Not with wands but with willpower: ‘Godmothers of Health’ partner with Confluence Health to expand vaccination access and healthcare equity

The term ‘godmother’ often conjures up images of magical benefactors, or a trusted protector who helps guide the way. While fairy dust may not have played a role, the Madrinas de Salud – ‘Godmothers of Health’ – certainly fit this definition to a T and brought their own sort of magic to North Central Washington, though their miracles were performed with willpower, not wands.

Messaging can be hard, especially for something as novel and unknown as COVID-19 when the entire world struggled to understand the magnitude of the issue in early 2020. In the early days of the pandemic, Confluence Health knew there was a need to ensure all communities had access to information about COVID-19, but also recognized that a difficulty in outreach existed.

“In 2020, with the start of the pandemic, it became very clear to us, almost immediately, that COVID-19 was affecting the Latino community in North Central Washington with greater rates of infections and hospitalizations,” commented Dr. Bindu Nayak, an endocrinologist and one of the co-chairs of the Health Equity Diversity and Inclusion (HEDI) Committee at Confluence Health. “In our community in the spring of 2020, there was not enough clear messaging that was culturally appropriate, and in Spanish, for the Spanish-speaking Latino community. Understanding the need for culturally appropriate public health information, innovators like Dr. Mabel Bodell created messaging that was easily disseminated on social media.”

And these efforts and messaging bore dividends quickly, with one COVID-19 video in April 2020 from Dr. Bodell, a nephrologist at Confluence Health and co-chair with Dr. Nayak on the HEDI Committee, hitting nearly 12,000 views in 24 hours. This information was having an impact and had hit upon a key aspect: messaging from a trusted person who understood the needs of the community.

As vaccines started to become more readily available, Drs. Nayak and Bodell at Confluence Health recognized that this effort needed to have ambassadors for the vaccine within the communities themselves. While they had a slogan and campaign – ¡Si a la vacuna! – that Dr. Bodell launched during a radio program, they needed boots on the ground to get the word out. Someone had to do the work of outreach and the task was far too great for any one person. Additionally, this outreach needed to come from people who could navigate and understand what would, and would not, be effective.

Reaching out to then-CEO of Confluence Health Dr. Peter Rutherford, Drs. Nayak and Bodell asked for a meeting to be set up in January 2021 with leaders in the Latino community, turning to a community action group known as Parque Padrinos – ‘Godfathers of the Park’ – who had previously shown how community-led, grassroots advocacy could work.

A partnership was born and soon the Confluence Health Foundation, a philanthropic organization that seeks to enhance and support Confluence Health’s ability to provide safe and superior healthcare close to home, pledged $200,000 to the cause, partnering with a local company, Teresita’s Consulting, to spearhead the effort to provide multigenerational, community-focused outreach. Later, a Health Resources and Services Administration (HRSA) grant was also obtained. And with that, the Madrinas de Salud began to work their magic.

The Madrinas work sounds simple: to increase access to COVID-19 vaccinations in Latino communities which have been disproportionately affected by the pandemic. However, culturally-relevant messaging can be difficult and requires out-of-the-box thinking.

“The pandemic taught us that the best way to know how to help is to have trusted individuals within these communities be included in formulating a plan. Collaboration between medical centers, health districts, and community leaders is essential to create new ways to address health disparities,” continued Dr. Nayak. “The Madrinas de Salud established a great relationship with our vaccination team at Confluence Health, facilitating vaccine clinics all throughout North Central Washington. They did something different that made a difference: providing culturally appropriate communication that made people feel welcome. For example, they set up a vaccination site at El Campesino, a clothing and goods store in Brewster that had been a trusted location for Latino community members for 30 years, making it accessible to working individuals by holding the clinic from 4 – 8pm.”

With a combined 4,721 hours worked and 7,491 miles of travel on the original grant from the Confluence Health Foundation, the Madrinas de Salud were busy. All told, their efforts yielded over a thousand directly scheduled appointments, reached out to 300 employers, and held more than 100 community presentations. Between October

2021 and June 2022, the Madrinas facilitated 3,742 vaccinations.

Teresa Bendito, one of the other founders of Parque Padrinos and owner Teresita’s Consulting, the company which helped lead the efforts outreach, explained that trust is what made the difference.

“The big part of the success of this initiative was that trust. We didn't have time to wait. We needed to get started,” Bendito explained. “We started in January 2021 and, had we waited for months instead, well . . . this prevented a lot of deaths. Our communities disproportionately affected by COVID-19 weren’t an afterthought.”

At a gathering this August at Confluence Health to celebrate the efforts of the Vaccine Equity Initiative, it was clear how much this partnership had meant, providing a bright beacon of hope during a dark time. Members of the Madrinas de Salud, the Confluence Health Foundation, and Confluence Health leadership spoke on what the effort had meant to them.

“I needed to help my community, to help others,” commented Rosario Rodriguez, one of the Madrinas. “I tried to help people with my heart.”

“Confluence Health came to help us. My respect goes out to you all for your decision to help us as a group,” said Teresa Zepeda, one of the founders of Parque Padrinos. “I didn’t want anybody left behind. By partnering with you, we helped a lot of people who didn’t want to believe in the vaccine at first.”

“Thank you for helping us to reach even those who were hard to find,” added Bendito.

And outreach was hard sometimes, with out-of-the-box thinking ultimately being the key. From Instagram to a priest’s pulpit, efforts were made to reach people where they were, from voices they trusted. At a migrant camp near Cashmere, tomatoes and chiles were given out to people who came to hear about vaccinations. In Tonasket, priests offered blessings to families who came to the church to hear about the pandemic and what they could do. One of the Madrinas, Guadalupe Peregrino, described encountering a big bear alongside the road during a road trip to Okanogan County that reared up and charged after their car as they pulled away hurriedly. Luckily, they made their escape and left the bear behind in the dust, shaken but heading off determinedly to continue their efforts.

But whether it was priestly blessings or cantankerous bears, the Madrinas de Salud focused on their task. Through their dedication and partnership with Confluence Health, the effort bore fruit. From a rate of 43% of the COVID-19 ICU patients at Central Washington Hospital identifying as Latino at the end of August 2021 despite making up only 30% of the population, that number dropped to 20% or less within only one month.

Across the state as of September 2022, 64.2% of Latinos have initiated their primary series of the vaccine; in Chelan County, that number is 65.6%; in Douglas County, 67.7%; and in Okanogan County, 76.4%, making North Central Washington a leader in vaccination rates.

“The confidence that Confluence Health had in the Madrinas de Salud and the service model of neighbors reaching out to neighbors was done at a really important time,” reflected Bendito. “Without the trust that this commitment generated, I don't know where we'd be today. The outcomes went beyond vaccination numbers. It transformed lives.

Not just the lives of people knocking on the doors, but those who received the vaccinations since it didn't end there. We also listened to their other needs and heard other impacts from COVID-19, including food scarcity and housing needs, which allowed us to help across a wide spectrum. This showed we cared about their health as a whole and, even more than that, it showed that we're there for them.”

Confluence Health serves the largest geographic region of any healthcare system in Washington State, covering over 12,000 square miles of Okanogan, Grant, Douglas, and Chelan counties. Confluence is one of only two locally-lead healthcare systems in the state with the purpose of maintaining availability and access to high-quality, cost-effective healthcare services for North Central Washington. The Confluence Health Board of Directors provides governance for Confluence Health, the Clinic, Central Washington Hospital, and Wenatchee Valley Hospital, and includes nine community board members and six physician board members.