COVID-19, Social EM

EM Docs in the Streets: A Call for Community Engagement During the COVID-19 Pandemic

The COVID-19 pandemic has prompted EM residents from Chicago's Swedish Hospital to reach out to their community, visiting local businesses to help educate and protect citizens.

Swedish Hospital, a community-based hospital in the heart of Chicago's Northwest Side, has taken to the literal “front line" of the COVID-19/Sars-Cov-2 pandemic. We have often tested the limits of our hospital capacity with more than 1,100 COVID-19 admissions since the initial outbreak, a number that continues to climb in each new wave. With the overwhelming number of COVID-19 cases seen in our community and in the greater Chicagoland area, we were shocked to find many patients naive of the present danger this disease brought to the neighborhood. Many were completely, blissfully unaware the virus even existed. Several of our emergency medicine residents became concerned and saw a need for community education and interaction.

Based in an area with 83 languages spoken in just over a square mile radius, we were presented with a unique problem for community engagement. Overcoming language and cultural barriers to provide effective community education, awareness of COVID-19 significance, and physical interaction on the streets of Chicago have been a few of the obstacles that needed to be overcome. 

Our resolution came in the form of a "boots on the ground" project: an avenue for education and community discussion involving visiting and reaching out to the many small businesses surrounding the Swedish Hospital service region. "Mom-and-Pop shops" ranging from restaurants to hardware stores that serve our diverse community heavily populate the mile radius around our hospital. These small businesses have been strained to survive the economic repercussions of the pandemic, and while recognizing this we also viewed them as a novel opportunity for community education, and an entry point to effectively help slow the spread of coronavirus in our neighborhoods.

With this in mind, we took to the streets with the goal to meet and educate numerous business leaders. Our conversations began with, "Hi, we're a couple of emergency doctors at Swedish Hospital down the road, how are you hanging in?" or some permutation. There was no set script, survey, or focused data collection objective. Primarily, we wanted to be seen and make the members of our community aware of the high COVID prevalence we face and that this affects the patrons of their businesses as well as their family members. We were prepared with a handout containing information regarding local testing centers, and our contact information in multiple languages if it was requested. We wanted them to know their physicians are here for them, paying attention to the community, and desire to help in all the ways we are able.

Most businesses were thrilled we visited because we met them on their home turf and expressed their importance to us as members of the community, especially as they struggle through this pandemic. In turn, we were met with a barrage of concerns. We often discussed masks, distancing policies, and had information regarding local testing centers if they requested it. We certainly ran into questions we couldn't answer about vaccines and other issues, but it was evident our presence alone brought a sense of assurance and comfort in a time of stress and confusion.

A rare encounter with a business owner proved difficult as we were met with apprehension. They seemed hesitant and concerned that EM doctors were in their store. Some initially believed we were there to chastise them or maybe they were just fearful that a doctor with almost guaranteed exposure to the dreaded coronavirus had walked through their door. Despite reassurance, some people simply didn't open up to us, and wanted us to leave. This was rather understandable, and of course we complied with their wishes. It is our hope, however, that this has planted a seed in their minds that we are here to speak with them when or if they are ready.

There were several interactions that stood above the rest. One of our first visits was with the owner of a small grocery store who had been in business for almost 30 years. He told us that his business, financially, was essentially stable. Product was flying off the shelves at the beginning of the pandemic. His greatest fear was losing his employees not to sickness, but secondarily to mental and emotional strain. He conveyed that the fear quickly spread amongst his employees, leading to several dealing with anxiety, depression, and exhaustion from protocol adherence. 

Another case was a bakery run by a young mother. Her two daughters were in the shop holding her hands. She said her normal lunchtime customers that sustain her business had completely dried up. She said she was not sure she could survive for more than 2-3 more months. She appeared exhausted. She had no questions for us, but she immediately opened up about her struggle, and seemed happier when we left than when we arrived.

Across the street a smoke shop employee was adamant that COVID is a hoax based on documentaries he had watched. He believed masks were useless, and that the government had fabricated the entire pandemic to rob small businesses and "take over." He couldn't be specific regarding his beliefs and was unable to name the documentaries from which he was basing his opinions but was certain that this whole thing is a fabrication.

Down the road, we ran into a liquor store clerk who only wanted to talk about his blood pressure. We tried to steer the conversation, but he was relentless. He seemed happier to spout through his mask about how his doctor finally got his pressure under control.  

On another visit, we talked with the employees of a second-hand store. They were most concerned about technical details of mask wearing. What works and what doesn't? Can it be under the nose? The manager gathered her employees (distantly), to make sure we could answer their questions, too. It was evident she cared for her staff and employees.

We visited 43 businesses all within a 1-mile radius of the hospital, and the response was overwhelmingly positive. It took more time than anticipated…walking between locations, waiting for managers and employees to finish with their customers before interrupting regular business for a few minutes. But it was worth the effort. Selfishly, the project felt GOOD. It was cathartic to connect. We realized how easily we'd been trapped in the doldrums of shuffling to the hospital and back. Getting out, building relationships, even masked and at a distance, was a relieving change of pace.

Our greatest takeaway was that our patients are hungry for accurate and proven guidance, and many of them have similar concerns as our health care teams. We feel the weight of responsibility in treatment and surviving viral surges, to keep from drowning in the process and flood of new information. We want to protect ourselves and our teams the best way we can. We continue to fight misinformation, and through it all the bread-and-butter asymptomatic hypertension is still in the waiting room.

The community is tired, too. They are worried about their mental health, and how much longer they can hold on. They struggle with social media misinformation and finding reliable information. They keep their families in mind, and still must remember to take their metoprolol amid this chaos. We share these struggles with our community, and as physicians we should seize this opportunity to connect with and guide them.

We understand that right now the last thing physicians want to think about is medicine when we're away from the hospital. We are not the government health department, but we are our community's physicians and front-line caregivers, and we often have the best pulse on the surrounding population. It is important to keep our finger on that pulse even in a setting outside the hospital, for it is through our close interactions within our community that we can intervene and make the biggest impact.

We feel that a "boots on the ground" approach to community education is simple, effective, and a convenient way to share accurate information with our community – which may, in turn, help them understand the information needed to help fight this pandemic along with us. Doctors, patients, and our communities can benefit greatly from such a project. Recognize that your favorite coffee shop may have questions and no one to provide them with answers. It's okay to say, "I'm a doctor, do you have any questions?" You may be surprised by the response.

Related Articles

Caring for Homeless Populations in the ED: A Quick Guide

People experiencing homelessness commonly present to the emergency department for health care needs, and the ED plays a crucial role, as it serves as the first — and often the only — resource for acce

Health Policy Journal Club: A Study of Firearms Safety Education in the Pediatric Emergency Department

The pediatric emergency department is a unique setting in which educational interventions can reach a wide variety of people. The Health Policy Journal Club examines a study conducted to gauge the eff