A Day in the Life of a Community Health Representative

As we approach “Take Our Daughters and Sons to Work Day” on April 28, which celebrates parents, guardians and role models, PWNA also honors Community Health Representatives (CHRs), who serve as role models in their tribal communities.

CHRs have a long history of service in Native American communities. An approach funded by the Indian Health Service (I.H.S.) for over 25 years, the CHR Program is 1,400 members strong and serves 250 tribes across the country. As paraprofessional health care providers, CHRs work on behalf of their tribes and communities, conducting community outreach and promoting health and wellness and disease prevention. No job description could ever account for the range of responsibilities CHRs carry out each day. Besides regular home health visits to monitor each clients’ condition, CHRs also provide group opportunities for preventative health care, conduct a variety of health assessments, transport patient for health and sometimes other appointments, and most importantly, serve as the consistent connection between their patients and community resources.

To truly understand the complexities and responsibilities a CHR manages, and to appreciate the valuable service and support they provide, you would need to follow them around for a day. PWNA did this, and here we share our glimpse of a morning in the life of one CHR and the myriad of needs she addresses.

6:15 a.m. — Picked up Sherry and transported to dialysis. Husband suffered his stroke earlier in week and she is afraid her needs are causing his health problems. Family has been trying to get assistance to have wheelchair ramp installed for several years (PWNA provided a new ramp and flooring). Couple needs follow up with housing and other resources to see what assistance is available. Took Sherry home; son met us and carried her back into the house. Son reported his father probably wouldn’t be released from hospital for a week or so, and additional transport would be needed.

10 a.m.— Arrived at Elderly Nutrition Center to set up a make-shift screening table for blood pressure and glucose screening with the Elders, while also creating the opportunity for them to discuss their own health risks and concerns with a trained Health Educator. Several Elders were already at the center and visited while the table was being set up and the congregate meal was being prepared. One Elder shared that she has several grandchildren living with her and the first aid kit (provided by PWNA) would be helpful for all the bumps and scraps they get while playing; she never had a fully equipped kit before now.

Complicating the work of a CHR is the reality that the health care system on American Indian reservations is beyond deficient. Shattered treaties and failed federal policies set the stage for routine underfunding of health care, leaving the Native population riddled with health disparities. A report released in 2004 by the U.S. Commission of Civil Rights, “Broken Promises: Evaluating the Native American Health Care System,” spotlights per capita health care costs across populations. Fiscal gaps clearly exist in U.S. health care funding levels: $5,000 for general population, $3,803 for federal prisoners and $1,914 for American Indians. These disparities are a factor in why tribal communities are taking a preventative approach to health care, and CHRs play a central role in this effort.

CHRs are trusted servants in their communities, the ones people turn to when they need guidance or help, or someone to advocate for their needs. In celebration of their dedication and service, PWNA honors CHRs for being role models and committing themselves to improving the health and welfare of their neighbors, families and tribal nations.