LATINO HEALTH ACCESS Santa Ana, California
By Mary Jo McConahay

The city of Santa Ana has the third highest rate of uninsured families in California, mostly Spanish-speaking immigrants. Unfamiliarity with a new culture, lack of transportation and childcare and concern about the authorities keep residents deeply in the dark about available health services. Through health promoters, trained community members who are managing or have experienced the same chronic health and well-being concerns, Latino Health Access helps bring education and services directly to patios, street corners and homes. LHA uses the activities, classes and services as entry points to promote wellness as a basic civil right.

Much of this city is baked concrete, flung out plain and hard like a big frying pan between desert and lovelier seacoast towns, surrounded by freeways and crisscrossed by streets that favor cars, not people. You can hear local women say, “I have felt so lonely here,” even as they look around at densely-populated apartment houses or a wide, commercial street.

In a town where one out of four persons is undocumented, it might seem natural that residents keep a low profile. “I arrived a few months ago and have spent most of that time shut up in the apartment,” said Leonita, 60, who came to stay with family. “Once I even got lost in the building.”

But Santa Ana is booming in population because most people come -- often from Mexico -- for work. Typically residents juggle multiple low-paying jobs, earning incomes that amount to only half the county average. One newspaper described this place as having the “emerging” look of the impoverished American inner city: not with the war-zone appearance of some black urban areas of the l960s and 70s, but with a less apparent, eerily sunny Southern California brand of poverty marked “not by blight, but by bustling employment and very crowded living quarters.”

No matter what it looks like from the outside, life here is a struggle for survival. Behind closed doors on trim streets residents describe loneliness and pressure, and the debilitating health conditions that come with them. Gone is the extended family left back home in Mexico, gone the old networks. Aislamiento is a word heard often, spoken in a tone between self-diagnosis and lament. Isolation. No time, no place for connecting. Youngsters come home to television or videogames, and food out of cans. “We live in an apartment building where my children not only can’t play, you can’t even speak loudly,” said Marisol, whose girls are age 5 and 8, and whose boy is nine. Some single family dwellings house 10 or 15 persons, not necessarily related.

Don’t tell the kids to go to the park: there aren’t any in neighborhoods where these families live. Besides, the streets are dangerous. Extreme tagging marks gang boundaries. Better to stay inside. Childhood obesity is a problem, bringing not only physical but psychological consequences. “I tell my son, ‘if they call you names, don’t be offended – if you love yourself no one can hurt you,’” said housewife Teresa Ontiveros, who has joined a Latino Health Access (LHA) child diabetes prevention and exercise class with Ivan, 13. “They give us measuring cups to use at home. I don’t buy sodas or chips any more, and I give him more cucumbers and salad. I learned that.”

The Santa Anas are the name given to peculiarly hot and strangely oppressive winds that can rise suddenly and send Southern Californians scurrying to shut windows and doors; some days they seem to originate right here. That’s the kind of day it was when Teresa Urizar, carrying a clipboard, stopped an elderly woman on Anaheim Boulevard and let her know services were available in Spanish, among people who cared. In minutes they were sitting on a curb, completing an evaluation for Latino Health Access, where Urizar is one of 16 outreach workers, called promotores, or health promoters. “She’ll show up,” Urizar said confidently as she moved on to a neighborhood of modest wood houses. There, amid dusty gardens with scraggly mango trees and nopal cactus planted for food and a touch of home, Urizar mounted one porch after another to talk to suspicious or welcoming residents. She searched especially for elderly who might be suffering from diabetes. “I have credibility with them because I have the same condition – it’s a kind of hook,” Urizar said. She and other promotores in LHA’s 3-year old Older Adults Program figure they have knocked on some 10,000 doors.

By reaching into neighborhoods this way, Latino Health Access aims at improving health by assisting uninsured, low-income Spanish speakers in navigating the system of available services, and providing a network of peers and promoters that educate – including the young -- to prevent disease and disability, and self-manage chronic conditions such as diabetes and arthritis. The object is healthy neighborhoods, and community organizing that can bring them about.

“The promotores are the heart of the agency, our unifying factor,” said Venezuela-born America Bracho, who founded LHA in 1993 to work with residents who feared authority and had no idea they had a right to care. Promotores may be men and women like Urizar living with diabetes, or women who once survived domestic violence, or ex-drug pushers and gang members who left gang life behind. They combine their own experience with specialized training to become the first trusted line of communication with neighbors. Then they push the envelope a little more. For promoters and LHA activists, as Bracho puts it, health care is a “human right” which begins not in a clinic but all over town.

“If we have to sell tamales we’ll do it – we’ll turn that vacant lot into a park,” said an undocumented mother who preferred not to give her name. She stood in a parking area where kids had set up a soccer game; braving knee scrapes, occasional cars, and falls on concrete. With LHA promotora Soledad Gutierrez, women gathered to plan their next attempt to convince City Hall to let them clean and maintain the overgrown but precious patch of open space for the neighborhood. To look at Sol, you would never know she had spent a long morning in a public housing apartment with housewives who suffered domestic abuse, women who gathered strength from their meetings with each other and Sol, who carries the authority of being a violence survivor like them. That earlier meeting had been an exercise in cacophony, straining to hear each other over scrappy toddlers and screams of multiple caged birds (with fish, the only pets allowed). But here in the quieter open air women’s words ring clear. “I don’t have papers, I don’t have English, but I need a place for my kids to play.”

Across town, the LHA successfully made a partnership with a local school to proctor part of the schoolyard as a park after hours, and hold after-school classes for young leaders in high risk situations, aimed at improving physical and mental health. But one recent afternoon a brown sheriff’s helicopter buzzed in place high over a nearby spot – it was impossible to see exactly where or why. The moment was an indicator of what programs can be up against. Promotora Maria Haro quickly shuttled all the small kids into a gym, closed the doors, and went into lockdown mode – nobody in or out -- as a safety precaution. On farther corners of the city, gang members were already gathering in knots in the waning afternoon; they recruit from the kind of young kids now spending time instead at their LHA programs in the gym. The chopper flew off just as the cabin fever of the youngest was reaching a bursting point, Haro opened doors and children spilled into the fenced yard again.

Later that night, about twenty people would gather in a circle to listen to a distraught woman speak of fear for her daughters in the face of a violent, alcoholic husband, and hear her voice thoughts of suicide. The circle is a regular LHA session where local residents can speak openly about abuse, or other issues of extreme stress. Two men would share experiences about overcoming similar thoughts of self-destruction and a young woman give practical advice from experience about shelters and police reports. A middle-aged LHA promotora would reach out a hand in comfort, offer tissue against tears, or gently ask questions. By the end of the night the anguished woman would say it was the first time she had not felt alone in her distress.

For now however, children still played in the late afternoon sun. A promotor in his 40s, a former gang member, stood by as a strong presence, as a role model for gang members who watched from a distance a living example of how they might turn a life around and be part of a welcoming, health-minded community.

“This space is ours,” said Teresa Ontiveros proudly of the fenced “park” at the school. “Every day more people come. We make friends, contact. It means less aislamiento.”