Promotoras in Peru

Building knowledge networks for better health.

by Nikki McCoy

In a recent conversation via Skype Michelle Glatt ’95 laughed, “There is no typical day in Ollantaytambo. I could be in the office all day building curriculum, or I could be hiking three hours to visit a village.”

The rural town of Ollantaytambo, Peru.

Ollantaytambo. Photo by Daniel Gasienica © 2.0 via Wikimedia Commons.

Glatt, a certified physician’s assistant with a master’s in public health, is the director of programming at Sacred Valley Health/Ayni Wasi, a non-governmental organization with sister facilities located in Seattle and Peru, respectively.

In the tiny rural town of Ollantaytambo, Peru—a gateway to the tourist destination of Machu Picchu, located about two hours from the nearest city of Cusco—Glatt works toward disease prevention and health promotion through Sacred Valley Health’s Promotora Program.

Matilde and Beatriz learn to use a digital thermometer with help from Ruben, a Quechua translator.

Matilde (left) learns to use the digital thermometer while Beatriz (center) tests one out with help from Quechua translator, Ruben.

Promotoras are community-elected representatives who receive basic health education that allows them to act as a resource to their families and villages. After training, they can assess common health issues, provide basic first aid, or for more urgent situations, encourage visits to clinics.

Promotoras also give frequent presentations on topics such as parasite prevention, nutrition, and the importance of vaccinations. They might also teach local weavers and farmers to address back pain or other musculoskeletal complaints through stretches and strengthening exercises.

And the program is working, delivering educational presentations to nearly 3,000 community members between February and July of 2015 alone.

Glatt puts the insights from years of clinical and healthcare information technology experience to work in practical, hands-on health promotion. In developing programming, she takes evidence-based knowledge about population health and modifies it for the community. For example, Glatt said, she might be working on complementary breast-feeding. She explained, “Children often become anemic by the time they are two years old and around 30 percent of the kids in Andean Peru are anemic. The foods added to infant diets after the exclusive breast-feeding age of six months often don’t have enough micronutrients, so we start with a nutrition curriculum from the World Health Organization for breastfeeding mothers and adapt it for our communities, based on the foods we know exist in Peru.”

The majority of Ollantaytambo’s inhabitants live in isolated villages, most without running water or electricity. More than one-third of children suffer from chronic malnutrition. Dehydration, anemia, and pneumonia are chronic issues for both young and old.

Promotoras study nutrition, preventive care, and other health-related topics.

Promotoras study nutrition, preventive care, and other health-related topics.

Currently 19 promotoras, mainly women, are in action across 13 rural villages in Andean Peru.

“I’m happier since becoming a promotora,” said Anastacio in an interview for Sacred Valley Health’s website. The resident of the T’astayoc community added, “Everyone in my community knows that I’m the health promoter. I like that they come to me with their health issues.”

Promotora training is the main layer in Glatt’s programming. A sub-program, designed for sustainability, is hiring docentes—the promotoras who train new promotoras.

“This is a train-the-trainer system,” explained Glatt. “This works well for us because it jumps through some of the cultural barriers. It’s also an opportunity to extend our geographic reach, giving isolated communities a greater chance at receiving information. So promotoras are not just in Ollantaytambu, they are now seven hours up into the mountains.”

Promotoras study nutrition, preventive care, and other health-related topics.

Michelle Glatt distributes vitamins. Photos courtesy of Sacred Valley Health.

A third program layer is vitamin outreach, where promotoras provide much-needed vitamins to children and pregnant or lactating mothers. The direct benefit is obvious, but another outcome is relationship-building and data collection—in exchange for the vitamins, community members share vital health information, including vaccine history.

Data documentation is an important piece of the program. Part of Glatt’s previous healthcare work in the U.S. was focused on improving electronic health records and mining the data to advance patient care.

Using that knowledge, Glatt is working to implement a health outcomes database system in Peru. Sacred Valley Health is young (founded in 2012), and while the staff know that promotoras are developing and sharing health care knowledge, Glatt estimates it will be another few years before they have enough data to demonstrate that chronic health conditions are significantly improving in the communities.

“I’ll feel successful if I build a program where I can actually measurably improve the health of the communities we are working with,” she said. “We’re not going to change the world, but we are going to reduce the number of kids with anemia and reduce the number of pneumonia deaths in this area.

“One of the things that has been driving me the past 20 years is the idea of health disparities—that your options for health shouldn’t be determined by where you were born.”

Originally interested in neuroscience, Glatt earned her B.S. at Evergreen.

Michelle Glatt.

Michelle Glatt. Photo courtesy of Sacred Valley Health.

“The way education is set up at Evergreen, I was able to explore subjects that I wouldn’t have had the opportunity to explore at another university. If I had to go through Biology 101 with 300 people sitting next to me, I doubt my interest would have been sparked as much as it was at Evergreen…I think with science at Evergreen, you just get into the good stuff a lot faster,” Glatt said.

She began her career as a physician’s assistant providing direct care at health centers serving immigrant and refugee populations. These experiences led her to a career in healthcare quality improvement consulting, where she helped clinics find creative ways to improve health outcomes for their patients.

Glatt’s Evergreen education, her work as a physician’s assistant, her consulting projects, and her desire to make a difference have reached a high point with her work at Sacred Valley Health.

Promotora Beatriz uses posters to teach about nutrition, hygiene, and healthcare.

Promotora Beatriz uses posters to teach about nutrition, hygiene, and healthcare.

“I think my entire career path has led me to this,” she said. “People are always confused about how I ended up in rural Peru, but it actually makes complete sense to me. The factor that ties it all together is my interest in healthcare disparities, so everything I’ve done up until this point is about how to do something better, or more creative, or more effective to address healthcare disparities in the populations that I’m working with.”