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Health promoters inform the indigenous community on COVID-19 – in their language

MICOP Health Promoters, Rosita and Lidia reach the streets of Oxnard of the Mixteca community
MICOP Health Promoters, Rosita and Lidia reach the streets of Oxnard of the Mixteca community (Photo courtesy of MICOP)
Access to Care
USC Center for Health Journalism News Collaborative
May 13, 2020

OXNARD – When the COVID-19 pandemic began, many indigenous workers in Ventura County were doubtful that the virus was real, mainly because they didn’t have access to information about it in their language.

Indigenous farmworkers and their families often don’t know about available health services or are afraid to risk a clinic visit, often due to the isolation that comes with a lack of fluency in English or Spanish, and sometimes, undocumented immigration status.

That’s challenging in normal times. During the coronavirus pandemic, it can be fatal. And these barriers — shared with other immigrants who primarily speak less common languages including Hmong, African languages such as Ibo or Yoruba and lesser known dialects from around the world — are poorly understood contributors to outcomes for COVID-19.

In Ventura County, these workers benefit from the help of health promoters who  provide vital information in their language. That’s harder to do during the pandemic. But those serving this community are still deeply committed to getting the word out.

Almost every day, Rosita Lopez and Lidia Lopez used to walk the streets of the city of Oxnard, in Ventura County, to inform low-income residents about low-cost or free health services in their area.

The two women, who share a last name but are not related, are health promoters, or promotoras, who focus mainly on the sizable indigenous community of Ventura. This community speaks various native languages including Mixteco and Zapoteco. The workers are mainly from the Mexican states of Oaxaca, Hidalgo, Michoacán and Guerrero.

There are an estimated 20,000 people in Oxnard who speak primarily an indigenous language. Most are agricultural workers.

COVID-19 takes a greater toll in working class communities where there is less access to health insurance or regular medical care, said Odilia Romero, an interpreter of indigenous languages and executive director of the nonprofit organization Indigenous Communities in Leadership (CIELO).

And, she said, those who are undocumented and already fearful of being deported are far less likely to risk a doctor’s visit, even if they have symptoms of COVID-19.

This is the reason why promotoras play such an important role in low-income and indigenous communities.

Before the outbreak, notebook in hand and wearing a shirt and nametag that identified them as health promoters of the Oxnard Mixteco/Indígena Community Organization Project (MICOP), Rosita and Lidia focused their outreach in a few familiar places in the city. They would either head to a laundromat, a public park, or to other spots in neighborhoods where indigenous residents congregate. Lidia speaks Mixteco and Spanish, while Rosita speaks Zapoteco, Spanish and English.

“I feel good helping because there are people who only speak Mixteco,” said Lidia, who found herself in the same situation when she arrived in the United States in 1993.

Lidia worked 12 years in the fields picking blackberries and another nine years picking strawberries. In those jobs, farm laborers work hunched over for hours. At the end of the day, when they try to straighten up, the pain can be excruciating, she recalled.  

“Besides, in the blackberry field we breathed a lot of dust from the chemicals they apply, and around noon, our throat felt like it was burning,” said Lidia. “Years later I learned that health is important and there are health discount programs and the county clinics have programs but sometimes people have doubts about [those programs].”

To prevent other people from missing out on available resources, Lidia and Rosita take pride in sharing information about health options tailored to each family’s needs.

However, now with the pandemic, the promotoras haven’t been able to walk the streets. Instead, Lidia said, MICOP staff created options for reaching people in other ways while working remotely. This includes public service announcements airing on local radio stations and phone calls to previous and current members of MICOP.

“They are in Mixteco, Zapoteco and other languages that the community speaks,” said Lidia. “There, we explain how they can keep themselves safe by washing their hands for example.”

The promotoras also are constantly answering questions posted on MICOP’s Facebook page and recently offered a session on signing up for Medi-Cal on Facebook Live.

They talk about discount programs offered through MICOP, including charity programs and the  Ability to Pay (ATP) program offered by the Ventura County to pay for doctor visits. For those who qualify, they share information on how to apply for Medi-Cal, the California program for low-income families and individuals.

Today, well into the pandemic, Rosita said, some people understand what is going on with COVID-19 and others think that the coronavirus epidemic is a political stunt – a pre-election campaign ploy to confuse people on who to vote for.

 “But those who do believe, they do take care of themselves and they have told me that when they come back from work, they remove their clothes outside and take a shower right away,” explained Rosita. By doing this they believe they are removing any virus that they may carry from work.

But sometimes maintaining social distance is difficult since these workers tend to live in crowded homes shared by multiple families, said Arcenio J. Lopez, executive director at MICOP.

He said risks emerge when workers share a ride to the fields in exchange for gas money, or what’s called a “raitera,” and not everybody knows each other’s health condition or hygiene habits.

Organizers at MICOP said companies have made a few changes to prevent infection among farmworkers during the pandemic. Juvenal Solano, one of the community organizers, believes about 70% of the area’s berry fields are enforcing some types of rules.

“They allow them to work maintaining their distance and at lunch time they tell them to eat separated from each other,” he explained. “However, we don’t think any of them is providing masks. They give them handkerchiefs or bandanas that are not very safe because they can still breath the dust.”

Solano said that farmworkers tend to speak their native language when they are working and speaking up is hard. Only when it is necessary to speak with the foreman does the worker who speaks the most Spanish approach.

Advocates at MICOP and CIELO, well aware of the vulnerability of their clients, say they feel an enormous sense of urgency. Field work hasn’t slowed during the pandemic, so getting information to farmworkers is vital.

Currently, advocates are working on a campaign to persuade employers to offer more widespread testing, to find ways for farmworkers to wash their hands in the field more easily and to provide them with face masks.

“We are concerned that [the virus] has already arrived and we have to identify those infected so that they can receive proper care and prevent them from continuing to infect more people,” Arcenio said.

Learning about the help available

Prior to the pandemic, the promotoras had seen some fruitful results. Among the beneficiaries of their outreach efforts were Rosa Perea, 30, and her husband Demetrio Salvador, 34. The farmworker couple has five children, ages 5 to 14.

The promotoras met the couple when they were confronting a huge problem. Perea had received a hospital bill for $2,200 for medical services due to a miscarriage, when the couple was expecting a sixth child.

Perea, an indigenous woman from Oaxaca, speaks Mixteco and some conversational Spanish. Salvador understands Spanish but speaks very little, and neither of them speak English or felt they could speak up for themselves.

After receiving advice from MICOP and help filling out paperwork for a healthcare discount program, Perea's bills were reduced to a combined $150.

Statistics from a 2017 study showed that around 250,000 Mexican indigenous agricultural workers and their families live in California.

Mixtecos and Zapotecos originate from some of the poorest areas of Mexico. Many cannot read or write, even at a basic level, and some do not speak Spanish or English, but only their native oral language. And many are undocumented.

With all these barriers, most are uninsured.

Other studies find that immigrants who have limited English proficiency also are less likely to have a regular source of primary care, to receive preventive care or to be satisfied with the care they receive. And, they may be at increased risk of experiencing medical errors.

Juana Zaragoza, the enrollment specialist for Medi-Cal and the Ventura County discount program at MICOP, said that before the pandemic, people who already went to the doctor and received a high bill usually came to her office, as was the case with Rosa Perea and her husband.

Advocates say it’s a harder battle to convince clients from indigenous communities to go to the doctor when sick – which has proved to be so important with COVID-19.

Before the pandemic, Salvador took pride in saying that he had never been to the doctor for a medical check-up and said he didn’t think he needed it.

"When I feel sick I take some pills and drink tea," said Salvador. “I don’t recall going to the doctor in Oaxaca. I grew up with the mindset of not going to the doctor.”

Perea said that this mentality is very common among indigenous men. Her two brothers, she said, do not go to the doctor either.

Advocating for the health of essential workers

Rosita said they continuously receive updates from local political and health officials, such as local Assemblywoman Jacqui Irwin, about COVID-19 so they can share it with the community. “Many words can’t be translated in the indigenous language but we try to explain the best possible,” says Rosita.

MICOP is also requesting that the state of California expand eligibility to unemployment insurance and other public benefits for undocumented immigrants and mixed-status families.

“[People] need to understand all these different intersections in which our community struggles with immigration, economic, social status, housing and the lack of trust towards those providing services from which they have been excluded for many years,” said Arcenio.

Agricultural workers cannot stay home because their work does not allow it. “They are considered essential workers, he said, but “excluded from the basic essential benefits they require.”

To see the health prevention videos in indigenous languages visit: http://mixteco.org/radio/covid-19-resources-in-indigenous-languages-from-southern-mexico/

About This Series

This project results from an innovative reporting venture – the USC Center for Health Journalism News Collaborative – which involves print and broadcast outlets across California, all reporting together on the state’s uninsured. Outlets include newspapers from the McClatchy Corp., Gannett Co., Southern California News Group, and La Opinion, as well as broadcasters at Univision and Capital Public Radio. 

Topics in this Series

  • Affordability
  • Access to Care
  • Expanding Coverage
  • Undocumented & Uninsured
  • Legislative Fixes