Nuestra Comunidad Sana

Nuestra Comunidad Sana, or “Our Healthy Community,” provides services to the Columbia Gorge Latino community.
Our mission is to develop leadership and share information to promote the well-being of Columbia Gorge Latino adults, teens and children using our healthy traditions and values and the best of our cultures.

Community Health Team
This team, which  includes a social worker, a nurse and several community health workers, works with the highest users of the Oregon Health Plan. The team helps patients improve their health by connecting them with the care and social services they need. Helping patients with chronic conditions use medical services more effectively results in higher satisfaction, better health and lower costs.

Invernadero Comunitario Raices (Roots Community Greenhouse)
Participants learn to grow their own food using organic methods. Benefits of the program include lower food bills, better nutrition, healthy activity, and greater connection to the community. Enjoy these blog posts from our Executive Director–all about our gardening programs.

Mid Columbia Health Equity Advocates helps Latino community members learn to address community concerns including wellness, recreation, mental health and education issues. This program results in higher participation in County Planning Commission, School Board and Hospital Board meetings. By building on the strengths and natural leadership of local Latinos, these projects improve their quality of life.

Health promotion programs like Pasos a Salud/Steps to Wellness offer support groups, outreach and education about diabetes and obesity. We also help people in a variety of ways with their health care needs.
 
Promoviendo Prosperidad/Promoting Prosperity provides business start up and development services to Latino business owners and entrepreneurs. 

Through Hombres Autoresponsables para Parar el Abuso Men Responsible for Stopping Abuse (HAPA), a court-ordered domestic violence intervention in Spanish, we help men break the cycle of violence.

Cover Oregon Assistance helps local low income workers and the general public understand and apply for health insurance.  

Raices Digital Storytelling Workshop

Young Latinos tell their stories…

Latino teenagers from Hood River, Mosier, Odell, and Parkdale participated in a week-long digital storytelling workshop. They learned to share the experience of being from both the United States and Mexico, of being drawn to both cultures, and sometimes being excluded by both cultures.

Participants learned to write a script, process photos, record their own narration, and put together a final product. See some of their short stories here:

Yesi tells a story about her dad; how hard he has worked and how much he sacrificed so her family could have what they need. (6 min. 13 sec.)

Rocio explains how fruit gets from the tree to your table, and how migrant workers, even undocumented ones, are essential to the success of farmers. (4 min. 15 sec.)

Nubia & Kelsey want to know, “What’s an Alien?” How does it feel to be labeled as an alien? What does it say about people in the US who would fence the border and shoot all who try to cross? (4 min. 11 sec.)

Lay Health Promoters

Definitions and Descriptions

Lay Health Promoters have a long history of providing public health services in many different cultures and countries. Lay Health Promoters have gone by many names including:
Village Health Workers, Primary Health Care Workers, Indigenous Health Care Workers, Community Health Promoters, Community Health Workers, Community Health Assistants, Community Health Representatives, Medical Auxiliaries, Rural Health Assistants, Community Health Aides, Brigadistas, Promotores y Promotoras de Salud, Indigenous Health Aides, Lay Health Advisors, Auxiliary Health Workers, Front Line Health Workers, Barefoot Doctors, Feldsher, Kaders, and Prokesa.

These terms are not necessarily interchangeable, since each has its own practical, historical and political significance. There are characteristics many Lay Health Promoter Programs have in common. The Promoters:

  • Come from the community in which they work
  • Are defined by their active stance within the community and health care setting
  • Are well trained and expected to perform health promotion, education and service delivery within a limited scope
  • Are not “doctors and nurses without a license” but may deliver primary care and preventive services within a limited scope of practice which they have been specially trained to do
  • Promote health among groups which have traditionally been denied adequate health care, and work for a more equitable distribution of health services
  • Respond creatively to local and national realities
  • Use “popular education” in their work.

It is important to note that Health Promoters are neither outreach workers nor untrained volunteers. Outreach workers often perform tasks which are extensions of the clinical health care setting; scheduling appointments, transporting patients, delivering medicine, making referrals, and handing out brochures. While Lay Health Promoters may perform some of these tasks, they do much more. They are well trained and are usually, but not always, paid for their work.

History

In almost all human communities through history, people have looked to their family members, friends, and neighbors for health care and health information. Before the development of the medical profession, community members, many of whom had received their training from older relatives, were the only health practitioners.

As early as the seventeenth century, a shortage of doctors in Russia led to the formalization of these natural helping and healing relationships. Lay people known as “feldshers” were trained to provide medical care to members of the military. After the Chinese Revolution of 1949, Mao Tse Tung promoted the training of “barefoot doctors”. These health care workers were so called because most were peasants, many of whom couldn’t afford shoes. Their mission was to take primary health care to remote rural areas where there were no doctors.

Beginning in the 1950′s, in conjunction with the development of labor unions and “liberation theology”, Lay Health Promoter programs flourished throughout Latin America.

While the Lay Health Promoter model is often associated with primary health care campaigns in the developing world, lay workers were also key staff in domestic programs in the 1960′s providing health education, child care, parenting education, and patient advocacy. These programs were frequently located in communities of color in large U.S. cities like New York and Los Angeles. It was also during this period that the Indian Health Service founded its Community Health Representative (CHR) program. The CHR program remains one of the largest and best-established lay worker programs in the country.

After falling out of favor in the 1970′s and early 1980′s, community health worker programs experienced a resurgence within migrant and seasonal farmworking communities in the late 1980′s. Programs founded during this period include the Camp Health Aide Program sponsored by the Midwest Migrant Health Information Office; the Border Vision Fronteriza Program based at the University of Arizona; and Nuestra Comunidad Sana based in Hood River, Oregon.

Training

Training for community health workers is most often provided in-house once the LHP has been hired. The amount and type of training which LHPs receive varies widely from program to program, and depends on the role which the LHP is to play and the resources of the program, among other factors. On one side of the spectrum are programs in which training time is short, perhaps several hours or a couple of days. LHP’s trained in this way often work as volunteers or receive a small stipend for their work. In the case of migrant and seasonal farmworking health aides, they continue to travel up and down the migrant stream. They share information informally with friends and family members.

On the other side of the spectrum are programs in which initial training is extensive, perhaps lasting several months. Usually, the LHPs who participate in such training are full- or part-time employees of a clinic or community-based agency. After their training they are able to carry out complicated and self-directed work, including lay counseling and health education with groups.

Because a goal for many LHP programs is the empowerment of the workers and their communities, a number of programs have found that Latin American style “Popular Education” is particularly appropriate for their work. Popular Education is based largely on the ideas of Brazilian Paulo Freire. According to Popular Education theory, all people have a large store of knowledge as a result of their life experience. The task of the educator is to tap into that store of knowledge, and help people organize their knowledge and use it to benefit their communities.

The methodology of Popular Education is interactive, participatory, and fun, and is thus much more accessible for community members lacking formal education. In addition, Popular Education is directed toward action, and thus especially appropriate for public health education.

Instead of the word “training”, programs using Popular Education prefer the word capacitation, from the Spanish capacitar;”to build capacity”. LHPs “participate in capacitation,” rather than “receive training.” Programs using Popular Education also frequently support the practice of having experienced LHPs play a large role in the capacitation of new LHPs.

Applications

The concept of lay health promoters is applicable to many cultures and communities, all age groups and a wide variety of health topics. These programs have been used in a wide variety of settings worldwide, targeting populations and needs specific to the community. In the United States, the broad range of successful programs has included church-based hypertension and stroke prevention in African-American communities, improved access to health care for elder Hispanic farm workers, and school-based peer counseling. These programs have succeeded because they are culturally appropriate and are integrated into key community activities.

An example of a successful program is the Speak to your Sisters Program in rural North Carolina. The objective of this program was to reduce the morbidity and mortality from breast cancer among African-American women over 50 in rural North Carolina. Since the church is a social gathering place for African-American women in rural North Carolina, recruitment took place after church services. Women in the church recruited other women by wearing a button saying “Speak to Your Sisters” and “Have You Had Your Mammogram?”

The women arranged health fairs to educate other women around the issues of breast cancer and to schedule appointments for mammograms. They also coordinated free mammograms for women who could not afford them, held support groups for survivors of breast cancer, and provided a forum for older women to “speak to their sisters” and provide social support around other health issues.

Another successful program is the Indian Health Service (IHS) Community Health Representatives Program (Oregon and nationwide). Native Americans are selected, employed and supervised by their tribes and trained by IHS to provide specific health care services at the community level. Nationwide, Community Health Representatives made over 4,218,617 client contacts in 1991. Sixty-four percent were done in the community or in the client’s home. Sixty-six percent were to address issues of general health care, 10% were for maternal and child health issues. Many contacts were also related to environmental, gerontological, dental and mental health issues. The CHRs most commonly provide problem assessment, health education and consultation. They follow-up and address physical, economic, and cultural barriers to health care.

Successful Lay Health Promoter programs, according to the Pew Health Professions Commission, include these elements:

  • A community needs assessment guides the LHP program development
  • The sponsoring organization has an established rapport with its community, and has hired staff who are multilingual and multicultural as needed to gain the trust of the community
  • The program has shared ownership empowering LHPs to design strategies,conduct training, and evaluate and refine program goals and objectives
  • The program has the flexibility to adapt to changing community needs and established partnerships with community-based health and social services agencies.

Meet Our Advisory & Resource Committee

Nuestra Comunidad Sana
Advisory & Resource Committee

Martin Campos-Davis
Oregon Human Development Corporation

Tina Castañares
Providence Hospice of the Gorge

Margie Dogotch
La Clinica del Cariño

Maija Yasui
Hood River Commission on Children & Families

Enjoy these blog posts from our Executive Director–all about Nuestra Comunidad Sana

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