In the end of July, I started my Lombard Fellowship as a Community Coordinator at Sacred Valley Health/Ayni Wasi. We’re located in the small town of Ollantaytambo in the Sacred Valley of Peru. The massive ruins of the fortress and temple of Ollantaytambo loom over the small town, population approximately 2000. During the Incan resistance against the Spanish conquistadores, Ollantaytambo was the site of an important battle won by Manco Inca against the Spanish forces led by Hernando Pizarro, the half-brother of Francisco Pizarro. Ayni Wasi means “House of Reciprocity” in Quechua, the native language of the Peruvian Andes, which is still spoken by a large percentage of residents of the Sacred Valley.
Our mission is to promote health in rural, high-Andean communities with limited access to healthcare. To this end, we have trained a network of 19 promotoras (community health workers) in 13 rural communities in the mountains above Ollantaytambo. These communities range in altitude from 10,000 to 14,000 feet above sea level; many are inaccessible by car or can only be reached by public buses or market trucks on certain days of the week. As a Community Coordinator, I train our promotoras about health topics that are important in their communities, including pneumonia, diarrheal diseases, anemia, wound care, and nutrition. We provide transportation so the promotoras can come down to our Ollantaytambo office for training days, where we teach them the importance of these health topics, run through disease scenarios, and practice using the protocols that enable them to decide if a patient can be treated at home or needs to be accompanied to the nearest posta (government health post). The promotoras use this information to give educational talks during community meetings, do educational house visits to community members, and provide first aid in their communities. As these rural communities are often a several hours’ walk away from the postas, having trained community members accessible to their neighbors greatly improves health outcomes in these communities.
Another central part of my Community Coordinator position is to be directly responsible for the promotoras in several of our rural communities. This entails visiting the communities several times a month to help reinforce the promotoras’ knowledge of health topics they feel weak in, accompanying them on house visits, and helping them prepare for community health education talks. The two communities I work in directly are called Huilloc and Yanamayo. I get to Huilloc by riding a public combi, a minivan retrofitted with seats for around 20 passengers, for 45 minutes up the mountain. There are two promotoras in Huilloc, Santusa and Teresa, both of whom have worked with Ayni Wasi since the organization’s inception. Santusa has repeatedly asked me and the other two Community Coordinators for Huilloc to visit her and help her increase her health knowledge and understanding. Yanamayo is located much further up the same mountain range, a two-hour ride by market truck or public bus along the winding, bumpy, one-lane dirt road. Matilde, the promotora for Yanamayo, has also worked with Ayni Wasi for three years. She only speaks Quechua and can neither read nor write, which means we have to adapt how we teach her our health topics. With Matilde, we use visual materials to help her learn and feel comfortable with the information. When I visit Yanamayo, I go with Escolástica, one of our Peruvian staff members who speaks Quechua, to spend the night in Matilde’s small cement house. We bring her food—generally fresh vegetables, cheese, and rice—to make soup to supplement the potatoes from her fields for our evening meal. As her hands busily knit, we talk with her about health topics that she finds difficult and help her feel more confident with the material so she can present it to her neighbors and other community members.
Currently, I am working on a qualitative research project with several other Ayni Wasi staff to gain a better understanding of the promotoras’ perspectives, experiences, and suggestions. The goal is to use this information to continue to improve the sustainability of our program and our ability to improve health outcomes in the communities we serve. This is especially important as we are in the process of hiring more than 40 new promotoras in our communities. They will enable us to reach more community members, as many of our communities are very spread out and it can be hard for the promotoras to reach all of the homes. I recently led two focus groups with twelve of our promotoras from both sides of the Sacred Valley, where we spoke about the factors that motivated them to be promotoras, their experiences within their communities, and how they feel the work has changed them and their families. The promotoras were excited about the chance to share more about their perspectives and what they have seen in their work with their fellow promotoras and with us. I hope to be able to do some follow-up with these promotoras and the new ones after the New Year.
One challenging aspect of my Lombard Fellowship as a Community Coordinator is the language barrier. While I am bilingual in Spanish, I had never previously learned Quechua, the language spoken by most inhabitants of this region. Many of our promotoras speak both Quechua and Spanish, but some, including Matilde, only speak Quechua. In addition, most of their interactions with community members are in Quechua as well. I am working on learning Quechua so I can better communicate with the promotoras, but it is a very difficult language to learn, as you can change the meaning or intent of words by adding prefixes and suffixes. Hopefully I’ll be able to carry out some conversations by the time I leave in June!
My Lombard Fellowship with Sacred Valley Health/Ayni Wasi has been a fantastic learning experience so far. Every day, I see how upstream factors like access to healthcare, language, living conditions, and economic factors influence people’s health decisions and well-being. I am very thankful for the opportunity to learn from these promotoras and to gain a deeper appreciation of Peruvian culture and how lived experiences impact health outcomes. I look forward to learning more in the next five months!