This past fall, when Minnesota began to see a surge in COVID-19 cases, members of the state’s Hmong community felt a disproportionate impact. With the spike in cases came a spike in calls to a COVID-19 hotline run by the Hmong-American Partnership (HAP), a nonprofit community development organization focused on the needs of the Twin Cities’ Hmong community.
“This fall’s surge really affected our community,” said Mai Moua, HAP’s interim CEO. “We are very clan- and family-oriented.”
This intense family orientation requires that people offering help to members of the Hmong community look at the situation from an informed perspective. A good example of this is the public health advice that individuals diagnosed with COVID-19 isolate themselves from other members of their household, Moua continued: “It is hard for someone who is not Hmong to understand that if one person in a Hmong household gets COVID, there is often nowhere else for them to go to quarantine. They are often already living in an overcrowded house of seven to nine people.”
People staffing a COVID hotline that is not culturally specific might not understand the complexities of Hmong culture and may give advice that isn’t applicable to a Hmong caller, Moua said. “So it only made sense that when they needed answers, members of the Hmong community turned to us. There is a cultural lens to how we do our work.”
The HAP hotline, staffed by a team of specially trained Hmong-speaking COVID-19 Community Coordinators, is open for callers from 8:30 a.m. to 5 p.m. Monday-Friday. Designed to provide answers, guidance and assistance to members of the Hmong community, the hotline is part of a suite of COVID-19 education programs run by the organization and funded by a COVID-19 Community Coordinators contract from the Minnesota Department of Health.
Launched in the fall, the COVID-19 Community Coordinators (CCC) program provides financial support to culturally specific organizations across the state. Like HAP, each CCC-funded organization has created hotlines staffed by coordinators familiar with the needs and languages of the specific community their organization serves.
Coordinators help community members find and get critical resources needed to deal with health and other concerns caused by the impact of COVID-19, including employment, food access, housing, child care, and legal rights.
Kou Thao, director of the MDH’s Center for Health Equity, explained that the CCC program came about after individuals from a number of different culturally focused organizations said they needed help to support their communities.
“There were a number of requests from communities for the state to provide greater investment for their needs and resources,” Thao said. “We created the initiative and requested funding from COVID-relief dollars.” The program, Thao said, was awarded around $10 million for 2020, with another $10 million to continue the work into 2021.
“In the end, we were able to fund about 40 organizations statewide that are reaching communities of color and members of the disability and LGBTQ communities,” he said.
COVID-19 Community Coordinator programs are funded to do three main bodies of work, Thao explained.
The first, he said, is to “do outreach and engagement to communities around COVID-19 information, like where to get tested, how to find test sites, how to register at test sites.”
The CCC program also funds COVID-19 hotlines like the one at HAP, Thao said: “Those hotlines are fully staffed and available 5 to 7 days a week.” Like the callers to the HAP hotline, he continued, “Members of some communities don’t always feel comfortable calling the state and asking questions for a number of reasons, including language needs. The people on these [culturally specific] lines have a deeper understanding of the specific communities they are serving.”
The final piece that CCC dollars support is sending staff from culturally focused organizations to support community members at COVID-19 test sites. “These staffers are from the community,” Thao explained, “so it helps when they show up at site. When community members go to a site and see a coordinator there, they feel more comfortable. These are people who look like them, who understand them, who can help with any accessibility needs, including language.”
A health-equity lens
The global pandemic has exposed a number of failures in the American health care system, but one of the most painful problems that have been made clear is the jarring health care gaps that exist between members of the majority culture and those who are members of traditionally oppressed groups.
On the statewide level, Thao said, staff at the Minnesota Department of Health have been working for years to correct those inequities. COVID has only increased the sense of urgency around their work.
“The state and the Department of Health have been using the lens of health equity and racial equity for almost a decade now,” he said. “That foundation is the way we approach the work, and we are bringing renewed focus to those issues now.”
He said that the department-wide health-equity focus helped to fast-track the CCC initiative. “The fact that we are able to prioritize community-based organizations and recognize their roles as leaders, that says a lot to the community that we value them and it is important for them to do this work.”
When funding was secured for CCC programming, Thao said that he and his colleagues identified a group of community-focused organizations that they thought would best benefit from the funding. They wanted to make sure that as many Minnesotans as possible were aware of resources available to help support them through the COVID-19 crisis, and it only made sense that they support organizations that truly understand the communities they serve.
“They range from grassroots to larger, multimillion-dollar organizations,” he said of the organizations participating in the CCC program. “They were chosen because they have the expertise already in the community and we wanted to reach as many community members as possible.”
‘We get it’
Like the COVID Community Coordinators at HAP, staffers who work on the CCC hotline at HACER (Hispanic Advocacy and Community Empowerment through Research), a St. Paul-based nonprofit that works with the state’s Latinx community to access, generate and disseminate credible research to inform institutional decisions and public policy, have an intimate understanding of the needs of their callers.
Because some of the callers to HACER’s COVID-19 hotline (651-304-6145) may be undocumented workers who do not qualify for state-run health care plans, Rodolfo Gutierrez, HACER executive director, explained that hotline staff are trained to explain other means of assistance.
“There is support for undocumented workers,” Gutierrez said. “[Our staff] understands why people have those concerns and we know how to connect them with programs that provide support with no questions asked.” In Greater Minnesota, he continued, many undocumented workers in meat processing plants reported that their employers told them to come to work even if they were sick. Reporting a COVID infection could result in dismissal, they said. HACER developed and translated information sheets for callers that outlined worker rights and helped connect them to legal supports.
Most callers to the HACER’s CCC hotline line speak English, Gutierrez said, but many feel more comfortable reading information in Spanish: “We worked with MDH to create some Spanish-language materials to help educate people about COVID-19.”
To further disseminate accurate information about how best to protect yourself and your loved ones from contracting the virus, HACER staff has created Spanish-language videos, radio shows and Facebook Live discussion groups focused on spreading accurate information about COVID.
Some HACER hotline callers have told hotline staff that they are concerned about getting tested for COVID, that the sites may collect personal information that could lead to deportation. Hotline staff explain that test sites are safe, and even offer to provide transportation to the sites and translation services once they get there.
Without MDH support, Gutierrez said, none of these programs could have been possible. COVID-19 Community Coordinator funding has allowed the nonprofit to hire nine new staff members to help expand the program.
“The crisis came quickly in our community so we needed to act quickly,” Gutierrez said. “The state funding helped us be able to do that.”
Hodan Guled, CEO of Briva Health, an organization dedicated to improving health care access in Minnesota, runs a seven-day-a-week CCC hotline (833-567-6662) focused on the needs of the state’s East African community.
She explained that when Briva hired its team of seven COVID-19 Community Coordinators they were looking for individuals who ”have experience working in the community, who are passionate about advocating on behalf of the community and are able to understand the unique needs of our community members.”
Many of the hotline’s callers are concerned not just about COVID’s impact on their physical health, but also about its impact on their financial health.
“We get calls every day from people who have been impacted economically, who lost their job, were unable to pay their rent or their mortgage, or put food on the table,” Guled said. “We’re connecting them to existing community-friendly resources that they may not be able to find on their own.”
Another important part of the Community Coordinators’ job is explaining how easy and painless it is to get tested for COVID, Guled said.
“We encourage people to get tested for COVID. We say, ‘Have you recently gotten tested? Would you like to know the nearest community testing location that you can go to?’”
At HAP, CCC funding made it possible to hire four full-time employees. The program will soon be extending its reach beyond the Hmong community, adding a care coordinator familiar with the culture and language of the Twin Cities’ growing Karen immigrant community.
“It does take a village to get all this information out,” Moua said. “We also have staff across the agency that are doing COVID-19 work around their existing programs.” Staff in HAP’s tobacco- and diabetes-prevention programs have now dedicated a portion of their hours to COVID-19 education, she added, “because their clients need to know that they are high-risk.”
In order for messages to truly resonate with clients, it’s important that all of the public health information that HAP staff deliver is handled in a way that acknowledges Hmong cultural sensitivities, Moua said. If she were working with a group of employees who look at the world form a Western lens, this could require extra education to get them up to speed.
But that’s not the case with her CCC workers, she said. They know Hmong culture because they grew up in it.
“They don’t need to explain that kind of stuff to us,” Moua said. “We get it.”