It’s a Tuesday afternoon in downtown Fresno, and a line of cars has wrapped around the block from the Fresno Economic Opportunities Commission to Chukchansi Stadium. A petite karaoke singer belts out George Harrison on the sidewalk, while the drivers, masked and corralled into reserved parking spots, wait for Testing Tuesday to begin.
The drive-through COVID-19 testing event is free, offered weekly as a part of Fresno’s African American Coalition. It aims to bring in members of a demographic that, according to the Centers for Disease Control and Prevention, is nearly twice as likely to contract the virus as whites and almost three times as likely to die from it.
Simultaneously, many Blacks delay care out of mistrust for the medical system, says coalition lead Shantay Davies-Balch. “There’s been generations and generations of mistreatment of Black and brown bodies, and it’s going to take time before that trust has been fully restored,” says Davies-Balch, a long-time public health advocate in the San Joaquin Valley and founder of the BLACK Wellness and Prosperity Center.
Black Americans have undergone centuries of abuse at the hands of science and medicine, stretching as far back as experimental surgeries on slaves. Unethical treatment of Blacks, however, isn’t just a relic of the distant past: One of the most infamous offenses, known as the Tuskegee Syphilis Experiment, began in the 1930s, in which the U.S. government recruited hundreds of Black men with syphilis into a study without their full consent and never informed them when the life-saving drug penicillin became widely available. The researchers continued observing the men as the disease ravaged their bodies. The study ended just 50 years ago, and only after investigative journalists brought the study to light.
Building trust and improving COVID-19 outcomes are two reasons Davies-Balch formed the African American Coalition. It’s an arm of the Fresno COVID-19 Equity Project, a massive collaboration of dozens of community benefit organizations (CBOs) that are working alongside the city, county and doctors from UCSF Fresno to bring COVID-19 testing and resources to Fresno’s most vulnerable groups.
“The first approach that we took really was to engage directly with the Black community, and partner with folks from the communities that we’re trying to serve,” Davies-Balch says. A large share of the recruiting was done through community groups, leadership academies, and churches in Southwest Fresno, where many African-Americans were forced to settle as a result of historical redlining policies.
One recruit is Brittnie Wilson, a master’s student in public health who joined the coalition as a contact tracer and resource specialist. “The mistrust that's so rooted in our community as far as healthcare, I want to be on the opposite end of that, and I want my kids on the opposite end of that,” says Wilson, wearing a bedazzled mask, face shield and disposable surgical gown.
Testing Tuesdays are an assembly line of registration and nose swabs, with teams of workers walking back and forth to cars to administer both standard PCR and rapid COVID-19 tests. A rectangle of widely spaced chairs and a privacy tent also allow testing for walk-ups.
But Wilson and her colleagues don’t just offer tests. They also make sure people who test positive leave with an isolation kit containing thermometers, face shields, gloves and a log for recording symptoms. During consultations before and after the tests, coalition employees screen for health needs, food insecurity and a suite of other resource needs in order to share important public health information and make self-isolation a little less daunting.
“Food boxes, mental health services, other testing sites, we have these services so you can stay home,” says Wilson. “We then have a group of partners that we work with, different CBOs, and we can reach out to those different CBOs and say ‘hey, we have this person and they need XYZ, we know you guys are big on dental, can we shoot them to dental?’...‘Can we get them connected to Medi-Cal?’ Those types of things.”
Wilson and her colleagues also received more than 40 hours of training in cultural sensitivity practices, learning common issues that could come up during conversations with members of the Black community, as well as language that may or may not lead to respect and trust. “Saying ‘ma'am’ and ‘sir’ is something that's custom to us, whether you know them or not,” she says. “So we had to make sure [employees] understood, ‘hey, make sure you say a ma'am to Mrs. Green, cause Mrs. Green's going to get you if you don't come correct to her,’ you know?”
The coalition has the capacity to test only 50 people each Tuesday, a ceiling they reach long before the end of the 2-hour event. But Aaron Foster, a community advocate working with the coalition who’s also here to get tested, points out that most of the walk-up clients waiting for results are not Black. “If you really look at them, how many of them look like me?” he asks.
Foster is an advocate with many local groups, including Advance Peace. It’s a program that aims to curb gun violence, partly by walking door to door to interact directly with residents of risky neighborhoods. Foster proposed taking the same approach with the coalition, and Shantay Davies-Balch agreed. Soon, he’ll be knocking on those same doors in predominantly Black neighborhoods, this time offering COVID-19 tests. “We have laser focus, it's very intentional,” he says. “We hit these doors, we make appointments and we show up.”
The fact that Foster, Davies-Balch and other coalition members are already known entities in Fresno’s Black community is part of what makes the program stand out compared to the outreach efforts by health officials with the county and state.
“You’ve got folks who look like you, who’ve been trusted in your community, been a part of your community all along, not just now but have always been there for you,” says Margaret Jackson, executive director of Fresno-based Cultural Brokers, Inc., which also provides the cultural sensitivity training to coalition members and students at universities across the state. “We’re not just barking out orders, we’re in this with you. We’re a part of this community, so it’s in all of our interests to figure out how we survive this thing together.”
Unlike much of public health messaging, which largely delivers uniform messages to everyone, Jackson says it’s important to acknowledge the needs of specific communities—for instance, by providing services to help those who feel they’re not equipped to self-isolate, or by conducting at-home testing for those with any number of reasons to not drive out to testing sites. “You’ve got to meet people right where they are and touch their hearts,” Jackson says.
The coalition’s reliance on networks of grassroots organizations and leaders embedded in the community has been a model for other programs in the state, says Dr. Jonathan Fuchs, a professor with the UC San Francisco School of Medicine and the Testing Strategy Lead with the San Francisco Department of Public Health. “Many cities and counties across the state, including San Francisco, are looking to Fresno’s innovative model for galvanizing a community driven response across the continuum of COVID-19 care,” he wrote in an email, “from outreach, to testing, to case investigation and contact tracing, to supporting a holistic community wellness response.”
Brittnie Wilson can explain her feelings about her job in one word: “Proud,” she says. “I'm proud when I go home. Cause we did it: Another day down, somebody we touched, somebody we reached. It may not have been everybody, but it was somebody.”