By Anne Blythe

Viviana Martinez-Bianchi, a Duke physician who has elevated Latino voices from humble lunch tables to halls of power throughout the coronavirus pandemic, testified before members of the U.S. Congress in late September about one of the silver linings from the past 18 months.

Community health workers.

Known as “promotores de salud” in Spanish, and widely deployed throughout Latin America, community health workers are the trained people who go into neighborhoods and workplaces to deliver crucial public health information. They have helped increase vaccination rates, guided parents and children to critical COVID testing, and provided a long-needed bridge from difficult-to-access health care systems to underserved populations.

Throughout the pandemic, many Latino organizations deployed teams of these workers to neighborhoods and events where the community health workers understood the culture of those they were trying to help, while also speaking their language.

“Community health workers are integral to the successful deployment of health care in the community,” Martinez-Bianchi told a joint meeting of two subcommittees of the House Committee on Education and Labor in late September.

Employing community health workers throughout North Carolina has been a long-held goal but was jump-started by the pandemic. The state Department of Health and Human Services started exploring the possibility of a community health worker initiative in October 2014.

In 2018, a group of stakeholders who held summits and listening sessions after looking at similar initiatives in other southeastern states issued a report with recommendations for how to get such a project off the ground.

By August 2020, the state announced the selection of seven vendors that would hire and manage more than 250 community health workers to be deployed to 50 counties.

Having an impact

Curamericas Global, which has an office in Raleigh, was selected to help launch initiatives in Alamance, Buncombe, Chatham, Craven, Davidson, Davie, Durham, Franklin, Forsyth, Gaston, Granville, Guilford, Harnett, Henderson, Johnston, Lee, Onslow, Orange, Pitt, Randolph, Surry, Warren, Wake, Wayne, Wilkes and Vance counties.

Andrew Herrera, executive director of Curamericas Global, joined a recent Zoom meeting of the Latinx Advocacy Team and Interdisciplinary Network for COVID-19, or LATIN-19, an organization founded by Martinez-Bianchi and several of her fellow Latina health care workers.

Herrera’s organization began reaching out to Spanish-speaking families across North Carolina in the early days of the pandemic when it was clear that Hispanic residents were being hit disproportionately hard by COVID-19. Many were on the frontlines, working in food processing plants, grocery stores, the construction industry and other jobs deemed essential that often did not provide opportunities for social distancing or working from home. 

Though nearly 10 percent of the North Carolina population identifies as Hispanic, they represented 44 percent of the COVID cases in July 2020.

Curamericas initially worked in partnership with the Consulate General of Guatemala in Raleigh to get more than 500 volunteers out to reach 10,000 Latino families by August 2020. Now the organization is working with 19 community-based organizations that already had crucial connections in the 26-county region, as well as paying workers at least $20 per hour, according to the organization’s website.

Some of those community-based partners include El Centro Hispano, where Fiorella Horna is the COVID-19 Project leader to 40 community health workers in the Triangle area. She pointed out that by September of this year, Latinos represented 18 percent of the COVID cases, a large drop from the July 2020 peak.

“I will send this to my community health workers often, I’ll share the dashboard and say, ‘Hey you guys, this is what we’re impacting. A little bit of what you’re doing is leveling the field,’” Horna said during the LATIN-19 Zoom call.

Find, teach and connect

In recognition of the impact that community health workers have had during the pandemic, DHHS announced that North Carolina was recently awarded $9 million, or $3 million for each of the next three years, in federal aid to expand the Community Health Worker Initiative to all 100 counties.

Maggie Sauer, director of the DHHS Office of Rural Health, said community health workers can help improve equity in access to care for communities that have faced systemic barriers for decades.

Horna and others who have worked with the community health workers during the pandemic explained how these teams connect to someone who might need help overcoming such obstacles.

“As part of their work, they know that their role as a community health worker, a trusted community leader, is to find,” Horna said.

“They’ll go into neighborhoods, they’ll go to work sites, they’ll go to shopping centers, laundromats, churches, businesses, wherever you need to find people.”

The mission, Horna said, is for them to “find, teach and connect.”

Thinking beyond the pandemic

Many are out in red or green T-shirts, approaching people and trying to get them information in bite-size pieces. Their job has evolved.

“The first six months of COVID, everyone was like, ‘Oh my gosh, what’s this virus?” Virus, virus, virus,” Horna said. “Then the next six months, it was ‘Oh my gosh, we have vaccine, what’s this about the vaccine?’ Vaccine, vaccine, vaccine. Now we’re in this mode where we’re like, ‘Let us talk about your health, your mental health, your well-being and what are you doing to stay safe.’ And then we can couch the conversations about the vaccine and testing.”

More recently, the community health workers have been getting questions about vaccine boosters, how to find COVID tests as schools reopened and queries about when children younger than 12 will be eligible for a COVID vaccine.

“The most important part of our work is community support,” Horna said. “Our community health workers are our eyes and ears in the community, but they are also those providing the support, giving the motivation, checking in on people who are anxious, feeling depressed.”

The community health workers can lend a needed ear, then connect people to resources they might not otherwise have known existed.

“It’s still there you guys, I know you guys know it, that people are heavy-laden with what’s going on,” Horna said. “So our community health workers are there and they bring them back to those community support entities at El Centro to do food or housing, or maybe it’s financial assistance or maybe it’s just having someone on the phone to talk to, a lot of that lately, so maybe it’s just somebody on the phone.”

Think outside the box

Martinez-Bianchi and others on the weekly LATIN-19 Zoom calls would like to see the community health workers used more, potentially even trained to administer vaccines to the homebound and others who have trouble getting to a health center for care.

“My hope is that we can go beyond the pandemic and continue to have community health worker teams sustainably funded, not just during an emergency crisis,” Martinez-Bianchi said. “There are crises happening all of the time. There are multiple epidemics that are happening to our community.”

She mentioned the high rate of uninsured people in the Latino community, particularly in Durham and Orange counties, which have many places to get health care such as Lincoln Community Health Center, Duke Health, UNC Health, Piedmont Health and private practices that are not always easy to navigate.

“Latinos in the rest of the country are about 26 percent uninsured,” Martinez-Bianchi said, citing an ABC11 report. “When we come to Durham and Orange counties, we are talking about 37 percent of Latinos without insurance. 

“That really marginalizes our community, so a community health worker program that can work together with Lincoln, with Duke, with other private practices and multiple practices in the area… we really need to think outside of the box about how we provide family health care. …The pandemic has really unveiled so many different problems.”

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