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Lili and Esther Gutierrez embracing in front of balloons

Mother-daughter promotoras on a mission to empower their community and improve health outcomes one person at a time

As trusted community members, promotoras—community health workers in Spanish speaking communities—are uniquely effective in immigrant communities because of their ability to establish meaningful relationships based on shared experiences, mutual respect and deep empathy.

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At 20, Liliana Vela Gutierrez (Lili) is already a veteran at helping her community.

“It’s something I was always good at,” she says. “Just like other people decide to do sports, in middle school I decided to do community service. My mom was a community leader in Mexico when she was pregnant with me. She tells me I was empowering my community even before I was born!”

Mother and daughter embracing and smiling at the camera

Photo courtesy of Lili Gutierrez

Maria Esther Gutierrez (Esther) moved to the U.S. when Lili was three. Building a new life in a new country was hard, but Esther was determined. She started volunteering at Lili’s public school, and the relationships she nurtured there and since made her a natural fit for the Community Health Ambassadors (Promotoras de Salud) initiative at Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, New Jersey, supported by the Johnson & Johnson Foundation.

Promotoras are frontline health workers and trusted community members in Spanish speaking communities who link individuals to health and social resources through outreach, community education, informal counseling, social support and advocacy. The project aims to engage the primarily immigrant community in New Brunswick in wellness and healthy lifestyle programs, including early detection, prevention and management of diabetes and heart disease. In 2022, promotoras trained by the program created over 30,000 touch points, recruited hundreds for COVID and flu vaccinations, and encouraged community members to seek cervical, prostate and breast screenings.

“My mom believes in empowering people,” says Lili. “She wanted to empower me and my siblings and other children in our community through education and now to be able to help people on the health side is something that makes her very happy.”

When Esther mentioned the program needed bilingual people, Lili was thrilled to join. As a student attending community college to get her pre-requisites for nursing school, working in community health was the perfect opportunity.

“I have big dreams,” adds Lili. “My mom pushes me to get my degree, because as a nurse or a doctor, I can do more than just translate. I can really get across the message about good health to my community. Getting that message from someone who looks like them is very important.”

Empowering a community to be hopeful about their future
Esther’s passion for this work comes from the same dreams she has for her four children. “I want our children to grow up healthy, to be nurses and doctors and mayors, and who knows, maybe even presidents,” she says. “I don’t want my community to be scared, I want them to be hopeful.”

Promotoras like Esther and Lili are uniquely effective in immigrant communities because of their ability to establish meaningful relationships based on shared experiences, mutual respect and deep empathy. Language is a common challenge and something Esther herself struggles with.

“Life is hard for people in our community, and it’s easy for them to get discouraged and give up,” says Lili. “But we build deep relationships, we exercise with them, we go to the same schools and churches, we really work to build a trust with our community.”

Everybody is different and everybody’s needs are different, Esther explains. “We try to be in their shoes. We tell them how they can live healthier lives, we tell them about summer programs for their kids, where to get flu shots or the COVID vaccine. We offer women pap smears and mammograms and tell them about preventive health.”

Many of these programs are available at no cost, but people don’t know about them, she adds. Sometimes the information offered may not be what the client is seeking but the trust the promotoras have built allows people to open up about other areas of their lives they may need help with. “In us they see a friendly face, a familiar Hispanic face. They feel safe with us and respond to us when we ask them what they need for their families.”

The pandemic hit the community especially hard and there has been a rise in mental health, addiction and domestic violence issues. Sometimes there are not enough resources to help, especially in the area of mental health, but as promotoras they try their best to pull resources together and each success story motivates them to keep going.

Esther recalls one woman confiding in her that she was in an unsafe domestic violence situation. Esther called everybody she knew, including the resources at the hospital, and worked relentlessly to help her get out of the situation and connect her with the therapy and support she needed to build her life back.

Another time a recent immigrant stopped Esther on the street informing her she was diagnosed with cancer in her country but didn’t know how to access the medical system here. Esther called the RWJUH Community Health office right away and was able to use their resources to put her on a high-risk priority list and get her the urgent treatment she needed at no cost.

“Sometimes I think, wow, I was able to do that, and I feel overwhelmed,” says Esther. “People always stop us in the streets and tell us how grateful they are, that they are healthy because of the work we’re doing. We help not expecting anything in return but we actually get so much back when people open up to us and let us help them.”

Esther couldn’t be prouder of Lili for how she inspires her community to be better. “Becoming parents, working and struggling to make ends meet, that’s it for many people in my community. My mom wants to break that chain,” says Lili.

Seeing Lili working hard to achieve her dreams makes Esther emotional. “I want people in my community to not be afraid to fight for what they want. Leaving your country is never easy, but seeing your children succeed makes it all worth it.”

The Johnson & Johnson Foundation is a registered charitable organization that reflects the commitment of Johnson & Johnson to create a world without health inequities by closing the gaps between communities and the care they need. Funded solely by Johnson & Johnson, the Foundation operates worldwide as Johnson & Johnson Foundation US (founded 1953) and Johnson & Johnson Foundation Scotland (founded 2007). These independent entities support both global and in-country partnerships and community-led initiatives to champion health workers, especially nurses and community health workers, and advance access to quality healthcare.

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