Based in the Salvation Army Kroc Center in eastern San Diego, Miriam Rodriguez and her team used their local connections to build the first Operation Change program to be delivered in the Spanish language. Operation Change provides a comprehensive approach to improving health in underserved populations where health disparities are at their highest, and in San Diego we see some startling variances in life expectancy, obesity and diabetes. In this podcast Miriam describes how the program is all about the empowerment of women, and how she and the participants were initially surprised to hear that mental health education would be a major component of the program. Part 4/7 of our Operation Change Series. Hosted by Dr. Bonnie Simpson Mason.
Episode 54. Operation Change Community Report: Salvation Army Kroc Center, San Diego, with Miriam Rodriguez
Based in the Salvation Army Kroc Center in eastern San Diego, Miriam Rodriguez and her team used their local connections to build the first Operation Change program to be delivered in the Spanish language. Operation Change provides a comprehensive approach to improving health in underserved populations where health disparities are at their highest, and in San Diego we see some startling variances in life expectancy, obesity and diabetes. In this podcast Miriam describes how the program is all about the empowerment of women, and how she and the participants were initially surprised to hear that mental health education would be a major component of the program. Part 4/7 of our Operation Change Series. Hosted by Dr. Bonnie Simpson Mason. Posted on July 15, 2020.
Dr. Mason: Hello, and welcome to another episode of The Health Disparities Podcast, conversations about health disparities with people who are working to eliminate them across the country and with passion. I am Dr. Bonnie Simpson Mason, your host, and this week we are recording our conversations at the National Harbor in Maryland, where we are enjoying a program of speakers and workshops at the annual Movement is Life conference. Over the last year, Movement is Life has been running a series of grassroots health programs called Operation Change in both rural and urban settings nationwide. We are delighted to have leaders from these programs here with us at the caucus to share their experiences with us for the podcast. So, today, we are welcoming from San Diego, Miriam Rodriguez. Welcome! We are excited to hear about the Operation Change program that you were in charge of in San Diego. Can you say Operation Change for us in Spanish?
Miriam: Operacion Cambio.
Dr. Mason: Racion
Dr. Mason: Operacion…
Dr. Mason: …Cambio. Okay, perfect. I won’t repeat that, but I’ll let you say it. So, what was your role in Operation Change in San Diego? What did you do, you know, within the realm of the program?
Miriam: So, I’m the coordinator and I am in charge of making sure I had a good team, which is the motivational interviewers and then also recruit the participants who are in our program. So, we kind of started from zero. We didn’t have resources. We didn’t have participants. So, we just had to see, you know, what is it that our community needs, and where is this community that we’re looking for, which is a Hispanic/Latino community, 45 to 70-year-old women.
Dr. Mason: Okay, so for our listeners who may not know, in your own words, what is Operation Change?
Miriam: Operation Change is a program to empower women who are minorities. And you know, we don’t like to say minorities, but the people who don’t get as much help or resources as others in our community, and people who obviously English isn’t their first language, so it’s makes it way more difficult to find help. Even though we live in San Diego, which is a pretty large Hispanic, you know, community close to Mexico, we definitely still are not there yet where they can go and find help. So, this program was brought to us. And I know we’re going to talk about it but the highlight of our program is that it’s all in Spanish. And first, they were trying to figure out if we wanted to do a bilingual program, but honestly, I was like, “No, that’s not going to work because we can’t expect them to understand English, you know, sometimes and then bring Spanish. If we’re going to do this, we have to do it right. We have to give them those Spanish resources 100%, so they can actually get the most out of this program.”
Dr. Mason: Absolutely. So, how long did the San Diego Operation Change program run, for how many weeks?
Miriam: So we are meeting for 18 weeks. We are already at the 11th week, which is pretty crazy.
Dr. Mason: Awesome. And you have how many enrollees in the program?
Miriam: We have a group of 22 women?
Dr. Mason: Okay.
Miriam: Yeah. And our attrition has been really well so far. They’ve definitely been coming often because they found that this is a safe place. And like I said, it’s all about empowerment. And they tell us every day, every weekend they come, they’re like, “Oh, I’m so sad. This thing is already almost over. Can we just keep coming?” And so, you actually see, you know, those changes in their mental and physical health, even though we’re not pushing for the, you know, physical. We just kind of give them the resources and what they do with it is, you know, what they want to do.
Dr. Mason: Well, let’s look at that a little bit closer. So, again, for our listeners who may not know, when your enrollees come to Operation Change, I know that there’s essentially a comprehensive approach that we take to supporting the ladies when they come in, but tell us about the components of the Operation Change program, because it’s pretty unique. So it’s not just an exercise program.
Miriam: No, no, no. So, there’s three components. So, the first hour, we work on presentations. So, we have different community health workers who come in and talk to us about different topics. And we actually have five modules that we follow. The first one is going to be mental health, going into some social support, and then nutrition, and then community health workers and then resources. So, for our community, I was really worried at first when they’re like, “Oh, the first thing you have to talk about is mental health.” And I’m like, “How is that possible?”
Dr. Mason: That might not be the best first subject, right, might not be?
Miriam: Yeah. I was like, “The Hispanic/Latino community, we don’t talk about our feelings. We don’t, you know, express ourselves. Our Mothers don’t tell us I love you, sweetie”, you know, like it’s different. So, I’m like, “How are we going to bring them in and expect them to share their feelings when if they go to therapy, they’re crazy?” You know, that’s our idea. It’s a taboo subject. So, how do we expect them to come in here and be like, “Oh, I’m going to learn about mental health”, like, you know? So I was really worried about it at first. But honestly, it’s such a great format that they have because once you get them to understand that mental health is important because when you’re looking at that side of your health, you learn that, you know, that’s the biggest part to show them that they matter, that their health matters. So, when they start understanding, like, “Hey, you know what? I am there for my family but are they there for me? Am I important? I’m not. So, now, I have to start putting myself first. And I have to come every Saturday. I have to make this commitment for myself,” because we teach them that “How are you going to take care of your family if you don’t take care of yourself?” And they always put themselves last, you know? It’s what my family wants to eat tonight. It’s not about me, it’s about what my husband likes. He doesn’t want a salad. What am I going to give him a salad? He’s not going to eat that. He’s going to look down at me like, “What is this?” And that’s what a lot of them share with us like, what do you mean?
Dr. Mason: Okay.
Miriam: Yeah. So it’s really interesting.
Dr. Mason: So, it sounds like from a cultural perspective—So, I know for a fact that Operation Change is taking place in several other cities across the country. This is the first year that it’s being held in San Diego. Correct?
Dr. Mason: So, then there are some challenges around creating a culturally competent and sensitive program. So, I’ve already heard one thing he said about, you know, translating, no, not translating, communicating the importance of mental health in a community where mental health is a taboo subject. So, how did you do that successfully and do so in Spanish? You elected to do the entire program in Spanish. So, did you have a mental health professional come in who spoke Spanish? Like, how did you all actually make that happen?
Miriam: Yeah, we had really good professionals who came in. For mental health specifically, we had two different speakers. So, one of them is actually a family therapist, and then the other person actually works for Jewish Family Services. And he was a Spanish speaker, which was kind of crazy. I was like, “Okay, that’s interesting.” They loved him. I don’t know if it’s because he was a male or what it was. But then we were talking about this as MIs and with my team, and we were like, “Why is it they liked him so much?” Well, you know what? Maybe it’s nice hearing it from a male perspective because now they understand that maybe men do care about how they feel, you know? And I was worried at first, I was really worried. I was like, “What if this guy comes in he, you know, looks young, and they’re going to be like, ‘What is this guy going to come teach me?’”, you know? But no, it was really effective. They definitely were interested, and they were always like, “Bring him back.” Yeah, his name is Fernando Pereira. He was a really great speaker.
Dr. Mason: So, there’s the presentation component, that’s the first part of the program on Saturdays, then what’s the next component?
Miriam: The next component is movement. So we spend an hour but technically, we don’t spend an hour. We spend like 30 to 45 minutes because like we’ve shared before, this group of women, they don’t really exercise, they’re not active in general. Like, if they’re active, they’re going to go to work or they’re cleaning the house like, “That’s enough. Like I did in my work, you know? I cleaned the house, like I moved all day, like, that’s fine.” I think the aspect that they’re missing out on is their mental health because it all ties in together. If I’m working out, my mind’s not going to be focused on what’s going on. And I’m learning something new, like it feels good. Like, it’s an all-over, new thing that they learn. So, we bring in instructors, and we are located at the Joan Kroc Center San Diego so it’s really nice. We have a great facility, we have a pool, we have a gymnasium, and we’re able to use instructors there and also bring equipment. For example, we did a circuit training one day, and it was crazy because we’re like, these ladies have never used no weights, they’ve never used, you know, like this is all new to them. But once they see you doing it– And first they’re all like embarrassed, but then they start laughing because they see that they’re all doing it together. Like they’re using the rope and they’re like, “This is so much fun.” And you know, it’s such a great experience and the fitness instructors at the Kroc Center are awesome, as well. The one who has been working really close with me, his name is Phil, he actually doesn’t speak Spanish but together we kind of made it work. So, we kind of just like explained each section like, “Oh, this is this, this is this” and it’s all about visual really. Exercise is all about visuals. So, if you show them what they need to do, they’ll do it.
Dr. Mason: So, you’re really exposing them to a whole other opportunity. Something else to think about I can actually– Exercise is different from laboring, right, from doing the actual work that you’re doing where you may be moving but exercise, we’re getting our cardiac rate up, right? And there’s some real physiological benefits to that.
Miriam: Right. But we also have to remind them that any movement is great. So, we put a chair out for them, and we say, “Sit down, get up, sit down, get up that’s moving.” That’s something new to them. They’re like, “You know what?” I didn’t think about that. That’s right.” But we teach them to do it right so they don’t hurt themselves, which makes a big difference where they can actually be like, “This is movement.”
Dr. Mason: Oh, that’s awesome. That’s awesome. I love it sounds like there were a lot of aha moments, which is the best part about Operation Change because you see people’s mindsets shift. You see it, right? And so that’s when we know we’re being a bit of benefit in partnering with our team members. So, then what’s the third component? So, there’s the presentation, there’s that movement component, and then what’s the third component?
Miriam: So the third component is motivational interviewing, which is the big, the key part of this program. At first, this was all new to us. So, my team went through motivational interviewing with Movement is Life. They brought over a team and they trained us Friday and Saturday. And what it is, is just kind of guiding these women to make a change without telling them what to do, which is kind of difficult. It sounds easy but if you’re talking to a friend, you’re like, oh, yeah, you should do this, you should do that.” It’s easy to tell them what to do but the hard part is listening to them and hearing them say, “Well, I drink a soda a day but yeah, that’s normal.” Like you want to be like, “No, don’t do that. You should not do that”, but you can’t do that. You’ll say, “How does that make you feel?”
Dr. Mason: Sure.
Miriam: You know, let them figure it out. Let them understand why they shouldn’t do it, or what they should change. Like, “How does that make you feel?” “Oh, well, I feel kind of lousy sometimes.” “Oh, well, what do you think you can do different? What are your other options?”
Dr. Mason: There you go.
Miriam: You know, and you also try to figure out like, “Oh, what’s stopping you?” “Oh, I don’t have money.” “Okay, well, how about you just start drinking water?” You know, just different things to help them realize, “You know what? I can make this change, and it’s up to me.”
Dr. Mason: How did your enrollees receive that? I mean, how did they like the motivational interviewing? Because that’s a lot of self-reflection and accountability.
Miriam: Oh, they love it. They’re like, “Give me homework.” They come up to me sometimes, and they don’t want to say it in front of their groups because, you know, they don’t want to be that person. But they’ll be like, “Hey, Miriam, can you tell them to give us homework? Because I’ll do it if you tell me to do it.” So, I’m like, “Okay, I’ll talk to them.” Or they love worksheets, like just a simple handout. I made a handout for them one day about self-care. And I did it in Spanish. And I did it very, how would you say, very casual. So, it’s not a formal sheet, it’s something like, “Get rid of negative people in your life, even if it’s your cousin.” And it sounds funny in Spanish, you know what I mean? So, it relates to them, and they take it in, you know, easier and they’re like, “You know what? That’s true. Yeah, my cousin bothers me. Every day she calls me. Like, let me just cut her off for a little bit. And let me get peace of mind for myself so I don’t have to carry this baggage of someone else’s, you know, negative things going on in their life.” You know? It’s pretty great.
Dr. Mason: Well, it sounds like you all are making a wonderful impact there in San Diego. Is there a particular story of one of your participants where you’ve seen a real transformation or something they may have shared with you?
Miriam: Yeah, so the interesting thing about this program is that my mom fit into this target population. And I was like, “What’s a better way to, you know, help the community than starting at home?”
Dr. Mason: There you go.
Miriam: So I actually, you know, I asked my mom to come she’s like, “Why do you want me to go to this? I don’t want to go to it, that’s embarrassing. You know, they’re going to know I’m your mom,” and just kind of that’s how Hispanic moms are. They’re very, like, they love you, but they try to act like, you know, that little distance. But yeah, she’s definitely been really helpful to me personally. I get to experience everything firsthand. So, I have actually changed a lot of my perspectives. I’ll go visit home and I’ll see, you know, the pressure on my mom, the family, what they need and what they want. And I’m seeing her also making changes as in like, my brothers will be like, “Oh, I need this” or “I need that” and she’s like, “Okay, well, I don’t have time for that right now.” Or, you know, like, “Oh, I want this for dinner”, like, “Okay, well, you figure it out.” You know? Or like those pressures of “Oh, your dad,” my dad, I guess he has high cholesterol now and then they’re on him like, “Oh, you need to eat healthier. Mom, why aren’t you cooking healthy for him? Why aren’t you doing this?” She’s like, “I’m doing the best I can and it is up to your dad to figure that out.” You know what I mean? So, I get to see her build, you know, I see her empowered as well. And then I see her come also and like have fun, move around. Just yesterday, she FaceTimes me and she’s in a Zumba class. She’s like, “Look at me!” You know? So it’s really nice and yeah, definitely, like we see each other and I know she really enjoys it, and it’s just a heartwarming feeling.
Dr. Mason: Oh, seeing her transform for the positive, right? Like, you said, being empowered. And what does she think about it being an all women’s program?
Miriam: She likes it. She definitely likes it. She likes that it’s an open space, especially for when we’d have presentations. She’s, not very talkative but if she has a question, she’s going to ask it and, you know, it’s nice to see she’s not afraid, either, you know, to learn more. One day we were doing pickleball. I don’t know if you ever heard of pickleball.
Dr. Mason: Okay, no.
Miriam: It’s kind of like tennis, but low intensity with like, a heavier ball. So, it’s like, you’re not moving as hard. And it’s a really great sport that they do at the Kroc Center. We had some volunteers who helped out. And so, we have one lady who has a prosthesis.
Dr. Mason: Yes. Prosthetic leg?
Miriam: Sorry, a prosthetic leg. And you know, at first, I saw her sitting down, and I was like, “You know, I understand, like, you know, you might be a little shy, you don’t want to, like, try something new because you don’t know what’s going to happen. Especially if you’re not used to moving, you’re like, ‘I can’t do that.’” And I heard her, she said, “Oh, I can’t do that.” And I’m, like, look over and I’m like, walk over there. I’m like, “Hey, what are you doing?” And then she’s like, “Oh, I’m just going to watch. It’s fine.” I’m like, “No, no, no, get up. Come on.” I got her up, and I sent her to the line where I know it wasn’t too much movement because she was worried about it falling off. If she moves too much to the right, it’s going to fall off. You know, she might be embarrassed or, you know, she doesn’t want to deal with that problem. So, she gets up and she gets in line, and I can see her, she’s a little nervous. But she gets to the front, so now she hits that ball, she’s like, “Okay!” and she keeps going. And she goes back in line, goes again, goes back in line.
Dr. Mason: Wow.
Miriam: And just little things like that. And I always tell my MIs like, that’s like our biggest thing we do. If we’re ever working out and we see someone sitting down, I’ll be like, “Hey, go over there. Go get her up, go tell her to do this.” Or if someone sits out and they’re just sitting in the chair, one of my MIs will go sit next to them and just like, “Move your arms, copy me”, you know, just so they can move because sometimes they think they can’t or I feel like other times like they might be embarrassed because, you know, they might be bigger than other people. But it’s all about building that safe environment and including everyone.
Dr. Mason: That’s right, that inclusion and equity. So, what I’m hearing you’re creating an equitable space that’s safe, because you’re giving people what they need, even if it’s different from what someone else needs but you’re meeting them where they are, so that’s huge. So, I think I’ll just wrap up with you, Miriam, letting our listeners know maybe how would you encourage them to maybe even start an Operation Change in their environment? Because this is new for you all, so what would you say to the people who say you know what, maybe we could start an Operation Change?
Miriam: So, we always talk about this, like you lead by example. So, right now, we’re leading, and we’re an example for them. And we were telling them, like, you know what? This is going to end soon, but now that you all have been through this, and you see how empowering it is, and you see how fun it is, it’s your job to now go out into the community and find, you know, somewhere else where you can do this or even with friends that live close to you or family, relatives. You can do it in your house. You guys can go walk around, come back, talk a little bit, discuss about what’s going on in life. All they need is someone to hear them out and someone to push them to keep working out. And also, if anybody else wants to do it out there who’s like a community health worker, find a church, find a community center, just get people together. And the biggest part is recruitment. If you know your community, you’re going to know where to find the people who need this.
Dr. Mason: Absolutely. Well, thank you so much for sharing your nuggets and pearls with us today. It sounds like if anyone in our listening audience wants to start an Operation Change program, especially in Spanish, that they need to come and talk to you because it sounds like you were successful in creating a culturally competent and sensitive program. Especially, you know, it sounds like some of the key issues were being able to communicate the importance of mental health, self-care, that sounds like that was huge, and providing them with additional support and homework which they really, really seemed to be drawn to through the motivational interviewing. So, congratulations on a wonderful program.
Miriam: Thank you so much. I hope other people out there can start this in their community because it’s going to make a huge difference if they do.
Dr. Mason: Well, if anyone inquires, we’re going to certainly send them to you.
Miriam: All righty. Thank you so much for having me.
Dr. Mason: Thank you so much. And we’d like to thank our listeners for joining another Health Disparities Podcast episode. Join us again at movementislifecaucus.com or you can subscribe to the podcast at iTunes, Google, Spotify and Stitcher. Our new episodes post every two weeks, so look out for a special series featuring other thought leaders from our partner organizations who are working to end healthcare disparities with purpose and passion. Thank you so much.
Miriam: Thank you.
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