Dallas health care workers educate patients on COVID-19, discredit vaccine misinformation

After her parents divorced when she was 10, Krystal Piña became a live-in caretaker for her grandmother. Five years later, she had more health care experience than many adults twice her age.

“You could say I was raised into it,” said Piña, whose grandmother was diabetic and in a wheelchair. “I wasn’t doing what a lot of other 10-year-olds were doing.”

She pursued a career in real estate after graduating from El Centro College, but again assumed the role of caretaker for her mother, who died of pancreatic cancer six months after her diagnosis.

It was a turning point that led Piña, 33, to Los Barrios Unidos Community Clinic in Oak Cliff, where she has been a community health worker since 2015.

“It just came so naturally that I thought, ‘This is what I want to do,’ ” Piña said. “I’m going to help people, and maybe share my experience as a caregiver with others so they can learn to take care of themselves or others.”

Community health workers, known as promotoras or promotores in Spanish-speaking communities, bridge the cultural and linguistic gap between patients and doctors to help explain medical terminology and teach patients about medication. They’re expected to play an important role during the distribution of COVID-19 vaccines, emphasizing the importance of immunization from a virus that has taken a disproportionate toll on the Latino community.

Latinos, who make up almost 90% of Los Barrios’ patients, are among the most vulnerable to infection and complications from COVID-19. This stems from their increased representation in essential industries and rates of underlying conditions, such as diabetes and asthma, according to the Centers for Disease Control and Prevention.

Community health workers’ greatest strengths are their abilities to mirror the community and build relationships with patients, said Dr. Sharon Davis, the chief medical officer at Los Barrios Unidos who spearheaded its promotor program in 2015.

“They earn the patients’ trust through relationships,” she said. “It’s just really funny the way our patients respond to promotoras because I might tell them something about asthma, but then they will ask the promotora, ‘Is that true?’ “

Community health workers don’t provide the level of care a doctor would, but they can administer tests and provide resources and advice on managing chronic diseases, as well as how to keep yourself and others safe.

“The kind of work that we’re currently doing, with COVID being so rampant, is trying to have the families understand what this means,” said Pamela Rodriguez, a care coordination supervisor at Los Barrios Unidos who became a community health worker at 19. “One of the things that I love to do is the teaching, being there to answer questions, provide support if that’s what they need.”

To become a community health worker, any Texas resident who is at least 16 years old can complete a 160-hour training program approved by the Department of State Health Services.

“It would be wonderful if we had a lot more people working as promotoras or promotores, and it’s super simple,” Rodriguez said.

Based on the success of its promotor program, Los Barrios Unidos plans to recruit Black community health workers for a new clinic opening in Red Bird next year, Davis said.

The number of community health workers has increased in recent years both nationally and in Texas, which has more than 4,000, according to the state health department. The average salary is $50,000 per year.

Having cultural empathy is especially important because the workers often need to address a patient’s nonmedical concerns, such as losing a job, putting food on the table or paying rent, Rodriguez said.

“We’re not letting those patients fall through the cracks — the ones that need a little bit of extra care, a little bit of extra support,” she said. The promotores are “connecting them to everybody that can offer what they’re looking for, what their actual needs are.”

Trust and communication have become especially critical to delivering consistent care and outreach during the COVID-19 pandemic, Davis said. As vaccine delivery draws nearer, community health workers will educate patients and discredit misinformation.

“Health care looks different than it used to, and it needs to look different,” Davis said. “Health care is really team-based care to really be effective, and community health workers — promotoras — are a very integral part of that team.”