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Promotores de Salud: above all, love and commitment

In the summer of 2023, the routine of Fabiola Carrasco, community health worker for Puentes de Salud, feels easier than it did in 2021. At that time, she faced unprecedented challenges breaking down the barriers between COVID-19 vaccines and hundreds of thousands of Latinos who, for various reasons, did not have access to them.

When Fabiola first started she would go out to the Latino communities of South Philadelphia and be greeted with rejections, doubts and fears regarding vaccines, she faces a far friendlier present. Today, she is known as a trusted messenger in her community. The worst moments of the pandemic are over, and you can see it in her smile, the same one she shows throughout our interview.

Fabiola along with more than 500 other community health workers were part of the Community Health Workers /Promotores Initiative of the “Vaccines for All” program, a project of the National Alliance for Hispanic Health (the Alliance) that brought vaccines to Latino communities.

In 2021, Latinos in the United States continued to be impacted disproportionately by the COVID-19 pandemic. Data from the Kaiser Family Foundation (KFF) – a non-profit organization focused on national health issues – indicated that Hispanics had infection rates much higher than their representation in the population.

Moreover, according to Dr. Bibiana Mancera, Director of Community Engagement at the Border Biomedical Research Center at the University of Texas at El Paso (UTEP) during the pandemic “Latinos were dying at a rate 2.5 times greater than other non-Hispanic groups”.

It was this situation that prompted the Alliance to work with community-based organizations to face this challenge head on. They turned to Puentes de Salud, an organization dedicated to promoting the well-being of Latinos in South Philadelphia through health and education. They stood out for having in place a network of community health workers who could be trained to give information about the vaccines and while some were even able to give the vaccine directly.

A different experience

Fabiola's career did not start with the pandemic. After completing her nursing studies in Mexico, she emigrated to the United States, where she and her husband owned a store and a restaurant. But her work has always been tied to the Hispanic community, and 10 years ago it became even more so, when she joined Puentes de Salud.

“I have been a community health worker for more than 10 years, since Puentes de Salud was founded. We have always had different types of projects centered on other diseases such as diabetes and cervical cancer. When the pandemic came, we had to switch gears and start working on issues such as promoting the COVID-19 vaccine and providing overall health advice," Carrasco said.

Despite having experience serving communities around health issues, the arrival of COVID-19 represented a different reality for her. She witnessed the vulnerability faced by many Latinos who did not have health insurance - a situation many of them still face, and that has made it more difficult to access adequate health care. She learned first-hand the frustration of those who do not know how to speak English and, consequently, found it difficult to express themselves when receiving care.

Another drawback was that a significant proportion of Latinos were front-line workers, which exposed them more to the virus. Some had to choose between going to work or risk losing their jobs.

According to a Pew Research Center survey, as of July 2021, 45% of Hispanic adults have had jobs that required them to be away from home in the past year and a half. The same study indicated that around 62% of Latinos had financial problems, such as complications paying bills or having to buy food from a food bank. In that same month of July 2021, KFF data estimated that only 41% of the Latino population had received the vaccines, a figure below that of other groups such as Non-Hispanic Whites (48%) or Asians (65%).

Although by July 2021 doses had been available in the country for at least six months, COVID-19 vaccination still presented great challenges. One of them was that, because of the misinformation campaigns about vaccines, many Latinos were afraid to get vaccinated out of fear of the supposed unfavorable side effects. Fabiola's work, along with those of other community health workers, consisted of dispelling rumors, facilitating access to vaccines, and getting people in her community immunized.

“Yes, it was different this time, there was always the taboo of fear, the fear of a new vaccine. They asked me: 'what are the symptoms? What are the risks that can happen?'. Many girls said: “I'm pregnant. I can't have that vaccine because I don't know if my child is going to have a bad birth' or 'I want to get pregnant in the future and I don't want something to affect my system', or things like I'm sick and the vaccine could make my health worse”, commented Fabiola.

Perseverance and hard work were the best tools for Fabiola to successfully overcome this situation. The recognition she had enjoyed and the trust she had earned as a community health worker for more than a decade allowed her to easily disseminate information about vaccines to neighbors and friends so that they could share it with more people.

And, in a change from what she had done on previous occasions, the community health workers worked in mobile clinics, that is, they were stationed in public spaces within the communities themselves, such as stores, schools, or churches. This represented the biggest challenge for her, due to the logistical aspects and the number of people to serve.

“You couldn't go to a clinic to get the vaccine? There was a mobile clinic near where you live. There was a very well-organized team to do it, which was there to deliver the first and second doses. For me it was exceptional, it was something great because it was not the work of only one person (…) The place, the time, the space, everything was a challenge, but in the end the challenge was met. When I saw that we had a mobile clinic and 100 or 200 people were vaccinated, it was exciting,” she said.

The results of this effort spoke for themselves. In it’s first two tears, the “Vaccines for All” program trained over 500 community health workers in more than 41 communities and managed to provide more than 760,000 doses of flu and COVID-19 vaccine to Latinos. Additionally, the information provided by these community health workers achieved a change in attitudes towards vaccines in those people who previously refused to be immunized.

In Fabiola’s opinion, “now many people who speak about vaccines don't have the same fear as they did at the beginning, people are more informed, and they tell you 'I can't die because I have both vaccines'”.

Goal Achieved

According to data from the CDC, as of February 2023, 88.2% of Latinos in the United States had received at least one dose of the COVID-19 vaccine, which is comparable to 87.1% of non-Hispanic white people. This represents a quick closing of the gap with the non-Hispanic white population, a testament to the importance of the work of promotores de salud such as Fabiola.

The work of Fabiola and the more than 500 Community Health Workers/Promotores is part of the efforts under the “Vaccines for All” program led by the Alliance. “It feels like a weight has been lifted off your shoulders,” Carrasco said. For her, the achievements are more than figures, they are also life lessons that marked her career.

“Personally, I learned a lot. I learned from people, from vaccines, to deal with the stress of each person; to give them confidence and encourage them”, said Fabiola, adding that the profile of a community health worker can be summed up in “above all, love and commitment”.


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