Introduction
The COVID-19 pandemic is currently the largest healthcare issue that the world has faced in recent history. Although the entire world feels its impact, some countries are more affected than others. With the largest number of confirmed cases in the world, the United States poses a special interest in terms of how the country’s healthcare system has handled the pandemic and what could have been done differently to achieve a better outcome. While the novel nature of the COVID-19 was a challenge in its own right during the beginning of the outbreak in the United States, it was also combined with and magnified by other factors complicating the design and delivery of healthcare services to the affected population. Limited resources in rural hospitals and the lack of cultural awareness regarding the ethnically complex populations affected were among these factors. A case study analysis reveals that, while there was not much breathing room to prepare better for the outbreak of COVID-19 specifically, hospital personnel could still engage in cultural immersion training well before the outbreak to be better equipped to provide culturally aware care to the population.
Background
The case study is focused on two hospitals – namely, the Valley River Hospital and Northwest Communities Hospital – serving a rural country in Oregon and their approach to handling the COVID-19 pandemic during its early stage on American soil. Both are critical access hospitals of 15 and 20 beds, respectively and belong to the Oregon Health Services, covering three counties of the state. The two hospitals have been preparing for COVID-19 since March when the World Health Organization declared it a pandemic. However, rural areas in the United States tend to have lower resources in terms of access to healthcare than urban areas (Cuadros et al., 2021). Due to their position at the end of the supply line, the hospitals in question faced challenges in procuring the necessary equipment and supplies and additional costs of transporting tests to urban testing facilities. Moreover, the hospital staffing proved not sufficiently prepared in terms of cultural awareness, especially since the majority of confirmed cases were Hispanics, including indigenous Guatemalans. Thus, at the beginning of the outbreak, both hospitals faced challenges due to insufficient material supply and a lack of cultural awareness.
Alternatives
The organization of testing in the hospitals and the drive-through testing facilities on the outskirts of the three-county area was most likely the optimal way to conduct testing. The alternatives, such as sending medical staff to test those potentially affected at home, would hardly be feasible considering the limited resources and lower population density in rural healthcare as well as a higher percentage of the elderly, who are more susceptible to COVID-19 (Henning-Smith, 2020). Given the difficulties that the Valley River Hospital and Northwest Communities Hospital encountered in procuring nasopharyngeal swabs or personal protective equipment, both hospitals could benefit from exploring alternative supply channels to meet the need. Since the case study identifies the lack of cross-cultural competencies, most notably when dealing with the Hispanic population of Guatemalan origin, as the main challenge experienced during the early stages of the COVID-19 outbreak, both hospitals could also use alternative approaches to alleviate this shortcoming. These approaches will be covered in more detail in the following section.
Proposed Solutions
Regarding the difficulties of procuring the necessary supplies and equipment to meet the population’s healthcare needs under the conditions of the COVID-19 outbreak, both hospitals could benefit from engaging alternative supply options. As mentioned above, the key reason why rural hospitals tend to have worse access to resources is the fact that they tend to be at the end of the supply chain, which is also explicitly stressed in the case study (Cuadros et al., 2021). Given that, the most logical solutions to the issue are either engaging new and previously unused sources of supply or straightening the supply lines and lessening the number of intermediaries in the procurement of the required supplies and equipment. If possible, the perfect option would be to establish a working relationship with the immediate producers of the required supplies and equipment. Since the case study does not offer additional information regarding the specifics of the supply chains of Valley River Hospital and Northwest Communities Hospital, formulating more specific recommendations does not seem feasible with the information available.
In terms of the personnel’s cultural awareness, the hospitals could and arguably should have done more to be better prepared to accommodate Hispanic and, specifically, Guatemalan patients as well as contain the spread of COVID-19. While the outbreak of COVID-19 was a sudden crisis, the population composition in the counties served by the Oregon Health Services was well-known long before the pandemic. The solution to the emerging problem of insufficient cultural awareness would be cultural immersion training, which Brock et al. (2019) recommend as an efficient approach to fostering cross-cultural competencies. Moreover, the generally lower standard of living, cramped living conditions, and cultural traditions make Hispanics more susceptible to the threat presented by COVID-19 (Gil et al., 2020). With this in mind, prompt and sustained delivery of information on countering and limiting the spread of COVID-19 is also a necessary solution to the problem of its increased incidence among Hispanics (Gil et al., 2020). This information, as well as its delivery, should be tailored according to the perceptions of the population, which, once again, stresses the necessity of improving the cross-cultural competencies of medical staff.
Recommendations
The recommended course of action for this case study is to continue providing COVID-19 testing in hospitals and drive-by sites while paying more attention to the medical personnel’s cultural awareness and information dissemination. Given the constraints of the pandemic, a full-fledged educational campaign intended to raise cultural awareness is hardly feasible. Based on existing experience, both hospitals need to identify a list of cross-cultural issues that are most likely to arise when aiding Hispanic patients, devise specific ways to address these issues, and disseminate the information among the personnel. The hospitals should also arrange staffing patterns to increase the likelihood of Spanish-speaking personnel being present in situations involving language barriers (Gil et al., 2020). In terms of information dissemination to counter the spread of disease among the population, it should mainly aim to prevent large social gatherings, which can be an exceptionally potent way to spread infection in rural areas (Mahale et al., 2020). For example, the information campaign may stress the vulnerability of older community members and p[resent it through the Latino concept of familismo, which emphasizes familial ties and the importance of family members’ safety.
Conclusion
To summarize, the Valley River Hospital and Northwest Communities Hospital, as described in the case study, organized efficient COVID-19 testing during the outbreak in rural Oregon, which seems to be the best option as compared to the alternatives. At the same time, both hospitals could have benefited from training in cross-cultural competencies with a focus of Hispanic populations before the pandemic or on-the-job training during the outbreak. An information dissemination campaign would also be crucial to prevent or limit the spread of COVID-19 in rural areas, particularly among Hispanics. Finally, the diversification and straightening of the supply chain for the necessary items and protective equipment is also advisable.
References
Brock, M. J., Fowler, L. B., Freeman, J. G., Richardson, D. C., & Barnes, L. G. (2019). Cultural immersion in the education of healthcare professionals: A systematic review. Journal of Educational Evaluation for Health Professionals, 16(4).
Cuadros, D. F., Branscum, A. J., Mukandavire, Z., Miller, F. D., MacKinnon, M. (2021). Dynamics of the COVID-19 epidemic in urban and rural areas in the United States. Annals of Epidemiology, 59, 16-20.
Henning-Smith, C. (2020). The unique impact of COVID-19 on older adults in rural areas. Journal of Aging & Social Policy, 32(4-5), 396-402.
Gil, R. M., Marcelin, J. R., Zuniga-Blanco, B., Marquez, C., Mathew T., Piggott, D. A. (2020). COVID-19 pandemic: Disparate health impact on the Hispanic/Latinx population in the United States. The Journal of Infectious Diseases 222(10), 1592–1595.
Mahale, P, Rothfuss, C., Bly, S., Kelley, M., Bennett, S., Huston, S. L., & Robinson, S. (2020). Multiple COVID-19 outbreaks linked to a wedding reception in rural Maine – August 7–September 14, 2020. Morbidity and Mortality Weekly Report, 69(45): 1686–1690.