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Rural and Resilient: Lessons Learned Amidst Pandemic Response

By Desmar Walkes, MD

Published May 10, 2021

As a local family physician who has called Bastrop County, Texas home since 1994, I have learned firsthand that my neighbors are no strangers to hardship. Our small but mighty community of 88,000 people has endured tragedy after tragedy, from the 2011 Bastrop County Complex Fire—known as the most destructive wildfire in Texas history—to several federally declared disasters, including the 2015 Hidden Pines wildfire and Hurricane Harvey, which wreaked havoc in 2017. Today, along with the rest of the world, our rural community faces arguably the most significant challenge of our generation: the coronavirus pandemic.

Over the years, I have seen the camaraderie and resilience these hardships have produced—and, how against all odds, the community has been strengthened by them. The experience gained from overcoming these past emergencies has equipped Bastrop residents with know-how in the face of adversity and has bred a great deal of trust, a vast network of volunteers, and a heightened level of preparedness within the community, all of which have been critical to the success of our COVID-19 vaccine rollout.

Leveraging Community Strengths to Build Our Approach

Like many, residents of Bastrop County had been isolated in their homes for months, longing for interpersonal interaction within their communities as the pandemic raged on. When mentions of a nationwide vaccine rollout began, residents were eager to receive it and return to “normalcy.” Drawing on experience, Bastrop County elected officials, community leaders and I created a pandemic task force. We immediately began holding internal conversations regarding vaccine access and distribution to develop a plan to safely and efficiently roll them out to the community once available.

My first order of business was to submit an application designating Bastrop County as a vaccination hub within the state of Texas; second was to develop a simple, straightforward survey for county residents to determine community appetite and need for the vaccine. Leveraging the task force to share the survey with area residents, we were met with an overwhelming response, receiving upwards of 50,000 survey responses within two weeks. With the vaccination hub application approved and community interest in the vaccine high, I knew forging the path forward would be a community effort.

Neighbors Helping Neighbors

Community leaders Debbie Bresette, Executive Director of Bastrop County Cares, and Computer Engineer Madeline Eden joined me and an army of volunteers to break down barriers to immunization that Bastrop County and countless communities across the country are experiencing—from technology and internet access to vaccine hesitancy and fears among immigrant communities—to pre-register or schedule residents for their COVID-19 vaccine. To reach residents with varying levels of technology familiarity and internet access, we deployed several methods of communications, including a volunteer-designed texting service, traditional and social media, and a call center staffed with bilingual volunteers, which was arguably the most critical.

Raising awareness and scheduling appointments for our neighbors was only half the challenge. We also needed to recruit and secure certified vaccine administrators to safely inject the vaccine into arms, as well as ensure those registered for vaccinations had reliable transportation to their appointment. To do this, we partnered with local pharmacies to provide technicians to our clinics, as well as regional transportation service, Capital Area Rural Transportation System (CARTS), to help those in need of a ride. As a result, Bastrop County’s waitlist for the COVID-19 vaccine grew from 30,000 to 80,000—and hope began to rise.

Community Impact

What started as a small effort out of my personal practice with two vaccine administrators and a few hundred vaccines given has transformed into a well-oiled machine of rotating vaccination sites offered six days a week, 20+ vaccine administrators, 1,200+ volunteers with more than 40,000 vaccines provided. None of this could have been achieved without the combined efforts of community residents, local leaders and activists, and medical professionals. Each of these groups brought their marbles to the game, shared those marbles, and figured out the best way to play together.

If our community has learned anything amidst this pandemic, it’s that although this work is not easy (and will never be easy), with determination, collaboration and knowledge-sharing, and a plan of attack – that oftentimes entails just putting one foot in front of the other – it is possible to win the collective fight against COVID-19. It is my sincere hope that rural communities across the country can leverage what we have learned and apply those insights to their own unique contexts to help advance their local COVID-19 vaccination distribution efforts.

If you’re interested in learning more about Bastrop County’s COVID-19 vaccination rollout or volunteering at one of our vaccination sites, please click here.


Dr. Desmar Walkes is a Board Certified Family Practitioner and the Founder of A+ Lifestyle Medical Group. She has served as Bastrop County’s local health authority since 2007 and will begin her new role as local health authority for Austin Public Health later this month.