After a spinal cord injury in 2014, Erin Smith (not her real name) was suffering from severe fatigue. Her home had become cluttered with mail and paperwork, which was out of character for her. Erin had heard about the Bridges to Health program through a friend who was a client, so she enrolled and was connected with community health worker, Lissette Rivera.
“Lissette came over to my house and helped me get organized,” said Erin. “She let me know about my insurance flex fund. (My doctor recommended) pool therapy but I couldn’t afford it, so she helped to access those flex funds to get me into the pool, which helped me physically, tremendously.”
Embodying a Culture of Health
The Columbia Gorge Region received the Robert Wood Johnson Foundation Culture of Health Prize in 2016, in large part because of its collaboration across sectors and its support and use of community health workers. Both of these aspects are core to the Bridges to Health program.
Housed within the Columbia Gorge Health Council, Bridges to Health has been connecting individuals and families to resources in Wasco and Hood River counties since 2017. The program collaborates with local health departments, health care providers, and non-profit organizations to improve access to resources and empower community members to improve their health. Its staff, who are community health workers (CHWs), meet weekly to learn from each other and share client successes and challenges.
While Bridges to Health focuses on health, it also works to improve social determinants of health: factors like housing and food access that affect health. This means CHWs work with clients to access anything from an appointment with a doctor or dentist to an affordable apartment or bus pass.
According to Bridges of Health, CHWs are trusted members of the community who also have lived experience that helps guide their work. “I can empathize with clients in some situations they’re in because I’ve been there,” said CHW Rena George, who is based at the Hood River Health Department. “I’m showing them there is a light at the end of the tunnel.”
Adapting to the ‘new normal’
When COVID hit in the spring, Bridges to Health began receiving referrals from local health departments for clients in isolation and quarantine who needed additional support to help them stay safely isolated. Because of the program’s existing relationships with the Hood River Health Department and North Central Public Health District, this was a natural partnership. Bridges to Health pivoted quickly to serve these families while continuing to work with clients having challenges accessing resources on their own.
“We help (families in isolation) with groceries, or picking up a food box, or delivering medication, masks, hand sanitizer, thermometers, you name it, even activities for kids,” said Katy Williams, program coordinator for Bridges to Health.
As the pandemic progressed, Bridges to Health has continually and flexibly adapted to serve the community’s most pressing needs. At this point, about 90 percent of CHWs’ day-to-day work is supporting families in isolation through the Bridges to Health Pathways COVID-19 Response Program, something the program’s staff could not have anticipated at the start of 2020. At the beginning of the pandemic, the program received about one or two isolation referrals a week. Now, one to 10 referrals come in every day, in addition to referrals for the traditional Bridges to Health program.
Bridges to Health staff and leadership soon realized that many clients in isolation for COVID also had unmet needs like access to food or housing. Because of this, many clients receiving services during isolation continue to stay enrolled in the program after their isolation period.
In order to support its COVID-19 Response Program, Bridges to Health received two grants: One from the Oregon Health Authority (OHA) and one from Providence Hood River. The OHA grant, which ran from July 1 through Dec. 31, 2020, included reimbursement for costs such as rent and mortgage support, utility support, and reimbursement for the food and supplies that CHWs purchase for clients. OHA will continue to provide some reimbursement into 2021. The funding from Providence Hood River has also been used to support families impacted by the pandemic. Overall and remaining program funding continues to come from PacificSource and Columbia Gorge Health Council. All funding streams have made a big difference by providing direct support to clients.
COVID impacts communities in different ways
While chronic conditions like hypertension, heart disease, and diabetes increase the risk of a more severe COVID case, so do race and income inequality. People of color and people with low income are more likely to work essential jobs in grocery stores, on farms, or in factories, where protections are often limited and outbreaks common. They are more likely to be uninsured or under-insured, making access to health care difficult.
Bridges to Health staff have seen firsthand the disproportionate impact of COVID in the Gorge community through their work.
“What we recognize is that inequalities already evident in our systems before COVID have been exacerbated by the impact of COVID,” said Suzanne Cross, program manager for Bridges to Health. “Many people have lost wages and that impact can be huge if you don’t have disposable income or if you are lower paid.”
Recently, CHW Josh Sendejas helped a family in isolation with a mortgage payment through the Bridges to Health Pathways COVID-19 Response Program. “If a family doesn’t have vacation or sick time, it’s hard to take 14 days off and support yourself,” said Sendejas.
“Health equity” means everyone has a “fair and just opportunity to be as healthy as possible.” Bridges to Health is helping improve health equity in the community by supporting those most impacted by COVID, many of whom are already experiencing challenges. Adapting to COVID hasn’t been easy, but the collaborative model of Bridges to Health and its resilient staff have allowed the program to meet the changing and varied needs of the community.
A version of this article appeared initially in the winter edition of The Gorge magazine, which is available now.