CHALLENGES AND OPPORTUNITIES FOR EMERGENCY PREPAREDNESS: Cristina Martinez, MD, MPH Miriam A. Marquez, PhD Catherine Dvorak, RN, CCRP Center for Translational Science Activities (CTSA), Mayo Clinic R ESULTS FROM KEY INFORMANT INTERVIEWS OF IMMIGRANTS AND REFUGEES IN O LMSTED C OUNTY, M INNESOTA

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Miriam A. Marquez, PhD No relationships to disclose”

Background The White House, congress, state and local governments have given emergency preparedness a high priority The tragedy of Hurricane Katrina shows what happens when minority communities and their unique needs are not part of emergency preparedness planning Olmsted County, MN is changing, becoming more diverse in culture, ethnicity and language – 13.8% minority population; minority enrollment in public schools is 26.8% with 68 different languages spoken

Study Aims To identify the most effective ways of communicating with Olmsted County minority communities with limited English proficiency (LEP) before, during, and after natural or manmade incidents, public health emergencies, and non-emergency events.

Study Design Exploratory qualitative study Target population: Five minority communities – Hispanic, Somali, Cambodian, Sudanese, and Vietnamese Method: Use of the “key informant tree technique” to identify and contact study participants, expected to recruit 13 persons per community Key informants occupy a position of responsibility and leadership in the community

Study Design Conducted a semi-structured face to face interview with each key informant in English First key informant for each community was recruited from the group of interpreters at Mayo Clinic Language Department Study was approved by Mayo Clinic IRB with verbal informed consent An analysis of agreement between informants was conducted to summarize informants’ perspectives and community information

Results The following tables summarize findings for Hispanic and Somali Communities No. of key informants 1412 Mean number of years in US Mean number of years in Olmsted Co. 11 Position/role in community All had direct interactions with community -from service providers to volunteer work; well known and respected Community leaders, well known and respected; working for non-profit or for profit organizations Hispanic Key informants’ profile Somali

Community Characteristics Size 4,000-6,000 persons1,500-2,000 persons Primary language(s)Spanish; Nahuatl (Indigenous language from Mexico); Tex-Mex; Portuguese; English Somali; Arabic; English; Italian Ability to understand instructions in English Higher education – oral/written Lower education – oral only Higher education – oral/written Lower education – oral only Elders and those with lower education do not read or write Somali Level of integration - Intracommunity - Olmsted Co community High Very low High, but with conflicts between clans/tribes Very low or none Employment opportunities Agricultural work; dairy farms, fast food industry; manufacturing; food processing plants; housekeeping Manufacturing; food processing plants and other industries Media usedNational TV (Spanish); out of town Spanish radio stations Local Somali TV; cell phone messaging systems Organizations with greatest interaction Faith organizations; Migrant ClinicMosque; Somali Community based Organizations; Salvation Army; United Way HispanicSomali

Families have information about what to do in an emergency 11 out of 14 informants (79%) considered families do NOT have the information 10 out of 12 informants (80%) considered that families do NOT have the information Information in native language 12 out of 14 informants (86%) stated that there is NO information in Spanish accessible to the community; only in the internet All informants (100%) stated that there is NO information in Somali at Olmsted Co. Resources available in case of emergency Limited resources, available only from faith organizations and non-profit agencies Limited resources, and only available from Somali community groups, faith organizations and community based organizations Major barriers in getting help English proficiency; public health system structure; lack or limited information in Spanish; immigration status (fear to look for help) Limited English proficiency; public health system organization; lack or limited information in Somali; religion/cultural traditions Can people get needed help Majority said NO; when available is not timely Not on time Suggestions to improve access to information and services Invite community members to participate in delineating emergency plans; provide training to community members Provide education on when to visit the emergency room and call 911 and where to go in case of a catastrophic incident Emergency Preparedness Information Hispanic Somali

Limitations Not able to complete interviews for the Sudanese, Cambodian and Vietnamese communities Interview time took longer than expected, an average of 60 minutes, informants wanted to talk about other community issues and needs

Conclusions Even when there are significant differences between Hispanic and Somali communities, there are similarities in their perspectives and needs related to emergency preparedness There is an immediate need to increase the knowledge about how to effectively prepare LEP communities to respond to major disasters and other emergencies The big challenge is how to adjust emergency preparedness plans to effectively communicate with minority communities before, during and after natural or manmade incidents, public health emergencies and non-emergency events

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