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2024BlogCommunity Health WorkersEl Salvador

Relationship Building and Accompaniment in Global Health Work

As an intern, volunteer, and fellow at International HELP (IHELP), I’ve had the opportunity to train more than 100 Community Health Workers (CHWs) around the world. It’s easy to mention that I have many “favorites” that come with my job and training the CHWs. For example, my favorite training day on projects is first aid. My favorite Salvadoran dish is pupusas revueltas (corn tortillas stuffed with meat, beans, and cheese). By far, my favorite part of my role at IHELP is growing in relationships with and accompanying our CHWs while working with community organizations at the local level. We spend time truly getting to know the people, both community partners and CHWs alike. This looks like being welcomed in their homes, sharing meals and stories, and understanding each others’ lived realities. This relationship building allows us to build trust with CHWs and community partners, and to sustain our connections to best support our CHWs over time.

Ashley and Monica (back row, right) with Texistepeque CHW group leaders

In March 2024, I traveled to El Salvador for a different type of IHELP trip. We didn’t set out to do any Community Health Worker (CHW) trainings. Rather, we spent the week simply spending time with people, to deepen relationships with the people and communities where we partner. (Our focus was being, not doing.) During the first few days, we did an assessment visit at a future project in San Juan Nonualco. Our community partner is a local church, with sites throughout the municipality. We visited each location, hosting interest meetings for local people interested in becoming CHWs and focus group discussions to learn from the people themselves what they consider the greatest health needs in their areas. We shared conversations, stories, meals, and more. The next part of the trip was to Texistepeque, to visit each active CHW group. During each group meeting, we listened to the lived experiences of the CHWs, hearing success stories and challenges/barriers. We welcomed feedback on how to best support and accompany them and listened to their hopes for the future. I feel inspired by the CHWs by listening to the work they’ve put in to improve the health of their communities. 

Ashley leading an interest meeting during a site visit in San Juan Nonualco

I want to share a passage by the late Paul Farmer, whose work and writings largely influenced me to enter the field of global health. A prevalent theme in both Paul Farmer’s writings and the work of IHELP is accompaniment through Community Health Workers (CHWs). CHWs are trusted community members with health education and skills that are empowered to accompany people in their communities. In my role, I accompany CHWs through my relationships with them, hearing about their lives and work, which is beautiful. In his collection of speeches To Repair the World, Farmer writes:

“Accompaniment” is an elastic term. It has a basic, everyday meaning. To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end. There’s an element of mystery, of openness, of trust, in accompaniment. The companion [Community Health Worker], the accompagnateur, says: “I’ll go with you and support you on your journey wherever it leads. I’ll share your fate for a while”—and by “a while,” I don’t mean a little while. Accompaniment is about sticking with a task until it’s deemed completed—not by the accompagnateur, but by the person being accompanied.

Ashley (back middle) and Monica (front center) with the Chilcuyo CHWs
Ashley leading a discussion with the El Sunza CHWs

My March trip to El Salvador was a time to accompany our CHWs, to deepen our relationships with them on their terms. I’m reminded now more than ever of the importance of relationship building and accompaniment in global health work, this work that ought to be from the bottom-up, rather than the traditional top-down approach. Sustainable and effective change comes from community members, which I witnessed myself on this trip through the CHWs I can accompany. Our time in El Salvador embodied “I’ll go with you and support you on your journey where it leads.” I am excited to see where the journeys of our CHWs lead.

Monica and Ashley with newly certified La Y Griega CHWs

We will be returning to San Juan Nonualco, El Salvador in May 2024 to host Community Health Worker (CHW) trainings. But before we go, I will run the Greater St. Louis GO! Half Marathon on Saturday, April 27th. 

You can help us make this project a reality! My goal is to raise $1310, $100 per mile of my half marathon. All proceeds from this fundraiser will go towards implementation costs of our 2024 El Salvador projects. By sponsoring a mile in whatever capacity (whether that’s $1 or $100 towards a mile’s goal), you can help educate, empower, and equip CHWs in El Salvador this year!

Ashley Richard, MPH, CPH

Fellow