How Long-time Health Promotoras Became Essential Messengers
ADRIANA DÍAZ and the PGN STAFF originally published the article under a Creative Commons license on PGN.
Photo: Courtesy of Latino Health Access.
JUNE 12, 2024. UPDATED JUNE 13, 2024
It’s been over a year since the U.S. officially concluded its COVID-19 public health emergency. But with the virus still around, promotoras de salud, a historical model of community health messengers, continue to play a vital role in Latine communities. Promotoras raise awareness about the importance of staying up to date on vaccines, educate communities on various health topics, and help fight misinformation.
As policymakers debate the future of community health workers amid health worker shortages, burnout, and funding challenges, Public Good News reached out to Latino Health Access, a Santa Ana, California-nonprofit that has trained health promoters since the 1990s.
Long-time promotoras Noraima Chirinos, Rosalía Vargas, and Nallely Enriquez reflected on their years working in communities and their biggest takeaways so far. Here’s what they said.
[Editor’s note: The contents of these interviews have been edited for clarity and length.]
Noraima Chirinos
Emotional Wellness, Lead Promotora
At LHA for close to 30 years.
On the ongoing work to raise awareness about vaccines:
“We don’t yet know what other consequences the [COVID-19] pandemic will leave us. I think it’s a never-ending task because there’s still a lot of resistance due to the misinformation in the media, in videos and people who said, ‘I’m a doctor and I don’t recommend the vaccine,’ and we don’t really know if they were doctors or not. We don’t know anything.
Maybe they were, but that brought about a lot of controversy in our communities, a lot of doubt.”
On why health workers must approach the whole human:
“As we trained people with diabetes to manage and control their disease, we realized that it wasn’t just about diabetes, but a whole slew of things that each participant had to resolve to be able to get that diabetes under control, to fully own it.
We realized we can’t just stop there. We must find other paths to grow and be able to help people more.
That’s how we expanded from a program like the one for diabetes to heart disease, prevention, then we included mammograms, in other words, breast cancer, then to osteoporosis and osteoporosis prevention, to women’s health, family health, and that’s how we expanded to a series of mainly educational services and programs for lay people to better understand health conditions and how to control them and what are the consequences of not managing your health.
We work with narrative therapy based on stories. Humans are stories, not a single story, but a world of stories. From the perspective of narrative therapy, the problem is the problem and the person is the person, so it’s not that a person is the problem; we separate the two. We see how that resonates and realize there are other factors to weigh in: the financial aspect, the son who’s being deported, the child who doesn’t learn as easily, the girl who works and is the family’s sole breadwinner. It’s not that this constitutes a family with problems, but that the circumstances as a result of the systems we live under and poor people’s lack of resources are the problem.”
On the biggest barriers to promotoras doing their work:
“It took the pandemic happening for health systems to realize the effectiveness of promotoras’ work.
The big barriers we’ve always faced are the health systems, which didn’t consider the promoter model until this tragedy occurred and it was us, the promoters, who were at the front line.
Currently, California is having discussions about certifying health promotoras, but the state still doesn’t understand our work model. So, how can they guarantee that, even though I’m certified, they will respect my work and trust me to let me do what I know how to do?
Many of the women who may be the best leaders in their communities may not have advanced academic degrees, but they have been trained and gotten the knowledge they need to educate their community.
They have a great heart, and the desire to help keep their community healthy, and that can’t be certified. They have the desire for our children to have a safe place to grow in and good educational opportunities, that can’t be certified.”
Rosalía Vargas
Food Distribution Coordinator
At LHA for about 24 years.
On how promotoras are effective trusted messengers:
“The way I see it from my years working here, the promotora concept is about neighbors working with neighbors. That’s how I started: organizing evening gatherings with my neighbors, talking to my neighbors, and finding out about what’s going on in each other’s lives.
‘Hey, what’s going on with you? I know about this resource, did you know about it? Use it; it worked for me.’
So, it’s about sharing not just the good things but the challenges as well, to support each other, so that if I made it, you can make it too.
The promoter model works because they are people from the same neighborhood. It works through shared experiences, and they know firsthand what’s going on there and what their neighbors are going through.
If I came from a different economic background and had to do this job here, I wouldn’t know what it means to go to sleep at night and listen to gunshots, or what it means to walk on a sidewalk with insufficient lighting, or what it’s like to live in an apartment with two or three other families, where there’s no privacy, where a lot of all types of problems arise, where you have to share, not because you want to, but because you don’t have the resources to afford your own place.
If I know all about this firsthand, I know what it’s like to want to get out of that situation. I would be happy that others are able to get out of it, too. If I made it out, I want others to make it, too.
So, it’s about the empathy that exists among families, among promoters and neighbors, of understanding firsthand what you might be going through because I went through it, too.
We speak the same language, we have the same shared experiences. I think that having empathy for people is what brings about the trust between promoters and families, that they’re also our neighbors, because we live in the same communities.”
Nallely Enriquez
Program Coordinator of Children and Youth Engagement
At LHA for more than 5 years.
On the importance of working across generations:
“The youth [we work with,] of course, we were concerned about them getting COVID-19, [but] they were more concerned about their parents and grandparents and getting COVID-19, and their parents being out of work.
[For a] lot of them, it was the first time where they really understood the family situation. Through COVID-19, that’s when they finally understood more of the family picture and where they were financially and what their needs were.
Besides that the academic need was huge. Before COVID-19, there were a lot of youths that were struggling with their grades, or even struggling socially, like making new friends, and COVID-19 unfortunately exacerbated all that.
As an agency, we had a huge campaign to get COVID-19 vaccines out to the community. So we were on the ground, going into neighborhoods, letting them know about the vaccine, and all the testing sites. We handled all that outreach, and it was very cool to see our promotoras really going out there in the community in our red van.
Our red van is very famous for a lot of the work and campaigns that Latino Health Access has done, but just going out into the communities, driving around with the megaphone saying, ‘Latino Health Access will conduct a vaccine clinic from this day to this day, and at this time. See you there!’
A lot of the youth, they tell us that they remember hearing that when they were inside their apartments.
And for us, it was very important to do that, because we know that for a lot of our community, even though the county and a lot of other agencies were spreading the news through social media, or just through these electronic outlets, for some of the parents of the youth or the grandparents, they don’t necessarily know how to use the phone sometimes, or they’re not always on their social media because they have to work, etc., so it was important for us to really get out there and spread all that information.”
This article is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the CDC Foundation totaling $69,392,486 with 100 percent funded by CDC/HHS.
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