Health Care Disparities

An informal network of providers allows access to a limited number of free or low-cost drugs, mammography, treatment and other services. This network includes volunteer physicians on both sides of the border, the local federally funded community health center, the local Catholic hospital on the US side, the Shriner's Hospital in Phoenix, hospitals in Tucson, the Mexican public social security hospital in Sonora, and the Santa Cruz County health department. The promotoras support the Santa Cruz County health department, doing home visits and translation on its behalf. When the county identifies diabetics, follow-up management is often handled by the promotoras. The promotoras have also been involved in a number of community issues. When the controversial replacement of a local well was proposed, promotoras and Institute-organized volunteers headed the county steering committee and organized door-to-door activities to advertise public meetings on the issue. Given their cross-border environment, the Institute has also fostered close working relationships with Mexican consular officials and municipal officials in Nogales, Sonora. The Institute has assisted Plan Retornowith donated supplies and health education. Plan Retorno helps deported individuals who have been dropped off in Nogales, Sonora far from their towns and villages of origin. The Way of the Heart model is different from what is more commonly seen in other promotora initiatives: It is a freestanding entity that has built a set of collaborative relationships with clinical providers and social agencies. Most other promotora projects appear to be sponsored by existing clinics and hospitals that use them to augment their outreach and patient management efforts. Staff Recruitment, Training and Retention Promotoras are recruited mainly through word of mouth, postings in community agencies and sometimes through newspaper ads. In the future, promotoras may be recruited from the teen promotora program that has developed out of the Institute's peer counseling work. The program explicitly seeks promotoras who reflect the culture, economics and demographics of the Nogales community. Persistence and resilience in navigating systems are the most sought after attributes. Pay is set at $8.50 per hour; other benefits are not offered. Pay has sometimes been delayed. Most promotoras are themselves enrolled in the AHCCCS program. Each promotora receives an initial three months of training in basic health