Empower Bolivian Women to be Local Health Leaders

During the rainy season, roads that run through rural Bolivia become virtually impassable.  After a heavy rain it is nearly impossible to travel down the dirt road, for example, that connects the eight villages in what is commonly referred to as La Banda of the Municipality of Minero.  It usually takes days of sunshine before the road can be used again.  In rural areas like La Banda, the rain affects much more than a day of outdoor activity and play.  The weather impacts access to schools, health centers and services as well as economic livelihood.

For the past three years, Etta Projects has been training community-elected local women to serve as community health promoters.  They have received training in first aid, nutrition, women and children’s health, and hygiene & sanitation promotion.  The health promoters play an important role in responding to the health needs of their community year-round, but perhaps their job becomes most important during the rainy season.

At 11 a.m. on January 6^th, Yovana began showing signs and symptoms of labor- severe back pain, cramping and diarrhea.  She immediately turned to her community health promoters, Marta and Calendaria.  By noon, the health promoters called the ambulance and the women waited and prayed that despite the heavy rain and impassable roads the ambulance would be able to arrive to the village to bring Yovana to the hospital.

While they waited for the ambulance, Marta and Calendaria put the lessons learned from the women’s health unit into practice. They held Yovana’s hand, kept her calm and led her through breathing exercises.  It was not until almost 12 hours later that the ambulance finally arrived to the village.  By this time, Marta and Calendaria were not about to leave Yovana’s side so all three women boarded the ambulance and started the commute to the hospital.  About half way there, Yovana was ready to deliver.  With no other options, Marta and Calendaria were forced to deliver the baby in the ambulance.  When they arrived to the hospital the doctor said the promoters did a “flawless” job.  Today both mama and baby - Luis Fernando Duran, 4,400 kg.- are doing well! 

The support that Marta and Calendaria gave to Yovana and Luis Fernanado is just one out of countless moments that proves both the need for and the effectiveness of Etta Projects’ health promoter program.  These women health leaders understand the health needs in their community, and they also understand the gap between their village and the available health services.  They are uniquely positioned to effectively respond to community health needs.  These women are known as community health promoters, but we like to refer to them as community heroes!

When Etta Projects began training local women from rural Bolivian villages to serve as community health promoters our goal was to bring skills and health supplies directly to isolated areas that would allow them to effectively respond to local health needs. Over the past three years, these newly-trained women leaders have risen to the challenge!  Today they tend to the sick and injured, maintain community health kits, coordinate with local health centers, and host health fairs and events.  Some of the health promoters have even returned to school to become nurses and others have earned leadership positions on municipal health councils.  Each and every one of the health promoters have become protagonists of change in improving community health.

The health promoters have brought light to many issues faced by women in their communities- one of the biggest being domestic violence.  Natasha Loayza of ONU Mujeres in Bolivia states, “Bolivia ranks 1^st of the 13 Latin American countries in incidences of physical abuse of women and second in sexual abuse, after Haiti.”  She adds that domestic violence is most prevalent in rural communities.  Etta Projects conducted its own study with the 45 health promoters and found that 77.78% (35 of the 45 women) have been or are victims of some type of domestic violence.  A woman from the village of Rio Viejo shared, “My husband is very jealous.  He makes me stay at home and care for him and the children.  One time, he abused me so badly I lost my unborn baby.”

Etta Projects has recently responded to this pressing issue by offering workshops to health promoters (and at times their spouses too) to promote gender equality, eliminate domestic violence and emphasize strong, positive values in relationships.  We aim to include both men and women in the process of advocating for women’s rights and against domestic violence.  Participants reflect on the importance of respecting the rights of women- not just for women, but for the entire community. 

On November 25th hundreds of men, women and children as well as municipal representatives and local doctors came together from 15 villages to celebrate International Day for the Elimination of Violence against Women.  The event, which was led by the 45 community health promoters, included presentations and songs from health promoters and male leaders, traditional dances by women and children and a large march where all the attendees chanted the rights of women.  Our goal is to not only strengthen justices circles among women in the community, but to also include male partners, adolescents, local leaders, reproductive health providers and local social welfare agencies in a collaborative process of change.