Joy Rivera’s most important take-away from her training as a Community Health Worker (CHW) came from a fellow student who had botched a role-playing exercise in class. After thinking it over, the student said, “I should have just asked, ‘How can I help you?’ and then listened.” For Rivera, that insight was key. “We can approach the person with all these assumptions, trying to put Band-Aids all over. Really, we just need to listen.”

Rivera trained as a CHW at Metropolitan Community and Technical College (MCTC) and is now Colon Cancer Screening Navigator for the American Indian Cancer Foundation. Becoming a CHW was a natural career move for Rivera, a member of the Snipe Clan of the Seneka Nation Haudenosaunee People who has always worked in the Native American community. Like all CHWs, she comes from the community she serves, which enables her to create stronger and more trusting relationships.

“The system is set up to meet mainstream needs,” Rivera said. “You’re all going to be treated the same. But we’re not all the same. This is where health disparities come in. I’ll do what I need to do to get people back in the system. Their voice will be heard.”

In her particular role, Rivera helps remove the barriers that keep Native American people from getting a colon cancer screening. Those barriers can range from distrust of Western medicine to lack of transportation or a working telephone. Elderly people and diabetics need to understand how the fast before the test will impact their medications and blood sugar levels. Homeless people need a place to stay during the 24-hour preparation period. People may also need help understanding the results of the test. Matching available testing facilities to someone’s insurance can also create hurdles.

While CHWs can have a range of titles, their scope of practice always involves bridging the gap between individuals and communities and the health and social service systems. In some cases they provide direct services, from wellness education to support groups to assistance in managing chronic health issues.

“There were two Spanish-speaking CHWs in my class, and they said, ‘Everything you do, throw in a language barrier,’” Rivera recalled. CHWs can also help bridge cultural differences, Rivera said. “In their culture you go straight to the hospital when you’re sick. That’s not cost-effective, so the CHWs were helping to educate them about clinic appointments.”

The program, now in its third year, resulted in 54 screenings in the first year and 102 in the second year. When someone completes a screening, Rivera tells them, “You just saved your own life.”

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What skills does a CHW need?

You have to have compassion for people. You need problem-solving skills. You tell people, “I’m going to make this easier for you. I’ve got the keys.” There’s a lot of documentation. You have to keep up to date — for example, the rules for colon screening prep have just changed. You need social skills to get good service from clinics and providers.

Is the demand for CHWs going to increase?

I see it growing. The CHW program bridges the gap between the system and the community. This bridge saves money and it saves lives.

What do you like best about being a CHW?

I like the challenge. It’s the challenge that makes me get up in the morning. I just can’t leave it alone. □