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By Andrea Tobias
Mariline Menager practiced internal medicine for more than a decade in her native Haiti before moving to Massachusetts in 2021. Even with her medical expertise, she found navigating the United States’ health care system confusing as a patient. She says the experience made her realize how much she “wanted to help other people in a similar situation.”
She discovered that Cambridge Health Alliance (CHA) trains volunteer health advisors who are deeply committed to and passionate about serving their local communities. Menager pursued the training and was so personable and effective, CHA later hired her as a community health worker in Cambridge.
Talita Teixeira is another natural at building relationships while sharing critical information and resources. Born in Brazil, she has attracted an impressive 120,000 social media followers from Greater Boston’s Brazilian community. Becoming a CHA volunteer health advisor deepened Teixeira’s knowledge and skills to benefit others like her who speak Brazilian Portuguese.
The two women are leaders in Cambridge Health Alliance’s Community Health Worker program. With the goal to promote and strengthen overall public health, it engages residents in eight communities, including Everett, Revere, and Malden. Newcomers to the region who speak Portuguese, Spanish, Haitian Creole, Arabic, and other languages can discover how best to care for their health and that of their loved ones with the guidance of both volunteers and paid employees.
The consequences can be severe when people don’t know how to access medical care on their own and they don’t have anyone to help guide them. Community health workers can make a life-or-death difference by partnering with residents on preventive health care education, referrals to affordable care, and addressing misinformation about the health care system. Residents know help is available if illness strikes, and that they are not alone.
Unique in Massachusetts, the program meets people where they are by connecting at houses of worship and community centers, health fairs and clinics, even local businesses and Facebook Live. Community members have the opportunity to learn about everything from breast cancer screenings to how to protect their mental health. The program supports public health departments to complement and expand upon existing services, benefiting the community as a whole. Put simply, it pairs people who care with those who need it most.
Bringing care to the people
Staying healthy involves more than just seeing a doctor occasionally. Public health officials consider the “social determinants of health” — the outside factors, from safe housing to job opportunities, that influence whether people are healthy and can stay that way. By some estimates, up to 80% of an individual’s health depends upon these outside factors.
CHA’s community health workers are compassionate and comprehensive in their approach, providing referrals to housing, food pantries, English as a Second Language classes, employment options, and more. “You name it and we try to connect them to the appropriate resources,” says Jamila Xible, director of Community Health and Access Programs for CHA. The model nurtures individual health while fostering a community’s overall well-being.
All CHA community health workers, whether paid or volunteer, receive 80 hours of training. CHA recruits participants from churches, mosques, and community organizations who “come from different walks of life and different countries, different cultures,” Xible says. “The conversations that come out of these trainings are very rich.” Trainees are trusted members of their communities with a talent for developing strong, caring relationships.
Building skills and workforce development
In return, volunteer trainees acquire new skills that can enhance their future job opportunities in health care and other fields, along with a sense of personal development and pride in helping individuals, families, and older adults who might be difficult for CHA to reach otherwise.
Health care professionals who move to the U.S. “bring medical background from their own country, but are not necessarily able to practice in the United States because of licensure and other issues. But they still want to be able to give back to their communities,” says Doug Kress, chief community officer for Cambridge Health Alliance. Through the volunteer training program, “they’re able to use some of their knowledge. They’re not practicing providers, but they can be connectors.”
At a time when the region desperately needs more health care workers, with a recent report from the Massachusetts Hospital Association showing 19,000 vacant positions, the Community Health Worker program is also dedicated to workforce development and attracting people from diverse countries and cultures into paid health care roles. Those goals are reflected with the CHA’s 2022 Regional Wellbeing Report, which identified three key equity principles to improve health in the region. They include language justice (the right of patients to speak in their preferred language); inclusion of under-represented voices in leadership and decision-making; and environments that acknowledge unique stressors of diverse communities to promote collective care.
These principles can make the difference between outreach to a community and true engagement. “Outreach is one-way, you call people with whatever message you want to give to them,” says Xible. “Engagement involves building relationships and encourages participation in decision making – you bring them into creating the message and in the process, help develop new leaders.” During training and afterwards, CHA emphasizes engagement.
How do I find a doctor?
Xible encourages trainees to imagine they are newcomers who don’t yet speak English, have not tasted many American foods, and aren’t sure how to rent a house for a fair price or register their children for school. “It can become a very traumatic experience with a lot of information overload. The last thing in their minds is ‘Where do I get a doctor?’ unless they are sick,” she says.
Newcomers to the United States may have no idea how to obtain health insurance or that if they want to see a specialist, they’ll need a referral from a primary care doctor. The Community Health Worker program guides them on such basics.
The program also uses playful ways to intrigue people about health. Menager loved teaching older adults about nutrition through a game show in Haitian Creole at a local church. The format made it easier “to get them to interact, and to see what was their knowledge about what they are eating,” she says. She was thrilled to see audience members laughing while learning about important topics like the sugar content in soda. They asked question after question about diabetes and high blood pressure.
The event settings vary in order to accommodate different people and needs. Volunteer health advisor Talita Teixeira has hosted question-and-answer sessions on Facebook Live with CHA physicians serving as experts. They covered COVID-19 prevention and other health care essentials in the audience’s language of Brazilian Portuguese.
Teixeira also asked friends who own a popular furniture store in Malden about hosting several health care fairs there, including resources for health insurance, clothing, and other needs. More than 500 people in total turned out. “It was awesome,” Teixeria says, the joy clear in her voice.
It’s results like that which make Xible call Teixeria “a force.” For her part, Teixeira thinks of herself as a bridge who connects her community to tools for a better life. “I wanted to be part of the CHA program,” she says, “because I love to help people and I love to help my community.”
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