Barrier After Barrier
“How do I get a vaccine?” It’s the singular question on the mind of the nation.
The process has proven challenging for many. A recent study found that 4 in 10 adults found the vaccine process difficult, and another 4 in 10 adults reported needing assistance to schedule their vaccination (KFF COVID-19 Vaccine Monitor Dashboard). Now, imagine the vaccination process with even more barriers. Maybe you know where to go to get a vaccine but you don’t have reliable transportation. Maybe you’re told to find vaccine information online, but you don’t have internet access.
Access to the internet is a privilege that many take for granted. The US Census reported that more than a million people in Texas alone do not have access to internet at home (“Presence and Types of Internet Subscriptions at Home”). For those returning to society after years away, like the formerly incarcerated, the internet is a mystery of science fiction. Many states released inmates early to decrease prison population density during the pandemic, but for those who have been away for a decade or more, the new world is inaccessible.
“People would say things like they were so simple.” said Hudson, 57. “‘Listen, go to your browser and open this up.’ I’m like, ‘Who is the browser?'”-“Former prisoners struggle to re-enter society. What happens when society moves online?” by Alexandra Marquez
Even if you’re lucky enough to have reliable transportation and internet access, be digitally literate, and be able to flex your schedule to suit whatever appointment you can get, there’s still one more condition to meet. English. For the limited English proficient, Deaf, and hard of hearing, vaccine information can be almost impossible to obtain.
Lost in Interpretation
In California, native Mixteco speakers don’t know the details of their own care because there are no available interpreters. Cultural incompetent systems pair Mixteco speakers with Hispanic interpreters who speak a different dialect. This apples-to-oranges solution leaves patients scared and alone, unable to advocate for themselves.
“I feel a lot of sadness in my heart, because I don’t know what’s going to happen to my husband, and I don’t know what his condition is,” she said through an interpreter on Feb. 19, as her husband lay in a hospital bed. “He’s suffering a lot in that place … He tells me people come and give him injections, he wants to know what they are, but he doesn’t understand.”– “Hospitalized For COVID-19 Without Information: What Californians Who Speak an Indigenous Language Often Face” by Claudia Boyd-Barrett
Linguistic barriers aren’t reserved for unique cases of rare dialects. California’s large Spanish-speaking population faces the same struggle. “Rosa Lazarovits, a Ventura-based marriage and family therapist who works mainly with Latinx seniors, said many of her patients have expressed panic over not knowing how to get vaccinated. The county does have an online portal with vaccine information in Spanish. But many seniors don’t know how to navigate the internet, she said” (Boyd-Barrett, Claudia).
A Virginia hotline sought to make vaccine information more accessible by providing a phone number in addition to online services. The problem? Interpreters weren’t available in enough languages. “Only two languages were offered when callers dialed in — ‘press 1 for English’ or ’press 2 for Spanish.’ But Virginia is home to speakers of many other languages — Chinese, Korean, Vietnamese, Arabic, Mongolian, Amharic and dozens more — who would need the help of [interpreters] to get their place in line for a vaccine” (Pradhan, Rachana).
In addition to facing language barriers, many minority populations distrust the healthcare system. This leads to even lower vaccination rates in those who are able to access vaccination information. Connecticut is seeing that impact in their community. “New data released from DPH showed that of the nearly 12,000 Black residents who were 75 and older and eligible to receive the vaccine, only 2,248 had received the first dosage. For the Hispanic population, of the nearly 8,000 eligible to receive the vaccine, only 2,780 receive their first dosage” (Moody, Dominique).
The reality is that equitable vaccine distribution is not a local issue. It’s a global one. WHO published a vaccine equity declaration in January, stating that “I“In the majority of low- and middle-income countries, vaccination has not even started which is a catastrophe as hospitals fill up,”,” (World Health Organization).
Putting Accessibility at the Forefront
We’re making strides to correct low vaccination numbers in minority populations, but since we already knew that COVID-19 disproportionately impacts these groups, it’s fair to ask: Why weren’t these measures implemented in the first place?
“You need to proactively plan,” said Christensen Lundin. “You’re not going to do a great job serving people if what you’re doing is reacting three minutes (after) someone told you they had a language need and you’re scrambling to figure it out.”– “Hospitalized For COVID-19 Without Information: What Californians Who Speak an Indigenous Language Often Face” by Claudia Boyd-Barrett
Accessibility cannot be an afterthought. The failure to provide care accommodations costs lives. To that end, we have not only failed our minority communities. We have failed as a community, as a nation, and as a people.
How do we correct such an egregious failure? We have to look to the people already dedicated to overcoming healthcare disparities, and let them lead larger initiatives with leadership buy-in. Supervisor of Interpreter Services for CentraCare Health in Minnesota, Laura Cranston, knew that misinformation, work schedules, and community trepidation were huge stumbling blocks for her community. Cranston set up COVID testing facilities in the parking lots of local businesses that employed minority workers. She also worked with community leaders to disperse accurate vaccine information. “I encourage everyone to use all available communication channels,” she said. “You have to reach your communities where they are instead of trying to make them come to you.”
For Hawaii’s The Queen’s Health Systems, unique language needs provide a challenge for interpretation. In addition to having multiple resources on hand, Director of Patient Relations and Patient Experience Wanda Sharp works hard to make sure the entire staff is well educated on the need for patient resources. Interpretation should be available every time the care team interacts with a patient, she says. Language access is not just the law, but the right way to provide care. “It’s important to not make patients victims of your processes [and] to recognize that patients don’t leave their rights at the door,” she explained. “You have to establish their partnership in the healthcare journey.”
Equitable healthcare is something we must build together, by inviting different voices and perspectives to the table. It requires humility and the ability to recognize where care has failed communities in the past. That’s a large part of the work that Chineye Anako, Regional Director of Diversity and Inclusion, is doing at Trinity Health of New England. “We’ve seen the disproportionate impact in Black and Brown communities, and now we’re facing equity issues with the vaccine distribution. We know that the communities that are hardest hit have some vaccine hesitancy, because of historic (and still current) treatment of those individuals in the health care system,” she said. “We have to confront these issues and communicate how we’re going to overcome them in order to gain some level of trust from our community.”
The lack of accessibility in health care is a crisis we can no longer ignore. We have to course-correct by acknowledging and addressing the inherent privilege in hospital care. From there, we can continue to build connections within communities, provide comprehensive and accessible language access, bring care to patients, and uplift all community members.
Boyd-Barrett, Claudia. “Hospitalized For COVID-19 Without Information: What Californians Who Speak an Indigenous Language Often Face.” California Health Report, 18 Feb. 2021, https://www.calhealthreport.org/2021/02/18/hospitalized-for-covid-19-and-no-information-what-californians-who-speak-an-indigenous-language-often-face/.
“KFF COVID-19 Vaccine Monitor Dashboard.” KFF, 30 Mar. 2021, www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccine-monitor-dashboard.
Marquez, Alexandra. “Former Prisoners Struggle to Re-Enter Society. What Happens When Society Moves Online?” NBC News, 29 Mar. 2021, www.nbcnews.com/tech/tech-news/former-prisoners-struggle-re-enter-society-happens-society-moves-onlin-rcna518.
Moody, Dominique. “Federal, Local, and Health Leaders Push for Vaccine Equity.” NBC Connecticut, 16 Feb. 2021, www.nbcconnecticut.com/news/local/federal-local-and-health-leaders-push-for-vaccine-equity/2423924.
Pradhan, Rachana. “‘Press 1 for English’: Vaccination Sign-Ups Prove Daunting for Speakers of Other Languages.” Kaiser Health News, 22 Mar. 2021, www.usnews.com/news/health-news/articles/2021-03-22/vaccination-sign-ups-prove-daunting-for-speakers-of-other-languages?fbclid=IwAR3wQYigSCCan2tzra98Ldg7dfsVVjMIRCmrRQng-eCJmixSx3_joU89SVw.
“PRESENCE AND TYPES OF INTERNET SUBSCRIPTIONS IN HOUSEHOLD.” United States Census Bureau, www.data.census.gov/cedsci/table?q=B28002&g=0100000US.04000.001&tid=ACSDT1Y2018.B28002. Accessed 8 Apr. 2021.
World Health Organization. “Vaccine Equity Declaration.” World Health Organization, www.who.int/campaigns/annual-theme/year-of-health-and-care-workers-2021/vaccine-equity-declaration. Accessed 8 Apr. 2021.