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Know the West

Public health workers innovate around social distancing guidelines

Outreach to immigrant communities moves to Facebook and phones, as roving mobile health programs deliver food and medicine.

 

The University of Arizona's Primary Prevention Mobile Health Unit sits idle in one of the school's parking lots in Tucson, Arizona, during the COVID-19 pandemic.
Roberto (Bear) Guerra/High Country News

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For most of her career, Sheila Soto, a public health worker based in Tucson, Arizona, has worked to bring health services directly to low-income and immigrant communities. She grew up in Idaho, where her parents were farmworkers, and spent much of her early career doing community outreach to immigrants and Latino agricultural workers. 

“I honestly hated working in the fields when I was young,” she told me. “So I promised myself I would do whatever I could to get to college and to help my people so we wouldn’t be suffering so much.”

After getting her master’s degree in public health at the University of Arizona, she joined the Primary Prevention Mobile Health Unit Program, a university initiative that provides preventive health services and screenings to immigrant communities across the country, from the nearby border town of Nogales in rural Santa Cruz County to the city of Denver, Colorado. The program is based on an already-successful national model, in which approximately 2,000 roving mobile health clinics provide outreach and resources to underserved populations.

The initiative has tried to address the enormous health barriers facing immigrant communities in the West — from bridging the language and culture gap in services to connecting undocumented immigrants to health clinics at a time when many are afraid to access federal services.

But in just a few weeks, the program has had to adapt to a new challenge: reaching residents during a global pandemic. Public health workers like Soto who have dedicated their lives to their communities, building trust through in-person visits, have had to change their methods entirely. But the information they are providing is more urgent than ever. 

“We are literally going down a list of all the people (whom) we’ve encountered and luckily, they are answering their phones,” said Dr. Cecilia Rosales, director of the Mobile Health Program. “They are very grateful that we are calling them.”

Rosales has spent most of her career bridging the health-care access gap for rural and immigrant residents in the Southwest through new programming and research. Now, she says, COVID-19 is adding an additional challenge. 

“What this pandemic is doing, or at least the impact it is having on communities, is it is adding to their already existing anxiety and fear, not just in accessing medical services, but also social services,” Rosales said. “We have a lot of mixed-status families, (who) even though they have citizens in the mix, still hesitate to access services.” 

“We desperately needed good literature and information in Spanish.”

Their reluctance is well-founded: In February, just a few weeks before the virus’ rapid spread became apparent, the Trump administration enacted a public charge rule barring immigrants who use government services like Medicaid or food stamps from applying for a green card or visa. In light of COVID-19, U.S. Citizenship and Immigration Services released a statement specifying that undocumented residents could access testing and treatment without fear of losing the ability to gain citizenship. But that information isn’t necessarily reaching the undocumented community, largely because the nonprofits and community centers that serve them are temporarily closed. 

Soto acknowledged there is a lot of distrust of the government — especially in this time of stricter immigration enforcement. “People are just scared,” she said. She’s had a hard time reassuring participants that they could still access care during this time. “It is kind of hard to make people believe that,” she said. 

Sheila Soto, the program manager for Tucson's Primary Prevention Mobile Health Unit Program, has shifted her focus to providing accurate COVID-19 information online to Spanish-speakers.
Roberto (Bear) Guerra/High Country News

Meanwhile, misinformation about coronavirus cures is proliferating, and not enough outreach is available to explain how the virus can spread in communities where multigenerational families are common. Noting the lack of reliable Spanish-language materials in the U.S., Rosales used her connections in Mexico to get essential information through the U.S. Mexico Border Health Commission. “We desperately needed good literature and information in Spanish,” she told me. 

Whereas Soto’s days used to involve weekly trips for face-to-face meetings around southern Arizona, now she spends time every day updating the mobile unit’s Facebook page with Spanish-language advisories about different federal and state resources as well as links to free lunches and unemployment information. Financial help has become more urgent; according to the Pew Research Center, nearly half of U.S. Hispanics have a family member who has lost a job or taken a pay cut due to the pandemic’s effect on the economy. 

But she could be back on the road before long: The Mobile Health Units will be delivering medications in partnership with Federally Qualified Health Centers, a safety net for uninsured and undocumented people. There’s talk of using the units for food deliveries as well. And their trips may become an opportunity to teach patients across the West about how to tap into telehealth options.

“It is the responsibility of everyone — but especially of organizations and government agencies that provide services — to continue to provide that credible information and keep our doors open,” Rosales said. “If we don’t treat everyone the same, then we are more likely to increase the number of cases.” 

Editors note: This story has been updated to reflect that Nogales is in Santa Cruz county. 

Jessica Kutz is an assistant editor for High Country News. Email her at [email protected] or submit a letter to the editor