Language barriers can’t be overcome without trust

Advocates and organizers working in immigrant communities where many people don’t speak English fluently are familiar with how systemic neglect, backbreaking work, and racism create vulnerabilities to illness. Particularly underserved are low-wage farmworkers like those Moheno has dedicated her life to assisting. The median income in Tulare County is just under $50,000, with 17% of residents living at or below the poverty line. Federal laws requiring documentation for medical coverage and prohibitively expensive state insurance plans mean that at least half of all farmworkers lack coverage and have no regular provider.

These conditions create documented gaps in care, ranging from a lack of trust in physicians to foregoing preventative care. Knowing this, Moheno has approached COVID-19 mitigation in predominantly Spanish-speaking communities through the lens of organizing, by building one-on-one relationships with residents and meeting people where they’re at, both in terms of physical location and education. The county is majority Latinx and nearly half of the eligible residents have not yet received a first or second dose of the vaccine. Those ages 50 and up have the highest vaccination rates, with nearly 85% percent of children 11 to 5 years old lacking any vaccination.

Along with county officials, Moheno has coordinated what she describes as “very successful immunization projects” for children ages 12 and under. From her own experience, Moheno knew that farmworkers living and working in rural communities relied on social and digital media for information. There aren’t print newspapers in migrant camps, Moheno explains, so education is the most important tool for changing minds and creating access to health care. Moheno worked with Spanish language media to make TV, radio, and digital media spots, funded in part by the county.

Part of the work consisted of providing basic information that previously hadn’t been made available. For instance, many parents had questions about the potency of the vaccine for their children and hadn’t been told that Pfizer developed a pediatric immunization with a lesser dosage. In terms of making sure that parents knew where to get the vaccine, Moheno and paid interns canvassed neighborhoods where residents are least likely to have health care coverage.

Comprehensive language access for Latinx immigrants requires more than Spanish fluency

Vaccine events for families have also been extremely effective in Los Angeles County, says Odilia Romero, the co-founder and executive director of Comunidades Indigenas en Liderazgo (CIELO), an organization that brings resources and support systems to Indigenous migrant communities. There are 17 Indigenous languages spoken in the region, including dozens of dialects, but Romero says that the county assumes Spanish fluency of Indigenous peoples. Even if community members have basic proficiency in Spanish, it’s still difficult to share more complex information.

“When it comes to information like COVID, or your rights, or courts or a medical surgery, then they don’t fully understand what’s going on,” Romero said.

There isn’t an official accurate count of how many Indigenous Latin American people live in the U.S. or in Los Angeles County, Romero says, but the estimate is around 15,000 and 19,000 nationally according to the U.S. Census. Based on CIELO’s own research, they estimate that there are at least 11,000 Indigenous people hailing from 2,500 households living in the region, making Los Angeles County home to the largest population of Indigenous people from Latin America, Romero says. The organization produces videos for social media and hosts vaccine events monthly, through which CIELO has vaccinated more than 6,000 Indigenous people in the county.

“You might think that’s a small number,” Romero said. “But considering the population that we work with [and] the language barrier for us, it’s huge.”

Romero says that the organization will go directly into neighborhoods where Indigenous people live, like the West Lake neighborhood of Los Angeles where there’s a large Mayan community. Later, at the vaccine event, CIELO will provide interpreters for the medical team, a band, and even artists to make traditional painted wood carvings.

“Someone told us, ‘when the county clinic came, they only vaccinated like 20 people. And when you guys come it’s 100-plus people,’” Romero said. “It’s a big difference that we bring in interpreters, and we do outreach in Indigenous languages.”

This outreach is life-saving, Romero says. Language access is a human right, she argues, given that understanding the importance of vaccination against a coronavirus infection can be the difference between life and death. This is especially true for children who are reliant on parents to access health care.

“It’s a huge negative impact if mom and dad are not understanding information of COVID or that the kids have access to vaccines now,” she said. “It puts the kids at risk when they go to school unvaccinated.”

Vaccine access is only one piece of the puzzle

In Fresno County, just north of where Moheno works in Tulare County, a different vaccine effort is underway. A grassroots coalition of organizations serving immigrants and refugees provided vaccine access and education, as well as other forms of financial support that low-income people might struggle with, like rent, food access, and transportation—social services that have both gotten more expensive and less reliable during the pandemic.

“We knew that, in our experience of working with these communities, they were going to be left behind in whatever response came,” said Tania Pacheco-Werner, a doctor who works with the coalition.

Pacheco-Werner says that the coalition has distributed over $2.9 million since the start of the pandemic. Pacheco-Werner works under Fresno State University to train community health workers to conduct contact tracing and to provide basic COVID-19 education to residents. Pacheco-Werner says that misinformation and a lack of information are some of the main reasons that parents won’t seek vaccination for themselves or their children, even if they’re available.

“It’s not like big cities where most people are vaccinated and even boosted,” Pacheco-Werner says. “There’s a huge provider shortage in our region.”

The vaccination rate for Fresno County hovers around 56%, and Pacheco-Werner says it’s a race against time to vaccinate more individuals before the Omicron variant sets in. In Fresno County, just over 65,000 minors are fully vaccinated, with the vast majority of the 280,000 residents under the age of 17 still waiting for a first dose. There’s work cut out for providers like Pacheco-Werner, but she’s hopeful that officials can remain nimble in their response to the virus and continue to vaccinate vulnerable people.

Similar to Moheno’s method of organizing to create access to public health services, Pacheco-Werner says that advocates and county officials realized that the community health worker model, or the promotora model, is the most effective way to reach families and parents who aren’t familiar with or don’t trust the American medical system.

Canvassing helps Pacheco-Werner and her team respond quickly to the concerns of community members. For instance, after hearing that provider sites were turning parents away because they didn’t offer pediatric vaccines, her team created a list of sites that did for distributing to parents. It’s not a long list, and many of the sites are located in the city center rather than in rural areas where access is most needed, but it is translated into Spanish and reduces the likelihood of families not having access to vaccines.

Language access also requires combating misinformation

Gepsie Metellus, the director of Sant La, an organization that provides outreach and support to the South Florida Haitian community, says that navigating a language barrier in immigrant communities requires more than simply making information available in languages other than English. Metellus stressed that information shouldn’t be subject to getting lost in translation, potentially have a double meaning, or be subject to misinterpretation. But that often isn’t the case, given that officials continue to learn about the coronavirus variants in real-time, and information about safety precautions can change.

“Anybody in any country where the language of the country isn’t your primary language, you’re going to misunderstand something, you’re going to be afraid that you have misunderstood [something],” Metellus said.

Metellus says her team’s work to dismantle barriers to access has less to do with making sure the local Walgreens or CVS has enough immunizations and is more about addressing persisting myths and misinformation about the pandemic. Vaccine hesitancy is often the greatest hurdle, Metellus said. In conversations with parents who don’t want to vaccinate themselves or their children, Metellus points to the fact that the U.S. immigration agencies demand that people receive vaccines before seeking a home in the country. She also reminds parents that children are required to receive a number of vaccines before enrolling in public school.

Pacheco-Werner agreed that it’s not enough to have a conversation with concerned parents about the vaccine’s efficacy. She argues that there needs to be substantive and continued acknowledgment of how forced sterilization and other institutional abuses have shaped immigrant communities’ trust of doctors.

“I think that when we’re not willing to admit that systems have let people down, we’re not being genuine,” Pacheco-Werner said.

If public health and elected officials are able to learn from and replicate the successes of grassroots organizations and efforts, then communities made vulnerable to the virus’s spread will be better off. Officials have acknowledged that the pandemic didn’t create inequalities, and the effects of COVID-19 have made it harder for them to deny the inequities that underserved communities have been enduring long before it began. And while that window is open, those who work with immigrant communities want to see this understanding put into action.

“One of the other frustrations that I have is that the people that are not vaccinated at this point are those lacking a medical home, [who] are monolingual or living in deep poverty,” Pacheco-Werner said.“There’s no recognition that the systems were not made to work for those people.”

Ray Levy-Uyeda is a Bay Area-based freelance writer who covers justice and activism. Find them on Twitter @raylevyuyeda.

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