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 health-care needs of patients, families and communities.
I’m Sarah Hexem Hubbard with the Pennsylvania Action Coalition and the Executive Director of the National Nurse-Led Care Consortium.
As part of our special vaccine confidence coverage, we’re taking stock of the latest vaccine confidence trends and some of the lessons learned so far during this public health emergency.
On this episode, Annette Gadegbeku is joining us for a community-health focused conversation regarding her work to promote vaccine confidence.
Annette is a family physician and an associate professor at Drexel University in Philadelphia. In addition, she holds various leadership positions at Drexel, including being:
Our producer Stephanie Marudas spoke with Annette.
STEPHANIE: Thanks Sarah. Annette, welcome to At the Core of Care.
ANNETTE: Thank you for having me today.
STEPHANIE: So here we are recording this conversation. It's January 31st, 2023. President Biden has made inklings that the end of the COVID-19 Emergency could happen as early as May. Where are we?
ANNETTE: Yes. That is an important announcement that will come. And things have definitely evolved and changed over the years with COVID. And it's important to still be aware of the virus, its risks, and how to continue to protect ourselves, our communities, our families, our patients and those that we serve, um, even more now than ever.
STEPHANIE: Yeah. And you, from the get-go, when the pandemic hit have been very active in various initiatives. And we'd love to hear about your experience, in rolling out some vaccination and testing initiatives at Drexel, that helped serve the community. And specifically at the Dornsife Center for Neighborhood Partnerships where you helped oversee the launch of mobile clinics.
Can you share with us some of the key community health lessons learned about rolling out these types of initiatives?
ANNETTE: So, previously, I was medical supervisor at the Dornsife Center’s Community Wellness Hub. I was there for several years prior to the pandemic. And even then, I learned about how to really assess and address the needs of the community through developing programming that was important to the community and the community's health surrounding the center, and particularly Drexel. As we study and work and learn in that community, we need to partner with the community that we are neighboring and also serving and important to learn from them as well.
So, some of the lessons learned about just implementing any community initiatives, service, programming, whatever it is that one chooses to do, it's really important to hear the voice of the community and to build trust. I think if I could whittle things down, there's so many things that are involved in this work, but if I could put at the very top is hearing voices, and building trust.
And what does that look like? It can vary, definitely. But understanding that this is a partnership, in that we are here to learn from each other, work with each other and to provide service and learn in the best capacity that we can with each other to provide the best health opportunities for our communities.
Some of the ways that we did this at the Dornsife Center Community Wellness Hub, under first Dr. Loretta Jemmott, who came and did a very comprehensive assessment of the needs. That is usually one of the first steps in any kind of community engagement. We, as particularly healthcare professionals, we like to think that we know and we like to do good things. We sometimes get ahead of ourselves in thinking we know what's best for communities and others, but it's really important to pause there and to really hear the voices and assess the needs and find out what has been done. What has not been done? What has worked? What has not worked? And how the community wants to assist you in implementing the wonderful ideas that everybody has in serving and utilizing the community. Not just going in, putting something together, implementing something, particularly going in making changes and then leaving.
And that leads to just building trust. And how you do that is just having multiple conversations with key community stakeholders. Community leaders, those who are already trusted in the community, whether they’re civic engagement leaders, whether they're pastors, block captains, whether they're already community health workers in the neighborhoods. And getting that validation that we are to be trusted and we are here to truly help and partner with the community to provide a service.
We did that also by having some weekly sessions at the Dornsife where people could walk in and ask questions. We called them Ask the Doc, and at one time we did have a nurse there. So Ask the Doc, Ask the Nurse sessions where people could walk in and ask their questions and get consultation and ask about medicines, ask about their health, ask about their numbers. And then we expanded that to some physicals, especially providing physicals for people to have employment, employment physicals, and get the tuberculosis screenings with PPDs.
We also had some community health chats. They were started out in person and then of course continued as the pandemic hit and continued. We transitioned those to virtual health chats. But these were sessions that were available. And I think we started them virtually, even before the pandemic, which was truly helpful because that was already established and people didn't have to make such an adjustment to attend these sessions.
But these were sessions where we would provide information, have some experts or consults and provide a platform for discussion for anybody who would like to join, to learn more about their health, learn more about health conditions, about wellness, various topics. And then got to see, um, again, a familiar face and a consistent face.
One of the other keys to community engagement is being consistent and showing up. And so, when people got used to seeing, I think, me and others, they knew who we were and maybe hopefully felt that we were giving great information and wanted to come back week to week to hear more.
And then, we were also a face that was in person that they could come to the Wellness Hub to see and to ask questions. So I think those were important steps and foundations that we established, particularly at the Dornsife Center, to build that community, to build relationship, to build partnership, and most importantly to build that trust.
STEPHANIE: So what we're hearing here is a multi-pronged approach that combined in-person events, virtual events, consistent events to build that trust. And to go back to one thing that you said about, early on the comprehensive assessment of needs was happening, learning what didn't work in the past and what did work. And here we were in the pandemic, pretty urgent, you know, to figure out, okay, how are we going to do this right? Curious to hear what some of those things were that hadn't worked in the past and where you could tread some new ground.
ANNETTE: Yeah, I think some of those things are just reinforced in what I mentioned. What definitely did not work and does not work is coming in, kind of feeling like, particularly as a large institution and a university, we're coming into your community, we're coming into your space, we're taking over, we're doing things and leaving or not following up.
And most importantly, too, we're collecting information, right. I'm talking about needs assessments. So we're surveying, we're asking questions, we're doing these things, but then the community doesn't hear back on what we've assessed and then what are we going to do about what we assessed. So that was really important and I think key, particularly at the Dornsife Center, in going back to the community, presenting what it is that we've learned, and how we're going to help. Proposing how we're going to address and then actually addressing it. And showing that we're here. One of our slogans is, ‘we're here because we care.’ But really not saying that in just words, but doing it in action.
So, that was one thing that was made very clear from the community voices that they did not want us coming in here. Doing things, disrupting their lives, giving hope, all those things and not being sincere. Not being consistent and then not really developing relationship and partnering and that means having continued conversations, not just getting that data and getting that information, doing something with it and moving on.
They wanted to be a part of the process. They wanted to have their voices heard. They wanted to know how they could be involved. And so, the things that we've done, we've definitely tried to incorporate the community and partner with them in anything that we do and listen and act on what they've said.
STEPHANIE: So, really creating this level of transparency, maybe transparency plus agency at the community level. And sort of segueing to the launch of mobile clinics as one of the solutions, is that something that came up as, you know, needing flexibility and sort of meeting that need to meet people where they are.
ANNETTE: Exactly. In my work, I’m a huge advocate for meeting people where they are. And as I continue to do this work, I continue to see where disparities and gaps are widened because of whether it's access, whether it's trust, whether it's misinformation, whatever it is that prevents the opportunity for people to engage with the healthcare system. And people are, are just not always coming. Even as we address those barriers, to come to our centers, to come to our offices, to come to our hospitals. There's some level of either hesitancy or inability or even a lack of desire or trust to go.
So, I believe how we can start to deliver healthcare services and support and education, counseling, all those things is to go meet people where they are. And not keep waiting for people to come to us because there's still going to be a subset of people that are not going to come. And so, yes, that was one of the basis for developing these mobile outreach, particularly for testing and vaccination through our mobile team during the pandemic. Of course, another motivation was just seeing communities, particularly those black and brown, and especially black and African-American communities in our own city, having higher rates of COVID infectivity and lower rates of vaccination when vaccines became available.
And knowing the statistics of the higher morbidity and mortality of our community, really being impacted from this virus. And I think with what I mentioned about what we had developed at the Dornsife Center, luckily we had already kind of had that foundation and so we were able to expand on that and use that foundation and the platforms that we had already established to hear the voices, to hear the concerns, to hear the questions, and to have a platform that enabled us to deliver good information, trust and information. Timely information and dispel myths and misinformation during a grave time of uncertainty and fear and anxiety and mistrust and distrust.
And so, we were given the opportunity by applying for a grant through the Department of Health in the city of Philadelphia. They were calling for people to propose programs to help with the disparities and what we were seeing and the impact of COVID. And so, I wanted to bring services where they were needed. So, we assessed our communities. We found that around our neighboring community were areas of that high infectivity, low vaccination rate when vaccines became available. So we wanted to make an impact in those areas and try to eliminate the barriers for testing and eventually vaccinations. So, we set up shop. First, we set up right outside on the lawn of the Dornsife Center in the parking lot. And we just showed up, and we showed up consistently week after week to provide testing. And we saw our numbers grow over time and definitely boom and explode during the surges that we had during the pandemic.
And so, we used that philosophy of meeting people where they are, showing up, being consistent, seeing where the need was and addressing it in the best way that we could find and know how at that time.
STEPHANIE: So in partnership with the city, you were able to launch these clinics, to address access issues as you indicated. And to actually run the clinic, what did you have to do? How did you staff it? Like what were the operational logistics that you also had to manage? I'm sure that takes a lot of coordination and what did that involve?
ANNETTE: So, luckily, we had the funding from the Department of Public Health in Philadelphia. We used that funding to, you know, hire staff, a team of testers. We had a program manager to help just coordinate the activities. But what was our pride and joy, I think, of our team was actually our volunteers. We utilized student volunteers from across the university. We had medical students. We had nursing students. We had public health students. We had undergraduate pre-med students, and other graduate students that came to help and volunteer in whatever way they could. Whether it's helping with registration or flow or giving out education materials.
We also had family medicine residents cause I'm in the Department of Family Medicine, and we made this actually a part of their community medicine curriculum to go to the sites.
And it was me and another physician, Dr. Ted Corbin, who is now moved to another university, but we particularly established the site at the Dornsife Center. Although we had other mobile sites in other areas, particularly West Philadelphia and other sites. But we were key, not just because we were doctors, but actually because we were African American doctors. And I think that held a lot of weight with the community. And thus, we also targeted our volunteers. We accepted all volunteers, but most of our volunteers were of the underrepresented communities. And, interestingly enough, we found that our participants that came through our testing and vaccinations very much mirrored the demographics of our volunteers. So, whether that's coincidence, I really actually don't think so, but I think it definitely was a contributing factor.
So, yes at first, we just had very meager operations. We set up tents, tables, chairs outside. And then, eventually as weather started to become a factor, we were able to secure a space within the Dornsife Center indoors.
And we had a place to have our testing and a place where people could wait for their results. And the biggest thing was it was free. And it was free because at that time, testing was free for everybody without insurance. And we had the supplies and we had the testing materials. We partnered with the lab, with LabCorp if we needed to send out any kind of specific P C R testing, depending on the situation of each individual.
So, I mean basic operations, and not to say that this was novel. We weren't the only ones in the city. I acknowledged that doing this. But there was not a lot. And at one point we were maybe one of very few and even only at some point during the pandemic, in our area that was providing free testing. And that was key. That was important as well.
STEPHANIE: It's interesting because throughout the past few years when we've been doing COVID-19 coverage on At the Core of Care, some issues have come up about how there were limited opportunities for residents or younger training medical professionals. So this clinic, this seemed to be able to amplify in a way where you maybe wouldn't see otherwise.
ANNETTE: We did, and that was one of our goals. We had some stated goals, of course, to meet the needs of the disparity we're seeing amongst the community for COVID. But we also heard and felt the desire of our health professional students wanting to help.
And the students’ across the city, experiences were varied depending on their institution and what they were able to do, what they were allowed to do, what they wanted to do. But Drexel is a very civically engaged institution. Our students wanted to be out there and wanted to help. And there were very limited opportunities for students to do this community engagement safely. And there were a lot of concerns about exposure for our students and liability and things like that. But yes, we were not only able to provide a service for our community members, but we were also able to provide an opportunity for students to serve, to give back, and again, learn from the community and the community members that were coming through.
And they learned to, not only how to engage, but to speak to people. They had to be up to date on their information. We were able to teach them as the guidelines and recommendations changed throughout the pandemic. You know, they were very engaged. Were asking questions and learning from us and learning about what people were coming with when they came in terms of their fears, their questions, their myths, and learned how to address those with the community members as well. So it was a great experience, I think for everyone.
STEPHANIE: And we could talk more broadly now about vaccine confidence, but to sort of make the connection here, a point that you raised about a lot of the volunteers mirroring the population coming through the clinic. And that's another theme certainly we've talked about on this podcast over the past two years about trusted messengers. And being able to relate to somebody who might be like you and having that connection. And I wonder what you and your colleagues learned in terms of vaccine confidence, through the clinics and other ways too?
ANNETTE: We definitely saw the vaccine confidence increase over time. With lots of conversation, either through our chats or conversation at our site. We had many people coming back frequently or repeatedly for testing. So we had a lot of repeat participants, whether it was because they needed a weekly test for work or they were repeatedly concerned about exposure or whatever. And so we definitely used, as vaccines became available and we partnered with Sunray Pharmacy to provide the vaccines and kind of mirror that to have a parallel, side by side, operation with our testing and our vaccinations. So as people were coming to be tested, we would educate about vaccination. Particularly, seizing the opportunity if they were negative for their COVID test and offer, would you like to get vaccinated today? We can do that for you today. And you know, that started out very small, meager. And over time, that definitely increased. And again, we saw a definite mirror, as the surges came. We saw a surge in vaccination uptake, right behind it. And that was cool to see and to learn from and to learn you don't give up on it. Again, be consistent, persistent, not pushy, not aggressive by any means.
And it wasn't about convincing people to get the vaccination. It was all a part of education and providing good information. Being a useful resource where people are getting information and using varied resources and some not, you know, evidence-based or some not very reliable. But being a consistent source of good information where we could just provide and have the conversations that people needed to have to get their own ideas and to use what information we give to make their choice.
We just wanted them to make the best-informed decision for themselves. And we did. We saw people come. Especially those that came multiple times, you know, the first time they were maybe like, absolutely not. But then we saw it change to, mm, let me think about it. And then we definitely had people that after a few times came and decided, for whatever reason, it could have been us, you know, we might be at any time planting a seed, watering a seed, helping to prune a plant in that area. Or they may have had an experience that kind of changed their mind about what to do. But the important thing is that we were there to bounce off questions, ideas, concerns, myths, and we were there to provide it when they were ready. And we definitely saw that.
So that was definitely cool to experience. And again, people sought us out, particularly those who are underrepresented that were there to ask ‘what did we think,’ ‘what did we feel,’ ‘what did we recommend?’ And again, it wasn't about convincing, but just giving informed information for them to make the best choice for themselves.
STEPHANIE: Yeah, I mean, it comes to one of your original points of the conversation about trust and you know, if there's somebody who can come and talk without judgment and just getting the facts.
ANNETTE: It was definitely good to see the shift and the change over time. And to be able to be available, to calm people's anxieties and fears and to see a transformation sometimes. And also just to have a pleasant conversation, regardless of what the outcome is. And again, just be available, for whatever is needed in that moment for people.
STEPHANIE: Yes. And you know, on that point, people who came to the clinic might end up having future healthcare experiences with you and your colleagues for their general health. Like you said, this is not a one-off, this is an ongoing relationship.
ANNETTE: And it is definitely something that we are trying to expand upon. What was really cool is one of our student volunteers from the very beginning, she created a website, and collated important informational resources for various needs. What we saw, of course, during the pandemic was a lot of the other disparities kind of just be magnified. Whether it's financial challenges, housing challenges, nutrition challenges, all these things, just magnified for our community. And so, some of our materials were geared towards helping, addressing, directing counseling for other needs. Whether they were health needs or social service needs. And so we were able to put all of that with a pamphlet and we used a QR code to direct people to those resources that they needed. And as we are continuing the operation in a slightly different way, but we're continuing our testing and vaccination at the Dornsife, we are definitely looking for ways to expand those services to address other healthcare needs, health conditions, screenings, and providing education and counseling in other areas. One of which, we got another funding opportunity to provide M-pox vaccination, along with our operation at the Dornsife. So we are actually officially starting that this week.
And then, again, we married those throughout the pandemic as well when we would do pop-up sites. We would have health screenings, blood pressure, glucose screenings, and then also our testing or vaccinations. So we did those for various pop-up events throughout the pandemic, particularly in the more seasonal months where we were able to be outside for those community health events. You're right, it's not a one and done, it's not a one-off, it's not a one condition or area type focus. We are definitely using the opportunity as we engage with the community to educate, counsel and provide other services for other things that they may need.
STEPHANIE: Keeping that in mind, Annette, as we talked about at the top of the show, you know, the end of the COVID-19 health emergency is coming. So what do things look like now, you know, how do healthcare professionals talk about COVID-19 and vaccines as part of routine healthcare? And certainly there has been a change in people's decision to get boosted further at this point.
ANNETTE: That conversation has definitely evolved over time. What that conversation looks like, sounds like is quite different and variable. Particularly now, at this current time, we've seen people's decisions get a little bit polarized by now. There's not a lot of conversation centered around so much information or trying to assess and address people's confidence or hesitancy. Because many people have made up their minds whether they're getting vaccinated or not. And I think we're at a time where I think people have heard as much as they feel that they need to make that decision. There are still a few people that can be in between. So, I think having the conversation is still important. Bringing it up is still important and I'm going to say how and why in in a minute. But just addressing where people are. I think people are a bit in a state where they kind of know what they want to do. They're pretty confident in what their beliefs and their comfort level is on the vaccine.
However, with every change, with every shift or transition, there brings more opportunity to have those discussions again. Like, this season, for example, we know that COVID increases during the fall and winter months. And so, we have other vaccines like the flu that we tend to offer and have conversations about.
And people are getting sicker during those months. And those are opportunities to have the conversation or when the new booster came out, that was an opportunity to have the conversation. But, I think shifting even away from situational conversations and making them more routine I believe is the way to go. That way that we're moving and the way that we should go. We know now that COVID is here and it's not going away. What it looks like and feels like for people may vary and change, but it's here. There's still risks involved with contracting the virus.
And, there's definitely risks for Black and brown communities. So, the conversations still need to occur, but it shouldn't be taboo, it shouldn't be situational. I think at this point it should be routine and that's what we're seeing. Some of the guidelines and the recommendations recently are coming out. It's going to be a part of the vaccine schedule. So we have all these other vaccines that we routinely provide and offer in a well visit or an office visit to providers. And so, making this now a part of your routine health conversation in an office visit. And you know, maybe we will get away from any stigma or stigmatized conversation around the vaccine.
STEPHANIE: How about access? You know, the government has covered a lot of the testing and vaccination. If this health emergency comes to an end, maybe things aren't defined yet, in terms of how, people who may not be able to afford a vaccination or testing, you know, how will they be able to access those health services?
ANNETTE: It's definitely something that we need to keep an eye on as policies change and coverage changes. We definitely saw that even while we were still providing our mobile testing, whether now the grant for the testing agencies to cover the vaccine had ended and so we had to go use people's insurance. And what about those that didn't have insurance? Luckily, there was another lab we could use to process tests. So, I think access to similar operations means mobile clinics I think are still going to be important going forward as that changes. We do have some initiatives coming through the city. I think some people are still being sent COVID home tests, and some offices and some of the health department and community health centers are able to provide testing for patients regardless of insurance. So, making sure we have that available for our patients is going to be important in our community.
I was a little sad and disappointed that the funding stopped in December. I think it's still going to be a need. I think regarding access or whatever it may be, because we're in close proximity with community members, being able to just walk up and come get tested or insurance. Granted our numbers did decrease significantly last year, which is a great thing and I think that's hopefully due to greater access or decreased need for it. Like I said, I think there's more access to home testing, home kits and things like that, so I think that contributes. But just wanting to be available again for those that need it and don't have that access. But just having it available. And I think that's why I'm happy that we're able to transition it to the Wellness Hub, who will continue those services regardless, and they'll have that available to utilize for the community. So, it's something that we need to keep an eye on and make sure that we're not leaving anyone out that needs those services.
STEPHANIE: As we take what you just said into consideration and all the various topics we touched on throughout the show, what might you want to leave listeners with in terms of any final thoughts, especially as we're here at this point, early 2023, going forward.
ANNETTE: I think it's a time we are feeling a bit relieved and less urgency about COVID and the virus. However, it's not the time to take our foot off the gas for continuing to educate and counsel and provide opportunities for people to stay safe, and particularly those populations that are marginalized and vulnerable. We need to continue to provide access, information, education and whatever services that we can provide for people and then also to continue the conversation.
I think it's a conversation that's worth having and worth bringing it to be a part of our routine healthcare and health maintenance. Our goal every year is to help all achieve their best health. That's what health equity is, and so the best, best health that they can achieve. And this is a part of it. This is a piece of it, but it's a part of assisting people to get to that health equity status where they're achieving their most, best health and wellness. So, always looking for the opportunities to not only engage, but to partner. And to provide and to learn, with our communities to achieve our best health.
STEPHANIE: Thank you, Annette, for sharing all your perspectives with us today on At the Core of Care. We really appreciate you making time to have this conversation with us.
ANNETTE: Thank you. Thank you for having me.
CREDITS
SARAH: Our special Vaccine Confidence series was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention or CDC. The CDC is an agency within the Department of Health and Human Services also known as 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.
Stay tuned for more episodes coming up in our vaccine confidence series. We’ll continue talking to healthcare professionals and frontline workers who are addressing issues that were exacerbated by the pandemic and promoting vaccine confidence.
You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at paactioncoalition.org.
And for more information about related upcoming webinars, COVID-19 resources, and upcoming trainings for nurses to obtain continuing education credits, log on to nurseledcare.org.
You can also stay up to date with us on social media by following @NurseLedCare.
At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder.
I’m Sarah Hexem Hubbard of the Pennsylvania Action Coalition.
Thanks for joining us.
