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R.I. groups provide healthcare to underserved communities

Providers emphasize importance of trust, accessibility

During the COVID-19 pandemic, when resources are low across the board, vulnerable communities around Rhode Island are finding access to health resources even more difficult. The Herald spoke with three organizations dedicated to increasing health care access for underserved communities.

The Ocean State’s “vulnerable neighbors” as Director of Lifespan Community Health Institute Carrie Bridges Felize puts it, mostly consist of Rhode Islanders who are undocumented, uninsured or do not primarily speak English. 

These populations, who were already at greater health risk before the pandemic, are some of the “hardest hit by COVID” both locally and nationally, according to Director of Strategic Partnerships and Grants at the Rhode Island Free Clinic Marvin Ronning. 

There are “so many small things that you or I may take for granted that we don’t think of that these families have to deal with on a day-to-day basis,” says Associate Clinical Director and Registered Nurse at Clinica Esperanza Lauren Greene.

All three of these organizations — Lifespan Community Health Institute, R.I. Free Clinic and Clinica Esperanza — offer free care to underserved populations around the state. They all go beyond medical care to offer what Ronning describes as a “patient-centered medical home,” providing everything from health-based education and medical screenings to COVID-19 tests and vaccines.

The pandemic presents another layer of challenges for these populations. In a time filled with misinformation, Ronning says, “there's so much information and, because it's changing very rapidly, it's very difficult to access information. And it's even more difficult to access that information in Spanish.” 

Bridges Felize concurs that “it's an ongoing challenge to get the right information and the right service at the right time in the right place to people, and delivered by trusted messengers.”

Most of the patient population at these organizations is Spanish speaking, with about a similarly high percent at the other organizations, so offering services in Spanish is a necessity for increasing accessibility to care. For example, instead of requiring patients who primarily speak Spanish to navigate a potentially confusing English website, each of the three  organizations offer phone lines for appointments and to provide assistance navigating the online portal.

Accessing vaccine appointments through the web “brings a great convenience to a lot of people, but it also leaves a lot of people out,” Bridges Felize said. “So I'm concerned about seniors or folks who may not be as web savvy or may not have access to or the time to constantly refresh and look for appointments and search.”

For Ronning, this work requires a “level of respect and dignity and care that is reciprocal with our patients. We're not just giving health care, we're giving equitable health care with dignity and respect, and that's about trust. That's about building long-term relationships.”

In terms of reluctance toward receiving the vaccine, Ronning said the people they’re “seeing may have some slight hesitation, but they're very excited to get it, and grateful to get it and are spreading the news to their families and community members.” 

Cesar Orduña ’20, a COVID testing site/vaccine clinic coordinator at R.I. Free Clinic who is on leave from the University indefinitely, agreed that “trust is definitely a really huge part especially, especially with vaccines. There's a lot of mistrust and a lot of concern from the community, so trying to break down those barriers is a huge part of being able to get everyone vaccinated.”

The need to accommodate child care and work can complicate the ability to get to vaccine appointments, even if they are already booked, Bridges Felize said. “When folks are working multiple shifts or are working jobs that don't allow flexibility, it's not easy to make a last minute appointment to go for a vaccine in the middle of the day.”

All three organizations receive their vaccine supplies from the Rhode Island Department of Health. “They’ve been really good with communicating with us,” Greene says.

“We are doing everything we can to make all COVID-19 services accessible to everyone, regardless of immunization status,” Joseph Wendelken, public information officer for RIDOH, wrote in an email to The Herald. “All testing and vaccination services are open to all people, no matter their immigration status. You do not have to demonstrate citizenship.”

Despite RIDOH’s efforts toward increasing accessibility, underserved populations still face tall barriers to accessing health care. These organizations “just really try to break down a lot of those barriers and make things easier for patients,” Orduña said. 

Volunteers who donate their time make these organizations possible, and help to provide crucial care for those who would otherwise not have any, according to Ronning.

“It's important for everyone to do their best to help others with everything that's going on right now,” said Orduña, himself a former volunteer.

“Typically, urban minorities are already suffering disproportionately from social disparities, social determinants of health,” Ronning said. COVID-19 “just exacerbated and really brought into sharp relief the inequities that already existed in the health care system in the United States.”

Some community members may have reservations about going to state-run testing facilities due to their undocumented status, demonstrating the need for trust between provider and patient.

“I was a little ignorant to ... the fear that would be brought along with just coming to a doctor's office to get care,” Greene said. “But when they walk through these doors, they're not scared. They know that they're getting good quality care.”


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