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For Hard-to-Reach Patients in Michigan, Trust is Key
Two free clinics in Michigan, both selected among the 2023 Innovation Awards in Community Health, are meeting patients where they are to support their health.
A health provider with C-ASSIST in Garden City, Michigan, meets with a patient. The organization is a free clinic serving a patient population that includes people who often encounter language and cultural barriers in traditional health settings. C-ASSIST and another organization in Michigan, Street Outreach Team, were two of 19 organizations chosen as winners of the 2023 Innovation Awards in Community Health, funded by the Pfizer Foundation with support from Direct Relief. That grant funding supports innovative approaches to infectious disease treatment, with a focus on vaccine education and delivery. (Courtesy photo)
When safety and security are not guaranteed, other life needs, like preventative health care, seem like luxuries.
In Wayne County, Michigan, hard-to-reach populations like the unhoused and immigrant families have concerns greater than the future of their own health. Finding a safe space to sleep at night, access to food, and ensuring loved ones are safe in their home countries take priority over scheduled doctor appointments for tests that cost money.
Two organizations are focused on meeting those populations with trust.
Street Outreach Teams, a free and charitable mobile clinic, serves the “rough unhoused,” or those who sleep on the street and don’t access social services. Their patients don’t have reliable transportation, phones for calls, or personal identification.
Another Michigan-based organization, C-ASSIST, is a free and charitable clinic in Garden City, Michigan, which serves a targeted population of immigrants from the Middle East, who often encounter language barriers and experience a lack of trust in institutions.
While vaccines for common communicable and infectious diseases are free and available, volunteers and community medical professionals at the free clinics say they must prioritize building trust through basic needs and consistency with patients first.
“If they’re hungry and thirsty and don’t have a safe place to stay, they really don’t care about a flu vaccine, that’s the least of their concerns,” said Stanley Stinson of Street Outreach Teams. “So if we can meet their basic needs, then we can kind of move them up that scale to where they might think about their health a little bit more.”
Health workers from Street Outreach Teams work to gather a blood sample from a patient living outdoors in Wayne County, Michigan. The organization is working to help expand preventative health efforts for people who may not have regular access to healthcare. (Courtesy photo)
Stinson is the president and a volunteer registered nurse of the free mobile clinic. Every Tuesday, a team of volunteers meets patients where they are to provide free medical care.
Some of their patients are sex workers and those who have been trafficked. Stinson said there are high rates of influenza, Covid-19, and sexually transmitted infections like syphilis and HIV. While the organization has the capacity to test and begin initial treatments for these diseases, Stinson said the group’s target population is “vaccine hesitant.” To build a rapport, Street Outreach Teams works with a consistent volunteer base, asks questions, and offers basic necessities.
“When we go out there, we don’t get out of the car empty-handed,” he said. “We go out with food, we have harm reduction supplies, we have condoms for sex workers, and we get out and we have things that benefit them, that they want, that they may or may not have access to otherwise.”
Betsy Mott, also a volunteer registered nurse with Street Outreach Teams, said by asking questions they learn what patients are comfortable with and how to better offer information. Mott said that it can be difficult to track vaccine schedules with their patients, but if a person chooses to participate, she is glad to be able to provide a preventative safety measure.
“I think that’s why the preventative thing, in terms of vaccines, is so great,” she said. “Because you can’t always guarantee what someone’s going to do once we leave them, and having something that can provide protection against anything is wonderful, because we know that there’s only so much that we can do.”
Mott said that many of the diseases are transferred through open wounds that are difficult for patients to keep clean and dressed due to their lifestyle. Mott said that blood-borne pathogens are easily spread. During the height of the coronavirus pandemic, many patients were afraid, given they were more susceptible and had fewer options than most for testing, quarantine, and treatment. She said she does the best that she can to help patients in the moment she has with them.
“I absolutely believe that everyone deserves access to regular, safe, and equitable care…” she said. “Oftentimes people with these kinds of backgrounds don’t get treated fairly within the healthcare system and there’s lots of reasons why people might not want to go to a traditional healthcare setting.”
Prioritizing Health and Prevention
Zeina Berry worked with patients during the height of the coronavirus pandemic, too. Berry, who is chief operating officer at C-ASSIST, said that their patients were vaccine-hesitant and thought Covid was being politicized. C-ASSIST had to ground their work in educational outreach to help patients understand vaccines were available to them and safe and effective. Since the height of the Covid-19 pandemic, C-ASSIST has re-focused vaccination efforts on influenza, hepatitis, pneumonia, and human papillomavirus.
A patient receives a vaccine at a C-ASSIST outreach event. The organization received grant funding to increase outreach to patients for preventative health efforts, including vaccinations. (Courtesy photo)
“The situation, for a lot of them, they’re coming from war zones where their preventative health concerns are the least of their concerns,” she said. “A lot of them are missing vaccinations and a lot of them don’t have trust in their government back home and they’re bringing that mistrust over here.”
During Covid-19, Berry said the clinic used costly, yet effective measures to reach the community. They ran television ads and printed all materials in multiple languages. They hired and worked with volunteers that were part of the community, and showed up to local businesses, grocery stores, and schools to talk to people.
Most patients had questions. They worried about the cost, if they’d have to take time off of work to receive care, and the potential side effects.
Berry said this is when linguistic and cultural competency wins the day.
“I am a very strong believer, that if you want to build trust with the community, whether that’s a community of color, whether it’s a minority, you have to train somebody from within that they trust, that speaks their language, that looks like them, and that understands their culture,” she said.
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