Community health worker provides social link between patients and healthcare  



All it took for Evelyn Nieves to relax after experiencing a panic attack was a piece of gum.

At the time, Nieves remembered she was searching for a new apartment after being evicted. She explained that the landlord of her apartment building had died and the new owners didn’t want tenants and gave residents three months to move out.

“I used to get a lot of panic attacks because I didn’t know what to do, where to go and the places, every time I would go to them, they would brush me off and take me through the wrong roads,” Nieves said.

With such an overwhelming task, Nieves turned to community health worker Leonarda Ortiz from the Community Health Center Inc. in Meriden. When Nieves was evicted, she was working with Ortiz to learn how to manage her type 2 diabetes, depression and severe anxiety.

Nieves said after learning about the eviction, Ortiz immediately got to work finding potential apartments, helping sign a mountain of paperwork and going to open houses with her. As a result, Nieves said she felt more relaxed with Ortiz’s help.

Ortiz had gum on hand if Nieves did start having a panic attack.

Ortiz is more than just a community health worker to Nieves — she is a confidant, a mentor and a guide. Although she is no longer Ortiz’s client, Nieves promises that she is never letting go of the relationship she has forged with Ortiz.

“There’s nobody like her that puts her all in it,” Nieves said. “If she can’t help you or she could see someplace else she could send you to, she’ll send you. She’ll keep on digging. She doesn’t forget anyone.”

Like the relationship built between Ortiz and Nieves, community health workers can have a positive impact on their clients’ access to healthcare and a healthy lifestyle. Community health workers also help build trust between their client and their medical provider.

What is a community health worker?

A community health worker is a community member who works with local healthcare systems to guide clients through the healthcare system while addressing the social determinants that affect access to health, according to the National Heart, Lung and Blood Institute.

In addition, the Centers for Disease Control and Prevention define social determinants as “conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

A community health worker typically identifies with the community they serve in one or more ways, such as through ethnicity, language, socioeconomic status or life experiences. They provide services like translating/interpreting, providing culturally competent education, informal counseling on healthy behaviors and advocating for their clients during medical visits.

Through their work, community health workers have improved access to healthcare services, increased the number of screenings and medical services, improved adherence to health recommendations, enhanced communication and reduced the need for emergency and specialty services, reported the National Heart, Lung and Blood Institute.

“We are making the difference in people’s lives, not only in people’s personal lives but in the medical [field],” Ortiz said. “We educate the patient. We have the time that doctors don’t have to educate the patient.”

Ortiz explained that she helps clients manage their type 2 diabetes and lower their sugar levels, also known as A1C. Over six months, Ortiz works with her clients at the Community Health Center in Meriden to develop individualized healthy habits through food courses, discounted gym memberships and in-depth explanations about their treatment plans.

For example, to improve access to exercise, Ortiz struck a deal with the Meriden-New Britain-Berlin YMCA to provide her clients and their families with reduced-cost membership.

Ortiz also explained that she has worked with clients who didn’t go to regular medical appointments, weren’t taking their medication or were wary of treatment because of misinformation.

Ortiz takes her time to explain everything and answers all questions to ensure her client understands what the treatment does and why it’s important. Educating her clients on medicine can also boost their confidence during doctor’s appointments to ask questions and to advocate for themselves when they aren’t comfortable with the recommended treatment.

Health education “creates a lasso of confidence between the doctors and their patients,” Ortiz said.

“You think you are just helping a person, but in reality, you’re practically changing or transforming their life,” she said.

In addition to her diabetes work, Ortiz helps children access affordable health insurance to bridge the healthcare gap.

For Ronald Rodriguez, connecting with Ortiz was the “blessing”. He said he began working with Ortiz after the Community Health Center front desk recommended him for Ortiz’s program because of his diabetes diagnosis.

Rodriguez moved to Connecticut from Puerto Rico in 2017 to pursue a job opportunity. He said that all of his family members and friends lived on the island, and as a result, he was in a highly vulnerable mental state. In addition, the new job caused him a lot of physical and emotional pain. But since he found community among Ortiz and her Community Health Center colleagues, he has made great strides in his physical and mental health.

“This entire planet needs 1,000 more people like Leonarda Ortiz,” Rodriguez said in Spanish.

Rodriguez had lost 23 pounds by following the recipes Ortiz provided. He explained that he loves to cook, so many sessions with Ortiz include finding healthy, but delicious alternatives to some of his favorite dishes.

He learned to substitute processed foods and sugar for natural ones. For example, instead of eating donuts, Rodriguez reached for an apple; instead of potatoes, he would get sweet potatoes. He also bought a blender and has learned to make “killer” smoothies.

Whenever Rodriguez was tempted to break his diet, he said he had Ortiz in the back of his mind encouraging him to make the healthy choice. Rodriguez proudly said he resisted the delicious fried Puerto Rican foods served during the holiday season.

“She’s the angel on my shoulder pulling my ear,” he said, laughing. “She’s present in my daily life.”

In addition, Rodriguez shares all of this new knowledge with his friends living with diabetes and even makes suggestions.

He explained that one particular friend spent most of his day drinking Coca-Cola. Rodriguez intervened, telling his friend he was “assassinating himself” by drinking so much soda and instead recommended mixing a small amount of natural juice with seltzer water so that his friend could enjoy his fizzy drink without the processed sugars.

Social determinants

In addition to helping navigate the healthcare system, community health workers address the social determinants impacting their client’s ability to be healthy. Issues such as access to safe housing, education, healthy foods, language and literacy barriers, and financial struggles can often deter or delay a person from seeking medical care.

These obstacles can make even the most manageable of health conditions difficult, wrote Dr. Dan Wilensky in a recommendation letter for Ortiz. Wilensky is a family doctor at Community Health Center in Meriden, the chief preceptor for the center’s APRN residency program and the medical director of ConferMED.

“As a family doctor, I’ve spent most of my career working in [Federally Qualified Health Centers] treating people whose social determinants of health contribute tremendously to their illnesses,” Wilensky continued. “Though I can order the correct diagnostic workups and prescribe the correct medicines, I have so many patients who just don’t respond as one might expect based purely on their medical situation.”

Ortiz said that a significant part of her work is connecting her clients with resources to help reduce their determinants. She knows that reaching medical goals can only be achieved by addressing the client’s situation.

She explained that throughout her five years as a community health worker, she had forged relationships with several housing facilities, the state government and local gyms to connect her clients with whatever they needed.

“People don’t take care of medical health because they have different issues,” Ortiz said. “When people have other situations like housing, food insecurity, transportation, they don’t focus on health.”

Hipolito Villanueva began working with Ortiz two months ago and he said the biggest challenge was housing. He explained that he had been looking for safe, stable housing and was struggling.

However, once Ortiz stepped into the picture, she was able to help him find an apartment, Villanueva said.

“She’s like a guide,” Villanueva said in Spanish.

Villanueva settled into his new home last month and can finally focus on his health and managing his type 2 diabetes, which he said is already producing promising results.

“I learned to value myself more, to be more responsible with my health,” he said.

Public outreach
and education

According to the CT Health Foundation, a community health worker can take on many roles and often work in specialized fields such as contact tracing, community outreach and public health education.

For example, in 2015, the Wheeler Clinic launched the Southington Health Outreach Project to educate and improve access to mental health and substance abuse services with funding from the Bradley Henry Barnes and Leila Upson Barnes Memorial Trust at the Main Street Community Foundation.

The goal of the project was to bring mental health and substance abuse awareness and de-stigmatize the subject for Southington residents, said Judith Stonger, vice president of prevention, wellness and recovery at Wheeler Clinic.

“Oftentimes people may go to their doctor, and they’ll talk about physical problems that they’re having, but they won’t talk about the fact that they’re depressed, or they’re very anxious...or people might understate their use of substances. So, as a result, people tend to delay seeking treatment,” Stonger explained.

She said the outreach work is done by the project’s full-time community health outreach coordinator, who can give health education, advice on healthy behaviors and provide referrals to other organizations for specialized help. She also helps address social determinants, such as transportation and childcare, to improve healthcare access.

Stonger added that the coordinator is often found in different high-foot traffic areas throughout Southington, such as the public library, food pantries and the Calendar House. Also, the coordinator may set up informational stations at town-wide events, such as the Apple Harvest and Trunk or Treat, to maximize their reach.

“[The coordinator] has a friendly face and a listening ear so that people feel comfortable with her, and they feel like they can share their concerns and get advice from her on possible referral sources,” Stonger said.

In addition, the coordinator helps organize mental health and substance abuse training sessions for the community, such as Mental Health First Aid, administering Narcan and suicide awareness.

Although the outreach project is not a typical community health worker position, Stonger said Southington residents had embraced the coordinator as a valuable resource.

“Sometimes all people need is a little bit of hope, or they just need someone to say, ‘I care, or I’m here to listen to you,’” she said. “That person can be a support, can be non-judgmental, can offer some hope, can offer some resources and can really just encourage people to just seek those resources that will be helpful to them.”

Impact

Wilensky wrote in his letter of recommendation that he didn’t realize the transformative impact of Ortiz’s work until she began working with two of “his most challenging” patients and saw significant lifestyle changes he could never accomplish while working with them.

“She combines the psychosocial with the biomedical and activates people to be engaged in their own health and medical care,” he said. “She connects with people who have eluded me for years.”

The first patient was a longtime diabetic who primarily spoke Spanish and struggled to manage his disease, Wilensky wrote. So, he connected the patient with Ortiz.

She immediately suggested that they provide the patient with a continuous glucose monitor. Although Wilensky initially hesitated, Ortiz reassured him and said she would do all the “leg work” to ensure the patient used the device correctly.

She accomplished this “Herculean task” by attending numerous training sessions on the device with the patient, filling out all the required forms, and closely watching the order. At the same time, Ortiz worked with the patient to develop healthy habits like diet changes.

As a result, Wilensky said there was a significant drop in the patient’s sugar levels, so much so that he didn’t need as much insulin. In addition, Wilensky noted that his patient seemed confident because he knew more about diabetes and the disease’s impact on his body.

“The last time I spoke with him, I found him to have become an excellent self-advocate. I realized that all of those years of appreciating him as a person with nonspecific cognitive limitations, I was really just seeing deferential behavior,” Wilensky wrote. “He just needed [Ortiz].”

The other patient who struggled with her diabetes was a heavy smoker, had a mental illness and coronary diseases. Wilensky wrote that at first, the “situation often seemed doomed,” but Ortiz was eventually able to connect with the patient.

Soon after beginning her work with Ortiz, the patient began experiencing many situational problems and was admitted to the hospital for chronic obstructive pulmonary disease and congestive heart failure. Even though they had only known each other for a short time, Ortiz was at the patient’s side both in the home and in the hospital up until the patient’s passing, said Wilensky.

“[Ortiz] connected with her on a deep level and provided a lot of caring,” he continued. “She was there to comfort not long before she died. I’m sure that in her time of need, our patient felt less frightened and less alone because of [Ortiz’s] attention.”

Ortiz added that during the pandemic she lost many clients due to COVID-19 complications. Before each passed, Ortiz said she would visit or call to check-in and bring comfort to her clients. She said that her clients would thank her for her efforts and for helping them right up to the end.

Big plans

Although she has been working as a community health worker for almost five years and has forged numerous relationships with clients and resources alike, Ortiz has “big plans” to further enrich her client’s experiences and education. For example, she hopes to develop prevention services to ensure that clients at risk for type 2 diabetes minimize the risk and expand the YMCA discounted memberships to all their locations.

Ortiz said she moved to Meriden from Puerto Rico 17 years ago and is proud to serve the community she loves.

“I want to serve the community. I want to serve with respect and provide all the resources that are available that they didn’t know existed,” she said. “I want to change people’s lives.”

cvillalonga@record-journal.com203-317-2448

Health equity reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at https://bit.ly/ 3Pdb0re. To learn more about RFA, visit www.reportforamerica.org.



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