A reflection on the ‘Nuestras Voces, Nuestra Salud’ Listening Tour
By: Rosa Flores, Senior Program Manager, and Paola Ilescas, Program Manager
Before joining the LCHC team, we worked at a community clinic located less than an hour away from the U.S.-Mexico Border. As members of the Migrant Health and Outreach team we heard first hand, sometimes at the foot of an avocado grove or at the edge of a tomato field, the many trials and tribulations of navigating healthcare. Language barriers with providers, insufficient health insurance, limited transportation options, trouble acquiring specialty care referrals, microaggressions experienced in a waiting room… the list was endless. We always did our best to listen attentively and offer solutions, albeit temporary ones.
As we signed folks up for dental or vision appointments or took farmworkers’ blood pressure in a flea market or farmers market parking lot, we understood the unique position we were in as outreach workers but also as clinic staff to better inform clinic operations and deliver better service to all, especially those who are systematically marginalized. For years, we worked closely with our supervisor and clinic leadership to establish programs and strategies that would adequately deliver quality healthcare services and education to those who needed it most. Still, because deep healthcare inequities are an unfortunate reality, there’s always more to be done.
The impetus for joining a statewide Latinx health policy advocacy organization was intentional. For us, the direct service experience of the past would support policy advances of the future. Additionally, the time at the clinic gave us a sure advantage on an emerging opportunity in the health policy space: Community Health Workers and Promotoras (CHW/Ps) as essential liaisons between the medical system and historically marginalized communities and policy advocacy champions for health equity.
For decades, CHW/Ps have been at the forefront of community health education efforts on an extensive number of topics. From nutrition to skin cancer prevention to reproductive health and more. Their unique ability to bridge cultural and linguistic gaps between health care providers and community members, especially in the Latinx and Indigenous community is unmatched. A perfect example of this is the vaccine education efforts seen throughout the state of California. State agencies and Community Based Organizations (CBOs) invested hundreds of thousands of dollars into education and awareness programs to prevent the spread of COVID-19. While radio ads, television ads, and traditional social media campaigns were reaching some parts of the state, many rural communities and communities with limited access to the hardware and software to stay informed were left to figure it out on their own. Additionally, face-to-face education was low due to poor public transportation infrastructure to and from health clinics or family resource centers. These communities were the hardest hit by the pandemic and saw the highest death toll. Once CHW/Ps who live in these communities received notice of any resource, they shared the information. This resulted in more testing, less vaccine hesitancy, better in-language outreach investments, and easier access to vaccine resources. State agencies are looking to CHW/Ps to continue sharing the abundance of resources and reliable information with individuals and families across California. Once again, CHW/Ps continue to demonstrate why they are leaders in health education, why they should be proactively included in the public health model, and why they need to inform statewide policy.
Last spring, we embarked on a pilot project that would prioritize the voices of predominantly Spanish speaking CHW/Ps in five regions across the state: San Diego, the Inland Empire, Los Angeles, Orange County, and the Central Valley. The listening tour is named Nuestras Voces, Nuestra Salud. Our objectives were the following:
- Understand the impact of COVID-19 on the Latinx community and the acute and long term health needs of the Latinx community.
- Inform and educate decision-makers about the experiences of Latinx Californians in regard to healthcare and wellbeing.
- Synthesize community experiences and share Latinx community priorities to inform the creation of a community prevention trust fund.
The result of Nuestras Voces, Nuestra Salud yielded nearly 50 CHW/Ps sharing their knowledge and expertise with LCHC staff and members of the California Alliance for Prevention Funding (CAPF). Here’s some direct responses heard during our conversations:
“I had to go to the clinic a lot during the pandemic and everything was via telephone. The diagnostics were different than what I actually felt and the appointments were also delayed and far apart. I had to go to Mexico for my surgeries because I could not receive them on time in the United States.”
“There were some community clinics, which are free for people without insurance, but appointments are few and far between and worse during COVID (even more wait time).”
“It’s not only that [providers] do not speak Spanish, but [services] are also not culturally compatible. People who do not have access to mental health [services] contact promotoras for information. If only there was more funding for programs from the start and then you can refer people to a psychologist […] Families would then experience stability and would understand that mental health is normal and that it happens to everyone. ”
“The community needs support with secure housing. A lot of people are living in their cars. In my community, my clients do not have a postal address because they live in their cars. They owe so much rent, which has been accumulating these past months.”
“…It is more difficult to receive services through [social] workers. With the pandemic flexibility is being given with MediCal, but with some families it is more difficult to receive MediCal, I think it depends on the social worker. There is a lot of racism, for me these are the problems that are happening… “
The evenings we spent listening to CHW/Ps on their and their community’s experiences in healthcare were reminiscent of our time in the field when we worked at the clinic. The main difference was our charlas (conversations) took place over a cell phone, through a Zoom screen, everyone in their respective homes. The sobering reality is that the pandemic has exacerbated the healthcare inequities that existed before it. As we work to rebuild a state that meets the needs of all regardless of income, immigration status, healthcare coverage; it is imperative that policy makers and advocates take bold action in supporting CHW/P’s efforts and take time to listen to what the issues are and act accordingly and responsibly.
Lorena Ojeda, a promotora in Los Angeles, shared her testimony at a hearing for AB 1038 for the California Assembly Committee on Health:
“Hello, my name is Lorena Ojeda. I live in Los Angeles, California and I have worked as Promotora for over 10 years in order to improve community health. I also suffer from diabetes since I was 16 years old and in my experience as a Promotora and as someone who has this condition, I have seen how the Latino community is afflicted by many social and economic inequities that impact individual and community health.
Before the coronavirus, we already had battles for equity and justice. Many of us Latinos work in occupations that do not pay fair wages and that do not treat us with respect or dignity. This leaves us economically unstable because we still need to pay high cost rent in comparison to what we earn and we have to support our families and put food on the table. Because we often live in low income communities, many services are unavailable or poor quality. For example, many of the schools in low income neighborhoods are not good and the students cannot learn and don’t have opportunities…
My work as a Promotora is important because it is a resource to support community members in low income communities. As a Promotora I have offered education on sex and reproductive health, nutrition, diabetes, and mental health. My fellow colleagues, Promotoras, and others who have taken my classes have told me that because of the work I do as a Promotora they have been able to make lifestyle changes to improve their health. I enjoy doing this work because it is dignified and because I am proud to contribute to positive change in my community. I ask that you support my work as a Promotora through the Health Equity Fund. The Health Equity Fund would provide more resources for Promotora programs and other community programs that would truly benefit the community.”
At LCHC, we believe that those closest to the pain are also those who should lead the healing. Systemic change includes CHWs and Promotorxs in decision making spaces, the policy development and advocacy process. Nuestras Voces, Nuestra Salud gave us meaningful insight on community health priorities and the type of solutions necessary to eradicate health inequities. These priorities are further elevated through policy briefs, available in English and Spanish. As we continue to work side-by-side with CHWs and Promotorxs, we invite you to contemplate what actionable collective steps we can take to accomplish health equity and welcome you to contact our team with ideas for collaboration.
You can access and download each regions full report on the LCHC research page under community data.
For more information on “Nuestras Voces, Nuestra Salud,” please contact Sr. Programs Manager, Rosa Flores, rflores@lchc.org. You can view the regional research briefs here.
