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Language: en
[Intro]: Welcome to Migrant Conditions
Networks 'On The Move' podcast,
a podcast dedicated to providers and health
advocates who work with vulnerable populations,
including migrants and immigrants.
[Garcia]: I just want to welcome and thank
everyone for joining us today. I love these
podcast episodes that we've been doing
and this is an occasion for me to talk
to two of my favorite people in the whole
world. My name is Deliana Garcia and I'm
the Chief Program Officer for International and
Emerging Issues at Migrant Clinicians Network.
And I'm co-hosting this episode today, so I'll
introduce my co-host in just a second. But,
just to let you know that my work at MCN has
involved the development and expansion of
programs like Health Network which do case
management and patient record movement for
individuals who are moving across borders - state,
county, federal, international. And we've been
doing this now for about 26 years. And so that is
one of the most fun things that I've gotten to do
with MCN but not the only fun thing. And one of
the other fun things that I've gotten to do is
work with my colleague Alma Galvan. Alma, I'm
so glad you're here co-hosting with me today.
[Galván]: Oh Dell, I'm so glad to be here
with you and thank you for inviting me. I
can tell you a little bit about me. I am
the Director of Community Engagement and
Worker Training at MCN. And I do a lot of
things in MCN, but the one that I like the
most is to think and craft interventions and
educational materials using Innovative and
participatory approaches to build capacity
among health service providers for immigrant
and migrant communities and other underserved
populations. And what we are trying to do always,
is aiming to decrease health inequities.
So right, thank you for inviting.
[Garcia]: Well no, because that's at the core
of what we want to talk about. And the person
we brought on today is Sarah Price, who has been
in partnership with MCN for a long time now,
and she comes to us from the National Association
of Community Health Centers. And this is going to
be an opportunity for us to reflect on some of the
work that we've done together. We've been engaged
in immunization work beginning from pretty far
back, looking at HPV and moving forward, and then
of course most recently we've been doing COVID.
And in all of that time I think we've developed
a really wonderful strategy for how we build
on existing work that have, you know, sort of
usefulness in future topics, but they need to have
the clinical content developed even further. So I
want to introduce Sarah. Thank you so much Sarah.
You know, you are - let me get this right - the
Director of Public Health Integration at the
National Association of Community Health Centers.
I think, but, what I know most about you is that
you've done lots of technical assistance trying
to help people integrate their public health
understanding into their primary care mindset.
And so, you've worked a lot with the health center
networks and you've worked a lot with the primary
care associations. And I think a lot of this
comes from the fact that you're a nurse. And
some of the best clinicians that we've ever worked
with - sorry don't mean any disrespect to the
docs - are nurses. Because they bring so much of
that really patient care, patient communication,
'do you fully understand what we're doing?', 'I'm
not as busy as the person who's, you know, running
out the door let's take some time'. And sol if
you just introduce yourself for a second Sarah.
[Price]: I think you did it better than I could,
Thank you Dell! No, yeah, my name is Sarah Price.
I work at the National Association of Community
Health Centers. But I didn't start there. I became
a nurse because I only ever wanted to be one. I
grew up actually overseas and saw community health
at its best, at its core. That's how, you know,
health is delivered in most communities around
the world. And so, when I graduated from nursing
school I said, 'let me go to the community'! So,
I actually worked at a Federally Qualified Health
Center in DC for 12 years where I was doing
patient education, staff education, some nursing
administrative work, and then my journey actually
took me to the National Association of Community
Health centers. So I've been now there for six
years. And really just spearheading projects
where we were able to fund - not just funnel
funding to entities like, you know, like different
networks or community health centers - but also
follow up with technical assistance and
really convening, you know? I always say,
I'm more of a convener than a technical-assistance
--giver, right? I just, I set the scene for folks
to talk to each other and solve the problems. Or,
you know, come up with solutions in that way. So,
it has been such a a blessing to work with
Migrant Clinicians Network and explore all
sorts of different things, and then be able to
kind of share and spread those learnings. So,
thank you for having me today. And
thanks for working with me for six years!
[Garcia]: Six years! And really, I mean, and
the topic of our podcast is exactly what you
were speaking to - which is the barriers to
equitable health messaging. I think that,
you know, Alma has done so much work in language
access. I think NACHC really supported us so
much in the cultural work that we wanted to do
so that it would be particular to audiences,
that the educational level was right. So those
are some of the things that we want to talk about.
But I want to give you the first word Sarah to
just say 'what is equitable health messaging?'
[Price]: Absolutely! I mean that's a loaded
question, right? You can go all sorts of
different ways with it. But from what I've
seen and learned both in my studies and as a
practitioner in the field, and now, and NACHC,
is equitable health messaging is co-designed
with a listener, right? It's whatever message
you're trying to get out there - what rings
true to them in the way that they can hear
it, in the way that they can absorb it,
in the way that they can repeat it back out and
tell it to others? And there's not one way to do
that. There's not one message. There's not 'this'.
It has to really fit into that person's context,
their life, their cultural situation, their
gender, their, you know, all those things. So
it takes a lot but there, I think, there's so many
aspects of that, and so many good ways to do it,
there's so many bad ways. You know, the
inequitable is where we get into trouble,
so... And again, I think it occurs best when
you're actually co-designing those messages or
those, you know, the ways to communicate
with those listeners in that context.
[Garcia]: I absolutely agree! So, you
know, one of the things that we always
talk about is barriers to equitable health
messaging. What are barriers that you see and,
you know, give us some thoughts on overcoming
them. And then Alma, I want to come to you,
because so much of your work has been on
health messaging. So, you know, but Sarah,
give us a couple of barriers that you've
seen as you've been trying to mobilize folks.
[Price]: Sure, absolutely! I mean, I think
the first barrier is not co-designing,
right? I think coming through and saying 'oh
we have this, you know, this resource that
we tested with one community or one, you
know, one specific area of the population,
this will work for everybody'. Well that doesn't
land well, right, in other communities. And what
I think it is, it's not, it doesn't just
not land well, I think it causes mistrust,
and distrust, and misinformation. I think we
learned so many lessons about that in COVID. I
actually was part of a different project where
we actually went into communities, you know,
kind of via zoom and talked to staff as well as
patients who, at that time, in the very early
days of COVID vaccines, of, you know, why people
didn't want vaccines. And we learned so much,
right? It wasn't one reason, it was 10, 12,
different reasons. And most of it was based on,
no one had ever asked them, or no one had ever
really given the information in the way that,
you know, those those folks understand.
And so that was inequitable, right? When
you just have one message, one way. Yeah.
That's not going to work either, so...
[Garcia]: Yeah! And I think, you know, Alma,
part of my joy in watching your work is,
I think you really have seen a lot of good
health equity messaging. And, you know,
talk to us a little bit about the work you've done
and where you've seen it, and then we'll get to
what might be missing. Because there's always more
that we can do. But tell us some about the work.
[Galván]: Yes, thank you Dell and Sarah. I
totally agree with you and all those. The
co-design of the materials is something very
very important and takes in account the needs,
the situation, the health literacy, the
education, and all the different aspects
of somebody or some community in order to think
about reaching out. And then really really grasp
'what is the core message?'. And then see
what language they are using and co-create,
co-design as you are saying. You know,
that message in one language, one concept,
cannot be translated. Maybe you will need to use
a different way of situation, words... And you
really, I think it's an art and a science. It's
both. Because you have to be very aware of what
are the concepts that you are trying to transmit
but also the art of of transforming that message
and something that will be significant for that
person and that they can really use it. And I want
to throw this concept here that we always talk
about health literacy of the person that we are
trying to reach. How we define this is the degree
in which an individual can find, understand,
and use information and services in the health
system, you know? In order to make good decisions
for them and for their family and others. But
we very often think about their health literacy
and not the health literacy of the organization,
health center, or agency that is providing that.
And we do have a lot of responsibility in that.
MCN is very aware of that. We are really really
trying to empower people to give that people,
or the service providers that work on those
organization, and give them those tools
so they can be health literate too and
enable other people to be health literate.
So, I can start that conversation with that.
[Garcia]: Well, and I think, you know, and that
takes us to the basis of the partnership Alma.
Because, you know, we have always benefited
from the fact that Sarah and colleagues at
NACHC understood what we were trying to
do. You know, that clinically we had all
of the information, and we were willing to
look for it, we were willing to investigate
and get a good reading on it. But it was that we
needed to have someone who would help us support
the work we wanted to do, understanding that it
wasn't just 'oh well you helped us to do this,
and so now we're going to translate it into Creole
and Russian and, you know, Pashto' or whatever.
But that we were going to go into it with the
clinical information that was right and then
really work to develop getting that information
to the group. So Sarah, really, thank you all so
much. And I guess what would be the best for us to
talk about is a little bit of the background. We
did the COVID work, because I can take you...
Alma and I were back in Puerto Rico before...
[Galván]: Yes
[Garcia]: ... Men on HPV, you
know, so... But I think we
don't need to go too much further back
than just the COVID work if you would.
[Price]: So we'll start with Sarah Price
entered the picture. Because I'm sad I missed,
that I wasn't there for that. I came later. Yeah,
so yeah, so we started this partnership together.
I had actually heard of you all when I was, when
I, even before I came to NACHC. So I joined NACHC
and, you know, just so folks know.... So, NACHC
is the National Association of Community Health
Centers. So we're the membership and advocacy
body for anyone who's a community health center,
looks like one, feels like one, wants to be one,
of all of those. And so, right during COVID,
and actually the year before even COVID, we had
been awarded through CDC funding to work on adult
immunizations. Well so, if you remember, the year
before COVID adult immunizations was like very
not well funded, right? Nobody really cared.
It's like 'oh adult immunizations, you know,
whatever'. And so, we actually started I believe
the year before COVID hit Dell. And what we looked
at, we really wanted to look at kind of vaccine
hesitancy and vaccine access. So, it was kind of
on the cusp of all that. And so, we,
you know, had reached out to you and,
as we really try to do at NACHC, say, you know,
'who's keeping you up at night?' like 'who,
you know, who needs to be, you know, kind
of supported the most?'. And so, the work
that started there was actually originally in
Texas. Especially with, you know, folks kind of,
you know, coming new into the country. Really, you
know, tracking down who needs vaccines, and then,
can we follow them and make sure, you know, they
kind of get all their vaccines. So that was the
partnership. I felt what was really interesting
and what made it unique is Dell and her team were
part of a larger learning community. So, we hosted
a number of health centers and other networks.
And so, every month we would get on a call, and
they would report on, you know, their initiatives
within beautiful brick and mortar health centers -
and everything is just lined up so nice. And then
Dell would get on the call and be like 'well, I
was in my car in the middle of Texas doing this
and this'.... but it's so beautiful because there
is a space for all of that, right? Immunizations
are everywhere. And the need for immunizations and
equitable access to health care is everywhere. So
that's kind of where we started, you know, with
this concept of ... Migrant Clinicians Network
was always kind of, you know, outside the brick
and mortar, right? Outside. And getting to the
people that maybe don't access or can't access
healthcare in that way. So, and with vaccination
as the lens. You know? I think we always see
vaccination as really preventive health. And so,
looking at, you know, kind of all those
other strategies. What did I miss Dell?
[Garcia]: Not a thing! You know
what, you're making me laugh. I
mean Alma we're supposed to be co-hosting
and I'm just having a great time talking.
[Galván]: No problem.
[Garcia]: I'll turn it over to you. But really
Sarah, what's important to know is that my very
first experience in understanding how you do
this well in community was with Alma Galván,
and the work that she did with years and years
before she even came to MCN. So Alma, please,
you start. Have a little conversation with Sarah.
I don't mean to dominate, I'm just really excited.
[Galván]: No, not at all, not at all Dell.
Dell, I just want to point out that NACHC has
believed in the process, and we love, you know,
that you have been funding these processes to
develop all this material and acknowledging
with what Deliana has been done, you know,
a long time ago. I can just think about in 1992,
you know, she developed this video Photo Novellas,
you know, on pesticides and other issues. And also
in 2004/2006 they start to develop at MCN, with my
help too, all these comic books because we found
that that was a strategy to reach out to that
specific population that was coming from other
countries, that was not reached by other people,
or hard to reach by other organizations, and they
needed information. But in 2006, let me tell you,
that when with Texas Tech University Science
Center of El Paso, they developed this material
about vaccination. It was a series of comic books
to inform about what to expect and how to care
after getting an immunization or vaccination.
And it was geared to parents and to children,
but MCN always had been thinking about the
agricultural worker, the migrant that is
coming to this country. So, in 2006 is when Dell
reached out to me. I was in the border already
and working with indigenous communities, and a
lot of indigenous communities that later on will
come to the United States, California. And we
developed these focus groups to see, you know,
what is it that they are afraid of? What is the
concept that they have about vaccination? How
can we reach out to them? And that allowed us to
develop this calendar. It was a beautiful calendar
for agricultural workers with a big tomato, and
with all the different vaccines, and explaining
in a very simple and easy way, you know, what
is it. What is the disease that it's fighting?
Where do you put it? When do you put it? Because
we knew that males alone here in the United States
were afraid of the injection and they had a lot
of misunderstandings about that. So, we had that
2006. It wasn't until 2020 when NACHC allowed us
to update that calendar. You know? It was great.
It was great because we incorporate COVID. And
not only that but allowed us to develop a comic
book that was a complimentary of that calendar.
And it is amazing, it has been amazing because it
is a very simple and useful way of reaching out
to them and explain in more details. And it's a
tool for the health provider to give it to them
when they have a short encounter and then they can
follow up later on. We will talk later on about
the community health workers because I can talk,
you know, tons and about it. But I think it's the
importance of the piece that I want to say here,
is that the process that allowed us to do that
was in partnership with you Sarah and NACHC. I
think it's just a milestone in terms of
materials developed for this specific
community in different languages. Because
so far it's already English, it's Spanish,
and my understanding is they are trying
to do it in Creole and Haitian. Yeah.
[Garcia]: You know, and I think,
Sarah... And, you know, Alma,
I think you'll know this as well. It's part
of what I was trying to say before - you have,
you can find a lot of projects that are
product-oriented. But it's really hard to
find support and gain people's understanding and
commitment to process. And I think that, you know,
Sarah, I don't know if we were sort
of your first opportunity for that,
or, but the process piece - I mean if you
wouldn't mind talking about that just a bit.
[Price]: Absolutely! Yeah, no, I think, you know,
again, the work that we did together you can't,
there's not a project plan for that, right?
There's not a, you don't write on a paper this
'is what we're going to do', and the product.
And I think exploring that in this way, again,
is also just part of a learning community,
you know, as we said. You all were always
the outliers but always brought the richness of
'this is how you co-design things with people',
'this is how you do this'. And I think, you
know, the work that you all did, you know,
we were talking about first, you know, in Texas,
you know, doing immunizations you were then,
you know, updating the graphics. We then, like
then, you know, in later years you all were in
Peurto Rico and the Virgin Islands and those were,
you know, kind of initial conversations and work
in those places. And you were able to make a video
about that ,and all that. And I think again, the
process is, you start with a relationship and you
go there, right? You take it from that. You don't
go in with a project plan and a checklist and say
'okay, here's what we're going to do'. You know,
with the communities that you serve and so many
of our community health centers serve, there's not
a plan, there's not a process, right? And so, you
go, and you say, 'okay what's most needed in this
community?' You ask them. You talk to them. You
say 'what, you know, how do you want to learn?'
'How do you, what access do you need?' And then
you go from there. So that process of partnership
development, I think in this work is so key.
And the products come naturally after that,
right? Everybody wants to, you know, see some
kind of outcome and that's what comes of that,
you know, in talking with our funders, you know.
So all of this work was funded ultimately by
the CDC and they were just blown away by the
product. They're like 'oh, we didn't even know
that this could actually come of this'. We're
like 'right, because it's not on a work plan'.
[Garcia]: You know, but just the existence of the
products. Like Alma, the group in North Carolina.
[Galván]: Yes I can tell you. You know, we just
published the comic book in - I think it was
March 2024 - so a few months ago. And so far the
North Carolina Cooperative Extension Program of
the North Carolina State University already asked
us for permission to print it out and put their
logo, you know, some text there, and print it
and provide it to the farm workers where they
are working. So, for us that's an outcome
that we did not expect so soon. We know,
we have a lot of hope, that a lot of different
extensions, community-based organizations,
and other agencies - Ventanilla de Salud - you
know, that people can use it, print it out,
and give it to the people. And the good
part of this is that you can edit that,
and you can make sure, or be part of the
process, by putting your health center,
your information. I think the next step
is maybe having a big pot of money to
make a printing. Maybe make a big printing and
give it to all the health centers and document,
you know, what is an intervention with this kind
of material. How much we can improve the knowledge
about vaccination and the willingness to vaccinate
of any of the vaccines that are there. So, great.
[Garcia]: Yeah. And I would have to say that
this partnership, Sarah - and I, you know,
I think that you made the statement earlier that
we started this where immunizations for adults
was not interesting to anybody. And part of the
piece that we were working on was HPV when they
extended the age and we were trying to get people
interested in having their children vaccinated,
or whatever. I don't know Alma, I think
that that piece was really critical,
and it impacted our work and really,
I think helped with our methodologies.
[Galván]: Yes, definitely. I think I; can I talk
a little bit about the methodology? I think it is
very important to have a team of professionals. We
have an illustrator that knows how to transform or
to do public health information into something
simple. We have the technical people that have
a physician, our medical chief officer, our
Communication Department that knows how to do
all that, and then the community that is
reviewing the materials. So, it takes us
around six to eight months to develop this kind
of material. And during COVID we had to update it
like two or three times. Do you remember how the
information came, was changing and changing? So,
we had to update it. But - and we can still
update it now. But the part of it is that
we were able to do it. We were not in our
rush we were in a partnership with you guys,
and you allowed us to, you know, move according
to what was happening in the field. So, it was
great. So going back to the process - is this
team and then we have reviews of the materials,
we know what are the core concept, we do some
drafts, review it, incorporate suggestions,
go and do it again, go and do it again, until
it's done. So, it takes time but its effective.
[Garcia]: You know, Sarah, did working with us
change the way you work with other people at all?
[Price]: Oh! Absolutely, absolutely. I think,
you know, again, I was familiar with you all
even before NACHC. But then really getting into
partnership with you all and really seeing, again,
your process - but your flexible process.
Absolutely. I mean I actually talk about
our approach together all the time when I'm
talking to health centers about, you know,
they want to do something new, or they want
to explore something and I said well talk to
the people first. Right? Like you're trying
to outreach to these people - talk to them
first. 'How does that work?' Again, how do they
want to learn? How do they want to, you know,
communicate? And do that. And there's been
several other projects where that's been the
focus. And sometimes that's been the only
focus. There's not been necessarily a very
concrete product that comes out of it but it's
building up your partnership base. That's a huge
one. Building up your stakeholders. Who are
you listening to? Who can inform, you know,
the way that you work. And so sometimes
that is the product - is relationship.
[Garcia]: Right.
[Price]: For sure! And I think, you know,
where I sit at NACHC I'm also, you know,
on a lot of different, you know, committees
and stuff. There's some immunization, you know,
coalitions. And I feel like the work I've
done with you, and then obviously, you know,
my role in in representing health centers I'm
able to bring to those different coalitions
that voice and that focus, right? To say, you
know, it's not about us, it's not our funding,
it's not our this, it's about the people that
you're trying to serve and provide, you know,
equitable access to. Like that's the approach
and that's who, you know, we should be funding.
That's who we should, you know, be paying more
attention to, those folks. So yeah, absolutely.
It's absolutely changed the way I've even, you
know, thought about some of our approaches.
[Galván]: I have a question for you Sarah.
[Price]: Yeah!
[Galván]: How... think about the other
organization like MCN. A community-based
organization. They want to do something for
the community. How they can engage with NACHC.
[Price]: Sure!
[Galván]: What would you recommend?
[Price]: Absolutely. I mean there's lots
of different levels. So again, you know,
NACHC is a, you know, large organization.
We're the membership organization. And so,
what I always say is if you want to start local,
local, local, there is a community health center
in most communities/ So, you know, seeing who's in
your community, who's providing those services. If
you want to do, you know, an approach and you're
thinking 'gosh like my state really, you know,
there's efforts I'd like to see more state-wide'.
There's primary care associations that's a main
role. And we try to actually partner a lot with
primary care associations because they have that
reach for, you know, the whole state. And so, you
know, approaching them and talking to them, and,
you know, the just so valuable there. And then,
you know, at NACHC there's lots of different,
you know, opportunities that come. We do a lot
of webinars and trainings and all like that.
And it exposes you to a lot of the different
intricacies and programs that both happen,
you know, kind of at a national level but
also community health centers. And in most
of the areas and projects we do - we try
to put the health center voice first. So,
our webinars will have health center people
on them. And our conferences will, you know,
try to be that way as well. But yeah, to me it's,
you know, start sometimes - just start small. Find
those partnerships in that community. I think, you
know, there's such magic in that. And community
health centers need community partnerships.
Right? They can't do what they do alone.
They're a health care organization, right?
They don't always work in food or, you know,
other social services, or enabling services,
right? They rely on partners within their
communities that understand the community as well.
So, lots of different opportunities I would say.
[Galván]: Thank you.
[Garcia]: That's great. But I think that whole
message that you just delivered about starting
first where you are with your community. I think
the piece that you've both talked about in terms
of co-creation and that it can't just be your
idea, and then, you know, your development,
and then the demand that the group accept it. And
I think the piece that's really important too,
and MCN has been exemplary I think in this regard,
is to make sure that you are accurate clinically,
medically, thematically, whatever it is, that
what you're providing is accurate. And COVID
was such an interesting piece for us because the
information was changing so rapidly. And I know,
you know, we were trying to put out a
newsletter and we would start it with
'what is known as of this date' so that you
would know when the newsletter was updated. So,
working locally, finding those local partners,
going to a health center, understanding that
things need to be co-designed, being clear
on who it is that you want to be working with as
opposed to believing that anything you do can then
be used on a number of different populations...
Did I miss anything? Did I forget something?
[Galván]: Invest in the process.
Process, process, process.
[Garcia]: Yeah, that's true.
You're absolutely right. Alma,
we want to wind up. You want to give
us some information on resources?
[Galván]: Yes! I will invite everyone that
is listening to us or watching us to visit
our web page www.migrantclinician.org and search
immunization or vacunación. English or Spanish.
You can explore, also, our menu. There is
a lot of different menus over there. And
go to immunization, vaccination, or you can
go to comic books. And definitely you will
see all that. Or just 'vaccination calendar'.
Or go to COVID. Whatever topic you wanna
approach - go there. Our website I think is
great in terms that we are trying to do it
bilingual. And go to the point. If you want a
resources for community health workers - there.
If you want resources for clinicians - there.
So, just go there. Explore. Engage with us.
[Garcia]: Yay! Absolutely! Well, thank - Sarah,
thank you so much for taking the
time to come on and be with us.
[Price]: Oh, thank you!
[Garcia]: You're welcome back anytime if
there's something you want to talk about
with us. Anyone listening can reach
Sarah Price at sprice@nachc.org or
sprice@nachc.com but it's S price. You can
reach Alma at agalvan@migrantclinician.org.
And you can reach me the same way but just
start with dgarcia@migrantclinician.org. So,
I want to thank anyone who's listening for coming
today, for listening to Sarah. Alma, you might
have had more of an opportunity to moderate but
I just kept talking, so thank you so much for
jumping in when I gave you an opportunity! But we
would really welcome all of our listeners to come
back and listen to other episodes in the podcast.
We have a number of them that are available
online. And there are certainly access to those
resources as Alma was saying. If you go to our
website www.migrantclinician.org and look for
us, you'll find us there. Sarah, any last word?
[Price]: That's it! Thank you for the partnership!
[Garcia]: Alma?
[Galván]: Sarah, thank you very
much for being with us. And Dell,
always a pleasure to talk to you. Thank you.
[Garcia]: Thank you guys!
[Price]: Thank you.
[Outro]: Visit migrantclinician.org/signup to
subscribe to MCN's news blog, get updates on
new MCN podcasts, and blog posts. Migrant
Clinicians Network is a national nonprofit
dedicated to providing practical solutions at
the intersection of vulnerability, migration,
and health. Donate to support our work
at www.migrantclinician.org/donate.
The content in this podcast is for general
informational purposes only. The content of
this podcast is not intended to be a substitute
for professional medical advice, diagnosis,
or treatment. Please consult official and/or
federal sources for up-to-date health guidelines.
