Making lifestyle changes to lead a healthier life continues to be a challenge for many people, especially for many Hispanics at high-risk communities living without health insurance and with limited access to health information. Promotores or community health workers (CHW) play a key role in educating these individuals about their risk for chronic diseases and the challenges they need to overcome to stay healthy and achieve behavior change. They also provide ongoing support to help patients manage the disease. But, having worked with several promotores or CHWs in the past, many times I have asked myself, what leads that person to become a CHW?
I was very fortunate to have the opportunity to talk to Juan Rosa, a CHW and the Healthy Living coordinator at El Buen Samaritano Episcopal Mission in Austin, Texas, to learn how being diagnosed with diabetes encouraged him to make the necessary changes and what led him to get involved in health education and help his community. Read below to learn his inspiring story.
When were you diagnosed with diabetes? How did it change your life?
I was diagnosed in November of 2012 and my life took a huge turn. So much so that my everyday life became very difficult, and the saddest thing was that I took the diagnosis so badly that it affected my life. I almost got a divorce, I started consuming alcohol, I was not eating healthy nor sleeping well and my body felt tired all the time. Also, I made the bad choice to stop taking my medicines and that did not help me at all with managing the diabetes.
Who or what motivated you to make healthy lifestyle changes?
Curiously, one day my daughter—who was 6 years old then—heard me talking about my situation and what I was not doing right and she came close to me and told me something that made me put my feet on the ground and “accept” my reality. I still remember it as clear as if she said it to me today, “Daddy, I don’t want you to lose your sight, your feet, or (you) to die yet. Take care of yourself so that me and my little sister can grow up with you.” She made a promise to help me remember the medicine schedule.
What was the biggest challenge you faced?
The biggest challenge was “accepting” that I had to live the rest of my life with a disease that I did not know anything about, much less all the complications that I would need to deal with if I did not take action at that moment. Now I see that you can manage diabetes, but most importantly that you can continue to do the best you can every day to not let your loved ones be affected by the disease.
Did you receive support from family members or health care professionals to manage the disease?
Unfortunately, in the beginning I did not get much help, and not because the help in the community did not exist, but more because I was not looking for it or I did not want to do anything for myself. But once I accepted my reality, I started to search for help with friends, family members and also talking more to my health care professional, and that’s how I started to improve my health.
What motivated you to become a health educator?
I saw the need to inform and educate people in the community, those diagnosed with diabetes, and to make them realize the importance of making the necessary changes to lead a healthier life. Also, I try to help them realize the importance of accepting that they are living with diabetes and that if they don’t take care of themselves, not only will they suffer, but their families with suffer too. One thing that I really like doing is that I dedicate time to them, one thing that unfortunately health care professionals cannot do, especially with those that do not have health insurance. Now, I give one to two presentations per month and my focus is to highlight the importance of going to the doctor and following instructions. I also provide them resources that are available in the community and I am also very honest and real with them and I tell them what can happen if they don’t follow the doctor’s instructions.
From your experience, what are the main challenges the Hispanic community faces regarding their health?
Lack of health insurance due to their legal status, language barriers, education level, fear to ask questions, lack of trust in the health care professional, and transportation issues (here in Austin, TX) many places do not have bus transportation available. The city is growing and in many places, especially in the rural area, there is no public transportation.
What do you think motivates people to make significant changes in their lifestyle? Do you have an example of a patient?
A woman that came from Mexico a few years ago and she was overweight. She was diagnosed with diabetes and I was lucky to be able to work with her closely. She understood that it was important not only for her to make the necessary changes, but for her children also, with both physical activity and nutrition. I spoke to her recently and she told me that she lost 70 pounds and that she feels a lot better. She is also no longer taking insulin, just other pills that help her manage diabetes. One key thing that helps people change their habits is that we talk to them one-on-one, face-to-face and we dedicate them time to explain everything step-by-step. I think that is what makes them so appreciative and encourages them to try their best to make the necessary changes.
How would you describe the promotores or CHW’s role in the health of the community?
It is a difficult job and many people do not recognize CHWs because many CHWs do not have a college degree. Many people do not have any idea of what “promotor de salud” (promoter of health) means, but it is something very important and I am a true example of that. Behind every CHW there is a personal story that ties him/her to the job he/she does, and that makes it that much more important because they have experienced these challenges on their own and they do it from the heart. Now, the CHWs work is being seen more as patient navigation, among other things we do, even the President Barack Obama has recognized the work that CHWs do.