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Community Health Worker - Archived Newsletters
Section Newsletter
Winter 2005

Message from the Chair

January 2005

Dear Colleagues:

Greetings to all and welcome to the CHW SPIG newsletter experience. I hope you all enjoyed the holiday season across the country! Please share this with many, especially public health professionals like other CHWs!

We have, once again, coordinated a very successful series of sessions during the APHA Annual Meeting, which was held during November 2004 in D.C. I want to thank everyone who was active in helping out before and during the Meeting. I want to thank all of the presenters; our preliminary feedback was excellent! I especially want to thank all of the CHWs who presented, many of whom put public health theory into practice with music and movement as well as with practical information, during our sessions. I also want to recognize the presentations and contributions of youth peer educators/CHWs from California and Washington, D.C., who participated in our annual youth focused session. Every session was well attended, informative and many were down right fun and exciting. We continue to reach our goal, which is to have participants of our sessions walk away with information and knowledge they can utilize and replicate when they return to the communities they serve.

Our business and program planning meetings during the Annual Meeting were enlightening and productive. During our 6:30 a.m. Business Meeting, we packed the room with over 30 people as we welcomed new members, shared committee reports and updates and facilitated brainstorming sessions to inform our activities for the upcoming year. I want to thank everyone who participated in these meetings and gave us valuable insight and new energy. My hope is that many of the people who attended will continue to stay active in the SPIG and in the CHW movement across the country. We had representatives from all across the country and from at least seven CHW networks/associations.

Have you made any “new” CHW Connections since our last newsletter? In the last edition of the SPIG newsletter I recommended that all CHWs begin scheduling a set time each month (or week if possible) to connect with other CHWs that are not part of their agency or discipline. It is my belief that we must create formal and informal bridges between CHWs and CHW networks across this country as we further develop and define ourselves. If you haven’t instituted a time for “CHW Connections,” it’s time! And if you have, please continue to connect, support, and educate each other! The SPIG will do our part by continuing to post contact information for CHW networks and associations. We also will host conference calls and meetings during conferences year round to help connect CHWs and their allies and partners.

In December I attended a forum hosted by our state’s Department of Public Health Commissioner. It was one of a series of “Public Health in the 21st Century” forums. This was the only forum held that focused on youth, and approximately 100 youth attended and many gave comments and a few represented their peer education programs on a panel that raised awareness about the plight of many youth programs in the state. I also was able to make public comments and deliver a seven-page article regarding youth peer educators and CHWs entitled, “A CHW’s view on creative ways to stem the tide of youth violence in Boston, Massachusetts” and potentially this whole country. In this article I discuss some issues regarding youth violence in my community from the heart. I then go on to give some recommendations on areas to explore sustained funding for CHWs/peer educators including community benefits programs, empowerment zone/development community linkage funds, HMOs, colleges/universities and policy makers/legislators. I’m advocating for us to continue to maximize the cyclical, categorical funding we currently receive but create new sustained funding sources for more holistic, generalist CHWs and peer educators.

As always I urge all of you to join our SPIG, become active in leadership and share information about the state of CHWs in your city, state and region. I’ll speak about SPIG leadership in our next edition as I prepare to pass the gavel to our Chair-Elect. As that occurs we are looking for more current CHWs (CHWs working in the field) to become active in the SPIG as we continue our mission to have strong CHW leaders and leadership.

Durrell J. Fox
Chair, 2003-2005

CHWs Rock APHA in 2004!

Anyone walking into the McPherson room of the Grand Hyatt Hotel in Washington, D.C., at 8:30 on Monday, Nov. 8 could be forgiven for thinking they might not be at a session of American Public Health Association’s 132nd Annual Meeting. The room was packed with community health workers, program directors, health care providers and college professors-throwing a beach ball around the room and dancing! We were being led through our exercises by Sra. Isabel Esteves Bello. As a participant in nutrition and physical activity classes at a clinic in Woodland, Calif., Sra. Bello integrated what she learned into her daily behavior. She then took the information back to her home in El Potrero, Mexico, and developed a promotora-led healthy lifestyles group for women in their tercera edad (senior years). This was the start of the wonderful three-day program of the Community Health Worker Special Primary Interest Group (CHW SPIG) of APHA.

Sra. Bello was one of more than 50 CHW presenters in the CHW SPIG’s program this year as part of our special effort to ensure CHW leadership and participation in our program. The over 350 participants who attended our eight oral sessions heard directly from CHW presenters about their role in chronic disease management, health care delivery, outreach to diverse communities, training and program evaluation. We heard from CHWs developing a new home visiting program in a New York City managed care organization, to CHWs working with Native American teen parents on a reservation in rural Arizona. Local youth who run their own teen clinic provided a dynamic and inspiring vision of the future of community health work.

Our Round Table Session, which was new this year, allowed participants to meet presenters in small groups and engage them in lively and rich discussion about their programs. Energetic popular educators from Oregon competed for attention with a CHW training program from Florida and eight other innovative CHW programs as participants moved around the room to sample the range and diversity of CHW work.

Once again, our social hour proved to be a big success, as we honored a special supporter of the SPIG for many years, J. Nell Brownstein of the Centers for Disease Control and Prevention. And once again we were surprised and amazed at the great turnout and energy at our 6:30 a.m. Business Meeting!

Thanks to all of those who helped to make this program such a success, and we hope to see you at next year’s Annual Meeting in New Orleans.

Training for Community Health Workers in Trinidad & Tobago

In February 2004, my employer asked if I had any ideas how the government of the Republic of Trinidad and Tobago might begin to develop community capacity to address the crisis of HIV/AIDS in that country. This was part of a much larger effort to exchange clinical information and technology, create clinical facilities, and improve access to health-care services for people living with HIV and AIDS (PLWHA).

I was told that the country has high levels of poverty, unemployment, substance use and soaring HIV/AIDS incidence rates. They also have limited clinical resources and inadequate supplies and medications. Although certainly overwhelming, I quickly realized that this is just the set of circumstances in which many of us Community Health Workers (CHWs) function most of the time. Through my experiences with members of the Community Health Worker Network of NYC and other CHWs who work with PLWHA, I knew that the CHW model was the way to go.

So, I suggested that the government of the Republic of Trinidad and Tobago would do well to develop the CHW model and support CHW programs to address this crisis. Wow, was I ever surprised a few weeks later when I was told the government liked the idea and asked if I would help them develop this CHW model. They wanted help to identify potential CHWs, assess their needs, and create training programs that would help them develop the skills to address this public health crisis. In April 2004 I traveled to Trinidad and Tobago to meet with people already doing this work, albeit in a fragmented and unsupported way. What I found was shocking!

Trinidad and Tobago is a two-island country at the southwestern end of the chain of Caribbean Islands and is located about seven miles east of Venezuela. The HIV/AIDS epidemic is certainly a worldwide crisis. However, as big a problem as it still is in our country, we must recognize that we have come a long way as a society in regards to how we look at the problem. Nothing makes this progress clearer than considering the struggles of less fortunate nations.

In the case of Trinidad and Tobago, the HIV/AIDS problem is viewed by the public the way it was viewed by North Americans in the mid-1980s. People living with HIV/AIDS (PLWHA) in Trinidad and Tobago have limited clinical services, an insufficient supply of medications, social isolation, and social stigma that often leaves them sick, homeless, unemployed, alone and living in poverty. This social climate is the product of misconceptions about PLWHA and misinformation about the disease in general.

Much of the irrational fear we experienced in the United States in the early days of the AIDS epidemic -- such as fear that you can catch it from being in the same room as someone or from brief physical contact, like a handshake -- are prevalent there. Many people believe that HIV is not transmitted through anal sex (because that is not considered “real” sex) or that smoking marijuana before or during sex will protect you from transmitting or contracting the virus. Folk myths like these have contributed to the spread of HIV/AIDS and hampered prevention efforts. Another complicating factor is the prevalence of fundamentalist religious extremism which preaches condemnation and abstinence as the solution to this public health crisis. Because of widespread social hysteria and religious extremism, people who test positive for HIV are often fired from their jobs, expelled by their families and dispossessed by their landlords. This social victimization of PLWHA, coupled with a lack of confidentiality about individuals’ medical information, has also led to a reluctance to get tested by people at risk, further complicating treatment and prevention efforts.

In a way very similar to the birth of the Gay Men’s Health Crisis (GMHC) here in NYC, the main support for PLWHA in this country are other PLWHAs. In homes, villages and homeless settlements everywhere, it is other PLWHAs that are caring for those suffering the most from the ravages of this disease. Also similar to our early experiences here in this country, these CHWs are mainly providing end-of-life services and supports. And most of them do it for free – out of a personal commitment to PLWHA and to their communities. They call themselves, “volunteers.” Many did not know they were community health workers, although they had certainly heard the name. However, they quickly adopted the title and found comfort in the knowledge that they were a part of such a noble profession and that they were not alone in the world.

CHWs I met in Tobago were visiting PLWHA in the hospitals to help feed and clean them. They were doing home visits to help PLWHA maintain their homes and clean their sores when they could not get to the hospital. They were helping transport PLWHA to the hospital when they were too sick to stay home. They would visit homeless settlements and shelters to check on the people they cared for. When asked about what they needed to better serve their communities, CHWs often mentioned antiseptic sponge kits to help clean people’s sores. They also need condoms for distribution. One CHW told me how he takes a six-hour ferry ride once a week to go from Tobago to Trinidad to pick up a case of condoms and then take the six-hour trip back home. A plane takes only 20 minutes, but they do not have the $7 to pay for the plane. So he takes this 12-hour trip once per week.

I was lucky enough to find two local leaders (CHWs) who were themselves living with AIDS to whom others turned for guidance and support. These CHWs helped me organize meetings with other CHWs. I was able to visit some of the homeless villages that had developed when people were expelled from homeless shelters. I met with CHWs from a variety of community and faith-based organizations that were serving the HIV/AIDS community. I conducted focus groups with the CHWs to identify their training needs that might be addressed in a training program. Surprisingly, they mentioned needing a set of skills similar to those listed in the National Community Health Advisor Study published by the University of Arizona in June 1998. They wanted to learn to communicate more effectively. They wanted skills in adult learning and informal counseling. They wanted to learn about how people accomplish change in their lives. They needed help setting personal and professional boundaries for their own safety. They wanted to know how to deal with the enormous loss and grief they experience in their work. They asked for skills in community organizing. They wanted respect and recognition for the work they do.

Using the information gathered from these meetings, we developed a 35-hour curriculum and returned to Tobago in August 2004 to share the training. The training included modules titled: The History of Community Health Workers; Strength-based Work with Families; Empowerment Approach; Popular Education; Communication Skills; Informal Counseling; Safety & Personal Boundaries; Stages of Behavioral Change and Principles of Adult Learning. The entire training was delivered through interactive and experiential learning methods with very limited lecture. It was particularly rewarding to witness the 35 CHWs who participate in the training develop camaraderie and respect for each other as the training progressed.

At the very beginning of the training we used a teaching tool developed by Noelia Wiggins and Teresa Rios from Portland, Ore., which uses a “radio talk show” format to share the history of community health workers. At the end of the radio show, there is a quote that says, “We are outreach educators, promotores de salud, community health workers and village health workers. Although we live in different times and places, we have a lot in common. We want to be able to do what is best for our communities. We want to be respected and rewarded for our knowledge and skills. We want opportunities to get more training and to advance within our field. As we begin to get to know one another and work together, we are gaining strength and power.”

The Tobago CHWs adopted this as their creed and recited it every morning, afternoon and upon returning from breaks. Every time they read it I felt more and more energy and conviction in their voices. By the end of the week-long training, they recited it with confidence in their developing capacity and belief that they would impact the future for themselves and their communities. They even started organizing an independent professional association of community health workers in Trinidad & Tobago so that they could inform policy and practice issues important to their profession.

There is a lot of work ahead for the government of Trinidad and Tobago. They need to build facilities, train a professional staff, establish a network for testing and surveillance, improve public education and develop prevention and treatment programs that utilize the CHW model. Because of the tremendous appreciation and enhanced capacity demonstrated by the CHWs who attended this training, the House of Assembly of Tobago has decided to use this training as a core requirement for CHWs working in programs funded by the government and will continue supporting organizations to send their CHWs to this type of skill-based training. This is certainly a huge endeavor, but if there is anyone who has the ability to make a difference, it is community health worker pioneers!

This was an absolutely inspiring experience for me and left me energized to continue working for full integration of CHWs into health care systems with recognition, dignity and respect.

Spotlight on a CHW: Betty Cline of New Mexico

Spend an hour with Betty Cline, and you’ll quickly understand why she was named 2004 Community Health Worker (CHW) of the Year by the New Mexico Community Health Workers’ Association (NMCHWA). She has an easy way about her that’s a little bit mom, a little bit confidante, a little bit coach. Her gentle face, framed by short, smooth black hair, breaks into an easy smile when she talks about her work as a CHW/promotora in south-central New Mexico.

Cline is the bilingual family outreach worker/promotora for Socorro General Hospital in Socorro, N.M. She specializes in prenatal and postnatal care for Spanish-speaking families who are not eligible for Medicaid or other public health insurance programs. Families receive support during the mother’s pregnancy, birth, and until the child is three years of age.

Located about an hour south of Albuquerque and spreading west almost to the Arizona state line, Socorro County is a region of contradictions. Home to New Mexico Institute of Mining and Technology and the western arm of the National Radio Astronomy Observatory, Socorro is a mecca for highly educated scientists and other professionals. The Very Large Array (VLA), one of the world’s premier astronomical observatories, sits on the county’s western edge. The VLA’s 27 radio telescopes are sophisticated tools that allow astronomers to probe the mysteries of the black holes and other phenomena. Films such as "Independence Day" and "Contact" have familiarized many people with the VLA.

At the same time, Socorro is a poor county in a poor state. Data from the United States Census Bureau show that in 2003, more than one-fourth (27.1 percent) of Socorro County residents, and 36 percent of children, lived in households with annual income that falls below the federal poverty level. The poverty rate in New Mexico was 18.6, the second highest in the United States (the national poverty rate was 12.1 percent). The federal poverty level for a family of five was $21,623. The median household income in Socorro was $24,694.
Many of Socorro’s families on the low end of the income scale struggle daily to meet their basic needs such as food, shelter, and clothing. Almost half of the county’s more than 18,000 residents are Hispanic. Of these, many are Mexican immigrants who speak only Spanish, do not qualify for Medicaid, and are not served by other agencies in Socorro. Without Cline’s assistance, these families “fell through the cracks with often disastrous outcomes,” according to her supervisor, Elizabeth Brewer-Beers, RN.

The word socorro means “succor,” or “help” in Spanish. The town was named in 1598 by Don Juan de Onate when Native Americans in the Pueblo north of the present-day town of Socorro presented him and his troops with corn.

Cline offers a different type of socorro to the most under-served of Socorro’s families – a socorro that includes education, compassion, advocacy and empowerment. Cline served 94 families in 2004. The mothers in these families ranged from 14 to 39 years of age. With Cline’s assistance, 100 percent of those mothers were breastfeeding at seven months, 100 percent of families were enrolled in Medicaid and 100 percent of children had up-to-date immunizations and received wellness screenings up to 36 months.

How does Cline achieve these almost unreal success rates with her clients? “For me, the real question is ‘How can we empower each other?’” she says. Recently, Cline started using Don Miguel Ruiz’ “Four Agreements,” a series of Toltec teachings explained in Ruiz’s book The Four Agreements. In briefest form, the agreements, according to Ruiz’ Web site, are: “Be impeccable with your word;” “Don’t take anything personally;” “Don’t make assumptions;” and “Always do your best.”

“I’ve been teaching my clients to use these four ideas as guideposts,” said Cline. “They really relate to these ideas. I feel like I’m doing a much better job with my clients since I’ve adopted these ideas in my own life.”

Cline starts spending time with clients as soon as they find out they are pregnant. She provides support, education, and advocacy throughout the prenatal period, during birth, and postnatal care through three years. She is often present at birth to translate and advocate for clients. She does not act as a midwife or doula, but as the patient’s trusted advocate.

To Cline, relationship-building is the foundation of her work. “It’s important to build a good relationship with the client before the tough things start to happen – like labor and delivery,” Cline explains. “After you’ve established that relationship, they often want you to be their coach during delivery.”

Often, people simply need help filling out forms. “My door is open to anybody who needs help,” she says. “I don’t turn anybody down.” She tells the story of a woman from Mexico who had a friend drop her off at the hospital’s emergency room. The woman ended up having surgery. When she came to Cline for help filling out forms, she didn’t even know she’d had surgery. No one had explained it to her, even though she had signed a surgical consent form.

A mother of two daughters, 15 and 9, Cline smiles almost as broadly when she speaks of her clients’ accomplishments as her elder daughter’s golfing prowess. “A lot of what I do is helping people to navigate the system. One of my clients called me this afternoon and told me that she had made her own appointment at the clinic,” said Cline. “That was a huge step.”

Cline’s dedication and passion for her work are inspired partly by her own background. Cline’s mother came to the United States from Mexico. “When I heard the stories about how some of these women are treated, I thought, ‘I would not want my mom treated that way,’” she says. “That’s when I knew I could make a difference.”

Cultural competence is an essential skill in Cline’s toolkit. She attributes her success in helping women to breastfeed partly to cultural norms, and her own understanding of them. “Among Mexican-American women, there’s a cultural openness about breastfeeding that reinforces and supports my message that breastfeeding is healthy for mom and baby,” she explains. “My job, in turn, is to reinforce and support that expectation, and to help them when they run into problems.”

Cline often accompanies her clients to their appointments to translate for them. Because most of her clients speak only Spanish, she must work constantly to fill the gap in communication that often opens up in the physician’s office. “Often, my clients come out of a doctor’s office and say, ‘I don’t know what they told me,’” she says. The barriers to understanding go both ways: often, English-speaking health-care providers can’t understand their Spanish-speaking clients’ needs. In the clinician’s office, Cline translates clients’ descriptions of their symptoms, problems, and concerns so that providers can understand. In turn, she translates providers’ responses and treatment suggestions in a way that clients’ can understand.

When she doesn’t know an answer, Cline turns to a readily available network of resources – midwives, nurses, physicians, and the La Leche League, among others. “You have to know how to ask questions,” she says. Initially, however, she found that health-care providers resisted her work. “When I first started, I couldn’t get through to the providers,” she says. “But once we learned we all wanted to do same thing, we became a team.”

Cline is part of a group that meets regularly to find out what’s working, and what’s not. The group is composed of local physicians, nurses, and social workers, residents, and other providers. They monitor things like the need for transport services, whether clients are keeping appointments, getting immunizations, and following prescribed regimens. Cline has earned the respect of the group, partly because her clients have a zero percent missed appointment rate. “I don’t accept excuses,” she says, smiling.

After six years as a promotora, Cline is confident that she has found her heart’s work. Despite the resounding success of her program, funding is sparse and questionable. “I see myself doing this even if funding disappears,” she says. “I’m not going to have the heart to say goodbye to all those people. I can’t let go of those families. They become part of you. This is not just a job: you have to love what you’re doing.”

For Cline, being a CHW is, more than anything, a chance to make a difference. It’s a responsibility she takes seriously. “What an impact we promotoras have,” she says. “We are the voice and ears of our clients. We do make a difference, and it can be measured in goals and outcomes. These programs work because we spend quality time with our clients – because we listen to them.”

University of Arizona AHEC Receives Grant to Develop Community Health Worker National Education Collaborative

The University of Arizona Area Health Education Centers Program recently received a three-year, $662,142 grant from the U.S. Department of Education Fund for the Improvement of Postsecondary Education to form a Community Health Worker National Education Collaborative.

The Collaborative aims to identify best practices for Community Health Worker college-supported education through establishing a consensus about best approaches to educational program delivery strategies, instructional materials and methods. In addition to the University of Arizona and Pima Community College, five partners from across the country (Connecticut, Flordia, Minnesota, Oregon and Texas) will provide technical assistance to 15 adapter institutions nationwide, with support from nationally recognized experts in the CHW field including Community Health Worker leaders.

“This postsecondary innovation is responsive to non-traditional, socio-economically disadvantaged, and ethnically diverse students, including U.S./Mexico border health 'promotores' and Native American tribal and Pacific Islander 'community health representatives' working in rural and urban resource-poor and medically needy neighborhoods,” explains Don Proulx, principal investigator.

Community Health Workers, also known as promotores(as), are people who volunteer or are employed to go into their communities to provide health promotion and disease prevention information. Responding to a shortage of health care providers, particularly in the rural areas, the CHW model has proven to be successful in disseminating information ranging from prenatal care for expectant mothers to the protection from pesticide exposure by migrant farm workers.

As the Community Health Worker field becomes more institutionalized in the U.S. health care system, education and training, which has been primarily provided on-the-job, is becoming more heavily scrutinized, adds Proulx. Furthermore, there is a growing interest in standardizing and streamlining educational efforts to take the burden off individual employment-based or community project-based programs.

The University of Arizona CHW Program has tested and validated a basic certificate program with community colleges (Pima Community College, Central Arizona College, Cochise College, and Northland Pioneer College) and has produced a competency-based curriculum resource guidebook.

Co-directors for this grant are Donald E. Proulx, MEd and E. Lee Rosenthal, PhD, MPH. For further information, contact: Nancy E. Collyer, senior program coordinator at the UA AHEC, (520) 629-4300, ext. 121 or

Collaborative Info:
Donald E. Proulx, MEd
Principal Investigator/Projector Director
Community Health Worker National Education Collaborative
Arizona Area Health Education Centers Program
(520) 629-4300, ext. 122

CHW Network Corner

The CHW SPIG is promoting the ongoing organizing efforts of CHWs across the country at all levels - local, state and national. We urge all active SPIG members to contact their local networks and get involved!

We recognize the enormous efforts of CHWs that are making this happen, and we also know that this is only a partial list. If you know of other CHW networks, please let us know! Contact the Newsletter Editor, Gail Ballester, at:, or (617) 624-6016.

In each issue, we spotlight one or more networks. If you would like us to highlight your network in a future issue, please contact the newsletter editor. This time, we are featuring the New Mexico Community Health Workers Association (see the article titled, "Spotlight on New Mexico: New Mexico Community Health Workers Association" in this newsletter).

Spotlight On New Mexico: New Mexico Community Health Workers Association (NMCHWA)

The NMCHWA was informally created under the University of New Mexico Prenatal Care Network in 1993 to provide a venue for community health workers to gather information regarding health and social service resources, share info on CHW programs best practices, education, legislative updates, peer support, political power for the CHW model and networking.

The organization met in different quadrants of the state, with CHW programs taking turns hosting the meetings. In 1995, a three-year grant from the Robert Wood Johnson and Henry J. Kaiser Foundations awarded to UNM Health Sciences Center helped to formalize the organization. Funding was provided for a full-time coordinator position and a part-time administrative assistant. The coordinator and part-time administrative assistant were hired in September 1995 and began the process of formalization. The process for training for NMCHWA members began from 1995 through 1998.

The mission of the NMCHWA is to bring community health workers together into a cohesive body that promotes outreach, education, and support for the CHW model for each other as well as their respective communities. Additionally, the association provides networking opportunities, information exchange and training for community health workers. The organization’s goals are: 1) To seek acknowledgement of the CHW/Promotora/Advocate model; 2) To promote credibility for the profession and a voice for workers & programs; 3) To provide education & training for CHWs at national, state and local levels; 4) To seek membership that reflects the entire community of lay health advocates state-wide; 5) To develop leadership among its members; and 6) To become independent as an association.

The NMCHWA has conducted nine annual training conferences. Attendees have come from all over the country. Funding for the conferences have come from organizations such as RWJ, UNM Kellogg Community Voices Project, the McCune Foundation, Archdiocese of Santa Fe, March of Dimes, Department of Health, Cimarron (HMO), the Rio Arriba Family Care Network, and the University of New Mexico CASAA Program. Scholarships for registration fees, travel and board are provided for CHWs whose programs are unable to fund expenses if funding allows.

In 1993, a training curriculum was developed though a collaborative effort between the University of New Mexico Area Health Education Center, the Prenatal Care Network, and focus groups made up of CHW program staff. The New Mexico Department of Health and the New Mexico Chapter of the March of Dimes Birth Defects Foundation provided funding for the curriculum. The resulting curriculum, "Reaching Out: A Training Manual for Community Health Workers," includes 40 hours of training.

The manual includes role-playing home visits, viewing films, class discussions, lecture and visits to health care providers. Participants are encouraged to take part in deciding how the training sessions will be conducted. Upon completion, participants are presented with a Certificate of Completion from the University of New Mexico Health Sciences Center at the annual statewide training conference. The curriculum is available for for $25 plus shipping costs.

Although the Reaching Out curriculum has an MCH focus, other topics are introduced as needed by the programs or individuals. NMCHWA members meet on a quarterly basis and request training on other skills. Among them are: Evaluation; meeting facilitation & planning; public speaking; group dynamics; communication; mental health, grant writing & fundraising; board training; and use of computers. Many of these topics are addressed at annual training conferences or quarterly meetings.

During 2002 and 2003, NMCHWA went through the process of incorporation as a nonprofit organization. NMCHWA achieved federal tax-exempt status in 2003, making it eligible to apply for funding and grants. In 2003, NMCHWA received a planning grant for the development of a strategic plan, including resource development, from the Funders’ Collaborative for Strong Latino Communities, a program of Hispanics in Philanthropy.

NMCHWA participated in the development of Senate Joint Memorial 76 for the 2003 Legislative Session that will initiate the development of a task force around a study that will evaluate the value of CHWs to the health care delivery system and their impact on public health outcomes; Economic development and access to health care. SJM 76 was passed. The results of the study, including legislative recommendations to address economic opportunities for the communities, were reported to the interim legislative health and human services committee at its October 2003 meeting.

NMCHWA is a board member of the Lay Health Workers National Network/Red Nacional De Promotors de Salud. Each year, a NMCHWA member is nominated by his or her peers to represent the association at the national level. This person serves on the planning committee for the annual national conference and in the development of CHW training needs, sustainability of CHW programs, Medicaid reimbursement efforts and certification initiatives. In addition, the NMCHWA has been used as a model for the development of CHW associations in other states.

For more information about the NMCHWA, contact Rose Gonzales, Executive Director, Phone (505) 255-1227; Fax (505) 255-1157; P.O. Box 81433, Albuquerque, NM 87198.

State and National CHW Networks

The Lay Health Workers/Promotores National Network: (877) 743-1500 or e-mail:

Arizona Community Health Outreach Workers Network (AzCHOW), Of, By, and For Community Health Outreach Workers;;
Lours Fernandez, Co-Chair; Flor Redondo, Co-Chair; Belen Feather, Secretary

The Community Health Worker/Promotoras Network, Maria Lemus, Executive Director, Vision Y Compromiso, 2536 Edwards Ave., El Cerrito, CA 94530; (510) 232-7869; (510) 231-9954 fax; e-mail:, or Maria at:

REACH-Workers – the Community Health Workers of Tampa Bay. Please contact Michelle Dublin, Chairperson of the network, at (727) 588-4018,

Community Health Worker Training Program, Hawaii Primary Care Association, Napualani Spock, Coordinator, P.O. Box 264, Pu'unene, HI 96784, Ph: (808) 280-0984; Fax: (808) 573-0734;

Community Outreach Workers Association of Maryland, INC. (COWAM), 259 North Lanvale Street, Baltimore, Md. 21217, (410) 664-6949 or (410) 669-7960, Dwyan Monroe, President.

Massachusetts Community Health Worker Network (MACHW), Lisa Renee Siciliano, Chair,, (508) 791-5893, c/o Massachusetts Public Health Association, 434 Jamaicaway, Jamaica Plain, MA 02130.

Michigan Community Advocate Association (MICAA), Contact:President-Roshawnda S. Thompson -; (616) 356-6205 or (616) 827-2094 or (616) 366-2759.

New Jersey
Extensions - Connecting Outreach Workers Throughout New Jersey and Beyond
Call Gateway MCH Consortium at (973) 268-2280 or Pat Wrazz at:

Healthy Mothers/Healthy Babies of Essex, Nichele J. Wilson, 303-309 Washington Street, Newark, NJ 07102, (973) 621-7758,

New Mexico
New Mexico Community Health Workers Association (NMCHWA), P.O. Box 81433
Albuquerque, New Mexico 87198, or BJ Ciesielski,, (505) 272-4741.

New York
New York City - Community Health Worker Network of NYC; 425 E. 25 Street; New York, NY 10010; (212) 481-7667 phone; Sergio Matos, Elena Schwolsky, Rita Taylor, and Romy Rodriguez;

Rochester - Rochester Outreach Workers Association (ROWA), Latisha Williams, Chair, (585) 274-8490.

Oregon Community Health Workers Association, 9000 N. Lombard Street--2nd Floor, Portland, OR 97203, (503) 988-3366 x28686, Teresa Ríos,, or Veronica Lopez Ericksen,

CHW SPIG Committee Updates: Membership and Policy

Membership Committee - Dwyan Y. Monroe

The new committee consists of: Dwyan Monroe – Chairperson, Niya Case, Joan Bliss, Ann Ganey and Kimberly Brown.

During the Committee Meeting in D.C., we came up with some ideas that we will focus on beginning 2005:
  1. Looking at cost-cutting of APHA membership & Annual Meeting: lowering/lobbying for lower price for CHWs.
  2. Outreach to APHA/SPIG members for sponsorship of a CHW to attend the meetings.
  3. CHWs fund-raising in our own states such as dinners, dances, carnivals and raffles.
  4. Letters to foundations for financial support to attend the meeting, such as Robert Wood Johnson, drug companies, Franciscan Sisters, and others.
  5. Follow-up to other letters that CHWs have distributed. For example, COWAM, Inc., sent a letter to Oprah Winfrey in support of CHW initiatives.
  6. Boosting membership at the APHA exhibits as well as having temporary booths set up at each session with sign-up sheets and basket for business cards.
  7. Soliciting regional APHA meetings to sponsor membership for CHWs in their area.
  8. Encouraging collaboration between other sections that may distribute sponsorship.
We look forward to a productive year in increasing the number of members in the SPIG.

Policy Committe - Lisa Renee Siciliano

Prior to the APHA Annual Meeting in Washington, D.C., the Policy Committee was busy preparing for the Governing Council meetings. Each year before the Annual Meeting the proposed policies are available to members. The policy committee read the proposed APHA policy statements and resolutions to be brought before Governing Council and made recommendations to either support or not support various policies. The SPIG was represented during all Governing Council sessions and hearings. This marked the first time that the policy committee for the SPIG has played such an active role in the policy process for the Association.

During the SPIG business meeting in D.C., attendees interested in policy took time to discuss the work the Policy Committee should take on during the next year. It was stressed that the CHW definition the committee is working on should be as inclusive as possible. The recommendation was made to consider all possible implications any national definition will have on the field of community health work.

This process of completing a CHW definition is taking much longer than anticipated, but the committee is committed to having as much CHW input as possible, as we move forward. The committee is working on a CHW input form and a draft definition to go out to all known CHW networks and organizations for comment. Please be on the lookout for the form in the upcoming months and take a few moments during organization meetings for discussion and comment. As always, the Policy Committee is looking for additional CHWs to participate. Interested CHWs should contact Lisa Renee at

Highlights on other SPIGs, Sections or Relevant Organizations: The Community-Based Public Health Caucus (CBPHC)

As part of a new initiative to reach out more to others involved in APHA, we will profile a different SPIG, Section or Caucus in every issue of the newsletter. This will help us meet, connect with and learn from our peers and, at the same time, promote the impact and recognition of the CHW field within APHA as a whole. This month we feature the Community-Based Public Health Caucus (CBPHC). In the past, we have proudly co-sponsored sessions with the CBPHC at the Annual Meeting. Our shared commitment to "community" makes us natural allies in improving health for all.

The APHA Community-Based Public Health Caucus was approved by the Executive Board in January, 2001. The Caucus is guided by the belief that community lies at the heart of public health, and that interventions work best when they are rooted in the values, knowledge, expertise and interests of the community itself. We believe that health encompasses the physical, mental, spiritual, environmental and economic well-being of a community and its members. We recognize the power of equal partnerships including community-based organizations, academic institutions, and health agencies, addressing health issues of the community. We understand that in order for these partnerships to be equal and for interventions to be community-based, community members must participate fully in the identifications of health issues and the selection, design, implementation and evaluation of programs that address them.

Caucus goals:

Contact: Stephanie Ann Farquhar, PhD
School of Community Health
450F Urban Center
506 SW Mill Street
Portland Oregon 97207-0751
ph (503) 725-5167
fax (503) 725-5100

A Healthy Recipe

This recipe was developed by the Salud Para Su Corazon curriculum from National Heart, Lung and Blood Institiute.

Fresh Cabbage and Tomato Salad

1 small head of cabbage, sliced thinly
2 medium tomatoes cut in cubes
1 cup of sliced radishes
¼ teaspoon of salt
2 teaspoons of olive oil
2 teaspoons of rice vinegar (or lemon juice)
½ teaspoon black pepper
½ teaspoon of red pepper
2 tablespoons of fresh cilantro, chopped

1. In a large bowl, mix together the cabbage, tomatoes, and radishes.
2. In another bow, mix together the rest of the ingredients and pour over the vegetables.

Quick Tip

Your family will love this tasty salad. The small amount of olive oil, rice vinegar, fresh herbs, and spices adds flavor, but few calories.

Yield: 8 servings
Serving size: 1 cup
Each serving provides:
Calories: 41
Total fat: 1 gram
Saturated fat: Less than 1 gram
Cholesterol: 0 mg
Sodium: 88 mg
Calcium: 49 mg
Iron: 1 mg

Ensalada de Repollo y Tomate

1 repollo pequeño, cortado en tiritas finas
2 tomates medianos, cortados en cubitos
1 taza de rábanos en tajaditas
¼ cucharadita de sal
2 cucharaditas de aceite de olivo
2 cucharaditas de vinagre de arroz (o jugo de limón)
½ cucharadita de pimienta negra
½ cucharadita de pimienta roja
2 cucharadas de cilantro fresco picado

1. En un recipiente grande, mezcla el repollo, los tomates, y los rábanos.
2. En otro tazón mezcla el resto de los ingredientes y viértalos sobre las verduras.

Sugerencia Rápida

A su familia le encantara esta sabrosa ensalada. La pequeña cantidad de aceite de oliva, vinagre de arroz o jugo de limón, hiervas frescas y especias le añaden sabor, pero pocas calorías.

Sirve: 8 porciones
Tamaño de la porción: 1 taza
Cada porción proporciona:
Calorías: 41
Grasa total: 1 gramo
Grasa saturada: Menos de 1 gramo
Colesterol: 0 mg
Sodio: 88 mg
Calcio: 49 mg
Hierro: 1 mg

Book Review: The Spirit Catches You and You Fall Down, by Anne Fadiman

In "The Spirit Catches You and You Fall Down," journalist Anne Fadiman tells the tragic story of a young Hmong child’s struggle with a seizure disorder and the clash between her parents and her health-care providers over her care. The story focuses on Lia Lee, the daughter of Hmong refugees living in Merced, Calif. It is also a wake-up call to health-care providers to seek understanding of their patients’ concepts of health and disease. With a compassionate and sensitive eye, Fadiman examines the multiple events – immigration, medicine, the war in Laos from which Lia’s family fled – that led to the collision between Lia’s parents and her health-care providers.

At age 8 months, Lia Lee was diagnosed with epilepsy, a disease in which parts of the brain sometimes malfunction, causing seizures. In Lia’s case, the seizures were “grand mal” episodes during which she lost consciousness, twitched uncontrollably, her breathing slowed, and blood and oxygen virtually stopped flowing to her brain. Left uncontrolled, grand mal seizures such as Lia’s can lead to brain damage and death.

Lia’s parents, Foua and Nao Kao Lee, had a different understanding of Lia’s illness. They knew that Lia had the sickness where “the spirit catches you and you fall down.” To them, Lia’s illness was frightening, but it was also an honor. Because the spirits chose to catch her, she might grow up to be a shaman.

Yet Lia’s physicians did not speak Hmong, and her parents did not speak English. They couldn’t describe their different interpretations of Lia’s illness to each other. Besides, there is no word in Hmong for “epilepsy,” and on Lia’s multiple visits to the emergency room, her physicians had no time to explain that in the medical textbooks they had studied, seizures were caused by a “short circuit” in Lia’s brain, not by spirits’ whims. They had to stop her seizures.

Lia’s physicians gave her the best care they knew how to give her. So did her parents. Yet Lia’s seizures continued to get worse, partly because the definition of “best care” differed so greatly. Her parents, not understanding Lia’s physicians’ instructions for administering medications, gave them only sporadically. Foua and Nao-Kao were labeled “non-compliant.” Lia continued to seize, becoming a regular at the emergency room in the small hospital in Merced. Finally, a massive infection caused Lia to seize prolonged, causing irreversible brain damage. Fadiman leaves us with Lia, now 4 years old, in a vegetative state. Lia will never walk, talk, play or recognize the family that loved her so deeply.

Fadiman writes with compassion and understanding, not blame. Fadiman’s work raises difficult questions about the ability of the health-care system in the United States to meet the needs of immigrants. What is the highest standard of health care? Would Lia have been better off had her physicians not prescribed the “best” medications – which were also the most difficult and complex for her parents to administer? What does it mean to be the “best” doctor? What does it mean to be the “best” parent?

In Laos, without access to emergency rooms and medications, Lia probably would not have survived her first year. As Fadiman observes, “American medicine had both preserved her life and compromised it. I was unsure which had hurt her family more.”

"The Spirit Catches You and You Fall Down" is an important resource for CHWs, health-care providers, public health workers, social workers, and others who work with immigrant populations. Lia’s story is tragic a testament to the importance of community health workers. Fadiman reminds us that familiarity with a culture requires more than just knowing a language: it requires an understanding of beliefs and concepts of illness and the body. One can only wonder how Lia’s life, as well as her family’s, might have turned out differently had a skilled, culturally competent CHW been a member of her health-care team.

The Healthy Health Worker: Taking Time to Play

Author’s note: Community Health Workers (CHWs) are giving people. They invest their days, their energy, and their hearts in the communities they serve. Sometimes, however, CHWs can give so much that they forget about their own needs. This column will explore ways that CHWs can take care of themselves. We welcome contributions and suggestions for future columns. Have an idea? Want to contribute a future column? Write the editors at

When I head over to my visit my neighbor Jane and her family, I’m often greeted by a 4-, 6-, and 8-year-old hard at play. Sometimes my progress is barred by a warrior wielding a sword (well, it looks kind of like leftover aluminum foil, at least in my adult world), or a cowboy galloping madly on a horse (it really doesn’t matter that the adult in me sees a wooden horse that isn’t moving an inch).

Of course, these antics usually interrupt whatever Very Important Errand I’m trying to carry out. I could be delivering groceries, making arrangements for cat-sitting, or planning the next neighborhood gathering. But once in a while, I stop in the midst my Very Important Errand and play with the young heroes for a while.

When I do take the time to stop and romp with my young neighborhood heroes, I’m reminded that most adults rarely engage in play. It’s just too hard to play when we’re hurrying to and from work, hustling from one meeting to another, responding to our clients’ urgent needs, and carrying out other Very Important Duties.

CHWs may find it even harder than most adults to squeeze a bit of play into their lives. After all, it’s hard to think about having fun when you’ve just spent the day with a client who’s been sanctioned by welfare, another who can’t figure out how to control his diabetes and landed in the emergency room last night, and another who can’t afford the co-pay on prescription medications.

Why Play is Good For Us
Yet the high stress levels of that CHWs face in their daily jobs may be all the more reason for CHWs to engage in play. Play may help to reduce stress. Because play often involves physical activity, it may be a way to get that recommended daily dose of movement without thinking of it as “exercise.” Play helps us to connect with others. Ever tried to play Frisbee with yourself? Besides, play is just plain fun.

Play often leads to laughter, and a growing body of research shows that laughter can boost immune function, improve mental outlook, and help people connect with others. Psychologist Steve Sultanoff, PhD, president of the American Association for Therapeutic Laughter, says that laughter can decrease the level of serum cortisol, a hormone produced by the body in response to stress. In addition, according to Sutltanoff, laughter appears to increase the body’s production of antibodies, substances that help fight off infection.

Laughter may even help dispel the effects of chronic disease. For instance, in May 2003 the journal Diabetes Care published the results of a study that showed that laughter can help people with type-2 diabetes control their blood-glucose levels. The study was conducted by a team of researchers led by Keiko Hayashi, PhD, RN, of the University of Tsukuba in Ibaraki, Japan. Hayashi’s team fed dinner to 19 people with type-2 diabetes. On the first day, the meal was followed by a boring 40-minute lecture. On the second day, they attended a 40-minute stand-up comedy show.

Researchers measured participants’ blood glucose levels after the lecture and after the comedy show. Blood glucose levels went up after both events, but the increase was much less after the comedy show. Similar results were seen in a control group of healthy participants without type 2 diabetes. The researchers concluded that a daily dose of laughter may help people with type-2 diabetes control their post-meal blood glucose levels.

Likewise, having a sense of humor may help protect your heart, according to Michael Miller, MD, director of the center for preventive cardiology and associate professor of medicine at the University of Maryland in Baltimore. Miller and his colleagues studied 300 people, 150 of whom were healthy and 150 of whom had severe heart disease. Using a questionnaire, they then evaluated each participant’s “mirth score.” The questionnaire asked people questions such as “If you arrived at a party and found someone else wearing a piece of clothing identical to yours, would you (a) not find it particularly amusing, (b) be amused but not show it outwardly (c) smile, (d) laugh, (e) laugh heartily.

Miller’s team found that people who scored above 50 on the mirth scale were significantly less likely to have heart disease. Heart disease was most common in people who were less likely to either see the humor in a situation or to use it as an adaptive mechanism, and they were less likely to laugh spontaneously even in positive situations.

Remembering How to Play
How can you reintroduce a spirit of play into your life? Start by writing in your journal about how you played when you were a child. What games did you play? What did you do when there was no one else around? (Hint: turning on the TV and eating barely reheated frozen pizza with one hand while wielding the remote with the other does not count as play). Write your own list. Or use the following list to get started:

  • Get moving. For most kids, play rarely means sitting still. It’s a treat to be released from a school desk, the dinner table, or any place that required sitting still for long periods of time. Play hopscotch. Jump rope. Ride your bike. Run as fast as you can down a steep hill. Go to a park. Swing in the swings. Ride on the merry-go-round. Play Frisbee.
  • Be silly. Play jacks. Play hide-and-go-seek with your kids (or your neighbor’s). Have a treasure hunt. Have a squirt gun fight with a friend. Blow soap bubbles. Finger paint and don’t worry about the mess. Buy yourself a coloring book and Crayons and spend an afternoon coloring in it.
  • Imagine yourself all over again. Play dress-up. Go to a thrift store and buy the most outrageous outfit you can imagine. Wear it to the grocery store. Host a costume party. Buy a goofy hat and wear it to work. Wear different color socks to work. Dye your hair an outrageous color. Paint your toenails different colors.
  • Learn from animals. Spend a day at the zoo. When you get home, look in the mirror and pretend you’re a monkey. Play with a dog. If you don’t have a dog, go to your local animal shelter and volunteer to walk one. Let the dog play dress-up, too. Give it a bandanna.
  • Make things. Make a paper airplane and fly it. Buy a potholder loom and weave a potholder in crazy colors. Get an origami kit and make shapes.
  • Go sledding in the snow. Roll in the snow. Build an igloo and hide out in it. If there’s no snow, roll down a grassy hill. If there’s no grass, bury yourself in the sand. If it’s raining, go outside and splash around in the puddles. Make mud pies.
  • Feel and taste things. Slowly savor a piece of chocolate, a peppermint, or a caramel. Take fifteen minutes to eat a raisin. Draw a hot bath, get yourself a rubber duckie, and splash around for a while. Close your eyes and run your hands over a rock.
  • Connect with something or someone. Hug a tree. Hug a person you care about.

Have fun!

APHA Needs Your E-mail Address

APHA e-mails members when their Section or SPIG newsletter is online. If you have not been receiving any notification, we may have an incorrect e-mail address for you. If you are receiving copies of Section or SPIG newsletters in the mail or by fax, APHA does not have your e-mail address.

If we have your correct e-mail address, we are able to send you newsletter notification that provides faster, more current information. The mailed versions of the newsletters face a delay of several weeks for the newsletters to be photocopied, folded, stuffed in envelopes, labeled and processed through the U.S. Postal System.

Watch for the next CHW SPIG Newsletter in Spring 2005!

APHA 2005 Community Health Worker SPIG Executive Board

Durrell Fox
New England HIV Education Consortium
Massachusetts Community Health Worker Network
23 Miner Street
Boston, MA 02215
(617) 262-5657

Chair Elect and Member Retention
Sergio Matos
Community Health Outreach
Health Plus PHSP, Inc.
195 Montague Street
Brooklyn, NY 11201
(718) 491-7575

Susan Mayfield-Johnson
Center for Sustainable Health Outreach
University of Southern Mississippi
Southern Station Box 10015
Hattiesburg, MS 39406-0015
(601) 266-6266

Policy Committee Chair and
Governing Council Representative
Lisa Renee Siciliano, LSWA
Massachusetts Public Health Association and
Massachusetts Community Health Worker Network
4 Lancaster Terrace
Worcester, MA 01609
(508) 791-5893

Program Planners 2005
Elena Schwolsky
Community Health Worker Network of NYC
452 51st St., Apt. 1
Brooklyn, NY 11220
(212) 481-5193

Tammi Fleming
Kingsley House
1600 Constance Street
New Orleans, LA 70130
(504) 523-6331 x172

Liaison to other APHA Sections, SPIGs and Caucuses
Tori Booker
Migrant Health Promotion
224 W. Michigan Ave.
Saline, MI 48176
(734) 944-0244

Communication/Continuing Education
Nell Brownstein
Centers for Disease Control and Prevention (CDC)
4770 Buford Hwy NE MS K47
Atlanta, GA 30341-3717
(770) 488-2570

Newsletter Editor
Gail Ballester
Massachusetts Department of Public Health
250 Washington Street, 5th floor
Boston, MA 02108
Phone: (617) 624-6016
Fax: (617) 624-6062

Member Recruitment
Dwyan Monroe
(410) 522-6500 ext. 256

Immediate Past Chair
Teresa Ríos
Community Capacitation Center
Multnomah County Health Department
(503) 988-3366 Ext. 28686
Cc e-mail to: Noel Wiggins:

Former Chair
Yvonne Lacey
Berkeley Health Department
1767 Alcatraz Avenue
Berkeley, CA 94703
(510) 644-6500

Immediate Past Governing Council
June Grube Robinson
724 Hoyt Ave.
Everett, WA 98201
(425) 249-2019

Lee Rosenthal
2250 East 8th Street
Tucson, AZ 85719
(520) 882 2105 x2