Ana Soto put off going to the doctor for several years, fearing she wouldn't be able to pay for the office visit.
Then a relative told her she could get a checkup for next to nothing at Valley Community Clinic in North Hollywood.
The word-of-mouth referral saved Soto's life.
A routine mammogram revealed a lump in her breast, the 49-year-old North Hollywood housewife said, speaking in Spanish through an interpreter. A follow-up ultrasound and biopsy confirmed the presence of a malignant tumor and a mastectomy was performed in September.
Throughout her ordeal, Soto said she has had the unwavering support of the clinic's promotoras, Latina health-care advocates who help low-income and uneducated Latinas bridge the cultural, financial and immigration divide that often prevents them from getting needed medical attention.
"The promotoras talking to me and explaining everything to me has been very important to me," said Soto, a soft-spoken woman with a shy smile, during a recent visit to the Vineland Avenue clinic.
"Now, everywhere I go, I talk about the clinic," she added. "I tell people they are not going to ask you about your immigration status or ask you for money, and you don't have to wait long for someone to see you."
Promotoras in the northeast San Fernando Valley program and a similar one at Clinica Romero in Echo Park provide counseling, wellness workshops, transportation assistance and other support to Latina patients.
Since February 2000, promotoras have served 2,500 poor Latinas in the Valley as part of the clinic's Acceso a la Salud (Access to Health) community outreach program. Valley Community Clinic operates the program on a $240,000 grant from the state Department of Health Services' Healthy Families pediatric health insurance program.
"In writing the grant to establish a Healthy Families enrollment program for children, we thought about the mothers' health-care needs and how they were not being met, and created the promotoras program," said Olga Duran, Acceso a la Salud director. "Many of them are poor, uneducated and unaware of the services available to them."
The promotoras understand the women's needs, Duran said, because many of them have come out of similar impoverished circumstances.
"The promotoras have a heart for the women and their issues," Duran said. "The promotoras are strong women. They have been through hard times. It's been through support that they have made it and they want to give something back."
Promotoras such as Jeannette Esquivel spend their days going to restaurants, bus stops, Laundromats, schools, community centers and storefront churches looking for working-class Latinas to let them know they have health-care choices.
"People don't have the right information," Esquivel said, sitting in her tiny clinic office. "If the income level is low, they worry about how they can pay. If they are illegal, they think they can't get health insurance. If they can't afford a prescription, they buy any kind of medication that they think will help. Our job is to let them know what rights they have."
The most difficult part of the promotoras' job is winning the trust of the Latinas they are trying to serve, clinic officials said.
"There is a fear about accessing services if they are not legal and a perception that their citizenship status will work against them, and so they don't come to us," said Ann Brit, clinic president and chief executive.
"Through Acceso a la Salud, it's us going to them," she added. "The promotoras make them feel like they are sitting down with a peer and asking questions of them."
At the clinic, the women enter a bilingual and bicultural environment. The waiting room buzzes with conversations in Spanish and English. Posters in both languages announce the availability of free HIV testing. Receptionists, in-take workers, nurses and physicians answer questions in Spanish.
Promotoras are also at the clinic to help patients cut through insurance red tape, offer referrals to other community services or plan community health fairs.
The promotoras' commitment to better health care for poor Latinas was apparent at a recent health fair at Fair Avenue Elementary School in North Hollywood.
At the daylong event, called Entre Mujeres (Among Women), health-care professionals offered information on diabetes, breast cancer, asthma, heart disease, nutrition and family communication.
At a stress-reduction workshop, fitness expert Andy Padilla got the women on their feet for light aerobics before talking to them about allowing other family members to take on some of the household chores--and to take time for themselves.
"The promotoras program really empowers Latinas to take care of themselves," said Nury Martinez, field director for state Sen. Richard Alarcon (D-Sylmar), who helped coordinate the event.
"Historically, Latinas have carried the burden of taking care of their husbands and children and neglecting their own health," she said. "Now they form a support group with other women to talk about breast cancer, cervical cancer and women's issues and educate each other."
Breast cancer survivor Soto knows all too well the importance of having a supportive promotora such as Esquivel in tough times.
"I used to get depressed because I didn't have part of my body and I had medical bills to pay and had no money," Soto said. "She always tells me, 'Be positive. If you are positive, you are going to be OK.' "
But more than encouraging words, Soto said Esquivel served as an advocate for her in an insurance dispute and accompanied her to a breast cancer survivors seminar that let her know she was not alone in her recovery.
Soto's experience has prompted her to lobby public officials for expanded medical insurance for the working poor and community-based health education programs.
And her message has hit home as well.
"I am talking to my daughter and my friends," she said. "I tell them to go to the doctor. They tell me, 'I will be scared,' but it's better that you go and find out than wait."