Antonia Sierra-Martinez still remembers the day she stood beside a sick neighbor who struggled to breathe, as she held a syringe for an injection she had only seen others administer.
“Yo era una niña. Te estoy hablando de siete, ocho años,” Sierra-Martinez said in Spanish. “I was a child. I’m talking about 7, 8 years old.”
The neighbor, Don Damian, begged her to give him the shot, Sierra-Martinez recalled. His adult children were there, but they had seen the girl help her mother enough times to trust her judgment.
That kind of responsibility was already part of Sierra-Martinez’s childhood in Santa María, a small Mexican farming community in the municipio of Jerécuaro, Guanajuato.
Her mother, the woman neighbors normally called when someone was sick, was out in the fields and couldn’t be found. Sierra-Martinez watched her give shots many times before.
Terrified that she could hurt him, still trembling, she prepared the supplies the way she watched her mother do it and gave him the injection.
When her mother found out, she didn’t scold her. Instead, she took Sierra-Martinez to Irma, the nurse who taught her mother to give injections, so the girl could learn to do it safely.
“If my mom wasn’t around, I was the community’s nurse,” Sierra-Martinez said.
Her mother had little formal education but became one of the people neighbors turned to when they needed help.
“My mom started advocating for electricity and potable water,” Sierra-Martinez said.
Her mother often depended on other people to help prepare letters and documents. As Sierra-Martinez learned to read and write, she took on that role herself.
Decades later in California, Sierra-Martinez, now 47, learned there was a name for the kind of work she did beside her mother since childhood: promotora de salud. In California, promotoras help bridge gaps between health systems and communities that traditional services can’t reach.
By then, Sierra-Martinez had fought to stay in school, taught people to read, coordinated rural education programs, earned a law degree, worked in municipal government in Mexico and survived a crash that nearly killed her.
The fight to learn
In her community, school ended after fifth grade, Sierra-Martinez said. Few completed their education, and instead, they prepared for marriage.
“I didn’t want to get married. I didn’t want to be tied down,” she said. “I wanted to study. I wanted to get out.”
With the help of a priest, Sierra-Martinez went to a nearby Catholic school to finish sixth grade, then did housework for the vice principal in exchange for a place to stay for secondary school.
But when her father, who was working the fields in the Central Valley, returned home, he pulled her out of school.
“My father would come back and say, ‘No, why should women study?’” she said.
Her teachers helped Sierra-Martinez keep up with assignments, and she kept going until, at 15, she moved out, rented a room, and sold freshly squeezed juices to support herself and her studies.
At the same time, Sierra-Martinez taught people to read in nearby communities and earned extra money by sending photos and reports to a television station in León.
She later went to Mexico City hoping to study medicine, but admission problems and health issues she linked to the city’s pollution brought her back home.
At 18, she joined Educación Inicial, working with rural families on early childhood development, nutrition and access to care. She eventually helped train and supervise women in their own communities doing that work.
Sierra-Martinez stayed with the program when she enrolled in law school, using the income to help pay for her education.
With six months left before graduation, Sierra-Martinez was returning from a training in a rural community when a tire came off the vehicle she was driving. The vehicle rolled with her sister and a friend inside.
When first responders arrived, they took the two passengers to a local hospital. Sierra-Martinez was left for dead on the side of the road.
The crash came during a period when Guanajuato’s emergency medical system was still expanding.
In the mid-1990s, the state strengthened its emergency workforce by adding ambulance equipment. Regional emergency services in rural areas did not arrive until years later.
“I was screaming inside, ‘I’m not dead, help me. Please don’t leave,” she said.
That December night, unable to move or talk, she remembers arguing with God in her head.
“‘Why do you do this to me? I’ve tried to be a good human being,’” she remembers asking, before accepting her fate. “Oh God, forgive me. You’re right. Who am I to argue with you?”
Hours later, she heard a familiar voice. It was Don Cuco, a former paramedic who sometimes accompanied her on work trips into remote areas.
“I don’t even know how … I managed to say his name,” she said.
She spent two months at a hospital. She was told she wouldn’t walk again. Her classmates took notes for her, and her teachers gave her oral exams at her bedside.
“I don’t like to leave things half done,” she said. “It took six months for me to recover, and that’s how long it took for me to graduate.”
As she recovered, a man she met before her crash, now her husband, stayed by her side and helped her recuperate.
“He values me. He takes care of me,” she remembers thinking.
Her mother did not approve of the marriage, but they got together and started a new life shared between Mexico and California.
A new life in California
Their daughter was born in California, but Sierra-Martinez returned to Mexico when she was offered a position as head of social and human development in the municipal government.
That position addressed many of the problems her mother tried to solve years earlier.
At the same time, she started a law firm with a former classmate from university.
Sierra-Martinez split her time between the two countries. Her partner worked in California while she and the children stayed in Mexico, and she traveled back and forth.
Her oldest daughter eventually spent about a year in California with her father. When she returned to Mexico, Sierra-Martinez said she began noticing the effect the separation was having on the children, something her mother noticed too.
“There are priorities in this life,” she remembers her mother telling her, reminding her that she had achieved professional success, and it was time to focus on her family.
Sierra-Martinez decided the family would live together in California.
“I left my house. I left my law office. I left my job. I left everything,” she said.
In California, living in a small trailer, Sierra-Martinez stayed at home for six months before she decided she needed to work.
Because she didn’t understand English, her options were limited. Her first job, sorting tomatoes at night on a conveyor belt, left her fighting dizziness and nausea through her first shift.
“OK, welcome to the American dream,” she remembered telling herself after purchasing motion sickness medicine after her first shift.
She took other agricultural jobs before landing work at a chocolate factory, first sorting ingredients and later working in chocolate production.
That job ended when production shut down during the COVID-19 pandemic. For Sierra-Martinez, being out of work soon led her back to something she had done since childhood.
COVID-19 and a familiar kind of work
As the COVID-19 pandemic took hold of the country, Sierra Martinez began volunteering as a promotora de salud, where she distributed food and supplies and shared information while also helping organize clinics.
When paid part-time promotora work became available, the chocolate factory also reopened, leaving her to choose between the better-paying factory job and community work.
“I love what I do,” she said, explaining that the choice to do community work was easy.
Her children, just as she did as a child, got involved and accompanied her to meetings, homes, and conversations with neighbors.
Around that time, Sierra-Martinez met Anabel Serna, promotora coordinator with the nonprofit Cultiva Central Valley, while the two were doing community outreach near Gustine for a USDA-funded program that provided farmworkers a one-time $600 payment for work performed during the pandemic.
Sierra-Martinez stood out, Serna said, for the energy she brought to the work and how quickly she responded when someone needed help. As they continued working together, Serna said she came to see Sierra-Martinez as someone she could depend on.
“Nunca he escuchado que ella diga, ‘no puedo’ – I’ve never heard her say ‘I can’t,’” Serna said in Spanish. “It’s always, ‘Let me see how I can do it, how I can solve it.’”
During the COVID-19 pandemic, a statewide effort involving 540 promotoras and community health workers reached more than 127,000 people through health fairs and educational outreach, and more than 432,000 accounts through messaging apps such as WhatsApp, according to a 2024 American Journal of Public Health report.
Their work included sharing health information, helping people find testing and vaccines and carrying community concerns back to health officials and researchers.
Today, the calls Sierra-Martinez gets can involve cancer, pregnancy, depression, food or a family trying to understand which programs they qualify for.
She does not always have the answer herself, but over the years she has built a network of promotoras and community contacts she turns to when someone needs help.
Part of her work includes working alongside UC Davis Researcher Carlos Castañeda, who partners with promotoras to help inform communities about the cancer research his team uncovers.
“I know Antonia very well, and I think she’s an amazing person,” he said. “She’s an amazing woman. She’s very talented. She has a lot of energy, and she has an amazing heart. We need more Antonias in California.”
When one family needed clothes, formula, diapers and food for young children, Sierra-Martinez tapped into her network. Soon, donations filled her car’s trunk.
“She told me, ‘I didn’t think there were generous people here,’” Sierra-Martinez remembers the woman telling her, with tears in her eyes. “That’s where we come in, to give them that confidence and tell them, ‘You can do this. You can do that.’”
For women new to the country or afraid to ask for help because they don’t speak English, Sierra-Martinez tries to build their confidence to ask questions, even if that means asking for someone who speaks Spanish at a store, clinic, or government office. She also gives families her phone number.
“If you have a problem, even if it is midnight, call me,” she tells them.
That kind of availability, Serna said, takes more than willingness. Gas, transportation, family responsibilities and unpaid time can keep promotoras from doing as much community work as they would like.
Contemplating when to stop
When Sierra-Martinez visits Mexico, she looks at programs she has learned about in California and wonders what could work around Santa María. Educación Inicial, the program she once helped coordinate, no longer operates the way she remembers, and she still imagines doing similar work there if she returns.
Her husband has talked about eventually moving back to Mexico, and Sierra-Martinez can see herself going too.
Years ago, Sierra-Martinez said, working was necessary to help support her children. Now, even with them grown, her calendar remains filled with community meetings, appointments and projects. Retirement, whether in California or Mexico, is difficult for her to imagine.
Her three oldest children have another idea. On Mother’s Day, she said, they came with gifts and told her she had worked enough.
All three now have jobs and offered to split the expenses so their mother could finally stay home.
“I can’t. I’m not someone who can just sit around,” she said. “It’s not part of me to stay still.”