Community Health Organizing Revisited

69 Brief communication COMMUNITY HEALTH ORGANIZING REVISITED To the editor: Elizabeth Kelly and colleagues [Vol. 4, No. 4:358-62] describe a model of community health organizing that is built from the grassroots up rather than from the top down. I used a similar approach to help increase access to care among Hispanic women at Boston's Codman Square Neighborhood Health Center (CSHC). Codman Square is located in Dorchester, a neighborhood of poor and working-class Hispanics, African-Americans, and whites. Hispanic women represent one of the poorest cohorts in the community. When I arrived at the CSHC in 1991 as a Spanish-speaking family nurse practitioner, the facility had been historically underutilized by the Hispanic community. While Hispanics made up 15 percent of the community, they were only four percent of CSHC patients. Some complained that Hispanics did not frequent the CSHC because of cultural isolation, feeling that CSHC staff members were unfriendly and that few spoke their language. Others had no health insurance. Still others did not know where the facility was located. Using the principles of Community-Oriented Primary Care1,1 established a cluster committee of Spanish-speaking patients, Spanish-speaking staff members , and other Hispanic community leaders. In a series of meetings to discuss the health needs of the Hispanic community, the most common concern was lack of access to the CSHC. The cluster committee recommended several solutions, which I helped transform into interventions. The first intervention, an in-service training program, consisted of 10 weekly two-hour classes on such topics as culture and its meaning, cultural barriers to health care, toleration of differences, the diverse needs of CSHC patients, and ways to work as a team. The format was a seminar with didactic presentation, discussion, and sharing of experiences by participants. Approximately 15 staff completed the program; attendance was mandatory with pay. I gave most of the classes, with input from the Hispanic cluster-committee members, who also served as guest speakers. Translation was provided as needed. All seminar material was printed in English and Spanish. The inservice training program was reviewed, revised, and approved by the cluster committee and the CSHC administration. For the second intervention, focus groups discussed breast and cervical cancer, HIV/AIDS, smoking cessation, and violence prevention—all topics mentioned by cluster-committee members as of prime concern—using SpanishJournal of Health Care for the Poor and Underserved · Vol. 5, No. 2 · 1994 70___________________________________________________________ language films and Spanish-speaking professionals from Alianza Hispana, a local Hispanic health organization. Female patients from the cluster committee brought friends and family members to these presentations, which also included screenings for the health problems under discussion. During the third intervention, I traveled to a housing project where much of our target population lived. I conducted a health mini-fair including bloodpressure screening and the distribution of Spanish-language information on lead poisoning, nutrition, immunizations, cardiovascular fitness, and health screening. I chose a location near the mailboxes of the housing project. When residents came to pick up their mail, my presence gave them the chance to ask questions; review information about medications, diet, and health problems; and generally engage in informal dialogue with a health professional. We also addressed structural barriers. For example, because some women failed to seek care because they lacked health insurance, we explained that no patients were refused service at CSHC because of lack of insurance or money. CSHC administration was receptive to these and other initiatives. For example, at the patients' recommendation, signs and teaching materials at the Center were translated into Spanish, and the administration hired three more Spanish-speaking staff members. These efforts quickly bore fruit. The proportion of the neighborhood's Hispanic residents served by CSHC rose from four percent at the onset of this project in September 1992, to 25 percent by the end of the project in November 1993—a 600 percent increase. More women were screened for cancer, cardiovascular risks, HIV and sexually transmitted diseases, and diabetes during this intervention than before it. Teaching Spanish to all CSHC employees remains a pressing need that was not addressed during this 14-month effort, which was funded by the National Health Service Corps as a result...