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NPR Story Focuses On Our Efforts To Vaccinate The Underserved

NPR Story Focuses On Our Efforts To Vaccinate The Underserved

Sofia Rudin,a  reporter at The Public’s Radio (Rhode Island’s NPR)  recently reported on Providence Community Health Center’s efforts to get underserved members of the community immunized against COVID-19. You can hear the story and view pictures here: https://thepublicsradio.org/article/vaccine-inequity-getting-shots-to-vulnerable-residents-is-a-marathon-not-a-sprint- or read a copy of the story below.

 

Vaccine Inequities: Getting shots to vulnerable residents is ‘a marathon, not a sprint’

(story by Sofia Rudin, Editor/Reporter, The Public’s Radio)

 

Filiberto Paredes first heard about the coronavirus vaccines on the news.

“Pregunté a la doctora si podía ponérmela. Me dijo que no, que tenía que esperar un poco. Seguí insistiendo.” 

“I asked my doctor if I could get it. She told me no, that I would have to wait. But I kept insisting.”

He called Anna Delgado, a community health advocate with the Providence Community Health Centers, months ago. 

“At that point, we didn't even have the vaccine. So I said to him, ‘We don't even have it because the frontline has not even gotten it.’”

She put him on the clinic’s list to get a vaccine. It would take three community health workers scheduling multiple rides to get him in the door. 

 

***

Filiberto is 76 and lives alone in Providence. 

In his majority-Latino zip code, one in six people has tested positive for the coronavirus. And Latino Rhode Islanders have been hospitalized and killed by the virus at higher rates, and at younger ages, than white residents. 

Health officials named Filiberto’s zip code as one of the priority areas for vaccine distribution.

And in mid-February, the health department gave 100 doses to the Providence Community Health Centers for their patients. 

“So there were about 10 of us calling patients all day on Thursday, Friday, and then on Saturday morning, as well,” said Chelsea DePaula, who manages the organization’s team of community health workers. 

Filiberto was one of the patients they called. 

 

“La trabajadora social mía me hizo la diligencia para darme esa transportación."

“The social worker coordinated so I could get transportation.” 

 

***

At 10 a.m. on a recent Saturday, patients started showing up at the Chafee Health Center, which sits just a block away from the industrial Port of Providence. Some came with walkers, others on the arm of a child or caregiver.  

After checking in, they took a seat in the long, windowed hallway. Nurses flitted back and forth, offering help with permission forms, answering questions, and calling patients back to the three vaccination stations. After a quick jab, patients headed back to a waiting area, where Dr. Andrew Saal, the health centers’ chief medical officer, was keeping watch. 

In the early afternoon, he got an email that mentioned that a patient was having trouble getting to the health center. It was Filiberto. He’d missed his ride. One of the staff had called him to try talking him through using a map application on his phone instead. The doctor went to check to see if he’d made it in for his appointment. 

“And then Dr. Saal called me and was like Chelsea, that patient never showed up,” said Chelsea DePaula, who was working the phones from home.

She called Filiberto back and scheduled him another ride. And she stayed on the phone with him until he got in the car. 

“And then Dr. Saal texted me when he got to the health center,” she said. 

“He was actually the last person to get the vaccine that day. The whole staff stayed after. Like, the clinic was supposed to end that 2:00. And I don't think he got there ‘til like 2:45. So everyone waited for him just so he could get his vaccine.”

“And then Dr. Saal made sure that he got in the lift on the way back.”

 

***

“It is a marathon, not a sprint,” said Dr. Andrew Saal. 

Most of the health center’s patients are low-income, and over 90% identify as a racial or ethnic minority. The organization asks all patients whether they need help with food, transportation, housing, or legal aid. And they routinely provide care in a dozen languages. At this vaccination clinic, three quarters of the patients listed their preferred language as s something other than English. 

 “Remember, we’re going for that subset of the population that has language barriers, socioeconomic barriers, transportation barriers,” he said. “These are not the people who, if they got a blast email, could show up at the convention center and participate in a mass campaign.”

He said PCHC will soon be receiving vaccines directly from the federal government -- part of an effort to get vaccines to low income areas and communities of color. The organization plans to vaccinate at six neighborhood clinics. 

Medical anthropologist Dr. Monica Schoch-Spana has studied equitable COVID-19 vaccine distribution, and said tools like rides, translation, and conveniently located clinics are only part of what’s needed to address disparities. 

“There is this deficit of social trust between communities of color, or some members in communities of color, and the institutions that are meant to serve them in the middle of a pandemic,” she said. “And that kind of work is different from just jabbing somebody in the arm.”

 

***

In Filiberto Paredes’ case, that trust was built by Anna Delgado. She’s the health worker who’s been working with him for about two years. 

Anna said Filiberto had missed a couple of appointments, so she gave him a call. 

“And I said to him, how about we do this? What about if you just come and you just see the doctor, and then let me sit with you. And then we can talk, let's just talk and then let me know what's going on.”

Filiberto immigrated from the Dominican Republic, and he’s worked butchering chickens and paving roads. At the time he and Anna met, his apartment had no water. 

“For him to get water, he had to go to the neighbor to fill up a bucket of water to be able to wash his face.”

She helped him get the water and electricity turned back on, and get his finances in a better place. And she regularly checks in to see how he’s doing.

“So he had lots of needs, and we just dealt with one thing at a time,” she said. 

For Filiberto, that kind of help has made a big difference. 

 

“Gracias a Dios y a ella. Me ha ayudó bastante. Yo diría que sin Anna Delgado, yo no sería nadie. Yo le agradezco bastante a Dios y después a ella. Porque se ha empeñado bastante con migo, y por la salud mía también."

“Thanks to God and to her. She has helped me a lot. I would say without Anna Delgado, I wouldn’t be anyone. I thank God a lot and also her. Because she really cares about me and my health.”

 

***

Filiberto was eager to get vaccinated. But Anna says many of her patients have been nervous about getting the shot. She finds little ways to ease their concern, sometimes by talking with a worried family member, or by texting pictures of a clinic to a patient, so they know what to expect. Other times, she says she’ll stay on the phone with them when they arrive for an appointment, to ease their worry that no one will speak Spanish. 

“I think the biggest barrier is time. Just giving people the time, giving them your ear, giving them the support,” she said. “It makes a difference, just a little bit more time.”

Millie Diaz

Millie Diaz first PCHC employee to graduate from College Unbound

Millie Diaz small photoMillie Diaz, Medical Front Desk Supervisor at our Chafee Health Center, is the first Providence Community Health Center employee to graduate from College Unbound. Millie took part in her college graduation ceremony via Zoom on February 27.

College Unbound is an innovative, degree-granting college focused on adults seeking a Bachelor of Arts degree. PCHC offers tuition reimbursement to employees enrolled in the program.

Millie was among the first group of PCHC employees enrolled in College Unbound in September 2019. She received her associate degree from CCRI in 2018 and was enrolled at URI when she learned about College Unbound and decided it was a better fit. It took her three semesters and some summer classes to complete her bachelor’s degree in Organizational Leadership and Change Studies.

“It was intimidating at first taking on full-time school with work and my personal responsibilities,” said Millie. “What helped immensely was the support I received from school and PCHC.”

Millie pursued her degree for the sense of personal reward. She is the second person on either side of her family to receive a bachelor’s degree. “I’ve always been held to high standards, even as a child, and I felt I needed a degree to meet those standards,” she said.

Millie joined PCHC in 2002 as a float patient services representative and held a number of positions before assuming her current role. Her ability to solve problems has led Health Center Director Michael Spoerri to refer to Millie as Chafee’s “Chief Solutions Officer.”

“I want other employees to know this is something they can accomplish,” she said. “It is an opportunity for both educational and personal growth. After College Unbound, I see things differently in terms of my professional life. I recognize things in my work that I didn’t before and I know my fellow students do the same.”

Tufts Health Plan

Tufts Health Plan and PCHC team up to expand access for Medicaid beneficiaries

In collaboration with The Providence Community Health Centers, Tufts Health Plan is providing its Medicaid RITogether members with increased access to high-quality care. Members can now see providers from the State’s largest Federally Qualified Health Center. 

“Our goal is to provide high quality, holistic health care to Rhode Island Medicaid beneficiaries, and increased access to care is an integral part of contributing to the health and wellness of our members,” said Jean Yang, president of Public Plans at Tufts Health Plan. “The Providence Community Health Centers is not only known for its quality and member satisfaction, but also its culturally-competent care delivery.”

Tufts Health Plan’s RITogether members can access any of Providence Community Health Center’s eight locations.

“We appreciate Tufts Health Plan’s commitment to equality, inclusion and helping communities cope with the disproportionate effects of the pandemic and racial equity, which align closely with our work,” said Merrill Thomas, president and CEO, Providence Community Health Centers. “We are committed to serving all members of our community and are pleased to expand our services to more Rhode Islanders through our new relationship with Tufts Health Plan. Like Tufts Health Plan, we are committed to serving all residents, regardless of major financial, social, cultural, and language barriers.”

RITogether members who may have questions regarding their coverage should call Tufts Health Plan for more information, at 866-738-4116.

vaccinating community

Health Center’s role in vaccinating community to grow in coming months

vax montage photoAs of early March, Providence Community Health Centers has been involved in two public vaccination clinics this year, one organized by the city of Providence in late January and another that we ran for our elder­ly patients in February.

This is just the beginning of our vaccination efforts. PCHC is one of the first 250 health centers nationally to be selected to receive ad­ditional vaccine supply directly from the federal gov­ernment.

The February 6th clinic saw our team vaccinate approximately 90 of our patients -- all 75 or older.

Our team continues to collaborate with our partners at the Rhode Island Department of Health for vaccine sup­plies and guidance regarding the priority populations targeted for immunization. Given our ability to report data by race and ethnicity, that dialogue has very much been a two-way process. PCHC data was instrumental in the state’s decision to expand immunization to lower ages earlier than initially planned.

The Incident Command Team – Kimberly O’Connell, Ralph Chartier, Wendy Chicoine, RN, MSN, PHNA, Dr. Nadine Hewamudalige, and Dr. Andrew Saal – continues to develop and refine our strategy to deliver as many doses as possible as soon as we can. Our vaccination plans include a blend of immunizations in our own neighborhood clinics, along with larger-scale events at a later date in collaboration with our community partners.

As we have done for more than a year, PCHC will play a critical role in caring for the community during this pandemic.

President’s Award honoree

Dedication to moms, newborns make June Carrara first-ever President’s Award honoree

June CarraraJune Carrara, RN, has been working in pediatric nursing with the Providence Community Health Centers for 28 years. This means she has cared for newborns who decades later are in her care again as they deliver their own children. It is those relationships that June, the first-ever recipient of the PCHC President’s Award, values the most.

“Every day, I get to spend one-on-one time with new mothers and babies,” said June, who has been our Newborn Nurse Coordinator since 2003. “This quality time is not always the case for providers today so I’m excited to be one of the first people in the room to get the child and mother off to a good head start.”

June is a critical link between newborns, their families, Women & Infants Hospital, and PCHC. She delivers newborn education, records prenatal histories, and provides documentation in the medical record. June credits community health advocate Yohana Sosa for her everyday assistance with translation services, case management referrals, and other important support functions. June joined PCHC in 1993 as a pediatric nurse at our Allen Berry Health Center before being named Assistant Health Center Director. Today, it is in a patient room that she is most comfortable.

“It is important to be there to answer a question the parents may have about a newborn who is up most of the night fussing or just feeding frequently,” said June. “Parents are often sleep deprived and are looking for the right information about what is considered normal. I am there to offer reassurance that our team at PCHC is always a phone call away.”

The PCHC President’s Award was created to recognize employees who are exceptional in demonstrating our core values while serving as a role model for others. June was nominated by five co-workers, one of whom wrote: “There is no way we could do what we do with the large number of patients at Women & Infants without June.”

Congratulations to June on this well-deserved honor.

Groundbreaking

Groundbreaking held for 9th PCHC health center site

Groundbreaking fotoOn January 8th, Providence Community Health Centers held a groundbreaking ceremony for its ninth health center -- PCHC Atwood. The new site, located at 31 Atwood Street, is scheduled to open in early 2022 and will include an Express Care department.

Merrill Thomas, President and CEO of PCHC, said the development of the new center was born from a board-led strategic plan and market assessment that identified Olneyville as the neighborhood with some of the worst health outcomes and data in Providence.

 

This $15 million dollar investment in the community will not only provide space for 14,000 more patients, it will also create over 50 full time, sustainable paying jobs,” said Thomas. “More importantly, this investment will provide a medical home and allow us to better address the health and racial equity issues that this neighborhood currently experiences.

The event included remarks from elected officials and PCHC representatives pictured here: Sen. Jack Reed, Board President and Chairperson Elena Nicolella, Merrill Thomas, Providence Mayor Jorge Elorza, and Providence City Council Sabina Matos.

COVID-19 vaccine

PCHC staff receives Moderna COVID-19 vaccine

COVID 19 vaccine On December 29th, the Providence Community Health Centers began administering its first doses of the Moderna COVID-19 vaccine to frontline workers from its health centers. The vaccine is not yet available at health centers for distribution to the public.

The initial shipment of the vaccine from the Rhode Island Department of Health includes 300 doses which are first being distributed to employees who are in closest contact with patients including members of the dental team, Express Care, and those who work in the COVID testing tent.

At 8:10 a.m. on December 29th, dental hygienist Carleen Signore became the first PCHC employee to get the vaccine. Carleen, who has been with PCHC for 15 years, was excited to receive the vaccine. “While the process to approve the vaccine was fast-tracked, I feel confident knowing that clinical trials were successfully conducted to ensure safety and effectiveness,” said Carleen. “I will encourage my co-workers and patients to get the vaccine.”

Moderna’s two-dose vaccine has proven to be 94% effective in preventing COVID-19 infections. As more doses of the vaccine become available, PCHC will offer it to its more than 500 employees, utilizing a tiered approach where frontline workers are immunized first.

Providence Community Health Centers has been a statewide leader in responding to COVID, opening the Rhode Island’s first drive-through and walk-up testing sites in April 2020.

Dr Hewamudalige

Dr. Hewamudalige named Medical Director

dr Hewamudalige  Dr. Nadine Hewamudalige has been named Medical Director for the Providence Community Health Centers, the state’s largest health center network.

She joined the organization in 2016 and most recently served as Physician Lead at PCHC’s Central Health Center.

As Medical Director, Dr. Hewamudalige’s responsibilities include guiding teams of physician site leaders, medical specialty chairpersons, and clinicians to ensure the delivery of high quality, safe, and effective healthcare. She will also focus on developing collaboration of clinicians across the PCHC network in the pursuit of excellence in clinical outcomes and patient access.

“In my years here, we have changed the way we provide primary care multiple times over to meet the changing needs of our patients and healthcare system,” said Dr. Hewamudalige. “We will continue to do so, always with an eye on delivering the best possible outcomes with a personal touch.”

“Dr H”, as she is known to many, is a graduate of the medical school at Ross University School of Medicine. She completed a family medicine residency at Penn State University Hershey Medical Center in Hershey, PA where she served as Chief Resident. Born and raised in Vancouver, Canada, she attended the University of British Columbia for her undergraduate studies.

“During her time with us, Dr. Hewamudalige has focused on improving quality metrics, teamwork, and collaboration, while advocating for and supporting providers and care teams,” said Dr. Andrew Saal, Chief Medical Officer at Providence Community Health Centers. “Now, she will help develop those priorities throughout our health centers during a time of transformation and growth.”

Dr. Burdette

Dr. Burdette discusses growth of behavioral health programs in PBN interview

The following interview with Dr. Nelly Burdette was featured in the December 21st issue of Providence Business News.

dr burdette  Dr. Nelly Burdette, associate vice president of integrated behavioral health at The Providence Community Health Centers Inc., was the sole employee in the behavioral health program when PCHC launched it five years ago.

Today, the program is staffed by nearly 20 clinicians. Burdette discusses its growth, the effect of the COVID-19 pandemic on mental health needs and her take on what role telehealth is likely to play in behavioral health treatment in the future.

PBN: How has the behavioral health program at Providence Community Health Centers changed since it was created five years ago with you as the sole doctor?

BURDETTE: When I began the Integrated Behavioral Health Program, it was just me trying to meet with all of the patients who wanted and needed the service, while also trying to create the program from the ground up. With over 60,000 patients and an overwhelming response to the service initially, it quickly became clear that integrated behavioral health was a critical necessity to our growth.

Today, we have 20 staff across our eight largest health centers in a variety of behavioral health disciplines. The past three years, we have been awarded for the National Committee for Quality Assurance’s Behavioral Health Distinction, the gold standard for providing the highest level of integrated behavioral health in the country.

We have created community collaborations that bring new and exciting options into the health centers such as acupuncture, housing services, medical legal partnerships, and both Rhode Island College and University of Rhode Island as student-training sites. Next up is the launch of an innovative multidisciplinary oncology survivorship treatment clinic in partnership with Roger Williams Cancer Center, starting in early 2021.

 

PBN: Roughly how many patients are cared for by PCHC’s behavioral health program, and what types of treatment does it offer?

BURDETTE: Integrated behavioral health embedded within primary care is a defining feature of PCHC’s approach to serving our population from a holistic perspective. In the health center setting, this care is a short-term, solutions-based treatment for patients across all ages who have mild to moderate mental health and substance use issues that would benefit from a different approach than specialty mental health therapy.

In 2016 – our first full year – we had more than 3,800 patient visits. We have steadily grown the number of patient visits every year since. In 2019, we had more than 9,000 patient visits and this year, we are already 1,000 visits ahead of that pace. We expect that growth to continue as the need for these services increases.

PBN: What sort of effect have you seen the COVID-19 health crisis have on mental health needs in Rhode Island, and are more patients coming to you for care?

BURDETTE: The COVID pandemic has exposed the underlying mental health and substance use epidemic that has been growing for years in our state. All PCHC patients over the age of 18 are screened for depression, anxiety and substance use. Anxiety in adults has seen the largest clinical increase across all sites since the pandemic began.

For children, needs have arisen around the intersection of this new approach to schooling and their home lives. A number of our school-age patients lack access to computers and the internet, and may have a home life situation that was already unstable prior to the pandemic. There has been a considerable increase in demand for behavioral health services in our integrated primary care settings and we have met that demand largely through our rapid adoption of telehealth.

PBN: Are you and other doctors at the behavioral health center continuing to see patients via telehealth because of the pandemic, or have you begun in-person visits again?

BURDETTE: While we started to see behavioral health patients via telehealth due to the pandemic, we have mostly remained on-site while doing so. We anticipate continuing to provide tele-integrated behavioral health after the pandemic is more under control. Frankly, many patients and providers prefer the telehealth service for the ease and access it opens up. We are now able to easily connect with our patients during their breaks at work or from their homes, without exposing them to heightened risks of in-person visits or struggling to consider how to arrange for and manage transportation and/or requesting time off from work.

We were very fortunate to have also received a grant from the Rhode Island Foundation that allowed us to continue to waive all integrated behavioral telehealth copays for our uninsured patients who use a sliding scale option.

PBN: Have you found telehealth to be just as effective as in-person visits for behavioral and mental health issues?

BURDETTE: For PCHC, integrated behavioral telehealth is often an improvement to an in-person visit, as it allows the patient more flexibility in their schedule. Telehealth also allows providers a glimpse into the homes and lives of patients in a different way than an office visit. However, we have found that for children under the age of 10 and elderly patients over the age of 65, there can be a limited knowledge base and comfort with telehealth that makes an in-person visit preferable.

There have been issues related to telehealth like internet connectivity, technological literacy of providers and patients, and the need for a safe and private location for patients to speak. Much of the research in this field, however, has found telehealth to be as effective for mental health and substance use as in-person care.

Mansi Kachalia James

Allergist/Immunologist Mansi Kachalia James, DO, joins PCHC

Dr Mansi K JamesDr. Mansi Kachalia James, a board certified Allergist/Immunologist, has joined the Providence Community Health Centers and will work from our new specialty clinic site at Randall Square, where she hopes to begin offering a wide variety of services including environmental skin testing, drug and food allergy testing and oral challenges.

Dr. James completed a two-year ACGME-accredited Allergy and Immunology Fellowship from Baylor College of Medicine, where she served as co-Chief Fellow. She completed her Pediatric residency at Baystate Medical Center in Springfield, Mass., following her graduation from Lake Erie College of Osteopathic Medicine.

During her fellowship, Dr. James gained in-depth clinical experience in allergic and asthmatic diseases, congenital and acquired immunodeficiency, and systemic inflammatory and immunologic disorders. She has worked on a number of research projects and has several health-related volunteer experiences to her credit from India and Ghana to Florida. Before starting medical school, Dr. James spent two years as a licensed teacher with Teach for America, working with children in low income communities to reduce the education gap.

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