‘To be a promotora you have to come from within the community — that’s the real power of the model’

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The week Alma Romero de Tlacopilco moved from Puebla, Mexico to South Philadelphia, she got sick.

It was in the late 1990s, before there was any culturally competent healthcare available to the Mexican immigrants in the neighborhood, and Tlacopilco sought advice from the immigrants she and her husband knew.

“I kept asking everybody, ‘what do I do, I feel awful,’” she said. “Everyone kept saying, ‘you have to tough it out because here you can’t get any health care at all.’”

Since 2010, Tlacopilco has worked as a promotora for Puentes de Salud, a position in which she gives immigrants like herself answers to health questions they can’t get through traditional medical channels.

Puentes de Salud has been linking Philadelphia’s Latinx community with healthcare resources since 2004. Along with its five promotoras, the organization offers medical services, wellness programs like yoga and art, counseling and educational workshops.

The organization came about because founders Dr. Steven Larson and Dr. Matthew O’Brien recognized Philly’s growing Latinx population had few resources for improving their health.

“Healthcare is not just access to a doctor or reading a prescription,” said Larson, the executive director of Puentes de Salud. “It has to do with the socioeconomics, the poverty, the lack of education, the lack of opportunities — a whole menu of stressors.”

“There was a subtext that these patients are not welcome here,” O’Brien added.

O’Brien, associate professor of medicine and preventative medicine at Northwestern University who studies the promotora model, saw promotoras as a way for trusted and accessible information about health to get to the community.

“We developed a group of promotoras very early,” he said. “They were really, and still are, a guiding force in the design of Puentes de Salud.”

Tlacopilco was one of the founding promotoras at Puentes de Salud, and helped decide on the name — which means “bridges of health” in English.

“For me a bridge is something that joins borders,” she said. “So that was the idea of a bridge.”

Tlacopilco noted that almost everyone on staff at the clinic at Puentes speaks Spanish, something that is very important when serving a neighborhood that has come to be known as “Puebladelphia” for the sheer number of residents who are originally from the state of Puebla in Mexico.

Significantly, four out of the five promotoras currently at Puentes, Tlacopilco told Generocity, are Mexican; the fifth is Peruvian. All of them are women; the youngest is 35, she said, but the majority are in their 40s, like herself. She and another of the Mexican promotoras, Irma Zamora, have been serving as promotoras pretty much since the beginning of the promotora program at Puentes.  Initially her work was — like that of most of the medical personnel at the nonprofit — pro bono; for the past few years she has been paid for her work.

Larson said promotoras are integral to Puentes de Salud because they are able to build trust with community members in ways that traditional medical professionals can’t. This trust allows them to become community leaders who can emphasize health in all areas of society.

The twice-annual “Walk for Better Health” is a promotora-led initiative.

“To be a promotora you have to come from within the community,” he said. “That’s the real power of the model. Because otherwise, it’s lecturing or it can be perceived as lecturing people.”

Puentes serves a community that is primarily comprised of undocumented people and low-income families, which creates obstacles to consistent healthcare. Undocumented people don’t have access to Medicaid and sometimes get turned away from other clinics.

“Our community doesn’t want to be sick. They can’t afford to be sick,” Larson said. “They’re motivated to really be healthy. So that’s already an advantage where a promotora is going to make a difference. Now we can offer them the information that allows them to take control of their lives.”

Tlacopilco lives in South Philly, and, along with her work as a promotora, she makes lunches five days a week, which she then helps distribute at Mighty Writers El Futuro from noon until 1 p.m., and works at her family’s fish market on 9th Street. She is also working toward the July opening — if COVID-19 allows — of the family’s eatery, Alma del Mar, which was featured in the most recent season of Netflix’s Queer Eye.

On a normal work day, Tlacopilco makes herself available to answer questions at Puentes de Salud’s clinic at South Street and 17th. She also organizes a twice-yearly diabetes walk, after which she hands out brochures emphasizing the importance of an active lifestyle. Since COVID-19 has temporarily closed the building, she began taking calls directly, making sure she was available around the clock, even if she was working at the fish market.

Promotoras at Puentes de Salud are trained in different areas of health that disproportionately impact Latin American immigrants, like diabetes and asthma. Tlacopilco was trained in sexual health, a subject she and her family never really spoke about before she began working as a promotora.

Even though promotoras are not doctors or licensed professionals, they are able to connect and follow up with their clients in order to help them sustain a healthy lifestyle.

“As a doctor, we try to tell people what to do about their health and help them out,” Larson said. “We realized you really don’t make a big difference that way, and you have to come up with a new strategy.”

When the coronavirus pandemic began, Tlacopilco said she had to learn about the virus quickly in order to relay accurate information to her clients. Although Puentes de Salud wasn’t able to provide a complete training, she said she felt prepared to learn about COVID-19 on her own thanks to the other trainings she’s received at Puentes for her promotora work.

“We’ve learned how to learn about these things, even if we haven’t gotten the instructions [about COVID-19 specifically],” she said.

Tlacopilco recalled a moment last week when she received a call from a man who said he had a terrible headache. She asked questions about any other symptoms to determine whether he had coronavirus, and after talking to him and hearing that he had never before had a headache of such intensity, she had her daughter call an Uber to take him to the hospital. She found out later that it was a stroke, and that her quick response may have saved the man’s life.

“It can be stressful [to be a promotora],” she said. “But this is something I really want to do for my community.”