Health workers who serve immigrant and Latine communities often experience the effects of changing immigration policies personally. Since many of them come from the communities they serve, these policies can really hit close to home, explains Erik Cardenas, co-founder and chief executive officer of Zócalo Health, a health care provider in California which is soon expanding to Maryland and Washington state.
Public Good News spoke with Cardenas this week to learn more about what he’s learning in real time from his team of community health workers and providers. If you’re a community health worker or if you work with folks who could be feeling the pressure of immigration raids, mass deportations, or the nationwide protests against these actions, keep reading to learn more from our conversation.
Here’s what he shared.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
PGN: Can you tell us more about you and your work? What led you to launch Zócalo Health?
Erik Cardenas: Zócalo Health was started back in 2021. I’m the son of Mexican immigrant parents. I grew up in a Latino community where access to care often depended on things like who you knew, how much English you spoke, or whether you felt safe showing up at all. The one-size-fits all health care system was obviously a difficult one to navigate decades ago, and not much has changed. We built this company to change that experience.
As a Latino-founded health care company that delivers culturally-rooted care to families who have been left behind by the traditional system, we really felt that we needed to build a model that, at the heart, [centers on] community health workers or promotoras. [They] could help us meet people where they are, help us build trust, and connect members and their families to doctors’ appointments, but also to a care model that we’ve designed that focuses on the whole person.
So, that means, not just the unmet social needs that obviously play a big role in limiting people’s access, but also helping them navigate the complexities of the medical and the behavioral health side of things.
PGN: Can you share more on what that looks like?
E.C.:. Our promotoras are salaried, trained, and deeply embedded into our care teams. Some of the important things that we’ve learned from them is their power to collect essential data through a variety of different mechanisms.
We train our promotoras on how to screen for a variety of needs that people may have. Because when you connect with someone, especially with a variety of unmet social needs, it’s hard to talk to them about prioritizing their health if they’re struggling to survive the day, right?
We do PHQ-9 and GAD-7 screenings for mental health. This helps us understand if people are dealing with anxiety and depression, or a lot of trauma. Especially with these mass deportations, communities are really on edge right now, and so those are some of the things that we’ve really been able to learn from these experiences, and it’s really informed how we approach each community.
PGN: With mass deportations and nationwide protests in the news, what are you hearing from your promotoras on the front lines? How are they preparing or meeting the moment?
E.C.: So, right now, the prep that goes into this is just making sure that our community knows that we’re trusted. We don’t share information with any of these authorities, and we value privacy.
We’re at a time that’s very reminiscent of when the pandemic started and everybody was moving to virtual care to help with social distancing. Because right now, it’s these tools that are allowing us to connect with people who are fearful.
This is impacting our own team. Like, we have promotoras who have families who don’t feel safe leaving their home.
These tools that allow us to connect people to doctors, our ability to deliver medications, our ability to do lab testing at home, we’re prioritizing bringing that type of innovation to our communities, because right now we are seeing people missing appointments.
We’re seeing people who are just scared to leave the house, go to a clinic, go see a specialist.
So, this is where our doctors and our therapists being available, you know, through a phone call or through a video visit, is becoming a critical way for us to fill important gaps that are being exacerbated by these issues.
You know, we serve multi-generational households. This means that we have entire households that are foregoing care.
It’s not just for sick care, right? Like, ‘Oh, we have a cold.’
We have people who have uncontrolled diabetes, who are dealing with renal failure, congestive heart failure. Like, we’re dealing with really sick people who really can’t afford to miss doctors’ appointments.
And right now, just with the uptick in distress that we’re seeing from people who are missing appointments out of fear, we’ll [also] coordinate [their] appointments with immigration. Like, it’s unprecedented.
It’s really difficult, and our team is doing everything we can to maintain that trust and make sure that people recognize that we’re going to try to meet them where they feel comfortable.
We are very fortunate that we have the tools that allow us to connect with people in a way that doesn’t force them into a building.
So, not only are we checking in on our community, but we’re checking in on our workforce. It’s just really forcing us to unite and ensure that we’re taking care of one another.
PGN: What do you want other health workers or the health systems who employ them to know?
E.C.: One of the things that we recognized really early on was the cultural wisdom that a lot of our promotoras have. It’s what helps us earn people’s trust.
I really like talking to promotoras about the familiarity that they have. Especially within the Latino community, with the -isms that we deal with, like familism, or, you know, marianism, or fatalism.
Because when we recognize them, when we know that they’re at play, it helps us influence people and their behaviors, and we can work around them to try to get people to prioritize their health.
You know, I’ve had situations where, you know, people refuse care. Like an elderly gentleman who, despite pain, is like, ‘Nope, I’m fine.’
And it’s like this machismo that some people have that just isn’t necessary.
So, giving promotoras the autonomy to help build relationships with patients is important. Having this ability to pick up on these, these influences, has been huge.
Without this knowledge, we would have taken a one-size-fits all approach and probably would have not been very effective in helping people. And so for me, when I think about promotoras, you know, it’s just a reminder that they are important assets.
Promotoras need to recognize that they are leaders, not just labor.
We need to invest in their growth, train them, build career paths, and involve them in the decision making, and really focus on ensuring that we don’t underestimate their power.