In 1991, the Amish community in Lancaster County, Pa., – one of the oldest and largest Amish communities in the country – faced a public health crisis: an outbreak of German measles. Setting aside their religious reservations about immunizations, the county’s Amish bishops approached Lancaster General Hospital (LGH) to ask for help with getting vaccines for the community’s children.

LGH was eager to help and partnered with Amish bishops and local fire stations, which are common gathering places for the Amish community, to provide free measles immunizations to approximately 5,000 Amish children in remote areas of Lancaster County.

“We saw the herd immunity aspect as a community benefit,” says Alice Yoder, LGHS’s director of community health and wellness. “The Amish were coming more and more in contact with the English population,” she says.

Nearly 25 years later, the initial collaboration has evolved into LGH’s “Partnering with Our Amish Neighbors” initiative, a variety of outreach programs that respect the population’s traditions and beliefs. Programs include a free child immunization program; educational group meetings for Amish women in their homes; health classes in Amish school houses; farm safety day camps; and programs addressing domestic violence and sexual assault.

Yoder says all efforts are conducted in partnership with leaders from Amish communities.

“We modify the work we do and our approach to advancing their health and wellness to make sure it’s culturally competent,” she says.

A recent safety initiative encourages the Amish – who traditionally dress in dark clothing – to wear orange reflective vests when they walk on the roads after dark so that they can be seen by oncoming cars. Another focuses on shared-lane markings, or “sharrows,” to ensure the safety of Amish driving buggies or riding bicycles on roads shared with cars.

“Lancaster County has surpassed half a million in its population and has a very strong tourism industry with people who come to see the Amish,” says Mary LeVasseur, LGH’s manager of community health and wellness. “We need to ensure that the Amish are safe on the road with the additional traffic.”

In addition to outreach and services, LGH’s senior management team has forged a strong rapport with Amish bishops throughout the county. Since the 1991 measles outbreak, the two groups have met quarterly to discuss the Amish population’s health issues, including access to services and financial concerns. Because Amish citizens in Lancaster County follow the guidance of their individual local bishops, these senior-level meetings have been a crucial aspect of building trust across the county, Yoder says.

The results are in the numbers. Since 1991, LGH has immunized 70,000 children, 46% from the Amish community. Eight-hundred and fifty-nine Amish women attended health information gatherings, and 30 women signed up for mammograms in the past five years. The domestic violence and sexual assault initiatives have provided outreach and education to 425 families.

LeVasseur says the key has been to approach the Amish community from a place of respect for their traditions.

“It’s important to remember that we have more in common with them than we don’t,” she says.