A woman in her late 60’s experiences chest pain, shortness of breath and fatigue. “Son los síntomas de un ataque al corazón” (You may be having a heart attack),” a friend tells her and proceeds to call 911 for help.
“Muy bien” (very good), calls out Florencia López, prompting other women to break into applause. López is a community health advocate or promotora, teaching a class on heart health to a group of Ramona Gardens seniors during their regular weekly meeting.
While not an improbable scenario, the incident is only a reenactment of what López had just gone over with the women: how to recognize the symptoms of a heart attack and what to do when they occur. The class is part of the Ramona Gardens Women’s Health Initiative, a program created to use promotoras to deliver practical and useful health information to women in this traditionally underserved and isolated community.
“A lot of the research show us that women are the primary decision makers when it comes to health in the family,” says Zul Surani, Executive Director of the University of Southern California’s Health Sciences Campus (HSC) Community Partnerships. “They control the kitchen, control what everyone eats, and in some cases, the health care decision making.”
The Ramona Gardens Womens’ Health Initiative is the result of a collaboration between HSC Community Partnerships and Clínica Monseñor Romero, a Boyle Heights community clinic that has been successful with its promotora program in Ramona Gardens.
Funded by a one-year $30,000 grant from the USC Good Neighbors Campaign (who also funds Boyle Heights Beat), the program hired and trained 18 promotoras ””all women but one”“ to learn and then teach a three-part curriculum on heart health.
According to Surani, the curriculum was created by the National Heart, Lung and Blood Institute but adapted to the local community, translated to Spanish and researched and tested by USC.
“We have experts that we can leverage to train the promotoras,” says Surani. “The promotoras are really connectors, brokering this really valuable information to the community.”
Training the promotoras
On a cold late January morning, the promotoras are gathered in a meeting room at Clínica Monseñor Romero, across the Los Angeles County-USC Medical Center on Marengo Street. Martha González, a Ramona Gardens resident and experienced promotora working for the clinic, leads the discussion. She asks about the first round of classes, the ones devoted to heart attacks.
Some of the promotoras ”“who range from young mothers in their 20s to grandmothers in their late 50s”“ say they have already instituted lifestyle changes in their families, as a result of what they learned in preparation for their classes.
For this session, the subject is hypertension. Reyna Díaz, a clinical project manager at the Keck School of Medicine of USC, takes over the lesson which begins by introducing the scientific terminology. With González at her side, Díaz goes over the teaching materials and demonstrates useful tips, like measuring out the amount of salt recommended for daily consumption.
The discussion is held mostly in Spanish, with some clarification in English for a woman who says she’s a pocha. Sitting among the women, Gabriel Ãguila stands out as the single male promotor.
Liliana Martínez, 54, takes careful notes.
“I wanted to participate [in the Women’s Health Initiative] because I think it’s important that our community is better informed,” Martinez later says in Spanish. “We don’t take care of ourselves.”
Finding out that she developed diabetes while she was pregnant with her daughter, now 25, was a life-changing moment for Martínez. “I had no idea of what diabetes was,” she says. “I heard the word ‘diabetes’ and I thought I was going to die, that it was like a cancer. I think the important thing to know is that you can live with this disease.”
Martínez said she became active in Ramona Gardens when her children began going to school and she joined the Parent Teacher Association (PTA). “If we want to see change [in our environment], it’s important that we begin with ourselves,” she states.
Taking it home
A couple of weeks later, on a sunny February morning, Martínez and two other promotoras are jointly teaching the hypertension class to a group of about 20 Ramona Gardens women of all ages.
A lot of the lesson centers on the evils of processed foods with high levels of sodium; attendees are impressed when they see the small amount of salt considered safe for daily consumption.
“Everything they talked about [that is wrong] is what I’m doing,” says Patricia Maldonado, 35. “I’m using too much salt, I’m overweight. Now I want to make changes for my children.”
Rosa Aguilar, 39, says she is overweight and is taking the class because she is afraid of developing diabetes. “We really need to know a lot of about our health,” she says. “We as latinas forget about ourselves to take care of our families.”
“I thought it was a lot of good information,” says Emily Hernández, 19. “Some of it I already knew, but it was good to learn more.”
After the class, a “healthier” lunch of turkey sandwiches on wheat bread with plenty of fresh vegetables on the side is offered. “I think women in our community are becoming aware”, says promotora Martinez.
Long term effects
With all three rounds of training and community classes completed, the Ramona Gardens Women’s Health Initiative now goes through an evaluation phase, with the expectation that a new grant will bring back the promotoras for sessions on diabetes and cancer.
But Surani hopes that the initiative also succeeds in connecting the Ramona Gardens community to nearby resources.
“There are a lot of people that still don’t have doctors that live in Ramona Gardens,” says Surani. “They can be connected to the Clínica, but also to other resources, like the County Wellness Center. We really want them to be plugged into this amazing new resource in the area of prevention, where they are able to get a heart healthy cooking demonstration, free exercises at the YMCA or at a real minimal cost.”
While accessing these resources still proves to be a challenge to the elderly and other physically challenged residents of Ramona Gardens, Surani hopes that data culled from this initiative may help those advocating for additional transportation resources in the neighborhood.