University–Coalition Partnership Reaches Rural Migrant Workers

On a Sunday afternoon, in the rural community of Farmway in Caldwell, Idaho, Kevin Cleveland, PharmD, pulled up a chair and sat across from an older Mexican American man. The man was eligible to receive five vaccines at the pop-up health clinic that day, but he wasn’t sure he wanted any of them—especially not the one for COVID-19. The student pharmacist who had been helping the man called Cleveland over for assistance.

Through a Spanish-speaking interpreter, Cleveland asked the man how he was doing, and the man described pain in his neck. The pharmacist explained what the possible causes could be but explained that he was not equipped to diagnose a neck problem. He encouraged the man to see his doctor for that instead. Next, the man told Cleveland about his trouble falling asleep at night. Cleveland discussed ways that the man could improve his sleep hygiene but also explained that, with age, it is not unusual to take a little longer to fall asleep at night.

“After we talked a little more, I said, ‘There are five vaccines that you need,’ and he said, ‘You tell me which ones I need. If it’s all five, I’ll get all five. You’re the first person who’s ever sat down and listened to me,’” Cleveland recalled.

The conversation took fewer than 10 minutes, and the man walked out of the clinic having received all five vaccines recommended for him on the CDC immunization schedule, including a COVID-19 vaccine.

Cleveland takes this trust-building approach to all the migrant- and immigrant-focused rural health clinics he runs through a partnership between the Idaho Immunization Coalition and Idaho State University College of Pharmacy, where he is an associate professor. The team hosts weekly clinics at the Mexican Consulate in Boise as well as pop-up clinics around the state in areas where there are concentrated populations of immigrants, refugees, and migrant workers.

Every clinic works the same way. Attendees get health screenings that included blood glucose and blood pressure checks and a note, in Spanish, if necessary, that lists the main issues they should bring up with their physician during their next visit. Next, the pharmacists and student pharmacists offer all of the vaccines for which the patient is eligible according to the CDC immunization schedule.

“We use the health screenings as a carrot. If they say they don’t know if they want a vaccine, then, as we’re taking the health screenings, we can have conversations about their hesitations and, usually while they’re sitting there, they say, ‘Okay, I might as well,’” Cleveland says.

Cleveland and his students and colleagues have used this method to screen, educate, and vaccinate Latino immigrants, migrant workers, and Peruvian refugees across the state, with plans to reach the Native American community later this year. The team has worked with local pharmacies to provide additional Spanish-speaking staff in pharmacies located near these communities so that they are able to stay open during the hours that would serve the community best. They advertise the extended hours on local Spanish-language radio stations.

The model for these clinics is based in part on what the Idaho Immunization Coalition learned through listening sessions with people from these communities. The Idaho Immunization Commission learned that community members wanted health care providers who they could trust; that they couldn’t get health care on weekdays or Saturdays; and that they tended to run all their errands for the week on Sundays after Mass.

More than 2 years after the first COVID-19 vaccine was administered in the United States, Cleveland and his team continue to meet the ongoing demand for vaccination.

“Reaching these communities was about changing our mindset,” Cleveland said. “We tailored our clinic experience to what we learned in the listening sessions about the need for trust and access.”

—Sonya Collins
April 2023

Community Outreach Tools to help develop partnerships in COVID-19 vaccination efforts and resources to Tailor Your Outreach to specific populations are available at APhA’s Vaccine Confident microsite.