Jonny Mondragon usually supervises medical assistants at the East County Health Center. But on a recent Thursday evening, he was serving pork posole.
Phil Bleth usually comes to work as a medical assistant. But on this night he came as Santa Claus.
Luz Brousseau usually sees children in a clinic exam room. This night she was painting candy canes on their cheeks.
On Nov. 29, nearly 200 mothers, fathers and children packed into a conference room draped with decorations, and crowded with poinsettias, to celebrate the holidays and mark the first year of Empezando con Salud, an innovative medical partnership tailored to their needs.
“It’s nice to see people happy, to spend time with them when they’re not sick, and get to know them,” said Brousseau, a community health nurse and a member of the project. “It makes medical visits easier.”
Empezando con Salud, which began in fall 2017, is a 2-year pilot of Multnomah County’s Maternal Child Family Health in partnership with the county’s clinical services.
Modeled after the Healthy Birth Initiative, Empezando con Salud aims to improve health for Latinx families who may otherwise struggle to access medical care and social services because of cultural, language or financial barriers. Families are recruited by their primary care providers at the East County Health Center, where a team of Latinx nurses and community health workers work with clinic staff.
“The program is integrated into the clinic, and it’s the first time we’ve done that,” said clinic manager Lynne Wiley.
“It’s been really good. The care is coordinated, so clients get more services.”
The Empezando Con Salud team, who all speak Spanish, visit more than 100 families at their homes and provide prenatal, developmental and Adverse Childhood Experiences screenings. The team helps families with everything from finding maternity clothes to locating specialists in Attention Deficit Disorder to securing energy assistance. They coordinate workshops called convivios where parents learn about birthing practices, breastfeeding and infant massage, but also where parents share their own knowledge and create community.
“This program helps a lot,” said one mom, Suheidy, who’d come to last month’s party with her partner, Jesus, and their 8-year-old daughter and 4-month-old son. “They tell you things like what to do if you can’t pay the electricity bill. You come to the clinic and you think you’re only going to get medical care.”
Generational Health
The program targets the social determinants of health — things like access to employment, housing and food — that play an oversized role in a person’s quality of life. Those are things the Empezando con Salud team will address.
The pilot is funded for two years through a $2 million grant from CareOregon’s Primary Care Investment Fund. The fund helps clinics build capacity, and it supports projects that address not only childhood trauma but also the social determinants that affect the health of children who haven’t even been conceived yet.
“If they have healthier births, and their children have healthier childhoods, then those children's children will be healthier,” said Maia Boucher, who oversees the project. “It really gets at the premise of how environment and other factors impact your health. If, at the end of the day, a client doesn’t have a safe place to sleep, that will pose a long-term risk to their health.”
Affordable housing is a common stressor for families in Empezando con Salud.
“I have a family of nine with a baby on the way,” said community health worker Yesenia Silva Hernandez. “I have been trying to get them affordable housing, but right now finding affordable housing is not easy to do.” Instead the growing family shares a one-bedroom apartment in Gresham.
Silva Hernandez and the team help mothers identify resources like rental and emergency utility assistance. And they help families through the rental search and application process.
“A lot of moms don’t know who to call, what question to ask or what you need to qualify,” she said. “For a lot of new moms from other countries, they feel they can’t qualify and they have to stay in a one-bedroom with 10 people and they sleep in the living room. They are dealing with a lot of stress.”
Speaking up
The team helps mothers advocate for themselves, in housing and in health. Ines Betancourt recalls one mom who stopped breastfeeding because her refrigerator broke down, leaving her no place to keep breast milk cold. The landlord kept saying he would fix it, and the woman didn’t want to push.
“A lot of families just feel lucky to have a place to live,” Betancourt said. But when Betancourt signed onto a letter demanding the appliance be fixed, a new fridge appeared the next day. “Working for the county creates a privilege, and we can stand up and say, ‘I know what you’re doing is wrong.’”
The team helps moms feel like they can stand up for themselves, too. When a client recently went into labor, she refused an epidural to calm the pain, even though the midwife kept asking. But, the mother told Betancourt later, “It felt good to tell someone, ‘no. I don’t want it, and I will tell you when I want it.’”
Health care settings can be an intimidating place for anyone, and many immigrant Latinas might feel they don’t have a right to push or complain -- be it culture or an immigration status.
“What I see is a lot is a fear to advocate for themselves, to ask for something. They feel like they are receiving a favor from anyone that represents the government,” Betancourt said. “They don’t ask questions because they feel like they have to agree.”
Nurse Esmeralda Flores, who both works with the Empezando con Salud team and has worked in primary care clinics, said mothers come into a fast-paced health center where providers get just 15 minutes per appointment, and it might feel like they can’t ask questions.
Flores recalls a new baby who was prescribed an anti seizure medicine, but after the new mother picked up the prescription, she was unsure what to do next.
“She never gave it to the baby because she didn’t understand what it was for or how to give it,” Flores said. “So we try to teach them to speak up and say, ‘I want to ask you this,’ or ‘I want you to explain this to me again.’”
More Support. New Ideas
Perhaps the most powerful element of Empezando con Salud is the community it creates, not only between Latina providers and Latina clients, but among the clients themselves.
Community is exactly what the team fostered when clients gathered last month for Empezando con Salud’s winter celebration. Families crowded around tables as children ran and giggled, and as babies ate and slept. Music from the Kumbia Kings and Selena y los Dinos played over a speaker. And staff from the program and the clinic adopted their alternate roles — face painter, Santa Claus, chef, waiter, DJ, raffle barker.
Mayra Jaimez-Mendoza came with her daughter Anyela, who had been released from the prenatal unit just two days prior. Mayra’s mother, Lupita Mendoza, grinned and rocked the little one. “This is her first party,” she said. “This is so important.”
Josephina Salizar joined the program after her cousin Laura Salizar enrolled. Josephina is pregnant with her third child, while Laura just had her second. Even though they’ve had children before, they said, Empezando con Salud has taught them new things. And they like the social support.
Back at the face painting station, Maria Ruano hovered near her son, 3-year-old Sesai, as he buzzed between the throng of children and the passing Santa. When Maria’s doctor told her about Empezando con Salud, she enrolled immediately. The clinic staff have known Sesai his whole life, which meant they also knew he and his mother needed support.
“This is my favorite clinic,” Ruano said as Sesai settled into a chair. He tilted his face up so his nurse, Christina Licona, could brush red paint across his nose and paint brown reindeer antlers across his cheeks.
Sesai has a form of attention deficit disorder, and his first years have been a struggle for Maria. After all, she has a job to do, and an older child who just turned 13. But Licona, her nurse, comes to the house now to help Maria. They have identified behavioral specialists and educational services that can help Sesai.
“She helps me a lot with my son,” Maria said, brushing away tears. “It’s more support, new ideas.”
