by America Bracho
The community work of America Bracho and Latino Health Access has inspired many readers. Here we have reproduced an article that was previously published in ‘Towards a healthy community,’ Dulwich Centre Journal (2000 No.3).
America Bracho and Latino Health Access can be contacted at:
A: 450 W. 4th Street, suite 130. Santa Ana, CA. 92701.
T: (714) 542-7792 F: (714) 542-4853
Latino Health Access seeks to act as an institute of community participation. We wish to provide mechanisms for community members to participate in addressing their own health issues. We aim to work with organising the talents, the resources, the knowledges, and skills of the community to address the issues they wish to address. We believe that many of the health concerns currently experienced by Latino people in this neighbourhood are primarily related to issues of human dignity. They relate to the fact that human dignity is jeopardised here by the effects of fear and poverty.
Principles of practice
In order to create an institute of community participation, a range of principles inform our work:
Refusing to generalise
The Latino population in North America is incredibly diverse. There are Latinos in this country of many different social classes. It is by no means a monolithic community. Within this county there are many wealthy, successful Latino people. It is very important for us to ensure that we acknowledge the diversity of Latino experience. We do not generalise about Latino lives. We speak only about particularities and we create the spaces for people to speak for themselves. If for some reason we do need to speak more generally, we often use statistics to do so. This can assist in ensuring that we do not misrepresent the diversity of Latino experience in this country.
People to define themselves
There is also a diversity of ways in which people in Latino communities identify themselves in relation to their cultural heritage. In Santa Ana the vast majority of Latino people are of Mexican heritage. Some describe themselves as Mexican-American and would be insulted if you called them simply American. Others however, consider Mexican-American to be an offensive term – they see themselves as simply and completely American. Others still, question the right of those who live in the US to call themselves American at all, as they believe this term really applies to the native peoples of the Northern and Southern continent of America. Then there are those who describe themselves as Chicano as a political statement – people born in the US of Mexican descent who are involved in the Causa (the cause). What we have learned is that it is up to people themselves to decide how they are described. Cultural identity is something that nobody should define for others. The histories which most local Latino people relate to are primarily those of rural Mexico. Generally speaking these are the histories that speak to them the loudest. It is through their children, who are born here in Santa Ana, that they become aware of the history of Latin-American struggle in the US. They become more connected with histories of this country through their children. For those children born here, many histories influence their lives and identities. The process of cultural identification is sometimes complex.
Questioning the idea of unity
Latino people in North America come from all over the Spanish-speaking world, and yet in some forms of community work there is an assumption, or even a hope, that community workers can unite Latino people. This seems an unrealistic aim, and one that could only bring disappointment and frustration. In Mexico, in one small town (like all other towns) people cannot be united. So, how can we expect Latinos in the US to unite? The Anglo-American community is not united – think of the dislocation occurring to so many Anglo-American families, or the issue of family violence. Union or unity in a community is never going to be generalised. It will occur only around certain issues. We do not seek to unify the community in any general way. We do however seek to find and build a sense of common-ground on particular issues. This is a process. We will probably never reach the destination, but we can do much along the way.
Working with common ground
Our work has much to do with finding common ground and then working on it, cultivating it if you like. We are convinced that there are personal and group interests in creating healthy cities. When we articulate and work with these common desires and hopes we can create space for co-operation across great differences. Once we are working on common-ground we have reasons to be together.
There are two areas of common ground that we frequently explore – the common ground of caring, and the common ground of having something to offer. All the people who live in this community, all of them, care about the future of their families and themselves and all of them have something very good to give. These are the assumptions by which we work.
We need to explore the particularities of what people care about as this is important in creating common ground. Through our explorations we discover that people care about their kids, their school, and their living conditions. They care about not having friends, about being lonely. They care about getting sick and not even having someone who could cook them soup. They care about their network that they have left behind in their country of origin. These are the concerns of all of the human family no matter how different we may be. And when these sorts of concerns and caring begin to be shared, we are creating common ground on which to work.
Sometimes people may not even be aware of how much they care – they may need a context to be created which they can step into. As we begin working on common-ground, ways are created in which people’s care can be demonstrated and this in turn makes visible new possibilities.
Building on the skills of community members
It is our responsibility to provide mechanisms in a sensitive way that enable people to demonstrate, to perform their caring. It is our responsibility to notice and enquire about the assets, talents and skills of the community and to provide contexts by which the people we are working with can take actions to contribute towards the accomplishment of their hopes, aims and dreams. In this process we are creating territories of common ground. The first commonality being that everyone cares about similar issues. The second being that they all have something to contribute in relation to that which they care about.
We work from the belief that every person and every community has skills and knowledges, strengths and assets which when mobolised can contribute to the creation of healthy communities. We do not start by recognising the needs of a community and trying to address these needs. Instead we start by recognising the talents, knowledges and skills of the community. Harnessing these, we believe, is the secret to transforming communities.
This orientation brings particular responsibilities for workers. We do not believe that ‘cultural competence’ (which is often talked about in the US) has to do only with being sensitive to the different realities of people from different cultures. We believe that competence as a professional from a cultural point of view, means much more than this. For a start, competent professionals need to be able to appreciate the skills and resources of a community, and the ways in which the particular community understands these. What is more, competent professionals then need to be able to play a part in assisting that person, or that community to engage with their own skills and knowledges in ways that contribute positively to their community.
Doing something for communities is not a demonstration of competence in our view. Nor is competence fixed; it fluctuates. That is why we must be accountable for all the work we do. And that is why we regularly meet with all our community workers to discuss how things are going.
Unfortunately, often we as Latinos do not appreciate the strengths of our own people. Often, thanks to the dominant culture’s representation of us, we are immersed in the deficits of our own culture. We are constantly made aware of the many things we don’t do, in all that is wrong, in the fact that we have such a high drop out rate from high schools, in the fact that two out of ten Latinas get pregnant during adolescence. We are so aware of these deficit views of our communities that we come to expect nothing more. We are so saturated with deficit understandings that don’t see the eight out of ten Latinas who do not get pregnant during adolescence or those young Latinos who do graduate from high school.
It is our job as workers to appreciate what we have. This involves a re-creation of who we are. It involves acknowledging our strengths, our beauty as individuals, as family, as community. This is not just a good thing to believe, this is our job, our responsibility, our obligation as workers. We are competent workers only if we can find and appreciate and build upon the knowledges and skills of those we work with. If we can’t see the resources, the assets that they bring, then that is our problem as workers. We need to come back to square one and think again until we figure out where on earth those skills and knowledges are. If we are not recognising them, maybe we shouldn’t be working in that particular apartment building, or maybe we need further training, or access to different conversations.
Away form notions of charity and towards partnership
Community work in this country, as well as in Venezuela and elsewhere, occurs in the context of the history of community workers coming to rescue communities. Minorities in this country resent that – particularly those who have been involved in political struggles. We are tired of people who come and study a community and then leave having offered nothing (as if we are weird objects of study), and we are also tired of people who come in to rescue us, as if we are poor, hopeless people. Approaches to community work that are based on charity do have a significant role for those that are hungry and in need of food. There are circumstances in which we as an agency do offer free services to those who could not in any way otherwise afford them. However, these situations are the exceptions in our work. We do not see our role as rescuing any one and generally we do not offer charity. Instead, we enter into partnerships with the communities with whom we work.
Towards a fair exchange
What is the basis of these partnerships? We work from a philosophy of mutual respect and mutual contribution. We believe that we have something to offer and that those with whom we work have something to offer. Both parties are putting something into every interaction. It is a fair exchange. These Latino communities are very resourceful. They always have something to give and they feel better if you let them give it to you as part of a fair exchange. We believe it is a mistake not to accept what people are offering. We have people here who come and tell us that they can clean for us, ‘I need the medication but I could clean, let me pay for this in some way.’ This is important, and we accept what people have to offer as a fair exchange. We believe this contributes to dignity and ongoing relationships of mutual respect.
In work informed by philosophies of charity, when people offer an exchange for services sometimes this is not accepted. It is assumed that those who are disadvantaged should not have to contribute. Although coming from good intentions, such a philosophy does not always have good outcomes and it is one we have moved away from. Even in those circumstances where we subsidise health services, such as eye surgery for diabetics in the community, in most circumstances we don’t pay the whole fee. We pay half and the people themselves come up with a payment plan for the other half. Of course we assist them, but they play their part. It is expected and respected.
The same philosophy is involved in our work within apartment buildings. We come offering certain things, but the residents have to offer something too. Some people don’t appreciate this. People meet us and they say, ‘What are you going to give me? What is it that you bring?’ Paternalistic approaches all over the world have corrupted reciprocal relationships. We are interested in creating the framework from which we can work together, in partnership and in fair exchange. And so, we acknowledge that we bring certain things to this partnership, we bring information, some resources, a desire to collaboratively make a difference to the health of the community, and some ideas about ways this could occur. But we are not the only ones who can bring something to the table. We ask the community members what they can bring as well. One of the most important things that we believe we can offer is an invitation to respectful partnership, one based not on charity but on fair exchange.
Utilising a broad definition of community
It is not just the talents, assets and skills of the residents that we focus on. We are also interested in engaging with the businessmen, the builders, the politicians who are in some way linked to these neighbourhoods in which we work. We need to involve everyone who cares about the future of the neighbourhood in which we are working. We are no longer interested in definitions of community that include only the residents and exclude those who work in the area, those who provide employment, those who administer the services, those who manage the economy, and political leaders. If the builders don’t come to this neighbourhood, if the politicians are not engaged, if the school system is dismal, and businesses do not employ locals, then there is no way the community will be a healthy one. The people who work in this neighbourhood spend the majority of their daily life here. They are neighbours; we must involve them. Even people who don’t work here but whose hearts and minds are connected to this place in some way, they are people to involve. What is extraordinary is to see how much it means to business people, to politicians, and to health professionals to become involved. It is beautiful.
For example, the local mayor and state senators have come and sat with our young people. Our young people now know them by name and by face. They have learned that there are ways to access those with influence. It is a different game for these young people when they know their representative by name. But it is also a different game for these senators. When they come to visit and meet with the youth promotores they themselves regain hope in these communities.
This has been an unexpected development. We never expected that the professional community and the political community would be so thirsty for hope. We now have civil servants who volunteer as they say it re-energises them. They say, ‘I need to go there. I need those meetings. I need to walk the streets with you’. So now, after a few years of invitations and inclusion we have civil servants who once would never have walked these streets, accompanying our promotores in their work.
Much of this work is about re-creating hope. We have come to learn more about the purposes, hopes and dreams of business people, bureaucrats and politicians. Playing a part in projects to rebuild healthy communities can be very significant to them as well. You actually see the sense of hopefulness begin to come into their eyes. In turn, they can open doors that we on our own could never open.
Locating problems in their broader social context
Sometimes we Latinos end up repeating what the system says about us and so, before we enter the communities, we need to think carefully about how we understand our lives and the lives of other Latinos in this country. We need to understand the problems people face within their broader social context rather than being invited into deficit understandings.
For example, it is important for us to talk about the welfare system in the US. This system provides some financial help for people below the poverty line. Many people in the neighbourhoods in which we work qualify for this assistance because of their income levels. This concept of welfare is new to many Latinos. There is no such thing as welfare in many of the countries of Latin America. The unfamiliarity of such a system, and the views in the media which depict those on welfare in negative ways, come to affect people’s views. People receiving welfare come to be seen as lazy. And this assumed laziness is used to explain why they are on welfare. Somehow, with a few deft leaps of logic, the people’s poverty is blamed on their laziness.
In this country there has also been a vigorous debate about welfare in the political arena which has included conversations about the ways in which welfare can perpetuate dependency. These discussions have also made negative claims about the people who access welfare and have influenced views within Latino communities. There is a common phrase to describe those who are on welfare. They are seen as ‘welfareros’ – addicts to welfare.
It is crucial that we talk with our staff about these understandings. We need to talk about why people use welfare and why people in the past were sometimes encouraged to stay on welfare by the system itself. People use welfare because they are in crisis. They are poor and need to eat, pay the bills and support their families. We explain that in developed countries there is a system for people when they are in those emergencies. There is a governmental responsibility to assist people in crisis and this is what welfare is designed to do. We also talk about the ways in which in the past the welfare system was sometimes entrapping. In some ways the poverty traps that were once associated with welfare meant that it made good sense for people to continue on welfare as it was the only way they could maintain health insurance. There was no benefit to try to obtain work. Recently, there have been many changes to the welfare system. These have resulted in many people no longer receiving welfare and they may also have removed the dependency traps which once featured so strongly in the system. Whatever the implications of these changes however, the legacies of stigma directed towards those receiving welfare support remain.
We need to analyse these things together because otherwise our workers will go out and say the same things about the community that the dominant culture says about Latinos. What we believe informs our practice. Deficit understandings of our communities and our lives surround us. They are fed to us minute by minute. When we believe them, our work quickly becomes frustrating. When we question them and when we understand the context of the lives of the people with whom we are working we are able to think in new ways. We become more open and compassionate. Possibilities become more apparent, and the knowledges, skills and assets of those we are working with become more visible. At the same time, our role becomes much more enjoyable.
Working with, not against, cultural values
In all aspects of our work we seek to utilise and build upon cultural values and histories rather than working against them. For example, there is an attitude frequently demonstrated by Latinas: first comes the family, second comes the family and after that comes the family. Therefore in our program, family is a key concept. We don’t tell Latinas that they should think of themselves first. Instead, we tell them it’s absolutely the best thing to love their families, but the greatest proof of that love is to take care of themselves. That way, they can take better care of their loved ones.
Developing an integrated response
In order to engage the entire community we have had to develop an integrated response – we have women working with women, men working with men, young people working with young people. We initially began working with women, then with men, then with young people. When we came to train young people in becoming guardians of their own health and that of their community we initially asked teenagers to join with us. Then we discovered we had a protest on our hands. The seven to twelve year olds in the building wanted to be involved too! ‘We can be guardians of our own health too!’ they were saying, and so we quickly arranged a program for them as well. Once we have the members of the community trained and working, the issues that they talk about with their respective audiences are very diverse.
Valuing evaluation and accountability
As community workers we believe we have a responsibility to clearly demonstrate the value of our programs. We need to be accountable in this way and be able to articulate the outcomes of our work. If we believe in community participation then we must be able to clearly demonstrate how we have gone about this. The wages for our promotores are generally funded by people outside of the agency. We must be accountable to them and explain why it is we work in the ways that we do, and the value of these ways of working. We chose to begin our program with the issues of diabetes management because we knew we could demonstrate this, measure it, document it. We could clearly show how our community intervention had real outcomes. We believe we have to be able to say how and why something is working. We may not be able to predict at the beginning where we will end up, but we can demonstrate clearly the journey we have been on, who has come with us, and the real effects of this journey. Evaluation is about value – what is it that gives value to this exercise? What aspects of it have value to you? Why? We have a responsibility to be able to answer these questions. This responsibility informs all our work.
Refusing invitation to division
Many times, from a great diversity of people we will receive invitations to division. Sometimes these may be from health professions who do not believe that businesses should be involved in such a program. Sometimes it may be from certain members of the community who offer solidarity if we join against another section of the community. We have learnt time and again that if we accept any invitations to division we may unite a group of people that think similarly on a particular topic but overtime this group will inevitably end up marginalised and isolated. We try to face this issue directly. Our promotores hear comments all the time that they must address, ‘I am so glad that you are Mexican because there are so many Salvadoreans,’ or ‘ I am so glad you are Salvadoran because there are so many Mexicans’. The first place that we start is with ourselves. We talk a lot with each other about our own cultural assumptions and how they may inadvertently influence our work. We talk about how to recognise invitations to division and how to refuse them.
Acknowledging the hazards
There are ongoing hazards in community work of this kind and we feel it is important to acknowledge these and consistently evaluate how we are doing at avoiding them. One of these hazards involves the tendency to think that we as workers are somehow in possession of all the knowledge and truth about issues of health that we need to give to the people we are working with. When acted on, this tendency can make one’s job very monotonous. It can also mean that workers cease to look for ways of enabling others to play their part in the transformation of their communities.
Another hazard involves the temptation to focus only on delivering services while forgetting about the broader question of how to empower the community. The opposite can also be true. It is possible to focus exclusively on programs related to empowerment while forgetting that in some circumstances people have urgent health issues that need to be addressed prior to their involvement in any program. How to manage the balance is a continual dilemma.
One of the other main hazards we face in this sort of work is to lose our vision. It is very easy to become overwhelmed with current issues and crises and to lose focus on the bigger picture, of where we wish to be in five years time. It doesn’t matter if we are from the left or right of the political world these hazards will be present in our work. Acknowledging them seems to be the first step in not replicating them.
There are a range of principles which inform our work as an institute of community participation. By refusing to generalise, and by allowing people to define themselves, we try to be realistic about the idea of achieving unity amongst any population. Instead of seeking unity, we focus our energy on ways of creating and working with common-ground. We explore the hopes and aspirations of community members and all that they have to offer. We find that these explorations are ways of creating territories of common-ground. We see it as our responsibility as workers to notice and acknowledge the skills and knowledges of those we are working with, and to provide contexts for these assets and resources to be put to use so that all community members can make contributions to the health and well-being of the community. This involves moving away from notions of charity towards partnerships based on fair exchange. In all our work we look towards a broad definition of community, one which is inclusive of residents, businesses and all people who share concerns and hopes for the neighbourhoods in which we work. We resist deficit understandings by always seeking to locate problems in their broader social context. And we resist the invitations to division that we all too commonly receive. These are just some of the principles by which we work. They are continually emerging and are always being adapted and refined. We are consistently trying to develop further principles which will assist us to avoid the ongoing hazards associated with the complexities of community work and participation.
Copyright © 2000 by Dulwich Centre Publications