Technically, they’re “community health advocates” or, in Spanish, the language they often use on the job, promotoras.
But in the neighborhoods where the team of women has been knocking on doors for the past five years — or reaching out by phone during the pandemic — residents refer to them by a more colorful term:
The Blue Shirts.
That’s a nod to the blue polos the promotoras wear as they canvas communities and dispatch health information in south Orange County. The shirts are informal uniforms used in their work on behalf of Providence Mission Hospital in Mission Viejo and the two Family Resource Centers that the hospital supports in Lake Forest and San Juan Capistrano.
But with coronavirus threatening to surge again in areas with low COVID-19 vaccination rates, the promotoras can be thought of in more urgent tones: Modern foot soldiers in a war against a rapidly changing disease that has already taken more than 5,000 lives in Orange County.
Secret weapon: Trust
The big threat right now is the delta variant, first recorded in India but now the dominant strain for new infections in California and much of the world. Like some other COVID-19 mutations identified by the World Health Organization and the U.S. Centers for Disease Control and Prevention, delta can pose a higher risk than the original, spreading more easily.
With delta in the air, literally, health outreach provided by the likes of promotoras is key in hard-to-reach — and still under-vaccinated — pockets of the county.
“We trust and hope that we are making a difference,” said Eduardo Moreno, who oversees the work of the promotoras as manager of the Healthy Communities Program at Mission Hospital.
“We don’t have a clear understanding on how many (unvaccinated people) are left in some specific neighborhoods. Success for us is to be able to bring people to the vaccination clinics.”
Overall, 52.7% of county residents have been fully vaccinated, as of an update on Tuesday, July 6, the latest from the Orange County Health Care Agency. But within the county’s Latino population, the ethnic group that is the main focus for the promotoras, county data shows that only 19% have received at least one dose of COVID-19 vaccine.
With the vaccination rate slowing since April, and infection and hospitalization rates starting to pick up slightly, the county and private health providers are stepping up efforts to contact harder-to-reach segments of the local population through a variety of tactics.
“These public health crises just show the differences based on income and ethnicity,” Moreno said. “It’s important to keep alive this campaign because those communities are the most vulnerable.”
So, promotoras in blue shirts walk and knock and talk, several times a week, for four hours at a time, in the late afternoon and early evening when adults are more likely to be home. They cover block after block of apartment houses in south county cities from Lake Forest to San Clemente and Rancho Santa Margarita to the coast.
Their main weapon is trust. In a community where people tend to be skittish about seeking health care and other assistance, trust is a powerful tool.
Some people targeted by the promotoras don’t seek health care because of their immigration status. Others don’t go because of language barriers, lack of child care, or trouble getting time off work.
And beyond the issues that are particular to the Latino community, there is rampant misinformation — The vaccine will include a microchip implant! You’ll be forced to pay for the shot! — that’s unique to COVID-19.
Said Moreno: “We struggle constantly with misinformation.”
Above all else, the promotoras work to be consistent providers of useful, accurate news.
Until April, pandemic restrictions had confined the promotoras to contacting people by phone. That enabled them to maintain connections in the communities they serve, but it wasn’t enough. The most effective messages, they say, are delivered in person.
“If the people don’t come to us, we come to them,” said Soledad Gomez, who coordinates the work of the promotoras at the street level when they are out in the community.
“Not all, but many people, trust us.”
Gomez has more than 20 years of experience doing this kind of work on behalf of the Santa Ana-based Latino Health Access, which has a contract with Mission Hospital to serve south Orange County. But the pandemic, Gomez said, was different: “COVID is more difficult, let me tell you.”
When someone opens the door, the promotoras don’t lecture or try to persuade them to go get vaccinated. Gomez said that kind of approach just turns people off.
Instead, following a friendly “Hola. Como esta?” after a door is opened, they’ll ask if that person and others in the household have gotten the vacuna. If the answer is ‘no,’ they provide information on when and where vaccinations are available.
On the spot, they can pull up a list of clinics and sites offering either the two-shot Pfizer and Moderna vaccines, or the single-shot Johnson & Johnson. They can sign up the most eager using an app on their phones; with others, they take phone numbers for a follow-up chat.
The promotoras try to counter misinformation and myths by providing solid, researched data from sources like the CDC. But only if it’s welcomed. What they don’t do is debate or argue with anyone. Instead, if a conversation isn’t likely to end with someone agreeing to a vaccine, they hand out fliers on upcoming free COVID-19 vaccination clinics at Family Resource Centers and other services.
“We don’t try to convince the people,” Gomez said. “We try to educate the people. When they are ready, they are ready.”
Recently, the four promotoras met at 4 p.m. on a still steamy Wednesday afternoon to start their trek amid the two-story, four-plex apartments that line a cluster of streets in San Juan Capistrano, across from Rio Oso park.
Margarita Farias, Catia Rivera, and Blanca Munguia huddled with Gomez before heading out, shoulder bags holding bilingual fliers and water bottles. They also toted gift bags, with stickers and crafts for children and, because this meet-up was days before July 4, tiny American flags.
They also carried tally sheets attached to clipboards, to mark the number of people they contacted and list those who did and didn’t want to be vaccinated.
“Ready, ladies?” Gomez asked.
Then they set off.
They paired up in teams of two, as always. “You never know who is behind a door,” Gomez said. “For safety, we never go alone.”
Dogs barked from behind fences and security doors. The women paid little mind; they’re used to that.
“Hi baby,” Gomez called to what sounded like a large dog barking and jumping up against a tall wooden fence that held him back. Nobody was home, but Gomez tried to soothe the dog: “What’s going on? Que pasa?“
Children zoomed by on bikes and skateboards. During their first hour of knocking, doors were answered mostly by teens or women. Some residents opened their doors to chat with the promotoras, others remained barely visible behind heavy screens. The neighborhood is low-income but well-kept; tiny yards and balconies were lush with succulents and cactus, rose bushes and other flowers.
At one apartment, a woman answered Farias’ question about her vaccination status. “Aqui,” she said, proudly. “Todos!”
“Todos?” Farias asked to make sure all four people in the household had been vaccinated.
“Si,” the woman confirmed.
“Que bueno,” Farias congratulated her. Gomez handed the woman one of the souvenir flags. The woman held it up and smiled.
The promotoras speak in Spanish. They ask the person answering the door if they’re vaccinated and what about others in the household? If they aren’t, are they ready? If they are, when and where — questions that often ferret out those who aren’t telling the truth to the promotoras.
The answers — and reactions — run the gamut.
At one apartment, a babysitter told them everybody in her family had been vaccinated.
Outside, a man pouring coolant into his truck’s radiator folded a flier into his back pocket.
Later, the promotoras stopped two other men on the sidewalk as they headed home from work. One of them said he hasn’t been vaccinated because he would have to pay for it.
“We told them, ‘No, it’s totally free,’” Rivera said. The men accepted the fliers with the clinic information.
“Nobody (here) is saying ‘Go away,’” Rivera observed. If they aren’t interested, she added, “they’re just not answering their doors.”
By the end of that day in San Juan Capistrano, the promotoras had knocked on more than 120 doors, about one-third of which went unopened. At least 30 people who had not yet been vaccinated showed interest in getting the shot. Of about 135 fliers handed out, 37 were fact or fiction myth busters.
But some areas are more distrustful. Earlier in the week, at a neighborhood in San Clemente, the promotoras encountered several residents who told them they didn’t believe in the vaccine.
“Each neighborhood is totally different,” Farias said. There are the few, she added, who answer with an uncompromising, “No! I don’t have it. And I don’t want it.”
Whatever the reaction, the promotoras just keep walking to the next door.
Find out more
Community Health Enrichment Collaborative (CHEC) Family Resource Center: fact/oc.org/frc/chec or call 949-489-7742
South Orange County Family Resource Center: fact/oc.org/frc/southorangecounty or call 949-364-0500
Source: Orange County Register