Ricardo Garay serves as a General Board Member for Texas SOPHE and is a dedicated program manager for the Community Engagement and Health Equity team at the Dell Medical School. His work focuses on addressing health disparities, informed by his experiences as an immigrant from Tegucigalpa, Honduras. In addition to his role at Dell Med, Ricardo facilitates community health initiatives in Central Texas, demonstrating his commitment to social justice and understanding of social determinants of health.
Q: What inspired you to pursue a career in community health, and how has your background as an immigrant influenced your work?
I define the role of a Community Health Worker as a community organizer that works with others to achieve liberation. Health to me, is a humanistic determinant, not a clinical exercise. I value a sense of belonging and general wellbeing as greater indicators of community health over traditional medical markers. Investing in collectivity and fostering solidarity continue to be areas of interest to me. I continue to be educated and inspired through storytelling and shared experiences, especially with those most affected by systemic violence.
I was born in Tegucigalpa, Honduras and was exposed to extremes from a young age. As a teenager, I volunteered as an interpreter and this was my first experience serving as a bridge between clinicians and community members. I came to the U.S. for college, and I was shocked at the high-tech / poor-human centered care. My first visit to a clinic felt humiliating and dehumanizing. I don't ever want anyone to experience that feeling and I believe we need to create healthcare systems for everyone.
Nothing is more American than immigration and I find it sad that this country continues to allow this dissonance to shape our lives. As a Community Health Worker, I feel it is imperative to call out violent rhetoric and any framing that causes harm. 25 Years after coming to the U.S., I don't quite feel like I belong, and this continues to drive my work.
Q: Can you share a specific project or initiative you’ve worked on that you believe made a significant impact in your community?
I joined the department of Population Health at the Dell Medical School during the early stages of its creation. This was a new school that promised the community to rethink healthcare and revolutionize medical education in Central Texas. I worked with others to elevate the role of Community Health Workers (CHWs) in these conversations and I was able to work with multiple CHWs across various projects. We were able to show that a CHW Hub was not only possible, but necessary to fulfill the promise of changing health paradigms. This team participated in some of the most inspiring stories of solidarity and human-centered care in Central Texas. Doing this work during a pandemic will forever stay with me. We did home visits, food deliveries, cash assistance navigation, vaccination work, and so much more. Many of those community members continue to stay in touch with me, showcasing the relationships that we built and reflecting the type of work that CHWs do. Our responsibility and accountability always remains in the community, and I am proud that we showed folks in Central Texas that this type of healthcare is possible (and essential).
Q: How do you see the role of community health workers evolving in the next few years, particularly in Texas?
When I came to the U.S., I was shocked that health services did not focus on Community Health Workers. Other countries elevate the role of Community Health Workers, respecting their understanding of social determinants of care and their ability to generate community trust to focus on prevention. In Texas, it continues to be an uphill battle to be any kind of healthcare provider. From a lack of Medicaid expansion to laws that cause harm and discrimination, this state makes it difficult to promote healthy living-especially in communities of color.
Despite these conditions, healthcare systems are starting to understand that there are great opportunities to improve health outcomes, lower costs, and shift responsibilities by respecting and elevating the role of Community Health Workers. I am hopeful that true leaders will start giving up seats at the decision tables and allow for CHWs to lead the transition to community-based health care.
CHW Certifications and job postings are popping up more, but we all need to advocate for roles that pay a thriving wage to retain and invest in CHWs long term. There are wonderful opportunities to create integrated teams of Social Workers, Nurses, and Community Health Workers to coordinate care. CHWs will need to organize and advocate for proper recognition within these healthcare systems and help create sustainable models of care.
Q: What advice would you give to individuals who want to get involved in community health and advocacy?
Stay accountable to your community. Build true and honest relationships with those most affected by structural violence. Do not participate in charity (vertical relationship), but instead focus on centering solidarity (horizontal relationship). Working in the community allows all of us opportunities to teach, but most importantly it allows us opportunities to learn. Participating at this level will also keep us accountable. Learning about the "People's History" and what the structural barriers are great places to start addressing public health. Furthermore, I believe it is important to have an anti-racist and anti-capitalistic stance in order to create better healthcare systems. Radical imagination is needed in order to shift paradigms.
Q: What are your hopes for the future of public health education in Texas, and how can organizations like TSOPHE play a role in that vision?
As a Community Health Worker Instructor, I am a proponent of Popular Education. We can all learn and teach at the same time. We need to advocate for truly democratic societies where everyone can participate. I envision education that is multilingual, multimodal, multi-generational, and radical. Shifting from "what to think" to "how to think" is the greatest opportunity in education. Critical thinkers will finds ways to interrupt violence and create local solutions.
TSOPHE can serve as a platform for voices that have traditionally not been at the table. Organizations can invest in indigenous healing and wellness platforms for people of color. I believe we all have a role to look at history and participate in reparations. I hope that public education in the state of Texas does not continue its trajectory of erasing important stories and elevating violent myths. There are opportunities ahead to get involved and make sure we can all learn and reconcile around truth and transparency. I look forward to working together to expand the people's history and to share knowledge around wellbeing and liberation.
