Collaborating with the Cora community in Gunnison
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GRAND JUNCTION, Colo. — The Cora, otherwise known as Náayerite, are an ethnic group Indigenous to northwestern Mexico. Gunnison County happens to boast the largest population of Cora people outside Mexico.
Cora traditions and beliefs are generally well-preserved, and the group maintains a spoken language with five dialects.
The difference in language and beliefs between the estimated 350 Cora immigrants and the rest of Gunnison’s population has led to disparities, especially in health care and access; but, Cora community leaders, Hispanic community leaders, and Gunnison Valley Health are collaborating to mend that divide.
One of the initiative’s primary leaders, Cole Cooper, is a master’s student in Rural Community Health at Western Colorado University whose final project was to work with GVH to explore the health beliefs and gaps of the Cora community.
Who are the Cora?
Among eight autonomous Cora communities, the majority live in Jesús María, located about 130 miles northeast of Guadalajara.
The Cora who live there are self-sufficient and maintain a strong community, although increased cultivation and trafficking of marijuana has led to increased violence and threats.
“They came here originally doing sheep herding, construction and things like that in the nineties,” Cooper said. “They were seen as really hard-working people and were really respected, then this became known as a safe place for them to migrate to, so we just saw an influx of Cora people over time.”
The growing Cartel violence in Nayarit, the opportunity for a safe community, and higher-paying work in the United States led younger Cora men and women to immigrate; but, with increased risks of border-crossing and opportunities for permanent work, many Cora people permanently settled in Montrose, Delta and Gunnison.
Those who settled provided a more delineated path and destination to other Cora people in Mexico looking to immigrate, which led to Gunnison now having the highest population of Cora people outside Mexico.
Gunnison’s Cora population has continued to grow, becoming a pillar of the mountain community; yet, leaders of the local healthcare system recognized that very few Cora locals go to the hospital or access local health services.
That wasn’t news to the Cora residents, including Magdaleno Diaz, an active leader and one of few translators among western Colorado’s Cora community.
Linking languages
For more than four years, Diaz has worked as a translator and advocate for other Cora people — when he isn’t working his daytime job at Western Colorado University.
He began by occasionally accompanying people to doctor appointments when they asked for help interpreting; he later volunteered at Gunnison Country Food Pantry, assisting customers with intake forms and resource connections.
“I know this because I come from the same place: we don’t really like to speak with other people,” Diaz said. “We (can be) embarrassed and nervous, because the first thing that comes to my mind is ‘I can’t do it, and I don’t say the right thing, I could be in trouble or something.”
Before long, he found himself trained and hired to interpret for Cora defendants at the local public defender’s office, courtrooms and probation office. With his little remaining free time, Diaz has conversed with Gunnison Valley Health leaders on his experiences and how to lessen barriers between Cora and healthcare.
The language barrier many Cora residents experience can be especially frustrating because many translation services center around Spanish, which is not comparable to any of the five Cora dialects. Additionally, a written form of the language has only recently begun to emerge.
“Before, (other Cora) always said when they go to the hospital, they sit in the waiting area for two or three hours before someone even talks to them,” Diaz said. “They started changing that, they said this cannot be happening.”
Jennifer Birnie, Vice President of Community Health and Development for GVH, played a role in kickstarting and funding Cooper’s Cora health report through GVH to determine the disconnect. She said solving these challenges has proven more difficult than identifying them.
“It’s really hard to find Cora interpreters,” Birnie said. “We’ve got plenty of Spanish-speaking interpreters, but very few Cora interpreters, so we literally can’t understand them. A lot of people make the mistake that a Cora person can speak Spanish — (some) of them can’t, they only speak Cora.”
“There are a bunch of different Cora dialects, so it’s a hard language to learn. Finding that expertise in our community to help with interpretation has certainly been a challenge.”
Working outside of Western medicine
One factor that could be even more impactful than the language barrier is the disconnect between Western Medicine and traditional Cora beliefs in health and spiritual healing.
Cooper’s research, alongside others, found that the Cora beliefs around health and wellness are interwoven with community and customs, meaning their well-being has a direct correlation with the people in their lives and families, as well as participation in routine ceremonies.
“At the hospital in Mexico where I’m from, if you break your arm, they fix it with natural medication,” Diaz said. “They make tea for so many things, like when you have a fever or headache, so you’re not going to the doctor too much.”
That hospital, the Jesús María Hospital, maintains two facilities: a Western medicine wing and an Indigenous medicine wing. The Indigenous wing consists of traditional healers, including Curanderos (spiritual healers), herbalists, doulas (midwives), hueseros (bone-setters) and sobadores (comparable to massage therapists).
Health providers from both wings of medicine can offer patients a diagnosis and treatment plan, working together to allow the patient to select what works best for them — sometimes, that ideal treatment can be a combination of both.
Because this holistic health model is the standard in the home country for most Cora people, many of them expressed a desire for similar, diverse healthcare.
According to Cooper, it is critical to understand that while Cora health beliefs don’t perfectly align with Western medicine, that does not mean they are incompatible. He said that the Cora people do not exclusively believe in spiritual causes of illness, as they believe in natural and physical factors too.
Bringing culture into health care
According to Diaz and Birnie, one easily identified solution is that GVH staff are culturally competent, ensuring Cora people feel safe and welcome to seek care. Birnie added that it’s one of the solutions already underway, as they have organized training that involves staff interacting with Cora residents to discuss their perspectives and problem-solve together.
“You need to have cultural competency and cultural humility coming from your hospital staff,” Cooper said. “They need to understand what the Cora (people) believe, so if a Cora brings up something around spiritual healing, they understand what they’re talking about and know to hold space for it.”
Regardless, Birnie said that — while GVH can’t revamp the entirety of a model serving the majority demographic – they have had several conversations with Jesús María Hospital about potentially providing some of the traditional healing avenues through telehealth. This would enable GVH providers and patients to “zoom in” a traditional healer for consultation.
According to Cooper, he has conducted more than seven presentations to GVH staff on the Cora health beliefs to raise awareness and cultural competency. He added that his report, while much lengthier than the presentation, was also made available to GVH faculty.
Beyond telehealth and teaching competency, Birnie said that an ideal solution for filling positions like doulas, or midwives, would be to train and sponsor a specific person through the necessary schooling to provide the service.
“A lot of immigrants move here, and they’ve got a lot of experience,” Birnie said. “They were lawyers, therapists and doctors, and they came here because they want a better life, but because of the language barrier or their legal status, they aren’t able to practice in the same profession that they did when they were in another country.”
“We’re not opposed to that at all, we just have to identify who those people are.”
Training people in the Cora community to work in a healthcare capacity is also a potential solution to the potential mental health disparities identified in Cooper’s report.
In the study, several incidences of what is known in Western Medicine as depressive symptoms (e.g., little pleasure in doing things; feeling down, depressed or hopeless; struggling to connect with family and community) were found among the Cora.
The report suggests these mental health challenges could stem from a few factors: the violence Cora people in Nayarit were escaping from (Cooper spoke to one Cora resident who had lost two brothers in the last few years due to Cartel violence), the traumatic experiences related their journey to Gunnison across the border and a culture where talking about mental health or personal issues is stigmatized as being crazy or weak.
To address this mental health gap within the Cora community, GVH is in talks with the Cora community to determine how they could help Cora residents receive education and training that would allow them to provide mental health support within their community while also destigmatizing mental health through advocacy and awareness.