By Rachel Bloom-Pojar
I am what academics might call a community-engaged researcher. Much of my research and writing involves telling people in positions of power (teachers, healthcare practitioners, health communicators) about how much they can learn from communities and their communication practices. I am interested in learning about ways that institutions can better invest their time and money toward building relationships and supporting the expertise that is already present in the community. It’s quite simple, really, but I think it’s important work. I don’t see myself as an expert, but rather, I try to leverage my privileges and resources to support and sustain the communities that I work with. Thanks to a Mellon/ACLS Scholars and Society Fellowship, I’m spending the 2020-2021 academic year working as a fellow at Planned Parenthood of Wisconsin (PPWI) with their Promotores de Salud Program. My role with this work is a bit like an intern and a resident researcher. Part of my time is spent in meetings and planning activities for ongoing educational programming with the promotores and the other part is spent with research activities (like interviews, focus groups, analyzing data, and writing) that are focused on highlighting the work of the promotores. So, while my colleagues are figuring out teaching online in a pandemic, I’m figuring out what it means to do community-engaged research remotely. A topic that is constantly on my mind is access.
Access and barriers to access have long been topics of interest for healthcare practitioners, researchers, and policy makers. They impact how healthy a community is and how well (or not) a healthcare system meets that community’s needs. Networks of access include many different aspects such as transportation, food security, housing, social services, family life, and more. Not only do people face barriers to accessing quality healthcare, but institutions often also face barriers to the ways they can access and connect with communities. Many of these barriers are inherent in the ways the healthcare system is set up to privilege spaces, professionals, and language practices that are separate from local communities—especially immigrant communities. One way that institutions try to “reach” Spanish-speaking immigrant communities is through promotores de salud (health promoters). Promotores de salud are often seen as lay people who can educate their communities about health information and transmit messages from institutions that are trying to reach the people where they live. Too often, the direction of information is top-down in the ways it moves from the healthcare institution to the community.
The hope is that improving access to information can lead to a decrease in health disparities and an increase in the utilization of healthcare services by these communities. But what about the information and education that can come from the community to inform and make positive changes to institutions? Part of my work this year is to lift up the stories, experiences, and expertise of the promotores de salud to help identify ways that the healthcare system might transform into something that is more just, equitable, and accessible.
So, what do these promotores de salud do? The specific role takes on different shapes depending on where they work and what institution they’re affiliated with. The promotores that I’m working with are experts in creating confianza (trust/confidence) and connecting people to resources. By building confianza with their communities, people open up to them about all sorts of things going on in their lives. They use a curriculum (CCmás) about sexual and reproductive health that was developed with input from the community. This curriculum is taught through conversations at Home Health Parties, or Fiestas Caseras, which were modeled after the Avon business model of gathering for a party in people’s homes and working as consultants. These fiestas caseras provide the space for the promotores to facilitate conversations about a range of topics on sexual health, reproductive justice, advocacy, and empowering the community. Through the support of various grants, the promotores also support non-partisan activities for civic participation by encouraging and assisting people with filling out the census and registering to vote. With the current pandemic, some of the promotores have turned to virtual gatherings to host Fiestas Caseras, and all of them continue to help connect people to resources available for legal issues, bill payments, health services, and more.
The promotores may work in similar roles with other organizations and many of them have other jobs in addition to their work with PPWI. They live within Latinx communities across the state of Wisconsin and they understand the daily challenges and injustices that immigrants from Latin America face while helping uphold essential businesses and our economy. With an understanding of the intersecting oppressions that their communities face, the promotores see their work as part of reproductive justice. By advocating for “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities” (SisterSong), they understand that the challenges immigrant communities face in reproductive healthcare is more than simply whether or not they have access to clinics and information about reproductive health. It is impacted by whether they can pay their bills, whether they have safe environments in their homes, whether they have been denied the option to choose whether or not to have more children, whether their children face danger in the U.S. or other countries, and so much more. This complex understanding of the realities that immigrant communities face in the U.S. could inform more holistic, equitable, and compassionate approaches to healthcare.
Health promoters are experts that researchers, administrators, and practitioners should learn from and compensate for their expertise. If their expertise and experience was valued as much as the credentials of our health providers, then we might see our community education models become more dynamic in the ways that institutions could be informed by communities and relationships between them could become more mutually beneficial.
Rachel Bloom-Pojar is an Associate Professor with the program in Public Rhetorics and Community Engagement at UW-Milwaukee and a Mellon/ACLS Scholars and Society fellow with Planned Parenthood of Wisconsin.