Samsamshariat Tina, Madhivanan Purnima, Reyes Fernández Prada Alexandra, Moya Eva M, Meza Graciela, Reinders Stefan, Blas Magaly M
The University of Arizona College of Medicine, Phoenix, Arizona, USA
Department of Emergency Medicine, LAC USC Medical Center, Los Angeles, California, USA.
BMJ Glob Health. 2023 Oct;8(10). doi: 10.1136/bmjgh-2023-012727.
The COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from indigenous communities in the Peruvian Amazon expanded their roles to mitigate the effects of the COVID-19 pandemic.
Fourteen CHWs from Loreto, Peru, participated in a community-based participatory research project using Photovoice, a technique encouraging vulnerable groups to take photos and develop stories illustrating their lived experiences. Participants were recruited from Mamás del Río, a local university-based programme, through purposive sampling. CHWs were asked to photograph how the pandemic affected their lives and work. Participants met four times over 5 months to share photos and develop action items. Data were organised into key themes using thematic analysis. CHWs shared photo galleries with policy-makers in Loreto and Lima.
CHWs produced 36 photos with 33 texts highlighting their roles during COVID-19. Three core themes emerged: the (1) collapse of health infrastructure, (2) use of medicinal plants versus pharmaceuticals and (3) community adaptations and struggles. The leadership of CHWs emerged as a cross-cutting theme as CHWs supported COVID-19 efforts without government training or resources. CHWs asked policy-makers for formal integration into the health system, standardisation of training and management of community pharmacies.
CHWs demonstrated their leadership and expanded their roles during the pandemic with little to no training from the government. Global investment in robust CHW programmes can fortify healthcare delivery.
新冠疫情导致秘鲁卫生系统崩溃，扰乱了亚马逊地区原住民社区获得医疗服务的途径。我们的研究分析了秘鲁亚马逊地区原住民社区的社区卫生工作者（CHW）如何扩大其作用以减轻新冠疫情的影响。
来自秘鲁洛雷托的14名社区卫生工作者参与了一项基于社区的参与式研究项目，该项目采用摄影叙事法，这是一种鼓励弱势群体拍照并讲述说明其生活经历的故事的技术。通过目的抽样从当地一个基于大学的项目“河流之母”中招募参与者。社区卫生工作者被要求拍摄疫情如何影响他们的生活和工作。参与者在5个月内会面4次，分享照片并制定行动项目。使用主题分析将数据整理成关键主题。社区卫生工作者与洛雷托和利马的政策制定者分享了照片库。
社区卫生工作者拍摄了36张照片，并配有33篇文字说明，突出了他们在新冠疫情期间的作用。出现了三个核心主题：（1）卫生基础设施的崩溃，（2）药用植物与药品的使用，以及（3）社区的适应与挣扎。社区卫生工作者的领导作用成为一个贯穿各领域的主题，因为他们在没有政府培训或资源的情况下支持新冠疫情防控工作。社区卫生工作者要求政策制定者将他们正式纳入卫生系统，对培训进行标准化，并对社区药房进行管理。
社区卫生工作者在几乎没有或完全没有政府培训的情况下，在疫情期间展现了他们的领导能力并扩大了其作用。对强大的社区卫生工作者项目进行全球投资可以加强医疗服务的提供。
