By Lindsay Palazuelos, Project Coordinator 

This blog post is the second in a series of Partners In Health’s supported project in Guatemala—Equipo Técnico de Educación en Salud Comunitaria (ETESC, Technical Team for Education in Community Health). Read Lindsay’s previous post.


Michelle Lightfoot, HMS student, helping two Health Promoters practice taking vital signs.


Jonathan Niconchuk, HMS student, talking with a group of Health Promoters during the vital signs practice.


The board after a simulated patient case exercise.

Recently, I was in the hot seat at ETESC’s Health Promoter training.  Why?  A runny nose of epic proportions.  The Health Promoters’ job was to diagnose my ailment.  As I sat before them, blowing into a hankie, they asked a series of key questions: how long had I been sick, did I have a fever, a cough, sinus pressure?  Their conclusion was that I had the common cold, albeit a particularly snotty one, and I had better have some tea. 

This relatively simple diagnosis was in fact the result of a sophisticated process: the syndromic approach to diagnosis.  This means using a pre-determined set of questions and clinical signs in the form of algorithms (flowcharts, in this instance) based on medical evidence and local epidemiology.  Health Promoters’ ability to differentiate among common illnesses--and refer serious ones before they advance--is critical to their role as clinical extensions in rural villages.  Francisco Pablo Francisco, a Health Promoter, explained, “I like the way we’re learning practical skills…Now we know [more about the human body], how to interview a patient, and diagnose what they’re suffering from.” In this model, Community Health Promoters serve as a local resource for common ailments, but most importantly, extend active case finding.

Two Harvard Medical students, Jonathan Niconchuk and Michelle Lightfoot, with the assistance of Clinical Director Dan Palazuelos, are leading ETESC’s cadre of health promoters in intensive trainings on the syndromic approach.  Through PIH’s collaboration with Harvard Medical School, the students gain valuable experience in global health while contributing to service or research projects on the ground.  “The process of teaching is the most powerful motivator to learn more yourself,” Jon reflected.

The training also emphasizes appropriate use of medications.  Most medicines are in Guatemala are sold over the counter in the same manner as hair gel or potato chips, sometimes leading to inappropriate use.  Through training, Health Promoters may help break many common patterns of misuse, such as antibiotic overuse or treating the symptoms of a serious chronic disease while the cause continues unchecked.

Another goal of the course is to serve as a training laboratory, yielding important insights into the best pedagogic methods for community health workers.  Feedback so far highlights using real or simulated cases (like me), as a top method.  The Promoters have made the method their own, and at a recent regional health conference, the ETESC group volunteered to lead just such a case activity for all the attendees.  “Seeing the Health Promoters adopt a patient-based learning style was great,” Michelle said. “It showed that they found it useful.”

In a remarkable show of dedication, the Promoters elected to add days to the trainings to be able to learn even more information.  I could hardly believe my ears when Francisco gave the course what I felt was the biggest vote of confidence.  In a country where the midday meal is nearly sacred, he urged, “We can keep going through lunch!  Give us more example patients, and we can practice while we eat.”  

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