Helping Under-Served Communities Navigate Health Barriers During the Pandemic

by Ben Adlin

A year into a pandemic that has killed half a million people in the U.S. and magnified deep inequities in the country's core institutions, it's extraordinary that Vicky Navarro and Thyda Ros aren't more exhausted.

A typical week might find Navarro crisscrossing King County with boxes of face masks and public health pamphlets in three different languages — English, Spanish, and Tagalog — while Ros plans a socially distanced dinner dropoff of deep-fried fish and green mango salad to a Khmer community elder. Then it's off to the next webinar, the next worried call from a neighbor, the next social media rumor to bat down.

The two women are so-called community navigators: individuals who've teamed up with Public Health — Seattle & King County (PHSKC) to help build trust with marginalized communities that have borne the brunt of the pandemic across virtually every indicator.

"We are the trusted messengers, the specialists of our communities," said Ros, who works with King County's Khmer community as a navigator. "We know the approach of how to really engage and connect with our community, whether it's food, language — anything that can make an impact."

"We're stronger together," added Navarro, who has been volunteering for more than 15 years and whose mother has long been involved in the local Filipina community. "I feel like there's this connection from the community — when you see their faces, picking up boxes of food or getting PPE, you see that hope."

The navigators' top-level goal is to help address persistent disparities in King County health metrics related to the pandemic, including infection and vaccination rates.

"The program got started as a way to address COVID-19 issues, especially within the BIPOC community. They were the ones that were affected by this the most," said Tausili Kalepo, who works with 10 of the navigators as a project monitor for the County program. "The desired outcome for the group is to educate the BIPOC community throughout King County to further their knowledge on all things COVID."

South Seattle and South King County, home to many of the county's BIPOC residents, have been among the area's hardest-hit regions.

Navarro said that much of the educational work she does as a navigator has involved providing information about the virus and vaccines to elders, who may not be able to understand public messages in English or are simply uncomfortable using the internet.

"Sometimes you need to show them visually," she said. "I'm like, 'Auntie, watch this video and see if you understand it or not. If you don't, then we can go through it together.'"

Other times she'll field calls from elders who need help making vaccine appointments online: "'Vicky, I need to call you because I don't know how to do it!'"

Ros said she's encountered situations where elders from the Khmer community arrived at vaccination locations only to find staff unprepared to serve immigrant populations.

"Many of our elders, they're confused and lost. At the site, there's no interpreter available," she explained. But when navigators are present, elders "come to the site and they're excited, because we're able to help communicate and help them with whatever their needs are."

Throughout the pandemic, King County has seen disproportionate COVID deaths among communities of color, particularly Latino and Pacific Islander populations. Black, Latino, Native American, and Pacific Islander communities, meanwhile, have seen the highest levels of COVID-related hospitalizations.

Now, as vaccines become available, communities of color are receiving the shots at lower rates than white people. Among people 65 and older, who are now eligible for the vaccine, the county's Black population has seen the lowest rate of vaccination among all racial groups, with 55.4% having had at least one dose, according to PHSKC's COVID-19 data dashboard. Hispanic/Latinx people have the next-lowest rate, at 61.6%.

By comparison, 70.5% percent of white people over the age of 65 have received at least one dose.

The county numbers aren't entirely reliable, however. The data is limited to records where race or ethnicity is listed, and a disclaimer on the County website cautions that the levels are "likely underestimated."

Regardless of the exact numbers, there's wide agreement among public health experts that the pandemic's impacts and lack of access to vaccines are hitting immigrants and communities of color disproportionately hard.

A number of factors contribute to the disparities, including language barriers among immigrant populations, distrust of the vaccine or the government approval process due to historical neglect or oppression, and People of Color being more likely to hold high-risk jobs.

The way data is collected can obscure the needs of communities that are subsets of a larger racial category. "You know how we lump in as 'Asian'?" Ros said of the Khmer community. "We're like a minority within a minority. We're lumped in with the statistics of Asians. We're not heard — and most of the time not noticed — by decision makers."

Many of those obstacles are precisely what the community navigator program is meant to address, Kalepo said. Not only do navigators distribute vital public health information to members of their community in a language they can understand, but they can also connect with friends and neighbors to more authentically process doubts or past trauma.

"There's a lot of distrust in communities of color of the government," Kalepo said, noting the infamous Tuskegee Study, under which the federal government teamed with a historically Black college in Alabama in the 1930s to conduct a decades-long study under the guise of providing free health care. "There's been a lot of institutional racism, historical trauma, inhumane testing on these communities. Having these leaders has increased trust exponentially."

Navigators have encouraged key community figures, such as religious leaders, to get vaccinated in public in an effort to lead by example. They also create Zoom presentations, host virtual meetings, or partner with other organizations to piggyback on outreach efforts such as food drives and pop-up clinics.

"More than anything is what they see on social media, on TV, that really influences their decision to get [vaccinated] or not," Ros said. "That's where I see us, as trusted messengers within our community, as really important."

Her goal as a navigator is to ensure community members have accurate information to make their own decisions. "What we explain to our elders is that all three vaccines coming are for the purpose of two things: to prevent hospitalization and death," Ros said. "We want to educate and empower them to make the right decision for themselves.

The entire team of navigators meets virtually on Thursdays to discuss the latest information on the pandemic. Often a public health expert or County official will join the meeting to answer the navigators' questions, whether they're about school reopenings or how vaccines are developed and tested.

Information travels both ways through the program. While the navigators have worked to spread public health messages to hard-to-reach populations, they've also brought back vital information about what their communities are experiencing and how the County might better approach underlying structural problems.

Navigators have repeatedly informed County officials, for example, that addressing the pandemic's outsized impacts on vulnerable communities requires a more holistic approach than merely informing the community about COVID or making more masks or vaccines available.

"Our navigators cut through all that and say, 'This is the real need that the community is facing,'" Kalepo said. "A perfect example is rent assistance."

At the end of this month, Washington's statewide eviction moratorium is set to end, though on Monday, Seattle Mayor Jenny Durkan extended the City's ban on evictions through June 30. More than 134,000 households in the state are behind on rent, according to U.S. Census survey data. While lawmakers are hoping to prevent an eviction crisis, navigators have been working to draw attention to the harm such a crisis would bring to their communities.

"They said to the County, 'We know this is not a public health matter, but if you ignore this, there's going to be a lot of people experiencing homelessness in King County, especially South King County,'" Kalepo said. "The one thing I can say about these guys is that they're super fierce. If they need something, they'll say it."

Both Navarro and Ros said it's impossible to reach out to their communities with COVID information without becoming a go-to resource on all sorts of related obstacles.

"It is supposed to be around COVID-19, but it's a whole package. People lost their jobs, people can't pay rent, people are without insurance," Navarro said. "There's a lot of things to being a navigator. The word itself is [about] how to navigate a lot of systems in our community right now."

While Navarro works for the County program as an independent contractor, Ros is involved with the County through her role in Khmer Community of Seattle King County, an organization first established in the 1980s as Khmer refugees arrived in the Seattle and Tacoma areas following the Cambodian genocide.

Ros revived the group a few years ago and has launched youth programs and services for community elders that, since the pandemic, have morphed into virtual meetings, phone calls, and arranging errands like transporting people to vaccination sites or picking up an elder's groceries.

The organization was displaced from its physical space in 2019, Ros said. A few months later, COVID hit. "In the beginning, we were really saddened because it was so fast. We had a few families that passed away," she said. "We had a mom who passed away, leaving three little kids."

Ros helped organize grocery donations for the family, ensuring that the food was culturally appropriate for the family and arranging for it to be delivered.

"With no space and all these projects in place, we continue to serve as best we can with what we have," she said. "With various contracts and grants, we're able to keep on moving and serve our community."

In fact, all the activity during the pandemic has actually helped the group grow. Ros said she's currently looking for a physical space around the White Center area, which could be used for youth programs, visual art, and culinary education.

"Forty years since we've been here, and still no community center to call our own and to give the community a sense of belonging," she said. "I'm hoping through all this work that we're able to bring our community together and start that healing process."

The community navigator program, at least in its current form, is set to last through the pandemic, Kalepo said, and a lack of additional funding means they can't expand the program beyond its current size of about 30 navigators. But he noted that the navigators themselves have called for a more permanent community liaison program to continue even after COVID subsides. County officials are currently hammering out details of such a program.

In October, PHSKC released a data presentation acknowledging systemic racism as a public health crisis, in line with messages from community navigators. The document traces how structural inequities affect BIPOC communities from birth, leading to disproportionate health and economic consequences.

"That's the good news out of all this work during the pandemic," Ros said. "I look at COVID as an opportunity to really dive deeper and to see all these underlying issues that rise to the surface because of COVID and to really voice our concerns and our needs with City and County and State."

Kalepo, who described his job as being "a fierce advocate for the advocators," said it's been "a total shock" to see how responsive King County officials have been to what they hear from navigators.

"I always have to pinch myself and be like, 'Hey, they are actually giving these people attention. This is wild!'" he said. "I'm kind of in disbelief, like a kid who saw a magic trick for the first time. How is this happening?"

Everyone from the program who spoke to the Emerald emphasized that the navigators' success so far in bridging gaps between BIPOC communities and civic leaders — combined with the ongoing demand for access to resources — shows a clear need for the program to continue in some form.

Navarro said she's beginning to recognize families that will show up at a food drive event on one day in Auburn, then a few days later at a separate event in Snoqualmie. One one hand, she's satisfied that work like hers helps families stay afloat. On the other, she's crushed that households have to spend all week collecting food to feed themselves.

"You just do it over and over and over again," Navarro said. "You don't know whether you're going to cry because there's so much need out there or just be happy that there's so much support."

Featured Image: Vicky Navarro (left) and Thyda Ros (right) are two public health community navigators working to help immigrants and communities of color access health care and find accurate information during the COVID-19 pandemic. Photo by Susan Fried.