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Bringing the COVID-19 vaccines to immigrant communities

Khadija Soufi
July 22, 2021

Our student-run clinic overcame language and cultural barriers to vaccinate thousands who wouldn’t otherwise have gotten the vaccines. Here’s how we did it.

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Justin Lau gets a bandage after his COVID-19 shot from UC Davis medical student Khadija Soufi at Shifa Community Clinic in Sacramento as undergraduate student Dana Hazem looks on.
Justin Lau gets a bandage after his COVID-19 shot from UC Davis medical student Khadija Soufi at Shifa Community Clinic in Sacramento as undergraduate student Dana Hazem looks on.
Credit: Edwin Garcia, UC Davis

It was a late evening in February 2021 when a young woman named Sima arrived at Shifa Community Clinic, hoping to get a COVID-19 shot. She held a 6-month-old baby in one arm while her elderly mother waited in the car. Our clinic — one of the University of California (UC), Davis, School of Medicine student-run clinics in Sacramento — had depleted its vaccine inventory that day after twice as many patients showed up as expected. Sima was one of many patients we had to turn away.

The hardest part of running Shifa’s vaccine clinic is not the countless hours it takes to plan and set up the clinic but looking a patient in the eye and telling them you can’t help them. Sima had heard about our vaccine clinic from an announcement in her native Pashto at the local mosque on a Friday. It took her a while to arrange transportation to the clinic, but now, just two days later, we had run out. I promised her we would call to schedule an appointment for her and her mother the following week, hoping that our promised vaccine shipment would arrive on time.

Fortunately, our supply came through and we were able to vaccinate Sima the following week. Like many immigrants in Sacramento, Sima’s language barrier, limited transportation, and poor health literacy had prevented her from getting a vaccine for several weeks. She had tried to schedule an appointment through California’s online portal but was unsuccessful.

But once vaccinated, she became one of our most vocal supporters, spreading the word and bringing in many more people from her community to be vaccinated. She felt seen and heard — both critical elements to addressing mistrust of the vaccines and the health care system in general.  

Sacramento is one of the most culturally diverse American cities and has one of the largest refugee communities. Not surprisingly, like many other under-resourced communities across the country, the Sacramento area suffered health and economic disparities throughout the pandemic, including higher rates of COVID-19 infections and hospitalizations and limited access to vaccines, according to the COVID-19 Resistance Poll conducted by Valley Vision and Sacramento State’s Institute for Social Research.

Once vaccinated, [Sima] became one of our most vocal supporters, spreading the word and bringing in many more people from her community to be vaccinated. She felt seen and heard — both critical elements to addressing mistrust of the vaccines and the health care system in general.  

While Shifa Community Clinic existed long before the pandemic — it was founded in 1994 to address the health care needs of Middle Eastern and South Asian refugees and other underserved populations in Sacramento — it has played a critical role in bringing the vaccines to these communities.

Our work started in late 2020 when the clinic’s leadership team recognized that the access, language, and health care barriers our patients faced may prevent them from getting the COVID-19 vaccines. We applied to become a COVID-19 vaccine provider and, once approved, had two weeks to plan logistics. With the support of our medical directors, we went from sketching the workflow on a small whiteboard to giving shots. As a UC Davis-affiliated student-run clinic, our workforce was made up entirely of student volunteers, from the undergraduates who staffed the intake table to the graduate students who provided counseling and administered vaccines. We arrived at 6:45 AM every Saturday and Sunday to turn the empty hall at a local mosque into a fully operational vaccine clinic with stations, waiting areas, and educational material in six different languages. During the week, we received vaccine shipments, organized supplies, scheduled patients, and — most importantly — trained new volunteers for the upcoming weekend.

Conversations surrounding vaccine hesitancy in marginalized communities focus largely on mistrust and fear. But my time at Shifa has shown me there is a bigger story centered around access and language and cultural barriers.

While we have an online portal for registration, we quickly realized that many patients were not able to navigate it easily. We immediately shifted our strategy to reserve half our slots for seniors and patients who weren’t tech savvy. This allowed us to allocate hundreds of vaccines to eligible walk-ins and respond to calls from people registering by phone. It was astounding to see how many eligible patients were unable to get vaccinated elsewhere, even after multiple new tiers had reached eligibility. In a month, we grew from 160 to 700 patients per day.

Conversations surrounding vaccine hesitancy in marginalized communities focus largely on mistrust and fear. But my time at Shifa has shown me there is a bigger story centered around access and language and cultural barriers.

In late April, we started pop-up clinics in a variety of familiar or culturally important locations across Sacramento. Hesitant patients with language barriers were more likely to want to get vaccinated at their local mosque or school rather than at an unfamiliar location. By collaborating with local organizations, religious institutions, and nonprofits, we had great turnout at these events, even as vaccination rates were decreasing across the county. 

At Shifa, we eased language barriers with interpreters and scribes. We also brought in volunteers from other student-run clinics — Clinica Tepati for Hispanic patients, Nadezhda for the Russian refugee community, HLUB for the Hmong population — and from various local mosques for Muslim populations. It was wonderful to see patients light up when they were directed to a vaccination table with a medical student fluent in their native language. The process of getting their vaccines was no longer a series of awkward and cold interactions; instead, lively conversations were encouraged and bonds were formed. Simple registration processes and multilingual pamphlets allowed us to address the informational barriers that prevented many refugees and immigrants from coming in for their vaccines.

Our outreach emphasized partnerships with local religious and community leaders in mosques and churches in the area to talk about vaccines and their importance during sermons, newsletters, and podcasts. Collaboration with community leaders allowed us to reach patients we wouldn’t have been able to otherwise. During the month of Ramadan, when Muslims fast from sunrise to sunset, we started to face more hesitancy about managing vaccine side effects and whether vaccines invalidated their daily fast. As a clinic operating in the basement of a mosque started by Muslim leaders to support the greater Sacramento community, we were able to address some of that hesitancy. We tailored our outreach response to each community we worked with. Examples included setting up a private vaccination area for Muslim women and accepting a variety of identification papers for undocumented patients.

While our outreach efforts focused on phoning patients and collaborating with local organizations, the most consistent flow of people came by word of mouth. Over 40% of patients were referred by family, friends, or community members. The more we were able to learn with and from patients like Sima, the better the vaccination experience we were able to provide. The more comfortable they were, the more likely they would return to their communities and tell their families and friends to get vaccinated.

To date, Shifa’s vaccine and pop-up clinics have administered more than 9,000 COVID-19 shots — a testament to the success of all these efforts. More than 85% of our patients are people of color or those from underserved communities.

In medical school, we are taught the importance of culturally sensitive care, leadership, and advocacy. At Shifa, we lived these lessons.

To date, Shifa’s vaccine and pop-up clinics have administered more than 9,000 COVID-19 shots — a testament to the success of all these efforts. More than 85% of our patients are people of color or those from underserved communities.

Being able to talk to my community, work together to create a plan, and provide some hope during the pandemic was truly the most rewarding and humbling experience of my life. I saw so many emotions in clinic ranging from apprehension of needles and vaccines to an overwhelming feeling of stability for the first time in months. Advocacy and community health work takes a lot of patience and foresight but holding on to those small moments of success made the larger vision feel closer.

It has been an honor to serve my community and, with their support, grow this project. Shifa has emphasized to me and all those involved that offering culturally sensitive care and addressing barriers can truly make a difference in the lives of thousands of immigrants and their families.

I want to thank the over 120 UC Davis School of Medicine, Betty Irene Moore School of Nursing at UC Davis, and California Northstate University professional student volunteers and the hundreds of UC Davis undergraduate students for their willingness to volunteer their weekends and Fridays to vaccinate our community. I want to acknowledge the Shifa team and vaccine clinic leads for their contribution to the project. A huge thank you also to medical directors Shagufta Yasmeen, MD, and Zahid Iqbal, MD, whose visions made this project possible. 

Khadija Soufi is a second-year medical student and a member of the AAMC Organization of Student Representatives at the UC Davis School of Medicine. She serves as the vaccine clinic director for Shifa Community Clinic in Sacramento, California.

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