HHI’s New Community Health Workers

Many people ask how we find our community health workers (CHWs); the answers to that question are as varied and unique as the health workers themselves. Some are former patients, or family members of patients. Some have volunteered during previous HHI field clinics, and some were suggested to us by community leaders. Cumulatively, they are four men and ten women whose ages span from 18 to 54 years. They speak Spanish, English, French and Haitian Creole, and they represent the communities of Negro Melo, Arroyo de Leche, Severet and Pancho Mateo. They are teachers, medical assistants, moto drivers, tailors, mothers, fathers, and now – community health workers.

Larikza, Yeraudiz and Yudi learn how to take blood pressure.

CHWs are nothing new: the barefoot doctor program in China and the accompagnateur program of Zanmi Lasante in Haiti are each at least 20 years old. The idea is simple: community members are trained to act as liaisons between physicians and patients by providing medicines, check-ups and health education to patients. This model can be highly effective in increasing medication adherence, preventing disease, and improving overall community health. Additionally, CHW programs build local capacity by providing basic medical skills and training to people who may otherwise have very few educational and/or job opportunities. For years the developing world has been ahead of the industrialized world on this front, largely out of necessity (e.g. more remote populations, dire poverty, physician shortages). However, the US is beginning to catch up: Dr. Atul Gawande recently published an article in The New Yorker about the success of multidisciplinary teams, including CHWs, in treating patients with chronic diseases (“Medical Report: The Hot Spotters,” 24 Jan 2011). We are seeing, over and over again, in multiple arenas, that CHWs can reach patients where doctors can not.

Genesis teaches other CHWs about the long-term effects of diabetes.

This is certainly true in the Dominican Republic. HHI’s Chronic Disease Management Program has nearly 100 patients, all of whom have hypertension, diabetes type II, epilepsy, and/or asthma. Many of these patients can not afford the moto ride necessary to get to the local clinic, much less the daily medications that their chronic diseases necessitate. Our CHWs fulfill a crucial role by following up on patients diagnosed with chronic diseases during HHI’s medical service trips, bringing them their prescriptions and providing them with monthly check-ups. They also provide health education and basic first aid to their entire communities.

New community health workers visit CMC, one of HHI's partner clinics.

HHI just expanded our corps of CHWs last Friday with the completion of our second training. Each of these new CHWs will add to HHI in different ways: there is Larikza, always ready with an illustrative story or patient example, and Willy, who speaks three languages fluently and dreams of medical school. There is Yeraudiz, whose heretofore-unknown acting skills improved many a class role-play, and Luz, whose prior experience working at an HIV/AIDS organization has already proved incredibly helpful. There is Yudi, who used her new first aid kit to help a neighbor the very first day she got it, and Dania, whose calm and confident manner will be endlessly reassuring to her patients. Carlito and Claudia form a husband-and-wife team whose skills and interests complement each other perfectly, and Genesis is a bright young woman eager to serve her community. This is the varied and unique group of HHI’s new community health workers, who will serve as teachers, caregivers, and community leaders in the coming years. We did not find them; they found us. And, my, are we lucky to have them.

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