Hispanic Liaison launches COVID-19 program to ‘reach the hard to reach’


SILER CITY — For the past month, lay health advisor Maria Herrera has spent over six hours each week knocking on doors in Love’s Creek to share COVID-19 information, resolve doubts and help her neighbors get vaccinated.

It’s her way of helping protect those who can’t — including her mother, whose health risks and drug allergy prevent her from taking the shot.

“My mom lives in Mexico and so, she wants to come visit me, but she can’t come visit me because she can’t take the vaccine,” said Herrera, a longtime volunteer for the Hispanic Liaison, in Spanish. “... So I’m doing this because I want to see my mother. I want to hug her. I want all this to end — I want it to end now, because it’s closed us off, it’s clipped our wings, as they say.”

Herrera is one of four specially trained advisors piloting the Hispanic Liaison’s new COVID-19 Lay Health Advisor Program, which seeks to bring COVID-19 information and resources to three predominantly Spanish-speaking neighborhoods in Siler City and overcome any remaining vaccination barriers residents may face.

Launched in February, the program equipped four residents of Love’s Creek, Santa Fe and Country Living mobile home parks with the knowledge and support to educate their neighbors about COVID-19, make the case for getting vaccinated or boosted, and connect them with testing and vaccination resources.

“This is about peers helping peers, peers reaching peers,” the Liaison’s executive director, Ilana Dubester, told the News + Record. “In the layout advisor model, it really is about, like, ‘Who do you believe, and who do you trust?’ So, it’s about friends and neighbors. It’s about, you know, the information coming from the closest source to you, being your neighbor or somebody who’s in your particular situation, perhaps.”

Paid by the hour, the Liaison’s lay health advisors work in pairs — each with one adult and one youth. In Love’s Creek, Herrera visits houses with Jordan-Matthews High School student Kenia Uribe-Arraiza between six to 12 hours a week, depending on when their schedules coincide.

Likewise, Jordan-Matthews senior Ervin Martinez, 17, has been knocking on doors in Santa Fe and Country Living with Lupe Tavera, his mom. Both Martinez and Uribe-Arraiza form part of the Hispanic Liaison’s youth program, Orgullo Latinx Pride, through which Martinez said he’d come to participate in the Liaison’s lay health advisor program.

“The reason being is because knowing me and my mother, we like to take care of people,” Martinez told the News + Record. “We really like to take care of, like, (our) friends. … Knowing that COVID really did have a massive effect on, like, everyone around the planet, I wanted to at least help in some way, to see if everyone’s all right, if they want to get the vaccine shot, see if we can motivate them to at least take the vaccine.”

All advisors have been fully vaccinated, and most have also received their booster shots. Some, too, even had doubts themselves about the vaccines at first. When Martinez first became eligible for a Pfizer shot last spring, he recalled, his mother didn’t want him to get the shot.

“The vaccine came out way too early compared to other vaccines,” he said. “For example, the Ebola vaccine that came out like, what, 10 years after the Ebola infection came out in Africa, (and) knowing that the (COVID-19) vaccine came early — that got my mom scared.”

Ultimately, she relented, Martinez said, and a few months later, after much encouragement from her son, Dubester and other Liaison staff, Tavera got a Pfizer shot herself — and the next two after that.

“These are folks that … know a lot of their neighbors — so not a stranger, not a health department, not an ‘authority,’ but somebody who also had doubts and had questions and was receiving information from all kinds of places, and wasn’t sure what to believe,” Dubester said. “And so, they have a lot of really personal experience that they can relate to their neighbors about their own journey to becoming somebody who now believes in vaccines, and who got vaccinated.”

‘Reach the hard to reach’

Planning for the Liaison’s COVID-19 Lay Health Advisor Program first began last fall in partnership with UNC’s “ACT UP” project, which seeks to help local health departments and community organizations provide COVID-19 resources and education to historically marginalized communities in Chatham and surrounding Piedmont counties. 

It’s part of the nationwide RADx-UP health equity initiative, which has invested millions of dollars in ensuring all Americans can access COVID-19 testing.

Besides other initiatives from March 2020 onward, the Liaison has worked with UNC for over a year and half to organize community vaccination clinics and testing events, as well as educate their Spanish-speaking clients about COVID-19 vaccines, testing and treatments. Two years into their efforts, they’ve taken care of the people eager to get vaccinated, and even those who just needed a little convincing.

Now, Dubester said, they’re down to “the folks who need even more convincing.”

“We decided to launch this program as a way to reach the hard to reach,” she said, “not only folks that may need some more information about the vaccines, and how safe and effective they are, but also, that maybe are facing other barriers — like work always during the week, so they don’t even know where they might be able to get vaccinated on weekend, or don’t have transportation or whatever it might be — so that we can uncover those and help folks overcome those barriers.”

The best way to do that, they concluded, was through the lay health advisor model — something that’s “been around forever,” Dubester said, to reach and educate people about community health issues via those they know and trust.

“It’s not some organization or somebody from a health department that perhaps comes with an agenda, so to speak, and as folks that they don’t know,” she said. “Establishing yourself as ‘I am your neighbor, and I’m here to share information and talk about this,’ disarms people in a way that helps them open up to have the conversation. It doesn’t mean everybody is going to change your mind, but at least it plants some food for thought, another way of looking at information about COVID now that you’ve heard it from your neighbor.”

In the beginning, the program encompassed four neighborhoods, six lay health advisors and an earlier start date, but another COVID surge, snow and scheduling conflicts bumped it down to three neighborhoods, four advisors and a Feb. 19 launch date.

“The other pair was in the old Justice Mobile Home Park,” Dubester said, “and unfortunately, they weren’t able to attend the training, so we couldn’t proceed with them.”

All four aspiring advisors attended a full-day training session on Feb. 19 led in Spanish by UNC’s Dr. Michael Herce inside Iglesia Metodista El Camino UMC in Siler City. There, they learned all they needed to know about COVID testing options, the three authorized vaccines and how they work, as well as how to help people make vaccination or booster plans.

“In addition to a presentation and discussion about these topics, the workshop was comprised of participatory, hands-on practice activities to prepare the lay health advisors for scenarios they may encounter during home visits in the community,” Herce told the News + Record. “For example, the lay health advisors practiced responding to a community member who wants to get vaccinated but faces real-world barriers like transportation difficulties, or community members who believe COVID-19 misinformation and are skeptical or confrontational during an encounter.”

Then the Monday after training, the real work began: All four went out for the first time to their assigned communities to knock on doors under staff supervision. Dubester accompanied Martinez and Tavera around Santa Fe Circle, while Deputy Director Hannia Benitez accompanied Herrera and Uribe-Arraiza around Love’s Creek.

“That went great,” Dubester said. “They were doing great, and they really absorbed a lot of the information that we threw at them and got very comfortable doing this, and so now they’re on their own knocking on doors.”

Of the six houses she visited with Martinez and Tavera, four agreed to a follow-up phone call with the Hispanic Liaison to set up vaccination appointments.

“And so that’s already a huge success right there,” Dubester said with a laugh. “Some folks just have questions about it, right? ‘Well, is it really my turn to get a booster?’ Or, ‘I’ve been thinking about it, but wasn’t quite sure.’ And so, it gives them an extra level of confidence when peers go and talk to their neighbors about also their experience with vaccines.”

During their visits, advisors also conduct a short, anonymous census to determine a neighborhood’s vaccination levels and distribute “goodie bags” with COVID-19 testing and vaccination information.

“And we definitely are finding people who are not vaccinated or children who are not vaccinated or folks who didn’t get their booster, but (who are) interested, that want to,” Dubester said. “And so, to make it really simple, we will host mobile clinics in their neighborhood.”

In fact, they’ve already planned their first mobile clinic in Country Living at Fontana Circle, from 10 a.m. to 1 p.m. on April 2.

Should the pilot project go really well, Dubester said, the Liaison may even bring in another group of community members for a second round of training as COVID-19 lay health advisors. Beyond that, she added, they may even expand the program to other community health issues.

Everything, however, depends on securing further funding, of which UNC has supplied the most, in addition to training and technical assistance. Either way, Dubester said she’s happy with the work the Liaison’s four advisors have so far accomplished — and enthusiastic about the progress to come.

“I was super excited to get this (program) off the ground … This is great,” she said. “We’re thrilled to be doing it and also that it’s already yielding positive results.”

‘That’s the most beautiful thing’

Since beginning her work in mid-February, Herrera and her partner have connected various people with the Liaison to set up vaccination appointments. Most, she said, are already vaccinated and many, too, have already taken the booster shot — or at least, so they say.

“I have no choice but to believe them because I am not sure that they have already done it,” she said. “But I want to believe that yes, they are already vaccinated, that they have been vaccinated for their own good, for the good of their family and their community. We are in the same boat and if we don’t go together, we are all going to sink.”

When her and Uribe-Arraiza’s schedules coincide, they usually spend between six to 12 hours a week visiting their neighbors with information and resources.

“Like, at first, they’re surprised because they say, like, ‘What are you advertising? What are you selling?’” she said with a laugh. “‘We’re not selling anything, and we’re not advertising. We are here to offer you an information packet. We are working as lay health advisors.’”

About 95%, Herrera said, have been “very open,” asking questions and listening to what they have to say. The other 5%, meanwhile, have “shut the door in their faces,” which she said only inspires her to work even harder to help the rest.

For Herrera, the work’s been a rewarding experience — and a small way she can make a big difference.

“I have one more reason to smile because we have visited homes with people who have already had COVID, who were in a coma,” she said, choking up, “and who tell me, ‘Wow, it’s good that you are doing this program, that you are talking to people, because if someone had come to talk to me before, I wouldn’t have had COVID. I wouldn’t have been in a coma. But there was no one to come knock on my door, reach my heart, talk to me and explain to me why you should get the vaccine.’ That’s the most beautiful thing.”

Reporter Victoria Johnson can be reached at victoria@chathamnr.com.