Magda Bullock, a lay health program instructor, and a student select and weigh fresh fruit at a local market.

Bullock, a nutritionist with the Harrisonburg-Rockingham County Health Department, earned her undergraduate degree and master's in dietetics from JMU. Like other instructors, she volunteers time for this sixth session of 10-week Saturday classes.

The class' 10 women -- like Bullock and several thousand other Latinos -- live near Harrisonburg. They are training to take their places among approximately 70 local promotoras, helping fellow newcomers care for their health. In addition to nutrition, topics range from oral hygiene and family planning to AIDS, tuberculosis and access to care. As the traditional caregivers, women are the focus, says Beth Rodgers, Promotoras director.

Nora Ramos-Martinez says "I hope to better myself, health-wise and knowledge-wise." Classmate Juana Avila says, "I want to have a better job, doing something to help people." Several promotoras are employed in health facilities, though the course only aims to train volunteers.

Bullock calls daily servings of beans fine as long as other foods are varied. The women discuss the American hazard of 'overweight.' Adela See says that at home in Guatemala, "We buy everything fresh. It's not the same thing to make chicken soup there and here."

See, also a facilitator at the health department, became a promotora in 2001, and joined that program's five-member, part-time staff as an assistant health education coordinator. Helping people choose doctors, apply for Medicaid, read prescription labels and check blood pressures are part of her routine, on and off the clock. By August 2001, promotoras had logged 1,854 such "health encounters."

Many immigrants, See says, "come from the countryside without family." They depend on someone like her for extended family-style support. "They say, oh, here's the 'grandma,'" See, 37, says. She also trained as a health interpreter in a program operated by the Blue Ridge Area Health Education Center (a partnership with JMU).

When a child gets an ear- ache, notes nursing professor Linda Hulton, language barriers or lack of insurance may keep parents from seeing a physician until symptoms worsen, and they rush to an emergency room. The child has grown sicker; costs have doubled. "There is not an easy fix," Hulton says. Yet parents may turn to a trained promotora -- a neighbor, relative, coworker or fellow-church member. She may take the child's temperature, persuade them a doctor is needed and find an interpreter.

While mothers study, trainees' children explore the playground at the Promotoras' current home, Asbury United Methodist Church. This Saturday, they're joined by JMU students. Sophomore Sarah Davelaar encourages a tiny, quiet girl named Evelyn down a slide, then scoops her into a hug. Evelyn may not know much English yet; and Davelaar says that in Spanish, "I know hola and gracias and that's it. That's the thing I'm learning -- a smile is a universal language."

Junior Kristin Callahan hands a toddler a dodge ball. Children chase marketing major Martha Kelley Sams in a round of "Duck, Duck, Chicken." Sarah Stanitz, a junior art major and JMU Optimist Club treasurer, recently led Promotoras' children in language-skill games. "The kids would laugh about how badly I pronounced Spanish, but I learned a lot." The Optimist Club's Madison Chapter focuses on helping children.

The Promotoras began in 1999 with a three-year Virginia Health Care Foundation grant. The 2001 budget was $52,747, primarily comprising "in kind" contributions of volunteer hours and space (including offices and administrative services from JMU). Though the grant expired in January 2002, Rodgers says contributors will keep the program going through this year. For 2003 and beyond, AHEC Director Christopher Nye says fund raising will be critical. Cutbacks may occur, but businesses dependent on Hispanic employment may be tapped and other grants obtained. Promotoras' survival depends on a sense of ownership by the Hispanic community, Nye says: "They're ambassadors."

The Promotoras idea grew from a program in Richmond's inner city and has inspired groups in Winchester and Nelson County to launch programs. Inquiries have come from as far away as Texas.

Rose Jannuzzi ('99), helped write the initial Promotoras curriculum. She and fellow-nursing students first visited a poultry plant, Mexican restaurant and Hispanic neighborhoods. After organizers listed topics based on needs, students located materials and created Power Point computerized lesson plans. Their curriculum was translated into Spanish. "Developing the lesson plan helped me to focus my teaching" of patients, says Jannuzzi, a native of the Philippines, nurse at Winchester Medical Center and family nurse practitioner student at George Mason University.

Seniors Carol Puryear and Krystal Woodson recently helped revise the curriculum -- updating statistics and child car seat information, looking for "Mr. Yuck" poison warning stickers. Puryear, who has interned in a critical care unit, says, "I liked looking at the community side of nursing because you can definitely see your effects." Woodson, who hopes to be a nurse practitioner, says the Latino population"is sometimes ignored."

Students work on the curriculum in Hulton's community health nursing class, Care of Vulnerable Populations. Promotoras instructors, like Bullock, are experts in their fields; Hulton says, "We just give them a jumping off point." Her students compile and update resource guides for Promotoras, including lists of local pharmacies providing Spanish interpretation. Students have taught Promotora trainees how to take blood pressures and given children's workshops with visits from firefighters and rescue workers.

Promotora graduate Iris Ramos supplies lunch at most training sessions. One of her menus features a juicy 20-pound turkey; "yellow rice" with peas, carrots and red peppers; a salad and fresh fruit. For one session, Bullock had trainees bring their own dishes, tweaking traditional recipes with their new health knowledge.

Chris Edwards