A Day in the Life of a New York City Community Health Worker

Last week I shadowed Rosaura Polanco, a community health worker in the South Bronx in New York City, where she provides underserved women with health education and essential health services. Having only seen examples of community health workers operating in sub-Saharan Africa, I asked Rosaura what unites them around the world, despite their differing roles and contexts.

“Empathy,” she replied. “I practice empathy, for everything, all the time.”

Rosaura arrives at a women’s loan session in the South Bronx, to deliver health education on sugar consumption. Photo by Jessica Turner for IntraHealth International.

Rosaura works for Grameen PrimaCare, a sister organization to Grameen America that provides women from low-income immigrant communities with high-quality, affordable primary care. By providing health education to women enrolled in the Grameen loan program, which provides group-based microfinancing for small business, Rosaura reaches a population that often remains hidden and excluded from formal institutions such as health facilities.

Each week the participants meet in one of their homes to repay their loan installments. Rosaura waits and then delivers short health education sessions. Photo by Jessica Turner for IntraHealth International.

Her morning begins with attending a loan group meeting of around 40 women who are mostly Latina. She sits patiently as participants deliver their repayments and discuss their business plans. These meetings can get highly charged: if someone doesn’t repay on time, the rest of the group shares the burden. Then Rosaura stands up and shares information about the dangers of high levels of sugar in the diet.

Rosaura is always on call. Participants in the loan program have her phone number and know they can call her for anything. Photo by Jessica Turner for IntraHealth International.

Over the course of the women’s loan repayment process, Rosaura will work through a carefully selected curriculum of topics, including diabetes, nutrition, cancer, and vision. She provides them with useful handouts and tips for staying healthy, along with advice for when and how to seek medical attention.

Rosaura works closely with community engagement teams at the local hospital, easing the women through the challenging process of obtaining health services when their English may be limited, legal status undefined, and insurance nonexistent.

“If I see someone is very scared, I say to them, ‘You remember Vicky in the hospital, right? Talk to Vicky, she’s going to help you there,” Rosaura says.

“The health system in the U.S. is so complicated,” says Meritxell Roca, program manager for Grameen Promotoras. “If you’re an immigrant with no papers and no insurance, it’s very impersonal. You go to the hospital and you are just a number. So for us it works to have a name or a contact somewhere, like Vicky. If you are lost, you know that you can go to her.”

Vicky (right) works in community outreach for a local hospital. She works closely with Rosaura to arrange appointments and serves as a friendly face and support system within the hospital. Photo by Jessica Turner for IntraHealth International.

Crucial to Rosaura’s role is the trust that she has generated with the women in her community. Like many community health workers, she knows the community she serves because she’s part of it. This trust is evident in the way the women look at Rosaura, speak to her, and embrace her throughout the session. Even their willingness to accept me, an outsider, into their intimate meeting, is evidence of the bond she has generated with this group.

“They see me as someone who understands them,” she says. “They don’t see me as on a higher level.”

This trust has grown not just through the education sessions, but through the appointments at the local hospital Rosaura books for clients. She even attends with them, when necessary — such as when a woman is nervous or needs a translator. She also builds trust through the experts in immigration law and domestic violence that she brings into their homes and through the late-night phone calls she answers when one of her clients needs support.

As a community health worker, Rosaura spends a lot of time on the subway traveling between meetings, the office where she prepares educational hand-outs, and the local hospital. Photo by Jessica Turner for IntraHealth International

As a community health worker, Rosaura guides these women through a challenging healthcare system at some of the most vulnerable points in their lives. The versatility of the community health approach enables health workers like her to respond to the unique set of challenges faced by the groups they serve. As I stood in the crowded room, feeling thankful to Rosaura for this rare opportunity, her intimate understanding and empathy were palpable.

Rosaura plays an integral role in the lives of the women she serves, and she’s not alone. Community health workers all around the world are dedicating themselves to ensuring the hardest-to-reach groups can access the health services they need, from rural communities in Rwanda to nearly 70% of the population in Brazil. They’re even being considered as a wide-scale solution to the problems of the National Health Service in the UK.

Rosaura is an advocate for greater strategic investment in frontline health workers. Here she speaks at the 2018 UN General Assembly with Vince Blaser of the Frontline Health Worker Coalition (left). Photo by Jessica Turner for IntraHealth International.

And as momentum grows around community health worker programs worldwide, advocates celebrated the unveiling of the World Health Organization’s first-ever community health worker guidelines this month at the Primary Health Care Conference in Astana, Kazakhstan.

To learn more, check out The Frontline Health Workers Coalition report on community health workers.

Rosaura received storytelling training from IntraHealth International and the Frontline Health Workers Coalition with funding from Medtronic Foundation last year and has since spoken to hundreds of policymakers to raise awareness of the need to increase strategic investment in community health workers. This article is a cross-post from IntraHealth International’s blog VITAL — see the original post here.

The author of this post, Jessica Turner, is a 2018–2019 Global Health Corps fellow at IntraHealth. Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. Want to get involved? Check out these great opportunities to support the health equity movement and consider joining us as a fellow or partner when applications open later this year! And don’t forget to connect with us on Twitter / Instagram / Facebook.