PROMOTORA CHANGING THE FACE OF HEALTH CARE EDUCATION: VOLUNTEERS SPREAD THE WORD ABOUT EXERCISE, NUTRITION AND MEDICAL CARE.

Byline: Susan Abram

Staff Writer

VAN NUYS - The neighborhood women swivel their hips in unison to a song that tells them to move suavecito -- or a little smooth.

They giggle in slight embarrassment as their teacher, Maria Romero, then leads them in country line dancing, followed by hip-hop.

"Arriba! Arriba! Abajo! Derecha! Izquierda!" Romero says with force. "Up! Up! Down! Right! Left!"

Romero is no exercise guru or choreographer. But her role within this Van Nuys church classroom provides a little-known link between the women she is teaching and the health-care community.

Romero is a promotora, or health promoter, part of a growing movement within California's health-care community that has come to rely on thousands just like her to spread the word about the importance of eating well, exercising and visiting physicians regularly.

Growing movement

Though there are no formal records, some say the movement in California has grown to up to 3,000 trained promotoras in the past five years. On Nov. 30, nearly 1,000 statewide are expected to meet in Burbank for a convention.

"I've learned so much about myself by doing this, and I have become much more conscious of the needs of my community," Romero, 40, said. "I talk to people about everything. Cancer. Diabetes. I try to break down barriers."

Much like the way women through history have relied on midwives, promotoras are predominantly Latina. They are trained for up to several months through various participating agencies, including Providence Holy Cross Medical Center in Mission Hills.

They organize workshops on emergency preparedness, pass out pamphlets about lead poisoning and serve up fact sheets about the symptoms of diabetes to just about anyone who will listen. Some do it for free.

"Their real strength comes from the fact that they understand the community because they come from the community," said Veronica Montoya, policy director for the statewide organization Latino Coalition for a Healthy California.

"They have been effective at filling holes that our health care hasn't been able to fill. It is a lot of women who are a part of this, and I think that's the incredible strength of the program. It boils down to an issue of empowerment."

The education they promote couldn't come at a better time, Montoya said, as she sees Latinos increasingly suffering from a cycle of illnesses: obesity that leads to diabetes and asthma, which can bring about depression.

One way to stop the cycle is to expand the use of promotoras, Montoya said.

State legislation

A bill introduced by Assemblywoman Lori Saldana, D-San Diego, would establish an obesity-prevention program inside school health clinics, using promotoras to teach the classes. The bill is expected to be heard during next year's legislative session.

"We're still hoping it will go through," Montoya said. "Frankly, there is very little information at the state level about promotoras."

And yet the practice is widely accepted among those who use them, said Steven Wallace, professor of public health and associate director of the UCLA Center for Health Policy Research.

"It's a well-established model," he said. "It's been proven to be effective so many times now, that when you suggest a promotora model in doing outreach, many call it appropriate."

The model works because promotoras combine mainstream information with cultural nuances, Wallace said.

"Every culture has their own set of issues that is sensitive," he said. "There's always been a community of knowledgable healers or use of the lay midwife in almost every culture."

Promotoras often implement a holistic approach to providing information, said Miriam Hernandez, promotora coordinator for Providence Holy Cross Medical Center, which runs a six-month training course.

By providing information inside churches, for example, the health promotora reaches women on a spiritual, mental and physical level, Hernandez said.

After encouraging women to attend health screenings, a promotora will often follow up, an important part of completing treatment, Hernandez said.

Though they are not licensed to give medical care, they learn to refer residents to government agencies, health clinics, social workers or in some cases, the police.

"A promotora may be out there talking about nutrition, but there may be someone out there who has other issues, such as domestic violence, and because she has been placed in a position of authority, she or he needs to have more resources," said Melinda Cordero, director of the promotoras for the health-care network Vision y Compromiso.

"With promotoras, organizations have the opportunity to reach deeply into the community," Cordero said. "Promotoras are navigators, they are bridges that connect residents to resources and they are confidants. In our health-care system, there is no longer the time spent on patients that need to be listened to.

"What I see now is more promotoras and their organizations interested in much deeper social change," Cordero said. "They want to get to the root causes of obesity, for example."

Others focus on the environment, speaking out on everything from the dangers of packs of stray dogs in a neighborhood to graffiti on walls to toys that may contain lead.

Challenges remain

In 2002, Pacoima Beautiful began the Environmental Home Educators Program to help combat lead poisoning in paint. At one point, the group was able to eliminate lead from more than 300 homes in Pacoima.

Maria Guadalupe Hernandez joined Pacoima Beautiful while participating in a community cleanup day back in 1996. Since then, she enrolled in English as a Second Language classes and joined the organization as a translator, then as a promotora, visiting houses and testing for lead in dust.

"I really like to help my own community because I live here," said the 40-year-old woman and mother of two.

So far, much of community she reaches out to has been receptive.

"I'm lucky, because all the people I've spoken with like good information," she said. "We try to use a real simple language, with pictures or images."

Though the movement seems to be working, some say several challenges remain, including sustaining funding for training. Groups also are hoping to coordinate to create more uniform training courses statewide.

Martha Lamas, 64, recently graduated from the six-month program through Holy Cross. A retired certified nurse's assistant, she said she still has the desire to help people.

"I have diabetes, so I know what questions these women have, what they are concerned about," said Lamas, who took a break from the exercise class Romero led.

"There are people who have diabetes and get very depressed about it," Lamas said. "You have to encourage them but at the same time not scare them."

susan.abram(at)dailynews.com

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4 photos

Photo:

(1 -- 2 -- color) Mary Romero, second from left, a promotora, leads an exercise class, above, at St. Elizabeth School in Van Nuys and then, at right, determines the body mass index of Magdalena Maturino while her daughter, Fernanda Contreras, looks on.

(3) Mary Romero, left, confers with Martha Lamas about her body mass index after taking a measurement. Latina volunteers are taking an increasingly larger role promoting health care within their communities.

(4) Paula Contreras, 2, joins the grown-ups in an exercise class led by promotora Maria Romero at St. Elizabeth School in Van Nuys.

Michael Owen Baker/Staff Photographer