The Estradas, who live in a mobile home in central Nogales, are pregnant again. But this pregnancy is going much smoother, thanks in part to Nuestra Comunidad, Nuestra Salud, a rural training program coordinated by The University of Arizona Health Sciences Center and funded by a three-year grant from Public Health Service and the U.S. Department of Health & Human Services.

Once a week, UA nursing, pharmacy, and public health students and faculty, and Arizona State University social work students, climb into a van and head out for a day-long journey to southern Santa Cruz County. The students make home visits, assess community health care needs, and develop intervention programs addressing issues such as teen-age pregnancy prevention, substance abuse and immunizations.

During the home visits, nursing students work alongside promotoras de salud (lay health workers) who work at the Mariposa Community Health Center and represent the Arizona Department of Health Services (ADHS) Health Start program in Nogales. A recent report indicates that the mothers in the Health Start Program, which helps reduce their cultural, economic or transportation barriers to health care, are more likely to get prenatal care earlier, less likely to have pre-term babies, and more likely to have average-birth-weight babies.

Students enrolled in Nuestra Comunidad contribute to the success of Health Start through a "real-life" learning mission, offering case management and community-based care to a grateful community.

"The visits have helped me a lot," Maria says. "Many people think that because you've already had a baby, you know everything about being pregnant and how to take care of yourself. We were worried about how tiny my first baby was. I was afraid the same might happen with this preg-nancy, but I feel healthier and I've learned a lot more."

"Our goal is to identify the health needs of the community and find ways to meet these needs," explains Maria Dolores Losoya, the promotora who works closely with the Estradas and with Eileen Kriter, the UA nursing student who makes the weekly joint home visits with Losoya as part of the Nuestra Comunidad program.

"We learn a lot about the people in this program when we enter their homes and see the support they have, the general health of their relatives, and how they keep their homes," Kriter says. "We try to provide additional support."

In the afternoon, the nursing students go to the District 28 Little Red School, a kindergarten-through-eighth-grade school about 5 miles northeast of Nogales. Here, they assess how the larger community affects the Little Red School.

Students conduct a comprehensive assessment that draws from the community's demographics and vital statistics, religion and community values, physical environment, health and social services, economics, safety, transportation, politics, government, communication, education and recreation. In close collaboration with the school community, an intervention is developed to respond to the priority problem or need. At the end of the semester, the programs are implemented. These have included team building and substance abuse education/prevention with 6th, 7th and 8th graders and their teachers, and immunizations for influenza and Hepatitis B.

"This school is a resource-poor, rural school," explains Marylyn McEwen, M.S., R.N., C.N.S., a senior lecturer at the UA College of Nursing and co-principal investigator on the Nuestra Comunidad program. "They do not have a health office or nurse. The programs the nursing students present are extremely helpful to this community."

At the end of the day, students once again climb into the van, ready to head home. The hour-long trip back to Tucson gives them an opportunity to hash over the events of the day, highlighting what they've learned and setting their goals for the next trip in the week ahead.

"I believe that one of the benefits of this program is what it does not only for the students, but for the community," says Marion Slack, Ph.D., assistant research scientist and teaching associate at the UA College of Pharmacy and principal investigator on Nuestra Comunidad. "The clients on the home visits have a different interaction with the students than they do with more experienced health care professionals. Clients seem to sympathize with the students, with their unfamiliarity with the community. They recognize that they are not experts, but that they are there to learn and help clients solve their problems."

Many of the clients are the same age as the students, McEwen adds. "They can see what the students have done with their lives and can use this as a positive role model to help decide how they can change their own lives."

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