Bridging the gap and breaking barriers, how HSC helped train a TCOM student to serve her community
Brenda Godoy got the email on January 26 and was in total disbelief. It was a fake. There’s no way this was this real. Surely, the mistake would be fixed, and Godoy would get a follow-up email saying she had not been accepted to the Texas College of Osteopathic Medicine. It never came. Godoy was in fact going to be part of TCOM’s Class of 2026 and she could not believe it.
It was not until March 7 that she told her family the good news; she was going to medical school. Amidst all of the tears of joy and happiness, Godoy already had a head start on her medical training a year before.
Thanks to The University of North Texas Health Science Center at Fort Worth, Godoy, working alongside Dr. Teresa Wagner — who is the director of the Community Health Worker program, assistant professor in Lifestyle Health Sciences and clinical executive for SaferCare Texas — was trained as a CHW to address problems in her hometown of Mount Pleasant.
The town had been ravaged by COVID-19, and the Hispanic community had the highest rate of COVID in the state of Texas. Titus Regional Medical Center, the only hospital in the county, knew they had a problem.
It was Godoy, Wagner, Titus Regional and an entire community that came together to overcome barriers in communication, trust and access to health care to solve the pandemic problems and much more.
Godoy herself, along with her family, has for years felt the effects and the struggles of not being able to easily access health care.
The first day of orientation at TCOM for Brenda Godoy was a milestone. She was starting medical school, yes, but it was the first time in six years she had health insurance.
“We have a big family when you include aunts and uncles, and a majority of them are uninsured,” she said.
The insurance situation with her family is complex with both of her parents being uninsured. When Godoy was 12, the big scare came for her family. Godoy’s mother was three months pregnant when she started having complications and was losing weight rapidly. When she was down to 85 pounds, doctors determined that a tumor in her uterus was the cause of the issues. This tumor had been discovered several years earlier but her lack of health insurance prevented her from immediately removing the tumor.
“She was very, very thin, however, I remember that during this time, my parents were admirably calm about the situation, and that brought me peace,” Godoy said. “Our faith in God really carried us. My mom needed the surgery or else her condition could worsen.”
When a financial assistance program offered to help with the cost of the surgery, relief came to a weary family. The surgery removed a six-pound benign tumor from her uterus and months later, her brother was born without any complications.
For years, her parents’ only outlet for health care was at annual free health fairs, but their underlying problems were never truly addressed. Starting in 2016, her father began to develop myriad health problems such as diabetes, hypothyroidism, psoriasis and hypertension. Searching for an affordable primary care provider was difficult, but it was through family friends that Godoy’s family was able to find a sliding-scale clinic in a neighboring town where her father could be treated. Regular access to health care was now accessible to both of her parents.
Her family’s experiences sparked Godoy’s interest in medicine. She wanted to advance health outcomes, especially for low-income and underserved communities. She graduated from Texas A&M University in May of 2020 just as the COVID-19 pandemic was sweeping across the world. Godoy was still preparing for the MCAT and medical school seemed almost out of reach at the time. She returned home to help with her two younger brothers, but with the hope of finding some work in the medical field.
It was then through a friend that she was sent a job posting at HSC for a community health worker.
“I initially wasn’t sure what a CHW was,” Godoy said. “When I learned more about the role and responsibilities of a CHW, I was very excited. It applies to many osteopathic tenants: very patient-centered, meeting the patient where they are with a holistic approach. It was an amazing opportunity to work with my community on a project aimed at improving access to health care services.”
She applied for the position in late 2020 and began waiting to hear back.
How the CHW program works
In Texas, a CHW must complete a rigorous training of 160 hours that covers eight core competencies of community health work: communication, interpersonal interactions, service coordination, capacity-building, advocacy, teaching, organizational skills and knowledge.
The goal of providing the training is to get more community health workers out in the communities that need them. Wagner became a certified CHW Instructor in 2016, and HSC became a certified institution to provide community health workers with continuing education in 2018.
“CHWs are natural helpers in the community who serve as a liaison — a link and an intermediary between health, social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery,” Wagner said.
In 2019, Wagner and HSC began working with Titus Regional Medical Center CEO Terry Scoggin on a plan to improve health literacy within the community of Mount Pleasant.
“We started looking at [health literacy] before COVID in 2019, and we worked with Dr. Wagner to put together a communication plan,” Scoggin said. “One of the issues we encountered was within our Hispanic community. There was a cultural barrier and a dialect problem, and we worked with Dr. Wagner and her team to understand that.”
Hispanics make up 50.4% of the population in Mount Pleasant, so finding a way to reach out to the community in English and Spanish was important to Scoggin. Once COVID hit, some of those plans were sent to the back burner, but some of those lessons were also implemented.
Tough Times in Mount Pleasant
As the pandemic ebbed and flowed across Texas, Titus County was particularly hard hit, especially among the Hispanic population. The county had the highest rate of COVID among Hispanics in the state, but the lowest mortality rate per 100,000.
There were communication barriers that were preventing the Hispanic community from establishing trust with health care providers, and the hospital discovered problems with some of their translators.
It was at this time in late 2020 that Wagner was able to secure grant funding, and she met with the hospital about hiring a CHW. Godoy had responded to the advertisement about the position, and Wagner felt she had the right person.
“She had just moved back to Mount Pleasant and already had an interest in health care, and she had done a lot of observations with providers,” Wagner said. “I felt like she would have enough community knowledge having grown up there and could serve as a bridge between Titus Regional Medical Center.
“I paid for her training through the grant to become a CHW and knew it would be beneficial for that community, but at the same time also beneficial for her future to have that credential,” Wagner said. “She got trained, passed and was certified by the start of Jan. 2021 and began working with Titus on their initiatives.”
Godoy got straight to work, organizing focus groups, talking with community members and getting the local churches involved.
“The focus groups participants from our Hispanic community voiced their stories and feelings of being unheard, unprotected and ignored by the health care system in our town,” Godoy said. “Many patients only speak Spanish and do not have anyone to translate for them. Sometimes their interpreters are their underaged children. In most instances, the hospital and clinics did not provide interpreters. Financial assistance resources, health and social services were also not readily accessible to them. They were grateful to have representation, and it was a privilege for me to be part of the team that brought this information to Titus Regional Medical Center.”
She also worked with Tracie Smith, the senior director of marketing for Titus Regional, who praised the efforts of Godoy.
“She did a fantastic job reaching those key leaders and making sure we had the right number of people in the room,” Smith said. “She put all the data together and what she had learned from the groups. We were very grateful.”
What Godoy found was no different from what her family had experienced. Economic instability, cultural and linguistic barriers and limited knowledge about services provided challenges to the Hispanic community in gaining access to health care.
That was about to change.
Once the data from the focus groups was received from Godoy, Dr. Wagner, Scoggin and Smith got to work on solutions.
“Terry (Scoggin) was very humble and very open to whatever our findings were,” Dr. Wagner said. “He opened up a bilingual clinic with Spanish-speaking physicians. He hired two bilingual physicians and opened up a community clinic for those who lacked transportation. It all came together that way and Brenda played such a significant role.”
Godoy’s work within her community was now seeing results. Clinics were opening, and Spanish-speaking physicians were being hired. The health care community in Mount Pleasant was starting to transform with the hope of gaining trust among the community.
“She was instrumental for our transformation,” Scoggin said. “She provided a very significant level of detail related to our challenges, especially with our bilingual focus groups and how we were communicating with the Hispanic community.”
Smith started changing the way they marketed health care materials to the community. They found that radio was a better tool to reach underserved populations as opposed to social media or internet-based information. The goal was to make it easier for the Hispanic community to understand and navigate access to the health care system.
The health literacy work with Dr. Wagner combined with Godoy’s community work gave Titus Regional Medical Center what it needed to break down those barriers.
“I wasn’t surprised in the scope, but I was more surprised at how it all worked out with Brenda,” said Dr. Wagner. “It’s just not typical to have the perfect CHW and the perfect CEO that follow through on everything you ask.”
Godoy’s work with Titus Regional Medical Center finished in August of 2021. She was now focusing on being accepted into medical school. It was her father’s birthday, Jan. 26, 2022, and she was accepted into TCOM.
Her family celebrated that day in March on Godoy’s birthday when she finally told them. Godoy’s parents have been determined every step of the way to help her succeed no matter how scarce the resources might have been. From selling homemade food and pastries to raising money for household expenses to maintaining their old vehicles in good condition for daily commutes, her parents have sacrificed for all of their children.
“I have been very blessed with my parent’s support, as well as the support from my entire family and those around me in my community, such as my professors, mentors, friends and classmates, all of whom have contributed to my accomplishments,” Godoy said.
During her first week at orientation, Dr. Frank Filipetto, TCOM’s dean, had words for the Class of 2026 during his welcome, but a few lines in particular resonated with Godoy.
“The way he speaks about the medical profession and health care system is very inspiring and encouraging,” Godoy said. “Dr. Filipetto said, ‘Everyone is different, and that is amazing. Patients want physicians who look like them, who speak like them, who know the community like they do.’ He also emphasized changing the way health care is delivered. I believe his words also apply to the CHW profession due to the valuable contributions they have the potential to make in the communities they serve.”
Scoggin echoed those sentiments.
“This is a springboard for us, to help enlighten us to continue the work,” he said. “It really changed our focus. We have to make ourselves better. This is on us to transform the way we deliver health care to the communities of color and underserved populations.”
Godoy recently received her White Coat with her family in the audience to cheer her on. Godoy’s osteopathic medical school path has just started, but there is no secret about where she wants to end up practicing as a physician.
“I want to go back to Mount Pleasant; that’s home for me,” Godoy said. “My ultimate goal is to open up a free clinic in my hometown. I volunteered at a free clinic in College Station and always thought about the benefit that it could have in my hometown and other rural, low-income and underserved areas.
“In addition to that, I believe establishing partnerships with other physicians and professionals from various fields such as social work, counseling, insurance and finance departments and CHWs — every point of contact a patient has as they navigate the health care system can really help patients get the information and assistance they need to prevent disease and improve and maintain their health. I think back to how much this could have helped my family and even myself. The goal is to bring health care to those who need it the most and don’t have access to it because of barriers.”