As I write this column the federal government shut down has ended until February 15th. No doubt this presented a huge hardship for our federal workers but also for the workers who work in supporting roles. I was traveling over the last two weeks and one of the concourses in a very large airport was shut down. Absent and without pay were the restaurant and food court workers, the housekeeping staff, clerks at the newsstands, the taxi and Uber drivers, and parking lot attendants. Many of these important hourly workers are also patients/clients who CHWs see in their daily work.
How does this relate to the work of the Alliance? The Alliance strives to be the voice of CHWs and to provide opportunities for sharing our voice in many community venues including policy. We want to equip CHWs to become leaders in their respective spheres of influence from PTAs to local government to serving on nonprofit boards of directors. As community leaders, we want everyone to be comfortable meeting with elected officials and advocating for the needs of their respective community which is why the chw leadership training includes exposure to the media, policymakers, funders and lawmakers. Policy, communications, philanthropy, organizing and networking are among key tools for change.
To that end, the third CHW leadership cohort is about to start in February. If you are an interested CHW who has not as yet applied or if you are a CHW employer or educator with a CHW nominee for this excellent leadership development program, then please contact co-facilitators LaTanya Black at email@example.com or Anne Ganey at firstname.lastname@example.org for more information. The leadership training is free of charge to those CHWs living or working in Ramsey, Dakota, or Washington Counties as result of a generous grant from the F. R. Bigelow Foundation.
I am also excited to share the 2019 National Assn of CHWs conference theme,“Unity 2019: The 20th Anniversary of the National Conference For and About CHW’s.” https://unityconf.org/19/ The conference will be held April 14-17, 2019 in Las Vegas. LaTanya Black, Alliance Vice Chair and board member and Community Engagement Consultant will be representing the Alliance at the conference.
I am a newer member of “We Can Change the World,” a political action alliance (www.WCCW-MN.org) that supports voter registration efforts and the campaigns of women from Washington County who are running for local and state offices. Where ever we live we each can participate in ways that work for our busy lives.
With newly elected officials in city and county government, here in Minnesota, and in Washington, D.C. it is important that all perspectives be heard and that we all share our voice. Your voice as a CHW, supporter, employer, educator and stakeholder matters.
With respect and gratitude for all voices,
Renae Oswald Anderson
Interim Executive Director
One thought on “Make Your Voice Heard”
My name is Marco Meneses, and I have been working as Community Health Worker from 1978 to 1985 in Colombia. After that I was for 6 years in Honduras with United Nations Volunteer assigned to the UNHCR, worked at the Salvadorian – Guatemalan Refugee camps and later with WFP with a project maternal and child attention feeding of vulnerable groups and promotion of productive activities at family level.
Later I went to Equatorial Guinea, Angola, Sudan and Somalia for the next 6 years working in nutrition, primary health care and training of local community health workers with International Medical Corps, CARE and World Vision international.
As result of a terrorist attack I suffered in Somalia In 1994, I returned to the USA for medical treatment and later reincorporated to the workforce as Community Health Worker in Illinois with Migrant and Seasonal Farm Workers with different churches and non-profit agencies.
With Kane County and Cook County (Illinois) I worked for several years with projects that addressed determinants of health. Worked at grassroots level and later in programmatic activities to increase availability of and access to culturally sensitive health care providers for families from Mexico and other Central American countries, Honduras and El Salvador, including Mayan – native- populations from El Petén (Guatemala).
The last 10 years I worked in Florida (USA) in chronic disease prevention for the “Healthy Choices, Healthy Living” managing and training local community health workers and advocating on behalf of vulnerable and underserved populations.
The last 4 years I have been assigned to work as Patient Navigator with a Federally Qualified Health Center. Federal Qualified Health Centers are community-based health care providers that receive funds from the HRSA (Health Resources & Services Administration) to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.
Patient Navigator is NOT similar to the Community Health Worker in the USA. There is not a totally agreement about definitions and roles of patient navigators and community health workers, some agencies use the term interchangeable. The concept of patient navigation was founded and pioneered by Harold P. Freeman in 1990 for the purpose of eliminating barriers to timely cancer screening, diagnosis, treatment, and supportive care. A critical window of opportunity to apply patient navigation is between the point of an abnormal finding to the point of resolution of the finding by diagnosis and treatment.
Currently the patient navigation model has been expanded to include the timely movement of an individual across the entire health care continuum from prevention, detection, diagnosis, treatment, and supportive, to end-of-life care.
Another definition is that Patient navigators educate and assist United States citizens in enrolling into health benefit plans stipulated in the Patient Protection and Affordable Care Act (ACA). Patient navigators are also called “insurance navigators” or “in-person assisters” who have defined roles under the ACA. Although their roles might overlap, patient navigators are not community health workers or health advocates. “Navigators” work in states with Federally-Facilitated Exchanges (FFEs) or State Partnership Exchanges.
Under the ACA, a health insurance marketplace, or exchange, is required to develop and fund a patient navigator program. The patient navigator’s primary role, as defined in section 1311, is to educate the public on information about health care plans, to facilitate enrollment into health plans, and provide information for tax credits and cost-sharing reductions. The education and information provided by patient navigators must be culturally and linguistically appropriate and provided in a fair and impartial manner. Patient navigators are required to meet standards and core proficiencies established by the Secretary of Health and Human Services.
Although I am a Certified Community Health Worker by the State of Florida and I was selected by the American Public Health Association as an outstanding Community Health Worker on 2017, my official title is Patient Navigator, but my functions are as Community Health Worker.
At the clinic I work with patients with diabetes and high blood pressure. It is an educational process that includes an evaluation of the patient’s attitudes, problems and roadblocks implementing the ACTION PLAN and how the family is involved in the treatment including medication, diet and exercise.
In diabetes, patient must agree to eat fewer carbohydrates at each meal. Written instructions “Eat Fewer Carbohydrates at Each Meal” given to the patient and discussed in details. Nutritional plate sample is given to the patient. Patient must set his/her goals. In addition patient is instructed about daily Blood sugars readings taken at home and recorded in Glucose Log. In the majority of the cases, I must take some time to explain the meaning of the word carbohydrate/starch, the balance between the ingested carbohydrates and the insulin levels.
In case of High Blood Pressure, patient sign “my action plan” and agreed to eat less salt. Written instructions “Eat Less Salt” is given to the patient and discussed in details (DASH DIET – Dietary Approaches to Stop Hypertension). Patient must agree to stay more physically active. “Sample Walking Program” and written instructions is given to the patient and discussed in details. Treatment Plan must include to record Blood Pressure in Blood Pressure log. Patient must have appointments with nurse every two weeks and keep informed the provider in any changes presented in the patient’s blood pressure.
In addition to providing Culturally Appropriate Health Education and Information (diabetes and high blood pressure, FIT tests, mammograms, smoking cessation, etc.), I provide Coaching and Social Support. Of all areas that define the CHW the “community connectedness” is of the highest importance.
As a frontline public health worker, the CHW must have an unusually close understanding of the community served. And serves a liaison/link intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self- sufficiency through activities such as outreach, community education, informal counseling, social support and advocacy.
In addition, the ability to understand health information is the number one indicator of positive health outcomes because so much of health care is about what we read and understand. If patients understand what their health issues are, what their medications are and how to take them, there are better health outcomes and fewer unscheduled visits to the physician’s office, fewer hospitalizations and emergency room visits, “Improving health literacy has a huge impact on quality of care, patient satisfaction and reducing health care costs.”
I expect, that I didn’t confuse you. There are many gray areas and a lot must be done to clarify the role of patient navigator, community health workers, and health coaches, but the need must be recognized. We must understand that the concept of CHW varies from country to country. I trained CHW and midwives in Angola (Menongue), Sudan (Bara, Tayba, Um Keredium,) and Somalia (Baidoa), where CHW carried a box with 25 basic medicines provided by UNICEF and the “Where is not Doctor” book from David Werner, and treated all the basic ailments in all the villages and towns.
Here in the USA, the highly sophisticated and technically advanced medicine and the pharmaceutical industry takes the curative concept in another dimension, but we forget the importance of prevention, healthy living, healthy eating and healthy lifestyles. This is where CHW play an important role.