Update, June 26: Nashua's Division of Public Health has moved its testing site to the parking lot of the Nashua Public Library as of Thursday, June 25. Tests will continue every Thursday there from 3 p.m. to 5 p.m.
Since early May, health worker Lisa Vasquez has spent most of her Thursday afternoons in the parking lot of St. Aloysius of Gonzaga Church in Nashua — which, at 3 p.m. on those days, transforms into a COVID-19 testing site.
Like other public testing sites for coronavirus in Nashua and elsewhere, this one has Vasquez and other public health colleagues donning gloves, gowns and face shields as they prepare to greet potential patients.
Unlike some other testing sites, this one isn't designed to be drive-through only — it also offers a walk-up option, for people without cars. And Vasquez says that, too, is by design: About one in four people in this neighborhood don’t own a car, according to Census data.
“When you drive around this community, you might see many people walking because it’s a walkable community," she says. "People can walk to the downtown area, to the library. Right behind us, there’s a walking trail.”
But accessibility for people who don't own a vehicle wasn't the only thing on the mind of Nashua's public health team when they scouted out this location. About 20 percent of people in the surrounding neighborhood are foreign-born, and about 40 percent are Latino, according to the Census.
“Nashua is culturally diverse in general, but in this area you see a lot of people that would maybe describe themselves as Latino, immigrants from Africa, Asia,” Vasquez says. “I can’t think of any place that might not be represented.”
The city's public testing site at St. Aloysius is part of an effort to try to cater its COVID-19 response to the specific needs of its community — which has been a learning process from the beginning.
About a month into the pandemic, in late April, the city set up its first public testing site at Nashua North High School. But that site wasn't reaching the Latino population, which was a priority for the city. One problem: The Nashua North testing site was only accessible to people with cars, which left out a large part of the community the city was trying to reach.
Bobbie Bagley, Nashua’s public health director, said that as her team tried to figure out a better spot for their COVID-19 testing, they paid close attention to "social determinants of health" — factors beyond someone's medical history that play a big role in shaping their health outcomes. This includes things like where someone lives, how much they earn and if they’re a racial or ethnic minority in this country.
“We wanted to make sure that we did not have barriers that would prevent people from being able to get to our testing sites,” Bagley says.
When Bagley and her team began looking for a place that would be easier for more people to reach, St. Aloysius fit the bill. It’s walkable, and it’s known in Nashua as the “Spanish church.”
“We wanted to make sure that we were reaching out to those communities that would be impacted the greatest by COVID-19, and are communities that are underserved,” Bagley said.
(Keep scrolling! The story continues below this graphic.)
As the Nashua public health team was figuring out how to deal with COVID-19 in their community, they were keenly aware of the nationwide statistics that COVID-19 was disproportionately affecting Black and Latino people. In New Hampshire, those two groups make up about 17 percent of total coronavirus cases statewide for which race is reported, but account for just a little over 5 percent of the state’s population.
The unequal distribution of COVID-19 in New Hampshire and nationally isn’t necessarily a surprise to Bagley. She says the disease is more likely to affect people with underlying health conditions, like hypertension, diabetes and obesity — and those already disproportionately affect minority communities. But she says other inequities are also a big factor: economics, education and systemic racism.
“We know in particular with our populations of color, those disparities have existed for decades,” she said. “And so we need to make sure that we have a particular focus on addressing those needs so that we can close those gaps and improve the health outcomes for that population group.”
When it came to coronavirus-related outreach, Bagley says a big priority for her office was connecting with community leaders and organizations with information about prevention, social support systems and locations to get tested for COVID-19.
Part of that work involved making sure important public health messages were being shared in different languages. Lisa Vasquez, one of Nashua's bilingual public health workers, does regular public service announcements in Spanish on local radio. She also translates information into Spanish, and spends time answering the city’s COVID-19 hotlines. But she says the city is working on getting information translated into Portuguese, too.
The city also has someone who can answer questions in French. Challenges remain, though: Bagley says they don't have the staff capacity to provide bilingual workers for full 12-hour shifts.
Even though there's more room for improvement, Bagley says Nashua’s strategy so far has reached the area’s Latino population in a meaningful way.
About 30 percent of people who have gotten tests so far at the city’s clinics are Latino, according to figures provided by the city's public health department. As of June 23, Nashua Public Health says 87 percent of people tested at city-run sites were White, about 5 percent were Black and 1.25 percent were Asian.
Bagley says she hopes to continue applying the lessons they've taken from their COVID-19 outreach so far to improve their work with more communities across the city, including among low-income households and African or African-American residents.
“We don’t have that same type of access or reaching out to the refugee population in Nashua,” Bagley added.
A few miles north, New Hampshire's largest city is starting to take a similar approach to the one Nashua began earlier on in its COVID-19 response. Manchester recently set up a mobile testing clinic in one of its predominantly Black and Latino neighborhoods, at the intersection of Union and Spruce Streets.
The public health department there worked with several local organizations that already have connections in the community — including Centro Latino, Hope Tabernacle and the Granite State Organizing Project — to set up the mobile testing site and get the word out. Spanish, Arabic and Swahili interpreters are available at the testing site.
“Our partners are able to use their existing social and professional networks to provide grassroots outreach to potentially isolated and/or high risk groups based on disease risk factors, such as heart disease and diabetes,” said Jaime Hoebeke, chief strategy officer at Manchester Public Health.
The state of New Hampshire is also taking note of this community-minded strategy, too. Gov. Chris Sununu appointed Bagley to a five-person equity response team in May, where she's sharing what her team has been doing in Nashua to help develop a statewide strategy and address some of the disparities seen across New Hampshire's COVID-19 cases.
But Bagley says this approach needs to be a sustained part of the state’s public health response — not just in the current pandemic, but when it comes to healthcare in normal times, too.