Florence M Simán

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Florence Siman is the Director of Health Programs at El Pueblo, a non-profit organization dedicated to strengthening the Latino community in Raleigh, N.C. She is originally from El Salvador, but has lived in Chapel Hill, N.C. for thirty-three years. She has worked at El Pueblo for nine years, where she works with lay health advisors, or promotoras, to improve access to information about healthcare resources. Through her experiences working with El Pueblo and another non-profit organization, she provides insight into how organizations can adapt material specifically to the Latino community. Siman discusses the need to increase access to information and resources to the Latino community in creative ways, given constraints of anti-immigration policy and enforcement. She shares several examples of how El Pueblo is soliciting community feedback and being mindful of community needs, while working in an environment of very specific short-term grants for programming. Siman touches on how immigration and health are linked, suggesting that immigration status is a critical social determinant of health. Finally, she reflects upon the resilience of the Latino community in the face of many political defeats.



Madhu Vulimiri: Interview with Florence Siman, Director of Health Programs at El Pueblo for Global Studies 390: Latin American Migration, on the morning of Sunday, April 21, 2013. The interview is taking place in the home of Florence Siman, in Carrboro, North Carolina and is on the topic of her experience working to improve Latino patients’ access to healthcare through El Pueblo--El Pueblo. The interviewer is Madhu Vulimiri. So, Florence, could you just start by telling me a little bit about yourself, where you're from? Anything you'd like to share like that.
Florence Siman: I am originally from El Salvador. I've been in North Carolina for thirty-three years, which is also pretty surprising for me because it doesn't feel like I've been here that long. And I have been working at El Pueblo for about nine years.
MV: So did you grow up in El Salvador?
FS: Yes, I grew up in El Salvador until I was thirteen. And my family moved--well, left El Salvador because of the political reasons--my father was never really involved with politics but he was friends with the Archbishop that was killed in 1980 with many other Jesuits. And so, we left El Salvador in '80, went to Mexico, were in Mexico for about two weeks, and then decided to come to North Carolina because my parents had a friend--a family friend who lived in Chapel Hill. And then, my mom's brother had a scholarship to Duke. And so, we came with the idea that we would be here for a couple of weeks, and thirty-three years later, I'm here. Everybody else in my family is back home.
MV: In El Salvador?
FS: Yes, everybody else went back.
MV: Wow. So you were pretty young when you came here?
FS: Yes, I was--actually had finished--. So, the school year in El Salvador is usually from like March, February or March, to October or November. And so we left El Salvador April 30th. So I had just started eighth grade. I had done perhaps a month and a half of eighth grade. And we came to North Carolina. I say May 18th, my brother says May 19th. We're still debating about that. [laughter] So, that was almost the end of the school year. And so I went to Phillips at the time it was called junior high school for about a month. For that month, I went into eighth grade for a month and then I was placed into ninth grade. So I never really went through an eighth grade program. I remember that summer going to Culbreth Junior High School to take English classes and feeling very overwhelmed about being here. It was very different.
MV: There was a culture shock for you?
FS: Oh, horrible culture shock. Yeah. I don't think it was only for me, I think it was for the entire family. I mean, we were not planning on moving. The idea was that we would be here for a short time and we ended up staying. And so, yeah, it was a huge culture shock for the entire family. Not understanding the language, not understanding the culture, not knowing how long we would be here for. I mean, I think it's different when you move to a place knowing that you're moving. But when you really don't know that you're moving and you're temporarily traveling to a place, it was a hard shift to make this our home.
MV: When you came here, did you identify as an immigrant?
FS: Not at all. I mean, I--I identified as a foreigner, because it was very clear to me that I didn't fit in. And Chapel Hill, it's interesting--even though people talk about this area being so open and so diverse--I remember being really shocked that people talked that way when I could see--especially by the time I got to high school, it was so clear that you walk into the cafeteria and African-Americans were to the right, whites were to the left. It was so divided. And then, foreigners were like in two tables. It was so wild to see that and to hear people saying how open and how diverse this community was, and people were so accepting.
MV: Kind of a disconnect.
FS: Very strong disconnect.
MV: Interesting. How did you--where did you go to college, and what did you do after high school?
FS: Interestingly enough, I haven't left Chapel Hill. Or, the Chapel Hill/Carrboro area. I went to UNC. So I graduated from high school in '84 and then I went to UNC and got my BA in international studies. I wasn't a hundred percent sure what I really wanted to do, like a lot of people. So I did international studies with a focus on anthropology and the third world. And then, after that I took a year off, which was a little complicated because of my immigration status. So I was here legally under my parents until I finished high school and then after that I had an F-1 B visa, which--no, F-1 visa, which is a student visa. I had that for four years until I graduated from UNC and then--. I don't think people understand how complicated the immigration system is. And so, for the next few years after I finished my BA, there was really nothing I could do. I mean, to stay in the area. So I went home for the summer and then came back here as a tourist for six months and went home for Christmas and came back as a tourist again. What I did is, I babysat. I took care of kids and did whatever I could to survive here.
At that time, I also applied to the School of Public Health. And my last year in college, what I really wanted to do--. I took a class on medical anthropology and I was really interested in that. I think that's--I understood that that was my passion. I really wanted to understand how people related to illnesses and understood illnesses in different countries and different cultures and how people try to address different illnesses based on their own understanding. I talked to my professor and she basically said that doing medical anthropology meant that I could either become a researcher or a professor and I realized that I wasn't interested in either one of those things. I wanted to do something a lot more applied. And so, she suggested that I audit a class at the School of Public Health and I realized that's exactly what I wanted to do. So I applied to the School of Public Health, the Health Behavior Health Education department and got in. I went to the program, even though throughout the two years I debated whether that's what I wanted to do. I wasn't one hundred percent sure. I kind of stuck with it knowing that at least having a master's and having that knowledge would be helpful. Yeah.
So I've been in the area ever since. I've really seen the transition between this community being a community that did not have many Latinos in it, and the Latinos who were here were mostly migrant and were not settling out of the migrant stream--to seeing a place where Latinos are a part of the community, whether people like it or not.
MV: Yeah. And how did you get involved with El Pueblo?
FS: So. [coughs] There was a guy--John Herrera--when he and his family, well, him and his wife moved to North Carolina. It must have been in '93 or '94. He started--him and his wife decided that they wanted to have a sense of community here. They started--any Latino that they met--they would talk about wanting to find out about what was happening in North Carolina. Him and his wife wanted to organize a festival. So they--I guess I was one of the people on the list--so he basically met somebody and he would to talk to that person and ask them for names of other Latinos in the area, so I guess somehow he got my information. He called me up and we talked for a while. I was part of a group that started with the first fiesta that was organized here. I think it was September of '95. I really didn't play an active role. Like I was part of that and I went to the first fiesta and remember being really impressed, finally seeing something organized by our community and for our community, was pretty exciting. [pause]
So, the group started talking about the actual needs, and realizing that this is not just something we can organize something once and that's it. We realized there was a need to organize something--leadership development. At the time, we were thinking not that much for Latinos, but thinking about folks who work with agencies to make sure they could get the funding to continue doing the work. And then, I guess in '95, the agency became incorporated and, so--. I'm not really sure that I actively did something to be part of that group. I just remember being reached out to and realizing something that I really wanted to work towards, became part of the board. I would say that initially, I wasn't really sure what my role would be within that board. I was on the board for about ten years and then I resigned when I became interested in--not ten years, about eight years--and I resigned in about 2004--no, 2003--when I found out that El Pueblo was interested in doing work with promotoras. And that El Pueblo was thinking of applying to get funding for work with promotoras. So, I resigned from the board and I applied for the position and came to El Pueblo.
MV: So what was the difference between the board and what you're doing now?
FS: So the board is--the role of a board is to oversee and guide the organization. Not really to implement programming. When I joined the board at El Pueblo, since we initially didn't have any staff, then our goal was a little bit to do some programming, but the programming was mostly related or around Fiesta del Pueblo and then a conference that we organized once a year. Then eventually the agency had a staff member. Once we became incorporated, it's required that you have a board of directors. Usually the board just guides the organization and the staff are the ones who do the work. And so I came to El Pueblo to shift that, because I was interesting in implementing a promotoras program and not just guiding the work.
MV: Were you interested in working with promotoras even before working at El Pueblo?
FS: Yes.
MV: How did that come about?
FS: So, before I started working at El Pueblo, I was working at an agency in Chatham County for ten years. It was an agency called Child Care Networks. It is a child care referral agency and even though childcare was not really my passion at all, being part of the agency and trying to help the agency develop programming for the Latino community, not just like translating materials, but trying to figure out how to adapt the materials they were doing for our communities. I remember talking about the need for us to do trainings with wom--. So if you're talking about childcare, you have registered child care providers who go through specific trainings. Then, many of the Latinas who could not become registered because of a lot of legal issues. And so, we decided that we couldn't really ignore this group of women who were providing child care because they were not registered. We could still provide them with training and with information. They have the same understanding of the same important things like CPR and first aid and how to call 911, without them necessarily being registered but just making sure that they had the information.
I remember working with women and doing trainings with women and realizing the power of women and realizing the power of our communities and how people talk about "Latinas being very submissive" and "Latinas having no power" and getting really frustrated about hearing that and seeing a different reality. Hearing the stories of women who had gone through days and days without food, without hardly any water. Hiding in the desert to make sure that they could come to the U.S. so they could provide a better life for their kids. And then hearing, in the media, how the Latino community was here, taking things out of the system, that the community doesn't pay taxes. Latinas are submissive and men are the ones who have power, and they are the voice of the women and--. I guess, I just realized that we needed to find ways to continue working with these women to make sure they had access to information. Because I felt like, when people talk about empowering women, well, we don't need to empower women. The women are already empowered. It's just providing information and connecting them to resources.
But--so I started realizing the kind of creativity the community has. At the time, people were really scared of accessing banks. There were a lot of horrible things happening to Latinos in Durham, for example. And then, seeing the creativity of the people in our community to figure out how to get loans. So they developed a thing called tandas where, every week, like five families for example. Put in a hundred bucks into a thing and then the first week your family takes the five hundred, then the next week the next family takes the five hundred and it's a way of getting community support to do what you need to do without relying on existing institutions. And so, I guess, just seeing that made me realize that, yes, when you come to a new country, you don't really understand how the system works and so our agency had a role in helping with that process, but then also, many times our community trusts our own community and not outsiders. So figuring out how do we strengthen our community so we are not relying on outsiders to advocate on our behalf, but we can advocate on our own behalf. So, I worked with women in Chatham for ten years, and that very last year, I found out about program that Planned Parenthood was doing here in Orange County and Durham County. They were looking for somebody to train promotoras on breast awareness or breast health. So I decided to take that on, like on top of my work, just because I was interested in learning more about the work of promotoras and helping in the process of designing a curriculum and training promotoras. So I did that for a year while I was at Child Care Networks and then I applied for the job at El Pueblo. So yeah.
And I guess, since it was so difficult for my family when we first moved here to figure out how things worked, it just seemed so logical if we had had--I mean, at the time there were not that many Latinos, but if we had had a neighbor or somebody who lived across the street who could have helped through the process of just connecting us, or telling us, or explaining to us how things were here. That would have made transition a lot easier. It just made so much sense for me that I've been here for a pretty long time and I'm passionate about health issues and community work to do this.
MV: That's great. What kind of different topics do the promotoras focus on?
FS: So, when I came to El Pueblo we had funding from John Rex Endowment, which is a private foundation in Raleigh. Their focus is to improve the health of children. in Wake County. The funding was specifically to work on asthma, diabetes, obesity, immunizations and dental care with a training on the overall access to healthcare. So, what is Medicaid, Medicare, Health Choice. Who qualifies for what? And also understanding that the healthcare system here is very different. And how, for many Latinos and Latinas, you go to the emergency room for care, because that's how it is in some Latin American countries. So understanding, that's not how it works here, and that if you go to the emergency room you're going to wait a long time, unless you're about to die. There's a priority. I think there's a lot of confusion sometimes thinking that it's discrimination--and I know there's lots of discrimination--but I think at times, there's a little bit of misunderstanding about--"I went to the emergency room and I had to wait for ten hours." Well, there's some cases where you might have had to wait because there are other people with a condition that's much more critical. Also it's outrageously expensive, and so making sure that people have the information about where else they can go for care.
After three years of working with promotoras, we conducted an evaluation of our program and it was interesting hearing from the promotoras about two issues that they thought were really important for us to address: reproductive health and mental health. So, our agency decided not to work specifically on mental health issues because UNC and Duke have a partnership to develop a program called Alma, and so it seemed pretty redundant when they were doing a great job, why would we--. So what we try to do is connect women to that program--and men. Although that program's specifically for women, but--.
But then, we also started hearing from the promotoras a lot about social determinants of health. I mean, that's not what they called it, but it was hearing a lot about immigration issues. So you can't talk to me about asthma outside of the context of immigration issues. If my child is really stressed about me being picked up by immigration, and me not being able to come home at the end of the day because I've been picked up by immigration, that can trigger an asthma attack. If you're talking about stress. If you're not talking about discrimination and racial profiling, and if you're not talking about poverty and all those issues, you can't really talk about health. So, we tried figuring out how to tweak our curriculum. We're actually still in the process of doing that, of figuring out how to tweak the work that we do to make sure that we include, or we understand health through a social determinants of health perspective. And then, try to make sure that it doesn't stop there, but we also help build our capacity to make change. It's not only understanding it, but then trying to figure out, what does this mean? What kind of power do we have as a community to make sure that we create some kind of change.
MV: That's great.
FS: Yeah, it's pretty exciting.
MV: How would you say that El Pueblo is unique from other organizations that are doing similar advocacy or outreach?
FS: I would say here in North Carolina you have a lot of agencies that are like centros for example, that provide a lot of information, resource, and referrals, and do basically like social service type things. They provide information, they provide resources. You have some agencies that do advocacy work, specifically with legislators, but I feel like our agency in a way could be a little different because of the fact that we're working more with community advocacy. So making sure that we as an agency understand the reality of our communities so we can collectively, with the community, advocate for change with the legislators. But at the same time, I feel like it's informing legislators about the realities that our communities are facing and then also that we're understanding for the community what kind of stands we should take.
For example, with the driver's license issues. When people ask me, what do I think about the driver's license issue. What kind of reality should the community be having? It's very difficult because I'm pretty privileged. I have a driver's license that's valid. And so, my initial response would be, of course people want to have a driver's license. So it doesn't matter what the license says, people want to have one, because they're sick and tired of paying fines and being scared. But at the same time, you have to understand that people are talking about their basic human rights and people are talking about their dignity. So do you really want to have a driver's license that says, 'No lawful presence' or something that in a way, you're taking people's basic human rights away. And so, I think as an agency, we're trying to make sure we're not speaking for the community but when we are asked to take a stand, that we actually take a stand that's informed by the community and understanding that our community's pretty diverse and so with regard to the driver's license issue, when people ask, I would say, as an agency we oppose. at the legislator. At the same time, we respect people's individual decisions, because I think as an agency, we can't decide what people should be doing. We can say we're against this, but we understand that people's realities are different. We can't really guide people. We can just say, this is how we feel as an agency based on what we've heard from the community, but I guess it's also an individual choice.
MV: Right. So Rachel told me a little about how El Pueblo has, I guess, shifted from doing more lobbying to now providing more direct services. So, I guess, could you tell me about how El Pueblo has evolved in the time that you have been there in that regard?
FS: Yeah. I wouldn't say that we've gone. Our agency has shifted through the years. I think initially, we didn't start as an advocacy organization. We started as an agency that was interested in cultural exchange and leadership development. I think, for a little bit, we went into working on community organizing and then we would focus on advocacy, but it was very legislative-focused. I think now as an agency, I wouldn't say that we're interested in direct services necessarily. We understand that that's part of what we have to do. We get phone calls all the time from people wanting help. or phone numbers of figuring out how to access certain services, so we end up doing that, even though we don't have designated funding to do that, but it's something that we realize there's a gap and people call, or people show up at our office, and I think that's something that's part of what we have to do. But I don't think we have stopped doing lobbying. I think our focus is not as much on doing lobbying as the only option, but on looking at community organizing as an other option. So it could be that we're organizing to lobby the legislature, but it could also be that we're organizing as a community to talk to the Board of Education or that we're organizing as a community to talk to a landlord about specific rights, or that we're organizing to go talk to a pharmacy about access to emergency contraception. So I don't think we've decided to do one or the other, I think we as an agency realized that we need to do both.
MV: Can you tell me--let's shift now into health--what kind of health resources El Pueblo provides to folks?
FS: So, in regards to health, I would say that our approach, as we've talked about, is about the promotoras and lay health advisors. And we have funding to do work around cancer issues, and so we have three or four lay health advisors that are based at the Mexican Consulate in Raleigh. They provide information about cancer prevention, about screenings, and also trying to connect people to specific services. And making sure that we follow up with folks. So when somebody who's at the Mexican Consulate approaches one of our promotoras, we have an interaction and that the person's interested in finding about screenings, then making sure that somebody follows up with them to make sure that they have received the care they need. If they haven't, trying to figure out how to support them in that process. So that in a way is direct care, or direct services. At the same time, making sure that you engage the people that you talk to, so they can come to our agency and be part of our agency in regards to advocating for change. So I think that's a little bit of the shift that I've seen. In the past, we used to provide that service, and that was it. And now trying to figure out, well--if we're helping or guiding in--guiding somebody in securing some kind of service, making sure that that person can be connected to our agency when we're organizing events and taking action.
We have programs specifically around reproductive health and reproductive justice with adults and youth. And that's--I would say, that's what really fuels me, and it's making sure that we have Latinos who are youth and older, who are working to make sure that everybody in our community has access to reproductive health choices.
MV: And can you just describe what you mean by that? Do you mean access to family planning, or--could you describe that?
FS: Well basically, it's whatever the person or the family needs to be able to be healthy. And so, to me, it means the full reproductive health choices that families need. And that they're respected if they want to get married or not, if they want to have children or not. And if they do want to have children, that they're respected and supported in the process of raising those children. We also feel that everybody has--should have--the right to decide what they do as a family. If they want to have children or not. If they--yeah. So, that's reproductive health issues.
And then we also have been working around prenatal care issues and developing fotonovelas, which are--they're comic book-like health education materials that are usually developed for low-literacy individuals. And so, we've developed fotonovelas, which are in English and in Spanish. It's been really exciting because we developed seven and they were actually--the photographs were taken with local women in the area, and the scripts were guided by the local women in our community. And these are being pilot-tested and will be shared with folks throughout the U.S. And it's a way of making sure that people are reflected in the stories. People understand that their realities are not different from the realities of people in the other areas of the U.S. It's a way of providing information in a fun way, so.
MV: Have you heard any feedback on them so far?
FS: We've gotten great feedback. We actually trained two of our promotoras in Raleigh and two promotoras here in Orange County to use the fotonovelas as tools to train pregnant women. And we've gotten great feedback. We've actually made changes to the fotonovelas based on the feedback from the women. So initially, for exmaple, the fotonovelas were in English on one side and Spanish on the other side, which if you read the literature, and if you're looking at how to develop materials for low-literacy communities, that's what they will tell you--that it should be separate. But it was interesting, because we started asking the women, and the women said, "No, we don't want English on one side and Spanish on the other side. We want the bubbles to have English and Spanish together." And we initially--that went completely against all the theories. And so, we pilot-tested it in more places and in Texas, and we had the same findings. People said they wanted to have it because that's the way it forces us to compare the English and the Spanish and we can learn. And so, that's how they have been developed. It's been really exciting to see that this process. I would say it's pretty groundbreaking, because if you look at how material has been developed in the past, it's been very different, and sometimes I feel like theory is one thing, but the reality of the community is another thing. And so, making sure that you're receptive to that feedback, instead of saying, "No, what you're telling me goes against what I know." You know, my reality is different, so I'm making sure we develop the material in a way that's what people want.
MV: Cool. That's a really cool program. I guess, what would you say are the challenges that you experience both, either personally or organizationally, in trying to improve access to care for Latinos?
FS: I think one of the biggest issues is, has to do with immigration policy and enforcement. So, this past year El Pueblo partnered with Wake Forest University to look at--or to better understand the impact of immigration policy enforcement on Latino health. And I feel like, people usually don't make a connection between one thing and the other. I feel that the community has been really effective in making the connection between immigration status and education, and the DREAM Act. And I think it's until now that a study has been done to be able to shed light on the importance of looking at the impact of policy enforcement on people's health, not only on access to services, because people are scared, but also on the impact it's having on family's and children. Being extremely anxious, being extremely depressed. Feeling hopeless, feeling overwhelmed. I cannot imagine being a five-year-old and having this constant fear that your parent might not come home, because he or she is picked up by ICE. And it's something that we had been hearing a lot from promotoras through our work, but I think it's been really helpful to have it documented now by a university as well. I think a lot of people wouldn't really have heard this information coming from an advocacy Latino organization, but I think it's different when you have a more traditional, more mainstream university partnering with us and coming up with this findings.
MV: Definitely. Really shows the importance of partnerships, diverse stakeholders.
FS: Exactly.
MV: On the flip side, what are some real successes that you have had in the past years that you've been at El Pueblo?
FS: I would say that has been an amazing success.
MV: The fotonovelas?
FS: Well, the fotonovelas and the partnership with Wake Forest, because I feel like at least we're beginning a dialogue. And trying to engage different partners. I think very few people have thought about reaching out to the health care system, to be advocates for immigration reform. I think the fact that we have worked in partnership and collaborating with other Latino organizations, I think for a while our organization was seen as a Latino organization that was trying really hard to be the best and the only Latino organization in the state. I think as an agency, we have shifted our approach in understanding that we can't move forward unless our communities and all of us move forward. So trying to figure out how as an agency, we take the lead whenever that's our role, and whenever that's not our role as an agency, we try to figure out how to partner with other organizations that can take the lead on those issues. I am trying to think--.
Something else that I think has been amazing success has been the work that we have been doing with youth. We organize, usually, an annual conference for Latino youth. It's organized with youth support and it's youth-led. It's been really powerful to bring a group of youth together. I think many times people--especially in small communities and in rural areas--feel disconnected and feel that they're the only ones that are dealing with this issue. It's been really powerful to see and to bring together youth who are in different areas who are realizing that this is part of a larger movement. And I think that's made many of the youth feel really encouraged about taking further steps and further action.
MV: Do you think that there is hope for, maybe, the youth getting engaged in the same way that it seems to have happened with immigration and education, as well as the links between immigration and health, like you're talking about?
FS: Yeah, we're beginning to see--. So I think, the other thing that we're trying to do is to make sure that we're doing intergenerational work. So our promotoras, we've had more promotoras working on health issues, and it hasn't been until like 2007 that we're starting working--no, 2008--that we started working with youth and reproductive health issues. I think working together to have the youth and promotoras to make sure that the promotoras can share some information and some passion about the work that they've been doing. But I think, also having the youth share some information with the promotoras about their realities as youth, and how they're being raised in a very different system, very different community. So making sure that both groups feel like they can learn from each other and work together to further their goals.
MV: Yeah, so it sounds like there's a lot of learning from each other.
FS: Right, and it's something that I think has really not happened. I mean, I think as an agency we have worked really well with both groups, but I think it hasn't been until--. We recognize that, I would say four or five years ago, but I'm not sure that we had taken any steps to make sure that we did things differently and right now, in the past two years, we had funding from John Rex Endowment as well to look at how do we integrate youth into all of our work. So, instead of just having a youth program, we have youth represented on our board, and it's been really exciting that now we have two youth who are on our board, and we have a promotora who is on our board. So, making sure that we don't only get input from the youth or from the promotoras, but that we have them in leadership roles where they are actually deciding and guiding the organization as to how the work needs to happen. We've known that that's something that we needed to do, but it was a long process to get to the place where we had the capacity to do that. And it feels like we're doing that now, so it feels pretty exciting.
MV: That's great. That's really important. How would you say that the availability of different health trainings is determined by grant funding?
FS: Yeah, I would say it's--it's very much determined by grants or funding. I think our agency, especially in health, we've been really mindful about that. And I've had tons of opportunities to apply for funding to do work that we didn't feel was relevant. And we have not. Which is difficult.
MV: You have not--.
FS: Applied for it, because we felt like it wasn't relevant. And it's been difficult, because at times I've been tempted. As an agency, at times, we've been tempted, because we hear that there's this funding opportunity, but we realize that it's not connected to where the promotoras want to go. And so, figuring out--I think what we're searching for now is for funding to support the methodology that we want to use. So, to support the promotoras' work, and not to support diabetes, or obesity, or HIV only. So I think, it's very common to be led by funding. I think in regards to health, we've done a really good trying to make sure that doesn't happen. Which in a way makes it hard, because I would say, since June 2010, we haven't had any designated funding for our promotoras work. So we've continued to meet with the promotoras, but we haven't had funding to provide stipends to the promotoras, to provide professional development opportunities, which is really hard. And so, I think we're trying to figure out whether we can get some funding, for example, to do HIV work that can be part of what we do, but we can do something broader. So, it's not an easy thing. And it's--I would say, it's an ongoing temptation. We have to be funded. So, I've been with the agency for nine years and I haven't had funding to do promotoras work, although I've continued doing it, but I haven't been able to do it as much as I wish I could have, because I get funding to do other stuff. And so, it's a constant struggle.
MV: I could see that being very challenging.
FS: It's like, you really want to just be focused on what the priorities are and what the community wants the priorities to be. At the same time, you have a reality as an agency, that you need get funding. So trying to figure out, how do we push foundations to understand the realities of the communities and to shift the funding. We've been pretty fortunate, for example, when we had founding from John Rex Endowment for promotoras work. The first three years, it was asthma, diabetes, obesity, and that, but then we went back to them and said, This is what we're finding out from the promotoras. Can we look at shifting our curriculum to make sure we're looking at it from a social determinants of health lens?" And they were very agreeable and supportive through that process. So I think it really depends on the funder and I feel like many funders are now shifting and trying to be more organic and understand that you can't really dictate what will happen, as an outsider, but trying to make sure that we're accountable and at the same time, trying to be guided by what the community wants us to be doing.
MV: Good. Well, that's hopeful.
FS: Yeah.
MV: What would you say has been the biggest lesson that you've learned from working with Latino folks in this area for so many years?
FS: I think what we talked about at the beginning is, the power that our community has. I think it's pretty easy for a community to not feel powerful at times because of what we see in the media, because of the way that we're being profiled, because of all the anti-immigrant policies, because of the many obstacles that our community faces, and because of--often, we're faced with defeats. So, it's--we're trying to change policies and it's not happening. We're trying to move forward and it's not happening. The Dream Act has been up in the air for a long time. Immigration reform has been up in the air. There's always something that comes up that becomes a priority. But I think it's been really--it's really humbling for me to see how much our community can really accomplish. Even though there's all these things happening, our community is very resilient, and has tried to figure out ways to move forward and to fight back, even though it's with very small steps. I think that's been pretty exciting.
MV: Yeah. How do you think that you have grown as far as being able to assist people?
FS: I think it's been a huge learning process. I feel that part of what keeps me really engaged, and I think keeps me having a positive relationship with the promotoras that I work with is, me being very honest about how much I've learned in the process, and how, like when I've made mistakes, assuming that something should be done a certain way, being able to recognize that sometimes I'm not really sure how we need to move forward, but that we as a community need to figure out that process. It's not really about me making that decision, but me listening to the community about how we want to move forward. Yeah, I'm not really sure I've answered that.
MV: That's okay. One question that I just thought of is--how, I guess, it plays into your identity, and I guess, I wonder how much of your work with Latino communities has been facilitated by having a background from El Salvador? Do you think your work would have been different, if you were, say, born in America and were raised here?
FS: Yeah, I think in a way, yes. I think I also do understand the privileges that I've had. I think, perhaps the fact that I'm willing--that I understand those privileges, I recognize those privileges up front, has helped me perhaps gain trust in the sense that I'm not going in saying that my reality has been the same, because it hasn't. I think part of it, my reality has been the same, in that I am an immigrant, and my family struggled when we arrived here, and that I had to learn a new language and I took a really long time to understand how the system worked here, and we faced discrimination, but I do understand I'm in a different reality because my family came here documented, because I had access to formal education, and I had access to the university. My reality has been totally different, but I think just having that understanding has helped, I think, me in gaining trust with the people that I work with. I think, yeah, I mean, just the fact that I've shared part of the experience, I think, helps.
MV: Yeah, great. I guess my one last question is kind of broad, with wishful thinking. If there was something that you could change about the healthcare system today, what would one thing that you would change, what would that be?
FS: As soon as I hear you talking about that, what comes up is immigration. And it's hard to think that the healthcare system would be related to immigration, but [ ] immigration policy was changed, then that would have a huge impact on the healthcare system. I feel like one thing that to me is really important is for the healthcare system to shift into understanding that you're working with human beings and that they have a history. The importance of taking and understanding that history. So, for me, it's really hard to think that a provider can diagnose based on just screenings. They might be able to diagnose, but you can't really adequately treat if you don't understand the whole person. I feel like the healthcare system is pretty disconnected from understanding the whole system, or the whole person. It's usually just understanding a specific part of the person, but not really trying to address health from a holistic perspective. I think that would make a big difference. I guess, it's just making sure that everybody has access to healthcare. I feel like, even with the Affordable Health Care Act, you're not going to have everybody having access to healthcare, because of the undocumented community, once again, is being left out of that conversation. So, I feel like that would be very important to make sure that when you're talking about everybody having access, then you're talking about everybody who lives in this country whether they're documented or undocumented.
MV: Right. Thank you so much for sharing with me some insights with your experience at El Pueblo.
FS: Well, thank you for taking the time.