Exposing Barriers to Racial Inequity in Health Care

When Patricia Johnson, RN, (kneeling right) saw data that showed Vermonters of color were getting COVID disproportionately and dying at rates three to four times higher than Caucasian people, she began by modeling vaccination. She volunteered to be among the first healthcare providers at Southwestern Vermont Medical Center, where she works in the Emergency Department, to be vaccinated.

While modeling was a good start, it wasn’t enough. Johnson continued by sharing reliable information, both through interpersonal conversations and on social media. She started a Facebook group to share information in a way that Black, Indigenous, and People of Color (BIPOC) Vermonters could relate. 

“Just talking about the vaccine with people. Authentic community engagement,” Johnson said.

She spent her free time answering questions like, “How was the vaccine made? What’s in it?”

“People need to be able to get factual information and care from people who look and talk like they do and who have similar experiences.”

The Facebook group is called GRITS. It stands for Green Mountain Resources for Residents Involved with Transforming/addressing Social determinants and health equity. The goal of the group is to increase awareness, promote education, and facilitate outreach to address racial/ethnic minority health equity in Vermont. The group also helped reveal the social, informational, systematic, and trust barriers inherent to the state’s vaccination plan.

“The efforts Patty has undertaken to inform and serve the BIPOC community are truly inspiring,” said Pamela Duchene, PhD, APRN, chief nursing officer and vice president for patient care services at Southwestern Vermont Health Care. “Her work has made a significant difference in the information and services available to patients from ethnic minorities.”

The group, along with the state’s chapter of the National Association for the Advancement of Colored People (NAACP), voiced the shortcomings of the state’s vaccination system. To start, the timeline was not sufficient to address the BIPOC community’s increased risk. The hours made it difficult for those with little paid time off to get to the clinics when they were free.

The language used to describe eligibility was not easily understood by everyone. For instance, BIPOC people are less likely to have a primary care provider, so the high-risk health conditions or “comorbidities” that would have made them eligible for early vaccination were not diagnosed. BIPOC Vermonters didn’t know that they qualified.

“Systemically, it’s difficult for people of color to get care. Built-in barriers influence people’s decision-making,” Johnson shared.

The state’s online sign-up system was difficult for those who have little or no access to technology or the Internet. For example, one had to go online to get the number even to make an appointment by phone. Those who made it to the online sign-up page were made to think that they needed insurance or a primary care provider in order to get a vaccine, because the page asked for that information, despite its not being required. 

In addition, the clinics’ locations were not accessible or approachable to BIPOC community members, some of whom have transportation challenges or traumatic experiences associated with state buildings and, as a result, state-associated programs.

Finally, the clinics’ staff was often not representative of the BIPOC patient population. Many BIPOC people have a well-justified skepticism around medical services, due to unjust experimentation and lack of consent perpetrated in the past.

“Hesitancy doesn’t mean that people of color were refusing the vaccine,” Johnson explained. “Inhumane things have happened. We need to recognize and repair that.”

Together with the NAACP in Vermont, the Vermont Department of Health, and others, Johnson helped to establish clinics specifically for BIPOC Vermonters. These specialized clinics worked to alleviate some of the barriers BIPOC people have encountered.

“We kind of pushed back on the state to ask how we could be helpful,” Johnson said. “Once the vaccines became more available, we were able to offer these BIPOC-specific clinics.”

The clinics were planned on Saturday, when people would be less likely to be scheduled at work. The groups ensured that the clinics were held at more BIPOC-friendly locations, like local churches. As much as possible, they aimed for a diversity among the people delivering the vaccine. In this way, the group facilitated four clinics within the state.

Organizers also made sure that there was information available to address other challenges visitors to the clinic may face, like food and housing insecurity, the need for sexual health information, translation services, mental health information, and substance misuse prevention.

“I am hoping to help destigmatize getting help. I also want to acknowledge the need for comfort and increase the likelihood of good patient-provider communication,” Johnson said.

“We are so proud of all that Patty has accomplished so far, ” Duchene said. “By working together with her and others, we are learning what extra steps are necessary to provide care more equitably to all of the patients in our area.”

On Wednesday, April 28, 2021, Patty attended the Presidential Address to the Joint Session of Congress as a virtual guest of Vermont Representative Peter Welch. While Johnson is proud of what she and others have accomplished so far and the awareness she was able to help raise, there is more to do.

“It’s getting there,” Johnson said. “We are making progress, but we can definitely do better to ensure everyone gets fair access to the vaccinations.”