They earn the patients' trust through relationships.
In the Oak Cliff neighborhood of Dallas, a quiet but consequential form of medicine is being practiced — not in operating rooms, but in living rooms and clinic hallways, by workers who carry both medical knowledge and lived experience. As COVID-19 vaccines arrived in late 2020, community health workers known as promotoras became essential bridges between a skeptical Latino community and the healthcare system, countering misinformation not with authority, but with trust. Their work reflects a deeper truth about healing: that medicine, to reach the most vulnerable, must first speak the language of their lives.
- Latino communities in Dallas face disproportionate COVID-19 risk — essential workers with no option to stay home, and chronic conditions like diabetes that turn infections deadly.
- Vaccine misinformation is spreading through the same tight-knit networks that make these communities resilient, threatening to undo public health efforts before they begin.
- Promotoras like Krystal Piña and Pamela Rodriguez are stepping into that gap — not as authority figures, but as neighbors who have lived the same struggles their patients face.
- Patients who won't take a doctor's word will ask the promotora if it's true — a dynamic that reveals how trust, not information alone, is the real currency of public health.
- Los Barrios Unidos is already planning to expand the model into Dallas's Black communities, signaling that team-based, culturally grounded care is becoming the new standard.
Krystal Piña was ten years old when she moved in with her diabetic grandmother and began learning, out of necessity, how to navigate illness and care. By fifteen she knew more about managing chronic disease than most adults. After college and a brief career in real estate, her mother's diagnosis with pancreatic cancer pulled her back into caregiving — and when her mother died six months later, Piña found her direction. In 2015, she joined Los Barrios Unidos Community Clinic in Oak Cliff as a promotora, a community health worker. It felt, she says, inevitable.
At Los Barrios Unidos, nearly 90 percent of patients are Latino — a population bearing a disproportionate burden of COVID-19. Many work in grocery stores, warehouses, and hospitals where exposure is unavoidable. Underlying conditions like diabetes and asthma, more prevalent in these neighborhoods, make severe illness more likely. Dr. Sharon Davis, the clinic's chief medical officer, launched the promotor program in 2015 on a simple insight: patients trust people who look like them, speak their language, and know their streets. "I might tell them something about asthma," Davis said, "but then they will ask the promotora, 'Is that true?'"
Pamela Rodriguez, a care coordination supervisor who became a community health worker at nineteen, describes the role as part medical, part social. Promotoras administer tests, educate patients about chronic disease, and answer the questions people are too uncertain to ask a doctor. They also connect patients to food banks, rental assistance, and unemployment resources — catching the ones who might otherwise fall through the cracks.
Becoming a community health worker requires no medical degree — only a 160-hour state-approved training program, open to any Texas resident sixteen or older. The work pays around fifty thousand dollars a year, and more than four thousand such workers are now employed across Texas. As COVID-19 vaccines began rolling out in late 2020, their role sharpened: they would be the ones sitting with hesitant patients, countering rumors, and making the case for trust in the language of lived experience. Los Barrios Unidos is already planning to bring the model to a new clinic in the Red Bird neighborhood, recruiting Black community health workers for the community it will serve. "Health care is really team-based care to really be effective," Davis said, "and community health workers are a very integral part of that team."
Krystal Piña was ten years old when her parents split. She moved in with her grandmother, who was diabetic and confined to a wheelchair. By fifteen, she had accumulated more practical medical knowledge than most adults. "You could say I was raised into it," she recalls. "I wasn't doing what a lot of other 10-year-olds were doing."
After high school, she tried a different path. She graduated from El Centro College and pursued real estate. But when her mother was diagnosed with pancreatic cancer, Piña stepped back into the role she knew best—caregiver. Her mother died six months later. That loss redirected her entirely. In 2015, Piña joined Los Barrios Unidos Community Clinic in Oak Cliff as a community health worker, a position that felt, as she puts it, inevitable. "I thought, 'This is what I want to do. I'm going to help people, and maybe share my experience as a caregiver with others so they can learn to take care of themselves or others.'"
Piña is one of thousands of community health workers—known as promotoras or promotores in Spanish-speaking communities—who operate in the space between patients and doctors. They translate medical language. They explain medications. They build the kind of trust that a physician in a white coat, speaking clinical English, often cannot. At Los Barrios Unidos, nearly 90 percent of patients are Latino, a population hit harder by COVID-19 than most. The virus has spread more aggressively through Latino communities partly because so many work in essential industries—grocery stores, warehouses, hospitals—where exposure is constant. Underlying conditions like diabetes and asthma, which are more prevalent in these neighborhoods, make severe illness more likely.
Dr. Sharon Davis, the clinic's chief medical officer, launched the promotor program in 2015 because she understood something fundamental: patients listen to people who look like them, who speak their language, who know their neighborhoods. "They earn the patients' trust through relationships," Davis said. "It's just really funny the way our patients respond to promotoras because I might tell them something about asthma, but then they will ask the promotora, 'Is that true?'" The promotoras don't replace doctors. They administer tests, manage chronic disease education, offer resources, and answer the questions patients are too embarrassed or uncertain to ask a physician.
Pamela Rodriguez, a care coordination supervisor at Los Barrios Unidos who became a community health worker at nineteen, describes the work as part medical, part social. "One of the things that I love to do is the teaching, being there to answer questions, provide support if that's what they need," she said. But the job extends beyond health. Many patients are juggling job loss, food insecurity, and rent they cannot pay. The promotoras connect them to resources—food banks, rental assistance, unemployment benefits. "We're not letting those patients fall through the cracks," Rodriguez said. "The ones that need a little bit of extra care, a little bit of extra support."
Becoming a community health worker requires no medical degree. Any Texas resident at least sixteen years old can complete a 160-hour training program approved by the state health department. The work pays an average of fifty thousand dollars a year. Across Texas, more than four thousand community health workers are now employed, a number that has grown steadily in recent years. Los Barrios Unidos, emboldened by the success of its promotor program, plans to recruit Black community health workers for a new clinic opening in the Red Bird neighborhood next year.
As COVID-19 vaccines began rolling out in late 2020, the role of these workers became urgent. They would be the ones explaining to hesitant patients why vaccination mattered. They would counter the rumors and misinformation circulating through neighborhoods. They would do what doctors alone could not: sit in living rooms, speak in the language of lived experience, and make the case for trust. Davis framed it plainly: "Health care looks different than it used to, and it needs to look different. Health care is really team-based care to really be effective, and community health workers—promotoras—are a very integral part of that team."
Citas Notables
I thought, 'This is what I want to do. I'm going to help people, and maybe share my experience as a caregiver with others so they can learn to take care of themselves or others.'— Krystal Piña, community health worker
Health care is really team-based care to really be effective, and community health workers are a very integral part of that team.— Dr. Sharon Davis, chief medical officer at Los Barrios Unidos
La Conversación del Hearth Otra perspectiva de la historia
Why does a patient ask a promotora to confirm what a doctor just told them?
Because the promotora is from the community. She's not an authority figure in a white coat. She's someone who understands what it's like to live in Oak Cliff, to work in an essential job, to have diabetes run through your family. That credibility is everything.
But doesn't that undermine the doctor's authority?
No—it actually strengthens the entire system. The doctor provides the medical knowledge. The promotora translates it into something that makes sense in a patient's actual life. They're not competing; they're completing each other.
Krystal Piña became a caregiver at ten because of circumstance, not choice. How does that shape the work she does now?
She knows what it feels like to be responsible for someone's health when you're still figuring out your own life. That's not something you can teach in a training program. When she talks to a patient about managing their mother's diabetes, she's not reading from a script.
The article mentions that promotoras help with non-medical concerns—job loss, food, rent. Isn't that outside their scope?
That's exactly their scope. A patient can't focus on managing their asthma if they don't know how they'll eat next week. The promotoras understand that health doesn't exist in isolation. They're connecting people to the actual resources that will let them survive.
What happens if there aren't enough promotoras when vaccines arrive?
Then you get lower vaccination rates in communities that need protection most. The vaccine is only effective if people actually take it. And people take it when someone they trust explains why it matters.