By Lisa Mitchell-Bennett, Special to MyRGV.com
I was first introduced to community health workers (CHWs), also referred to in Spanish as “promotores”, when I was a young 20-something just out of graduate school and newly arrived to the Valley.
I was working with a clinic on a binational project to improve prenatal care to underserved pregnant women here in Brownsville and across the border in Matamoros. I remember walking through a settlement of tin shacks in what was then the Matamoros garbage dump (“el basurero”) with a doctor and a CHW (promotora).
The women and children residents of the basurero community spent their days picking through the burning heaps of trash to find pieces of metal to sell and barely eked out a living. While the reserved women showed quiet respect for the physician, when the promotora explained the health information they seemed to light up and truly connect.
The promotora understood the complexity of their circumstances and engaged with them with respect and empathy allowing them to feel seen and heard like the doctor could not.
In the 30 years since that first encounter, I’ve had the privilege of working closely with promotores (men and women) in many different capacities at several organizations.
According to the Centers for Disease Control (CDC), apromotor (a) or community health worker is a frontline public health worker who is a trusted member of a community or has a particularly good understanding of the community served. “A CHW serves as a liaison between health and social services and the community to facilitate access to services and to improve the quality and cultural competence of service delivery” (CDC).
I have seen the powerful impact of CHWs who go into homes and neighborhoods and listen, observe, assess, advocate and act alongside families in need. There are many organizations and healthcare institutions that benefit from the contribution of CHWs, like clinics, community-based organizations, mental health providers, hospitals and community organizers.
The model has been successful around the world and took root in the United States in the early 1990’s, with a large and early presence here in the Rio Grande Valley and along the US-Mexico border.
Paula Saldana has been working as a community health worker (“promotora”) for many years at Planned Parenthood and other organizations. She recently advocated, along with others, for recognition of this important workforce through aCameron County proclamation that declared June “Community Health Worker Month”.
Saldana, along with her colleagues,has created a Facebook resource page for community health workers in the area called “Las Super Promotoras”. The page has over 700 followers, local and from outside the area, and they share resources, training and best practices.
Saldana is a champion of her colleagues and thought it was time for them to be recognized, especially in light of their role during the COVID-19 pandemic.
“I saw the city and county in Dallas recognize community health workers through a proclamation, and I figured we should do it here in the Rio Grande Valley, where we have by far the highest number of certified CHWs in the state. Our area has always been a leader in terms of promoting and encouraging the role of promotores because our residents and health care system benefit so much from their contribution given the challenges they face.”
Those challenges include persistent poverty, over half the population with no health insurance, limited access to primary healthcare, and high rates of chronic disease.
“Promotores are the heart of the community. Here in the Valley they share the characteristics and life experiences of the people in the community. They’ve gone through it and they present the information with so much confidence because they are well-trained, have empathy and are really able to listen.”
The State Department of Health Services (DSHS) has a certification program that requires 160 hour course and yearly continuing education for CHWs. Dr. John Hellerstedt, Commissioner of the Texas Department of State Health Services, recognizes the importance of community health workers as “an essential asset to Texas health” (DSHS).
CHWs have a been a force of effective connection between the healthcare system, local government, churches, schools and social services during the pandemic. They were deployed early on tohard to reach residents (in colonias and rural areas, elderly shut-ins) with crucial information about COVID-19 as well as supplies like groceries, medication and masks.
The UTHealth School of Public Health employs 20+ community health workers to work with clinics and healthcare providers. During the pandemic they have provided a crucial connection between physicians, social service agencies and patients.
Saldana shares, “When I heard about COVID-19 I worried that our CHW work would pause. Who am I kidding these are such hard working people who want to serve the community they are not going to stop. They continued to do their work and adapt. A lot has to do with the fact that share the same life experiences as the community.
It’s harder for doctors and healthcare professionals to connect with patients. Sometimes they don’t understand barriers their patients face, or they judge them or simply cannot communicate with them. Promotoresbridge that gap.”
Promotores are often not recognized and compensated for the important role they play in keeping our community informed and healthy. Saldana thinks they should take on more leadership since they really know and understand struggling people and their day-to-day lives.
“I would love for all CHW’s to be well compensated for their work, and even to run for office. I’d also like political leaders to listen to CHWs and maybe even take the CHW training course. It might help them really learn and understand about why people do what they do and where their constituents are coming from.”
Community health workers (promotores) are effective at communicating and motivating the most vulnerable, hard to reach population to access resources, change behavior, seek assistance and social support.
CHWs teach cooking and diabetes classes, visit homes, deliver food and medication, take blood pressures, intervene in a crisis, make referrals,advocate for neighborhood change, lead walking groups, assist with applications and provide hope and a voice to so many individuals and families, because Tu Salud ¡Si Cuenta! (Your Health Matters!)
