While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Position: Director, Division of Health and Human Services, Campesinos Sin Fronteras
Emma has impacted her community by pouring herself into something that will last her lifetime—decent health care for the working poor. In doing so, Emma has inspired me and many others to sacrificial giving. Her quest for justice and wholeness for the working poor family goes on. She has changed the face of social service locally.—Community Advocate at the Arizona Department of Economic Security
I am a fighter. I am not a quitter. I'm a fighter and I have not given in to the circumstances that have found me. Whatever I learn from those experiences, I pass on to the people around me, so they don't have to go through what I went through in order to learn that they have the abilities to solve problems. What I tell our own volunteers is about giving, about personal sacrifice, and believing it is so worth it to do what you do. I think that establishing that as true leadership is one of the things that is most important.—Emma Torres
Emma Torres was only 11 years old when her parents took her out of school and emigrated from Mexico to the United States in 1969. At the age of 13 she quit school to help her family. She worked in the fields of California, along with her parents, aunts, uncles, and cousins—just one among the thousands of migrant workers, many under-age, who harvest the foods that grace Americans' tables. Life is hard for such workers—their housing is often sub-standard, their working conditions frequently unhealthy and unsafe. Moreover, their access to health care and other services is limited by an array of barriers.
Young Emma knew nothing about this as she bent in the fields picking strawberries in the hot sun. Then one day, Cesar Chavez and his farmworkers' union organizers came to California's Salinas Valley and to the fields where she and her family were working. "Everybody was talking about this strike ... about better salary for farmworkers, better conditions," she later recalled. "When we saw all the red flags and hundreds of people walking in the middle of the road ... we didn't even think twice. They didn't have to come and convince us. We were ready. We picked up our things and walked with them."
At age 15, Emma's social consciousness had been awakened. "You know fire when it starts?" she says. "It just goes strong, fast. Nothing can stop it." She and her family became strong supporters of the movement, helping to feed the crowds of workers who flocked to Chavez' banner. The movement's tactics were nonviolent—union organizing, demonstrations, boycotts. But the growers—those who owned the farms—and their hired "guards" were not playing by the same nonviolent rules. One day in an ambush in San Lucas, CA, Emma and her family, along with co-workers on strike, were beaten with sticks while police stood by. By the age of 16, Emma Torres had been targeted as one of the movement's leaders—and thrown in jail. But by then the farmworkers' union had gained considerable momentum, having won an historic battle with a segment of California's growers. Called the United Farm Workers (UFW), the union had, by 1972, effectively organized most of the nation's grape industry, claiming 50,000 members, and had forced grape growers to accept union contracts for the first time. While the life of the farmworkers remained harsh, gains for grape pickers included a union-run hiring hall, which meant an end to discrimination and favoritism by labor contractors. It also meant somewhat higher wages, a health clinic and health plan, credit union, and other benefits. Over time, improvements for farmworkers in general followed, though because of the entrenched disparity of power between growers and workers, farmworkers' overall plight has continued to be difficult.
In 1977, at age 19, Ms. Torres married a fellow farmworker, with whom she dreamed of starting a family. By the age of 23, she had one child, and another on the way. That year, however, her young husband was diagnosed with leukemia. He died at the age of 26, leaving her devastated, with two young children and dim prospects for her future. Throughout her husband's illness, Ms. Torres had had to travel long distances to and from the hospital where he was being treated. With almost no command of English, she found it difficult communicating his needs and her own to health care professionals and service providers. The social service providers did not treat them well. "We had always worked," she remembers. "We had never depended on any service or anything. It was very difficult for me to ask for their services. Besides having my own pain, being mistreated like that was so painful—like we were stealing from them." Through her despair, the rebel inside flared again. She became determined to do something—take some action—to change these conditions, so that others would not have to endure what she was experiencing.
To provide for her children, she knew that education would be an important key. She enlisted her mother to help with childcare, and in 1979, enrolled in a trade school, taking ESL (English as a Second Language) classes and achieving a General Education Diploma. In 1983, her mother moved in with her and they went back to Mexico, living just across the US/Mexico border, near Yuma, Ariz. From there she commuted the many miles to Western College in Yuma, in order to work toward a health and human services degree. One day, when a school secretary mentioned an opening for a receptionist position at a Woman, Infant, and Child (WIC) Center in Yuma, Ariz., Ms. Torres went into action. In order to improve her typing skills to make herself eligible for the job, she began rising before dawn to arrive at school in time to practice.
This was a difficult period, a time of self-doubt and near despair. Ms. Torres faced criticism from neighbors and family members who felt she was selfish, leaving her mother to raise her children. Her self-esteem was at an all time low. She recalled, "They said, 'you're a widow, you should be weeping at home, crying your heart out, and letting everybody else feel sorry for you and take care of you.' But anger gives me strength to do things. I told my mother, 'Do you think they will feed me if I stay home? I have something in mind I want to do, and I don't care about anything else!'" She got the job at WIC.
In 1988, while still at WIC, the University of Arizona's Department of Family and Community Medicine selected her to work for a year as a consultant on a pilot perinatal project called Health Start/Comienzo Sano. Her assignment was to recruit people from the community to serve as lay health workers. Like her, they had to be representative of their community economically, socially, educationally, linguistically, etc. The idea was that these workers, once trained, would fill gaps in the health care system by tending to the health needs of migrant farmworker women.
In 1989, after six years at the WIC center, Ms. Torres left her job to become a migrant liaison for a local community health center, The Valley Health Center Clinic in Somerton, Ariz. There she developed the Western Migrant Network Tracking System, coordinating and assisting with medical services for migrant farmworker women as they migrated in and out of state. The program, like most of her creations before and since, operated on a shoestring budget. Ms. Torres often wound up driving clients long distances to medical appointments. She also translated educational materials, coordinated outreach activities, and conducted bilingual nutrition education classes—all in addition to her regular duties at the center (such as blood screenings and nutrition assessments).
In 1991, Ms. Torres was recruited to open new community lay health worker programs in western Arizona, using the same principles as Health Start/Comienzo Sano. Under her leadership, lay workers in these programs addressed new issues, such as substance abuse, pesticide awareness, and other health education activities. The new outreach concept of lay health workers, promotoras, provoked resistance in the medical community. Ms. Torres had to convince many doctors that well-trained lay health care workers were not a threat to public health, but an asset. Her efforts succeeded, and the programs took root. Today, promotoras is considered a model for community lay health worker programs around the nation. At the same time, Ms. Torres was also becoming an advocate for those she served. In 1994, US Secretary of Health and Human Services Donna Shalala appointed her to the National Council on Migrant Health.
By this time, Ms. Torres had remarried, had one more child, and—since 1983—had been taking college courses. "If I could, I'd be in school right now full-time," she said later, "I would be getting my master's or my Ph.D. Once I was able to see that I could learn—that was one of the most amazing things for me. And every program I have taken on has been something that I had not done before, but I have taken the risk to learn."
Her next venture was another pilot project—a mobile unit bringing health care to pregnant women living in rural and isolated communities. Inaugurated in 1994, the MOMOBIL quickly became a successful model project, and Emma Torres began to loom large in Arizona/Mexico border area health care circles. "She literally sparkled in a room of community health providers," said the director of Arizona's Department of Health, Office of Border Health, who, upon meeting her, immediately offered her a job as programs and projects specialist.
In 1997, Ms. Torres became project manager of Puentes de Amistad (Bridges of Friendship), a substance abuse prevention partnership in Yuma, Ariz., where she still works. There, she took on responsibility of developing staff, finding volunteers, creating coalitions, and conducting community outreach. Through this job, she coordinated programs on both side of the border with Mexico, serving workers who frequently crossed back and forth. Currently, she spends a great deal of her time writing grant proposals—a signal achievement considering she had been essentially English illiterate up to the age of 23.
In recognition of her many accomplishments, her devotion and self-sacrifice, her ability to motivate and inspire others, her strength and creativity in promoting health care for the disadvantaged, Emma Torres was nominated for the Robert Wood Johnson Community Health Leadership Award, which she received in 1999. The $100,000 award to further her vision has loomed large for Ms. Torres. Puentes de Amistad's budget that year was in the $200,000 range, with several of her ongoing projects in need of additional financial support.
Through the Community Health Leadership Program (CHLP), Ms. Torres was introduced to her state legislators, and had the opportunity to advocate with them for farmworkers' needs. "I am not really out there in the political arena," she admits, "But I am not ignorant of the importance of politics. I do know a lot of people, and I have learned a lot of things. You don't have to know everything or do everything to be able to get what you need. But I do have friends who are politicians whom I go to when I need help."
CHLP also afforded Ms. Torres the chance to get to know other award-winning community health leaders, through the award reception and annual retreats. "It's like they're part of a great big family I belong to," she says. "Whenever I think, 'This is too much, this is too hard, I don't want to do this anymore,' I remember them, and the struggles they have been through. And if I gave them a call, I know they would immediately try to help me."
The Community Health Leadership Award has given Ms. Torres instant credibility. She reports that she is now perceived as an authority on migrant worker health issues, and widely sought after for her leadership. She serves on the boards of several organizations dealing with issues such as migrant health, tobacco use, HIV, perinatal health, and cultural competence. In 2001, she received the US/MEX Border Health Association, Health Care Worker of the Year Award, locally recognized as Orgullo Hispano (Hispanic Pride). Presently, Ms. Torres works for Campesinas Sin Fronteras (Farmworkers without Borders) as the director of the Division of Health and Human Services, where she continues taking the lead in providing health education and advocating for better access to care.
Regarding leadership, she says, "It's about giving, not receiving. Not everyone can do that, and that's okay—because you have to want to do what you're doing, and love what you're doing." Her vision for the future includes further development of her administration and proposal writing skills, more advocacy work, and continued attention to the needs of those she serves—America's migrant farmworkers.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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