May 11, 2001

Program Changes Health of Latino Community One Vida At A Time

By Yvette tenBerge

Carmen Gonzalez* (name changed to protect privacy) starts this Tuesday morning as she does most mornings. She rises to make the eggs and oatmeal for her family's breakfast and sets the cereal boxes, low-fat milk and orange juice on the table. Her husband and the two of her six grown children who still live at home sit at the small kitchen table and quickly consume their meals in order to make room for the grandchildren. As usual, Ms. Gonzalez eats standing. As the small house empties, she clears the table and wipes down its red and white checked, plastic table cloth. She washes the dishes and sets them on a towel on the counter to dry.



Olga Sánchez (middle) and Dr. Ana Navarro (right) prepare to had a very excited Maria e. Felix (left) her graduation certificate.

Gathering speed, she dresses and, then, brushes out her shoulder length hair before changing her grandson's diaper. Rounding up three of her daughter's children, she grabs her purse and her car keys and heads outside to an old, navy blue, Toyota Corolla parked in the driveway. She drops two of the boys at their elementary school, checks her lipstick in the rear view mirror and restarts her car. Glancing nervously at her watch, she maneuvers through traffic until finally pulling into the parking lot of St. John's of the Cross Catholic Church in Lemon Grove.

Ms. Gonzalez scoops up her grandson, heads past the large, stark-white church building and enters the Kirk Community Center. The doors close behind her as she walks by the nursery without stopping to leave her grandson, and enters a room filled with nine other women and one other child. Inside, the women converse excitedly in Spanish as they sample refreshments, drowning out the laughter of the school children who play just outside the window.

An immaculately clad woman invites the group to take more refreshments, promising a lesson on them later, as she waves them to their seats. She welcomes everyone warmly, notes that two women are missing and, then, reminds those who are present that today's Por La Vida session, the second of fourteen, two-hour classes, is a "very personal" one on self-esteem, entitled "The Fountain of My Life." It is 9:00 a.m.; Ms. Gonzalez settles into her seat, and Olga Sánchez starts her meeting.

Por La Vida Cuidándome is a community-based health promotion program that has conducted outreach to North County, East County and South County Latino communities since 1987. In recognition of the fact that Latinos who earn low incomes, have lower levels of formal education, and have limited access to health care are in need of health promotion services, a bicultural and bilingual staff at the University of California at San Diego (UCSD) and San Diego State University (SDSU) developed and implemented this program, perhaps the most subtle and powerful one of its kind to date.

Por La Vida, which is under the direction of UCSD faculty member Dr. Ana Navarro, is based on a system of recruiting, training and supporting lay health advisors, called consejeras, who lead bilingual educational sessions on nutrition, cancer prevention and screening and tobacco control. What becomes obvious after reading through the thick, orange and white Facilitator's Guide and after sitting in on some of the classes, though, is that these sessions do a great deal more than simply teach Latinas how to choose healthier products at the grocery store. As Olga Sánchez, one of the few, paid Consejera Coordinators, discovered when she attended her first Por La Vida class as a participant in 1988, the program also serves to empower a segment of the population that is most often overlooked and underestimated: Latina women.



Por La Vida Board Member: Dr. Ana Navarro, hugs Celina Garcia-Chavez at a graduation ceremony in San Marcos. Olga sánchez stands to their left.

"When I started with Por La Vida, I was just like many of the women who are in my classes, today. I did not speak English, and I had a husband who did not want me to leave the house. I still wanted to do something, so I would volunteer my time at my children's schools in National City," says Ms. Sánchez, who was recruited by program employees trained to keep their eyes peeled for Latinas who exhibit natural leadership skills and a commitment to their community. After attending classes led by a consejera who did not speak English, Ms. Sánchez knew that she had found the opportunity for which she had been waiting. "I was so happy to finally find something that I could do. After graduating from my course, I had a huge sense of satisfaction and realized the power that these classes really have. Yes, they help us to strengthen our community, but they also give us back, or help us find, our self-esteem."

The strength of the Por La Vida program, which will be funded by the National Cancer Institute (NCI) until August 2003, lies in its use of existing social networks and on its understanding of the culture in which its participants were raised. First, women from the community are identified and recruited as consejeras, a role that is based on behavior associated with the traditional role of "helpers" within the Latino community. Each consejera receives all class materials free of charge, along with a stipend of between $1,400 and $2,000.

These consejeras are, then, trained to conduct small group educational sessions on a particular health topic in courses such as the 19-week and 14-week nutrition and cancer prevention classes held in North and South County, and the 14-week tobacco control classes held in East County. Upon completing the course, each consejera receives a small gift and a certificate of completion at an emotional graduation ceremony attended by the family of each participant. These newly trained consejeras, then, go on to teach their own group sessions using the "culturally appropriate educational curricula" developed by Por La Vida. To populate their classes, consejeras select 10 to 15 new recruits among women who are their friends, neighbors and family members.

Ms. Sánchez hands out a sheet of paper on which a picture of a fountain is printed and instructs the women to write answers to five questions somewhere on the sheet. After responding to questions like "State something personal, like a problem or difficulty that you have overcome" and "Name someone in your life whom you have helped," Ms. Sánchez sets the tone of the session by revealing some shockingly personal details about her own life. Then, the miracle happens. Rather than shy away from the exercise and its deeply revealing nature, these women join Ms. Sánchez in baring their souls.

As each woman shares her answers with the class, laughter flows as easily as tears. When Ms. Gonzalez' turn arrives, it becomes clear that this woman whose daily life seems ordinary is actually nothing short of extraordinary. She tells the class that she and her eight brothers and sisters were raised by her mother in Tijuana, Mexico. Despite their poverty, she describes her childhood as a "happy time" and speaks of her hard-working mother with respect and affection. Then, she reaches inside of herself to confess that the problem that she had to overcome began when a close family friend started to molest her regularly. Tears stream down her face as she tells the group that she became pregnant with her first child at the age of 15. She describes the years that it took her to overcome the feeling that she was a worthless person, a person who did not deserve to live.

Ms. Gonzalez takes a deep breath, collecting herself. She, then, shares an event in her life that fills her with pride. "Ever since I was a child, I have been able to look into people's faces and see the ones who need my help. One day when I was 16, I passed through a park. I was on my way to pay my rent and to take an elderly neighbor of mine to the free clinic. As I was walking, I noticed a young, pregnant girl who was half sitting and half lying on a park bench. A boy of about 16 was standing near her. After seeing her face, I could tell that something was not right," says Mr. Gonzalez. She describes the events that followed, which resulted in the 15 year-old girl being allowed to give birth in the free clinic only after Ms. Gonzalez gave her own rent money to pay for the necessary sonogram, medication and baby clothes. "After she gave birth, [the couple] asked me how they would be able to repay me. I told them that they owed me nothing because I did it for their little girl, not for them. As I left that hospital, I did what I have done every night of my life that I can remember. I thanked God for putting me where he most needed me that day."

Although many of these woman barely know each other, they offer Ms. Gonzalez their support. One tries to cheer her up by asking, "So, whatever happened to the old lady you were taking to the clinic," and another tells her that "the day that you found that woman, she found an angel. That angel was you."

Despite the fact that the combination of very limited finances and a lack of formal education leaves many of these women with few options, their stories prove that they have the perseverance and heart needed to improve their communities. In Ms. Gonzalez' case, the list of organizations and programs for which she has volunteered is long, and it includes graduation from Familias Saludables, another 10-week Por La Vida program aimed at preventing drug and alcohol abuse among teens.

When asked why she donates so much of her time to programs like these, Ms. Gonzalez' answer is simple. "I do it to help my children and to help my community. Everything that I learn in these programs, I take with me," says Ms. Gonzalez, before optimistically outlining her future plans. "My dream is to have a place in Tijuana where I can offer everything for our people. Whether it is help with diabetes, cancer or emotional support, I plan to take care of people who need me."

As the class continues and each woman shares something about herself, something slowly changes about these women. They look at each other with a new sense of understanding and a new sense of trust. Ms. Sánchez ends the class by bringing the women back to earth with her promised tips on nutrition, and, then, dismisses them. The women gather their yellow legal pads, pens and worksheets as she bids them all good-bye. When the room is finally cleared, she relaxes and sums up her opinion of what Por La Vida does for each of the women whose life it touches.

"You have to realize that many of these women's husbands do not want them to be here. They want them home all of the time, and they do not even want them to get out and talk to other women. I used to fight with my husband about that. I would tell him that I did not come to this country to be locked in my house making beds and food. There were plenty of times when he hid the car keys from me and threatened to take apart the car so that I could not use it," says Ms. Sánchez. She glances at the Fountain of My Life worksheet before continuing. "This program helped me grow as a person, and from that time on, I knew that I wanted to give that same opportunity to the other women of my culture. We all need emotional support, and we all need our strengths to be recognized, and this program has helped do that for so many of us."

Although Ms. Sánchez wholeheartedly celebrates the strengths of Por La Vida, she does admit that the program cannot afford to offer employment opportunities to the intelligent and capable Latinas it finds and trains. "We have women with a lot of potential who are working at Taco Bell just to make a living. It saddens me that these women are not given chances to realize their potential," says Ms. Sánchez, who volunteered with Por la Vida for four years, herself, before finally landing the job for which she now "lives."

From the looks of pride on the faces of the women who graduate at the end of each session, and from the enthusiastic clapping and cheering that goes on throughout each two-hour plus event, there is no doubt that each participant is deeply affected by their time with Por La Vida. Husbands and children, each of whom are dressed in their Sunday best, are introduced to the Por La Vida staff and to the other volunteers, and each of the women, many of whom opt to wear orange in honor of the program, exude radiance. As Ms. Sánchez presents each new consejera with her certificate, she retells heartwarming stories about them taken from classroom moments and conversations.

Por La Vida many not be able to offer their graduates full-time employment, but perhaps with the confidence it helps to instill in its participants and the new bonds that these women form with one another, they will be able to find ways up and over the daunting social obstacles that are planted in their paths.

To find out more about Por La Vida, contact Maria Turingan at (858) 822-2055. To reach Olga Sánchez, call (760) 591-0028.

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