It’s early morning and still dark in the border town of Yuma, Arizona when Liliana Arroyo and Ana Torres head out to the bus stop, a Circle K store, and finally, the fields.
Stopping to chat with farmworkers making their way to work, the pair provide information – in English and Spanish – about health screenings and how to prevent what they call “the three enemies:” diabetes, hypertension and high cholesterol. Latinos can face these health issues at higher levels compared to other groups in the United States.
As the farmworkers relate other issues about their families, the women listen intently, sometimes sharing their experiences. They offer referrals for help with tax returns or getting kids into schools. And when people get help with one problem or question, they usually return when another crops up.
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Arroyo and Torres are promotoras, lay health workers who serve the farmworker community to which they belong. Arroyo picked produce alongside her father as a student. Torres still picks lettuce on weekends.
Popularized in Latin America, the concept of the promotora first came to the United States in the 1960s to help migrant farm workers access health care and social services. For farmworkers, health care is an issue because they rarely get health benefits through their employer, may have difficulty accessing care due to a lack of money, language barriers, and immigration status. The model is built on peer-to-peer education and support. While women have traditionally filled the role, men (promtoros) also have participated.
Parts of the Affordable Care Act (ACA) refer to the idea as a way to expand access to health care among vulnerable populations.
And as states began implementing the ACA, Emma Torres, executive director of Campesinos Sin Fronteras (who is not related to Ana) started receiving phone calls from around the country about the approach.
Her organization, which means “farmworkers without borders” in English, helps educate farmworkers and low- and moderate-income residents about health issues, especially ones associated with working in the fields.
Since becoming one of Arizona’s first promotoras decades ago, Torres estimates she has trained as many as 2,000 people to perform the job. Her work has extended beyond just training.
In the fall of 2013, Arizona Western College (AWC) launched a program to train and certify promotoras, which AWC and Torres say is the first of its kind in the country. So far, about 30 students have earned certificates.
“People tend to think promotoras are only uneducated people,” Torres said. “I realized at the local level, if we could get our promotoras to be certified, they would get more validity to the work that they do.”
The credits, which cost about $70 each, are transferable to other programs, such as an associate’s degree. Torres hopes certifying promotoras will help expand access to higher education and jobs in social work, health care and community organizing.
“It took me so many years to even find a way to obtain a more formal education,” Torres said. “I knew what I wanted, but there was not a path to follow.”
A Different Life
Known as the “lettuce capital of the world” and the birthplace of Cesar Chavez, Yuma County has – according to Torres – the highest concentration of farmworkers in Arizona. During harvest season, about 90,000 migrant workers, travel to the area, many of them from California, to pick lettuce.
Another 50,000 seasonal workers are local, harvesting broccoli cauliflower, celery and lettuce.
Torres knows firsthand the challenges the workers face. At age 13, she left school to work in the fields alongside her parents, both farmworkers from Mexico, and seven siblings. They were followers of Chavez, the civil rights leader who unionized farmworkers.
“That was my whole life. I didn’t have the traditional going to school, going to prom, graduation or anything,” she said.
She married a farmworker, but five years later, when she was pregnant with their second child, he was diagnosed with leukemia and passed away.
“I had to change my whole life perspective,” Torres said. “I didn’t want my kids to be in the same position I was, being a widow, uneducated, poor, not knowing what to do. That was my inspiration to try to find a different life, a better life.”
Torres took courses in English at night, earned her GED, learned to type and began to take college classes in subjects she deemed useful, such as child development.
“The part I remember feeling just the fact that being in college, it was really a stimulant for me to want to continue on. It just felt so good.”
With parents educated only to the second grade, Torres was unfamiliar with the structure of academics, so she amassed a patchwork of credits. Recommended for a job at the local WIC nutrition program as a receptionist, she traded field work for a new environment of office phones and computers.
Some discriminated against Torres for her imperfect English, she said, but her supervisor offered encouragement. Eventually, Torres moved on to a job educating farmworkers about nutrition and healthy pregnancy. “I loved it and I was good at it,” she said.
In addition to knowledge about community resources and disease prevention, the role required compassion and the ability to lead by example. “You have to be genuine. You have to be nonjudgmental. You have to keep things confidential,” Torres said.
She continued studying, carrying an English-Spanish dictionary with her to look up unfamiliar words.
“I had such a hunger for learning because I felt that I had not had the opportunity,” Torres said, noting that she’s come to see poverty not only as a lack of money but also a lack of knowledge.
Torres eventually became an expert in prenatal care and chair of Healthy Mothers, Healthy Babies, a nonprofit, community-based prenatal program that uses the promotora model. She earned an undergraduate degree and a master’s degree in social work with a mental health specialization.
“Promotoras have a capacity to develop,” she said. “They can be the best leaders and advocates in their communities.”
Sometimes people don’t see their own leadership potential, Torres added: “You have to help them discover it.”
Walking the Line
In Yuma, Torres is known for her perseverance.
“Emma Torres is a force in our community,” said Mary Schaal, a dean at Arizona Western College and an early board member of Campesinos Sin Fronteras.
Campesinos holds an annual “Dia del Campesino” (Day of the Farmworker) at which advocates for workers in the Yuma area and provide information about health and social services.
Since outreach to workers is often done in the fields – private land own by the workers’ employers – this can be tricky, Torres said.
“In Yuma County, we have to be very astute, very clever in how we approach this population,” Torres said. “Cesar Chavez was not necessarily considered a hero by the growers.”
Torres and her family were involved in a strike that Chavez led.
“I know what went on, I still have very fresh memories. I understand that resentment of those people [growers]” she said. “I may not agree with it, but I understand it.”
Seeing things from someone else’s perspective is a primary objective of a promotora. “First you need to know the community,” Arroyo said. “You need to put on their shoes.”
Arroyo, who has spent four years as a promotora, was among the inaugural class of students in the AWC certificate program. Although she has a master’s degree in media and communications, she said earning a certificate inspired her to consider continuing her education, perhaps getting a master’s degree in mental health at a university in Yuma or Tucson.
“Oh, yeah, I have plans and dreams,” Arroyo said with a laugh. “I’m 40 years old, but I’m feeling young and strong to do this.”