DGH Live Blog: "Experiences in Community Health- Community Health Worker Training in El Salvador and Mexico"

Workshop/Break-Out Session:  Experiences in Community Health- Community Health Worker Training in El Salvador and Mexico.  Saturday July 16th, 2016



Juan Manuel Canales- Chiapas, Mexico

Irma Cruz Nava- Oaxaca, Mexico

Abraham Perez Martinez- Estancia, El Salvador


Summary:  This workshop highlighted community health worker/promotora programs supported by DGH in El Salvador and Mexico.  The presenters highlighted their individual projects and shared their collective experience. 


Juan Manuel Canales shared the work in and around Altamirano, Chiapas, Mexico, with the autonomous Zapatista communities, in which he has been working for over 16 years.  Dr. Canales brings the message that a community health mindset is critical to this work.  The “Community Medicine” framework is very different than the approach to health in most of Mexico and the U.S.  “We need to deconstruct the professional and capitalist mindset.  First, to work with indigenous communities, we need to take time to learn their languages.  There are three main indigenous groups in this region we work with.” 


He described the societal structure of the autonomous communities, including the Good Governance Councils.  He works with these communities and trains health promoters to work in areas where there is otherwise little or no access at all to healthcare.  He trains people at all levels- beginner to advanced, sometimes teaching to all levels within the same workshop, which can be a challenge.  He teaches the promotoras health prevention, nutrition, first aid, etc. and they perform vaccinations, minor surgeries, women’s health and other areas.  He also teaches the promotoras to triage sick people to local health clinics or hospitals when there is an urgent need.  He showed many beautiful pictures of the Zapatista communities. 


Abraham Perez Martinez shared the work in Estancia, El Salvador.


This work began during and after the armed conflict, with a group from France called Doctors of the World who introduced the community health worker/promotora model.  Initially, the El Salvador government didn’t support the use of promotoras, but with the change in power to FMLN government in 2008 and 2009, there is now much greater support for community based health approaches.  Although it is not 100% what the communities want to see happen, there is much greater access than prior.  In 2002, La Asociación de Campesinos para el Desarrollo Humano (CDH- Peasants for Human Development) began to more formally work with the Mayan communities in promotora training, health education, and other community health projects.  One of these projects includes Siete Semillas (7 seeds), and through this work they are able to identify and treat children who are malnourished. 

Currently, there is an epidemic of violence in El Salvador.  CDH works with youth to help them find alternatives to violence and build a future path that can help youth avoid gangs.  There is a lot of concern about this right now. 


In summary, he notes that to do this work, respect of the local community is the key to success.  When groups come and they do not listen to the community voice, or have a different way of working, things do not go well and CDH are not interested in this kind of collaboration.  The work that is done is presented to the community on a yearly basis each December, in order to promote group participation and shared responsibility. 


Dr. Irma Cruz Nava spoke about the work with Comunidades Campesinas en Camino (CCC) in Oaxaca, Mexico, as well as her experience working in El Salvador.  


In Tehuantepec, Oaxaca, the health project is fairly new, and has been going on for about 2 years.  Previously the CCC was focused solely on organic farming practices, and with the understanding of the connection between health, nutrition, land use, and overall wellbeing, they wanted to bring this attention to health and wellness to the communities in which they work.  The farmers grow organic chili, hibiscus, sesame, and other products, and bring it to market using a solidarity model among their farmers’ collective.  Currently there are 8 different community projects.  In discussions about health, they focus on community and social values, and healthy behaviors and practices that promote wellness.  Each week, Dr. Cruz meets with the health workers in each community and they work together to rescue and cultivate traditional plant medicine, improve nutrition, learn basic first aid, and explore areas of health improvement.  They also offer some medical services including health fairs, integrative therapies such as massage, acupuncture, and yoga, and other healing modalities. 


There was a short group discussion where people were invited to share their experience and explore the topic.  Some notable concepts were that Community Health is the cornerstone of this work.  Working in community health and with promotoras will be different in each community, and is based on the needs of each community.  Because of this, processes are holistic, and move forward at a slow pace.

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