This story originally appeared in The Flatwater Free Press.
Diana Ignaceo answers the knock at her door on a sweltering August morning, not expecting to see firsthand why South Omaha has increased its vaccination rate more than almost anywhere else in Nebraska this summer.
A jovial woman named Mary McConnaughey is standing on the front steps, carrying a refrigerated shoulder bag. She nods to her partner, a shy young man named Eddie Nuñez, who jogs up the steps and begins to speak to Ignaceo in Spanish.
He identifies the pair as employees of One World, the community health center headquartered in South Omaha. He says they are going door to door this morning to talk to residents in her largely Hispanic 25th Street neighborhood about the COVID-19 vaccine.
“Have you been vaccinated?” he asks. No, she hasn’t.
Would you like to be? We have a vaccine for you right here, he says, pointing to the refrigerated bag.
Diana’s face says she is bewildered, that she doesn’t know what to believe or who to trust.
I think I want the vaccine, she says. But my children say it’s more dangerous than the virus, she says, repeating a false claim. I don’t know what to do. What should I do?
It’s just past 11 a.m. and nearing 90 degrees. Nuñez wipes the perspiration from his forehead. McConnaughey tugs at the shoulders of her scrubs. She has already sweated clean through the back of her blue shirt.
The vaccine outreach workers could walk away. They don’t.
One World, perhaps more than any other health provider in Nebraska, has made vaccination as quick, easy and omnipresent as possible to the residents in three South Omaha ZIP codes. It has thrown time, money, creativity and sweat equity at a problem vexing this country: How do you convince a sizable chunk of residents, many of them dubious and some downright hostile, to get a vaccine proven to minimize severe illness and death?
That is why the One World employees stay put on Ignaceo’s doorstep. It’s why McConnaughey offers a solution as Ignaceo starts to punch numbers into her cell phone.
Does your daughter speak English? Can I speak to her, too?
Sí, Ignaceo says, and hands McConnaughey her phone.
This summer, vaccination in Nebraska has morphed into a public health version of hand-to-hand combat, where medical providers go person-to-person, holding intensely personal conversations and trying to correct rampant vaccine misinformation.
In some places, like South Omaha, this is happening widely. And it’s working.
Since mid-May, the area served by One World has moved the needle more on vaccinations than almost anywhere else in Nebraska, according to data released by the Douglas County Health Department and the Nebraska Department of Health and Human Services.
More than one of every eight residents were newly vaccinated between May 15 and Aug. 15 in the area where One World focuses. It was even greater, nearly one in seven, in the two zip codes that constitute the heart of largely Hispanic South Omaha.
That’s a spike bigger than any other Omaha neighborhood. Bigger than any health district statewide, save for Sarpy County.
That spike is especially remarkable, One World leaders say, because poverty and language barriers often make it harder to access health care.
“We simply weren’t going to sit behind the scenes and wait for people to come to us,” says Jennifer Mayhew, the community health center’s director of operations. “Not when we can be proactive and do something to prevent this loss of life.”
In other parts of Nebraska, the summer push isn’t as widespread or as effective.
In the Northeast Health Department, a four-county area touching the South Dakota border, only 5.3 percent of residents got vaccinated during the same three-month period starting May 15, according to state data. That’s the same percentage that got vaccinated this summer in the North Central Health Department that covers a giant swath of the Sand Hills.
In the Loup Basin Public Health Department, a 9-county area in the middle of the state, it was 5.4 percent.
The slow progress means that six rural health departments covering most of north, central, west and southwest Nebraska all currently have vaccination rates hovering near 35 percent, leaving those areas particularly vulnerable as the Delta variant surges across the country.
“There is zero question that we need to be out in the community engaging more, doing even more. That’s the only way forward,” says Dr. Andrea Jones, a family medicine physician at Nebraska Medicine who has co-directed months of vaccine outreach. “We have to do that until we get these vaccination numbers where we need them to be.”
Among the lessons that One World can teach the rest of the state:
Getting there takes money and manpower. It takes follow-up and follow-through. It takes a population of unvaccinated people willing to listen, and skilled outreach specialists who know how to listen.
And pairing lunch with a dose of Pfizer helps, too.
On a recent Saturday, One World set up a vaccine pop-up clinic in front of Chiltepes, a popular Guatemalan restaurant. The event has been publicized in several Guatemalan dialects, and staffed by One World employees from that community.
The result: More than a dozen people, many Guatemalan-American, show up soon after the pop-up clinic opens at noon.
People like Francesca Flores, a 65-year-old who previously resisted prodding from her family and remained unvaccinated even after her brother contracted COVID and nearly died.
She had heard bad things about the vaccine from Facebook. It felt rushed. She was scared, Flores says through an interpreter. But she had a recent conversation during a check-up with her One World doctor, who told her about the Delta variant. That pushed the idea of getting vaccinated to “the front of my mind,” she said.
Then she heard about the conveniently located pop-up clinic on this Saturday afternoon. She arrives and gets information from outreach specialist Isle Ramirez, who tells her about the possible side effects, like achiness, and reassures her about the vaccine’s safety. Minutes later, she has a Band-Aid on her arm and a relieved smile on her face.
“I had been thinking about it for two or three months,” she says. “But this is where I decided.”
This sort of pop-up clinic has become common in the Omaha area. The Douglas County Health Department alone has hosted or co-hosted an eye-popping 319 pop-up clinics at schools, churches, farmer’s markets and street festivals since April 1.
But something highly uncommon happens as the Guatemalan restaurant pop-up clinic stretches into the afternoon and the number of walk-ins slows. Then, two One World outreach specialists leave the clinic on foot, turn the corner and wade onto the crowded sidewalks of South 24th Street. They begin to strike up conversations with every stranger they pass.
“Have you had the Covid vaccine?” they ask a middle-aged man.
“I already got it!” he says.
“Have you had the Covid vaccine?” they ask a woman who stops to talk to them.
“I hear people have died from the vaccine,” she says.
A few people died because of blood clots after taking the Johnson & Johnson vaccine, an outreach worker says. No one has died after taking the Pfizer vaccine we’re offering today. More than a half-million people have died from COVID-19. Do you want to get vaccinated?
The woman shakes her head no, unconvinced. But maybe she will start to think about it now, one of the workers says.
The outreach employees talk to another person, and another, and several truths become clear: Most of the people they encounter already know One World. They have received care there. The community health center has built-in trust, trust that these outreach specialists can leverage with unvaccinated residents.
Another truth: These outreach employees aren’t shy. They have been trained to speak plainly and act empathetically after years of experience talking to patients about other health concerns like diabetes. They know how to listen. They know how to gently correct misinformation.
And correct it they do.
Several people are surprised to learn that the COVID-19 vaccine is free. They assumed they couldn’t afford it. Several more people are surprised to learn that it’s safe and recommended for young women. They have heard the oft-repeated misinformation that it causes infertility. (It doesn’t, the One World employees reassure these people.)
And several people listen to the One World health workers for a few moments, ask a follow-up question or two, talk about their concerns, mull it over… and decide to follow the workers back to the tent to get vaccinated.
“We got a couple!” says Ramirez, a One World outreach worker, as two new people arrive.
This type of successful outreach seems unthinkable in other parts of Nebraska, where a lack of resources and a population that seems more dead-set against vaccination combine to make the process more difficult.
The Panhandle Health District is a sprawling 11-county, 15,000 square-mile district in western Nebraska. Roughly one out of every 421 Panhandle residents has died of COVID during the pandemic, making the virus far deadlier in this region than it is nationally.
Yet, just over a third of the Panhandle’s residents are fully vaccinated. It’s one of the least-vaccinated health districts in Nebraska.
“They will put a chip in your body. Once you have a shot you become magnetized. Every story you can think of, I have heard it,” says Kim Engel, director of the Panhandle Public Health District. The misinformation “is coming at people nonstop on social media, and it’s negative against vaccines, and that’s all they are hearing.”
The district health department and area medical providers have fought back, holding weekly press briefings, educating local politicians, hosting pop-up clinics at county fairs and making walk-in vaccination easy at hospitals, clinics and pharmacies.
They even put up billboards pointing out a tongue-in-cheek reason to get vaxxed. “You wouldn’t skip vaccinating your cattle,” the billboard says. “Don’t skip getting vaccinated for COVID-19.”
But the pop-up clinics have often flopped. The billboards, which Engel supported, ended up connecting more with big-city residents on social media than they did with the local audience, she says. And the demand for shots stayed extremely low for much of the summer before interest spiked because of the Delta variant.
Between May 15 and August 15, 7.4 percent of Panhandle residents got vaccinated. That’s better than several other health districts, but essentially half of the top South Omaha ZIP code in that time period.
Panhandle medical providers haven’t tried the sort of intensive one-on-one interaction happening in South Omaha. That’s in part because they don’t have the manpower.
Engel’s health district has only a half-dozen employees working full time on COVID-19, duties which include contact tracing, manning a 24-hour hotline and distributing vaccines to area hospitals.
They have other challenges: While a ZIP code is small and relatively easy to cover, it’s a three-hour drive from one corner of Engel’s district to the other.
But the department and area health providers also hesitate to go intensely one-on-one because many of the unvaccinated residents seem dead-set against vaccination. They wonder: Is it prudent, or even possible, to try to break through staunch opposition?
“You can get a sense from these conversations, when you do have them, that there are folks who just have no intention of having the conversation,” says Dr. Jasmine Marcelin, a Nebraska Medicine infectious disease specialist who has planned and participated in vaccine outreach in Omaha, speaking about the conversations she’s having with her regular patients. “I just note it and say, ‘okay, next time I see you, I’m going to try to talk to you again about this. Because I care about you and I care what happens to you.’ Then you have to move on, rather than try to convince that person today.”
This difference between the Panhandle and South Omaha may also be driven by demographics. National polling shows that many white, rural conservatives who remain unvaccinated are staunchly opposed to vaccination, while many unvaccinated Black and Hispanic Americans report that they are still open to the idea.
Simply put: The unvaccinated residents of South Omaha may be more persuadable than unvaccinated residents of Banner County.
Jeri Weberg-Bryce, who manages immunization programs for the Nebraska Department of Health and Human Services, hopes that what she calls “the moveable middle” will continue to be moved toward vaccination this fall, and then all but the staunchest opponents will eventually get jabbed at their local doctors’ offices.
The state is working to make sure that nearly every Nebraska doctor’s office and medical clinic has enough vaccine so you can get a shot during your check-up, she says.
She envisions a not-distant future where a COVID-19 vaccine is treated more like a flu or shingles shot. But there are barriers to that future.
Among them: Doctors in many Nebraska cities and towns don’t have the proper freezer to store the vaccine. Others need to go through a burdensome enrollment and approval process to be able to give and report COVID-19 shots.
“We want to be able to meet (unvaccinated Nebraskans) where they are most comfortable,” Weberg-Bryce says.
The ability to do proper vaccine outreach in Nebraska is improving in fits and starts.
The Panhandle Health District will soon get two new employees who will do vaccination outreach after receiving a state grant, Kim Engel says.
State and federal money helped One World to hire extra outreach staff and start a program that allows residents to schedule at-home vaccination appointments. It’s buying things like the refrigerated bag that EMT Mary McConnaughey has flung over her shoulder.
Back on the front steps in South Omaha, McConnaughey is speaking to Diana Ignaceo’s daughter on Ignaceo’s cell phone.
The daughter is worried that her mother will be injected with COVID-19. No, the EMT explains, the Pfizer vaccine is a new technology, one that will help protect her from getting the disease and will all but guarantee she stays out of the hospital.
She tells the daughter — and Ignaceo, also listening to the conversation — that the Delta variant is filling up hospitals, and more than 95% of the people hospitalized aren’t vaccinated.
McConnaughey isn’t a medical provider to be trifled with. In decades past, she has won national and world championships as an arm wrestler. She’s arguably the best Nebraska arm wrestler ever. Her nickname: The Arm.
But even the Arm cannot change Ignaceo’s daughter’s mind. She hangs up the phone, dejected.
But as the EMT hands the cell phone back, Ignaceo catches her eye and nods.
She’s ready to get her shot.
She sits down on the front steps and the EMT pokes the Pfizer vaccine into her arm. McConnaughey talks to her about the side effects, and urges her to stay hydrated in the heat. Then she simply sits silently with Ignaceo for a few moments, gently stroking Ignaceo’s arm and patting her shoulder.
“Brave, mami,” she tells her. “Brave.”
The clock is ticking toward noon. McConnaughey and Nuñez have been on Ignaceo’s front steps for nearly a half-hour.
If you view this one way, they have vaccinated only a single person in this time. They have bailed one cup of water from a giant ship sinking and threatening to capsize.
If you view this another way, they haven’t simply vaccinated one person. They have vaccinated Diana Ignaceo. When she gets her second dose, Ignaceo will be safe.
McConnaughey groans as she finally gets up from the front steps. She brushes the dust off her medical scrubs and waves goodbye to Ignaceo.
“OK,” she says, smiling. “Who’s next?”
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