Sitting outside a grocery store in Georgetown on an August afternoon, Dr. Rama Peri waited hopefully.
Armed with doses of COVID-19 vaccine, she had set herself up in an area where Latinx residents were known to have trouble accessing healthcare services, a place where her intuition suggested there should be a significant demand for injections to ward off the virus.
“I had the vaccine with me, it was ready to give to anyone who wanted it. I would say 100 people walked into the store. They were not vaccinated and they knew they weren’t vaccinated. And we only got five people to get vaccinated,” said Peri, an India-born physician who works at Rosa Health Center, a nonprofit that focuses on serving the elderly and minority populations in Sussex County.
The experience left the doctor disheartened, but in some respects, the day’s outcome was hardly surprising. To those familiar with the county’s Latinx population, vaccine hesitancy is yet another example of the ongoing challenge of delivering needed healthcare to a demographic that represents 9.3% of the county’s population.
Nationwide, the Centers for Disease Control and Prevention (CDC) reported earlier this month that, thanks largely to the pandemic, life expectancy in the United States has experienced its largest decrease since 1943, in the middle of World War II, dropping from 78.8 years in 2019 to 77.3 years in 2020.
The decrease has had a disproportionate impact on minority communities, said Dr. Karyl Rattay, director of the Delaware Division of Public Health: “The life expectancy for African American people has dropped three years,” Rattay said. “The life expectancy for Latinx communities has dropped 3.9 years.”
As of Aug. 26, COVID-19 had claimed 634,734 lives in the United States, including 1,869 in Delaware, according to The New York Times’ case count.
While only 5% of the state’s deaths from COVID-19 occurred within the Latinx community, the pandemic has helped draw fresh attention to some of the factors limiting that group’s access to healthcare.
According to health officials familiar with the Latinx community in Sussex County, those factors include cultural aspects, accessibility and misinformation.
Rosa Rivera, chief operations officer for La Red Health Center, which has served Sussex residents with no or limited English proficiency for 20 years, has seen patients encountering many of those barriers.
For example, some health centers require patients to have a referral before receiving treatment, an obstacle to those who do not have a primary care physician, she said. Having a valid identification card can be problematic for undocumented residents, and not having transportation or having to rely on another for a ride is another factor in missed appointments.
The greatest issue of all might be communications, according to Christine Cannon, executive director of the Arsht-Cannon Fund, a major supporter of nonprofits that promote access to healthcare and opportunities in education for Delaware’s Latinx residents.
“Most families are Spanish-speaking or Spanish-dialect and so these families have to find somebody when they are sick and that’s usually the priority,” said Cannon, formerly a nurse with ChristianaCare and a member of the nursing faculty at the University of Delaware. “Having to find a provider who is Spanish-speaking reduces the number of options.”
Cannon also brings up the issue of trust, especially for those who are undocumented, meaning that they are not citizens or lack the standing to be in the country legally.
“These families have to trust where they are going … because they are afraid,” she said. “There are so many issues around this that keep people from getting healthcare, even basic checkups. They are not going to go somewhere and take the risk that they are going to get arrested and deported.”
The trust issue shows up in other ways as well. Many groups, like poultry workers and sanitation workers, were told that they should be vaccinated because they were working in crowded, high-risk settings, only to find that vaccines were not available for them.
Misinformation is another factor related to trust. Many people are being led in the wrong direction due to misinformation from family, friends and social media.
“Right now there is a lot of misinformation, a lot of fear,” Cannon said. “Many people in our state from the Latino communities have resisted getting vaccinated because of this.”
Rosa Rivera recognizes the power of social media, especially if it’s the sole or primary source of information someone is receiving: “One of the biggest problems for testing and immunization was the amount of misinformation in social media out in our communities,” she said.
"We've got to get back to some of our normal, routine health screenings and chronic care management approaches that are impacting people, and quite likely, our minority populations more, so that outreach isn't just limited to COVID testing and vaccines."
An interpreter at Rosa Health Center helped 55-year-old patient Griselda Vasquez, a native of Guatemala, describe her experiences. Vasquez’s husband lost his life to COVID-19 last year.
“It’s been very hard for her and her family,” the interpreter said. “They don’t want to go through something like that again. That’s why when the vaccine came out they immediately got vaccinated because they’re afraid. They got vaccinated for protection. They don’t want to live with a mask for the rest of their lives.”
And when people ask her about getting vaccinated, Vasquez encourages them to do so.
“A lot of people ask her why do I have to get vaccinated and she explains that it’s important to protect themselves,” the interpreter said. “Then they tell her there’s a lot of bad media about the vaccine and she says, ‘Well, if that were true a lot of more people would be dead and she would be dead because she’s vaccinated.’ So she tries to encourage people to get vaccinated and see that not everything in the media is true.”
Vasquez also recognizes the importance of routine checkups. Many in the Latinx community are hesitant, especially women.
“There are a lot of different hidden towns or hidden villages that don’t show the women the importance of healthcare,” the interpreter said. “So that when they are presented with this that they’ve never seen before. They get resistant to that until they learn that it’s necessary to keep you healthy.”
And Vasquez knows that firsthand. She benefitted from a routine pap smear that found fibroids and a routine mammogram where a cyst was discovered.
Peri, the Rosa Health Center doctor, provides a larger perspective on the vaccine and how ideology in the United States differs from other countries.
“I originally came from India, and in India thousands of people were dying and they did not have access to the vaccine as easily [as] here,” she said. “In this country, the government made sure there was a vaccine for every single person. The fact that there were a lot of people who didn’t want it, it’s hard for me to understand.”
Currently healthcare centers in Delaware are trying to engage the community about getting vaccinated. Rosa is working on a vaccine awareness video for the public with people in the community who have been affected by COVID-19 offering their testimonials on the importance of vaccination.
“As a state, as a country, [it’s essential] to hang together to say, ‘Alright, let’s do this and get vaccinated,’” Peri said. “And then you stop the virus dead. If everyone got vaccinated in the whole country in the next month, we would stop COVID dead in its tracks and no one else would have to die.”
And Rattay, the DPH director, said then the goal is to follow that up with other outreach: “We’ve got to get back to some of our normal, routine health screenings and chronic care management approaches that are impacting people, and quite likely, our minority populations more, so that outreach isn’t just limited to COVID testing and vaccines.”
There are several healthcare organizations in Sussex County that aim to serve residents who speak Spanish, or languages other than English. They include:
- La Red, (302) 855-1233, has three sites: 21 W. Clarke Ave., Milford; 300 High St., Seaford; and 21444 Carmean Way, Georgetown
- Rosa Healthcare Center, (302) 858-4381, 10 N. Front St., Georgetown