The coronavirus pandemic has forced health care providers to think outside the box when it comes to delivering critical medical services to underserved populations. On this episode of HealthChangers, we’ll hear about the work that’s happening at the Oregon-based Virginia Garcia Memorial Health Center on the front lines of the COVID-19 public health emergency.
The mission of the Center is to provide high quality, comprehensive, and culturally appropriate primary health care with a special emphasis on people who face barriers to receiving care. We’re joined by Peggy Maguire, President of the Cambia Health Foundation, which has been a long-time philanthropic partner of Virginia Garcia; Serena Cruz, the Executive Director of the Virginia Garcia Memorial Foundation -- and by Dee Cruz, who serves on the foundation's board.
Leslie Constans (LC): Good morning, Peggy.
Peggy Maguire (PM): Hi, Leslie.
LC: We're about to hear a conversation between Dee Cruz and Serena Cruz, who are going to be talking about the work that Virginia Garcia Memorial Health Center has been doing on the front lines of the COVID-19 crisis. Before we hear from them, I wanted to ask you about why community health centers are so critical to the health of our communities and what Cambia Health Foundation is doing to support them.
PM: Thanks, Leslie. I appreciate the question. When the pandemic first started, we suspected that people with less resources would be among the first to be impacted and the last to recover. We have seen health disparities playing out across our nation and it's been sad to watch. The Cambia Health Foundation approved $1 million in grant funding for federally qualified health centers in Oregon, Washington, Idaho, and Utah. We've made this investment because we know that federally qualified health centers are serving those among us who have the most needs, and they're also doing really innovative work in whole person care.
If we want to address this pandemic, we've got to address it in a way that makes sense for the communities that are experiencing it.
PM: In addition to our investments in federally qualified health centers, we've also made specific grants to organizations for PPE, for other supplies, and for access to clinical services. Our goal is to ensure that health care providers have the necessary equipment and resources they need during the pandemic, and that all people have access to quality care and testing. We have been collaborating with Virginia Garcia for many years, and we've supported them philanthropically because of the work that they do. They work to ensure that everyone in our community, including migrant farm workers, have access to quality health care.
This pandemic has magnified some of the problems with our health care system but it's also strengthened our resolve to continue to work with organizations like Virginia Garcia to foster a health care system that is more person-focused, economically sustainable, and inclusive of everyone.
LC: Great. Thank you so much for that perspective and background, Peggy. Let's listen to some of the powerful stories that Serena has to share about the challenges Virginia Garcia is facing and the heroic work that they're doing.
PM: Thanks so much. I look forward to it.
LC: Welcome, Serena and Dee, to the HealthChangers podcast. Really excited to have you joining us virtually today for our conversation. I'd like to kick it over to you, Dee. You are a member of Virginia Garcia's board, and you're also at Cambia Health Solutions as Vice President of Consumer Obsession. I thought it'd be great to have you kick off our episode and continue on with Serena Cruz.
Dee Cruz (DC): Awesome. Thank you, Leslie. Serena, we are so happy to highlight the work that you're directing on behalf of Virginia Garcia, the Foundation and the work that the health center is doing. Can you start out by telling our listeners a little bit more about you and the organization that you serve?
Serena Cruz (SC): Thanks so much for inviting me to join you, Dee. I'm so grateful for your service on our board and for Cambia support, and I love telling Virginia Garcia's story. It started over 44 years ago when Virginia, a six-year-old girl, was traveling from Texas to California to Oregon, following the crops every year. In 1975, she got a cut on her foot and California, and when they arrived in Oregon, it was infected. They sought medical care, but she didn't get adequate, culturally relevant care, so she died from a treatable infection. The power of her story is how the community responded. The legacy she leaves and that those founders leave is what arose in that horrible situation. Latino community leaders rallied Vista volunteers. It was the 70s, it was a time of political activism, and people came together with a certainty that no other child would die like Virginia died.
There are great stories about how the founders sat in with the nuns at the Sisters of Providence until the nuns agreed to begin investing in health care for migrant farm workers in camp that summer. Within days of her passing, she died on June 17th, and just weeks later, July 3rd, there was an MOU that was signed, and a week after that we began delivering services in the camps.
It was the 70s, it was a time of political activism, and people came together with a certainty that no other child would die like Virginia died.
SC: From that summer to today, we work in the migrant camps every summer, ensuring that there's access to health care for folks who are there. And we've expanded. We started just volunteers in the camps, we started to hire with a grant, and then two years after that, we became a federally qualified health center. We started in a two-car garage in Cornelius, Oregon. Today we have 17 sites throughout Washington and Yamhill County, five primary care, comprehensive primary care clinics, six dental clinics, five school-based health centers, a women's clinic and a mobile medical dental van that continues to deliver care in the summer to the camps as well as to schools.
We're serving over 52,000 people in Washington and Yamhill County. We're the largest nonprofit federally qualified health center in the state of Oregon. We're also deeply diverse. Sixty percent of our patients speak Spanish and over 60 different languages are spoken by the 52,000 patients we serve. It’s really a place full of mission and passion, and our response to the COVID-19 crisis follows in line with our history and our focus on removing barriers to health care for folks in our community.
That really is what brings me to Virginia Garcia. My mom was an undocumented Mexican immigrant until she was almost 20 and the stories of her encounters with then the INS, Immigration Naturalization Service, and her pride over becoming a citizen, her value of health care for us as we grew up, knowing that we needed access to that. As it turns out, I really needed access to that to grow up healthy and be able to focus on school.
It's really a place full of mission and passion, and our response to the COVID-19 crisis follows in line with our history and our focus on removing barriers to health care for folks in our community.
SC: Those are the things that keep me at Virginia Garcia, knowing that people like my parents are the people we serve. That brings meaning and purpose and a whole lot of reward out of this work.
Right now, our patients are experiencing a ton of fear and anxiety. All our staff from the call center to providers to folks working in outreach, tell us that there's countless stories that are told to them about how scared people are for their families, how scared they are about the economy and their ability to provide for their families. The level of food insecurity is incredibly high. There are knowledge gaps, when so many of our patients speak many different languages, there is not the same level of awareness in all of those languages of the ways to protect yourself from this disease, manage the disease if you get it, and how to protect your family. There's a lot of concerns that are being faced by our staff, when they encounter patients. And then they're scared themselves.
Virginia Garcia Staff are Providing Revolutionary Care to Communities
DC: The work that you guys were already doing in the community was so critical, in terms of access and kind of personal health, exactly sort of in the way that you described it, and now you layer a pandemic on top of that. How's the team doing in response to that, given the additional challenges for the folks that you guys serve?
SC: The staff are amazing. They're super heroes. I am in awe of them, their courage, their capabilities every single day. It's like a roller coaster that they're riding. On the one hand, there are immense highs in the sense of reward and purpose in the work that they're doing, and knowledge of how important the service is that we are providing and in reducing spread and in helping to manage hospital systems, so that they can serve the folks who really need to be there.
But there's also incredible downs. I mean every single day there's a change in policy, whether that policy is about PPE or screening criteria for COVID or the delivery of telehealth. The level of adaptability to change is so high, that that can also be hard and heavy for our employees to feel. So many of them talk about how it feels like a head spinning rapid transformation. We went from, and I know we'll talk about this later, but we went from 3 percent telehealth visits in the beginning of March to 92 percent last week.
It's revolutionary. They embrace their role and are proud of it but it also takes its toll on them. We're trying to figure out how to be good partners in the community, along with serving our patients.
SC: It's revolutionary. They embrace their role and are proud of it but it also takes its toll on them. We're trying to figure out how to be good partners in the community, along with serving our patients. We’re partnering with the county around the delivery of care to farm workers and thinking about folks who are most vulnerable in agriculture right now. We're partnering with folks in housing and in direct community service, to try to meet needs for our patients. There's just so much going on but the network is strong and I think that part of it is really powerful.
DC: Serena, you mentioned housing and food insecurity already, in addition to the anxiety for the patients that you serve. We talk about social determinants of health and how that impacts the health and wellbeing of people outside of just the care setting, housing and food. It sounds like the work that you've done with community partnerships, even in the lead up to the crisis, is helping maintain some of that support for the people that you guys serve now.
SC: You're exactly right, Dee. What we're seeing right now is that the health disparities that existed before the pandemic are exacerbated, and that the social determinants of health and their role in keeping people healthy and safe are even more evident now. I shared that food insecurity is an overwhelming problem that we're seeing. Our first COVID-19 patient, when he was released from the hospital to convalesce at home, we learned that he had no food at home. That was a really difficult situation for him to be in. If he left the house, he would spread the virus by going to the store for food, but he needed food to be able to fight the disease. To keep him safe at home and reduce the chances that he would spread the disease to others in our community, we delivered food from community actions emergency food bank directly to him in his home.
Our first COVID-19 patient, when he was released from the hospital to convalesce at home, we learned that he had no food at home.
SC: There are stories like that every single day that I hear our staff tell. It's everything from what are all the things that that patient needs to keep them safe at home, how can they address the fact of their other family and try to isolate, so that the rest of their family doesn't get sick in conditions where people are often living with more people in a household than at the average person in our region. They don't have sick leave. They don't get paid time off. When they're asked to stay home, if they are healthy, and then asked to stay home because they have somebody who has contracted the disease in the home, that is a huge hardship on these families. If they are undocumented, they're not going to get a relief check. Yet, here they are, amazingly contributing members of our community, paying into the social security, and they won't get that relief and that support.
Seeing all those things, it is all magnified, these pieces that affect people's health right now. And yes, we feel again grateful that we are in the place where we are to be providing and making those connections and supports. It's also made us very focused on advocacy and the kinds of things that we need to make sure that people have in place are a part of our discussion right now. Ensuring the workers relief fund and engaging our board and our staff and advocating for that is an important thing for us.
While Trying to Save N95 Masks, Virginia Garcia Needs Fabric Masks to Give to COVID-19 Patients
DC: Serena, you guys are really on the front line of stopping community spread and supporting needs. Again, both health and social needs that the patients you serve have. How was the PPE situation? Are you guys able to provide that level of service kind of confidently and in the care setting that you guys provide it?
SC: PPE is such a challenge for almost every health care organization right now. We've been very lucky that a couple of years ago, we received a massive donation of N95s, almost to the point where folks in our organization were like, “Do we really want to take these? They're going to take up a lot of space.” As it turns out, we're so grateful that we have them. That is not something that we are worried about right now because we had this store of them. So, we were able to go to our own storage for that. When folks want to donate N95s to us, we say “No, please take them to the county so that they'll get delivered to the other organizations in the community who need them.”
Well, now we're desperate for [fabric masks] so that we can give them to our patients. I have to tell you, it's been on every call for the last week, when we get together as a medical huddle on a daily basis, there's a question about fabric masks.
SC: We've also been grateful to organizations like DCI that have contributed surgical masks to us. When you don't need the level of the N95, to have a surgical mask is super important. We've been able to secure face shields and gowns. We've taken a few steps. One, to preserve and protect what we do have, we reduced, really before folks reduced in the state, dental activities because dental is so highly PPE intensive because their procedures and the practices are really spreading bodily fluids. By limiting, we consolidated three of our clinics and now only do emergency care for dental, which helps us again in keeping folks out of the emergency rooms. It also means that we are reducing our demands for PPE internally and helping to make the stores that we have go further.
The one area where we are finding ourselves particularly challenged right now is around fabric masks for our patients. For weeks, we heard that fabric masks weren't relevant and we didn't need to worry about them. So when people were offering them to us, we said, "No, thank you. We have N95s and surgical masks, so we don't need fabric masks." Well, now we're desperate for them so that we can give them to our patients. I have to tell you, it's been on every call for the last week, when we get together as a medical huddle on a daily basis, there's a question about fabric masks. Because our staff doesn't want to give out a surgical mask that they know that we will need, and yet we also need to protect the patients and ourselves with just ensuring that the patient has a mask. That is one place where we are about to launch a social media campaign, to request more. We're going to be very grateful to all the donations of the fabric masks that we get.
DC: Serena, what I appreciate about serving with you and observing the amazing work that you guys do at Virginia Garcia, is the resilience that and innovation that was built in from the founding of Virginia Garcia and how it came to be and how quickly the community rallied. The same thing is happening during the COVID-19 crisis. In particular, as you mentioned, for a population where health disparities are only being exacerbated, Virginia Garcia was an early screening center in Oregon. Can you talk a little bit about that and the impact that that's having both on triaging the population that you serve?
It’s been amazing to see how the values of removing barriers and ensuring access to care and ensuring high quality care, and a real public health ethic has just blossomed and boomed in this crisis with the leadership on the executive level.
SC: Thanks, Dee. It’s been amazing to see how the values of removing barriers and ensuring access to care and ensuring high quality care, and a real public health ethic has just blossomed and boomed in this crisis with the leadership on the executive level, as well as just every single provider and staffer and their belief in making this happen. I can't tell you enough how amazed I am to be a part of this effort inside our organization.
We recognized how important screening for COVID-19 was going to be for our patients. Important because we knew that many of them come from vulnerable parts of our community and were more likely to be more affected by the disease. We also know that because of the barriers to health care, that our patients in particular face, it was critical to ensure that they got access to these tests to demonstrate the level of the effect in our community.
We did not test while the state told us we couldn't, and then the moment that the state allowed entities to begin to test, we launched our drive-up test sites at every single one of our primary care clinics. Then, over course of that week, about a week and a half after that began, we launched drive through testing sites in Washington County and in Yamhill County. We knew that both the demand for testing was going to explode at some point. We knew that to preserve PPE, if we could focus the screening sites, instead of at every single one of our clinics, we would preserve PPE there too.
The results that we're seeing are... I don't know how to say. They're just plain overwhelming. So as of Friday, we had completed almost 500 screening tests, and of them we had 51 positive tests and 49 of our positive tests were Latinos.
SC: The drive through testing sites are now operating, one at Hillsboro Stadium and one at the Yamhill County fairgrounds. And we still do limited testing at our primary care clinics because there are folks who don't have access to transportation, who need to use public transportation. And so our clinics are going to be a better match for their ability to get in and get screened for the disease. The results that we're seeing...I don't know how to say it. They are just plain overwhelming. As of Friday, we had completed almost 500 screening tests, and of them we had 51 positive tests and 49 of our positive tests were Latinos.
Coronavirus Case Rates are Higher in Communities of Color
SC: I know. That statistic means that as of Friday, 98 percent of the folks we tested, who tested positive, were Latino. It's staggering. Then, I learned today, that in our state we comprise 15 percent of every Latino that's tested positive in the state. What it says to me is that there is clearly not enough testing taking place in the state, and not enough testing taking place where Latino community members have access to it. Because if this is the kind of over-representation we're seeing in our community, clearly that kind of representation exists in other parts of the state. It makes me sad and scared about folks not getting access to this sort of care. It really shines a light on where our state's focus needs to be. It needs to be connecting to the challenges that Latino community is experiencing right now. If we want to address this pandemic, we've got to address it in a way that makes sense for the communities that are experiencing it. So, as I said, it’s overwhelming but it does reinforce we're doing what we should be doing right now.
DC: Not only are those statistics staggering, but the fact that you guys are supplying that service is amazing. Do you think that the relaxed testing guidelines that were just released, do you see that having a positive benefit on potentially expanding kind of the representation like you mentioned of folks getting testing?
SC: Absolutely, Dee. I think that it was really important for the state to release their relaxed testing standards. The relaxed testing standards will make it possible for more people in the state to get access to screening. Then, once we know who has the disease, being able to follow up with them and to help them limit their exposure to other people will manage the spread of this disease.
It really shines a light on where our state's focus needs to be. It needs to be connecting to the challenges that Latino community is experiencing right now.
SC: I do hope that that means that vulnerable communities of color will get more access. For vulnerable communities to get more access to these tests, it means that we need to have these set up all over the state. I'm not sure we're there yet. I think screening is key to our ability to do much of anything with respect to this disease. It's the only way we're going to know what's happening in our communities, to know who's being affected and the only way we're going to ultimately be able to open from shelter-in-place, whatever level that looks like. This is a key part of the solution.
'Essential' but Unprotected Farmworkers Live in Fear of COVID-19
DC: Serena, given the spread of the crisis and the stay-at-home nature to stop the spread in farm worker communities, that creates a whole different way to serve those communities. Can you talk a little bit about how Virginia Garcia is thinking about that?
SC: Exactly, Dee. It's just a part of our core mission and where we came from, to be thinking about the farms and the farm workers. We recognized not too long ago that there was a chance of a pretty big tragedy coming forward in the farm camps. So, we've been working internally and in partnership with Washington County and Salud, from Tuality OHSU, to think about how we can educate camp owners, nursery owners and wineries about the ways that they can protect their workers through hand washing stations, social distancing, masks and that sort of thing. We’ve also been thinking about how do we step up our screening for COVID-19 in the camp and intervene quickly, should the disease start to spread.
So, we would usually go to each camp two or three times over the course of the summer. Instead, what we're planning to do is go to each camp every week and test several people, so we can try to catch the disease before it spreads. We're working with the camp owners to talk to them about how many people should be living in one site, because they can't operate as they have in the past and expect they won't be a place for a very tragic disease spread. So, we're talking to them about that, talking to them about access to hand washing and kitchen cleaning routines, so disease spread can be managed as well. Our farm workers are essential workers. They have to be out there so that the rest of us get to have food on our tables. It's important that we think about them and how this situation is affecting them and threatens their health, their livelihood and their lives. So, that's some of the stuff that we're working on right now.
Our farm workers are essential workers. They have to be out there so that the rest of us get to have food on our tables.
DC: Serena, thank you for sharing that. I think it's so important for folks listening to understand the depth of the potential impact on critical folks in our community and the people that supply the food on our table. We don't think about health access for them in the same way, I think, or it doesn't come kind of top of mind. I really appreciate you sharing that and for the work that Virginia Garcia has done, leading up to it, and the fast pivot in order to protect workers that you guys are making and already thinking about what this upcoming season of migrant labor that will start here soon, if it hasn't already started.
SC: Thank you so much, Dee. One thing I want to make sure I say is that we know we can't do this work by ourselves. We know that it takes leadership like yours on our board and on the health center board. It takes community partners like Cambia, DCI, A to Z, Line Works, foundations like Murdoch, stepping forward to support us, individual donors and then partners like Pacific University. When they heard that we were trying to expand our screening sites, they offered up their dental van and we're now going to lead their dental van in McMinnville, which will let us use our medical dental van throughout Washington County even more. It takes partners and supporters to really do this work, and we're just grateful to be a part of this community, really trying to ensure that everyone gets access to the care that they need right now, and that we can flow this crisis and hopefully someday get back to normal times.
DC: That is my hope too, Serena, and you guys are absolutely on the front lines of helping Oregon as a community get there. So thank you.
LC: Serena and Dee, thank you so much for being guests today on Health Changers and sharing the story of the work Virginia Garcia is doing to ensure the health of people in our communities. I just want to thank you again for this wonderful conversation and for joining us.
DC: Leslie, thank you for hosting us and for the work that you and your team do in highlighting our important community partners like Serena and the work that she does at Virginia Garcia.
SC: Thank you both so much. Leslie and Dee, we at Virginia Garcia are deeply honored. I'm deeply honored to have joined you today and grateful for your support. Thank you.
You can find more information on all our episodes at cambiahealth.com. Follow us on Twitter @Cambia. You can now find HealthChangers on all of your favorite platforms. Just search for “HealthChangers” on platforms like Apple podcasts, Spotify and iHeartRadio. Please subscribe and leave a review.
Links and Resources:
Serena Cruz, Executive Director of the Virginia Garcia Memorial Foundation
Peggy Maguire leads Cambia’s companywide palliative care and caregiver strategy