Challenges to Mainstream Health Care in Oakland’s Underserved Communities

By Adizah Eghan

It's not your normal health care setting: Reggaeton is thumping from a space where people are doing Zumba. Food is available – for free.

It's the annual health fair held at the East Oakland Leadership Academy, a charter school serving inner-city K-8 students. The health fair is organized by nursing students at Samuel Merritt University, and it serves a dual purpose: serving the Oakland community and recruiting people of color to SMU's nursing programs. The federal government classifies East Oakland as a medically underserved area.

Foot traffic is low, but the fair is filled with liveliness. For the past 11 years, EOLA has provided food and health care to the community through events like this fair.

“Health is always a concern for us" says Laura Armstrong, EOLA's founder and executive director. "Getting the information out to everybody and providing a local place close in the neighborhood for them to come is just something that we do. It’s all about the community."

People curiously stroll through the school enjoying the free goodies and asking plenty of questions about their blood pressure, body mass index and sugar intake. The SMU students answer questions as they hand out pamphlets. The Samuel Merritt booth is placed right in front of the entryway so that any interested EOLA kids can start thinking about nursing school and connect with the university now.

Raychole Javius, 31, is from East Oakland. She stands outside EOLA munching on a free sandwich she got inside. Javius has Medi-Cal, but it’s been 15 years since she saw a doctor.. She says she’s afraid to go, “It makes me nervous, actually. It makes me very, very nervous about the results or what they can tell me or I don’t know.”

Need for Greater Cultural Understanding

Javius says it’s the way she was raised. Her parents hardly went to the doctor and did not like to take medications. “When I’m dying and I can’t breathe, then I’ll call 911 or get my butt to the hospital,” she laughs.

Javius says she stays healthy by exercising daily and avoiding takeout foods. But she knows that she’s due for a visit to the doctor’s office, “I will go because that’s the right thing to do. But I’m scared, that’s all, I’m scared.”

None of Javius's attitudes surprise Dr. Winston F. Wong. He's director of disparities and quality initiatives at Kaiser Permanente, “There is an issue with regards to how safe individuals feel with their care provider," he says, "and how much that care provider has credibility with regards to understanding their family situation, their community and their cultural context.”

Some of the nursing students also have personal experience with this issue of comfort and safety.

Dale Wong is one of three nursing students greeting people as they enter a small classroom to get their blood pressure checked. He talks about the risk of hypertension and stroke with ease to a woman whose blood pressure is on the higher side.

According to Wong, each community has different needs. “Health fairs bring awareness especially if you have them in different communities in Oakland, like West Oakland, Chinatown and the Fruitvale area.”

“Looking at my culture, we just don’t talk about it sometimes,” he says. I’m Chinese, and my grandparents were very secretive about their health problems. They didn’t want to burden their families. When they did go to the doctor’s office, they didn’t want any procedures done, for anything.”

Health fairs are a great initial step to get people out and receiving care. But Kaiser’s Dr. Wong warns about the false sense of security they create. “One blood pressure taken in a busy playground or gym is not necessarily the way that we think care [is] best provided to people.”

“I think that health fairs maybe have a role, but they’re certainly not the solution per se with regards to providing access for underserved populations,” he said.

Recruiting Students of Color to Health Professions

Shanda Williams, 31, is a senior at Samuel Merritt. Williams decided to become a nurse after she accompanied her grandmother on a doctor's visit. Her grandmother has a history of hypertension, heart attack, and stroke and knows it's important to visit the doctor to get the medication she needs.

“When the doctor asked her if she was eating healthy and exercising she would lie,” Williams said.

When Williams confronted her grandmother about lying to the doctor she told her, “He’s a white doctor, he just wouldn’t understand the way that we eat.”

The things that are hardest to explain often run along cultural and racial lines. “I realized that I needed — our community needed — more nurses that looked and were reflective of the population (of the) Bay Area,” Williams said, which is the reason she is pursuing a career in nursing, here in her own neighborhood.

“I want to be able to say 'Hey, I come from the same neighborhood you come from, I grew up with the same kind of customs and rituals that you had and yes, we can do this together, you can be honest with me because if you’re not honest with me, I can’t treat you properly,'” she says.

Samuel Merritt puts effort into recruiting students of color and engaging existing students in the community. They provide scholarship money, support for mothers and nursing success seminars. However additional support is needed to build up the diversity of California’s future workforce.

A UCSF report states, “Low high school and college graduation rates for underrepresented minority youth make it difficult to increase diversity at medical and nursing schools in particular. The allied health professions continue to be more reflective of the state’s population. The community colleges that offer allied health programs attract a diverse student population, but attrition rates are high and programs have difficulty finding the resources to expand to meet growing numbers of applicants.”

Another way to gradually break down the cultural barrier is to employ more community health workers or promotoras, as they’re known in Spanish, to help people self-manage their conditions and chronic diseases.

Kaiser's Dr. Wong says these workers have credibility as peer educators and peer supporters. Their work extends the reach of physicians and medical offices and they are linguistically and culturally relevant to their respective communities

An additional option is the use of mobile medical units. These units bring the high quality professional infrastructure of a medical facility to patients so that individuals don’t have to worry about transportation to their doctor’s office.

It’s unclear how many generations it will take for those in underserved communities to comfortably experience care. But it is evident that as the population in California continues to grow, more unconventional models of care will need to be paired with active recruitment of a more culturally adequate workforce.