Diana Gomez is the director of the Yuma County Public Health Services District and a member of second cohort of the “Emerging Leaders in Public Health,” a Kresge Foundation initiative that supports leaders at local and county public health departments across the country to strengthen their organizations and improve the health and well-being of the people in their communities.

During the 18-month program, teams of public health leaders work together to think beyond the traditional role of a public health agency and implement approaches designed to enhance organizational and leadership competencies in business, planning and public health systems development.

In this interview, Gomez discusses the most pressing public health issues affecting her community and how her involvement in the initiative has helped her and her colleagues to better address them by thinking outside the box.

Q: For readers who may not be familiar with Yuma County, please tell us about your community.

A: Yuma County is in the southwest corner of Arizona. We border California to the east and share our southern border with Mexico. Because Yuma County has some of the highest number of days per year of sunshine in the world, agricultural work runs here year-round. So, we have a lot of migrant farmworkers. Some are seasonal workers who have visas to work in the United States for a certain length of time. Others follow the crop cycle, first here in Yuma County and then by migrating into California, and we also have farmworkers with dual citizenship who cross the border every day to work here and choose to live in Mexico because it’s cheaper. There are language and cultural challenges that come with that. We share a population, so the border is not just a boundary, it is a shared region. The fluidity of the movement, and also the fact that people can transmit diseases – any disease – moving back and forth so much, makes it imperative that we work together to ensure the health and wellness of our communities.

Additionally, just in the past two years, Yuma County has experienced an influx of asylum seekers, first from Central America and more recently Haiti and Brazil. We also have two large military bases –the Army and the Marines – and two tribal nations-Quechan and Cocopah. So, as you can imagine, there is a lot of interagency collaboration, both within Yuma County and with our partners across the Mexican border.

Q: Given Yuma County’s very diverse population, what unique challenges has your community faced with regards to COVID-19?

A: Shared space means shared challenges, responsibilities and potential for new partnerships. Our first COVID-19 case was on the military base, followed by several travel-associated community cases. Because of ease, and proximity, when California implemented COVID restrictions, people traveled to Arizona for events. When Arizona implemented restrictions, people traveled to Mexico. The movement was fluid and constant.  We also started seeing COVID cases in our migrant community. That was challenging because our partners in Mexico didn’t have access to testing supplies or personal protective equipment in the beginning the way we did, or to the vaccine once it became available. We had the challenge of trying to work collaboratively with them when they didn’t have these critical supplies. We reached out to nonprofits and foundations to get Mexican health care workers personal protective equipment so they could at least have some protection. We had a lot of people with dual citizenship who lived in Mexico but were crossing the border to come here because they were getting sick and couldn’t get the medical help they needed in Mexico. As a rural community with only one hospital, the combination of winter visitors, migrant workers and people with dual citizenship crossing the border for medical care really stressed our health care system.

Once the vaccine became available, we had to confront the fact that there is a lot of fear in our community, fear of the government, fear of the vaccine because it is being provided by the government, and fear that if someone received the vaccine while applying for U.S. citizenship, they would be seen as benefitting illegally from the government and would then be denied citizenship. So, we had to address those concerns before people would get vaccinated. We worked with trusted messengers in every community to ensure questions and concerns were addressed and to provide pop up clinics throughout the county.

Q: One year into the pandemic, Arizona was recognized by the Centers for Disease Control and Prevention as one of the top ranking states in COVID vaccination rates for communities with high social vulnerability and cited Yuma County as one of the three AZ counties that “significantly contributed to this result.” How have you and your colleagues been so successful in addressing the COVID crisis?

A: Communication was key in building trust, and collaboration was critical in making things happen. Our state health department and local health officers association worked together to build a robust response throughout the state in both urban and rural communities. We talked through challenges, linked each other to resources, worked on joint communication campaigns.

The challenge was addressing vaccine hesitancy and misinformation. Once the vaccine became available, we went to different churches and community groups and said, ‘We understand that people are scared and that as the health department, we are a government entity, so there may be concerns, would you be willing to promote a vaccine clinic and register the participants? All we will do is show up to actually administer the vaccine.’ And they were eager to help. We set up ‘pop-up’ clinics at worksites, schools, churches, apartment complex parking lots and community centers. We partnered with nonprofits that work with people with special needs, we partnered with senior centers, we partnered with businesses, with anyone who wanted to. Because they are all trusted messengers in their community, and we needed that trust.

Another challenge we faced was around our supply of vaccines. Usually, in the winters, our population doubles because of migrant farmworkers and H2A visa holders, as well as winter visitors from Canada and our northern states who come here to escape the cold. But that population change isn’t captured in the regular census, and so our allocation for the vaccine, which is based on the regular census, was really limited. So, we had to get that resolved.

We worked closely with our local, state and federal elected officials to make them aware of our challenges as well as our successes. They were very engaged throughout the pandemic.  We also invited two teams from the Centers for Disease Control and Prevention to visit Yuma County. The CDC team helped us identify ways to increase connectivity, trust, and communication as we moved forward.

We met with leaders from the agricultural community, representatives from the Mexican Consulate, tribal leaders and representatives on our binational health coalition, which included Mexican health officials to determine needs and identify potential for collaboration.

The CDC team and our staff worked with local community health workers (Promotoras) to interview migrant farmworkers and helped us to identify migrant movement patterns. Working with them, we were able to figure out, ‘Okay, these workers are leaving Yuma County and heading to Salinas, California.’ This was important because we were in this situation where the farmworkers were getting their first dose here, but then they left for Salinas before it was time for their second dose. So we worked together to find Federally Qualified Health Centers, which are in most areas, and connected with employers in California and said, ‘Here are the names of the workers who are due for their second shot,’ and made sure it was all set up.  The process helped strengthen existing relationship, and forged new ones. At the end of the day, we had more partners at the table. This year, all those stakeholders reached out early to request flu shots and COVID booster shots.

Q: How has your work evolved as your community’s needs have changed?

A: We have been working in recent years to be seen by our community less as an adversary and more as a partner. For us, that has meant a lot of outreach. We joined the chamber of commerce. We began offering worksite wellness programs, including flu shot, diabetes and hypertension clinics. We did outreach to schools. And through these conversations, we also worked to position ourselves as an agency that isn’t just about enforcement but can also help get things done. For example, we traditionally do a lot of permitting for mobile food vendors and food licenses for festivals. So, we contacted various cities offering free seminars for vendors in partnership with their permitting offices so that participants learned food safety guidelines and how to meet code requirements. This also gave us an opportunity to explain the “why” behind some of the regulations. We also reached out to our local universities and community colleges and invited their nurses to do rotations with us in our diabetes classes. Through these sorts of actions, we have started changing the narrative from one of a regulatory agency that swoops in to tell people what they are doing wrong to more of a partner who wants to help people to succeed.

And, while all these actions were very valuable on their own, they also really helped us when COVID hit because now that the community knew us better, they reached out to us for help. Instead of seeing us as an adversary, they called us and asked us what they needed to do to be able to stay open during the pandemic. They wanted to work with us.

Our partnership with the nursing programs was huge. We were very short staffed when we opened our vaccination clinics, so nursing students and recent grads staffed them. Public health students assisted us with contract tracing, law enforcement and paramedic students helped with translation, traffic control, and registration at our testing and vaccine clinics. Previously, we would have never thought to use nursing students, and that speaks to a larger shift in how we think about our community. The partnership was a win-win and we have now embraced an academic health department partnership to continue to build on that foundation.

A lot of times in public health, even though we mean well, we don’t know what the frontline workers at the homeless shelter or hiring center or senior center know about the community members they work with on a daily basis. They have a unique insight. So, as a public health authority, my job is to give voice to them. Previously, we would say, ‘From a public health perspective, this what we think you, the community, needs to do.’ Now, we are much more inclusive and think much more outside the box. We ask people what they need and what is important to them.