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A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico

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Abstract

We conducted a qualitative study employing structured interviews with 38 community health workers, known as health promoters, from twelve rural municipalities of Chiapas, Mexico in order to characterize their work and identify aspects of their services that would be applicable to community-based tuberculosis (TB) control programs. Health promoters self-identify as being of Mayan Indian ethnicity. Most are bilingual, speaking Spanish and one of four indigenous Mayan languages native to Chiapas. They volunteer 11 h each week to conduct clinical and public health work in their communities. Over half (53%) work with a botiquín, a medicine cabinet stocked with essential medicines. Fifty-three percent identify TB as a major problem affecting the health of their communities, with one-fifth (21%) of promoters reporting experience caring for patients with known or suspected TB and 29% having attended to patients with hemoptysis. One-third of health promoters have access to antibiotics (32%) and one-half have experience with their administration; 55% complement their biomedical treatments with traditional Mayan medicinal plant therapies in caring for their patients. We describe how health promoters employ both traditional and allopathic medicine to treat the symptoms and diseases they encounter most frequently which include fever, diarrhea, and parasitic infections. We contend that given the complex sociopolitical climate in Chiapas and the state’s unwavering TB epidemic and paucity of health care infrastructure in rural areas, efforts to implement comprehensive, community-based TB control would benefit from employing the services of health promoters.

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Acknowledgments

The first author would like to thank the Yale School of Medicine (YSM) Committee on International Health and the David Rockefeller Center for Latin American Studies at Harvard University for their financial support through a Downs International Health Student Travel Fellowship and Term-time Research Travel Grant, respectively. He would also like to thank the YSM Office for Student Research for supplementing my Downs Fellowship with a NIH student research stipend. To Drs. Curtis Patton, Sheldon Campbell, and Miguel Reyes-Múgica, thank you for your advice and support during the planning phase of this project. To Leonel Gónzalez Ortíz, Dagmar Castillo Roblero, Julio Quiñones Hernández and Gabriel García-Salyano from EAPSEC, thank you for your years of friendship and for being “mis primeros profesores de la justicia social.” To my colleagues at Partners in Health and the Division of Global Health Equity at Brigham & Women’s Hospital, especially Joia Mukherjee, Paul Farmer, Jim Kim, Joe Rhatigan, Howard Hiatt, Arachu Castro, and Ophelia Dahl—thank you for teaching me how to fight for global health equity; you are all an inspiration to me.

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Authors and Affiliations

  1. Division of Global Health Equity, Department of Medicine, Brigham & Women’s Hospital, 651 Huntington Avenue, FXB Building, 7th Floor, Boston, MA, 02115, USA

    Michael E. Herce & Arachu Castro

  2. Division of Global Health & Human Rights, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Jacob A. Chapman

  3. Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA

    Arachu Castro

  4. Partners in Health, 888 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA

    Arachu Castro

  5. Equipo de Apoyo en Salud y Educación Comunitaria, Calle Francisco León, EAPSEC, No. 76, San Cristóbal de Las Casas, Chiapas, 29230, Mexico

    Gabriel García-Salyano

  6. Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA

    Kaveh Khoshnood

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  1. Michael E. Herce
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  2. Jacob A. Chapman
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  3. Arachu Castro
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  4. Gabriel García-Salyano
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  5. Kaveh Khoshnood
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Correspondence to Michael E. Herce.

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Herce, M.E., Chapman, J.A., Castro, A. et al. A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico. J Community Health 35, 182–189 (2010). https://doi.org/10.1007/s10900-009-9206-0

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