Puente community health workers connect locals to doctors and other preventive services

When you struggle with health issues, sometimes it’s easier to talk to a friend you trust than to a doctor you don’t know. Someone who is approachable and speaks your language.

That’s the principle behind Puente’s new Community Health Workers / Promotoras de Salud Project, which recently secured funding to train and hire community members to visit farms, ranches, and all people in need on the South Coast. The Promotoras (three bilingual, two Spanish-only speakers) will talk to people about their health – and discuss the importance of preventive services and seeing a doctor regularly. They will play a key role in helping funnel more local patients into the recently opened health clinic housed in Puente’s offices.

“The Promotoras don’t have as much medical knowledge, but they do have community knowledge. They will act as the bridge between the community and the medical clinic,” says Molly Wolfes, Community Health Coordinator for Puente.

Puente’s pop-up medical clinic, a satellite of San Mateo Medical Center’s Coastside Clinic in Half Moon Bay, opened in March. Since then, the county doctors who staff the clinic have seen 99 patients. Nearly 80 percent are low-income farm workers and their families.

The clinic represents the latest attempt to address the serious lack of health services available to several under-served and under-insured communities on the South Coast. As many as 500 individuals do not have regular access to a physician, a dentist or an eye doctor. For everything from check-ups to pediatrics and OBGYN, help is as much as an hour away. Not only do some farm workers lack cars in a place where public transportation is almost non-existent, they have trouble making it to appointments. Doctors’ office hours don’t exactly correspond to their intensely long work shifts, and many farmers live day-to-day on the money they make. Taking the day off to see the doctor could mean no money for food.

The result is that 40 percent of adults have not seen a doctor in the past year, according to a recent community health care survey Puente conducted.

“Especially within the Latino community and couch surfing/mobile communities in La Honda that have struggled to access care, there is a perception that barriers exist preventing them from getting care. Some of the perceived barriers may include fear, a language barrier, or transportation and child care issues,” says Wolfes.

That will change now, thanks to a plan conceived by Puente health advocates with support from San Mateo County Health System. In early August, Supervisor Don Horsley and the other members of the Board of Supervisors voted to approve Measure A funding for the Community Health Worker/Promotora program totaling $351,235 over two years.

Big day on the South Coast — The San Mateo County Board of Supervisors voted unanimously yesterday to fund Puente’s first community health worker/promotora program. from left to right: Molly Wolfes, Kerry Lobel, Supervisor Don Horsley, Rita Mancera, and Dr. Susan Ehrlich, Chief Executive Officer at San Mateo Medical Center.

Big day on the South Coast — The San Mateo County Board of Supervisors voted unanimously yesterday to fund Puente’s first community health worker/promotora program.
from left to right: Molly Wolfes, Kerry Lobel, Supervisor Don Horsley, Rita Mancera, and Dr. Susan Ehrlich, Chief Executive Officer at San Mateo Medical Center.

The funding will train several community members, including some Puente staff, as Community Health Workers/Promotoras. Bringing new people into the clinic requires active outreach, face-to-face conversations, and an understanding of what’s needed to connect patients to doctors.

If someone lacks health insurance, Promotoras can help make an appointment with a Puente Resource Navigator. If a Health Promotora notices signs of depression, they can make a referral to Puente’s mental health services. If a nurse’s attention is called for, the client can be referred to Karen Hackett, a San Mateo County Public Health nurse headquartered with Puente.

Puente also arranges free transportation to and from any medical or dental appointment for local participants who need it.

The county has already committed funds to help Puente and the Medical Center split the existing exam room—making two exam rooms in one of its portables. The program could grow from there. In the first year of the Promotoras grant, Puente will need to touch at least 100 new participants every month.

“If this actually works – and I think it will – the numbers will look really good, and that will justify getting a second portable to perhaps expand the clinic,” says Supervisor Horsley. “I’m excited to see this partnership between the County, Puente, and the Medical Center – we’re truly building something from the ground up in Pescadero.”

The starting point is setting up a once-yearly physical for local residents, with a focus on preventing serious medical conditions before they start.

“Quite a few of our patients have never been to a doctor. I realize that’s odd because they’re middle aged, but they’re from rural areas and they’ve never sought medical care,” says Jonathan Mesinger, Clinics Manager for both Half Moon Bay and Pescadero.

Puente Executive Director Kerry Lobel describes the habit of self-care as a kind of “muscle memory” that Puente hopes to induce. To that end, Promotoras will also lead formal weekly health support classes for those who suffer from chronic diseases, such as diabetes, to teach patients and their family members the best prevention techniques as well as strategies for care. Later on, the classes will expand to smaller groups at the ranches themselves.

Health Promotoras are not only from the community they serve, they will be taking control of its future. This kind of self-advocacy approach to change – from the inside – is part of Puente’s continuing initiative in building community leadership.

Karen Hackett, right, talks with Sandra, one of the new Promotoras.

Karen Hackett, right, talks with Sandra, one of the new Promotoras.

Take La Sala, Puente’s twice weekly social space for farm workers: a former participant is now part of the staff that helps run the program. Women from Pescadero and La Honda lead Puente’s Zumba classes. And local parents, who are trained as facilitators, teach Puente’s Abriendo Puertas sessions on early childhood education and development.

“It’s a well-established principle here that peer leaders are the way to go. We knew that was the best way to approach health prevention activities,” says Lobel.

Puente’s Health Fair is another ongoing strategy that targets health prevention in particular. The second annual Health Fair on October 4 will have a family focus, with free flu vaccines and multiple health screenings available for all ages, and a bike rodeo, a drawing, and fun kids’ activities. The message: seeing a doctor doesn’t have to be a scary ordeal, so let’s get it all done in one day.

Health care has always been a front-burner issue in Pescadero. The Pescadero clinic is the latest iteration in the search for a medical home on the South Coast that goes back more than 30 years. As early as the 1970s, community leaders established a clinic inside a local school, and later, in Pescadero Community Church. The South Coast Collaborative and North Street Community Resource Center worked hard to get doctors to the area before Puente came along. The county thrice funded a mobile health van staffed with doctors and nurses, but it was discontinued when money ran out.

In 2014, the county set aside $1 million to outfit a new medical van but then withdrew the plan. Without a van, the bricks and mortar clinic requires Health Promotoras to conduct outreach. It may not be perfect solution, but it’s the closest the community has come in a while.

“It’s been filled with pain and gain for so many years now,” says Lobel. Three years ago, Puente renewed its health strategy with major assistance from the Lucille Packard Children’s Hospital Stanford in the form of a multi-year grant as well as grants from Kaiser Permanente, Mills Peninsula Health Services/Palo Alto Medical Foundation, and the Gordon and Betty Moore Foundation.

“Today’s approach to healthcare is a result of a deep partnership between Puente and Supervisor Don Horsley,” says Lobel.

In October 2012, Supervisor Horsley promised that if Measure A passed, funding would be used to bring medical care to Pescadero. Horsley was true to his word, first exploring the concept of a mobile van, and then leveraging a partnership with the San Mateo Medical Center to bring a medical team to Pescadero on a weekly basis. He secured Measure A funding to remodel office space at Puente for two exam rooms, and for the Community Health Worker/Promotoras Project.

According to Lobel, “100 local residents have received healthcare, to date, because of Horsley’s efforts – that’s a huge accomplishment.”

Puente is now pushing for pediatric care where possible. And according to Mesinger, the county might add a pediatrician to their Pescadero clinic if the numbers warrant it. This year, for the first time ever, Puente arranged for a Coastside Clinic pediatrician to come during backpack distribution day. Nine children were able to get their physicals and be ready to go back to school.

The Promotora model originates in Mexico, and it has been used in other contexts with success in the U.S. Here in San Mateo County, the Sheriff’s Office used home visits and community workshops in North Fair Oaks as a way to educate parents about the warning signs of drug use and gang affiliation among young people.

Mesinger himself was manager of the Fair Oaks Health Clinic in Redwood City for many years, and clinic patients were 85 percent Latino, demographically similar to clinic patients on the South Coast. Most spoke Spanish only. Mesinger says the experience taught him that patients need to become comfortable with their doctors over time, and that those long-term relationships take time to build. Mesinger says county staff is looking forward to building those relationships in Pescadero.

“The key is, how much are you a part of the community that you’re serving?” says Mesinger. “The community knows Puente, and that’s a big advantage. It really helps to be associated with Puente.”

Join Puente for its second annual community Health Fair on Sunday, October 4 from 11 a.m. to 3 p.m. at 620 North Street in Pescadero. Come for a health screening and Medicare counseling, stay for the raffle and kids’ activities. For details, visit www.mypuente.org.

Volunteer with Puente this fall

There are three ways to volunteer with Puente in the coming months. Please contact Volunteer Coordinator Abby Mohaupt at amohaupt@mypuente.org or 650-262-4095 for more information or to volunteer.

Language Exchange: During the fall semester we plan on having ‘coffee shop’ style classes at the end of every month at ESL classes. This means we ditch the classroom and set up a bunch of tables in the elementary school and have volunteers come in and speak English to the students. We’re also working to have the last 30 minutes all in Spanish, but we want to ask the students first.

The first session will be Sept 29th 7-9 PM at Pescadero Elementary School.

  1. Training will be Monday Sept 28th at 7 PM.
  2. You will need to fill out the full volunteer application.

Mentoring Youth: There are 16 students at Pescadero High School that  are in critical need of tutors- mainly in English and Math, but there will be other subjects as well. We’re looking for tutors who are willing to make a semester commitment to a student and to be a solid accountability partner for their studies. Some of the students live in La Honda so for you La Hondaers that would mean not a far drive. If you want to go above and beyond- some of these students are about to enter into high school this coming year. If you plan on sticking around the area for the next 4 years you could personally help one of these students graduate high school by sticking with him or her. Requirements are

  1. Ideally you would meet with the student twice a week for an hour and half at a time, be their accountability partner, and be a solid/stable person in their life.
  2. A commitment to a student from Aug 18th- Dec 22nd.
  3. Fingerprints and background check (which Puente will reimburse you for)
  4. Filling out complete volunteer application.

Reading Partners: The Elementary School students in Pescadero need help reading. Puente is going to round up 20 volunteers who are willing to read with and listen to a couple of students once or twice a week from 3-5pm at the Elementary School. Requirements are:

  1. Attend training on August 31 5-7pm. (More trainings will be scheduled as interest requires.)
  2. A commitment to a student from Aug 18th- Dec 22nd.
  3. Fingerprints and background check (which Puente will reimburse you for)
  4. Filling out complete volunteer application.

Puente youth travel bridge to adulthood in just one summer

What happens when you give a teenager a summer job? A 15-year-old girl learns to fit in with her co-workers. An 18-year-old boy makes new friends from around the world. A mother watches her 16-year-old daughter learn the value of hard work, and their relationship is transformed.

Puente’s Youth Leadership and Employment Program has always reached beyond giving young people the chance to earn an hourly wage. It’s also about exposing them to the world of adulthood, building a vision for college, giving them marketable job skills, and improving their academic performance at school.

Puente youth also go on several tailor-made summer field trips, which are both fun and educational. This summer, Puente took the group to the Monterey Bay Aquarium, to Genentech, to the capitol building in Sacramento, and to San Francisco’s Chinatown, Flood Buidling, Coit Tower, De Young Art Museum, and Fisherman’s Wharf. Some also toured Facebook.

The experience transforms the youth in unexpected ways. Back in June, Sofia Betteo, 15, was feeling like a fish out of water at Puente’s summer youth program orientation. She and her mom had just moved to the South Coast from Belmont, a city on the Bayside, and she was preparing to switch from a high school of 3,000 students to one of 95.

Sofia participates in yoga with some of the children at the Half Moon Bay Library.

Sofia participates in yoga with some of the children at the Half Moon Bay Library.

She didn’t really speak to anyone during an overnight camping trip to help the 38 Puente youth get to know each other. A few days later, all of the teens filed into the Pescadero Elementary multipurpose room and formed a circle with Puente staff members to take turns introducing themselves.

Puente Executive Director Kerry Lobel started the icebreaker by introducing herself and handing a green hula-hoop to the next person, who spoke, then handed it off to someone else. Many of the students barely spoke above a whisper. “Louder!” called Lobel. (Public speaking is one of the skills Puente youth learn over the summer.)

Later, after meeting many new people at Puente, Betteo then met a new group of co-workers at the Half Moon Bay Library, her placement through Puente, assisting with a children’s reading program.

It was her first summer job, and she enjoyed learning how to read to 6-year-olds. She made them snacks and supervised child yoga and playtime. She also helped the library staff reshelf books, and tutored an older child who struggles with his English.

By August, Sofia had gained a strong measure of confidence.

“I think getting to know everybody was a big deal – your co-workers, people at Puente. Now I see that everyone is part of a tight community,” she says. “It was really nice to see that and how I fit into that. It was a nice surprise.”

Since 2007, Puente has been the largest employer of youth on the South Coast and a strong bridge to adulthood, helping students develop their own resumes and cover letters and working with them on their personal statements for college, starting when they are as young as 14.

Every summer, Puente offers a credit recovery course to students who need to boost their grades in subjects like English and Algebra. This summer, Puente hired Shannon White to help students meet their academic requirements and keep them intellectually stimulated over the months off from school. White, then a Lilly Endowment Teacher Creativity Fellowship Recipient and a high school teacher in Indiana, volunteered with Puente last summer. This year she helped students meet their summer reading assignments and write their book reports.

White often found herself reading to youth who struggle with reading to themselves. “I’m not sure how much students have had of that in their lives,” she says.

Shannon meets with a student to discuss the student's academic schedule and resources.

Shannon meets with a student to discuss the student’s academic schedule and resources.

“I’ve been astounded by the life experiences these students have,” adds White. “You can’t tell from looking at them, but some of these kids have had some pretty traumatic experiences or complicated living experiences and they struggle academically.”

Until this summer, Puente received federal funding to pay people like Shannon White as well as youth salaries. Now that source of funding is gone, and the Youth Leadership and Employment Program is imperiled.

Thanks to an intervention by San Mateo County Supervisor Don Horsley and generous community support in the form of individual donations, Puente has raised $108,500 so far this summer. That’s excellent news in the short term, but it does not address the question of sustaining the youth program without depleting Puente’s reserves, says Kerry Lobel, Executive Director of Puente.

“There’s some relief on some of the summer youth salaries, but it doesn’t address the amount of funding that was going to pay for our support staff,” she says.

Puente needs to meet the remaining funding gap for youth salaries of  $81,500 by the end of the summer. Please click here to donate. A donation of $493 supports one Puente youth for one week.

It would not be an understatement to say that Puente’s youth program has helped Cristian Antonio springboard into adulthood. The 18-year-old has worked with Puente every summer since he was 14. In past years he has helped run the LHPUSD Panther Camp, tutoring younger students in English and math. One summer he worked at Pie Ranch through a Puente partnership called Homeslice, a storytelling project that helped him hone his skills in public speaking.


Cristian participates with campers at camp.

What he always wanted was to work at YMCA Camp Jones Gulch in La Honda as a counselor and this summer, he got his wish. “I like to be that big brother,” he says.

Antonio loved his summer supervising children as they hiked and played and swam and made art together. He liked the camp itself so much, in fact, that camp administrators got wind of it and offered him a year-round job – something he can do on weekends while he attends community college next year.

But the best part of all was the week of camp orientation, where he connected with fellow counselors from the UK, Australia, France and Poland. They became such good friends that he intends to visit some of them next year in Europe – a first for him.

“We talked all night long. I can’t explain it, there’s like a bond now,” he says.

Isabel Gonzalez also formed an unexpected bond this summer – with her mother, Evelia Ramirez. The single mom works long hours at a restaurant to support her children, including Gonzalez, who is 16. Until this summer, they fought quite a bit.

Evelia and Isabel together.

Evelia and Isabel together.

“Isabel used to tell me, ‘Why are you tired? You don’t do anything at your job,’” recalls Ramirez. “She would yell and scream. She would always want stuff and I wouldn’t want to give her money for it.”

Those tensions disappeared when Gonzalez started her first-ever summer job in June, working at the Half Moon Bay Library in the same reading program as Sofia Betteo. Suddenly she knew what it was like to be on her feet much of the day, to exert herself, and to meet an employer’s expectations.

As a result, she started to see her mother in a very different light.

“Her perspective toward me has changed,” says Ramirez. “I think that her job is making her think and understand what comes with working – the idea of it.”

Ramirez says that in the course of two months, her daughter has become patient and conscientious. She is now a pleasure to live with and is more responsible. She used her first few paychecks to replace a broken cell phone, and she has been taking better care of it.

“It think the job has been so beneficial for her – especially when she got her first check,” laughs Ramirez.

Sofia Betteo, Cristian Antonio, Isabel Gonzalez and other Puente youth need your help today. Please click here to donate to the Youth Leadership and Development Program. Thank you!