Community Health in the Hands of Neighbors

[This story has been updated to clarify some statistics and to include information omitted in an earlier version.]

They are not doctors or nurses. They are unable to diagnose diseases or prescribe medication. Still, for many in their neighborhood, they embody the difference between managing chronic illness and being healthy or spending more time in the hospital – or, even worse, dying prematurely.

These everyday New Yorkers, most of whom live in developments of the New York City Housing Authority (NYCHA), have been trained by the New York City Department of Health and Mental Hygiene (DOHMH) to become community health workers who have the skills to help their own neighbors stay healthy.

“We do not diagnose, but we offer practical information and guidance about how to prevent disease. Our purpose is to promote good health and teach [people how] to control and manage their chronic illnesses so they can take care of themselves and other members of their families,” said Guillerma Maritza Martínez, a community health worker (CHW) in East Harlem.

Martínez, born in Cibao, Dominican Republic, graduated from LaGuardia Community College, and later received training to become a community health worker with Harlem Health Advocacy Partners (HHAP). The HHAP initiative was launched in 2015 by the DOHMH’s Center for Health Equity in order to improve the health of the residents of five of NYCHA’s housing projects located in East Harlem and Central Harlem. The area is known for having high rates of chronic diseases such as diabetes. Since then, more than 780 individuals have participated in the program.

“We also tell them that they need to change their lifestyle in order to improve their health. We talk to them about nutrition, physical activity and stress management,” said the CHW, who, in addition to meeting with clients at a minimum of twice a month – sometimes in their own departments – also offers group walks and weekly workshops at a community center for seniors in Lehman Village, one of five NYCHA developments participating in HHAP.

“Sometimes, in order for people to take control of their health, they need more than their doctors and nurses. They need the support of their neighbors, families and friends. The people they trust,” said Dr. Aletha Maybank, deputy commissioner and director of the DOHMH’s Center for Health Equity.

“In East Harlem, where 50 percent of residents are Latino, the rates of chronic illnesses such as hypertension, diabetes and asthma are disproportionately higher than in other neighborhoods. […] For that reason, we launched the HHAP, which works through CHWs from the same neighborhood to provide health training to local residents,” added Maybank.

Guillerma Maritza Martínez (left) explains to Dominga Ortiz the effects of an asthma attack. (Photo by Pedro F. Frisneda)

A total of 12 CHWs like Martínez and three other health advocates employ talks, workshops and visual aides to educate residents, for a period of six months, about prevention and the way these diseases may cause complications and attack different organs in the body. All of these services are offered free of charge.

“We explain to them in detail what the pancreas is, where it is located, and what happens when someone suffers from diabetes. We also show them the bronchia when they are normal and when they are swollen from an asthma attack, which makes patients feel like they are suffocating because air is unable to go through,” said Martínez.

Chronic illness

According to DOHMH statistics, 54 percent of the residents over 35 years old living in these five NYCHA developments have been diagnosed with high blood pressure; 29 percent have diabetes and 12 percent have asthma or have suffered an asthma attack in the last 12 months.

“In total, three of every four NYCHA residents over age 35 in the 5 East and Central Harlem developments have one of these three chronic illnesses, which may not only incapacitate them but also end their lives prematurely.

Worse yet, a third of them – 35 percent – said that they suffer from two or three of these conditions simultaneously, while 21 percent of them have four or more. This makes managing their health more complicated and expensive.

That is the case of Dominga Ortiz, a Dominican woman who has asthma and hypertension. She has lived in NYCHA’s Taft Houses for more than 13 years.

“In 2013, I had such a severe asthma attack that I had to stay in the hospital for three days. I have had high blood pressure since I was 40,” said Ortiz, who will turn 63 on Aug. 4.

A group of participants in HHAP’s walking program in East Harlem. (Photo courtesy of HHAP)

Ortiz, who has participated in the HHAP program for more than six months and who never misses the weekly workshop and group walks, belongs to a group of more than 33 residents (clients) who are currently benefiting from the biweekly personalized health counseling offered by Martínez as part of the HHAP’s CHW program.

“The program has been really good for me. My blood pressure has come down a lot, and my asthma feels much better. Also, I am pre-diabetic, and I have learned a lot about diabetes and how to prevent it,” said Ortiz.

The native of Dominican Republic said that her blood pressure dropped considerably in the last few months (from 172/90 mm Hg to 117/70 mm Hg).

“With my blood pressure so high, I had a lot of stress, but now I have it under control with the four pills I’m taking. I am also eating better. I eat more greens and vegetables, everything low in salt, and I feel great. I know that my health has improved quite a bit,” she said.

Although the counseling and other services Ortiz receives from HHAP are free, this program doesn’t cover medical expenses like doctor visits or medications. However she can pay for that because she has Medicaid like many other residents of NYCHA.

Education is wellness

Martínez, who always dreamed of being a sociologist, worked in sales for 19 years but moved on to a career in community health. She says that she has seen tangible improvement in the residents’ wellness as a result of the work promoting education and awareness about how to maintain good health that people like her have carried out in the community. [Watch as Martinez walks with participants in the HHAP program and talks about the satisfaction she gets from the job in the video filmed and produced by Stephanie Daniel at the top of the story.]

“It is incredible when you learn about chronic disease and you use that information as a weapon to help others. I have had clients who came here with very high blood pressure who are not taking their medication because they no longer need it,” said Martínez.

Aside from the knowledge she has acquired at the DOHMH trainings, Martínez knows what some of her clients are going through because she too has diabetes.

“I am suffering from diabetes myself. Both of my parents have it, but it is under control. It is a test for me, and I can show my clients how I control my illness and that of my loved ones with what I know,” she added.

“I always tell them: ‘Ma’am, even if your daughter or son does not have diabetes, they need to prevent it. You must help them not to develop it by changing your lifestyle,’” explained Martínez.

This map of NYCHA developments in East Harlem indicates in red those areas with the greatest density of residents with poorly controlled diabetes. (Image courtesy of Harlem Health Advocacy Partners)

The uninsured

In addition to the education and vital advice offered by the CHWs, NYCHA residents who are in the HHAP program also receive assistance obtaining health coverage. This includes help enrolling in a plan and solving any issues they may find when the time comes to pay their medical bills.

An estimated one in five NYCHA residents in East Harlem – 18 percent – depends on emergency rooms to obtain regular health care. Most of them are Latinos born in Puerto Rico or the Dominican Republic.

“We are affiliated with Community Service Society, an organization specialized in health coverage, and we refer anyone who needs health insurance to them,” said Martínez.

The CHWs also help residents navigate the complex health insurance system, and get them connected with clinics and community organizations, health care providers and a number of social services.

“It is important that someone who knows our culture and speaks our language talks to us first and explains everything before we go to the doctor. That way, we know everything about our disease when we get there,” said Ortiz.

CHWs learn about mental health disorders such as schizophrenia, bipolar disorder, anxiety and depression in addition to their training about chronic diseases such as diabetes, hypertension and asthma.

“We often meet people with diabetes who are depressed, as these diseases go hand in hand. Thanks to our knowledge, we can recognize the symptoms and offer help,” said Martínez.

“We do not have a solution, but we can connect them with resources available to the community,” she concluded.

Between poverty and poor health

 According to the HHAP Initiative Report, most of the people living in these five East Harlem NYCHA projects live under the federal poverty line. In general, 42 percent of the residents have salaries below $20,000 per year, with 51 percent of the women and 42 percent of the men earning less than that.

Also, the report shows that, aside from the high rates of asthma, diabetes and hypertension, other chronic diseases prevalent among this population are arthritis (38 percent), high cholesterol (35 percent), cardiovascular disease and stroke (13 percent), osteoporosis (11 percent), cancer (7 percent), and emphysema and kidney failure (each appearing in 4 percent of the local residents).

Twenty-three percent of the residents reported that they don’t suffer from any chronic health condition, compared to 54 percent of all New Yorkers over 35.

An estimated 77 percent of these East Harlem public housing residents are overweight or suffer from obesity, 21 percent of them smoke, and 14 percent of them have an unhealthy diet, which puts them at a higher risk of suffering from illnesses such as high blood pressure and diabetes.

NYCHA is the largest public housing complex in the country, with 328 buildings and more than 400,000 residents in the five New York City boroughs. Of these, 12,720 people live in the five East Harlem NYCHA developments. The report states that “a higher percentage of the population in these developments is either younger (<20 years old) or older (65+ years) than the overall population of NYC,” and adds that residents of the five developments are more likely than all NYC residents to be female and Black or Latino.

The HHAP initiative began its community outreach activities with CHWs in February 2015 in five public housing developments: Clinton Houses, Johnson Houses, King Towers, Lehman Village and Taft Houses. The East Harlem complexes were selected for their high rates of poorly-managed diabetes in comparison with other New York City neighborhoods.

Find help

If you are a NYCHA resident in East Harlem suffering from asthma, diabetes or high blood pressure and wish to receive personalized health counseling from the CHWs or participate in group wellness activities, call (646) 682-3400. All HHAP services are free of charge and do not affect any other programs or public assistance you may be currently receiving.

Pedro F. Frisneda is the health editor of El Diario. His article was written as part of the Health Reporting Fellowship of the Center for Community and Ethnic Media at the CUNY Graduate School of Journalism and funded by a grant from News Corp. The video by multimedia reporter Stephanie Daniel was produced with support from the New York State Nurses Association for Voices of NY coverage of health equity issues in the NYC area.

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