Casa de Salud trains bilingual health workers from the communities it serves

Latinos account for about 6% of the U.S. physician workforce

States across the country face a healthcare workforce shortage, and the need is particularly high in rural areas and within Spanish-speaking communities. In New Mexico, 32 of the state’s 33 counties face a shortage. Latinos make up 20% of the population, but they account for only about 6% of the U.S. physician workforce.

Casa de Salud, a primary care clinic in Albuquerque, New Mexico, has built a pipeline aimed at that shortage. Its year-long health apprentice program has trained more than 300 bilingual high school and college students since its founding in 2005. The program’s stated aim is not only to help students from marginalized backgrounds get into medical programs, but to keep them in the community.

Program developer Colette Village Center, who is from the Standing Rock Sioux Nation, said: “You’re more likely to work in a community if you grew up in the community.” “We want to see more representation of lower-wealth individuals, under-represented individuals in healthcare, because that saves lives,” she said.

What apprentices do at Casa de Salud

When new apprentices arrive at Casa de Salud, they work their way through different stations at the clinic, starting at the front desk, then moving to taking vitals, and ending in the clinic’s lab, where they process tests and learn how to draw blood and run EKGs. While at Casa, apprentices also help with the clinic’s syringe exchange program and learn about its gender-affirming care program.

Gisselle Martinez, 21, is a college student who is not a doctor or a nurse — at least, not yet. Between classes, she works as a bilingual health apprentice at the clinic. On top of taking vitals, she is certified in harm reduction: she can run a needle exchange and give out fentanyl test strips. She also understands how a patient’s trauma and past neglect can show up in an exam room.

In a primary care exam room, Martinez demonstrated how to take a manual blood pressure in a trauma-informed manner. “I’ll be getting a little bit closer to you to put the cuff on,” she said. “It might be a little tight. Let me know if you feel any discomfort and I can take it off.”

Martinez said: “My entire life I had to pretty much translate for my parents whenever they would go to the doctor.” Her parents speak Spanish. That responsibility sometimes felt overwhelming, she said, like when she did not know how to translate certain medical terms, or when she herself had to go under anesthesia and explain the risks to her parents.

Through Casa de Salud’s apprentice program, she is working toward becoming the certified nurse anesthetist she wishes she and her parents had access to. “As a bilingual first-generation student, I aspire to help my community,” she said.

Alongside their formal training, apprentices participate in workshops about healthcare history and receive mentorship from their peers and alums. Between patient rooms, the clinic keeps a bookshelf well-stocked with study materials for university entrance exams and a cabinet full of free scrubs. Bulletin boards carry scholarship opportunities, financial aid advice and information about the local university’s pre-med society.

Casa de Salud provides care to a patient base that is predominantly Spanish-speaking and 80% uninsured. Because of the health apprenticeship’s bilingual requirement, Village Center said 100% of the apprentices are themselves Latino, and many, like Martinez, are also first-generation college students.

Village Center said the clinic recruits students not only from local colleges, but through the college assistance migrant program and the nearby high school, where students have historically undergone the same training. “I already knew about Casa de Salud because my family, back in the day, used to use it,” said Sebastian Hernandez, a 19-year-old health apprentice who is studying biochemistry and film production and hopes to become an internal medicine physician.

The program also produces its own instructors. Casa de Salud photographs show Martinez, a current apprentice, receiving instruction from Sujey Merino, a former apprentice and current trainer at the clinic. Trainer and former apprentice Edelin De las Casas shows apprentice Miriam Rios how to run an EKG, and another photograph shows Martinez performing an ear lavage on patient Leslie Fonseca as directed by De las Casas.

Community origins: the promotoras who founded Casa de Salud

Casa de Salud opened in 2004 when a local physician approached a group of promotoras — trusted liaisons between the community and healthcare workers — in Albuquerque’s predominantly Hispanic and Latino South Valley neighborhood.

“There were a few of us women who called ourselves the promotoras tradicionales, who would do limpias,” said Lorraine Cordova, one of Casa de Salud’s founders, describing a spiritual cleansing common in the Mexican folk healing tradition of curanderismo that often uses herbs, prayer and intention-setting to process emotional stressors.

The group met every few weeks at a gym in the South Valley, where they offered limpias, massage, reiki, accu-detox and other treatments. Seeing the need for connecting culturally grounded caregivers to the healthcare system, Casa de Salud soon after launched its health apprentice program.

Many of the clinic’s patients continue to use alternative medicines like those its founding promotoras offered. “A lot of the times when those people go to the doctor, they get disrespected for having those kinds of traditions,” said Village Center, who added that the clinic still tries to teach health apprentices about those practices.

Alumni outcomes and the next step

Alejandra Casarrubias was among the program’s first students. Today she is a registered nurse, a sexual assault nurse examiner and clinical manager at Casa de Salud. “You don’t only have to be bilingual, but bicultural,” she said, describing the importance of training healthcare providers who understand the communities they serve. The Association of American Medical Colleges says “patients from minoritized races tend to fare better with doctors of the same race,” across metrics like infant mortality and compliance with healthcare plans.

At least a third of the students Casa de Salud has tracked have gone into the healthcare field, with more than half of those attending medical school. Sixteen alumni have gone to school to become physician assistants, advanced practice providers who are increasingly filling healthcare gaps in rural communities.

“Any type of grad school that I had seen, whether it be CRNA [certified registered nurse anesthetist], PA [physician assistant], MD, medical school, all of them are so competitive to get into, so it’s intimidating,” said Fabian Corral, an alum of the program who is currently enrolled in school to become a physician assistant. “But when you’re surrounded by other people who also want to do that stuff, it’s encouraging.”

Corral and two other students in his Casa apprenticeship class are now enrolled in the same physician assistant program at the University of New Mexico, where they meet for study groups together.

“I don’t know what my future holds, but if it has to do with serving the community, then I would feel like I made the right choice,” Corral said.

Martinez is still working toward her credential as a certified nurse anesthetist, and the clinic’s founding approach — recruit from the community, train for the community — is still running.