Early in 2020, Duke Family Medicine residents Dr. Roosevelt Campbell and Dr. Andrew Flynn began noticing a disturbing trend in their clinics. The COVID-19 pandemic, wreaking havoc in every part of American life, seemed to be disproportionately hitting communities of color. In May, Black Durham residents were 40% less likely to be tested for COVID-19, yet more than twice as likely to test positive when compared to white residents.
“COVID testing sites were primarily in white neighborhoods and information about testing, medical care, and prevention was not equitably distributed through the city,” said Flynn. “Most significantly, in the early stages of the pandemic and into the summer, Black people in North Carolina were dying of COVID at almost twice the rate of other people.”
During his clinical rotation at Lincoln Community Health Center, Campbell and Dr. Holly Biola, Chief of Family Medicine at Lincoln, discussed the success of a group of local providers, researchers, educators, and community advocates who were meeting via Zoom to tackle similar disparities in the Latinx community. In fact, Campbell and Flynn had been attending the weekly calls with the Latinx Advocacy Team & Interdisciplinary Network for COVID-19, or LATIN-19 since its inception in March 2020.
“This group was tapping into grassroots community stakeholders to discuss barriers and challenges,” said Biola, “and they were finding success with innovative ways to mitigate the overall impact of COVID-19.” Through her connections, Dr. Biola would soon help Campbell and Flynn link to several members of the African American faith community.
According to Campbell, the LATIN-19 group was very effective at leveraging connections and knowledge about needs in the community and disseminating vital information about the virus and testing. “They were debunking myths about COVID-19 and how it was spread,” said Campbell.
Dr. Viviana Martinez-Bianchi, former program director of Duke Family Medicine Residency and one of the founders of LATIN-19, advised that a similar group should form to address the needs of the African American community. She introduced Campbell during a Partnership for Healthy Durham Access to Care Committee meeting in June where he presented the idea. Members of the community expressed interest and with their approval, Campbell and Flynn set out to schedule the first meeting.
“We needed to pull together well-connected stakeholders within the African American community in Durham to discuss the immediate needs related to the pandemic and help to disseminate accurate information to the community members,” said Campbell.
The first formal meeting of the AA/Black COVID Community Response group was held on June 17. Now named the African American COVID Taskforce Plus (AACT+), this diverse team has been meeting weekly with attendance between 40 and 60 people. Guest speakers from community organizations and Duke share stories about their firsthand experiences with the pandemic and draw on their collective knowledge, energy, and influence to create necessary change. These presentations from the community and frontline workers help to inform and guide planning efforts and action items for AACT+.
“Dr. Campbell and Dr. Flynn started up a group that included members of Duke Health, Lincoln Community Health Center, the Durham County Department of Public Health, Community Health Coalition (CHC), Durham Together for Resilient Youth, Durham Academy for Physicians, Pharmacists and Dentists (DAMDP), Old North State Medical Society (ONSS), and the Inter-Denominational Ministerial Alliance,” said Biola. “From there it has grown to include representatives from Partnership Effort for the Advancement of Children’s Health, Durham Public Schools, Senior PharmAssist, and GeriatRx, among others, and the number of participants just continues to grow.”
While Campbell, Flynn, Martinez-Bianchi, and Biola inspired the creation of AACT+, they are quick to point out that many others inside Duke and beyond have been vital leaders and contributors. “AACT+ exists because of the efforts and commitment of our colleagues and the community,” said Campbell. “We would not be successful without the people who come each week to engage meaningfully on the needs of our communities.”
“[AACT+] was key to dissemination and support for the testing held at African American churches and pharmacies in Durham through collaboration of DAMDP, CHC, and ONSS,” said Dr. Maria Small, Duke Associate Professor Obstetrics & Gynecology and Medicine. “These events were key to early COVID testing as they focused on Black and Latinx communities and were unique because they were free walk-up/drive-up events that didn’t require registration. AACT members mobilized to volunteer at these events during the early stages of the pandemic and directly serve Black and Latinx communities.”
Sabrena Mervin-Blake, Staff Director of the Community Engagement core for the Duke Clinical and Translational Science Institute (CTSI) and a founding member of AACT+, has dedicated resources to help sustain AACT+. Through Mervin-Blake’s commitment of support, Leatrice Martin has become a highly valued resource for the group. Martin, who works for CTSI, provides logistical support for the weekly virtual meetings, manages the ever-growing mailing list of attendees, and invites a variety of community-based and clinical experts to present findings, updates, and resources to the meeting participants.
“Without Leatrice’s time and effort, it would have been very difficult for us to grow as much as we have,” said Campbell. “She has extended our reach into the local community to invite stakeholders and to share updates about COVID testing and vaccine sites with our group.”
A newly formed AACT+ executive team helps define and oversee broad initiatives and workgroups for the coalition to address, including 1) information dissemination, 2) COVID testing, 3) community resources 4) advocacy, 5) grant and research funding opportunities, 6) physical and mental health, and now 7) information about and access to the COVID vaccine in traditionally underserved communities.
“Authentic community engagement is at the heart of this group — meeting people where they are, listening to their concerns, and taking action based on those concerns,” said Kimberly Monroe, Program Manager with the Duke Office of Community Health. “It is important to meaningfully engage the people who have long been left out of the process—listened to, but not necessarily heard. Using the Principles of Community Engagement as a guide keeps us focused on building and establishing strong connections and a commitment to making the spaces and places where we work, live, and play better for everyone.”
Over time, the composition of the group has evolved to include leaders from faith communities and community-based organizations focused on providing care and resources to underserved members of the community. AACT+ provides a safe space to discuss the needs of the community, to coordinate efforts and ideas, and to learn about services, resources, and opportunities that already exist.
“We don’t want to reinvent the wheel,” said DeLon Canterbury, Chief Executive Officer of GeriatRx and newest member of AACT+ executive committee. “We want to leverage what is being done by other organizations to make sure that these efforts to serve our communities have broader reach.”
Addressing racism in health care and the need for patient advocacy are two specific areas of focus. Duke and other healthcare providers in the community are grappling with the impact of racism within the healthcare system and are looking to AACT+ for guidance, including more effective vaccination support in underserved communities.
As part of this work, Duke Health and Duke CTSI are committed to dismantling racism in health care and addressing health inequities. In the summer of 2020, CTSI formed the Equity in Research core to elevate, advance, and accelerate equitable, inclusive, anti-racist, and anti-bias research. “We look forward to working together with our community in authentic, mutually beneficial, bidirectional ways toward the goal of health equity,” said Mervin-Blake, Staff Director for the Equity in Research core.
Among other accomplishments, AACT+ has worked to connect community stakeholders with resources and accurate information to help community members find out about COVID screenings and vaccines, health education, mental health services, clinical studies and research, and food.
“These community organizations have been incredibly receptive and responsive,” said Martin. “They’ve made my job easier with their willingness to join, to offer resources, and to suggest stakeholders we should invite to the group. All I hear is ‘Yes!’ when I make a request. It has been so encouraging to be a part of this movement on behalf of the African American community in Durham.”
Post-pandemic, AACT+ will evolve again, changing from African American COVID Taskforce to African American Community Taskforce. “The needs of our community beyond COVID still need to be addressed,” said Dr. Angeloe Burch, Executive Director for the African American Dance Ensemble and Secretary of the Inter-Denominational Ministerial Alliance of Durham and Vicinity. “The pandemic highlighted the disparities and distrust, and helped us to pull together to create a better and more effective system for supporting our communities. We need to continue to meet, discuss, address, and evolve to better support and serve our communities.”
This article is the first of a series of articles that will explore the work of the AACT+ group over the next year.