Houston Chronicle


Health care and education program brings hope to ‘colonia’

BROWNSVILLE – Up until last November, Letty Banda didn’t know how t o use a thermometer. She wasn’t alone. Most of her neighbors in the Cameron Park colonia hadn’t read a thermometer, either – much less owned one – and many didn’t know which end to stick in their mouths.

Without insurance and unable to pay expensive medical bills, Banda and her neighbors had rarely been examined by American doctors.

When they or their families were sick, the women went across the border to see doctors in Matamoros, Mexico.

Some sought advice from local healers and parteras (lay midwives). In emergencies, some sought help in hospital emergency rooms.

All of this is fine, if the people have choice, said Martha Warburton, administrative director of Co-Prima, an experimental primary health care program which set up shop in Cameron Park in November.

For most of the people Co-Prima treats, however, nothing has been available – nothing in terms of basic services.
Because most of the families earn a little money and their own plots of land, they have not traditionally qualified for Medicaid. Because they speak little English and are poorly educated, they weren’t aware of the programs that might have helped them.

Many families at the colonia live in substandard houses that don’t have running water or electricity. None of the families lives where there is proper drainage, pavement, sewage treatment or garbage disposal.

Not knowing how to use a thermometer – hardly considered modern technology – may be shocking, but it is symbolic of the ignorance linked with poverty.

Co-Prima’s founders, pediatrician Carmen Rocco of Brownsville and Dr. Jordan Finkelstein, who heads adolescent medicine at the University of Texas at Galveston, wanted to improve access to good medical care for Letty Banda and her neighbors. They wanted poor people to be treated by the same physicians wealthy Americans are able to use.
They also wanted to do battle with ignorance. Rocco and Finkelstein designed an innovative health education program for Co-Prima to give colonia residents a chance to beat the ignorance and break out of the poverty cycle.

It’s very easy to stay in that cycle, said Dr. Carlos Quevedo, Co-Prima’s health educator. It’s natural to do what you automatically do every day.

“We’re talking about habits,” he said, and some continue, even those that are making them sick.

Spawned by the Texas Legislature’s indigent health care bill in 1986, Co-Prima emphasizes prevention, early treatment and – above all – education.

The legislature funded 26 demonstration models in an attempt to provide cost-effective health care to the poor. Co-Prima, one of the models, gives primary health care (not hospitalization or visits to specialists) to 1,000 people, 870 of whom live in Cameron Park. The remainder live in a colonia called Olmito.

The program matches public sector funds with private sector medical care. Physicians receive $100 a year for each patient they treat, and they must see each patient at least three times a year in their offices. The program also allocates money for lab work and prescription drugs.

Although much of Co-Prima’s $500,000 funding goes toward actual medical care, a significant portion is dedicated solely to education.

Quevedo works full-time with four colonia women who act as liaisons between Co-Prima’s staff, doctors and participants. One of those liaisons is Banda.

She remembers when the social workers came to the colonia last fall and started screening people for Co-Prima. Her family was eligible, so she signed them up. One of the social workers, Tonie Gomez, persuaded Banda to become a health-care liaison.

Married, 29, with two sons, Banda was reluctant to become a part of Co-Prima. She had a sixth-grade education and a cosmetologist’s license. Her work experience included a brief stint cutting hair and five months in the Haggar factory when her husband, a painter, couldn’t get work.

When Gomez called her the day of the first meeting, Banda just wasn’t sure about leaving the house.

“I told her, ‘Well, I’m not sure. Maybe I’ll be there,’” she recalled. “But, at the last moment, I grabbed my kid and ran over.”

Banda has since become chairwoman of Co-Prima’s lay board of directors.

She knows her neighbors by name and says they stop her in the road to thank her for her help.

Banda describes the colonia as a very isolating, lonely place for women who stay at home.

Now that Co-Prima has come along, however, things have gotten better.

Not all the benefits of the program have been health-related – not directly.

For instance, there aren’t any parks or playgrounds at Cameron Park, and children have been left to play in overgrown, snake-ridden lots and in roads and ditches.

Co-Prima workers couldn’t qualify this as a direct health problem, but they knew that children were getting hurt and in trouble.

Responding to mothers’ complaints that their children were playing in unsafe areas, Quevedo had a large lot mowed and turned it into a track.

He has convinced a group of boys to work at two local car washes where they can earn enough money to buy sports uniforms, and he gets the boys out to the field to play ball.

Quevedo also encouraged women who have never exercised to walk around the lot every night.

Now, even in the heat of the summer, young, middle-aged and old women gather at 7 p.m. to walk their laps.

“We’re a community now,” Banda said, obviously pleased with her work. “People are happier here. We had nothing before. Now we have something.”

She and her co-workers, Patty Vital, Elsa Garza and Gloria Moreno, hold monthly health-education classes in their homes.

Quevedo drills them on the circulatory system, parts of the body and other basics to prepare them for classes with specialists from Galveston who teach them about diseases such as breast cancer and heart disease.

The liaisons also host outside teachers at home several times a month and gather neighbors for sessions on breast feeding, infant nutrition, food groups and accident prevention.

The liaisons have worked diligently to provide an atmosphere where women can ask their questions without worrying about being misunderstood or having to pronounce things correctly.

They can ask if the bump on their son’s head might be cancer. They can ask if sucking on ice can cause pneumonia.

“Now I have lots of questions,” said Maria Christina Rodriguez, who has lived at Cameron Park 10 years.

Rodriguez took her sons to Matamoros before Co-Prima came along.

“Before, I was too shy and embarrassed to ask any questions. Now, I get more explained.”
Sometimes, the sessions aren’t very successful.

Often it’s hard to get people to come to the classes, although they are asked to attend once a month in return for the care they receive.

And sometimes, education itself just isn’t enough. “You can teach them boil their water before they drink it, but if they don’t have electricity…,” said Paula Gomez, director of the Brownsville Community Health Clinic.

Martha Warburton expressed a similar concern. “Hiring a nutritionist to teach is pointless if there’s no food,” she said. “Poverty stretches across the board.”

So far, it’s early to tell whether Co-Prima has been a success. But Rocco, Finkelstein, Quevedo and Warburton are extremely pleased with what has happened. “Our population’s use of the emergency room has been minimal,” Finkelstein said.

Participating physicians grumble about the endless paperwork Co-Prima requires them to complete, and they say they spend too much of their time filling out forms when they could be seeing patients.

“We’re filling in forms for ever visit. That’s where we could save money,” pediatrician Adele Bromiley said.
Warburton insists that without that paperwork, the program will not be able to verify what it says it has done.
To be refunded, Co-Prima will have to prove it has provided health care to a segment of the population previously not reached by existing programs. It will have to show that it has provided cost-efficient care and that patients are in better health now than they were before the program began operating. Participant surveys and doctors’ records will be the best proof.

Doctors also have complained that $100 plus $50 for lab work just doesn’t cover costs. Bromiley said that “one didn’t go into this as a money-making proposition,” while Dr. Francis Gumbel, who sees between 30 and 40 Co-Prima participants, contended that he just couldn’t meet his costs at Co-Prima’s rates.

Gumbel said he strongly supports Co-Prima, but because his practice is largely made up of low-income patients, he can’t afford to lose money on that many patients. “If they make the reimbursement any less, I won’t be able to afford it,” he said.

Doctors complain that there aren’t specialists for referral and that they can’t hospitalize patients in Brownsville because the program doesn’t provide money for this.

Administrators have tried to compensate by sending patients to Galveston or getting them reduced-rate appointments to see specialists in town.

The biggest complaint from doctors, administrators and patients is that Co-Prima’s funding is in limbo.

The program must be approved by the Lower Rio Grande Valley Development council.

Co-Prima has passed through two special committees “with unanimous favorable comments” and must now win the approval of the council itself. “It looks very good,” Warburton said.

Without refunding, Co-Prima wouldn’t continue to provide health care, and participants once again would be left high and dry.

“I don’t know if we’ll afford going to a doctor here,” said Banda, concerned that the medical care and progress they’ve made will evaporate.

“But I know if we have work, we’ll try.”