• Health Care in Action
• Empowerment on the Altiplano
• Progress in the Lowlands
• Going to the People
• United Methodist Fellowship of Health Care Volunteers

Health Care in Action

The Emmanuel Community Center gave us our first opportunity to see Comprehensive Community-based Primary Health Care (CCPHC) in action as a working model for holistic health. At Emmanuel, when a new child comes to the church's daycare center, a local health promoter from the church's health center goes to the child's home for a family diagnosis, identifying needs and looking for the root causes of any problems. Much of the inspiration for CCPHC comes from the work of Dr. Mabelle Arole and Dr. Rajanikant Arole, who developed a model Comprehensive Rural Health Project in Jamkhed, India.

CCPHC is based on three principles: equity, integration, and empowerment. The program reaches all the people, including the poor and other marginalized groups. It integrates curative and preventive care, including economic and environmental concerns. And through accessible, affordable, and sustainable health care, the people of a community are empowered to help themselves—both in assuming responsibility for their own health and in acquiring marketable skills that enable them to support their families. When the women acquire these skills and start businesses, the impact on family health is direct.

In Cochabamba, we saw this community-based model working in a powerful way. We saw young children coming to the Emmanuel Community Center for nutritious food, mental stimulation, and emotional and spiritual nurture. We heard women speak with dignity about the work they do to promote the health of their families and communities. We saw the "third age" elderly women—who, in the past, were left at home in isolation—now visited by the center's health-care workers and trained in making crafts to sell.

Empowerment on the Altiplano

From Cochabamba we headed to La Paz, one of Bolivia's two capitals, located on the altiplano, or high plateau. At an elevation of 12,000 feet, La Paz is one of the highest cities in the world. Snowcapped Mount Illimani provides a stunning backdrop for the city, where adobe houses seem to climb steep canyon walls.

Our destination was the tiny village of Ancoraimes in the highlands along the eastern edge of Lake Titicaca. There, staff members welcomed us warmly to the Community-based Primary Health Care programs of Andean Rural Health Care. The Frank S. Beck Hospital, the only hospital in the Ancoraimes area, serves as the center for a census-based, impact-oriented public health-care program that is administered by Andean Rural Health Care in partnership with the Evangelical Methodist Church in Bolivia. Primary and secondary health care is provided to families in 51 small surrounding villages that are home to the Aymara, the indigenous people whose ancestors lived on the altiplano before the time of the Incan empire.

The dream that these indigenous people would become responsible for their own health care has come to fruition. The public health-care program is carried out mainly by indigenous community health workers from the Aymara villages. These workers visit every home in every village at least twice a year. Using this strategy, they have achieved an immunization rate of more than 90 percent and have reduced the risk of death for children under five to one-half that in other areas of Bolivia. Grassroots education focuses on environmental concerns, sanitary practices, and other preventive health-care measures.

A young Aymara mother, Primativa Mamani, shared her story of appreciation for Andean Rural Health Care. She believes her life and that of the child clinging to her skirt were saved because caring health providers were there when she had complications in childbirth. She graciously showed us her home and spoke with pride and dignity of her work as a community health promoter.

Progress in the Lowlands

The final leg of our Bolivian journey took us to the tropical lowlands of Santa Cruz. There, in nearby Montero, we visited another of the Andean Rural Health Care centers. We heard that immigrants from surrounding mountain areas come to Montero, but many who are are at high risk of disease are afraid to come to the clinic. So a team of community health volunteers goes to their homes. The community is divided into 38 barrios, each assigned a health worker. A family chart is developed for each home to assist in promoting health for each family member. Growth and immunization charts are kept for the children. Family planning methods are discussed with the adults. Ongoing health education is provided based on the family's individual needs.

The needs in Montero seem very great. The open market is littered with garbage and puddled with stagnant water. Dogs roam freely amid the flyspecked meat carcasses hanging in the hot sun. Many homes in the barrios have no indoor plumbing or running water. Animals and children live together on tiny plots of land.

Yet, in the midst of an overwhelming public health challenge, there is a sense of hope in this community, thanks to the Andean Rural Health Care Center. The dedicated staff members proudly share the center's accomplishments, passing around a certificate for achievement in reducing tuberculosis. Many more people now have access to running water, they tell us. Their laboratory can conduct water analysis, and people are being taught how to disinfect water that is impure. Latrines are being built. Opthamology and dental services are available. In many ways, progress is being made and lives are being changed.

Going to the People

During our first days in Cochabamba, we met with the Itinerant Team for the Promotion of Integral Health in Latin America and the Caribbean. These dedicated professionals from Argentina, Bolivia, Brazil, Chile, Cuba, and Guyana shared with us a common dream: that all the children of God may have the possibility of enjoying full health in harmony with family, with community, and with the God of creation. They shared with us some advice that is simple, yet profound:

United Methodist Fellowship of Health Care Volunteers

Members of the United Methodist Fellowship of Health Care Volunteers (UMF/HCV) are doctors, nurses, dentists, hospital managers, physical therapists, other health-care professionals, and laypeople who are willing to support and participate in time-limited health-care missions in the United States or throughout the world. Members receive a quarterly newsletter, listings of volunteer medical opportunities worldwide, and connections within their own jurisdictional structure and its medical organization.

UMF/HCV's purpose is to invite health professionals and other interested individuals to nurture and witness their Christian faith through ministries of healing of body, mind, and spirit as servants of Christ, providing health care to a world in need.

Phone: 208-234-4159
Fax: 208- 234-4223
E-mail: boeroger@crsinternet.com

Margie Hesson, a member of Spearfish United Methodist Church in Spearfish, South Dakota, and the author of several books, is on the nursing faculty at South Dakota State University. See also "Hope and Healing Through Comprehensive Community-based Primary Health Care" by Sarla Lall in New World Outlook, March-April 1999, pp. 22-25.