Sacred Valley Health/ Ayni Wasi’s inaugural class of promotoras (community health workers) recently completed their final capacitación in the core promotora training program. The eight promotoras matriculated into the community health worker program two years ago, when they were elected by their respective communities to become community-recognized health representatives. Since then, they have attended monthly training workshops facilitated by SVH/Ayni Wasi staff, seen more than 400 individual patients, and educated their neighbors about important health topics in 36 General Assembly meetings and in 23 presentations to smaller community groups. The approximately 1600 residents of their communities now have access to a local trained health worker thanks to the promotoras’ hard work and that of the SVH/ Ayni Wasi staff.
The promotoras of our first cohort (Cycle 1) are an inspiring group of women who have made a impact on their communities in the last two years. Many people in isolated Andean communities are fearful and suspicious of government clinics, and reluctant to seek out medical care even in dire circumstances. Our promotoras serve as a vital link between their communities and the clinics. All promotora training sessions are held at clinics, and promotoras develop familiarity and connection with the clinics and clinic personnel. This connection enables them to feel confident in making referrals and accompanying patients who need care. Recently, Promotora Matilde Quispe Macchaca detected symptoms of pneumonia in a patient and rallied family members to accompany him to a health clinic despite his misgivings. Promotora Teresa Echame Vargas conducted a similar intervention with a patient suffering from a severe skin infection. She explained to him that the infection could threaten his life if left untreated, and successfully persuaded him to seek clinical care. Without these frontline interventions—diagnoses, referrals, and education—these ailments could have produced worst-case outcomes.
One of our Cycle 1 promotoras, Escolastica Castillo Obando, was recognized early on for her exemplary dedication to the program and was promoted to the role of Community Coordinator. She works in a supervisory capacity, overseeing two Cycle 2 promotoras. This model of training promotoras who go on to supervise other promotoras will enable us to reach more and more outlying communities. Importantly, it also provides leadership opportunities for local women. Whether in the office or in their communities, the Cycle1 promotoras embody empowerment as they increase health knowledge and access to services.
At the capacitación that marked the promotoras’ graduation from the core training program, Program Director Becca Williams and Head Nurse Leticia Huanca congratulated the group on their accomplishments. “You should all be so proud of how much you’ve learned and the work you’ve done in your communities over the past two years,” began Becca. She emphasized that a promotora’s role is ongoing, and that the work will continue even though monthly training sessions have ended. Graduated promotoras will participate in continuing-education courses that will meet with less frequency than the core training workshops. Additionally, all of the promotoras will be invited to attend an intensive 6-session development workshop on leadership skills. Those that complete the workshop will be eligible for full-time Docente (Mentor) Promotora positions within the organization. With our support, the selected Docente Promotoras will supervise future cycles of promotoras-in-training, who themselves will be chosen from communities even more remote than those within our program’s current reach.
After these congratulatory remarks and announcements, we got to work! There was still some business to take care of in the final capacitación, including a review of some of the most crucial topics the promotoras studied during the two-year training period. Community coordinators led the promotoras in role plays about gestational health and signs of alarm, nutrition, and first aid.
Then came the simulations. Mary rolled up the sleeves of her sweatshirt to reveal grotesque lacerations and burns drawn on with red marker. The promotoras feigned gasps and quickly applied soap and water, band-aids if the treatment called for them. “Oh, oh, ya me siento mejor,” (I already feel better) sighed Mary, faux-relieved. In another role play, Courtney ate a piece of bread and pretended to choke. Promotora Teresa rushed to the scene and performed the Heimlich maneuver. Though probably a foot shorter than Courtney, she managed to expel the lodged piece of bread within seconds. Once everyone was reseated, Katherine fainted to the floor. “She’s unconscious! She’s not breathing!” cried the community coordinators. In response, the promotoras took turns performing chest compressions until Katherine came to.
After a lunch and cookie break, the promotoras gathered to take a group photograph and plan their September 26 graduation ceremony.