KANSAS CITY, Kan. —It's the healthy ones who come to the United States, leaving family, friends and the security of home to try to make something of their lives.
But immigrants face a cruel irony after they arrive: The longer they're here, studies have shown, the less healthy they become.
That's how it was for Patricia Arias, who crossed the border with big dreams. She came from Mexico, she said, brought by a man who "promised me the moon and the stars."
Eight years later, all she could see was the ceiling of her apartment.
The man had left, and the hotel housekeeper was lying on an injured back, home alone with two young children.
She had bent over to organize her cleaning cart when a disk popped out of position. The pain debilitated her.
With few resources and limited English, she had to depend on the care of her 6-year-old son. Today, Arias still lives with back pain. But the experience helped her find a calling.
She is one of several dozen "promotoras," volunteers who work with their immigrant community as "health promoters" in the Kansas City area.
She and the others say that cutting-edge medicine won't solve most of the health problems they see. The real ailments are isolation, fear and ignorance.
Health promoters got their start in Latin America, and the program reached the United States in the 1980s. The local group, mainly women, works out of El Centro, a Kansas social-service agency.
Last year, the promotoras walked the neighborhood around 10th and Central in Kansas City, Kan., armed with the legitimacy that clipboards, business cards and matching polo shirts gave them.
They conducted health surveys with the residents, most of them immigrants who peered suspiciously at first from behind padlocked doors or barred windows.
But with time, those inside opened up.
"They almost kiss your hand," Arias said. "They ask for help. They implore us. They thought we were doctors. They thought we were going to solve all their problems."
As health officials try to catch up with the influx of immigrants in the Midwest, the promotoras have become informants from the field. They serve everyone, in the country legally or not.
"Every time I meet them. I learn," said Paula Cupertino, a professor of preventive medicine and public health at the University of Kansas Medical Center.
"When (I'm) thinking about a new program to develop, they are like a consultant," she said. "Instead of me developing a program and dumping it in a community of people, they take the bottom-up approach."
Faced with overwhelming need, the health promoters have wished at times that they could offer more than an encouraging conversation, a tip toward a low-income clinic or a flier outside Walmart.
Health education and disease prevention are key because few immigrants have insurance. And the ones who are here illegally would hesitate to venture to a clinic for fear of deportation, Garcia added.
Most recently, through a grant from the Health Care Foundation of Greater Kansas City, the health promoters are helping people stop smoking. They preach the gospel at churches, sharing stories of cigarettes, gum disease and lung cancer.
The health promoters also recognize that traditional public health approaches have failed their community.
A traditional approach to health might advise people to go to a gym, lift weights or take a jog. Instead, the health promoters have organized occasional Friday night dances.
Because Hispanic immigrants get most of their information from the radio, the promotoras also have written a "radio-novella" based on their own experiences. It is like the radio soap operas they listen to every day, only with a health message.
Cielo Fernandez, who directs the health program for El Centro, hopes that in two to three years, the group will have fully covered the community.
The progress so far, she says, is "just the top of the glacier."