NEW ORLEANS — Shakeitha Young was home on a rainy Saturday morning, cleaning up bits of toast strewn by her 1-year-old, Jalayah, when the knock came.
A nurse in teal scrubs, rain boots and a white poncho was on her porch, offering Young an on-the-spot COVID-19 vaccine. Young eagerly agreed, swinging open the door with Jalayah propped on her hip in a unicorn shirt and diaper. Despite her job as a hospital technician, sanitizing medical equipment like IV pumps, the 32-year-old single mom of three said she hadn’t yet been offered a shot.
In her quaint, sparsely furnished townhouse tucked in a public housing complex in the city's Upper 9th Ward, nurse practitioner Sophia Thomas injected Young with her first dose of Moderna vaccine.
Joined by housing authority workers, Thomas went up and down Oliver White Avenue offering in-home vaccines to residents of the majority-Black Desire area, a historically underserved, low-lying neighborhood where 64% of people live in poverty, according to the U.S. census.
The area is notorious as the former home of one of the nation's largest public housing complexes, where people endured grim, unsanitary living conditions for decades. The complex was demolished under federal mandates in the late 1990s and new residences were built in its place.
Public health experts say door-to-door vaccination outreach to underserved neighborhoods like Desire is needed to protect vulnerable communities of color who have suffered disproportionate deaths and hospitalizations from COVID-19.
In Orleans Parish, where Young lives, Black people make up 59% of the population, and a staggering 72% of COVID-19 deaths, state data shows. But only 42% have received a first vaccine dose.
"It's not just the elderly homebound" who need in-home vaccines, Thomas said. "It's young families, the single moms. It's working people."
A lack of transportation, trouble taking time off work and other logistical challenges make it complicated to get to the doctor or clinic for a shot.
Thomas, an advanced nurse practitioner, has spent more than two decades caring for patients in rural health clinics and urban community health centers. Many of her patients in these neighborhoods suffer from diabetes, asthma, pulmonary disease and obesity – all illnesses that disproportionately impact people of color because of longstanding systemic inequities and that put them at higher risk of contracting COVID-19 and complications.
“When we’re talking about going into the neighborhoods, we’re talking about bringing health care services to patients where they are,” said Thomas, who practices at DePaul Community Health Centers. “If we didn’t, the likelihood that they would be able to get the services, get the vaccines, is limited.”
Door-knocking in Desire
During the door-to-door vaccine effort, DePaul Community Health simultaneously offered vaccinations at Thrive, a community center that’s served as a trusted resource for the housing complex ever since Hurricane Katrina devastated the town.
There, community health workers also loaded their cars with boxes of Second Harvest dinner kits – sweet potatoes, cabbage, seasoned poultry and gallons of milk – and delivered them to residents, following Thomas around the neighborhood with her vaccine kit.
Thomas was glad to find a number of Desire's residents already had received at least their first shot. But there was still plenty of hesitancy, misinformation to combat and a wide spectrum of overarching health care challenges.
When met with resistance, a bubbly Thomas, with fiery red hair and bold blue eyes, patiently detailed the vaccine's safety and how it works. It wasn't enough for some.
“Not now. Not for a couple years,” said one resident, who said no to a shot but accepted a box of veggies and milk. Others declined without opening the door.
Priscilla Rieux, 69, had an appointment to get a shot. The retired school nutritional services worker waited expectantly in her lime-green townhouse adorned with gauzy blue curtains and a vintage couch.
Thomas chatted with Rieux, asking after her health and checking to see if she had immune issues or other concerns. Her son Eric Rieux, 38, hovered nearby, occasionally chiming in.
Thomas was just about to deliver the injection when Priscilla Rieux mentioned she'd just begun chemotherapy. Thomas lowered the needle, and said she needed to clear the vaccine with her oncologist first.
So, Thomas turned to Eric Rieux and offered it to him.
“I might take that shot and get sick," he said, lugging a box of food from the team to the kitchen.
Thomas explained cold-like symptoms mean the immune system is doing its job, but he wouldn't budge. She said she’d be back in the neighborhood to give others their second vaccine.
“I might have a change of heart then,” Eric Rieux said.
Taped to Brenda DeBouse's front door was a piece of white paper with “handicapped” written in Sharpie. It took several minutes, but she opened the door to find Thomas offering a vaccine.
“This thing, it’s not even a wheelchair," said DeBouse, 61, propped on her broken seated walker. "The wheels don’t turn, because it slides. I have to be careful I don’t fall. I fall a lot.”
She explained that her son, an Uber driver whose daughter just had surgery, struggled to get the time off to take her to the doctor for her two shots. She is hoping to get a scooter so it's easier to get on the bus to get to her appointments on her own.
She wished Thomas could have come by her house sooner.
"That would’ve been easier," DeBouse said.
Blocks away at a tiny shopping center where a beauty shop adjoins Louisa’s Meat Market and liquor store, Thomas encountered more hesitancy. Overhearing her offer a beauty shop worker the vaccine, a customer shook her head and turned on her heel.
"Don't even ask me," the woman said. "I don't trust medicine."
Muhammad Abdallah, 32, one of several Jordanian and Palestinian immigrants who work at the stores, said his whole family contracted COVID-19. Only his mom has gotten vaccinated, and he's reluctant.
“It’s not on my mind,” he said in Arabic.
'Getting people to trust'
Just south of Desire, along the west bank of the Mississippi River, is the mixed-income neighborhood of Algiers. Last February, at the onset of the pandemic, DePaul Community Health's lead infectious disease specialist, Dr. Stacy Greene, opened a new church there called ImpACT Ministries of New Orleans, serving a predominantly Hispanic and Black community.
Greene leads regular vaccine education webinars at both the clinic and through his church. His dual roles allow him to have influence and "explain things from a medical standpoint, but also have that trust because I'm a minister, a pastor."
"Our greatest barrier that we're dealing with now in our city as well as our state is getting people to trust, stopping and blocking that vaccine hesitancy," he said.
Solving for a multitude of hardships and barriers, from access to apprehension, is complicated, and has been made more so as communities of color reckon with disproportionate impacts from the virus and compounded grief stemming from racial injustice.
"Complex problems require complex solutions," Greene said. "Nothing is monolithic or one-way. We reach different communities different ways."
The day after the door-to-door vaccine effort, the rain cleared, and Greene was joined by about 20 mask-wearing worshipers at ImpACT for Sunday service.
DePaul Community Health's communications director, Kertrina Watson Lewis, and her 5-year-old daughter Parker, were there for their first in-person service since the start of the pandemic.
"I'm a little nervous," Parker said.
Greene's sermon stung with emotion as he recalled the year's "chaotic, wild" turns: the pandemic, social injustices, mass shootings, the recent shock of a missing Black student at Louisiana State University found dead in the river.
"It seems like we went out of the pot and into the fire, almost," Greene preached. "Every time I turn on the news, there's something that grieves my heart."
At the end of the service, he led a prayer for strength and hope. Lewis wiped tears from her eyes.
"We've had a lot of things thrown at us," she said, but her community is "resilient."
Greene wants his church to be a pillar of that resilience.
"My job as a pastor and as a minister and as a doctor is to get people vaccinated, to protect them from COVID, but what do you do when you're dealing with these problems of sickness, death in the family? Economic situations, depression, anxiety?" he asked.
"There's so many things we have to do," Greene said. "We want to give people vaccines of hope."
Reach Nada Hassanein at email@example.com or on Twitter @nhassanein_.
This article originally appeared on USA TODAY: COVID-19 vaccination efforts take door-to-door approach in New Orleans