Thursday, November 3, 2005/lk
August 17, 2005
Cars lined the streets outside the White Salmon Park Center a week ago Sunday. Balloons bobbed in the breezy evening and the sounds of celebration coming from inside could have been mistaken for a Quinceanera — the “coming out” party for Hispanic girls on their 15th birthday.
In a way, the celebration happening inside was a coming out of sorts. But instead of one girl, there were 15 women being honored. And they weren’t 15; the womens’ combined average age was 43.
The celebration in their honor, however, was as important as any Quinceanera. On that night they graduated from a six-month program that has changed their lives — and marks the beginning of what could become a profound shift in health habits for Hispanics around the Columbia Gorge.
The path to Sunday’s graduation celebration began more than two years ago as a seed in Dr. Helen Bellanca’s mind. As a physician at La Clinica del Carino in Hood River, Bellanca had always worked with her Hispanic patients on weight control and healthy lifestyle issues.
“We all know Hispanics have higher rates of obesity,” Bellanca said. “And Hispanic farmworkers have even higher rates than the general Hispanic population.” According to the Centers for Disease Control and Prevention, 65 percent of Hispanics in Oregon are overweight or obese. A study by the California Institute for Rural Studies found that among the Hispanic farmworker population in the state, 76 percent of women and 81 percent of men are overweight or obese.
Bellanca knew that working with patients one-on-one was “inefficient.”
“Obesity is a chronic disease that needs help from the whole community,” she said. Bellanca began working with Lorena Sprager, a Hood River health educator and consultant, and Dr. Tina Castanares, a physician at La Clinica and longtime public health advocate, to outline a program that would allow her and a team to address obesity in the Hispanic farmworker population in the Gorge.
Called Vida Entera y Sana (Whole and Healthy Life), the program was awarded a $600,000 grant from the U.S. Health and Human Services’ Office of Minority Health ($200,000 for each of three years). The program, administered by La Clinica, has four components; the women graduating last week are part of “Redes” (meaning “networks”), which began with a six-month intensive weight loss course emphasizing healthy eating, exercise and education. The graduates will now be trained as health promoters who will take their knowledge and expertise — and personal experience in working toward a healthy lifestyle — out into their community where they will advocate for healthy lifestyle changes among family, friends and co-workers.
Other components of the grant include a breast-feeding support program, a program to teach families to grow and maintain a home garden, and a program to help health care workers at La Clinica to better address and manage obesity.
Lorena Sprager, project co-director, and lead health promoter María Antonia Sánchez, began screening women for the Redes program last year.
“We were looking for Hispanic farmworker women who were at a point where they wanted to make a lifestyle change, or had started to make a lifestyle change,” Sprager said. Other requirements were that the women were interested in learning, had good communication skills and a wide social circle (evidenced by such things as attending church, working outside the home or having lots of neighbors). Women were sought and picked from communities around the Gorge, including Hood River, The Dalles and White Salmon.
After a rigorous screening process, including several interviews, the women chosen were asked to sign an agreement committing to sticking with the program, which included attending six months of weekly classes. A “support person” — a husband or close family member — was also asked to sign the agreement, committing to provide vital support to the participant as she made challenging lifestyle changes.
At the start of the program in January, the women underwent a health screening to record baseline measurements like weight, cholesterol level, blood sugar level, and waist circumference. Then began the weekly classes.
The women met each Saturday for three hours. Sprager and Sánchez led the classes and also participated in the program (Bellanca did, too). Each class focused on a different health topic. One concentrated on different kinds of aerobic exercise and how to increase exercise in daily life. Another provided an overview of good nutrition. Still another was about learning “positive self-talk,” including recognizing that self-esteem affects health and weight control issues.
During one class the women went on a field trip to Rosauers, where they learned to read food labels and find healthy alternatives to processed foods. At still another, Sprager gave each woman a surprise gift: a jump-rope she’d bought at The Dollar Store after the women reminisced about their favorite activities from childhood. (Many of the women are now using the jump-ropes regularly for exercise.)
The week before graduation, the women underwent the same health screening they’d had at the beginning of the program. They’re still awaiting the results, but all of the women know they’ve changed over the past months. They can tell by their clothes, which are looser than they used to be. They can tell by their energy levels, which are greater than before. They can tell by the way they feel, which is better than they have in years.
In typical Hispanic fashion, the graduation ceremony was cause for celebration as well as reflection. After a hearty and healthy meal of chicken and vegetables, brown rice and cactus salad, the crowd of more than 75 family and close friends of the graduates moved chairs in front of the stage and the women went backstage to prepare for the ceremony.
Dressed in formal black — many with elaborately coiffed hair and carefully applied makeup — the women helped each other fasten on banners across their shoulders in a hallway behind the stage. “¡Sí se puede!” the banners read. “Yes, we can.” The back of each banner said, “Beautiful woman.” Each woman was handed a single red rose to carry.
Out in the hall, lights dimmed and the women filed onstage. They took their seats, many glancing nervously at the audience.
Sprager, speaking Spanish, welcomed the crowd and spoke about the program.
“A lot of people think (Redes) is a diet program,” she said. “It’s not a diet program. Redes is the beginning of the road to better health for our whole life.” Then Antonia Sanchez spoke, highlighting the importance of the womens’ family and friends on their journey.
“All of these women have decided to make changes in their lives,” she said. “But to make changes, we need the help of family, community. All of us who have started walking this path know there are barriers, and when we reach a barrier, we need help from our family and our community.”
In groups of four, the graduates then stood and shared prepared anecdotes about their journey and what they’d learned. One group held up photographs of themselves before the program. Another showed a can of soda, along with a container filled with sugar to illustrate how much sugar is in a single can of pop. Another had prepared collages showing healthy lifestyle choices.
Finally, each woman was presented a diploma. One of the program directors spoke about each woman as she received her diploma, and then each graduate had a chance to speak. Most of them thanked God and their family and friends, as well as their fellow graduates. One grad welled up with emotion and was unable to speak.
Sprager spoke for all the women when she was presented with her diploma (the directors also graduated from the program, since they participated in it along with the other women). “I want to thank all my friends,” she said, sweeping her arm to show the women seated onstage next to her. “I only have one brother, and I have always dreamed of having sisters. Now, I feel like I have sisters.”
Indeed, the women have grown as close as family. In their months of meeting together, they opened up and shared their private struggles with one another. One of the rules of the program, which were formulated by the women themselves, was: “What we talk about with the group doesn’t leave the group.”
Since the formal classes ended in May, the women have been meeting every two weeks as a way of getting together to support one another. Those meetings will continue as the women go through testing and training to become health promoters, and then go out to work in their community.
Because it is part of the four-pronged, three-year grant, the Redes program is a one-time deal — for now. But Helen Bellanca hopes it is the beginning of what could become a model program not only for local communities but nationwide.
“For the next 18 months of the program, we’re going to rely heavily on these women,” she said. The program directors will be in close contact with the promoters as they work in their communities. There will be ongoing training and evaluations of effective — and ineffective — strategies.
“As a nation, we need to learn why there is such a high rate of overweight and obesity in this population, and how to address it,” Bellanca said. “We’re hoping that at the end of (the three year grant), we’ll know what works and what doesn’t.”
All of the women who graduated last week from Redes know they have their work cut out for them in the months ahead. As graduate Alicia Mondragón stood on the stage with her diploma in hand after the ceremony, she spoke from her heart.
“Tonight was a very special night,” she said. “There was lots of emotion and nervousness. Now I plan to continue ahead with more desire.”
She paused, then lifted her diploma into the air and fairly shouted, “¡Sí se puede!”