March 5, 2019

ASU research specialist teaches communities to take control of their health

By the time Berta Carbajal found herself in a conference room, shoulder-to-shoulder with state legislators, members of a city council and heads of the Valley of the Sun United Way, she had decades of experience as a community health worker, had co-founded and later single-handedly run a network to educate and connect other such “promotorespromoters” — as they are called in Spanish — across the Valley, and was serving as a research specialist at Arizona State University’s College of Nursing and Health Innovation, where she worked under the supervision of Professor David Coon to recruit local residents for research studies.

But she never thought of herself as a power player. So she was still a bit hesitant when she was asked to attend the meeting to lend her opinion about a Valley of the Sun United Way community health initiative.

The initiative was focused on addressing food insecurity in a low-income neighborhood in Phoenix. It had been underway for about a year but wasn’t yielding many results, hence the meeting to reassess their approach.

“I remember listening to everybody, and my turn came to introduce myself, and I said, ‘I have a question: How many residents are here?’” Carbajal recalled. There were none. “So I said, ‘OK, thank you.’ And I sat down. Because the bottom line is that it's not going to work (without input from the community).”

The folks at Valley of the Sun United Way took her point and ran with it. They asked Carbajal and Coon to officially partner with them and implement the promotor model — in which members of the community, both professional health care workers and volunteers, are trained to be resources and advocates for their communities’ health — in their outreach programs.

That was three years ago. Just last week, the Promotores HOPE (Helping Other Promotores Excel) Network held its second annual Dia Del Promotor, a day full of workshops, panel discussions and networking opportunities geared toward supplying promotores with the best resources and most up-to-date information to disseminate among their communities.

More than 100 promotores were in attendance, a mark of the significant growth the HOPE Network has seen over the past few years.

Esther Villa, a resident of south Phoenix, has been a promotor for five years now. In addition to providing information about ESL and GED classes to her community, she spends Saturdays working in the community garden and encouraging others to participate and learn to eat healthier.

“Sometimes organizations don't know exactly what the community needs, so promotores can help because we live in the area, so we see the problems (firsthand),” she said.

Carbajal co-founded the network about a decade ago but was never able to secure reliable funding until partnering with VSUW. For years, she ran the whole operation in her free time because she saw how important it was and how much the communities relied on promotores for health information.

coon and Carbajal

Professor David Coon and Berta Carbajal address the attendees at the second annual Dia del Promotor. Photo by Emma Greguska/ASU Now

“Berta embodies the essence of the promotor,” said Coon, a long-time supporter of the network who also serves as associate dean of research at the College of Nursing and Health Innovation. “She is a lifelong promotor who learned at the feet of her grandmother and her mother. And we need more like her because this work is critically important.

“These are people that are of the community, in the community, connected to the community. They really are a lifeline for the community. They help bridge the gaps that exist between people and a variety of different services.”

Last December, Carbajal celebrated 42 new promotores’ completion of the three-day training program. After their training, Carbajal and other HOPE Network volunteers continue to meet with the promotores to make sure they’re on track.

“The ones that graduated yesterday, I already told them they have homework,” Carbajal said.

At their next meeting, they’ll need to present Carbajal with a list of their communities’ needs — such as health insurance accessibility, domestic violence, immigration issues and mental health — which they will have obtained from going out into the neighborhoods and connecting and talking with residents. Then, they prioritize the needs, and a plan on how to address those needs is set in motion.

Community health work is something that runs in Carbajal’s blood. As a child, she recalls her mother and grandmother being the “go-to” people in the neighborhood.

“This is how I describe the promotor community model: They're community members that are the go-to people,” Carbajal said. “I was little and I remember neighbors coming to Doña Regina, my grandmother, because they knew they could trust her.”

Later, her mother took over that mantle. In one particularly harrowing memory, Carbajal was in the kitchen with her mother, who was teaching her how to make tortillas. A sudden banging on the door stopped them in their tracks, and her mother rushed to let the woman crying at the door inside.

Her husband had hit her, the woman told Carbajal’s mother. And it wasn’t long before he showed up at the door demanding his wife come home.

Carbajal remembers that her mother still held the rolling pin from their tortilla-making when she opened the door and spoke to him. But there was to be no more violence that night; Doña Sylvia, as her mother was known, told the man to leave, and he listened. Once things had settled down, she helped the woman find a safe place to stay and advised her not to go back to her husband.

“They respected her, they knew she could be trusted,” Carbajal said of her mother. “If somebody was unemployed and they needed a food box, she could connect them with how to get one, or she would take it to them herself. So I learned from the best.”

Top photo: More than 100 promotores gathered for the second annual HOPE Conference. Photo by Emma Greguska/ASU Now