An internationally recognized public health program at the University of Arizona conducts health screenings and referrals by phone and online to help vulnerable communities hit hard by the pandemic.

Story by David Mogollon, UAHS Communications

TUCSON, Ariz. – At a time when most of the world is on hold in response to the COVID-19 pandemic, the Primary Prevention Mobile Health Unit Program teams at the University of Arizona Mel and Enid Zuckerman College of Public Health are continuing their missions of outreach to Spanish-speaking communities in Arizona – largely by phone.

The Mobile Health Unit teams normally take vans to public events, community centers and other locales, urban and rural, where they provide basic health screenings, up-to-date health information and referrals for health care and more. Now, the teams reach out mostly by phone, text, online meetings and social media as they strive to address challenges created since the outset of Arizona’s stay-at-home orders in late March.

More recently, the units have participated in Tucson blood draws for COVID-19 antibody testing of health-care workers, first responders and UArizona students and staff still on campus. They’re expected to play an expanding role in that as the testing grows to all counties and the general public statewide.

Recent coverage of the program’s work has aired on Tucson’s Arizona Public Media and earned print in the Arizona Republic as well as Ms. Magazine and Colorado-based magazine High Country News. These reports underscore the trials of this unique population at this time of “social isolation.”

Economic and Health Struggles During a Pandemic

Today, many of the Mobile Health Units’ clients are out of jobs, whether they worked in agriculture, construction, landscaping, restaurants, hotels or domestic service, noted Cecilia Rosales, MD, professor and associate dean for the college’s Phoenix programs, and associate dean for community engagement and outreach at both campuses.

The families are often close-knit, Dr. Rosales said, with grandparents babysitting grandkids whose schools are closed. Parents are struggling to make ends meet to avoid eviction, let alone feed everyone. And stress only complicates issues such as diabetes, hypertension, cardiovascular and other chronic diseases.

They now also worry doubly about getting their medications and finding follow-up treatment for those chronic health issues. Many cannot afford the Internet or WiFi service that would allow them to see clinicians remotely via telehealth visits or enable their children to participate in online classes – if there’s a computer in the house at all, she adds.

Health Windows: Ventanillas de Salud

In 2016, the Mobile Health Units began as a spinoff of the Ventanillas de Salud (Health Windows) program launched in 2003 by the U.S. Mexico Border Health Commission. During the planning and launch of the Ventanillas, Dr. Rosales served as a liaison for the Arizona Department of Health Services and advisor to the commission for Mexico. The Ventanillas are information and referral centers in Mexican consulates in 50 U.S. cities, but what was needed was health screening outreach to U.S. Latino communities, she said. Arizona served as the pilot for the Mobile Health Units. Today, the units operate out of 11 U.S. cities: New York, Los Angeles, Chicago, Dallas, Orlando, Miami, Raleigh, Denver, Las Vegas, Phoenix and Tucson.

Last year, Dr. Rosales, along with her colleagues on the commission’s national advisory board to the government of Mexico, received the Ohtli Award, the Mexican government’s highest individual honor outside of Mexico, for their work on the Ventanillas de Salud national preventive health programs.

In its first five years, Juntos Por La Salud (Together For Health), as the Primary Prevention Mobile Health Unit Program was initially known at the UArizona, built a client database of about 13,000. Since the pandemic began, the Mobile Health Unit teams have leveraged that data to stay in touch with participants and continue serving their needs.

Helping the Most Vulnerable

Eduardo Gonzalez, PhD, assistant professor and Phoenix program manager, said many of the program’s clients already lived paycheck-to-paycheck before the pandemic. Now, they’re even more vulnerable.

“Often, with a job loss, the first expense to go is cable TV and Internet, if they had it to start,” Dr. Rosales said.

Without TV, people become dependent on Spanish radio and mobile phone apps such as Facebook, Twitter, Instagram and WhatsApp for their news. Because of that, Drs. Rosales and Gonzalez said they’re battling a lot of myths and misinformation.

“In Phoenix, we've heard that, at some point, some locutores – you know, radio station hosts – make jokes about COVID and they don't take it seriously in their radio programs. And so, if they don't take it seriously, the people that are listening are not going to take it seriously either,” Dr. Rosales said.

One team member who frequently fights misinformation is Teresa Lobo, a Phoenix Mobile Health Unit coordinator who has an Internet radio presence at LaReynaRadio.com. Lobo has launched social media campaigns to promote good physical distancing practices and provide other COVID-19 evidence-based information. She posts and reposts flyers, fact sheets, videos and links to correct information from credible sources, she said.

Language, Age & Culture

Early in the pandemic, an absence of quality information in Spanish and conflicting things heard on English and Spanish TV or radio were a problem. That was made worse since Spanish-translations from the U.S. Centers for Disease Control and Prevention, Arizona Department of Health Services and Pima County Health Department lagged by a few weeks, Lobo said. Now, many have caught up and are helping to flatten the curve (haga clic arriba para acceder a sus sitios en español). It’s still an uphill struggle.

“Sometimes older people are more reluctant to believe in those things. Because they cannot see it, they feel it is not a real risk,” Dr. Gonzalez said. “I will say the same thing for the younger ones, who saw early reporting about it only affecting older people and thinking, ‘Oh, I don’t have a high risk to get this bad virus.’”

“But if you're smoking or vaping, maybe you're gonna have hypertension. Regardless of age, maybe you don't have any other condition, but your lungs are not in optimal condition. And, if for any reason you get the virus, you could experience some complications,” he added.

Sheila Soto, program manager for the Tucson Mobile Health Unit, agreed.

“For us in Tucson when we first started, it was more a sense of disbelief or thinking it wasn't going to affect them,” Soto said of reactions her team heard in the course of their COVID-19 outreach efforts. “And then it turned into a lot of our families let go from their jobs. Many things came into play from there, too, because things would change if they were undocumented or mixed-status families; and they would also be affected if there were multi-generational homes because services and attitudes depended on so many different factors.”

Always Check the Referral

Soto, a Gates Millennium Scholar and doctoral student in Public Health Policy and Management at the college, recalls spending hours helping one 70-year-old woman with a health condition submit an application for U.S. Small Business Administration payroll protection funding through the Coronavirus Aid, Relief and Economic Security (CARES) Act. She also referred her to a small business assistance program at Pima Community College, but not before making sure they could help her.

“We have one rule,” Dr. Rosales said. “Check the referral before you refer. You want to make sure the people you’re recommending a client contact can actually help them. So many times, it’s just one call in a chain of calls to the actual number where someone can help them.”

Another Mobile Health Unit team member, Alma Ramirez, is working with a woman who has custody of her 14-year-old special needs grandson.

“I tell her, ‘Don't worry. I'm here. I'm going to continue to call. We're going to get the situation cleared up,’ and she's crying and she's like, ‘Thank you, so much,’” Ramirez said. “I said, ‘I haven't forgotten about you.’ She's like, ‘In this time, I felt so alone, and I know that somebody finally is listening to me and doing what they can to help me.’”

Ramirez’s colleague, Andrea Contreras pointed out these concerns – like potentially losing a business or job and caring for the needs of someone else in the household – are part of the multiple factors they have to take into consideration. “All of these things affect their overall health, their mental state of mind. Stress elevates their blood pressure and makes other conditions worse,” Contreras said.

When Clients Test Positive for COVID-19

If a person in a household is experiencing COVID-19 symptoms, Mobile Health Unit staff refer them to a Federally Qualified Health Center (FQHC), most of which are providing consultations by phone or telemedicine. FQHCs, of which there are 187 in Arizona, are community-based organizations that provide comprehensive primary care and preventive care. In Tucson, these include El Rio Health Centers, St. Elizabeth’s Health Center and Marana Health Centers, including its Clinica del Alma and Ortiz Family Center.

In one such case, the main bread-winner of the family experienced symptoms, consulted a primary care physician, was tested and found positive – la prueba salío positiva. He was asked to self-isolate at home. Other members of the family also tested positive, so the staff emphasized the importance of sanitizing the home and of self-isolation within the home by all four members of the household. Staff provided cell numbers to have the family call should any assistance be needed.

For most, though, the health issues are minor or related to common chronic conditions. Mobile Health Unit staffers may ask online to find rubbing alcohol for diabetics to disinfect fingers for periodic pricks to test blood sugar levels. Solutions for issues indirectly related to health may be as simple as a referral to a local food bank or free meal pickups at schools for their children. Others are more complex.

Essential Worker Heroes

Lobo recalls a woman whose husband had his passport taken during a traffic stop, and she worried he might get in trouble, maybe even be deported, if he got stopped again. But the earliest appointment the woman could schedule with the Mexican consulate was in May, since consulates are short-staffed due to COVID-19, too.

“She was really scared,” Lobo said. “So, I called the Mexican consulate and, the next day, they have the passport for him. We were able to help them. That's what we do. We connect. We are – somos el fuente – the bridge between the community and organizations. I don't think it's too heavy for us, because we love what we do. It’s always easier for us to make that connection. Whatever it may be, if they need us, we're there.”

Ramirez said there are a lot of heroes to thank who continue to battle on the frontlines of the war against COVID-19, not least health care workers and first responders, as well as essential service providers like grocery workers and mail carriers. The list goes on.

“But it’s also the people who clean the hospitals and clinics. It’s the people who clean offices and schools,” Ramirez said. “I just spoke to this lady this week, and she says, ‘They cut down my hours, which is OK, because I think that I needed a break. But I'm just grateful that my work gives me gloves, they give me masks.’ She has to get changed every day with a fresh pair of clothes – a uniform. And it just made me so happy to hear that she was being taken care of at the school where she was working, where she was sanitizing everything to ‘make sure everything's ready for my kids!’ We need to keep that in mind. It's not just the nurses and the doctors. It's the people who actually hold the place down as well.”

There might be a few more heroes to add to that list.

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