Women’s health takes center stage at Puente. La salud de las mujeres ocupa un lugar central en Puente.

Tricia O’Hara has met a number of monolingual Spanish-speaking women with unanswered questions about their health – things a doctor would be able to answer, about pregnancy, menopause, cervical cancer and other conditions.

“Questions like, ‘How bad is this? Am I going to be okay? Am I notgoing to be okay?’” says O’Hara, who is Puente’s Community Health Manager. “I’ve met women who know they’ve been diagnosed with something, but they don’t know what they have been diagnosed with or what the next steps are.”

Many women living in and around the South Coast must contend with a triple-whammy when it comes to their bodies: language barriers, access to care and lack of health education generally. Many don’t have easy access to a car to get to appointments, let alone a health care provider who speaks Spanish and can help them understand what is happening, explains O’Hara.

Puente’s Thursday night medical clinic staffed by the Coastside Clinic helps address these barriers. It has a doctor on hand who provides some women’s health services, and the clinic only takes patients with certain kinds of health insurance. For instance, the clinic sees patients with Access and Care for Everyone (ACE), a San Mateo County funded health care program for low-income adults who do not qualify for other health insurance, regardless of citizenship status. The nearest full-time medical clinic with an OB-GYN is in Half Moon Bay.

But that changed recently. Thanks to a co-initiative with the San Mateo County Health System, Puente is now offering a women’s clinic on the last Wednesday of the month. It is staffed by Marissa Pfohl, a nurse practitioner who speaks Spanish and serves on the San Mateo County Street and Field Medicine Team.

Pfohl sets up the women’s clinic in the same Puente portable that serves other patients on Thursday nights. She and her team will see patients without health insurance of any kind, and they can sign women up for certain government programs that fund women’s health services like birth control, mammograms, and pap smears. She will spend up to an hour with each patient, giving them plenty of time for exams, tests and questions.

There is often a lot of catch-up to do. “A lot of these women haven’t seen a provider in ten-plus years, or even longer. They didn’t access a lot of services in Mexico. We’ve seen women that haven’t had pap smears, and who are well overdue for their routine preventative screenings who have not been able to access those services,” Pfohl says.

In-house clinic services include basic pelvic exams, breast exams, STD screening, pre-conception counseling, the aforementioned pap smears, mammogram referrals, and most forms of birth control. There are two government-sponsored programs that cover most services, and even important procedures, like if a woman has an abnormal pap smear and she needs a biopsy, and mammograms, and even breast cancer treatment.

The women’s health clinic started seeing patients in late May. Now the priority is spreading the word, and that’s where Puente’s team of Community Health Workers/Promotoras will come in. Pfohl also encounters some women on her twice-monthly visits to local farms and ranches as part of the Street and Field Medicine Team, but mostly, those visits put her and her colleague in contact with male farm workers.

“We know there probably are a lot of women we haven’t met yet. That’s where we’re really relying on the Promotorasto help us with outreach, to help get them into care,” she says.

Treatment is huge, but it isn’t enough on its own. You can’t prevent yourself from getting sick if you don’t know about the lifestyle factors that contribute to a disease. And you may not get help for something if you can’t recognize the symptoms.

When it comes to women’s bodies, these questions are key – and this has led to a new effort at Puente to elevate the level of education and health literacy around women’s health in the form of educational workshops.

Puente offered three public health workshops this year. The topics were chosen based on the community’s most-asked questions. Yesenia Ramirez is a Puente Promotorawho attended all three.

“We started talking about the effects of pesticides and chemicals on people,” she describes. “And then people wanted to know how to prevent different illnesses that affect the heart and the brain. So, we talked about different types of illnesses.

“Then people wanted to learn about sexuality and the different types of STDs – how they’re contracted and what they are.”

The first workshop was co-ed, and the second two were women-only, according to Ramirez. They were all in Spanish.

The first workshop dealt both with the hazardous pesticides that many local workers encounter in plant nurseries and have serious concerns about. Many people in the workshop have had the experience of being ordered to re-enter a nursery that was recently sprayed with toxic plant pesticides – even though the safety signs warn against it. “They end up with headaches and all kinds of things,” says Ramirez.

And they heard about the long-term health impacts of exposing their households to popular cleaners like bleach and Fabuloso, which contains sulfuric acid. “We learned that it is harmful over time for kids and parents – it’s better to use products like vinegar instead of these toxic chemicals,” adds Ramirez.

The workshops were conducted by an outside facilitator and were dynamic by design. For the one on STDs, the facilitator quizzed the crowd about what age girls can get pregnant, and at what age they thought it was appropriate for a boy or girl to date. They talked about their answers.

“One thing that surprised me was that a girl of eight or nine has sometimes already had a sexual experience – that’s something that can and does happen,” says Ramirez.

They also discussed how to talk to their kids about STDs, and how to know when to bring them to the doctor, since many STDs are asymptomatic.

Another workshop focused on understanding chronic diseases and serious ailments, especially those that are found in older adults. “There are a lot of women, ages 50 and up, who want to know about the diseases that can affect your brain, your heart,” says Ramirez. “I also see people who have problems with their kidneys – they know they’re sick but they don’t understand it.”

By popular demand, the next health workshop for women will focus on coping with menopause, and the physiological component of that.

“You could see even in the workshops that there is a strong desire for more of these educational opportunities. It’s something our community is really ready for, and wants to be able to access,” says O’Hara.

La salud de las mujeres ocupa un lugar central en Puente

Tricia O’Hara se ha reunido con varias mujeres monolingües de habla hispana con preguntas sin respuesta sobre su salud, cosas que un médico podría responder, sobre el embarazo, la menopausia, el cáncer de cuello uterino y otras condiciones.

“Preguntas como, ‘¿Qué tan malo es esto? ¿Voy a estar bien? ¿No voy a estar bien?’ “, dice O’Hara, que es la Gerente de Salud Comunitaria de Puente. “Conocí mujeres que saben que les diagnosticaron algo, pero no saben con qué han sido diagnosticadas ni cuáles son los próximos pasos.”

Muchas mujeres que viven en los alrededores de la Costa Sur deben lidiar con un triple golpe en lo que respecta a sus cuerpos: las barreras del idioma, el acceso a la atención y la falta de educación sobre la salud en general. Muchos no tienen acceso fácil a un automóvil para llegar a las citas, y mucho menos a un proveedor de atención médica que habla español y puede ayudarlos a comprender lo que está sucediendo, explica O’Hara.

La clínica médica de Puente el jueves atendida por la Clíinica Coastisde ayuda a abordar estas barreras. Tiene un médico a su disposición que brinda algunos servicios de salud para mujeres, y la clínica solo atiende a los pacientes ciertos tipos de seguro de salud. Por ejemplo, la clínica atiende a pacientes con ACE, un plan de seguro proporcionado por el condado para los residentes sin importar su estado de ciudadanía. La clínica médica más cercana a tiempo completo con un ginecólogo se encuentra en Half Moon Bay.

Pero eso cambió recientemente. Gracias a una iniciativa conjunta con el Sistema de Salud del Condado de San Mateo, Puente ahora ofrece una clínica para mujeres el último miércoles de cada mes. Cuenta con Marissa Pfohl, una enfermera practicante que habla español y trabaja en el equipo de San Mateo County Street y Field Medicine.

Pfohl instala la clínica para mujeres en el mismo portátil al que Puente sirve a otros pacientes los jueves por la noche. Ella y su equipo atenderán pacientes sin seguro médico de ningún tipo, y podrán contratar mujeres para ciertos programas gubernamentales que financian ciertos servicios de salud para mujeres, como anticonceptivos, mamografías y pruebas de Papanicolau. Pasará hasta una hora con cada paciente, dándoles suficiente tiempo para exámenes, dar resultados y preguntas.

A menudo hay mucho seguimiento que dar con las pacientes. “Muchas de estas mujeres no han visto a un proveedor en más de diez años, o incluso más. No tuvieron acceso a muchos servicios en México. Hemos visto mujeres que no se han hecho la prueba de Papanicolaou y que están muy retrasadas en sus exámenes preventivos de rutina que no han podido acceder a esos servicios, ” dice.

Los servicios clínicos internos incluyen exámenes pélvicos básicos, exámenes de los senos, exámenes de detección de enfermedades de transmisión sexual (ETS), asesoramiento previo a la concepción, las citologías de Papanicolaou mencionadas anteriormente, derivaciones de mamografías y las diferentes formas de anticonceptivos. Hay dos programas patrocinados por el gobierno que cubren la mayoría de los servicios, e incluso procedimientos importantes, como si una mujer tiene una prueba de Papanicolau anormal y necesita una biopsia, y mamografías, e incluso el tratamiento de cáncer de mama.

La clínica de salud femenina comenzó a atender pacientes a fines de mayo. Ahora la prioridad es difundir el mensaje, y ahí es donde entrará el equipo de Promotoras/Trabajadoras Comunitarias de Puente. Pfohl también se encuentra con algunas mujeres en sus visitas dos veces al mes a granjas y ranchos locales como parte del Equipo de Medicina de Calle y Campo, pero en su mayoría, esas visitas la pusieron a ella y a su colega en contacto con los trabajadores agrícolas masculinos.

“Sabemos que probablemente haya muchas mujeres que aún no hemos conocido. Ahí es donde realmente dependemos de las Promotoras para que nos ayuden con la divulgación y ayuden a que reciban atención,” dice.

El tratamiento es enorme, pero no es suficiente por sí solo. No se puede evitar enfermarse si no conoce los factores del estilo de vida que contribuyen a una enfermedad. Y es posible que no obtenga ayuda para algo si no puede reconocer los síntomas.

En lo que respecta al cuerpo de las mujeres, estas preguntas son clave, y esto ha llevado a un nuevo esfuerzo en Puente para elevar el nivel de educación y alfabetización en salud en torno a la salud de la mujer en forma de talleres educativos.

Puente ofreció tres talleres de salud pública este año. Los temas fueron elegidos en base a las preguntas más frecuentes de la comunidad. Yesenia Ramirez es una Promotora de Puente que asistió a las tres.

“Comenzamos a hablar sobre los efectos de los pesticidas y los productos químicos en las personas”, describe. “Y luego la gente quería saber cómo prevenir diferentes enfermedades que afectan el corazón y el cerebro.” Entonces, hablamos sobre diferentes tipos de enfermedades.

“Entonces la gente quería aprender sobre la sexualidad y los diferentes tipos de enfermedades de transmisión sexual: cómo se contraen y qué son.”

El primer taller fue mixto, y los otros dos fueron solo para mujeres, según Ramírez. Todos estaban en español.

El primer taller trató tanto de los plaguicidas peligrosos que muchos trabajadores locales encuentran en los viveros de plantas y tienen serias preocupaciones. Muchas personas en el taller han tenido la experiencia de recibir la orden de reingresar a un vivero que fue rociado recientemente con pesticidas de plantas tóxicas, a pesar de que las señales de seguridad advierten contra ello. “Terminan con dolores de cabeza y todo tipo de cosas,” dice Ramirez.

Y se enteraron de los impactos a largo plazo en la salud de exponer a sus hogares a limpiadores populares como el blanqueador y Fabuloso, que contiene ácido sulfúrico. “Aprendimos que con el tiempo es dañino para los niños y sus padres: es mejor usar productos como el vinagre en lugar de estos productos químicos tóxicos,” agrega Ramírez.

Los talleres fueron conducidos por un facilitador externo y fueron dinámicos por diseño. En el caso de las enfermedades de transmisión sexual, la facilitadora interrogó a la multitud sobre la edad a la que las niñas pueden quedar embarazadas y a qué edad pensaban que era apropiado que un niño o niña saliera con alguien. Hablaron sobre sus respuestas.

“Una cosa que me sorprendió fue que una niña de ocho o nueve años a veces ya tuvo una experiencia sexual; eso es algo que puede ocurrir y sucede,” dice Ramírez.

También discutieron cómo hablar con sus hijos sobre las enfermedades transmitidas sexualmente, y cómo saber cuándo llevarlas al médico, ya que muchas ETS son asintomáticas.

Otro taller se centró en la comprensión de enfermedades crónicas y dolencias graves, especialmente las que se encuentran en adultos mayores. “Hay muchas mujeres, de 50 años en adelante, que desean saber sobre las enfermedades que pueden afectar su cerebro y su corazón,” dice Ramirez. “También veo personas que tienen problemas con los riñones, saben que están enfermos pero no lo entienden.”

Por demanda popular, el próximo taller de salud para mujeres se centrará en hacer frente a la menopausia, y el componente fisiológico de eso.

“Se podía ver incluso en los talleres que hay un fuerte deseo de más de estas oportunidades educativas. Es algo para lo que nuestra comunidad está realmente preparada y quiere poder acceder,” dice O’Hara.

La salud de las mujeres es un componente importante de nuestro continuo apoyo a nuestra comunidad. Por favor, considera hacer una donación hoy.

Medical Crisis Prompts Lifestyle About-face for Local Mom


Susi Arias was worried. Her parents were not well, it was clear. But they refused to see a doctor. “My dad would say, people die in the hospital,” she recalls. “And my mom would always say she would do it later on.”

Neither of her parents, Concepcion and Jorge, had been to see a doctor in a decade or more. It never seemed urgent, and they never had the time. Concepcion cleaned houses and Jorge worked in agriculture. At their home in La Honda, Arias and her two siblings noticed a pronounced difference in their  parents’ energy levels and temperaments.

“I didn’t know what to do, what to give them. I saw my mom was always sleepy. She went to bed right after dinner. And my dad was always in a bad mood,” recalls Arias.

That changed when Molly Wolfes knocked on their door. Wolfes, Puente’s Community Health Coordinator, was making the rounds with her Puente health promoter team, Yolanda and Yesenia, and Chris King, a San Mateo Nurse Practitioner and his Medical Assistant Rafael. When Wolfes asked Concepcion how she was feeling, she admitted she was “nervous because there was stuff that had happened.” Wolfes talked her into visiting the doctor at Puente’s Thursday night health clinic in Pescadero. She made an appointment on the spot for herself and her husband.

“I told her, ‘You think there’s something going on. The stress of worrying about being sick is going to make you more sick. So let’s do something about it,’” says Wolfes.

Less than a month later, the blood test results came in. Both Concepcion and her husband had uncontrolled diabetes. Her kidneys were struggling to do their job. Her blood glucose levels were dangerously high, and his were even higher. In the urgent testing that followed, it became clear that they were both at risk for further complications.

She sat in her car, weeping. “I was thinking, is this it?” Was this the end? A cousin of hers, much younger than Concepcion, had been diagnosed with Type I diabetes and was on insulin. She had two young kids. Life was a huge struggle.

The pain, the muscle aches, the weight gain and the exhaustion now made sense. But Concepcion was terribly frightened. And she didn’t yet know what to do about it.

Fortunately, neither Concepcion nor her husband needed insulin. What they did need was a major lifestyle overhaul. And that became the impetus for one. Rather than just take their prescription pills and hope for the best, Concepcion took her doctor’s advice and transformed both her physical activities and her family’s diet. Before long, they were eating more cauliflower, rice and fewer tortillas. The kids also got in on the act, helping cook the food and giving support to their parents.

“It lit a fire under them. I think the fear of getting sicker pushed them to change their lives,” says Wolfes.

The benefits of a healthy lifestyle have extended to Arias and her siblings. “Now I’m happier because my mom is feeling better. Our diet is different. I’ve lost weight and so have my brother and sister,” she says.

Today, Concepcion is out of the danger zone. Her blood glucose level is within the normal range, and she has lost more than 25 pounds since April – and counting. Her husband Jorge has been slower to make changes.

She’s proud of her progress, but can’t escape the guilt she feels at not having gone to the doctor earlier. “This could have been prevented. God has given us another chance. We need to make the most of it,” she says.

Puente’s in-house medical clinic, a satellite of San Mateo Medical Center’s Coastside Clinic in Half Moon Bay, sees a lot of patients like Concepcion with untreated diabetes, as well as blood pressure issues, heart conditions, and chronic repetitive stress injuries: a total of 121 unique patients, representing 355 appointments, since March 2015.

Often patients hold out until their symptoms become intolerable, which is never a good policy but can be due to fear or barriers getting to the clinic like transportation or lack of time.

Arias diagnoses the problem: fear. “People are scared. They don’t know what it’s like at the doctor or the dentist.”

That’s where Puente’s health promoters, or Promotores de Salud, come in. They make a one-on-one connection with people and give them a chance to discuss concerns about their health. They will sometimes talk people into seeing a doctor, like Wolfes did. And they schedule their appointments, whether for medical care or to renew their health insurance, through Puente.

Of course, the main incentive is accessibility. Before Puente opened the county-funded clinic, locals would have to drive to Half Moon Bay, San Mateo, Redwood City or Palo Alto to see a doctor.

“If the clinic had not been in Pescadero, I wouldn’t have gone to the doctor. I couldn’t take the time off from work,” says Concepcion.

For more information about Puente’s health promoter teams, email Molly Wolfes, Community Health Coordinator, at mwolfes@mypuente.org.

Want to support Puente’s health and wellness programs? Donate today.

Puente’s Health Fair Just Days Away

Free Flu Shots and More on October 2 from 12-3PM

When I first came to work at Puente two and a half years ago, I noticed that nearly all of Puente’s programming was designed to maximize participants’ time.  Members of our community have a lot on their plates with work, family, school, and more. Living in a rural area, without easy access to transportation and many medical services, means that many people must take unpaid time off work to attend to their medical needs.

The idea of the health fair started three years ago: one event where people could get most of their yearly health screenings done at the same time and have fun with their families. We wanted to help people make the most of their time and create a one-stop-shop – a place and a time where convenient and efficient health services and information were available to our local community. The idea of the fair was to break down the barriers to getting care.

Over the years the Health Fair has evolved to fit the community’s health needs. This year, the fair consists of three parts: health screenings in the Pescadero elementary school multi-purpose room, a traditional informational health fair outside on the playground, and a kid’s soccer tournament on the school field. Health screenings include free flu shots from San Mateo County’s Health Department, blood pressure screenings from the Red Cross, skin cancer screenings from PAMF, musculoskeletal exams from the San Mateo Medical Center, vision screenings from UCSF, and dental screenings from the Ravenswood Clinic and SONRISAS. Participants will also have the opportunity to talk privately with a diabetes nutrition counselor as well as get information about the importance of breast exams and HPV vaccines. Attendees will also be able to sign up for Stanford Cardinal’s Free Clinic pilot program which launches in late October at Puente’s medical clinic.

Outside on the playground, attendees will find information about Puente’s services and programs, nutrition, herbal medicine, vitamins and supplements, lead and pesticide exposure, hospice care, housing and legal advice, Lyme disease prevention and more. Representatives from Planned Parenthood, the Legal Aid Society, the Red Cross, Cañada College, and Project Sentinel will also be providing information about the services offered by their organizations. A local fitness instructor will lead fitness and agility testing. Get your workout and enjoy a treat on Blender bikes — led by Pie Ranch — a fun way to make a smoothie!

There is a completely FREE soccer tournament for youth, ages 6-12, fruit and veggie face painting, children’s activities led by the Half Moon Bay Library, a bounce house and a free pedometer contest where the more steps you complete, the more prizes you win.

In addition to all of the booths, there will also be live local music from three amazing local musicians, and a Zumba demonstration. Students from Pescadero Middle School will sell fruit parfaits to support their trip to Washington, DC. There will also be a raffle for an iPad mini, activity trackers for adults and kids, gift cards, kids bikes and more!

Please join us! The health fair will be this Sunday, October 2nd, from 12pm-3pm at the Pescadero Elementary School. The fair is bilingual and open to all!

For more information, contact Molly Wolfes, Community Health Coordinator, at 650-262-5989.

Many thanks to Health Fair sponsors: San Mateo County Measure A, Kaiser Permanente, Stanford Children’s Health | Lucile Packard Children’s Hospital Stanford.

Puente needs your support for our health and wellness programs. Please donate now.