Days before Kim Rhoads launched a Covid-19 study in Oakland, the epidemiologist had her doubts. The UCSF doctor intended to test as many Black residents as possible in a one-day campaign at the Eastmont Mall. But she hesitated on her strategy to hold a single, mass, pop-up testing event that was far more likely to attract a broad range of Oakland residents, rather than just Black residents — one of the groups least studied in Covid-19.
As Rhoads slept the night before Eastmont’s launch, a thunderstorm broke, waking her and literally raining on her plans. She decided to cancel the event and regroup, and her next steps arrived along with a lightning strike. Instead of testing at one site, she decided to focus on a series of smaller, more targeted pop-ups. Up until her study, no one had deliberately engaged the Black community on the issue of Covid-19. Doing so would give her information on how best to reach a community skeptical of medical institutions.
While African American case rates weren’t as high in the region as they are elsewhere, its death rates were highest in Alameda County, and disproportionately high in San Francisco and the United States. Rhoads felt this campaign could double as a testing strategy and an opportunity to engage and educate about the virus and a vaccine. She knew that a long history of discrimination would make Black residents the most reluctant community to embrace a vaccine, despite its potential to save lives.
“The reality is, our history in this country is different than everybody else’s,” Rhoads said. “When the lightning struck, [I said,] ‘We’re doing this [study] for Black people.’”
To maximize the Black tester turnout and coronavirus education, Rhoads reached out to Black clinics, churches, the Alameda County Public Health Department, organizations like Brotherhood of Elders Network, Friends of Frank, and other locals. Over the next couple of weeks this became known as Umoja Health, or “United Health,” a moniker that soon became the testing campaign’s driving force and namesake.
The first puzzle Rhoads and Umoja needed to solve was how to reach a Black community dispersed through census tracts in East and West Oakland. The reality of the population being scattered dictated the need for multiple pop-ups in both parts of the city.
“We couldn’t do one big one and expect West Oakland to come to East Oakland or expect East Oakland to go to West Oakland,” Rhoads said.
And, within each neighborhood, Rhoads and Umoja had to figure out where Black residents congregated. The Akoma Outdoor Market, a Black and Brown Farmer’s Market run in East Oakland by the East Oakland Black Cultural Zone, became the first pop-up site.
The farmers’ market drew local traffic from throughout East Oakland, which is known as a “food swamp” of junk-food outlets. Case in point: the McDonalds that sits near Akoma. “If you’re offering a food resource like this, everybody around is going to come out,” said Ghila Andemeskel, a UCSF health educator who volunteered for the campaign.
Umoja’s two pop-ups at Akoma drew 75 and 74 people, and Black residents represented 63 and 59 percent of those, which Rhoads deemed a success, despite falling short of her initial pie-in-the-sky 80-percent goal.
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The testers next enlisted the help of faith leaders, known and trusted in the community, who preached to their congregations about coming out and getting tested. Rhoads also joined Bible-study groups to talk about the campaigns, and held separate meetings with faith leaders for campaign input. It worked.
The pop-ups at Acts Full Gospel Church and Center of Hope Community Church attracted the largest total number of testers: 254 and 198 people. Respectively, 65 and 62 percent of those tested were Black residents.
The West Oakland pop-ups ran into the impact of gentrification. At one in de Fremery Park (known to Black elders as Lil Bobby Hutton Park), no Black residents appeared for hours, said Jared Spencer, a staff aide to the Alameda County supervisor of that district, Keith Carson. Instead, through the morning, Asian and white residents filled the park.
The experience underscored the effects of gentrification on historically Black West Oakland, Spencer said.
“It’s not that white people are there, it’s that there’s no Black people there,” Spencer said.
Rhoads found that the percentage of Black testers in West Oakland ranged between 32 and 48 percent. And the majority of Black testers who did come out to the West Oakland pop-ups were largely homeless, she said. That compared to a 7 percent homeless population — mostly Black residents — for all of Umoja’s sites.
Even though the West Oakland sites were less successful than those in East Oakland, 54 percent of all testers were first-timers, demonstrating reach into a new population. And, the representation of Black testers at the pop-ups was still about 10 percent higher than the local Black health clinics, Rhoads said. At the latter, Black residents accounted for less than a quarter of total covid tests, despite comprising 80 to 90 percent of patients.
Rhoads wondered why they weren’t coming out, and tested a few of her hunches.
She decided, for example, that distrust of doctors could deter people from testing, so Rhoads deliberately distanced the Umoja pop-up aesthetics from healthcare institutions.
The pop-ups resembled more of a neighborhood block party, equipped with DJs from Hip Hop for Change who blasted gospel, Motown and rap hits that caused people to dance on the street; nearly all volunteers were from Oakland and Black. And she was one of the only doctors on site.
“When you arrive here, they’re just community people, not a whole bunch of doctors.” Rhoads said. That helped increase the turnout.
But even more integral than the pop-up atmosphere, Rhoads learned, was the outreach. Each week Umoja volunteers hit the blocks near the location to leave flyers and knock on doors, talking to residents to dispel apprehensions.
Kevin Epps, a documentarian and community organizer, said being Black, from the Bay, and talking “hood,” facilitated tough conversations about comorbidities that put Black people more at risk for covid death. Such conversations also helped convince people to show up for testing.
“If I say my grandmother has diabetes, and my cousin got hypertension, it feels like there’s no disconnect,” Epps said. “It’s not a ‘me against you,’ it’s a ‘we.’”
During these conversations, Rhoads had canvassers ask residents about the vaccine to gauge their willingness to be vaccinated. She worried about the disproportionate death rates of Black residents nationwide, and knew overcoming skepticism would save lives.
Umoja’s early survey showed only 40 percent of the Black residents they asked were willing to take a vaccine. This makes Black residents the least likely of all ethnicities to want to get the vaccine, and echoed the findings of a statewide survey where Black interest was even lower.
Rhoads understands why. Already, the deep-rooted distrust Black Americans have toward medical and government institutions had come up in her weekly meetings with volunteers and other members of her team.
Umoja volunteers said that Black residents complained that Kaiser Permanente, headquartered in Oakland, denied them covid tests at first because of strict eligibility standards. Although this happened to all of Kaiser’s members when the Covid-19 crisis hit, some populations were more likely to see this as part of a pattern. Umoja’s survey showed 50 percent of its Kaiser patients were Black. Recently, Kaiser has relaxed its testing requirements.
But there were other reasons for skepticism. Back in March, Verily, a research group owned by Google’s parent company, promised to boost testing for low-income Black and Brown residents, but failed so clearly that Alameda County and San Francisco County terminated their Verily contracts.
Epps said that in his conversations with residents, several mentioned the Tuskegee experiment, in which the federal government refused to treat Black men who had syphilis for 40 years, in the name of research.
Rhoads believes that campaigns like the Umoja testing campaign can restore some of that trust. When the vaccine gets distributed, she said, Umoja will be best poised to distribute it to Oakland’s Black community, and potentially save lives.
“I would be willing to bet that Umoja health could get more vaccines out to people who are vaccine hesitant than the clinics,” Rhoads said.
By campaign end, Umoja gave out 1,115 tests, 55 percent of those tested were Black, and 52 percent of Black people said Umoja could contact them for future research, making it the most willing race out of all Umoja’s testers.
Other institutions are taking notes from this approach, which is “community taking care of community.”
“That’s what Umoja’s about,” Rhoads said. “When you come on site, you can feel that.”