Lines of cars pack the parking lot at Chukchansi Park in downtown Fresno. Pachoua Lor approaches an oncoming car, a friendly smile masked behind her PPE. She greets the man in the car who is waiting for a COVID-19 test. Lor hands him some paperwork and lets him know about resources ranging from where to obtain free food to mental health services.
Lor is a community health worker, functioning in partnership with the Fresno COVID-19 Equity Project, which serves underserved areas of Fresno. She is among the hundreds of community health workers who have been trained to provide COVID-19 outreach at free testing and vaccination sites.
Since April 2020, the Central Valley Health Policy Institute at Fresno State has been involved with the equity project – which uses a community-based approach to disseminate vital information related to COVID-19, working in partnership with community benefit organizations and healthcare provider, UCSF Fresno. Together, they provide access to no-cost testing and vaccination sites, and provide social and health services to the county’s most vulnerable communities.
The Central Valley Health Policy Institute received a $42,877 grant from the City of Fresno (via Building Healthy Communities) and $111,244 from the County of Fresno to essentially serve as the education and data hub for the project. The institute provides in-depth training for hundreds of community health workers, who extend various cultures and languages prevalent here in the region.
“The institute has long prided itself in its ability to help systems and communities work together to achieve health equity,” said Dr. Tania Pacheco-Werner, co-director of the Central Valley Health Policy Institute. “The pandemic allowed us to be able to respond to the needs of those most vulnerable with the evidence-based Community Health Worker model. In addition, our position as a university partner allowed us to quickly gather and adapt data and research in a way that was easily translatable to those who were being most affected by the pandemic.”
Lor, a Sanger native, returned to the Central Valley after graduating from U.C. Berkeley in 2019. She plans to head to pharmacy school next, and says coming back to serve her community, especially now in this capacity, was an important part of her journey.
“My ability to speak Hmong and my understanding of our culture is very important in building trust within our community,” Lor said. “There is definitely a cultural and generational gap between my generation and the elderly generation. For example, many Hmong are very spiritual, and they believe tying blessed strings around their hands means they’re protected. But as a community health worker, my role is to educate them on COVID and how it spreads, so they can stay safe and prevent it.”
Institute leads training
Back on campus, Yesenia Silva-Aguilar and Sonia Mendoza are preparing to lead another comprehensive training for community health workers. As research analysts with the Central Valley Health Policy Institute, they are among the team of seven researchers whose role is to lead training efforts. Since last April, they have helped train over 106 community health workers from various community benefit organizations, encompassing over 16 languages and cultures.
Before each training session, Mendoza and Silva-Aguilar must equip themselves with the knowledge necessary to disseminate information. This includes taking the latest scientific data from the Fresno County Department of Public Health and simplifying it for the general public. This work can sometimes stretch over days and weeks, especially with fast-changing information constantly emerging. In recent months, as evidenced by the ongoing shift in the pandemic, their training efforts have turned to the vaccine.
How effective is it? Who is eligible to receive it? What are the different types of vaccines? With three types of vaccines now available, those are questions the research teams have had to quickly find answers to. So far, they’ve held three training sessions for community health workers to get them up to date on the latest vaccine health education. For Mendoza, the ability to provide these answers is one way she can do her part to keep communities safe.
“This is about helping others out there that actually need this information – particularly in areas of concentrated poverty,” Mendoza said. “Through our community partners and community benefit organizations working collaboratively and cohesively to give this information to our community, we are able to penetrate, target and find all these gaps with people in Fresno County and rural areas that need our help. Community health workers are able to get to them, share this information and break it down for them in a way they understand.”
Before community health workers can go out in the field, they must complete a 20-hour training module that covers a wide spread of topics from myths about COVID, case compliance, navigating technology and HIPAA, among others.
For the research team, building a partnership with the community benefit organizations was essential to moving the project forward, particularly when it came to contact tracing. The existing relationships community organizations already had with their community was an important piece of the puzzle.
“In the beginning, we saw many people getting tested, but there weren’t enough hands to call them back, so with the community health workers, they kind of filled that gap,” said Silva-Aguilar. “We also knew people had more familiarity with community health workers through their organizations, and they could trust them with sensitive information.”
During those calls, community health workers also provided a listening ear for those experiencing the physical, mental and emotional tolls of living amid a pandemic. Many feared not only for their health, but about how to survive financially. This led to increased training and resources for those in isolation and quarantine.
“Many of us are experiencing the effects of staying in quarantine for so long and not being able to get out, but imagine also having the stress of testing positive or thinking that you were exposed or not knowing how to feed your family,” said Silva-Aguilar. “If you’re the caregiver of your family, it takes a toll mentally.”
Nearly 900 households have utilized these isolation and quarantine services since the program began.
With over 320,000 COVID-19 vaccines distributed to Fresno County residents in the past month alone, it offers hope for Mendoza, who says she will continue to do her part, for as long as it takes.
“I think about all of the families going through this and when I see their faces, I see my family. I see my uncle and my aunt and my cousin in these families,” Mendoza said. “And that’s why I’m passionate about waking up everyday to do this work. I can identify with these families and understand their sorrows and their fears. This is real life – and everybody has a story to tell. Everybody matters.”
Visit the COVID-19 Equity Project website for the latest updates and for more information.
(Photos courtesy of Fresno COVID-19 Equity Project and Reading and Beyond)