This week we connected with Dr. Lisa Chew, Associate Medical Director of Ambulatory Services at Harborview Medical Center and associate professor at the UW School of Medicine; Martine Pierre-Louis, Director of Equity, Diversity and Inclusion for Harborview Medical Center; and Paula Houston, Chief Equity Officer for UW Medicine and Associate Vice President for Medical Affairs at the UW. Together, they spearheaded the creation of multiple mobile vans to provide COVID-19 testing in underserved communities.
Q: Could you tell me a little bit about each of your roles and how you three know each other? Had you worked together before this project?
LC: I provide clinical leadership, direction and oversight of ambulatory care services at Harborview Medical Center. My focus is on the design, implementation and operations of programs that promote high quality, safe, equitable and cost-effective medical care. I am dedicated to improving the delivery of care for underserved populations and currently chair the Harborview’s Equity, Diversity, and Inclusion Council — with Martine Pierre-Louis — to integrate efforts to address disparities and advance equity at Harborview Medical Center.
MPL: As Director of Equity, Diversity and Inclusion, my role is to identify, define, assess and make recommendations on the implementation of policies, practices and processes that promote health equity and workforce diversity and inclusion at Harborview. As part of this role, I connect with community partners in order to make their experiences and voices an integral part of the planning, designing, delivery and evaluation of our services.
PH: In my role, I am leading the work to advance equity, diversity and inclusion across the UW Medicine system as we strive to become an anti-racist organization. Our work is focused on policies, practices, education and training within three objectives set forth in our Healthcare Equity Blueprint – Workforce and students, community engagement and clinical improvements.
LC: Paula, Martine and I have worked together on issues related to equity, diversity, and inclusion at UW Medicine.
Q: How did the idea for the mobile testing vans come about?
LC: Early in the pandemic, we noticed that the majority of the patients hospitalized for COVID-19 at Harborview Medical Center were limited English proficient. We wondered if this finding held true more broadly. When we looked at data across UW Medicine during the month of March, we found that limited English proficient individuals and persons of color had much higher positive rates of COVID-19 than the rest of the population.
We also observed that there were very high COVID-19 rates in South King County which coincided with where communities of color live who had limited access to testing. This was a health inequity that we needed to address. We were also aware that people who are homeless are at high risk for contracting and developing complications from COVID-19 infections. We had to figure out a way to develop a testing program that would be easily accessible for these populations and communities and we needed to do it quickly. Mobile testing vans would allow us to be nimble.
Q: How did you identify the populations you wanted to serve with this approach?
LC: We looked at the data from UW Medicine, analyzing COVID-19 positive rates disaggregated by race, ethnicity, language and geography. This allowed us to identify communities in King County most at risk. In addition, we engaged with the Community Health Boards who represent many of the racial/ethnic groups that were disproportionately affected by COVID-19 to hear their stories of the challenges within their communities.
PH: Along with using the data and information from public health — Martine and I having worked in south Seattle specifically — knew there were communities there (Black, people of color, limited English proficient, immigrants) who historically have been marginalized and have had less access to healthcare. Given this, we wanted to prioritize south Seattle as a location for our first mobile van.
Q: What are some of the challenges you’ve faced getting these vans up and running? How did you overcome these challenges?
LC: One big challenge was to find funding for the program. Philanthropic support allowed us to jumpstart this effort and mobilize resources. Although we needed to work quickly, we wanted to ensure that our testing effort was safe and effective. We sought the input from Community Health Boards to better understand the facilitators and barriers to testing. This information provided valuable guidance as to how we would develop a testing program that would be meaningful, impactful and culturally sensitive.
Working out the logistics of a mobile testing program was no easy task. For example, we needed to find locations, ensure adequate staffing, figure out the traffic flow, outreach to the community, follow infection prevention protocols, provide interpretation support, and notify patients of their results. The teamwork, creativity and tireless effort by many of my Harborview and UW Medicine colleagues and the partnerships with multisector organizations such as community health centers, schools, colleges, faith-based organizations, local government, businesses and Seattle King County Public Health were essential in helping us overcome these barriers. It was amazing to witness the shared sense of responsibility and collaboration across Harborview, UW Medicine and the community.
Q: What is one thing you wish more policy makers understood about COVID-19 and its impact on underserved communities?
LC: The COVID-19 pandemic highlights the longstanding inequities that exist in our nation. We need to prioritize the health of individuals without privilege. In addition to providing access to high quality health services, we need to address the social determinants of health and environmental and community conditions that impact health to be successful. This requires collaboration among health care systems, communities and multisector organizations to identify health priorities, unite around shared goals, develop culturally tailored solutions and ultimately improve the health and well-being of the community during and long after the pandemic.
From the beginning, the University of Washington and UW Medicine have supported our state’s efforts to mitigate the effects of COVID-19. “Huskies fighting COVID-19” is a feature series highlighting individuals whose work is making an impact from Public Health and Computer Science & Engineering to the Virology Lab and the emergency room.