones giving the vaccinations just prepping. And you know, when you're planning an event, you yeah, we're planning it, but it's so different from experiencing it being there. But I think that we just try to do the best that we can.
JOANNE: And also, I wanted to add to that, thanks for bringing it up Dora, that also knowing what vaccine that people wanted, you know, because there's three vaccines, you know, you had the Moderna, you had the Pfizer, you had the J&J and just making sure that we had the sufficient vaccine or, you know, maybe doing a poll to find out what vaccine people were interested in, to make sure that we have the right stuff.
SARAH: And based on how TCA Health performed, the Chicago Housing Authority actually invited you all to become the main COVID-19 vaccine provider, I believe, serving about six different sites. So can you tell us about that?
JOANNE: We kind of work with the Chicago Housing Authority’s, Assistant Director of Clinical service services and the resident services, to plan, the best way to engage and educate the patients and to schedule them for the vaccine. So we expanded to the south side. So like I said, we started here at Altgeld Gardens. But then, of course, with working with the director, we reached out to all of the Chicago Housing Authority complexes and they kind of set us up, you know, again, you know, for word of mouth for what we did here at Altgeld and how we can set up the clinic inside the complex where people can just come, they don't have to, you know, travel or get on the bus or anything, just come down to the community center or the community home and we will administer the vaccine, the first dose and the second dose, and we also even reached out you know, it was really helpful because we were able to even knock on people's doors like say for instance if they made an appointment, and they didn't show up because appointments really helped. It really did. And they didn't show up you know, of course we had the assist from the residence director so they can say ‘oh well you know she lives in apartment 5B, so we can go and knock on the door we can say hey, you know you were supposed to come for this vaccine and tell what happened. Oh, and all that stuff. But we're still here. You know, we'll wait for you. And they would we didn't we didn't get a whole lot of pushback. They actually came. So it was it was really a great experience. So I think from there we did, we went all over. So it was just the south side. We went to the south loop, we went to the suburban areas.
DORA: I just think that it's so important to make sure that this residents have access to the vaccines. And as JoAnne said we're coming to their homes. So it's, you know, either at a lobby, if it's an apartment building, or at a hallway, wherever we can be, we will be there. So it's, it's just, you know, we're trying to just gather and get as many people as we can, and if we're able to travel and get there is the best thing that we can do for the community.
SARAH: What were you hearing and seeing, or what maybe you still hearing and seeing in terms of the ability to participate, you know, online or some of the signup portals. Were there challenges around that that you saw?
DORA: So I think with our communities is more so of the older patients, they have no access to Internet. Sometimes, they are at apartment buildings that they have no access to, or even a smartphone to be able to register online. I mean it's difficult for retired older citizens who need the assistance, but they can't do it for themselves. So that has been one of the challenges that we encountered as far as I know. What do you think, JoAnne?
JOANNE: Yeah, I agree with that. So mostly, I would say, that will be the challenge, is people registering via the internet. But then again, like I said, the young people, they didn't really have that big a problem, because, of course, everybody nowadays has a smartphone. And with us actually going to the site, they didn't have to worry about transportation, even though TCA does offer transportation. They didn't have that barrier. I mean, we were right there right there on site, you know, at the great hours, so we get there early, we were there through lunch, we tried to stay as late as possible, so that if anyone had to go to work, they can come by once they got off, so it was so there wasn't a whole lot of barriers other than like, like Dora mentioned, for the older residents just signing up online. But that was the great thing about you know, it was not a requirement, you can just walk in and sign up in person.
SARAH: And then in terms of the operation, you know, when you were really scaled up to those six vaccine sites or more at this point? How many nurses were you deploying to vaccinate? You know, how many people were you vaccinating per day? Or per one of these clinics?
JOANNE: Given the vaccine is not the most labor intensive thing you know, so we can deploy one nurse who can possibly give the 100 vaccines, but then you have to have the other personnel to do the evaluation. Because of course, once you get the vaccine, we evaluate you for 15 minutes. So we follow all the CDC standards. So you did have to social distance. And you did have to sit and wait for 15 minutes to make sure that everything was okay, before we would discharge you. So one, one nurse and a couple of evaluators. Someone to do registration of someone to do outreach. Sometimes we gave we had giveaways. So someone to do that. So pretty much I would say two medical personnel, and then mostly other administrative support.
SARAH: So you already shared a little bit about that spillover effect of having a vaccine clinic where people live and how that may have addressed some vaccine hesitancy. And you know, also speaking about really, you know, we talk a lot about how nurses are trusted messengers, but really thinking about, you know, TCA health as being this part of the community that is a trusted messenger. So I'm wondering if there are any stories that stand out to you in terms of how that actually looked in practice.
DORA: So I think I heard this story from you, JoAnne. And I know that was the one guy that was following you guys from site to site to see because you want to see other people getting vaccinated and make sure they were okay before he agreed to get a vaccine. So in other words, he followed them around for like two or three different communities to make sure to just to see what the people look like, after they get the vaccine. And then once he confirmed it, guys that Oh, they're doing good. There's nothing happening to them, then he decided, Okay, I guess I'm going just give in, and I'm going to get my vaccination today.
JOANNE: Yeah, and at the last minute, he waited to the very last, like, we're packing up to go. And he's like, Okay, I think I've got to do it. Okay, that's cool. Most of the vaccines that we administered, everyone, people returned for their second dose. So it was it was great.
SARAH: And so now obviously, you know, vaccination has started to slow. So how has that been impacting your operations? I know you're transitioning into more and more COVID-19 testing? What does that look like now?
JOANNE: So yes, it has definitely transitioned. I mean, we still have people coming in for the vaccine, which is great. But of course, we have double the amount of people coming in for the testing. And that could be because a lot of jobs are requiring it. Of course, the schools are requiring it. So you know, once a child is exposed, you know, we have families coming in with, you know, five and six kids just to be tested. But of course, these are also young kids under the age of 11. So we hopefully that will change once Pfizer approves for the younger kids to get the vaccine, we won't see as many people coming in for testing. And then with the mandates going on, the jobs requiring the vaccine, and if you don't have the vaccine, you have to be tested. So I think that can account for some of the increase in testing. But we're sure hoping that that's going to turn around again. So that we're doing two tests, three tests a day and 100 vaccines. That would be great.
DORA: I think JoAnne, I want to just support what you just sad. We unfortunately, as far as the testing goes, we're just getting like massive amounts of school age, children coming in to get tested, where if they have a little cold or runny nose or anything, the school would just let them know, like, No, you can't come to school. So then they have to come in and get tested, we provide free testing for all. So we have lines and lines. I think we tested about 60 people just in one day. And a lot of them like JoAnne says they're very young kids all school age, or people who also call in from work because I'm not feeling well. I have body aches, I have flu like symptoms. And of course right away, they tell you to stay home. And so in order for them to return to work, they have to have a COVID test approved that they were tested. And we're trying to work on the vaccination status, unfortunately we're not as busy as we were before. JoAnne is absolutely correct. We are doing more testing than vaccinations right now. But we're still catering to the community. So that's, you know, that's a good thing. We're hoping that things will change.
SARAH: So where are you testing mainly? Are you using the vaccine clinic approach again, or are they coming into the health center?
JOANNE: Oh, no, we are definitely keeping our vaccine clinic open. So when people come to get tested, we try to encourage that they can get vaccinated, you can still get vaccinated inside. Most of our testing is done outside. We do have a pod at our center for outside testing unfortunately, you know, we still have a COVID restrictions like most places, so we don't really allow you to come in without a screening. So we do screen everyone for COVID before they enter the building, but in order to make the process a little more seamless, you know, we can't screen the amount of people that are coming for the testing. So I mean, we basically do their temperature. We do now have a provider who will do the screening questions, but we do have a pod outside. So it works. But the Winter is coming. So we will probably be making some changes to that. But the vaccine clinic remains open during the testing, because we still encourage people to come in and get their vaccine. And they don't need an appointment, they can make a same day appointment.
SARAH: And have you had any success with that someone coming in to do their mandatory testing? And then I said, You know what, I'm tired of all this testing, I'm going to get vaccinated.
JOANNE: Yeah. And I and I always push that I'm like, aren't you tired of having this thing, stick up your nose, just get the vaccine. And I actually have a story. I talked to a police officer, because police officers, they come in their squad car, and they get tested as well. And I asked him, you know, why are you being tested? Don't the Chicago Police Department require you to get the vaccine. So he gave me this whole big thing about how he didn't want it. He even told me that his dad had COVID. And I was like, Well, didn’t that scare you? Or didn't that make you concerned? Don't you and his dad had passed from COVID last year. And he really talked about it. And I kept saying, Well, of course the first thing they ask is did you get vaccinated? Of course, yes, I got vaccinated. And look, I'm still here, standing here talking to you about it. And I talked to him for a long time. And he kept he was saying no, his partner was still sitting in the car. And then as I went out to give him the results of his test, because we do the rapid tests, which was 15 minutes, he said, You know what? I think I'm going to do it. And I said, Great. Come on. So I walked him in, and he actually got the shot that day. I was like, yay, tell your friends.
SARAH: Have there been any other stories about vaccine hesitancy that you would want to share? Like what, you know, what are the sticking points? What are you hearing from the other members of the community?
DORA: I hear so many different stories, oh, my God it’s just unbelievable. Anywhere from the government is trying to put a chip on us. So they know what we're doing where we are, what are we talking about? Another one is, of course, there hasn't been enough research to prove that the vaccine is a good thing. It just like, the government just passed it so fast. And normally, medication takes years and years for them to do a research for the FDA to get it approved. And now with this thing is like, within 12 months, we had a vaccine or 18 months, we had something for it. And so people feel very hesitant about that. They feel that, you know, with any other medication it takes forever and ever for the FDA to approve it. So how can this went through so fast? Why? Why is it? Is it because the government wants you to do it that way? And that's the way you know, it's all a government conspiracy of all things that they're just scared. I think they're just very scared. A lot of it is lack of education, too, as well. And as I said, and that having the right information, given to them and just feeling that everything just went about it too fast. And they're feeling that it’s just not the right thing to do right now.
SARAH: And so what do you say when that comes up in a conversation when they say, you know, it came to market too fast? How do you how do you respond?
DORA: So my number one thing is, well, you know, all the vaccinations, we have a flu vaccine, right? And sometimes every year we have to come up with a new vaccine, because there's different strengths. So like the flu vaccine is not the same one every year because you kind of have to kind of go and research it and see what strands of the flu we want to get. So think of it that way. But when it comes to medical terms, it's very difficult for people to understand it unless you talk to them in layman's terms or speak to them in a language that they can understand.
JOANNE: Sometimes when I'm helping with the testing, I like to challenge people, you know, I'll ask them, why do they not want to get the vaccine, and like Dora said, the most thing is that they don't trust the government. And then they say things like, well, the vaccine came out too fast. And sometimes I will even challenge them. You know, I always let them know this is just conversation, I just want to know what you guys are thinking. Then I ask them the question of where did you hear that information? Because I'm always curious to know that you get that from social media, did a friend tell you that or do you know somebody who experienced that? Did you get that from a healthcare professional? Most people say they heard it on social media.
SARAH: So switching gears a little bit you know, just looking back on the past 18 months now has been incredibly stressful for everyone and especially nurses and health care workers. So how do you manage that personally, for your teams, in your health centers? What does that look like for you?
JOANNE: Just encourage safe practices. I mean, that's all we really can do. You know, we have all the proper PPE for all of our employees and staff, just to make sure that we do all the right thing sanitize make sure we're social distancing as much as possible, requiring people to wear their masks properly over their face over their mouth and nose. And just you know, being careful.
SARAH: And how about you, Dora? How have you sort of experienced stress or found ways to manage this really challenging time?
DORA: So I think TCA has done a good program in regards to that. We've had some Fridays, half days off to just kind of like regroup as a group, and talk about different feelings or just engage in other activities other than just work, work, work, because sometimes that can be very stressful too. I think that the employees, they feel good about that. They feel good about taking some time off, and just being even if it's two hours, two and a half hours off, where they can just focus on themselves, play a game, or sit around a circle and talk about what's bothering them, or what their feelings are. I think that has helped a lot. I'm just making sure that we just let them know that they're so valuable to us that their work, what they do every day, that we couldn't do it without them. I think that makes a huge difference too when people feel they’re being valued. And so I think JoAnne, and I try our best to do that every day.
JOANNE: Yes, thank you, Dora. Well said. And also our CEO and administrative team, they do provide us with all of these fun activities, to kind of break away from the stress, you know, you’re going to have a good Friday off where you're going to play games and not be worried about it. And you know, of course, are where we are located in the Altgeld Murray gardens, we have such a great field, I don't even know what to call it now. Like we have all this grassy great area, where we can actually do a lot of things outdoors. So you know, we can feel free, and social distance and have fun. So it's been really good.
SARAH: But I'll just open up, you know, if you had anything you wanted to add about your hope for how the pandemic would shape healthcare, or really just any other final words?
DORA: Trying to remind healthcare workers to really work on a lot of communication with your patients. And not to judge them in case they do decide not to get the vaccination or if they decide to deny certain medical treatment. I think that at the end of the day, everyone has the right to accept or deny any medical treatment. And as healthcare providers, we have to just be there for whatever their needs are.
SARAH: Joanne, Dora, thank you so so much for joining us on At the Core of Care.
DORA: Thank you for having us.
JOANNE: Thanks for having us. I really appreciated it. And I hope our conversation helps someone out there that's listening. And thanks so much for having us.
SARAH: Funding for our special Housing is Health series comes from the Center to Champion Nursing in America, which is a joint initiative of the Robert Wood Johnson Foundation, AARP, and AARP Foundation.
Special thanks to our partners through the National Training and Technical Assistance Program at the National Nurse-Led Care Consortium.
At the Core of Care is produced by Stephanie Marudas and Emily Previti of Kouvenda Media and mixed by Brad Linder.
I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.