DULUTH – The snow was just starting to melt outside while folks trickled into Gloria Dei Lutheran Church for a nontraditional service — a COVID-19 vaccine clinic.

The site had been chosen by a group of Central Hillsiders who had been hired by a local nonprofit to help their neighborhood navigate the pandemic. The team knew their neighbors would appreciate the vaccine clinic location and the personal outreach that brought more than 60 elderly residents in for their first vaccine dose.

"I'm a part of the Hillside, so I get to see firsthand what my neighbors need," said Tiffany Fenner, a Healthy Hillside steering team member.

Fenner and others on the six-person team answered an ad in November for the part-time jobs "dedicated to helping Hillside residents and stakeholders get through the COVID-19 pandemic as successfully as possible."

They have spent months going door to door, handing out masks and information and simply having conversations about what needs are going unmet.

"The folks who live in the Hillside are historically underserved," said Andrea Crouse, community development manager with Zeitgeist, the Duluth nonprofit focused on arts and community development that put together the Healthy Hillside initiative. "We're going to be on that road to recovery for a long time. There's just so much job loss and housing insecurity, so we're helping people through that and connecting them to resources."

The effort comes as a recent local survey showed deep distrust with medical institutions among the city's Black population — many of whom live in Central Hillside in the shadow of the Essentia Health and St. Luke's campuses.

One of that report's recommendations was to have local residents lead the charge in improving their neighborhood's health outcomes.

"Many of them were already doing this work, to some extent, before they got hired," Crouse said. "We're happy to be able to pay them."

'Trusted individuals'

Stretching from Mesaba Avenue to E. Sixth Avenue above downtown Duluth, the Central Hillside is the city's most racially diverse neighborhood, housing just 6% of the city's total population but a quarter of its nonwhite residents. The poverty rate, 35%, is also nearly twice that of the city as a whole, contributing to unequal health outcomes the COVID-19 pandemic has exacerbated.

The Healthy Hillside team came together in December with federal CARES Act money and other federal funds, including a Centers for Disease Control and Prevention "vaccine hesitancy" grant, with the goal of finding people who "are trusted individuals who are already active in the community," Crouse said. Team members are paid $18 an hour for up to seven hours a week through the end of July.

Fenner, who is part of the First Ladies of the Hillside advocacy group, said neighbors have responded well to the campaign, which has included outreach through events at the Damiano Center, a safe and recognizable place in the neighborhood.

"It's about making connections," she said. "It's helping not only my own children but others' as well."

The pandemic has had an outsize impact on low-income communities and communities of color. Nationally, researchers found "high levels of income inequality harm population health (indicated by high levels of COVID-19 incidence and mortality), irrespective of racial/ethnic composition," according to a study in the medical journal JAMA Network Open earlier this year.

In St. Louis County, 92% of the population is white but 80% of COVID-19 cases have been among white residents. Duluth's first deaths due to COVID-19 were at an assisted living facility in the Central Hillside neighborhood a year ago.

Christina Trok, a Healthy Hillside team member, Healthy Alliances Matter coordinator and NAACP Duluth Branch member, told a virtual audience in February that "we need to figure out ways to serve the community."

"I really hope that in these discussions when we're talking about equity, that we can create systems to reduce these types of barriers that come up," she said during a presentation on a COVID-19 needs assessment report for Duluth's African Heritage community.

That report showed that historical distrust of medical institutions and providers runs deep among Black residents.

"Once you go to the doctor so many times and you feel like you're being mistreated, and not being heard, you just stop going," one resident told the Health Equity Northland group that put together the report.


For the outreach team, tackling COVID-19 means building trust in a way hospitals haven't been able to.

"They have relationships and connections with the community that we don't have, and we recognize that," said Jill Doberstein, manager of community outreach for Essentia Health, who was at the Gloria Dei vaccine clinic on March 12. "So now we're going to have these opportunities to go to those coalitions and say: We know we're missing people. How can you help us reach them?"

For Linda Barber, it was as simple as seeing a flier in her apartment building and reaching a person when she called to sign up for her first vaccine shot. An appointment made at a hospital fell through after the provider lost the record of the appointment, she said.

"It's better if I get it — I'm a senior citizen and have some health issues," said Barber, 65, who posed for a photo following her shot with a sign that read: "I got vaccinated because I want to boost my immune system so I don't get the virus."

By the end of the day, no one had missed their appointment, save for two who were sick, even as a majority arrived by bus or on foot in the wake of a March snowstorm that closed schools. Another vaccine clinic is coming up next week that will be available to more residents now that state guidelines have expanded to include all Minnesotans over 16.

Eventually the Healthy Hillside focus will shift toward addressing the "secondary impacts" of the pandemic that could continue contributing to health disparities in the neighborhood, Crouse said, something Zeitgeist has been working on for several years.

"Loss of employment, workplace safety issues, housing insecurity and social isolation that lot of elders are facing," Crouse said. "I'm grateful for the folks on our team who have a big heart for these topics."

Brooks Johnson • 218-491-6496