Supported project:
Mexico / Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC)

The residents of the southern Mexican state of Chiapas, mainly indigenous Maya, have long struggled with poverty, political violence, and dismal health conditions, including Mexico’s highest infant, maternal, and tuberculosis mortality rates. Armed violence between the Mexican government and allied paramilitary groups and members of the Zapatista National Liberation Army, which has been simmering since 1994, has disrupted peasant life in rural Chiapas, and has particularly undermined access to health services. Well before the Zapatista uprising, the Equipo de Apoyo en Salud y Educación Comunitaria (EAPSEC, Team for the Support of Community Health and Education) began working to improve access to health care for the indigenous poor in Chiapas. Since 1989, PIH has collaborated with EAPSEC to improve medical infrastructure in the region and to recruit and train hundreds of health workers, known as promotores.

As a "supported project" of PIH, EAPSEC shares many of the principles and practices of our model of community-based care. In particular, EAPSEC focuses on training and empowering promotores to educate their neighbors, attend to many of their basic primary healthcare needs and recognize when they require more expert clinical care. PIH supports these efforts with modest but important contributions to EAPSEC's annual budget and by encouraging doctors to work in Chiapas as part of the PIH-affiliated Global Health Equity Residency program at the Brigham and Women's Hospital's Division of Social Medicine and Health Inequalities.

In the town of Amatán in the Northern region of Chiapas, EAPSEC has been working with a coalition of local leaders to build and staff a community health clinic to serve the rural population. In the span of just six months in 2004, EAPSEC and the residents of Amatán designed the facility, completed the construction with donated time and materials, and began seeing patients. The clinic now includes a small pharmacy, a community meeting space, and four examination rooms.

Until early October, 2005, substantial progress could be measured in the number of community health promoters trained and deployed, the number of patient visits at village clinics, and the number of workshops conducted in impoverished indigenous communities. Then Hurricane Stan struck Chiapas with torrential rains. Floods and mudslides swept away entire communities of thatch-roofed huts, washed out roads and left thousands of people without access to shelter, food, potable water and health care.

PIH and EAPSEC sprang into action, sending out teams of health promoters and doctors, setting up temporary clinics in two of the worst-affected communities, and mobilizing donations of medicines and equipment from as far away as France, Switzerland, and the United States.

By late 2006, more than a year after Hurricane Stan, significant improvements had been made, but much remains to be done to rebuild infrastructure destroyed by the storm.
Currently 137 health promoters work in 11 municipalities and 83 communities across four regions of Chiapas, serving a catchment area of approximately 16,900 people.