Hi — I’m Courtney and I’m the Media and Development Coordinator for Sacred Valley Health / Ayni Wasi. Anyi Wasi is our Peruvian name in the Quechua language.
House of Reciprocity
We work to improve health through education, access, and empowerment in the rural High Andean communities in the Peruvian Sacred Valley.
The organization is relatively new, not even 4 years old, so my position mainly consists in getting our message out through the airways, letting people near and far know about the work we do. The position is new as well — I’m only in my third month of working with SVH/Ayni Wasi. As you might imagine, three months isn’t much time to understand the contexts we’re working in.
I may not be able to respond to these questions as thoroughly as the promotoras (community health workers), who have been living here all their lives.
However, I can provide you with what has been blatantly obvious to me from the moment I stepped off the plane.
As you know, health inequities are so pronounced that they’re visible to even an untrained eye.
Where did you grow? Were you always intent on working on issues of rural community health?
I grew up in suburban New Jersey, of all places. And though I always knew that I wanted to help people articulate and fight for more dignified living conditions, community health hadn’t exactly been on my radar. During my year of graduate study at Lehigh University in Politics and Policy, I began to research opportunities to work in Latin America. I know that in order to have a meaningful impact working with underserved populations, I must first understand my own privilege. In part, that’s why I chose to transplant to Ollantaytambo, Peru. Living and working in a different setting was the best way I knew how to situate my upbringing in a broader context.
The challenges and barriers of providing quality healthcare in rural Peru seem overwhelming, from language barriers to lack of infrastructure — like clean water and sanitation — to lack of hospitals, physicians, and basic health services. Rural indigenous populations so often face the largest burden of inequity and poorest health outcomes, all across the world. Why do you think this? How do the people you support in Ollantaytambo describe this inequity?
I conceive human health as individuals’ ability to translate resources into outcomes in a way that leads to a dignified life.
Global structural racism and classism impede rural Indigenous populations from actualizing in the arenas of education, employment and income, living conditions, and access to health services, which by my definition are all essential to human health.
These well-known sources of oppression are compounded by historical factors specific to the Indigenous experience in Peru, factors such as colonization and forced assimilation. One outcome of colonization — and its modern-day iteration, globalization and global tourism — is this:
Indigenous cultural identities are increasingly interpreted through outsiders’ standards and priorities. As a result, many Indigenous populations are losing the ability to determine their own livelihoods and activities, which has enormous consequences for health.
As for the people we support in the Ollantaytambo District, they’re ready to see improvements on these fronts.
They speak about (at least, to us) inequities in health in terms of unfairness and government inaction. They’ll point to a nearby urban center and contrast its infrastructure with their own communities’ perceived deficits.
In a country where most services are publically provided, communities expect government promises to be fulfilled equally. Inequities in health, then, are often regarded as neglect.
Creating local health systems that support community decision making and inclusive participation seem like a faraway ideal given the scale of inequities in power, especially when it comes to health. How do Sacred Valley Health’s Promotora Program and community general assemblies work?
The Promotora Program was founded out of the need to provide a sustainable solution to the health care problems that pervade the High Andean communities. It seeks to fill gaps in health services from the ground-up rather than compensate for them from the top-down.
Rather than having visiting medical professionals provide clinic services — which would compete with government health posts and, importantly, reinforce structures of power — the Promotora Program seeks to transfer health knowledge from accredited medical professionals to local people through training in basic diagnosis and services.
It seeks to empower local people to become health advocates and activists in their communities.
SVH/ Ayni Wasi promotoras attend monthly trainings, held at government clinics in the district. They then share their knowledge at community assemblies and on a more informal basis through household visits and small group presentations. The goal of this information sharing is for the promotoras’ knowledge to eventually permeate the whole community, allowing all residents to make informed healthcare decisions for themselves and their families. In addition, promotoras’ sustained engagement with neighbors creates a space for community members to identify and pursue their collective goals.
Promotora Luzmila makes a poster for her community presentation on UTIs next week. Image Credit: Sacred Valley Health.
What kind of leadership and participation do these assemblies foster?
During General Assemblies and secondary presentations, the community-selected promotoras educate their neighbors about health topics they’ve identified as important. The exchange of information helps strengthen voices within the community on issues related to health.
Also, it gives community members the tools to advocate for themselves and adapt to changing circumstances. As tourism encroaches more and more upon local customs and lifestyles, the High Andean communities will be better fortified against cultural degradation if they are accustomed to brainstorming and decision-making.
What are some of the most difficult moments you have faced in this work?
Like any international development organization, we’re working to put ourselves out of business.
Eventually, we’d like for the promotoras to embody health knowledge and authority in their communities; we’d like to approach the zero limit of our influence. But this takes time, and I sometimes worry that there’s too much of ourselves in the programming.
We’re moving towards a staffing model wherein the promotoras will take on more responsibility designing the curricula — the content and its presentation — but there are inherent challenges in this as well. On one hand, it’s crucial that the program is given over to the very people it’s meant to help. On the other, though, language barriers (most of the promotoras speak the local Indigenous language, Quechua) will make it difficult for program planners to ensure that the health information being delivered is accurate.
And then I start to ask myself, is accuracy more important than ownership? How much are we — Western-directed NGOs — willing to trade accuracy for cultural corruption? I struggle with these questions, but I do think it’s important for the international development community to engage with them honestly.
How do you envision how a social movement for the right to health — for Article 25 — can change things?
Social movements create spaces for mass dissent.
Ollantaytambo Hills. Image Credit: Tawhai Moss. Some rights reserved.
Ideally, a movement like Article 25 would motivate, at first, like-minded people, then policy-makers and world leaders, and eventually people who didn’t know about the debate at all, to critique the status quo.
To ask questions about why things are the way they are.
Why, for example, are 59% of communities covered by the 2007 census of Indigenous Peoples without a health facility? Why is the maternal mortality rate in Peru still approximately 200 maternal deaths per 100,000 live births?
Social movements give voice to those without formal representation.
They require the participation of those that have the most to gain from social change. For SVH/Ayni Wasi’s October 25 project, we have invited the promotoras to photo-document instances of health and un-health in their communities. Some of them will tell stories. They’ll be speaking for millions of Indigenous people living in rural areas that don’t have cameras in their hands and NGO staff recording their thoughts.
I asked you about your most difficult moments, I think it’s only fair to balance it out — What are some of the most beautiful moments you have faced in this work?
It’s always motivating to see community leaders validating our program.
Behind the scenes, we struggle to develop material that’s culturally appropriate, and sometimes I fear that we’re not getting there.
But last week, I attended a community presentation on alcoholism led by two promotoras in the town of Huilloc. They were presenting at the monthly meeting of the town’s artisanal collective, a group of more than 80 women. Though they were dealing with a tough subject matter — alcohol consumption contributes enormously to domestic violence in the High Andean communities — the promotoras remained firm and informative throughout.
Afterwards, they were invited by the collective’s president to present at every subsequent meeting of the group.
It’s this kind of feedback that lets me know that we might have struck a chord.
This September, world leaders are convening at the United Stations to kick off a set of global goal-setting negotiations for a post-2015 development agenda. If you could sit down with President Humala, what would you tell him?
I crowd-sourced this question, because I thought President Humala might want to hear from as many people as possible. Here’s what I got:
“I would want to discuss improved attention and services at the [government-run] health posts!” — Mary Underwood, Community Coordinator
“Equal care for the Peruvians coming from rural communities. Care for Peruvians without a national identification number and the ability to get that number even if they’re not born at a health post or hospital.” — Josselyn Agura, Community Coordinator
“That he give everyone in Peru access to potable water!” — Promotora from the community of Pilcobamba
“I’d ask for more money and support to be designated for program that benefit Indigenous peoples (such as expanding the posta services in rural areas and training interpreters). It would be great if you didn’t need a national ID number to get health insurance. I’d also ask him to do something about the crazy levels of air pollution in Lima.” — Anna Gajewski, Monitoring and Evaluation Coordinator
Are there any Peruvian poems or quotes that you or your staff return to for inspiration?
I asked one of our Peruvian staff members, Leticia, if she, herself, drew upon any poems or quotes for motivation. She told me she knew a poem. Twenty minutes later (after hearing amused chortles from her corner of the office) I received this email from her:
Las princesas de Ayni Wasi de cabellos de oro y ojos de estrella empezaron dejando esfuerzo / atravesando barreras peligrosas, / nevados frígidos, vientos silbadores, y recibiendo contraste de los apus, / luchando con gallardía dentro del programa salud preventivo. / En el éxito de la lucha se desgasto los zapatitos / poderosos en los tramos de las carreteras y herraduras incaicas, / gracias a las valientes princesas.
The princesses of Ayni Wasi, with golden hair and star eyes, began by giving their efforts traversing dangerous barriers, frigid mountaintops, whistling winds, y receiving the echoes of the mountains, struggling with gracefulness within the program of preventative health. To succeed in the battle, our powerful shoes become worn in the stretches of roads and Incan horseshoes, thanks to the brave princesses. (My apologies — the full beauty is lost in translation.)
Sacred Valley staff. Image Credit: Sacred Valley Health.