Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a biweekly series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.
Jan 14, 2008 (CIDRAP News) – Planners in Texas are preparing the US/Mexico border for an influenza pandemic by drawing on a unique workforce: bilingual community health workers called promotores.
El Paso County agencies use promotores to provide outreach for numerous public health programs in border communities. (El Paso County sits across the Rio Grande from Ciudad Juarez, Mexico.) District training programs are beginning to offer innovative coursework on pandemic influenza to further promotores' roles in protecting their communities. Planners also hope that the use of promotores will surmount several of the economic, political, and linguistic challenges to preparedness in the region.
Serving a unique bilingual region
Seventy-seven percent of El Paso County's residents are Hispanic/Latino, and most residents speak Spanish at home. Conditions are difficult: El Paso is one of the poorest counties in the United States. Approximately 80,000 people live in more than 200 colonias in the county.
The Texas Secretary of State's office defines a colonia as "a residential area along the Texas-Mexico border that may lack some of the most basic living necessities, such as potable water and sewer systems, electricity, paved roads, and safe and sanitary housing."
Political issues are another barrier to health information access in the colonias. "People who come from Latin American countries are reluctant to seek government services," said Joanne Bates, MPA, MPH, health education instructor for the Emergency Preparedness Program at El Paso City-County Health and Environmental District. Mistrust can be due either to experience with systemic corruption in a country of origin or to fear of reprisal based on residency status in the United States, Bates said.
Promotores usually live in the neighborhoods or colonias they serve. "Promotores are a link to the community, a gateway to the community, a link between bureaucracy and the people," said Bates, a certified health education specialist.
The district partners with promotores trained by El Paso Community College in El Paso and Texas A&M University in College Station. Most promotores in El Paso are students, and they can usually use their training for continuing education credit.
Although many promotores volunteer their time, The Center for Housing and Urban Development at Texas A&M pays its promotores through an AmeriCorps VISTA program. Several promotores from the community college are international students from Latin America with previous training as doctors and nurses, Bates said.
Promotores forged relationships with El Paso residents in 2006 when a massive flood forced evacuations and caused home destruction in El Paso and Juarez. "In one area, they said that we were the first people they'd seen come and check on them. They were grateful to know that there are people who care about them," she added.
When preparedness runs up against poverty
The flood underscored the importance of family preparedness, a challenge for a county with 25% of households living in poverty.
"How do you teach a family to stockpile bottled water when they're living paycheck to paycheck? You can't stockpile a disaster kit like that," Bates said.
The district uses a shopping list that allows families to stockpile specific items over 5 months. Promotores also are establishing relationships with faith-based organizations that may alleviate some of the economic burden of preparedness.
El Paso's proximity to the Mexican border adds the 1.7 million residents of Ciudad Juarez to promotores' Spanish-speaking audience in El Paso.
"Our community's so unique—there really isn't a border," Bates said, referring to the movement of workers and schoolchildren. "When you talk about [Strategic National Stockpile] planning, we can't discount the population of Juarez. It benefits us to be planning for them."
Pandemic preparedness education for El Paso promotores uses a train-the-trainer format. Promotores educate other community members to provide preparedness services and are strengthening peer networks between El Paso and Juarez. Promotores from El Paso recently partnered with Paso del Norte Health Foundation to distribute information on pandemic preparedness to Mexican promotores.
Forming, and informing, promotores
The USA Center for Rural Public Health Preparedness at Texas A&M conducts much of the pandemic-related training for promotores in McAllen, Laredo, and El Paso. Recruitment of promotores began in September 2005, and their training centered on basic infection control tips.
The course served as an entree with several groups of promotores in the region. "We find that speaking in Spanish and going to talk to them face-to-face is very helpful. The culture is one where getting to know you is important," said Kay Carpender, assistant director of the USA Center for Rural Public Health Preparedness.
In the summer of 2007, the center held courses for promotores on communicating pandemic flu risk to the public. Speakers delivered the trainings in Spanish, but they occasionally used English to familiarize promotores with clinical terms. Facilitators used a workshop format to allow promotores to develop uniquely tailored risk communication messages in groups. Promotores also received a bilingual handbook with bold, colorful pictures to use as a resource in the field.
"Emergency preparedness to a promotora is probably not as important as diabetes, tuberculosis, and sanitary conditions," Carpender said. The center has found, however, that promotores embrace the concept of preparedness when staff members listen closely to their training needs.
For instance, promotores recently requested training on mental health during an influenza pandemic, because they wanted to bring that information back to their communities, said Annie Graham, project coordinator for the USA Center for Rural Public Health Preparedness.
"Promotores really help people get the services they need," Bates added.
View tools and reviewers' comments for the "Promotores for Pandemic Influenza" practice