Culturally Attuned Training Brings Healthcare to Remote Areas
One of the groups supported by Seva's Community Self-Development Program (CSD) is EAPSEC — an acronym for its Spanish name, which means Team for the Support of Community Health and Education. Formed in 1985, EAPSEC is a group of health educators working in Chiapas, the state with the highest percentage of indigenous people and the worst health and poverty indicators in Mexico. EAPSEC provides primary health care training to marginalized groups that lack access to trained doctors.
Last year, with support from Seva and Partners In Health, a leader in international community health programs based at the Harvard School of Medicine, EAPSEC trained 137 community health workers across four regions in Chiapas, bringing health care to about 17,000 people.
Here is an interview with Julio Quiñones Hernández, a Clinic Coordinator with EAPSEC, conducted by Seva's Chiapas Program Manager, Roger Maldonado, and translated from Spanish.
Tell us about the communities you serve.
Most of the places where we work are very remote. It's a tropical, mountainous area. To reach the most distant communities in the Sierra region, we walk for about 12 hours because there is no other transportation.
The people in these villages don't have access to the information they need to care for their health. They live by the customs their grandparents taught them. If they boil their water or not, it is because of their grandparent's teachings. They can only live by what they know.
Sometimes a doctor comes, maybe once every two years. He gives some medicine and a little information, and then leaves — but this doesn’t have much of an impact. You need a health worker who is from the community and knows the beliefs of the people, and knows which customs are good and which of these customs should change.
Describe the training that health workers receive.
We train them in two fundamental areas. The first is called the social aspect. For example, health workers should know that diarrhea can be caused by bacteria or parasites; but they should also know that it can have an environmental cause or can be caused by certain customs. Health problems have many roots, not just biological causes.
The health worker needs to know that lack of latrines in homes is a cause of many illnesses; the same with not boiling water for drinking. All of these are social problems. The health workers recognize these problems and try to help find solutions.
The second is the medical aspect. The health worker learns to diagnose common diseases and learns what should be done when different symptoms are present. If they see a person with symptoms beyond their understanding or that requires more expert care, they will arrange to take the patient to a doctor.
So it sounds like preventive care is a big part of what you do.
Right. Disease is a consequence of poor health. That is how we see things at EAPSEC, and that is how the health workers should understand their role.
We can't say there is health when a person is malnourished or when they have no clothes. We can't say there is health when the people are cutting down trees and doing away with their own mountains. Health covers a very broad set of issues for us and does not necessarily mean medicine.
How has Seva Foundation helped EAPSEC's work?
Without Seva we would not be able to travel to our different training sites, and couldn't cover the transportation costs of the health workers. Seva helps us to keep our work going.
But it's more than just the economic aspect of things. It's not like they just give us the money and that's where the contact breaks off. No, rather there is an exchange between us — such as when Julie [CSD Program Director from the Berkeley office, Julie Rinard] comes to Chiapas and goes with us to the communities and stays for a time. That is when we help each other move forward in our work. We are working and learning together — learning how to make a difference for the people we serve.