A silver van pulls up to a coronavirus testing site in the parking lot of La Familia, a daycare and family services center in Fort Collins. Cristina Diaz and her coworker hand fluffy, pink unicorn stuffed animals to the kids in the backseat. They load boxes of rice, milk, and masa flour into the back.
Diaz’s big brown eyes peek out above her black face mask, which has ‘Cristina’ written across it in red cursive. She oversees Larimer and Weld Counties as the regional coordinator for Project Protect Promotora Network. These ‘promotores’ — community health liaisons — educate Latino residents, mostly Spanish-speaking migrant workers, about COVID-19.
In the past, promotores have worked with public health departments to reach underserved communities on issues from smoking cessation to cervical cancer. Through federal CARES Act funding, and the Colorado Department of Public Health and Environment, this group launched in September to get the word out on virus prevention and care.
Promotores oftentimes lack formal medical training, but they are well-connected in their communities. Diaz, for example, has served on the boards of Northern Colorado nonprofits. Until recently, she was a social worker. Today, her strategy is to first draw people to the testing site with food boxes.
“And then say, ‘Hey, by the way, we have COVID testing right here. Do you have any of these symptoms? Do you know anyone?’ So they're going to leave here and they're going to go home like, ‘Hey, I just went and got this food box and I got tested.’ And then we're going to have more people here this afternoon,” Diaz explained with a laugh.
Going where people live and work
Working conditions, living situations and language barriers are among several factors that have led to high infection rates among Latinos in Colorado. These promotores are stepping up to educate people who have not been reached by mainstream information sources.
“It’s overwhelming as an English speaker,” Diaz said. “So I can even imagine, you know, as a Spanish speaker and even though Spanish speaking, not all of them tend to be literate. You can't just be like, ‘Oh, here's a form. Read this, you know, share it with your family.’ If they are sharing it with their family, they're probably sharing it with their 8-year-old or 12-year-old. And then all of a sudden, it's the job of the 12-year-old to educate the family on it.”
Promotores across the state are providing workers with winter clothing, masks and hand sanitizer by going to where they live and work: farms, warehouses and mobile home parks, for example. Project Protect Promotora Network has worked with the CDPHE on COVID-19 testing events, as was the case at the site in Fort Collins.
In their work, these promotores hear about needs that go beyond the coronavirus, relating to internet access, childcare and housing. In addition to language and literacy barriers, many Spanish-speaking workers are scared or distrustful of the government.
“You don’t know how to ask for help so you prefer don’t do it,” explained Soraya Leon, a promotora who lives in Greeley, where the majority of coronavirus cases are concentrated in the county.
At the testing site in Fort Collins, wearing two masks and a face shield, Leon’s breath fogged up the clear plastic shield; condensation dripped down the inside.
As a promotora who began doing this work in November, Leon has heard confusion and disbelief about the virus. But, when she talks to workers about it, she said they listen in part, because when Leon divorced her American husband, she became undocumented and needed help herself.
“I was there, I was in the same situation,” Leon said. “I know what you feel when you have issues.”
The Weld County Department of Public Health and Environment has worked with promotores in the past, but not specifically on coronavirus prevention. The department was unable to do a recorded interview for this story but in an email, a spokesperson outlined what they have done, from putting out messages on billboards, posters and social media, to interviews on Spanish-language radio.
‘I think it has contributed’
Dr. Mark Wallace, the former chief medical officer of Weld County, believes communication issues have contributed to the high infection rate among Latinos in Weld County.
"I think potentially, in the beginning, was more impactful, that lack of clear communication,” Wallace said. “I think it is less of that today since we've been struggling with this for as long as we have… So there is that fundamental level of awareness because we're doing a better job of communicating in a way that is linguistically and culturally aware.”
Wallace is now the chief clinical officer at Sunrise Community Health, a group of clinics in Northern Colorado; around half of their patients identify as Hispanic or Latino. He explains that since the beginning of the pandemic, the medical community has gotten better at talking through what terms like ‘isolation’ and ‘quarantine’ mean in daily life, for example. Now, he is beginning to think about the next communication issue: the vaccine.
“It's likely to have some similar challenges, I'm not going to be pollyannaish about it,” Wallace said.
Polling has shown around 60% of Coloradans are planning to get the coronavirus vaccine. Numbers were slightly lower among Blacks and Latinos. Wallace thinks it will be people like his bilingual medical assistants who will be most effective at getting the word out.
The next challenge? Vaccine communication
“I'd say if the Pope got a COVID vaccine, that would go a long way,” Dr. Michelle Barron, the senior medical director of infection prevention for UCHealth, said with a laugh.
She also hopes that her mom, who is from Mexico, will get the vaccine and then tell her friends.
“That would be the gossip. ‘Oh! Did you hear Nora got the vaccine? Oh, we should go get our vaccine too!’... That, I think, is the power,” Barron said.
Barron said that community members and health workers — like promotores — are important pathways for information, but that this issue of communication is complex.
“The messaging that we're putting out there may work for 80% of our population, but what do we do differently for those 20%?” she asked.
At the state level, the CDPHE intends to reach marginalized communities through its Champions for Vaccine Equity initiative. The nonprofit Immunize Colorado launched a Vaccine Equity Task Force in September.
Both the CDPHE and Weld County’s health department plan to work with promotores on vaccine education. Cristina Diaz, the promotora heading up the food boxes event in Fort Collins, expects the Project Protect Promotora Network will do this sort of work, but she predicts challenges.
“You know, it's hard to get them here just to do the COVID testing, so I can’t imagine a vaccine,” Diaz said.
This is part two of KUNC's series, "Over-Infected, Under-Resourced: COVID-19 Hits Colorado Latinos Hard." Click herefor more stories.
