On Friday, January 21, 2022, a truck is parked on Fourth Avenue in front of St. Michael’s Roman Catholic Church in the Sunset Park neighborhood of Brooklyn. On a warmer day, that vehicle would be the hub for a nurse and a few care and research coordinators from Memorial Sloan Kettering Cancer Center. But with freezing temperatures outside, the MSK team set up shop in the lobby of the church and is chatting in Spanish with attendees leaving that morning’s church service.
These MSK team members are sharing information about the health resources and screenings available that day, as part of a new Mobile Health Unit — a community outreach and education initiative from MSK’s Immigrant Health & Cancer Disparities (IHCD) Service. Since launching in December 2021, the Mobile Health Unit has visited more than a dozen locations in Brooklyn, the Bronx, and Manhattan.
Speaking the Same Language
One key facet of the Mobile Health Unit is that staff can communicate with residents in both English and Spanish. This is critical for bringing care directly to where people live.
Marisol Lucero, a community outreach coordinator, was on-site that day. She says the language barrier between the communities that IHCD serves and the healthcare system is one of the most difficult obstacles for people to overcome.
“Engaging these communities in Spanish, their preferred language, helps us form a deeper connection with people and makes them comfortable sharing more information about their health and needs,” says Ms. Lucero.
It’s also crucial for education. Team members can provide education materials and guidance — in English and Spanish — about nutrition, cardiovascular disease, and more. They also can help individuals navigate questions about health insurance, including how to access and sign up for coverage, and direct them to locations where they can receive the COVID-19 vaccine. Additionally, the Mobile Health Unit team can conduct screening procedures for general health problems. For example, they can check blood pressure, glucose, and cholesterol levels.
“I love being out in the community because it allows our team to meet people where they are, connect with them in their own language, and bring care directly to them,” says nurse Jessica Llamozas, who helps provide the clinical services offered by the Mobile Health Unit.
Timing Is Key
Mobile Health Unit members have been meeting people at a particularly vulnerable time, as the COVID-19 pandemic continues to disproportionately affect communities of color throughout the U.S. “Through this outreach, we have heard that many people delayed their healthcare over the past two years — whether it was an annual physical or a cancer screening and everything in between,” says Ms. Llamozas.
For community members who may have missed an essential cancer screening during the pandemic, are under- or uninsured, or don’t have access to cancer screening, the MSK team provides information on how to access cancer screening, including at MSK’s Ralph Lauren Center, conveniently located in Harlem. To date, about 210 people have been referred for cancer screening at the Ralph Lauren Center.
She adds that everyone who visits the Mobile Health Unit receives a document to take home that includes their blood pressure, glucose, and cholesterol levels — and sometimes that’s the push someone needs to take the next step in getting follow-up care. For those who aren’t sure how or where to access care, the MSK team is there to help.
“We make sure they have our phone number so if they need help, they can call us,” Ms. Llamozas says.
This comfort is aided by familiarity. The Mobile Health Unit plans to visit the same sites consistently over the next several months, so that it becomes a regular and welcoming sight to residents.
“We have already seen that people who have engaged with us bring family members, friends, or neighbors to see us the next time we are in the neighborhood,” Ms. Lucero adds.
A Personal Touch
Also there in January was community outreach coordinator Kenneth Giron, who joined MSK in 2021. Working with the Mobile Health Unit is his first real opportunity in public health, and to him, the work is personal. “I come from an immigrant family and understand that being undocumented and new to the U.S. can be a very scary experience,” he says. “We want to help bridge the gap for individuals in that position so they are able to access resources, information, and services that will help them feel more secure.”
That morning, one elderly resident, who walked with the assistance of a cane, asked for a ride home. Mr. Giron didn’t hesitate to summon a cab for her. When she shouted to ask whether she had to pay for it, Mr. Giron waved his hand and said, “Don’t worry about it.”
By early afternoon, the Mobile Health Unit team had provided health education and screenings to six Sunset Parkers.
Understanding a Community’s Needs
Josana Tonda is the manager of community outreach in IHCD and leads the Mobile Health Unit effort. She came to MSK after 14 years as the director of Ventanilla de Salud (VDS), a national program overseen by the U.S.-Mexico Border Health Commission that allows the Mexican population living in the United States to access healthcare services at 49 Mexican Consulates. MSK works with VDS, and MSK’s Mobile Health Unit partners with VDS’ larger outreach program.
Ms. Tonda notes that the most important measure of success for an outreach program is the trust of each unique community.
“Healthcare institutions have to show each community that they are a priority, and we have to go to them rather than expect them to come to us,” Ms. Tonda says. “New York City is an incredibly diverse place, so it’s critically important to take the appropriate time and care to understand the individual needs of a community.”
Ms. Tonda estimates that close to three-quarters of the community members that her team serves require some type of navigation assistance, whether it’s related to insurance, documentation, or making healthcare appointments. She recounted an experience from a previous day in Sunset Park, when the team spoke with a man who was undocumented and currently living in a homeless shelter.
“We asked him if he was OK, and he replied that he was fine but needed help,” she says. “After learning more of his story, we began the process of helping him get an ID at his consulate. Having an ID will allow us to help him sign up for an insurance program and find a primary care provider,” she says.
Evidence Supports the Approach
Research has shown that mobile outreach can improve cancer screening rates in underserved communities. In a January 2022 study in the journal NPJ Breast Cancer, MSK breast cancer surgeon Virgilio Sacchini reported the effect of mobile mammogram vans on breast cancer screening rates in underserved communities. From 2014 to 2019, more than 32,000 women across New York City had a no-cost breast screening on a mobile unit provided by the American-Italian Cancer Foundation. More than half of the participants identified as either Black or Hispanic, and more than 60% of the participants had an annual income of less than $25,000. Additionally, 30% did not have health insurance.
“Unfortunately, there are more and more data documenting differences in diagnosis and treatment among different populations,” says Dr. Sacchini. “Black, Latinx, and other communities of color have less access to cancer screening services, which can result in later diagnosis and worse outcomes.”
MSK’s Mobile Health Unit does not offer mammograms, but eventually the program may provide other cancer screening and prevention services, including fecal immunochemical tests for colorectal cancer screening, screening for prostate cancer through the prostate-specific antigen (PSA) blood test, and the vaccine series for human papillomavirus (HPV). While the program is being piloted in New York City’s five boroughs, there are plans to expand its reach to Long Island, Yonkers, Westchester, and beyond later in 2022.
This initiative is funded in part by the Mother Cabrini Health Foundation, the U.S.-Mexico Border Health Commission, and the Centers for Disease Control and Prevention.