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Health centers look to fill gaps in vaccination efforts

Providers navigate transportation, language barriers to connect with patients

Malama I Ke Ola Health Center is pictured in 2018. While the clinic has not expanded to those 18 and older yet, staff are working to reach out to residents at high risk for the virus as well as communities facing language or other barriers. — The Maui News / MATTHEW THAYER photo

Health centers across Maui County are expanding COVID-19 vaccination efforts to overcome any access-to-care obstacles that residents may face in rural communities.

“I think the health centers are doing an incredible job given the limited resources we had up until now,” said Cheryl Vasconcellos, executive director of Hana Health. “It’s been financially challenging, it’s been challenging for all of our staff and community, so we’re getting there and I’m really proud of the progress we’re making. We’ve really done some incredible things because it’s been a learning curve for all of us.”

Hana Health, Malama I Ke Ola Health Center, Lana’i Community Health Center and Moloka’i Community Health Center were among the 15 recipients of Hawaii Community Foundation’s $1.09 million grant, which will support the work needed to overcome technological, language and transportation barriers.

The grant, as well as the previous $1.3 million telehealth grant distributed to federally qualified health centers earlier this year, totals nearly $2.5 million in grant funding from HCF over the last six months. Select health centers in Hawaii also received nearly $32 million in American Rescue Plan funds, with about $2.6 million going to Malama I Ke Ola, $839,500 to Moloka’i Community Health Center, $835,375 to Lana’i Community Health Center and $812,875 to Hana Health.

HCF’s goal of getting more than 20,000 of Hawaii’s most vulnerable residents vaccinated in the next few months among the 15 organizations receiving grants is “doable,” health providers said Tuesday during an interview with The Maui News.

About 5,000 could come from Lanai, Hana, Molokai and Malama health centers.

“These vaccine clinics are not easy to coordinate and put together, I mean it’s really time consuming and it’s added another layer of work to already overloaded health centers,” Vasconcellos said. “But I think we’re going to make it.”

The majority of the funding will help increase immunization administration and education outreaches for rural communities or historically underserved populations that the centers care for, as well as support any specialty care needs.

“Community health centers have always played a vital role in Hawaii and the past year has made their value even clearer,” Chris van Bergeijk, senior vice president and chief impact officer at HCF, said in a news release last month. “By increasing our investment in the capacities of Hawaii’s community health centers, we intend to fortify and accelerate the impact of a wide range of initiatives addressing the needs of the medically underserved that have long existed in our islands.”

Ahead of the curve

Smaller communities like Molokai, Lanai and Hana have been ahead of the curve in vaccinating residents, in part because they were able to expand to more people more quickly.

About 825 Hana residents, or roughly 65 percent of the district, have received at least one dose of the vaccine since the start of vaccination efforts at Hana Health. The clinic expanded its rollout three weeks ago to patients 18 years of age and older – much sooner than the rest of the state, which is still focusing on older populations on Oahu and only recently directed Neighbor Island health offices to open vaccines to younger residents.

The goal is to vaccinate 90 percent of Hana’s population in the next month or so.

“We’re actually moving fairly well in Hana. We started vaccinating Dec. 31, I remember the date so well — all the planning and excitement around kickoff,” said Vasconcellos. “We’ve been vaccinating every week since then.”

By early March, over half of eligible residents on Lanai and Molokai were vaccinated, thanks to efforts between local hospitals, health centers and other providers.

At the Lana’i Community Health Center, Jared Medeiros said that roughly 956 doses of Moderna have been administered so far, not including Lanai Community Hospital, which distributes Pfizer vaccines.

About 400 to 500 people are vaccinated on average at large community distributions when the Lana’i Community Health Center partners with Lanai Hospital and Straub Medical Center, he said.

The island recently received its shipment of J&J vaccines, and Medeiros said they are preparing to make those available, too.

However, while there’s a stocked supply of vaccines, Medeiros said that the challenge has been following the state’s phased rollout plan and finding enough people within each phase who want the vaccine.

“We started off very similar to our other community health centers with approaching the tiers but we quickly found that, for us in rural places, that the tiers don’t really work,” he said. “It’s challenging for us to find people in those tiers who want the vaccine and to get them scheduled, and we’ll crack open those vials of vaccine and we will have 10 doses that we have to find 10 people for, and so it’s not as easy as some places where you have this huge pool of people to pull from.”

Most health clinics in rural areas adjusted their vaccination strategies by opening eligibility up to anyone 18 years old and up.

“It’s been interesting seeing this roll out, you know just going from not having supply and kind of filtering out, and so I’m just excited that our community gets offered a chance to get vaccinated if they want it,” he said.

Despite expanding eligibility sooner than the rest of the state, Lanai, Molokai and Hana health centers have all struggled in getting younger people interested in taking the vaccine.

“We are working on making some educational videos to help reach this community,” Medeiros said.

Regardless of ethnicity, residents between the ages of 18 and 30 have been “difficult to reach” as far as being receptive to the vaccine, Vasconcellos said.

“It’s the younger folks who don’t really think that they are at risk and so are not as interested in getting the vaccine as the kupuna have been,” she added. “So we’ve been thinking of ways to really target that group as a way to support the rest of the community to make sure that young people aren’t getting exposed and bringing it home to other household members.”

Helen Kekalia Wescoatt, CEO of Molokai Community Health Center, echoed the need to reach out to the younger millennial generation about the vaccine and how to navigate past misinformation on the internet.

A lot of residents have been “waiting and seeing” how their family and friends are reacting to their vaccine doses before they make a decision.

“Primarily what we hear the most is ‘I’ll get sick from it’ and that it’s a live virus,” Wescoatt said, adding that people tend to “adopt it fairly quickly” once they see others come through fine.

Other challenging groups to target include those who are not incentivized to get vaccinated if there are no changes to the travel restrictions or if there is no hope that they “can get their life back to normal,” she added.

However, one of the ways that the Molokai health center is using HCF funding to support vaccination efforts is by investing in education and outreach.

“We know we’re going to have to spend a lot of time talking to the community and engaging in different ways in addition to some of the traditional and educational marketing efforts that cost money,” she said.

Still, the Molokai health center has administered 828 doses of Moderna vaccines so far.

Through February and March, providers focused on vaccinating the health center’s patients who qualified under the Phases 1a and 1c categories.

The center also hosted a mass vaccination distribution on March 25 and 26 for Molokai residents 18 and over.

“We are moving forward with continuing to service all Molokai residents who are interested in receiving the vaccine in that age group,” said Wescoatt, who added that Molokai will be receiving shipments of Johnson & Johnson next week through the state Department of Health and the federal vaccine program.

Another mass vaccination distribution of the Moderna and the J&J vaccines for all residents in that age group is scheduled for later this month after the health center’s patients complete their second doses.

Breaking down vaccine barriers

For some, it’s not just a matter of hesitancy over the vaccine, but also barriers to access that include language, transportation or time.

In Wailuku, Malama I Ke Ola has administered doses to about 1,300 patients and community members since receiving Moderna vaccines from the DOH supply. Of that number, about 250 people are fully vaccinated.

When the statewide vaccine rollout expanded to Phase 1c, which included workers in the food industry, Chief Operating Officer Cassie Savell said that Malama I Ke Ola reached out to nearby restaurants whose workers might want a vaccine.

She added that they have recently ordered J&J shots and are awaiting distribution.

Malama I Ke Ola has also been reaching out to help coordinate vaccinations for communities who have been at high risk for the virus, such as Native Hawaiians and other Pacific Islanders.

Staff are also continuing their education and outreach for the local Micronesian community where there is “vaccine hesitancy,” Savell said.

“So far that’s been working,” Savell said. “There’s a lot of language barriers there and a lot of misinformation on social media, so we’ve been focusing on that.”

The health center has also partnered with homeless shelters and Kanu Ka ‘Ike, a family-owned business whose mission surrounds culture, health and education, to target congregate living facilities.

“We have not yet expanded to 18 and over, yet. We’re trying to figure out our staffing for that,” said Savell, who added that HCF funding will help to support their operational needs, marketing tools for multiple languages and employee resources. “We are stretching our staffing needs to be able to accommodate the demands. We have a few things in the works to try and make that happen so that we can do that.”

On Lanai and Molokai, health officials are trying to bring vaccines directly to people.

Medeiros said that the Lana’i Community Health Center has been reaching out to large employers, providing them with educational materials to share with their staff to encourage vaccinations.

“Everybody knows from last year, with everything shutting down and our islands going into lockdown, that everybody understands the importance of having jobs and staying open, and the importance of vaccinations helping that,” he said.

Now, health providers are looking into visiting businesses and offering vaccination clinics to “further break down any barriers,” such as saving employees travel expenses and time.

Wescoatt said the Molokai health center is tackling the issues of transportation and internet access in rural communities by using HCF grant monies to bring on a team of health care workers to operate a mobile medical clinic, which will be equipped with a lab, telehealth services, specialty care access and vaccines.

The mobile unit is currently in Honolulu waiting to be shipped to Molokai.

“This will be a primary vehicle that we will use for the really rural areas of the island that don’t have any internet access, so the unit will also be taking all that in itself to support the telehealth appointments,” Wescoatt said. “Transportation is also an issue on Molokai and we’ve really seen it really impact some of our patients in 2020 because we don’t really have a bus system — we have two cabs on island now.”

Capacity on Maui Economic Opportunity vehicles are also limited due to COVID-19, she added, so not being able to freely attend appointments or go to a grocery store or pharmacy “becomes a huge burden for our patients.”

“So the mobile medical clinic, thanks to HCF, I think is a huge critical point in addressing and reducing those access barriers that we’re seeing coming out of COVID,” Wescoatt said.

Vaccine supply and support seems to be plentiful at this point in the pandemic, she added, but “now we’re here with this precipice of ‘But who wants it?’ ”

“Now that we have them and we’ve ramped up the supply and we have a very supportive federal team to make sure that that happens, especially in the rural areas, I think the biggest challenge is finding people that are ready,” she said. “I think that will come down to a lot of trust building from the top and then all the way down, all the social media and those types of platforms, and how information is being disseminated.”

* Dakota Grossman can be reached at dgrossman@mauinews.com.

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