Who Are Community Health Workers?

For much of the past year, Saving Mothers worked with community health workers (CHWs) from the Northern Manhattan Perinatal Partnership. Amital Isaac conducted an interview with Asia Toure, one of the CHWs we worked closely with as part of our NYC mPOWHER Program. Read on to learn more about who community health workers are, what their role is, and how they are crucial for improving maternal and reproductive health.

Amital: Tell us who you are, what you do, and how NMPP and Saving Mothers are connected?  

Asia:  So I’m a Community Health worker. We primarily work in Northern Manhattan, but with everything going on with covid we’ve expanded a little bit.  We’re a home visiting service originally but with everything happening we’re not doing that anymore right now. We meet with the moms when they first learn they’re pregnant and we stick with them throughout the entire time that they’re pregnant and even maybe up until the baby is 3 years old.

We help the mom become self-sufficient because sometimes there may be certain barriers that are preventing the mom from moving forward. Whatever those barriers may be, so if mom needs to finish her education, we’ll give her resources for that. If she needs mental health support, then we help her with that as well. Whatever it is that we can help her with that’s going to help her and make it easier for her to get to where she needs to be for her and her family. 

Amital: What are the barriers that you most commonly see in women what are some of the challenges that pregnant women and new moms face in Northern Manhattan?

Asia: Gosh, there are so many… I would definitely say that the biggest thing would be having a strong support system. And that translates to everything from where they’re living or who they’re living with. Even access to healthcare and prenatal care. Sometimes certain clinics just don’t handle their patients well because they may be overrun themselves. Not everyone is as outspoken as they can be about their prenatal health care or even just about their regular health care. So those obstacles are where they don’t feel comfortable with their prenatal doctors and then they make the choice to not go and skip medical appointments, and that’s dangerous for them and the baby.  But this is a major factor in a lot of communities. 

Amital: I’m curious so what is the best care in your view? What does that include and how different is that from what women are getting in Northern Manhattan right now? 

Asia: The best care in my opinion would be that those women feel heard when they are speaking about any concerns that they have. That they don’t feel that they’re just being brushed off, and even when they go to their doctor’s appointment that they’re not there for hours waiting to be seen. They may have other kids that they have to pick up from school. It’s an uncomfortable experience for them. And That’s not something that people necessarily consider, they just think “Oh, she’s just going to the doctor, that’s it.” 

Amital: How has the partnership with Saving Mothers impacted your operations at NMPP? 

Asia: The partnership has definitely brought to light a lot of necessary medical information, as well as information in regards to a mom and her health, and how we as a society view moms and pregnancy. It was very eye opening. And they are so compassionate. Dr Tara and everyone, they are so compassionate about the moms and how the moms are being treated and how they’re being helped. Because when you’re pregnant everyone thinks all about the baby. And even after you have the baby they’re still only thinking about the baby. They’re not considering the mom a lot of times. So I think that Saving Mothers plays a very very important role in helping us to have a different perspective of pregnancy and being a mom. 

Amital: Wow you just gave me chills. That’s amazing and that’s exactly why I’m volunteering for this organization. Now I want to turn the focus to you: how would you describe your role in just a couple sentences how would you summarize what it is that you do? 

Asia: I would summarize it as being a professional friend. In the sense that you have to keep that boundary of course, but I want my client to be able to talk to me about whatever is going on with them. If they have a concern I want them to be able to come to me. This way if they open up I can help them to the best of my ability. 

Amital : So what do the community health workers who work with NMPP do? 

Asia: It’s a variety of things , they can definitely go to appointments with moms if need be. We can help them complete applications for things, like job applications or housing forms. Any kind of paperwork we help them with as much as we can. It’s mostly just us acting as advocates for them if they are not able to speak for themselves or their children, and we link them to resources in the community if we are not able to directly help them ourselves. 

Amital: Amazing, I didn’t know that your role was so broadly defined, that is really incredible and a huge service to not just to the community but to society. I think more cities and countries should have community health workers like yourself doing this kind of work. 

Asia: Thank you. 

Amital: We’re trying to give people a sense of the experience that pregnant women in the community and vulnerable populations go through. So for majority of women that you work with, what is their experience like? 

Asia: I would say their experience somewhat depends on where they’re from, because if there is a language barrier, or if they are here and they are undocumented then they’re fearful of that as well. Those are really big issues for a lot of the pregnant women. Because they feel that when they go to the doctor, they feel that the doctor will not really understand them and their culture. And it may even be that that doctor speaks to them in a way that shows they don’t understand or they’re not willing to understand their culture and how they do things. And so then women will simply not go to their prenatal appointments because they don’t feel heard. They may also feel outright scared because they don’t want to be found out that they are here and undocumented. So it’s that type of fear that makes them forego care that they really should be getting for themselves and for the baby. 

Housing is another big issue for these women. A lot of clients that I have worked with are either in the shelter with their kids or they’re about to go into one because they’re in a domestic violence situation. But their options in regards to housing are limited because their income is limited, so they don’t have that much to choose from. 

To me, when I speak to them, they’re depressed. Some will even tell me that they are outright depressed, and so they will not do a lot of things but they need to do to get themselves ahead because they have so many other things that are pressing on them and it makes it hard for them to go about their day. So I’ve seen some of that too. 

We have a questionnaire that assesses where they are with depression, and depending on where the mom is at we will forward that information to the therapist that we work with. And also, because sometimes you just have to sit and listen to your client just to see how they’re feeling because a lot of times They may be talking about one thing but you keep hearing something that they’re mentioning and that they may not be realizing. So you have to sometimes just sit and just listen to them so you can get a sense of what’s happening and what’s going on. So we do that and can then figure out from there what we can do. 

Amital: Yeah so like you were saying earlier you your role is is really like a friend because that’s what friends do, they listen, they let their friends talk and vent and then when they realize that that their toolbox is limited and they can only do so much then that’s when a good friend says “I think you should talk to someone.” 

So now I want to switch the focus now to what are the ways that COVID-19 has changed things for you? It’s been incredibly difficult for everyone of course but specifically for you I imagine it’s brought a very specific set of challenges. 

Asia: It definitely has changed things a lot. It’s made the connection that you first develop, you know that first impression that you get and that first connection that you develop when you meet someone- that’s kind of gone because now we’re doing everything remotely. So that is challenging. Because it’s hard to develop a connection over the phone and you’ve never met each other before, and you’re asking personal questions, too, so that makes it even more challenging. I think that now what it does, is from the initial call when we first meet, it takes a little bit longer to build that connection. I wish it didn’t have to be that way but that’s kind of what it is. Now things are going to be a little slower moving to build a rapport with each other. 

Amital: That makes a lot of sense. Do you miss that personal connection, and going to meet them in person? 

Asia: I do. I do miss, you know, the personal connection that I’m able to have with my clients. I also miss when you go to someone’s house, whether it’s their house, or it’s a shelter, or if they’re staying with someone, I miss that part of it as well. Because I get to see how they are living and what’s going on and who else maybe around them. When you’re on the phone, and you have a new client, you don’t know how they’re living and you can’t necessarily ask  about their situation. But it’s a lot easier to bring up certain things that you may have seen when you went to their home and then you can bring it up later. But now you really don’t know what’s going on in their home that we can maybe help with and that they may not want to talk about. 

Amital: You’re absolutely right. When you get to go there in person you get to see and play detective. You can use all of your senses, your gut tells you things and you notice little details, so how have you adapted to that, have you come up with maybe new questions as an organization that you guys have to ask since you can’t go in person anymore?

Asia: We haven’t come up with new questions that we ask but we do focus on letting the clients know certain businesses or certain offices for certain things may be closed but that we still are able to get help. And we also let them know that they just have to reach out to us if they need that type of assistance. And I just had this experience recently with a client but I was fortunate enough that I was able to meet with her before lockdown so I already knew about her situation and I was fearful because while she was pregnant she has another daughter. I was fearful that now that she was going to be there all the time with this person that something is going to escalate, and it did. So I was so happy that she called me, and it was like 5 on a Friday and she told me what happened, and I immediately gave her the number for Safe Horizon, and I keep in constant contact. Even when she’s not in constant contact with me I still try to reach out just to let her know , and she’s one of my clients who actually calls me and is really comfortable sharing things with me. So I was glad I was able to do that. But now that everyone has to be more inside, things become heightened and it’s hard to assess that over the phone when you’re first talking to someone and you’ve never met them or been around them before. 

Amital: Absolutely because you don’t know what their baseline is.  And you can’t see things. The work that you do is so, so, SO important. I’m going to pivot a bit now. Can you tell me a little bit about the zoom trainings that you’ve been doing and how those have been going? 

Asia: Before the lockdown began they had planned to speak to us at the office about preeclampsia and a lot of other pregnancy conditions. They give us information to look over, to get our opinion on how we are receiving information and what do we think about it or what do we think it’s saying to other women. I love those so much. They really put in perspective how you take in information, and what we’ve been taught. You know that information that’s been put out to all of us, whether it’s posters up in the doctor’s office, or on the bus or on the train or something that you may see, that information that’s being put out is being put out for a reason, and it’s intending to convey a message. New Yorkers are so busy and you just go about their day but you don’t really realize how you’re being impacted by so much information, especially health information. You read things and then you just move on. I definitely think the zoom meetings we’ve had were very informative and definitely opened up my eyes to a lot like my perception and how also I am receiving the information. I was very happy to participate. 

Amital: How did you get into this line of work? Did you have a medical background or social work background? Because so many parts of this job are so many different things. 

Asia: So I got into this line of work from my own life experiences, because I was a teenage mother, I had my first daughter at 17. So it came from that experience. So the things that I do I had someone in my life do for me: she came to visit me while I was pregnant and she told me all the basics. Then when I had my daughter she came to look at her, to talk with me, see how she’s growing and how I was feeling. So that really stuck with me for a really long time. It’s always been something that really touched my heart, and I know how scary it is even if you’re 20 or 30 and it’s your first time having a baby you’re still going to be nervous. There’s still things that you’re going to be nervous about. And a lot of times someone doesn’t always have someone to talk to about it and who understands them. I felt that I wanted to be in that space so that I could at least provide that extra support that they may or may not have and hopefully that could help them get to wherever they need to be. 

Amital: What do you think the community workers need the most right now and how is Saving Mothers helping? 

Asia: I think that what community health workers need right now would be access to different organizations because I know some organizations that have completely closed or are open only once or twice a week. For instance if you need to call them they’re closed so you have to email them and then you have to wait a couple days for them to respond. 

I think Saving Mothers is doing a great job of putting out there the picture of what a mom truly goes through when she is pregnant and when she has a baby. And I think saving mothers has done a really wonderful job of making it very plain and clear. Also having other doctors on board too, so that when they are speaking with their patients they’re speaking to them in a more compassionate tone.  

Amital: So you’re saying Saving Mothers is also having an impact on how doctors are speaking to their patients too? 

Asia: Yeah, I definitely think they are, and I think that it’s just a matter of getting the word out there.