Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107241

Christina T. Holt, MD, MA, Department of Family Medicine, Boston University, Dowling 5 South, One Boston Medical Center Place, Boston, MA 02118, 617 414 6344, tinaholt@bu.edu, Michael Herce, MD/MPH 2005, School of Medicine, Yale University, Yale New Haven Medical Center, New Haven, CT 06510, Arachu Castro, PhD, MPH, Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, and Joia Mukherjee, MD, MPH, Partners In Health, 641 Huntington Avenue, Boston, MA 02115.

The Mexican health system utilizes centralized distribution and decision-making processes. This leaves many in regions where poverty, political conflict and armed violence have developed in the last ten years without needed access to medical care. For the majority of the 20,000+ mostly indigenous inhabitants of the Amatán region of rural Northern Chiapas, the nearest government health care facility is a 2-hour drive. Facing barriers to health care access, a team of CHWs—known as promotores—committed their time and energy, obtained clinical training, and solicited funding in order to build a primary care center in their community. Working with advanced Health Workers from a Chiapas-based NGO—EAPSEC or Team for the Support of Community Health and Education—the Amatán promotores built a six room clinical facility, obtained medical supplies to address treatment needs, contracted for ongoing clinical supervision and support for the basic CHW work, and successfully solicited a full-time physician “rural training” position to address secondary health needs. Additional clinical and community development projects include surveillance and treatment of tuberculosis, prenatal care and pediatric growth monitoring. Although geographic and political obstacles could have prevented them from responding to local health needs, these CHWs developed the leadership and strategic planning skills to set priorities and direct the health system to meet identified community needs. Meeting regularly and using consensus to set priorities, these Amatán CHWs have been able to marshal substantial material and technical resources to meet the needs they recognize in their rural community.

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