Migrant Health Promotion's work improves the health of farmworkers and rural communities in multiple ways. In this section, Migrant Health Promotion offers examples of the measurable, demonstrated impact of Promotores' and Promotoras' work on community health by topic. Please note that these examples are illustrative, not exhaustive. Some of these programs accomplished additional objectives and many other successful programs are not described in this section.

 

 

• Maternal and Child Health
• Physical Activity and Nutrition
• Prevention and Control of Diabetes
• Occupational Health & Safety
• Environmental Health
• Breast and Cervical Cancer Screening and Prevention
• Effective Treatment of Tuberculosis
• Children's Health Insurance
• Food for Mothers and their Children
• Public Policy Changes
• Mental Health
• HIV Testing and Prevention
• Substance Abuse and HIV Prevention with Teens 

Maternal and Child Health

During the summer of 2005, 40 Promotores(as) at six Migrant and Community Health Centers in Michigan led individual and group education, provided referrals and hosted special events to improve the health of the women and children in their camps. These Promotores(as) ensured that:

• 100 percent of pregnant farmworker women received prenatal care. In comparison, only 66.8 percent of Michigan Hispanic women received adequate care in 2007.¹
• 95 percent of newborns were breastfed.   Nationally, 80 percent of Hispanic women in all occupations breastfed² and only 65 percent of Michigan women in all racial groups breastfed their babies.³
• 93 percent of farmworker children five years of age and under were up to date on their immunizations. The immunization rate for Hispanic children ages 19-35 months in the United States was 78 percent for the year 2007.⁴

"I never would have considered breastfeeding if it wasn't for my Promotora. She answered so many questions, and she was there to help me if I needed it. She even helped my mom learn about some of the myths."

-New mom and labor camp resident

In 2007-2008, three Doulas provided prenatal education classes to 483 people and actual doula services to 163 women in the lower Rio Grande Valley, Texas.  Their work contributed to a dramatic decrease in Caesarean section rates among first-time mothers – less than 8% of first-time mothers assisted by Doulas gave birth by Caesarean section, compared to 44.5% of Hispanic women in Cameron County overall (2002-2004; http://soupfin.tdh.state.tx.us/birth.htm)

In 2009, the Doulas’ work resulted in the following:

• 100% of the children in the program obtained a medical home
• 100% of mothers in the program have an ongoing source of primary and preventative care
• 0% low or very low birth weight babies were born to program participants and
• Over 90% of program participants breastfed their babies.

Nuestro Futuro (Our Future) Promotoras work to decrease the incidence of children born with neural tube defects in Cameron and Hidalgo Counties in south Texas.  As a result of individual outreach and group classes providing information about folic acid consumption to thousands of people, over 96% of the participants reached signed a “compromiso” or promise to increase their consumption of folic acid and to educate an average of six others about its importance.

During the 2007?2008 program year, Promotoras directly served 1,741 people through

individual encounters, group sessions, and referrals. An additional 10,746 were reached

through health fairs, radio presentations, and other community events.

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Physical Activity and Nutrition

The Promotora Community Program (PCP) focuses on diabetes self-care management, community organizing, healthy eating and physical activity. Offered in three south Texas colonias,activities emphasize family and community based solutions that are culturally and linguistically appropriate to our population, as well as interesting and fun. Cooking and nutrition classes, exercise groups and health education sessions involve the participants in changing behavior such as consuming more vegetables and fruits, drinking less sugar-filled beverages and making physical activity a part of their daily lives.

 2009 Program participants report that their knowledge of diabetes and nutrition has increased, they now read food labels when shopping, they make better food choices, they know how to make traditional Mexican food with healthier ingredients, and they feel more energetic. And, one participant lost 60 pounds after being in the program for four months.

 Staff and community leaders also work with restaurant owner/managers to promote culturally healthy menu selections.They visit participating restaurants bi-weekly to check in and support the intervention. Restaurant managers participate in community meetings to further support the healthier life style initiative.

In 1999 and 2000, Promotoras leading the Camina Conmigo (Walk with Me) Program recorded 4,419 contacts through physical activity sessions with more than 1,500 community members and they provided nutrition education to 1,573 individuals. "The exercise sessions helped me change my lifestyle," said one community member of her experience with Camina Conmigo in the Rio Grande Valley of South Texas.

Four Promotoras in the Para Nuestra Salud (For Our Health) Program led walking groups in South Texas counties with over 1,165 participants in 2001. More than 200 women participated in physical activity at least two times each week for a minimum of 12 weeks: "This is the first time I have ever really exercised," said one community participant. The Promotoras also conducted peer education and outreach focused on women's health; 768 individuals, or 81 percent of those referred, received health care as a result.

"If it wasn't for this program…, I would have never made the time to exercise. Since I have joined the group, I feel more motivated, more energetic and agile."

-Exercise group participant

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Prevention and Control of Diabetes

In addition to addressing diabetes through the Promotora Community Program, MHP aggressively addressed diabetes through a collaborative, multi-year program called the REACH Promotora Community Coalition from 2000-2007.

Select results follow:

18 full-time and four seasonal Promotoras working in the Rio Grande Valley recorded 6,175 health encounters with over 1,000 community members. Furthermore, they enrolled over 2,800 community residents in walking and nutrition classes, provided diabetes self-management classes to over 800 individuals with diabetes, and attracted more than 500 parents to diabetes education sessions at schools.  Apart from educational classes, they led healthy cooking demonstrations, physical activity sessions and other accessible activities designed to prevent and control diabetes. Activities were based in schools, at health centers and in the community.

The Promotoras worked with Progreso and Rio Hondo Independent School Districts to replace sugary drinks from school vending machines.  They also successfully advocated for local stores in the colonias to offer low-fat milk and healthier cooking oils and for participating restaurants to place healthy-meal recipe cards on their tables.

Final results showed that walking group participants meeting the 150 minutes per week of physical activity target increased from 19.5% to 33.1%.  Cooking class participants increased their consumption of green vegetables and fruits in addition to switching from whole milk to 2%, 1% and skim milk.

"I am a diabetic… and I am grateful to this program because it has helped me better control my diabetes. I went from a 206 blood glucose level to a 106!"-Colonia resident

 

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Occupational Health and Safety

Eye Safety in the Field

During the summers of 2001-2003, Promotores(as) in Illinois and Michigan provided safety glasses to their co-workers and conducted educational activities about the importance of preventing eye injuries and illnesses. In 2001, 786 workers on 34 farms were divided into three intervention blocks:

(A) Promotores(as) provided protective eyewear and training to farm workers;

(B) Promotores(as) provided eyewear but no training to farm workers;

(C) eyewear was distributed to farm workers with no Promotores(as) present and no training.

Results from pre- and post-intervention questionnaires demonstrated greater self-reported use

of eyewear in all blocks after the intervention with Block A showing the

greatest change. And, Block A showed the greatest improvement in knowledge on questions related

to training content.  These results show that Promotores(as) are an effective way to train farm workers in eye health and safety and to improve the use of personal protective equipment and knowledge.

"All the people learned something, especially about eye illnesses... They think, 'we're just old.' They don't think it's the consequence of working in the fields, in the sun. They don't think that's why we get cataracts, pterygium, illnesses like that."

-Sandra Arellano, Promotora

 

Pesticide Safety

In the summer of 2000, Promotores(as) in Northwestern Michigan taught their co-workers and neighbors about pesticide safety, pesticide poisoning and the federal worker protection standard. They conducted 600 one-on-one educational encounters about pesticides and 26 pesticide safety group sessions with 558 people. Evaluation results reveal that the Promotores(as) reached 100 percent of the people in their camps with pesticide safety information. The Promotores(as) successfully organized their co-workers and advocated for changes in the workplace. They staged two work stoppages when they were sprayed with pesticides and informed the growers that it is illegal to spray while workers are in the field. Both growers stopped the practice of spraying while the farmworkers were at work.

"Twice, one of our Camp Health Aides and his family were working in the asparagus fields, and the grower began to spray in the same field. Our Camp Health Aide advised his family to leave the area, but some of the people did not want to leave for fear that the grower would somehow retaliate. But the Camp Health Aide reassured them that it was their right to leave the field and the grower could not retaliate, so they walked off the field. When the grower saw them leaving, he stopped and left the field so they could continue to work."

-Carmen Garcia, Program Coordinator, Pesticide Education Program, Shelby, MI and former Promotora

 

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Environmental Health

Lead Education and Prevention

No Más Plomo (No More Lead) worked for the prevention of blood-lead poisoning in selected

colonias in Hidalgo and Cameron Counties in 2007?2008. In counties positioned on the Mexico?U.S. Border, the extensive use of candies, pottery, and medicines from Mexico that contain lead make the education of colonia residents extremely important. Although only a  one?year program, No Más Plomo provided over 2,600 individual encounters and group presentations to educate residents about sources and consequences of lead poisoning and methods of lead?poisoning prevention. The program also helped residents gain access to screening and treatment for blood lead poisoning.

 

Saliendo Adelante

Saliendo Adelante (Moving Forward) was a one-year program focused on identifying and preventing direct contact with polluted water, identifying methods for water treatment and food safety.  Promotores(as) developed a presentation on symptoms of exposure to environmental toxins, poison control including household toxins, and pesticides.Community concerns about solid waste disposal led to the Saliendo Adelante Clean-Up Campaign, a one-day event in April, 2006. Over 250 families participated and 48,000 pounds of trash were collected.

 

 

Breast and Cervical Cancer Screening and Prevention

In Michigan, 65 percent of Farmworker Women Receive Annual Exams

In 2003, 45 Promotores(as) at five Migrant and Community Health Centers in Michigan worked with their farmworker peers to break down access barriers to annual gynecological exams. Through one-on-one education, Women's Health Night events at the clinics and other group activities, they ensured that 65 percent of women had received a pap test in the last year by the end of the 2003 migrant season.

"She was 53 years old and hadn't had a pap smear in 12 years. If it hadn't been for this program and the Promotoras pushing them to get their paps, she wouldn't have known she had cancer. We think because we don't have babies that we don't have to go."

-Alicia Sanchez, Program Coordinator, InterCare Community Health Network, Bangor, MI and Promotora

In Texas Women Gain Health Care and Knowledge

In 2003-2004, eight seasonal Promotoras increased breast and cervical cancer awareness and facilitated access to screening among Latinas in the border region of South Texas. Over 2,000 women received individual education or participated in Promotora-led group education sessions using Migrant Health Promotion's Nuestra Salud videos and activity guide. The Promotoras completed 2200 women’s health assessments  and over 500 individuals received cancer screening as a result.

"I enjoy what I do, I love to hear the women we refer tell us that they kept their appointments and everything went well. Others are not so lucky and have shared with us their diagnosis of breast cancer or cervical cancer. In these cases, I find comfort in that they are now aware of what is going on with their bodies and are getting the appropriate treatment and care they need."

-Lucy Ceballos Felix, Promotora and Training Specialist

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Effective Treatment of Tuberculosis

In the Rio Grande Valley, five Promotoras provided directly observed therapy (an effective treatment regime for tuberculosis) to 142 patients, conducted 370 screenings and provided education to 4,296 colonia residents in 1998. The Texas Department of Health credits the Promotoras with maintaining a 96-100 percent compliance rate for tuberculosis treatment among their colonia patients. In Texas, the overall completion rate for tuberculosis therapy for more than one year was 89 percent in 1998.⁵

 

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Children's Health Insurance

The Children's Health Coalition of the Rio Grande Valley and MHP’s Covering Kids and Families Program has reached thousands of families with essential information about the Children's Health Insurance Program (CHIP) and Children's Medicaid programs.  Coalition members helped families at regional schools apply for CHIP and Children's Medicaid and  distributed information and applications at retail stores during Covering Kids' Back-to-School Campaigns. Coalition members also worked closely together to stay abreast of rapidly changing policy and reached thousands of families with updated news. In 2006,  Promotoras helped close to one thousand Texas families apply for or renew CHIP and Children's Medicaid coverage for their children, and made referrals to Migrant Health Centers, WIC, Food Stamps and Social Security offices. "My 11 year old son has asthma. CHIP has helped my family afford taking him to regular doctor visits, occasional specialist visits and buying two prescription drugs every month. I don't know what I would do without the affordable CHIP coverage. I would have to choose between paying my light bill or purchasing my son's medication every month."

-Program participant and mother of three

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Food for Mothers and their Children

In collaboration with the Texas Department of Health and local WIC (Women, Infants and Children's Supplemental Nutrition Program) agencies, Migrant Health Promotion trained and supported six Promotoras in the WIC Outreach Program. They helped colonia women understand the process and enroll during the 2000 winter season. The Promotoras provided education to 1,200 low-income families and made more than 500 referrals; 70 percent of their WIC referrals resulted in new families receiving benefits.

In 2009, the Supplemental Nutrition Assistance Program, Para Nuestras Familias, began providing food stamp information and enrollment assistance directly to colonia residents.  66% of all those prescreened for benefits received benefits.  One of the most rewarding cases was that of Olga and her disabled husband. Olga came to the SNAP Promotora to inquire about local food banks. When asked why she had not applied for SNAP she responded that she would not qualify. The Promotora encouraged her to at least do a pre-screening which she reluctantly did. Based on the pre-screening output it was determined that could potentially qualify for SNAP. The Promotora assisted with the application and proceeded to fax it. Months later, the Promotora was surprised to see that Olga’s husband went out of his way to go to the community center and personally thank her for her kind assistance and for encouraging them. They now receive $340 per month from SNAP.

 

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Public Policy Changes

Since 2001, MHP’s La Voz Latina program has focused on community empowerment, advocacy and reproductive health and rights issues in the colonias of south Texas. Initially, Promotores were trained and supported to meet with local, state and federal legislators to advocate for more accessible reproductive health care services.  Since then, the work has expanded dramatically with increased funding over the last few years. Currently, the program operates in ten colonias with approximately 100 trained, volunteer community leaders and over 1,000 women are directly impacted each year. Of all of MHP’s programs, La Voz Latina Program involves the most individuals that have no access to health care (84%) and who lack insurance of any type (88%). Conducting the program often entails breaking through social isolation and fear faced by many women. Participants are offered educational and empowering opportunities through community meetings, community improvement projects, basic health literacy trainings, referrals for appointments, leadership network meetings, campaigns for public transportation, and radio interviews.

The program’s most recent notable achievement was the establishment of a new public transportation route. After carefully preparing, La Voz Latina participants scheduled community meetings with officials such as the Director of the Brownsville Urban System, a County Commissioner, and directors of Rio Metro Transit Company.  The goal of these meetings was to establish a public transportation route that would cross a main east-west axis road and enter an isolated colonia, Luz del Cielo. Transportation officials agreed not only to create a new route that included several communities along this main road, but added no user fees for one year, allowing previously isolated women to access health clinics, schools, and work. The Ms. Foundation (a funder of La Voz Latina) selected Lucy Felix, La Voz Latina’s Program Coordinator as one of its 2008 Gloria Steinem Women of Vision Awardees.  The Award honors women from across the country for their successful social activism and grassroots efforts.

"Wow! We met our goal of scheduling an appointment and meeting personally with our State Representatives and Senator and actually had a real conversation about our concerns regarding the colonias and the need for more health and social services."

-Promotora

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Mental Health

Promotores(as) in both seasonal farmworker camp settings and rural communities in South Texas have made an impact on the mental health of their peers.  In 2002, Promotores(as) in Colorado, Michigan and North Carolina provided education, referrals and emotional support to farmworkers with mental health, substance abuse and related concerns. They conducted a pre- and post-season survey to evaluate the impact of the Salud Para Todos Program on farmworkers' stress and depression levels. Results of the survey demonstrate that 73 percent of the farmworkers increased their knowledge about stress and depression and that 60 percent decreased their levels of stress.

Since 2006, Promotores(as) have been addressing the mental health needs of residents in 14 colonias of rural, southern Hidalgo County, Texas. The program establishes new routes to primary, preventative, and behavioral health care for medically underserved residents and helpes uninsured colonia families in the target area to improve their health and take collective action to promote health in their communities. From 2006-2009, the program had reached over 3,000 participants and:

• Increased their knowledge by 24% after attending group health education presentations  (as measured in 2008-2009) concerning topics such as depression, anxiety, substance abuse, domestic violence, teen violence and gangs, stress, and mental illness
• Made 1,139 referrals for medical or counseling services, utility assistance, local food pantries, and transportation assistance, as well as assistance enrolling in CHIP, Medicaid, and Prenatal CHIP;
• Increased the percentage of people in the service area who knew how to access medical or mental health services by 66%;
• Increased the percentage of people able to identify the signs or symptoms of depression, stress or anxiety from 84% to 95%; and

New initiatives beginning in 2009 will move closer towards integrative health care by bringing a mobile clinic and counselors directly into rural colonias, and incorporating nutrition and physical fitness education through outreach and trainings.

"We made people aware about mental health issues, and this has helped them take responsibility for their choices."

-Promotora

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HIV Testing and Prevention

Farmworker and rural communities in both “upstream” and “downstream” areas have benefitted from the peer health education of Promotores(as).  Eight adult Promotores(as) trained as HIV test counselors reached 2,286 community members in South Texas with information about HIV/AIDS, risk factors and prevention during a three-month period in 2002. They provided pre-test counseling, OraSure Tests and post-test counseling to 260 community members. These community members received services within the privacy of their own homes, in a culturally and linguistically competent manner. A growing body of research suggests that voluntary HIV testing and post-test counseling about risk factors for HIV infection can help promote reductions in sexual risk behaviors and increased condom use.^{6, 7}

In 2002, seventy-four percent of the farmworker teens participating in Michigan Infórmate activities reported an increase in health behaviors likely to prevent HIV or other sexually-transmitted infections.

"A lot of people say that they didn't know this or that about HIV when we are talking to them ... and they need to know it to protect themselves."

-Magdalena Hernandez, Promotora

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Substance Abuse and HIV Prevention with Teens

In 2009, eight Teen Health Aides at two sites documented 414 health education encounters.  They also facilitated 21 group sessions and eight theater performances on topics such as HIV/AIDS, Mental Health, Domestic Violence, and Substance Abuse, reaching approximately 775 participants.  Farmworker teens participating in Infórmate activities complete surveys designed to demonstrate the impact of the program on their lives. Teens who viewed an Infórmate theatrical performance increased their knowledge related to HIV/AIDS and STDs by 11%.  The health care providers who were trained by the Teen Health Aides increased their knowledge of health Issues affecting migrant and seasonal farmworker adolescents and of the culture of migrant and seasonal farmworker adolescents by 41% and 30% respectively.

In 2008, the Teen Health Aides at DuRussels’ and Chase Farms increased in their

knowledge from 11.1% responding with at least 85% accuracy in the pre-season survey (alcohol, tobacco and other drugs; HIV/AIDS and STIs; and community resource knowledge) to 33% responding with at least 85% accuracy in knowledge of the aforementioned topics in the post-season survey.

"If I didn't learn this stuff from Infórmate, I don't think I would learn it at all." Jason, participant

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References