Ignacia has to rap sharply on the front door to be heard over the high pitch of the Huayno singer crooning out of her neighbor’s radio. She is allowed inside right away—everyone knows each other in a 40-person community. Ignacia begins her introduction, “I am your health worker and am visiting houses around the village to see if anyone has any diseases or problems that they’d like me to look at.” In Ignacia’s community of Marcuray, all of her neighbors are aware of her position as a health promoter, but still, few visit her home to get advice or seek treatment. Many residents of Marcuray and other isolated communities have grown accustomed to coping with their health issues by themselves, as they live far from government health clinics. Having a promotora in close proximity means that the community members no longer have to endure their health troubles on their own, but unfamiliarity and possible discomfort with having assistance near at hand might prevent some from seeking it out. With the support of her Sacred Valley Health community coordinator, the promotora goes house-to-house both to publicize her position and to build the trust and confidence of her neighbors.
The promotoras absorb a considerable amount of information in their relatively short training period so that they will be able to identify a wide range of conditions and treat a subset of these.
Sometimes a promotora will visit a neighbor to offer care and they will present her with complicated issues to which she is not prepared to respond. When this happens, the promotora refers the patient to the nearest medical clinic for more advanced care. In this way, the promotoras expand the reach of the clinic network.
Something we try to instill in the promotoras during capacitaciones is the ability to recognize their own limits as community health workers. Through their training, they’ve become proficient in basic first aid and the detection and treatment of common conditions, like diarrhea. However, there is much that they cannot and should not attempt to treat independently. Sometimes, across cultures, health workers find it difficult to say the words “I don’t know.” Will encouraging the promotoras to admit to their limitations cause a loss of community confidence or, conversely, inspire respect and curiosity? This is one of the many questions that we face in determining how to guide the promotoras to be as effective as possible.
– Written by Community Coordinator Josselyn Agura