Promotoras Guide Uninsured Coachella Valley Residents to Heal Services

Promotoras now play a key role in connecting communities to health services. Photo by Jonathan Olivares

When Yesenia Ortiz met Maria, a few years ago, Maria was a short thin woman with dark hair and bright eyes that had started unexpectedly losing a significant amount of weight. At her thinnest, Maria, who was originally 115 pounds went down to 78 pounds. She was also experiencing pain and a burning sensation in her stomach and throat. In addition to worrying about her health, she also worried about being uninsured and not having access to care.

Which is why Ortiz, a certified enrollment counselor for healthcare services in the Eastern Coachella Valley, became so important to Maria. Ortiz helps applicants navigate through the county's complicated process of accessing health care services, something that can be challenging for most people.

However, Ortiz's work is more nuanced than just explaining forms or pointing people to the next line they should stand in. More than just an enrollment officer, Ortiz is also what is known as a promotora and plays an essential role in connecting immigrants with urgent health care services. Promotoras or promotoras de salud (Spanish for health promoter ) are lay health-care advisers, traditionally within Latino communities.

To a large extent, in addition to guiding applicants through the application and enrollment process, the success of promotoras like Yesenia Ortiz relies largely on their cultural sensitivity to the significant Latino population that seek the services. By engendering credibility and trust within the community, their role is not only to give applicants information, but to bridge the needs of applicants with a county system that does not offer much or any assistance.

Ortiz and other members of the team at local non-profit Clinicas Salud Del Pueblo helped Maria enroll into the Medically Indigent Services Program (MISP). While MISP is not an insurance, it is meant to be used on an emergency basis and does not include prenatal, dental, or mental health services for adults between the ages of 21 and 64 and is only accepted at county health centers such as Clinicas Salud Del Pueblo where Ortiz is based.

Clinicas Salud del Pueblo make sure to reach out to residents of the Eastern Coachella Valley across widespread Riverside County. Photo by Paulina Rojas.

The Medically Indigent Services Program, an emergency health services program is geared to some of Riverside County's most vulnerable --low income residents that do not have health insurance coverage -- is particularly mired in complications. Moreover, in counties such as Riverside, MISP is one of the few services available to immigrant workers, including the undocumented. Currently there are 6,680 people enrolled in the program.

Like Maria, the applicants Ortiz works with in the Eastern Coachella Valley are largely immigrants that speak or read little to no English, some can't read or write at all. Some are undocumented and are fearful of exposing themselves to government officials.

Ortiz has witnessed however, that despite these challenges, applicants finally come forward to access services when their health symptoms become intolerable, urgent. Often the process of seeking and acquiring help can seem almost equally unbearable.

I used to cry a lot because I felt like I had nowhere to go Maria said in Spanish. It was very difficult for me, I would always pray and ask god for mercy.

For Maria, having the assistance of experts such as Yesenia, readily available to assist her made experience in getting the care that she needed a lot easier.

Agricultural labor relies on low-wage workers, including undocumented immigrants that are often vulnerable as they are exposed to high-risk environments but do not have access to comprehensive health care.

Ortiz has noticed that like Maria, many of the applicants that she assists in the Eastern Coachella Valley often have difficulties accessing the program due to the fact that they live in isolated and rural communities. Many times, applicants do not have cars and rely on rides or on sparse public transportation.

When applying for MISP here in the valley there is an application issue because most people that are applying to MISP are living in Mecca, Thermal or farther out east, she said.

However, late in 2015 an MISP enrollment officer started going to Mecca on the fourth Monday of every month for a few hours, making it slightly easier for residents to apply and enroll in the program. Before then, most applicants from the east valley would have to travel to Indio to submit their application. While this has helped alleviate those in need, Ortiz says it is not enough.

It would be nice if they had someone there all day, Ortiz said. Clinicas Salud del Pueblo also provides free transportation to any of their sites. All patients have to do is call 24 hours in advance and a van will take them to and from their appointment.

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If needed, members of the outreach team make house calls to help people apply for programs such as MISP.

In addition to lack of transportation potential applicants are often deterred from applying to MISP by the convoluted process and the lack of information about it. Ortiz said that some of the people applying dont know how to read or get easily confused by the complicated vocabulary. Promotoras always suggest that applicants come into the clinic or to call for assistance. This helps eliminate any complications that might come up during the application process.

Also, Ortiz and other Clinicas Salud del Pueblo staff are bilingual. All promotoras on the team speak both English and Spanish. You understand more than the language, it is the culture, Ortiz said. You know where they are coming from.

It's not just a job, we go beyond to see how we can help, we dont just limit ourselv

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