Supporting immigration pathways one vaccine at a time

Jenise Jones, RN, BSN, and Carmen Miller were conducting their regular, once-a-month, home vaccination appointments with refugee clients when they realized one visit was going to go a little differently.

“We were literally met with the dining room table fully set” says Jenise, recalling beautiful dishes, hot milk, and homemade food. “There was no ‘oh thank you, we’re OK.’ Instead, it was ‘Come, sit. We’ll eat first.’ The wife was not as fluent in English, but she was pulling out pictures of the kids. We really got to know them.”

The time around the table with patients emphasizes the personal nature of vaccination appointments in someone’s home—even when the nurse and patient are working through a language barrier.

RHHD began offering at-home appointments during early COVID-19 vaccination efforts as a way of reaching people who weren’t able to leave their homes to receive vaccines. Jenise was with that early COVID vaccination team, which eventually morphed into RHHD’s Doses on Demand program. As more people received COVID vaccines, the Doses on Demand model expanded to include additional vaccines.

As the name suggests, Doses on Demand goes where there is need. Increasingly, RHHD nurses were seeing a need for vaccination in refugee communities. Amy Snearer, the Senior Public Health Nurse who coordinates RHHD’s Newcomer Health Program, says that vaccinations for refugees need to happen on a strict timeline: “After a refugee has been in the country for one year, they are eligible to apply for their green card. A green card allows them to stay in the USA permanently, so it is a big milestone for them. U.S. Citizenship and Immigration Services requires a person applying for a green card to have certain vaccines. We provide those vaccines free of cost to the newcomer so they are ready to apply for their green card when eligible.”

For refugees and other newcomers—including folks in the U.S. with Special Immigrant Visas or Parolee status from Afghanistan—the resettlement process is arduous. It’s a long timeline with many steps, and so RHHD aims to make the medical components smooth and convenient.

While Amy and her team can often complete the first round of vaccinations in a vaccine series during a clinic visit at RHHD’s West Henrico location, they work with a limited number of appointments. It can also be difficult for newcomer families to arrange time off work, transportation, or childcare to return to the clinic after their initial visits. Doses on Demand ensures that people can stay on track to complete their green card paperwork in the one-year time frame.

Jenise explains that when Amy meets with patients at Henrico West, she creates a spreadsheet of people who will need follow-up vaccines. Program manager Carmen Miller contacts people on the spreadsheet to create an at-home schedule. “And then one day a month we do a run and see whoever, wherever, to provide whichever vaccine Amy says they need to receive.”

The idea of “at-home” vaccination can be a little misleading, as Jenise and Carmen have visited patients at work if that’s the easiest location for vaccination. And where Jenise used to travel with just COVID-19 vaccines, she now comes equipped with everything from tetanus to MMR to flu—”all the things the client might need to receive.”

Jenise and Carmen use Propio language services to communicate with patients who may not feel comfortable with English, and they travel with hard copies of vaccine information handouts in a variety of languages. And Jenise says it’s important to translate not just linguistically but culturally; she’s learned to remove her shoes before entering a patient’s home for example. “Jenise has so much experience vaccinating people through COVID, flu, and mpox,” says Amy. “She is the perfect person to meet newcomers where they are and make it as easy as possible to complete their vaccines.”

And although Jenise has conducted home visits for several years, she stays aware of the unique role she plays: “It’s just a very humbling experience; you don’t always know how other people live. It makes you think about what people are going through just to be in the U.S.”

The Office of New Americans-Refugee Services provides more information about health screenings, green card application support, and additional resources for refugees and other newcomers. And if you’re someone looking to update or confirm your vaccination records—whether you’re a newcomer or not—you can visit VDH’s Immunization Information System to request those records.

And still looking for a flu or COVID-19 vaccine? Make sure to visit for locations and appointments regardless of your residency or insurance status.