Emergency Preparedness for African Immigrants in West Philadelphia Prepared by the Robert Wood Johnson Clinical Scholars University of Pennsylvania 2009-2011 Cohort September 23, 2009 In collaboration with The Philadelphia Department of Health Division of Infectious Disease, Bioterrorism and Emergency Preparedness Program About the Authors The Robert Wood Johnson Foundation Clinical Scholars program is a post-residency health policy research fellowship designed to integrate Scholars’ clinical expertise with training in program development and research methods to help them find solutions for the challenges facing the U.S. healthcare system. The program includes training in leadership and community-based participatory research, with the goal of developing future leaders to conduct innovative research and work with communities, private and public organizations, practitioners and policy makers to improve health and healthcare in community settings. After their training Scholars will be able to effectively translate and implement research into policy and practice that meets the needs of the community. The University of Pennsylvania is one of four participating universities. Each site selects seven scholars from a competitive pool of applicants drawn from all medical and surgical specialties. The 2009-2011 cohort of University of Pennsylvania Robert Wood Johnson Clinical Scholars conducted this project and authored this report through a partnership with the Philadelphia Department of Public Health. The Clinical Scholars are listed below: Amy Tsou, MD, MA, [email protected] Brownsyne Tucker Edmonds, MD, MPH, [email protected] Janice Scobie, MD, MS, [email protected] Jeff Kullgren, MD, MPH, [email protected] Neera Goyal, MD, [email protected] Niamey Wilson, MD, [email protected] Sophia Jan, MD, [email protected] 2 Acknowledgments We would like to acknowledge our partners at the Philadelphia Department of Public Health, particularly Steve Alles, Chad Thomas, Giridhar Mallya, Nan Feyler and Commissioner Donald Schwarz for the opportunity to undertake this project and their support during each phase. We would also like to thank the many community and organization leaders who gave generously of their time to participate in interviews and make personal sacrifices on a daily basis for the service and betterment of the larger African immigrant community in Philadelphia and the Delaware Valley. 3 Table of Contents Executive Summary ……………………………………………………………………………………………………………………… 5 Introduction and Objectives ………………………………………………………………………………………………………… 7 Methods ……………………………………………………………………………………………………………………………………… 9 Semi-structured Interviews ……………………………………………………………………………………………. 9 Literature Review …………………………………………………………………………………………………………… 9 Community Deliverables ………………………………………………..……………………………………………… 10 Findings ……………………………………………………………………………….......................................................... 11 African Immigrants in Philadelphia …………………………..…………………………………………………… 11 Population Demographics ………………..................................................................... 11 Barriers to Health Care ………………………………………………………………………………………. 12 Social Network …………………………………………………..……………………………………………………..…… 15 Service Organizations ……………………………………………………………………..……………...… 15 Religious Organizations ……………………………………………………………………………………... 16 Community Perspectives ………………………………………………………………………………………………… 18 Best Practices in the Literature ……………………………………………………………………………………….. 20 Recommendations ………………………………………………………………………………………………………………………. 21 Messaging ………………………………………………………………………………………………………………………. 21 Dissemination ……………………………………………...……………………………………………………………..…. 22 Vaccine Distribution ……………………………………….…………………………………………………………..….. 23 Advisory Group ……………………………………………….…………………………………………………………..…. 25 Investment in Relationships .…………………………………………………………………………………………… 26 Closing Remarks ………………………………………………………………………………………………………………………….. 27 Appendices ……………………………………………………………………………………………………………………………….… 30 Directory ………………………………………………………………………………………………………………………… 30 Social networking contact listing ……………………………………………………………………………….…… 42 Calendar of events ……………………………………………………………………………………………………….. 47 Medical and Dental Resource Directory ………………………………………………………………….……. 49 Map : Free Clinics, Metropolitan Philadelphia ………………………………………..….….… 50 Map : Free, Low Cost Clinics, West Philadelphia ……………………………………………..… 51 Funding Resource Listing ………………………………………………………………………………………….…… 52 4 Executive Summary In 2006, Hurricane Katrina directed the nation’s attention toward the disproportionate degree of suffering, injury, destruction and death faced by the poor and by racial and ethnic minorities in the wake of a natural disaster.1 This storm and more recent natural disasters have heightened our awareness of the unique vulnerabilities of immigrants in community emergencies. The novel H1N1 influenza virus now poses a global threat and government agencies are preparing for the possibility of widespread H1N1 influenza infection in their communities. Efforts to prepare for H1N1 prevention and vaccination in Philadelphia offer a critical opportunity to ensure an equitable response to this and other public health emergencies in our city. With this goal in mind, the Bioterrorism and Emergency Preparedness Program of the Philadelphia Department of Health Division of Infectious Disease partnered with the Robert Wood Johnson Clinical Scholars Program to develop an outreach strategy for emergency preparedness in the growing population of African immigrants in West Philadelphia. To that end, we set out to: (1) identify key stakeholders in the African immigrant community; (2) develop relationships with community groups and community leaders; (3) identify effective means of information dissemination; and (4) assess the community’s attitudes towards H1N1 influenza and potential barriers to vaccination. We conducted semi-structured interviews with a network of community stakeholders comprised of opinion leaders, service organizations, faith-based organizations, health care providers and ethnic media. Community Perspectives We identified the following recurring themes from our interviews with community stakeholders: The African immigrant population is extremely diverse. African immigrants identify most strongly along national or ethnic lines, and are often affiliated with a national or ethnic organization. Religious communities often bridge ethnic differences. While many organizations are organized around a particular ethnicity, religious organizations often serve as a bridge between ethnic groups. Consequently, religion plays a powerful unifying role which may be important for community organizing and outreach. Avoid targeting. Healthcare initiatives should avoid singling out the African immigrant population to the exclusion of other population subgroups, as this can engender suspicion of being associated with a particular problem. Diverse opinions exist about H1N1 vaccination. Vaccination is widely accepted and considered an important aspect of health maintenance for many African immigrants, while others have religious objections or fatalistic views that serve as obstacles to vaccination efforts. Basic health and economic needs are most pressing. The vast majority of community leaders noted that many African immigrants are preoccupied with fulfilling basic needs, and the potential threat of the influenza is not a priority in comparison to immediate, more urgent economic concerns. 5 Information travels best by word of mouth. In the African immigrant community oral communication continues to be the primary manner in which information travels. Rich networks of community organizations and leaders already exist. Within each community, distinct networks propagate information. Community leaders command immense trust and respect and often serve as the starting point from which information flows. Core Recommendations Based on the findings from community interviews as well as a literature review of best practices, we arrived at the following five core recommendations: 1. Craft culturally competent messages with attention to linguistic diversity, sensitivity to religious traditions, and appreciation for government distrust. 2. Disseminate information through existing networks and community leaders, focusing on word-of- mouth messaging and radio broadcasts to supplement television, flyer and web-based education campaigns. 3. Consider non-traditional outreach and vaccine distribution strategies that include French interpreter services, education at hairbraiding shops, taxi stands, churches and mosques, and unique identifier systems for tracking vaccine administration. 4. Create a community advisory group charged with developing a shared understanding of immigrant needs and resources, assisting in outreach and communication strategy development, and providing on- the-ground support in an emergency. 5. Invest in community relationships and capacity building efforts to foster reciprocity and trust. 6 Introduction and Objectives The media coverage of Hurricane Katrina left images of devastation and desolation imprinted into the collective conscience of Americans. Dennis Andrulis and colleagues describe the tragedy as “a graphic portrait of what happens when communities’ unique needs are not part of preparedness planning and execution.” 2 The event directed the nation’s attention toward the disproportionate degree of suffering, injury, and death faced by the poor and by racial