Nadia
At the start of COVID, when the stay-at-home orders were first issued, people retreated to their homes, apartments or the homes of family members to wait out what would be months of sheltering in place – an effort to “flatten the curve.” For a large population of people experiencing homelessness, they were living on the streets or in temporary shelters, unable to remain in isolation from the virus, leaving them particularly susceptible to infection.
Shelters took extra sanitizing precautions, and temporary Wellness Hotels were set up to help isolate people with COVID or expected of having COVID – but this population remained at risk of chronic outbreaks.
Doctors and medical professionals at Albuquerque Health Care for the Homeless (ACHC) increased street outreach and began working to prevent COVID’s spread in shelters or on the streets. Nadia began working as the Dental Director at AHCH two weeks before the state shut down. In a fortuitous twist of circumstances, Nadia also brought with her a Master’s in Public Health – something which would help to shift and inform how AHCH responded to the severe threat of COVID among one of Albuquerque’s most at-risk populations.
This is her story, in her own words.
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I started my job on March 2, 2020 – so literally two weeks before everything shutdown. It was interesting because I was able to see two weeks of what [the AHCH] campus looked like pre-pandemic where it was just thriving and there were people everywhere.
I had a meandering path to get to dentistry. My dad is a dentist; I never wanted to be a dentist, but I was a bit lost after I graduated from undergrad and I didn’t know what I wanted to do, so I ended up working for him and at the same time, applied for the Peace Corps. I ended up joining the Peace Corps and lived in West Africa for two years. When I came back, I had to go through more schooling to do pre-requisites for dental school and then started dental school. After dental school, you have options when you graduate – you can jump into the workforce; you can become a specialist or you can do a one-year, general dentistry residency, which is an in-between-step between dental school and working. It’s helpful if you want to work in community health.
I did that at St. Vincent DePaul in Phoenix. It was all privately run and funded through various charitable organizations in Phoenix. It gave me a beacon of where I wanted to head in my career; I always knew I wanted to be in public health – that was never a question. I received my Master’s in Public Health at the same time as my dental degree, and I knew I wanted to be a director of a clinic somewhere, eventually.
I wanted to do community health and had worked with the healthcare for the homeless in Houston for about a month in dental school. I wanted to work with this population because there’s so much to do – it’s never-ending. You find such passionate people. People don’t work with the homeless population because they’re forced to. They work with them because they want to, and that’s a really unique workforce. It’s easy to be surrounded by people who are passionate and enthusiastic, and I think that’s a rare thing to find in work.
When I was hired at AHCH, it was an 80:20 ratio of dentistry to admin time. So, one day a week of admin and in-clinic 80% of the time. But, when I got here, it turned into more of a 50:50 dentistry/public health. I found myself filling that 50% of time just keeping everyone informed and trying to re-strategize with senior management and our Policy Director and our Medical Director on how best to manage COVID in this population.
As dentists, we’re naturally poised to be champions of PPE – every time you go to the dentist, people are in masks and gowns – so it naturally became that I was the go-to for COVID. I have a real interest in understanding public health crises, so I started sitting in on talks in my free time that were offering updates on PPE and aerosol viruses. I seemed to have the bandwidth and time to listen in, and then report back.
We shut down just about everything except for emergency services. Our medical clinic essentially still stayed open. We shut down the resource center – anything that would have brought clients and staff members together in a community space. Our dental clinic stayed open, but for emergencies only. We ordered new aerosol-sucking machines for the dental clinic; we implemented a single point-of-entry and mandated masks. We did all of that early on and evolved as the literature and recommendations came out.
We also started shifting to doing more outreach during COVID. There will always be people who don’t want to come to campus and interact with people. We pivoted at that time to deploy our medical providers and public health workers. I spent a lot of time and weekends at the Westside Shelter trying to help maintain things. In the Wellness Hotels, there were some days when the whole hotel was full; there were 80 people needing medical attention around the clock because they were either COVID-suspected or COVID-positive. It was an opportunity for us to reach folks who we might not have otherwise reached, but also – they needed the help so we shifted to move off campus to meet folks where they were.
We had one outbreak in October in the Westside Shelter that we managed to get fairly under control. I think we had one death, but it didn’t happen again because we learned so much. The shelter is set up poorly for isolation of any kind, so we restructured it a bit. The back part became an isolation area. When that became too overwhelming, the Wellness Hotels opened and we moved all people under investigation to the hotel so they could be isolated. And that process was constantly shifting based on recommendations and travel orders and public health orders. Do people stay two weeks? Ten days? How often are people tested? There were times when it was taking 5-6 days to even get testing back from the labs. The shelter’s strategy was to do random testing to keep the cases from spreading and there was a time – December, January, February – when their cases were lower than the community’s. The constant testing worked and it’s still working.
From an epidemiological and research-based perspective, I was able to help offer public health strategy on how to not spread this virus. I was seeing what other folks were doing – how they were de-intensifying their shelters. Most places – bigger cities like Phoenix, Dallas and Seattle – had more money than we did, but I could strategize on how to clean up, how we should separate folks, what airflow looked like. We did a whole study on the actual outbreak of patient zero in the Westside Shelter, and who became positive around them. We set up dividers, had rooms cleaned, talked about the testing approach. We needed all different spaces – for gender, for people recovering from COVID because they weren’t going to get infected or infect anybody. We put people under investigation in one place; travelers in another place. People who are coughing somewhere else. With limited space, how do you divide that up for best practice?
In January, we received Moderna vaccines that were allocated for our staff. They come in a case, so we couldn’t get fewer vaccines. We’ve now fully vaccinated our staff and have vaccine left over. We tried to think about early on – in terms of equity and access – about what was important to us and our clients in terms of getting vaccinated. Our approach has been two-pronged. We don’t plan on hosting any kind of huge vaccination event. That’s not what we’re really built for; instead, we’re going to do a more targeted approach. Technically, people experiencing homelessness are not eligible yet, but those who have chronic medical conditions, and are over a certain age, are. We have pinpointed that population for vaccines. During street outreach, we’ve administered ten, first round vaccines. It was struggle to get ten people to say “yes.” There was a lot of fear surrounding the idea of vaccines. We’ll do more education and engagement with folks – find out what values are leading them to say “no” and try to discuss what values can lead them to say “yes.” Hopefully, if we get one person in one community, that person will spread the word and we’ll get a slow “yes” from the group as a whole.
Our philosophy is to get shots in arms. We’re not holding back because we find it difficult to vaccinate this population with two vaccines. We’re slated to get the Johnson & Johnson vaccine in the coming weeks and we’ll vaccinate by appointment on campus or on street outreach with whomever says “yes.”
I was lucky growing up. I have a great family and they let me go where I wanted to go and do what I wanted to do, and find my own way. My dad is not from here – he’s from East Africa; I wasn’t born in the United States either. Culturally, my dad still sometimes doesn’t understand American culture, but he is without a doubt the most generous human being on earth and he does understand that. My parents laid the foundation for who I am, and teaching English and English literature in the Peace Corps in Cape Verde – it beyond helped to shape who I am today.
I think all of these things just came together to put me where I am. I’m not sure if someone with a different background would have had the same passion for public health or would have rather focused just on dentistry as opposed to systems work and strategy during COVID. I never imagined that I would be in this position at this time. But it all sort of worked out for everybody – that I was able to bring my experience and my passions, and ability to learn and take these issues and break them out for our staff. Dentists, as a whole, aren’t usually elevated into these types of positions – but it has been a huge blessing.
