Community Health Workers: Filling an Urgent Need in the UAII Community
They say that all good things must come to an end. But for many of us at UAII, it is far too soon to say goodbye to our dedicated Community Health Workers. “The CHWs have been enormously beneficial for our organization,” said Joseph Quintana (Kewa Pueblo), Director of Development. “As we strategize for the future, CHWs have helped us be as proactive as possible. We understand how valuable each and every one of them is.”
It seems that most UAII staff members agree with Quintana…
“We see a lot of people that are stuck at home,” explained Ramon Enriquez (Nambe Owingeh Pueblo), Director of Youth Services. “They’re battling unemployment or underemployment. Typically, this time of year is really hard on our community. There are spikes in suicide, substance abuse – and these are all services that we offer at UAII, but many in our community don’t know about it. When the CHWs talk to the people, I’m amazed by the feedback we’re getting – ‘Really? We didn’t know you provided those kinds of services!’ People are surprised to learn that we have a full clinic with a Native American doctor and a new Workforce Program. There are so many people asking about jobs, PPE equipment, healthcare – our CHWs are happy to let them know about our services.”
The effect of the pandemic on the local American Indian community will be long lasting. Both the health care system and the landscape of social services in Los Angeles have been permanently changed. With food insecurity, housing instability, slow job recovery, and the replacement of in-person health services with telehealth services, the need for CHWs to bridge communities and systems of care is greater than ever before.
“UAII plays a critically important role,” said Enriquez. “We hear from community members that there are so many different messages coming from different areas, and it’s frustrating. I live adjacent to Orange County, and they have a different set of public health orders. So, depending on where you live, you’re getting a different message on the safest way to get through the pandemic. There is a lot of confusion. But through our CHWs, UAII has begun to take on a leadership role, putting out one cohesive message for our Native people. I know that a lot of our people are looking for that cohesiveness.”
As Los Angeles navigates the uncertainties of COVID-19, the American Indian community has suffered worse health outcomes than any other racial or ethnic community. We’ve faced reduced access to healthcare, struggled with less personal interaction and an increasingly computerized lifestyle, and inadequate supplies such as food, masks, cleaning products, and hand sanitizer.
“I’ve been one of the people to deliver PPE care packages and I’m just so blessed by that,” said CHW Nancy Arteaga (Chocktaw). “I can’t even put it into words, because just seeing a smile on someone’s face receiving these packages has been a blessing. Many families are suffering from the quarantine on top of family members who have COVID, and I talk to them about it. I’ve become so much more alert to the community and their needs. Many families don’t want to talk about the pandemic. But they shouldn’t be afraid to talk, because we understand each other in our community.”
Nizhonii Begay (Navajo-Pima-Lakota-Sioux), the youngest member of the CHW team, added, “What really inspires me is getting our community the help and resources they need. I was a senior in high school when this started, and I was really looking forward to graduating, going to prom, grad night – this was supposed to be the biggest year of my life. It still hurts. But now that I have a job as a CHW, I can help my family and my community get through this together.”
UAII CHWs began their training in November, and their contract will run out at the end of this month. In only two months, they have conducted hundreds of wellness checks over the phone, helped countless community members enroll in online patient portals and prepare for upcoming telehealth appointments, conducted virtual coaching sessions, and provided thousands of PPE supplies like masks and hand sanitizer. They have also served as cultural navigators between community members and fragmented systems of health care, mitigating fear, and correcting misinformation within our community.
“Access to healthcare must be our top priority,” said esteemed CHW Team Leader, Danielle Sandoval Enlow (Jicarilla Apache). “Our community worries constantly about healthcare. We worry if we can see a doctor when we need one. Especially right now during the pandemic, that’s what our people need. They need access to healthcare – and they need something they can trust. There is a stigma based on the history of our Native people. I know personally with a lot of my family members, they ask, ‘Are the doctors really taking care of us? Are they really watching out for the benefit of our wellbeing?’ As CHWs, we can help close that gap.”
CHWs are trusted members of the community who share lived experiences with family members and peers. They are trained experts, capable of navigating complex systems of care and serving as a link between clinical and community-based services and the people who need them most. Studies show that when community health workers are integrated within healthcare systems, they advocate on behalf of patients and play a bridging role between patients and clinicians, transferring and interpreting information and ensuring that patients are connected to appropriate care.
CHWs also address the misinformation, fear, and stigma surrounding COVID-19 by providing timely, accurate information about COVID-19 transmission, precautions that people can take to protect themselves and their families, and tools for obtaining access to care and support that many are unaware of.
“So many of us have lost our jobs and are struggling to provide,” said CHW Stephanie Pasco (Native Hawaiian). “Access to healthcare, jobs, and housing are the biggest concerns in the people I have seen.”
CHW Nichole Landers (Cherokee-Chipowa) added, “It’s amazing what UAII is doing. The work is so important because our community needs to be aware of the resources that are available for them, knowing where they can go when they need help. If I’m struggling financially, if I’m struggling to provide food, I know that I can go to UAII and they are there. I want people to know that if anyone needs a shoulder, or anyone just to listen, I’m here.”
CHW outreach has revealed that many UAII community members are unable to pay their rent, or have recently lost their job. Many community members are expressing despair associated with an inability to engage in community gatherings and pow-wows, physical activity, or healthy eating, while also facing lost income, poor job security, homelessness, or problems obtaining enough food and PPE supplies. In these instances, CHWs have leveraged their cultural connectedness and shared life experiences to offer practical advice, referrals, and support. Their efforts have included facilitating PPE delivery, connecting socially isolated older adults over the phone, and providing a listening ear for those in need.
“Our Elders feel very lonely,” said Arteaga. “They are helping care for their grandchildren and also concerned about their own grown children. Our Elders need a lot of support.”
As we define our path forward from the COVID-19 crisis, we at UAII recognize the integral work of our CHWs in supporting our clients and community members, including the critical role they play as frontline team members during the pandemic. Moving forward, the UAII CHW program will require sustainable funding in order to continue beyond December 2020.
“This has been a very unique grant,” said Enriquez. “Because of the short-term nature of the program, we’re reaching out to community members who already know about our programs – but there is a much bigger community out there of American Indian folks. If we have more time to continue this outreach work, we can reach a lot more Native folk. I definitely think we need a longer-term program like this because as our CHWs talk to people, it surprises me how many do not realize the variety of services we offer at UAII. Maybe they were exposed to UAII through one program, but our CHWs are informing them about other programs that we offer – the community clinic, our mental health services, our workforce program, the American Indian Clubhouse. I’d love to see more outreach and more public health programming moving forward so that we can all learn the best ways to adapt to the new post-COVID landscape.”
“Many families are in need of social activities for their kids,” said CHW Tawa Volden (Cherokee). “Interactive activities are so important because there is not a whole lot that they can do right now. Tutoring services are also needed. And we offer all of these services at UAII. Many families are looking for food pantries or food banks, or mental health counseling services, and they aren’t aware we offer these.”
The Los Angeles County Community Health Worker Outreach Initiative has coordinated and mobilized community health workers in communities throughout Los Angeles that have been heavily impacted by the COVID-19 pandemic, to provide accurate and up-to-date information regarding COVID-19 and connect residents with needed critical services, including health care, testing, mental health services, and other safety-net services such as food pantries and workforce assistance. They share current public health directives and inform residents about safety requirements at sectors that are open and requirements for worker safety.
“As the CHW team leader, I’ve enjoyed the dynamic of bringing a diverse group of people together and watching everybody individually grow through the program,” said Enriquez. “I think this been a huge benefit to our entire community, and these CHWs now have a new skill set that will serve them. I’m also finding a lot of hope in the community. They can’t wait to get back to it. We come from a very resilient community. Just looking at what our ancestors did and that we are here today. Looking for that strength and the challenges that they endured, we can get through this.”
“My biggest inspiration is our people,” added Sandoval Enlow. “To see those faces and those families, and to try to reach out to them and give them a message of hope. The pandemic has been so overwhelming. But our CHW team is providing for our community – for our youth, for the Elders, for families. Nutritional services. Health care services. There is a large demand for our services – we just need to get the word out.”
COVID-19 in California
The mortality rate for COVID-19 in the United States is 1 death per 100 cases (a 99% survival rate).
In Los Angeles County, the death rate is 82 deaths per 100,000 cases of COVID-19. Ninety-three percent of the people who died from COVID-19 in Los Angeles County had underlying health conditions. Many health and economic risk factors make Native Americans vulnerable to the impacts of COVID-19 including:
- Disproportionate rates of underlying medical conditions that may lead to a compromised immune system, such as diabetes, heart disease, and lung disease;
- Mortality rates from coronary heart disease and diabetes more than double that of other races;
- A higher percentage of uninsured individuals; and
- A higher rate of poverty, with 56% of adult American Indian households reporting incomes of less than 200% of the Federal Poverty Level.
Spanning the entire state of California as of December 28, 2020, the total number of reported COVID-19 cases in the American Indian/Alaska Native community reached 5,023 and there have been a total of 82 deaths, according to the California Department of Public Health. (Note: Most COVID-19 cases go unreported.) Among children ages 0-17, there were no reported deaths due to COVID-19. Among young adults aged 18-34, there was one death among 1,624 reported cases. Among adults aged 35-49, there were six deaths among 1,268 reported cases. Among adults aged 50-64, there were ten deaths among 1,026 reported cases. Among adults aged 65-79, there were 30 deaths among 382 reported cases. And among adults aged 80+, there were 35 deaths among 138 reported cases.
“CHWs are tremendous representatives for UAII out in the community, and we know it’s not easy,” said Quintana. “They’re putting themselves in harm’s way in some instances, going into homes and having face-to-face interactions. But we step up for each other. We’re doing this for our Elders. We’re doing this for our youth. And we’re so proud of our CHWs and their valuable work. We are so inspired by them. At a time when there is so much darkness around us, our CHWs have been a light helping to lead the way.”