Huynh quizzed students on women's health topics and passed out prizes, including the popular key chains. Later, silence gripped the classroom when she recalled a local woman who waited too long for cancer treatment, leaving her children behind. Huynh spoke to students in the native language they shared, Vietnamese.
A community health educator for an Asian advocacy organization, Huynh embodies a nationwide trend of deploying specially trained lay people from ethnic enclaves to teach neighbors about health, connect them to available medical services and in some cases support them through the process.
For decades the approach has been growing in developing countries where it is used to address doctor shortages. In the United States the practice has taken off in the past 10 or so years in response to greater patient diversity and awareness of health disparities.
Also known as health promoters, peer educators such as Huynh are proving particularly effective at helping newcomers overcome such barriers as lack of insurance, confusion about the U.S. health care system, insufficient information on potentially life-saving cancer screenings and even cultural taboos that make it difficult for some women to acknowledge and seek medical help.
"The nice thing about community health workers is they are part of the community so they really understand the needs of the community better than people from the outside," said Theresa Byrd, a professor at the Paul L. Foster School of Medicine at Texas Tech University in El Paso. Byrd recently began combing the data from a health promotion effort she designed to improve the rate of pap smears among Latinas in the community.
While she's still tabulating the numbers, "Many more people got pap smears among the group contacted by health promoters than in the control groups." Her effort involved promoters tracking down women who had not gotten pap smears and then giving in-home presentations in Spanish on the importance of the procedure.
Beyond the Waiting Room
A key tenet of health promotion is to go where the community is rather than waiting for patients to show up in a doctor's office, which is why Vietnamese outreach efforts in Orange County sometimes take place in beauty schools, the gateway to the region's largely Vietnamese nail salons.
Only a few miles away from the Garden Grove beauty school is the mostly Mexican-American city of Santa Ana, Calif. There, Spanish-speaking health promoters from Latino Health Access, a community health organization, often approach women in a popular Mexican grocery store and go door-to-door, giving information on breast cancer and setting up mammogram appointments. Latino Health Access also focuses on diabetes management, mental health and obesity.
With an army of promoters teaching classes and knocking on doors regularly, "We make more than 40,000 contacts each year," said America Bracho, president and CEO of Latino Health Access.
Her organization also uses promoters to cope with domestic abuse. Since it's not feasible to go door-to-door in these cases, promoters have to get creative, in some cases staging tortilla giveaways with attached messages reminding women that tortillas -- not abuse -- are part of Hispanic culture.
Promoters are equally mindful of cultural mores at the Asian-American Health Initiative in Montgomery County, Md. In a Vietnamese Catholic church, for example, they used drawings rather than graphic photos of breasts for a cancer presentation, upon request. In speaking at mosques, promoters know to offer highly discreet settings in which to let women in the audience examine a model breast for lumps, according to Sanjana Quasem, program coordinator at the initiative.
Spotting War Trauma
Promoters in Chelsea, Mass., have worked in communities that hail from Somali, Congo and Eastern Europe, said Sarah Abernathy Oo, who leads the Massachusetts General Hospital's Chelsea HealthCare Center. As a result, promoters at the center regularly respond to problems arising from conflict and immigration, such as war trauma among Bosnian and Iraqi refugees or a Central American woman raped during border crossing.
Like many who supervise and train promoter, Oo recruits health workers from within the communities they serve and provides ongoing training in health and medicine in order to ensure accurate, up-to-date information.
But there's always a debate about whether promoters should receive more formal education and gain certification, or whether that process distances a promoter from her own community, said Steven Wallace, a professor at UCLA's School of Public Health.
Staying closer to the community makes it possible to make more convincing argument about the need for preventive treatments, he said.
"For example, research shows that in Latino communities, there is less interest in how a health procedure is going to benefit the individual and more interest in how it's going to benefit families. So instead of saying, 'You're more likely to live a long life,' the message has to be more like, 'Think about what would happen to your children if you got breast cancer and died,'" he said. "It's figuring out those messages. That's why people need those programs."