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Drawing on inner resources 

On a recent Saturday morning, the back booths of Pancho's restaurant in Siler City are filled with women of many colors--Mexican, Honduran, Guatemalan and Colombian. A celebration for "graduates" of a health training program at the Immigrant Health Initiative housed at Chatham Hospital is under way Some have brought husbands and children along to the festivities. Strollers and baby seats are crammed into the spaces between the tables. As waiters shuttle back and forth with steaming plates of camarones and enchiladas, classmates join hands over the backs of the red seats and say a quick prayer of thanks.

Chatham Hospital's program trains Latinas as volunteer pregnancy aides, or "doulas," who can translate, take women to their prenatal appointments and keep them company in the delivery room where few doctors and nurses speak Spanish. In the two years since it was created by the Immigrant Health Initiative housed at the hospital, more than 40 women have been trained as comadres to help their friends and neighbors through pregnancy and birth.

Maria Plata took her daughter-in-law's place in the doula program after the younger woman moved back to Mexico last year. Plata has had five children--six of them in Mexico--and her silvery hair adds to her aura as a friendly matriarch.

Does it make a difference when women from the community are involved in births?

"Sí, claro," she says. "It gives the mothers more confidence."

Latino leaders and health-care experts agree that given the lack of trust many Spanish-speaking immigrants place in the existing health-care system, community-based programs may be the best way to make an immediate difference in the lives of pregnant Latinas. In addition to the doula program in Siler City, El Centro Hispano in Durham has recently begun training Latinas as lay health advisers to get the word out about the benefits of taking folic acid during pregnancy.

Support for these programs has come from foundations and nonprofits. El Centro's program was funded through a grant from the state March of Dimes. A Duke Endowment grant paid for the program at Chatham Hospital. (That grant, which was extended for an extra year, runs out in June.) Participants are referred by churches and community organizations with roots in the Latino community.

In the short term, organizers hope their efforts will ease the isolation many Latinas experience when they arrive in North Carolina by recreating some of the social networks they've left behind. In the long term, they hope to be a model for improving the health of the broader Spanish-speaking community.

"What we're really doing is looking at what talents are there in the community to be developed," says Pam Frasier, an assistant professor of family medicine at UNC-Chapel Hill and founder of the Immigrant Health Initiative. "So that when these outside resources go away, the good work can continue." EndBlock

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