This picture is from my father and was taken in Ecuador a year ago. My father is an older adult that needs a lot of support from his family. In my role as a CHW, I work with older adults. Many feel lost, but through the help of CHWs like me, they can find clarity. CHWs are trusted members of the community. We can often relate to the people we work with because we have faced similar situations at some point in our lives. When COVID hit Jackson Heights/Corona/Elmhurst in March 2020, we started calling asthmatic patients to ensure they stayed away from the emergency rooms. Many patients needed to be reconnected to their primary care providers, so we helped them by scheduling tele visits. Some needed help getting refills for their asthma medication. We were able to reach out to the providers or hospitals to facilitate this. Others needed help accessing resources such as food pantries and SNAP, navigating health insurance, etc. Others did not need anything but were thankful that someone was calling to check up on them. Navigating the healthcare system is challenging in and of itself, but a lack of access can make it even more difficult. In our community, we lost many friends and family members to COVID, mainly due to the lack of access to proper healthcare. Today, two years after the beginning of the pandemic, I see how our community members still face the same challenges accessing healthcare. Patients are getting medical appointments too far apart. Others have difficulty attending their appointments due to limited availability or scheduling conflicts that arise because they are unable to take time off work. Due to these barriers, we often see patients in the emergency room even though it does not provide them with the continuous medical care they require. We need to keep advocating for healthcare coverage for all as a basic human right. At the same time, we must promote more CHW programs that bring hope to our community.

An elderly person suffering from food insecurity timidly exits their building to pick up a food delivery. This client was facing food insecurity and did not know what to do. Elderly folks often don't believe in or don't understand how to use technology, ask for deliveries, apply for free senior delivery services, take calls for intakes, go to the senior centers, or leave their houses to buy groceries. The fear of being infected holds them in their houses, starving or eating what they have left from weeks ago. During the pandemic, family visits, CHWs, home health care services, and other in- person visits stopped. Some elderly clients did not want to receive anybody in their homes due to the COVID-19 pandemic. Our clients must trust that CHWs will connect them to the resources that can provide free prepared food and grocery deliveries, connect them with food pantries, or teach them how to order food by phone. They shared with CHWs like me: "I don't have anything to eat." "I do not have money to buy food." "I do not know how to order food or grocery deliveries." "Un pancito más por favor en la comidita [please, just one extra piece of bread with my meal]." "I haven't been eating the last 3 days." "I cannot be starving because of my health condition." "I cannot receive the prepared food because I don't have a refrigerator." My clients felt at ease knowing that I would listen to their concerns and address their needs.

I took this picture in 2019 when I went back home (Ivory Coast) for my wedding. It was an exotic place by the beach with many opportunities for guided outdoor activities. Having people walking down the trail behind you and not knowing what they will do to you is a little bit scary, but when you have a bit of trust, you really don’t care. You just enjoy the moment and receive the assistance you requested. Trust is also important in my work as a CHW. I assist clients in applying for Human Resources Administration (HRA) over the phone. You can imagine how hard it is sometimes, especially when there is a language barrier and I have to use an interpreter. Some clients trust me with almost everything. They will reach out to me for something that is not necessarily related to what I do as a CHW. Others do not want to provide their information, which makes my work difficult. Some clients will ask many questions before providing their personal information, especially their social security number. Some clients are not technology savvy, so it is difficult for them to submit their required documents using the Access HRA app. In one case, I suggested that a client send their documents to my work email so I could submit everything online. They declined my assistance. Unfortunately, they received a rejection letter because of failure to provide proof of documentation. Scammers are the reason why people do not put their trust in others when it comes to personal information. I do believe that when you reach out to the client multiple times to provide or receive an update, he or she starts to open up and share more information about themselves.

Everything began with a call. As a CHW, I was the first person to whom this client was able to express their feelings. They were looking for support, help, and someone who understood them. During the call, the client expressed a desire to be understood by their family members and their health care team. They expressed their frustration watching their health deteriorate without an explanation or having a clear idea about their future. Every day was different. On some days it was worse than the day before, making daily activities more challenging to be completed. The lack of trust forced this client to suppress their feelings because they feared being judged or considered weak or a liar. The client said: "Confio en ti y sé que harás lo mejor para ayudarme y no me perjudicarás ni me engañarás [I trust you and I know you’ll do your best to help me, and you won’t harm me or trick me].” I was their support system, someone who built trust and built their self-confidence to speak up when needed. I was able to provide the available resources for them and was there to guide them during the different processes. I also encouraged them to seek education about their medical conditions through a professional and to not give up on finding the right team for them.

This photo is of me conducting a health presentation to a group of seniors. This group showed me how important it is to have trust and “buy-in” with the community. The first time I did a presentation, they barely interacted with me, and it seemed like they were uninterested in what I had to say. The next time I went to do a presentation, they were much more open with me because they were comfortable. I was no longer a stranger disrupting their routine but someone they could trust and accept information from. They answered questions and shared their own health tips and personal things from their lives. Trust within the community isn’t something that is automatically given. It may take several interactions with an individual or a group before they can openly accept that you are there to help or share information.

These steps represent access to the outside world. For a family with a relative who requires a wheelchair, the story can be very different. I visited this family several times while working with them. I took the picture because I wanted the medical team at my clinic to see what it was like for this family to leave the house every time they went for a medical appointment with their family member. Most importantly, I wanted to help this family get multiple doctor’s appointments on the same day. Many families can’t find an affordable and safe apartment with accessibility. Families end up in relatively safe and somewhat affordable places like this one, but they go through extreme challenges carrying their children and their wheelchairs up and down such steps. Their daily routine becomes an absolute physical challenge. They do this daily to attend school and go to doctor’s appointments. As CHWs, we can often assist them by scheduling multiple medical appointments on the same day or by creating online profiles for them on the city housing lottery’s website. However, we also often feel frustrated because we can’t change some of the housing conditions many families in our communities face.

For many reasons, this light blue stand from the Government offering free phone services could be seen as a sign of mistrust in my community. Many families I worked with in the past have spoken against it, believing that their personal information, such as IDs, home address, Medicaid information, etc., would be taken and used for fraudulent activities by unknown individuals. Even though many families know that this resource can help lower some financial stressors at home, some decided not to apply for free phone assistance. As a CHW, it is my duty not just to connect families with services and resources in our community but also to teach my community about them. Most importantly, I help community members understand why these resources are being created in the first place and how they can benefit from using them. After responding to questions from community members regarding the benefits of applying for a free phone, many end up feeling more comfortable giving their private information to me or other CHWs who can assist with free phone applications and other government services.

This photo shows a church in my community and the sun shining through clouds. I think this is representative of how important religion can be for many of my clients. Many of them put their trust in a higher being, no matter the specific name used for that higher being. When faced with a difficult ordeal, even with our assistance, they will look to their religion for guidance on what to do. Faith and trust are often used interchangeably, and after a stormy or gloomy day, there will be a light shining through in their lives.

"La Cosechita [Little Harvest]”: The Pandemic was really hard on our mental health. We were forced to keep our distance from each other, and most of our client cases were put on hold, but every CHW found their unique way to fight. Food was costly and very difficult to find, and our students went to 100% online education. Using my son as a model, we started growing fruits and vegetables in the front yard of our house. We collected rainwater and killed a lot of calories by taking care of our plant babies twice a day. I regularly posted motivational pictures, and from there, conversations were initiated, and rapport was built. My son disliked it initially but later learned to enjoy that connection with nature and spirituality. Our clients told us many things. They adapted to new healthy habits and connected with lovely memories from childhood. The fruits and vegetables they harvested were the most delicious they had ever tasted, and the picky eaters were trying new things!

Trust was hard in March 2020. No one knew how the events would unfold. Trust was gone. Trusting people was hard, and nobody knew whom to trust. The pandemic was difficult because I had never experienced anything like it. I certainly did not trust anyone after the world was hit with coronavirus. But most of all, we heard all kinds of things happening in the world, and when things started in the United States, it felt like the world was ending. It was unclear what was happening to us. The reality hit when I thought to myself, "I just celebrated my son's birthday at his school." Later that evening, news of the SHUTDOWNS hit. The trust was broken when the government knew about the virus and said nothing. All the deaths in the beginning. It broke my heart to see all of these people dying. It broke my heart to see freezer trucks parked in front of the hospitals for dead bodies. Queens Hospital and Elmhurst Hospitals were at the center of the pandemic, with thousands of deaths in the beginning. The world saw both hospitals in the news. I live in Queens, and I was a Community Health Worker for a company that sent me to educate people about asthma (Adult, Pediatric, and Pulmonary Clinics). I still wonder if all the workers I used to see made it alive.

It broke my heart to see the city find empty land to put the bodies in white boxes next to and on top of each other. It broke my heart when families could not claim the bodies to make funeral arrangements. THE MOST HURTFUL THING WAS WHEN FAMILIES HAD TO SAY GOODBYE THROUGH THEIR MOBILE DEVICES. WORDS CANNOT EXPRESS HOW THAT MADE ME FEEL, OR HOW THOSE FAMILY MEMBERS FELT. I spent almost three months in my apartment with my son. I ordered everything I needed. When my orders arrived, I wiped everything with Clorox wipes before they entered my apartment. I remember the first weekend, I went to pick up a few things and saw that I had to stand outside of the supermarket to wait to get in. I knew then that things were serious. I went to another store and picked up a few items. Finally, after three months, I planned with my son to take a walk around the neighborhood. The neighborhood and I felt estranged from each other. Little by little, I started going back to the stores with two masks on my face. This picture shows my son and me out in the neighborhood after three months indoors. Masks were hard to find. I had to make my mask (a headscarf and rubber bands). We wore glasses due to the fear of droplets in the air. It took two years for trust to be rebuilt, and for it to resume to a certain degree for us to move on.

As a CHW, we need to grip hands with our community members. That is a perfect way to build TRUST. Gripping hands is when a relationship brings about a natural acquaintance. It indicates that you’re doing life with this person. You’re walking side by side with them and there is a mutual agreement or need afforded. Please take a closer look at the picture. You will see in the image that some of the hands are gripping tighter and some have a looser grip than the other. This symbolizes that the community members’ environment or circumstances can be a struggle. Some community members would hold on tighter because of desperation and need for help. When working with community members, it can get hard. There are many barriers that we don’t see when talking with a community member. They are not willing to grip hands with you in the first interaction. Building trust is a daily commitment. Don’t make the mistake of expecting too much too soon. In order to build trust, first take small steps and take on small commitments. Then, as trust grows, you will be more at ease with making and accepting bigger commitments. Put trust in, and you will generally get trust in return. It’s a process that has to be built daily.