We had another school vaccination clinic last week. This time at Denver’s McMean Elementary School at its family resource night. Along with dinner, new family orientation, clothing distribution, there was also vaccination. The vax team and school worked together following the mobile health clinic strategy outlined in my last report for Ashley Elementary School. And they came.
We accomplished two objectives.
- Vaccinate kids to be in compliance with state childhood immunization standards and as a plus! Vaccinate their parents.
- Through cultural validation, establish a rapport of trust with the community. By authentic community engagement McMean families there that evening, mostly immigrants and asylum seekers, felt respected and cared for and appreciated. If family members were fearful/mistrustful of public health, we lowered the barrier of fear.
We vaccinated probably 35 children and 80 adult family members.
Adult family members were directed to the vaccination table for flu and Covid-19 shots manned by Denver Public Health Institute at Denver Health. They processed through relatively quickly.
The Denver Health Mobile Vax team provided the childhood VFC immunizations. They had a harder job. VFC vaccinations are not as simple as flu and Covid-19. A lot of CIIS checking (we had 3 CIIS checkers) is required to ensure children of various age ranges were receiving the appropriate vaccinations. That takes a lot of time checking out each child.
Most of the kids were way behind on their vaccinations, requiring multiple vaccinations. Too many required 7 or more shots to be compliant (and thank goodness we could give them). This was largely because so many kids were from newly migrant families and/or had never been to a brick and mortar clinic.
We were scheduled to operate between 3pm and 6pm. Families were lining up by 2pm, however. When vaccinations started we had a traffic control system that closely monitored the ever increasing numbers in line. Within an hour it became clear that there was no way newcomer children to the line could get vaccinated by 6pm. We had to apologize to those families who came after 4pm that we couldn’t serve them that day. Adults would be able to get their shots, but regretfully we had to refer families with kids to other clinics at other dates.
I hated to do that. Turning people away does effect trust. We had the vaccines but were just overwhelmed by the response to our outreach with so many unvaccinated adults and children we had reached out to. I was so thankful the combined vax team continued doggedly working until 7 pm until that the last adult/child in line got his shot.
Why the overwhelming numbers? Because people without health insurance heard the outreach messages in their own language validating their culture and they responded.
A couple days later, the opposite happened. I provided a day long free Mental Health First Aid training for Spanish language parents at a school in Montbello. The training was funded by a mental health organization using standard protocols that work with more privileged families. Neither the school nor the provider realized the need for outreach in a cultural context prepared for Spanish speaking parents. Outreach was in translated, not transcreated, Spanish through email requiring registration using a scanned QR code. Newcomer Latinos rarely respond to QR code appeals. As a result only 4 parents showed up as walk-ins. None of them had used the QR code. They had heard about the training through word of mouth in their community (the barrio telegraph) and were intrigued about how to respond to the mental health challenges from their children.
With only 4 in attendance, however, the provider health organization asked me to cancel my training. By the book protocols required at least 5 in attendance to justify the cost of training . My response? No. We will have the class. There are 4 women who want to make a difference in their families and their community with this training. We will have the training presented in a cultural validation way that will make a difference in this community. And we did!
It’s certainly a problem in diminished cost effectiveness, when too few show up for health clinics like in Montbello. Which is much more common than the high numbers of people we had at McMean Elementary last week, as well as Ashley Elementary, the week before.
Yet it’s also a problem for community if too many show up and we have to turn people away!
With so many migrant families now uninsured and not qualifying for Medicaid, we have a new crisis. If they don’t come to clinics that’s a problem. But if they come in overwhelming numbers that’s also a problem. We dealt with that at McMean Elementary but had to turn people away. Their children will be eligible for Medicaid by 2025. We must gear up to better address the problems now.
The “we” meaning both established clinics wanting to be the medical homes for the community, mobile vax clinics, and organizers like me. We’re working on that.