It's a busy morning at the mobile health clinic at Piney Point Elementary School in Houston. Mothers, mostly undocumented immigrants, crowd around a long table filling out forms and waiting anxiously for their children to be checked by the doctor.
Ana Henriquez is one of them. She's never used the clinic, but her 3-year-old hasn't been his bubbly self lately and she's worried. Turns out, he's fine - and emerges with a smile and a strawberry lollipop.
Going to the doctor can be daunting for many new immigrants. Some don't know how to navigate the system; others struggle with the language barrier. But Ms. Henriquez says the whole experience has been easy, in part because she's been guided throughout by a fellow Salvadoran.
His name is Manuel Platero, and he's part of a growing effort in community health. On any given day, he might help a family get insurance, teach a mother the importance of breast feeding, or take troubled teens to a church youth group.
The idea behind the promotora (or promoter) program is to train a group of immigrants about a variety of health issues and then send them back into their communities to share that knowledge. That might happen at a grocery store, an apartment complex, or a child's school.
The practice has long been part of indigenous life worldwide. But it was first tried formally after World War II, when communist China used lay health workers, or "barefoot doctors," to reach rural populations cut off from hospitals. The idea spread to Latin America, where respected women in many hamlets were taught basic health principles and how to give injections and administer medications.
While forms of the promotora idea have been used in the US since the '60s, it's now being tried on a larger scale. Texas became the first state to authorize promotora certification three years ago, and Houston is on the forefront of the movement.
The urgency of such programs is clear, say public health officials. Immigrant populations have exploded in the past decade: The foreign-born now make up 11 percent of the US population (or 31 million people), up from 8 percent (20 million people) in 1990. More than half of those new immigrants are from Latin America.
"The implications [of this influx] for healthcare are tremendous. Demand on the system is going to continue to grow," says Steven Wallace of UCLA's Center for Health Policy Research. "There needs to be a continual search for solutions that go beyond drugs and expensive clinics. Promotoras are one such solution."
Further, says Dr. Wallace, US health officials are increasingly aware of nonmedical influences on health, like exercise and nutrition. "We can prevent a lot of health problems by arming people with knowledge and changing [their] environment."
But these efforts, which often help illegal immigrants, ignore the real problem, some say. "There is a high cost to cheap labor," says Steve Camarota of the Center for Immigration Studies, a conservative think tank. "You cannot bring unskilled immigrants into this country and not sock the taxpayer with a big bill."
For instance, he says, most illegal immigrants lack health insurance - leaving taxpayers to pay the medical bills. Last year, $35 billion was spent on the uninsured, $30 billion of that from taxpayers.
"The upside of programs like these is that if illegal aliens come forward before the [health] problem gets serious, you avoid some of that cost," he says. "But the downside is that the more people who access healthcare, the more burden it creates."
The idea to bring promotoras to Houston came from pediatrician Peggy Goetz's trip to El Salvador six years ago. There, she noticed that hamlets with promotoras had much higher rates of immunization and lower birthrates than those without.
While US promotoras wouldn't be able to give injections or distribute medication, she thought the concept could work here: "They were making a significant impact for a fraction of the cost, simply by using the talents of people in the community."
So she started ProSalud, modeled on the Salvadoran program. The seven promotoras, most of whom are women earning $8 an hour, face questions ranging from diabetes to domestic violence. Some live in low-income neighborhoods and foster an image of "the Doña Maria," whom anyone can feel comfortable approaching.
They strike up conversations at laundromats, talk at police stations, and help at mobile health clinics, like the one at Piney Point Elementary run by Texas Children's Hospital (TCH). And they're invaluable, says TCH nurse James Warden, finishing a child's checkup and stepping out of the converted mobile home for fresh air. "I don't know how we did it without them."
More important, they relate to the patients in a way he and his US-born colleagues often can't. "I'm as white as they come. And when I start speaking Spanish, I get this deer-in-the-headlights look," he says. "A lot of parents are more apt to open up if they see one of their own here."
Indeed, while Henriquez is comfortable at the mobile clinic, she smiles broadly when she finds out Platero's family is from the same mountain hamlet she migrated from two years ago. "She knows my dad's side of the family," says Platero, then begins to explain the intricacies of applying for low-cost health insurance.
Henriquez nods and heads home with her son, the insurance application in her hand and Platero's cellphone number in her pocket.