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Page | 1 Health Horizons International Facilitator Manual Community Health Workers Course April 2011
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Health Horizons International
Facilitator Manual
Community Health Workers Course April 2011
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Table of Contents
3-4
Unit 1: Introducciones y Expectativas
5 Horario
6-11 Animal Cards
12-13 Unit 2: La Misión de Horizontes de Salud
14-18 Evaluación
19-20 Unit 3: Los Signos Vitales y Primeros Auxilios
21-22 Wound Pictures
23-24 Unit 4: La Presión Alta
25-27 Pictures of Hypertension Symptoms
28-29 Pictures of Hypertension Consequences
30-31 Pictures of Ways to Lower High Blood Pressure
32-34 Unit 5: La Diabetes
35 Picture of Pancreas
36 Picture of Insulin
37-39 Pictures of Diabetes Risk Factors
40-42 Pictures of Diabetes Symptoms
43-44 Unit 6: Las Enfermedades Infecciosas
45-48 Pictures of Modes of Disease Transmission
49-51 Unit 7: Los Medicamentos y la Adherencia
52 Unit 7 Review Questions
53-54 Pictures of Allergic Reactions
55-56 Unit 8: La Salud Pública y la Educación Comunitaria
57 El Parrafo de la Diarrea
58-59 Unit 9: Responsabilidades de los Cooperadores
60-61 Patient Confidentiality Positive Role Play
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Unit 1: Introducciones y Expectativas
Objectives:
By the end of this unit, cooperadores will be able to:
● name the other participants as well as the facilitators
● describe the rules decided upon by the group to create a respectful and supportive
learning environment
● explain the schedule, structure and associated materials of the training
● complete a pre-assessment covering first aid, chronic disease, infectious disease,
medication adherence, and public health
Necessary Materials: name tags, animal cards, pencils, pencil sharpener, timer, chart paper,
markers, Cooperador workbooks, snack
Time: 95 minutes
● Introductions (20 minutes)
○ Greet the group and introduce yourself. Today the group will be learning about
each other, the facilitators, and Health Horizons International (HHI).
○ Distribute name tags and markers to everyone.
○ Distribute animal cards and instruct each person to find their “other half.” Once
they have found their partner, they will have six minutes to make name tags and
get to know each other (e.g. ¿Cuál es tu nombre? ¿Cómo es tu familia?
¿Dónde vives? ¿Por qué quieres ser cooperador? ¿Cuál es tu comida
favorita?). If there are two facilitators, role model the activity for the group.
○ Set the timer for six minutes. After three minutes, remind the pairs to switch
roles so that the original partner asking the questions is now answering.
○ After six minutes, ask each pair to present themselves to the class. Each
cooperador should introduce his/her partner to the class, reviewing all
information discussed.
○ Ask cooperadores to remove their name tags. Ask one participant to attempt to
name all the cooperadores and facilitators. Continue until everyone has had a
chance to name everyone in the group.
○ Collect the animal cards.
● Rules (20 minutes)
○ Explain that a respectful and collaborative environment is necessary for
cooperadores to learn and work to the best of their ability. Thus the group will
decide on some basic ground rules that will apply to everyone and facilitate a
successful learning environment.
○ Ask the group to brainstorm various rules and expectations. Write down all
suggestions. Encourage participation from all cooperadores.
○ When everyone has contributed, take a vote on the four or five most important
rules. Ensure that punctual attendance, respect for others‟ opinions, and class
participation make the list.
○ At the end of the activity, write down the rules that were voted upon in large text
on a piece of chart paper and hang it somewhere in the room for the rest of the
course. If a cooperador breaks a rule over the course of the training, approach
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him/her individually to review the rules that were agreed upon.
● Logistics (15 minutes)
○ Hand out a workbook to each cooperador. Explain they will need the previous
days‟ notes during every class, so they should bring their workbooks every day to
remain organized and prepared. This is the only thing they have to bring with
them to every class.
○ Ask cooperadores to open their workbooks to the schedule. Review each day‟s
activities and objectives aloud.
○ Explain that being a cooperador is both a responsibility and a privilege.
Additionally, after cooperadores have gone through the training and acquired
some experience, they will be eligible for a monthly salary. In order to receive
certification and the opportunity to become an HHI employee, however,
cooperadores must prove that they are responsible and reliable.
○ Ask a volunteer to use the schedule to review which concepts will be discussed
during the next class.
● Pre-Assessment (30 minutes)
○ Explain that the purpose of the pre-assessment is not to judge or grade the
cooperadores; instead, it is to understand what they already know and do not
know in order to make the training more useful. Answers will not be discussed
during today‟s class, as they will be taking the same assessment at the end of
the training.
○ Go over the structure of the questions together, explaining how to complete
true/false questions, multiple choice questions and short answer questions.
○ Complete the first true/false question and the first multiple choice question
together as a whole group.
○ Set the timer for 25 minutes for the cooperadores to complete the remaining 23
questions.
○ Snack (10 minutes)
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El Horario de la Capacitación de los Cooperadores de Salud
Hora Lunes Martes Miércoles Jueves Viernes
1:00 - 2:30
Presentaciones y Expectativas * identificar a los
participantes y los
profesores
* hablar de las
reglas escogidas
por el grupo
* explicar el horario
y los materiales
necesarios
* terminar una
evaluación
Los Signos Vitales y
Primeros Auxilios
* reconocer las cifras
normales del pulso,
la frecuencia
respiratoria y la
temperatura
* tomarle los signos
vitales de un paciente
* vendarle una herida
* explicar la
importancia del
técnica estéril
La Diabetes * explicar las causas de
la diabetes y diferenciar
la diabetes tipo 1 del tipo
2
* reconocer los síntomas,
efectos y factores de
riesgo de la diabetes
* darle recomendaciones
saludables a un
diabético
* identificar los cuatro
medicamentos usados
para tratar la diabetes
* usar un glucómetro
Las Enfermedades Infecciosas * explicar las diferencias
y similaridades entre las
enfermedades infecciosas
y crónicas
* describir la transmisión
de infecciones
* dar ejemplos de las
infecciones parasíticas,
virales, por hongos y
bacterianas
* decir algunos factores de
riesgo de las infecciones y
cómo evitarlas
La Salud Pública * explicar las maneras
en que la salud
pública puede afectar
a la salud comunitaria
* preparar una charla
educativa bien
organizada
2:30 - 4:00
Horizontes de Salud
* definir la salud
y la salud
comunitaria
* conocer los
programas de
Horizontes de Salud
* describir la misión
de Horizontes de
Salud y explicar
como está apoyada
por los programas
La Presión Alta * definir “la presión
arterial” y “la
hipertensión”
* explicar los factores
que suben la presión
* tomar la presión
* reconocer las tres
medicinas usadas por
Horizontes para tratar
la hipertensión
* decir cinco maneras
de bajar la presión
sin tomar medicina
(La Diabetes cont.) Los Medicamentos * identificar los antibióticos,
antiparásitos y antihongos
usados por Horizontes
* explicar la importancia
del cumplimiento
correcto del tratamiento
antibiótico
* describir las síntomas de
una reacción alérgica
contra los efectos
secundarios
* explicar el peligro de
tomar medicamentos
Responsabilidades * encontrar servicios
médicos que se
corresponden con las
necesidades del
paciente
* explicar la
importancia de la
privacidad del
paciente
* describir las
características de un
buen líder
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Unit 2: La Misión de Horizontes de Salud
Objectives:
By the end of this unit, cooperadores will be able to:
● define individual health and community health
● explain the various programs of HHI
● describe the mission of HHl
● relate how HHI‟s programs support its overall mission
Necessary Materials: chart paper, markers, workbooks, pencils, pencil sharpener, program
labels, timer
Time: 85 minutes
Homework: Introducciones, Expectativas y Horizontes de Salud
● Individual and Community Health (25 minutes)
○ Ask cooperadores to open their workbooks to “La Historia de la Diarrea.” Ask the
cooperadores what caused the child to eventually die from typhoid fever.
Encourage the group to think broadly about the causes of disease, including lack
of vaccinations, open sewage, poor animal control, lack of parental supervision,
poor hygiene, malnutrition, lack of education, inappropriate clothing or footwear,
lack of government intervention, etc.
○ After the diagram is complete, ask the cooperadores, “¿Cómo se define „la
salud‟? ¿Qué es „la salud comunitaria‟?” Write their answers on a piece of chart
paper.
○ Discuss the definitions of both terms. (According to the WHO, “la salud es el
estado de completo bienestar físico, mental y social, y no solamente la ausencia
de infecciones o enfermedades.” “Community health” broadly includes the ways
in which a community affects the health of its inhabitants, as well as how
community members are involved in efforts to prevent disease and improve
health.)
○ Return to the child in the diagram. Ask the cooperadores, “¿Este niño está
sano? ¿Estaba sano antes de tener la tifoidea? ¿Cómo le afecto la salud
comunitaria a él?”
○ Encourage the cooperadores to view „health‟ from a socioeconomic viewpoint:
are poor communities more or less healthy than rich communities? Why? Is that
fair? What can we do to change these inequities?
● HHI Programs and Staff (25 minutes)
○ Ask cooperadores to open their workbooks to “El Caso de Tomasina” and
distribute pencils. Explain that this is a story about an imaginary family that gets
help from HHI. As they listen to the case study, they should circle all the different
“helpers” involved: anyone who helped the patient get medical care, from start to
finish.
○ Ask one cooperador to read the paragraph aloud. While the case study is being
read aloud, hang the labels for “Operativos,” “Programa de Enfermedades
Crónicas,” “Primeros Auxilios,” “Educación” and “Especialistas” to create
columns under which you will write the helpers‟ roles.
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○ Take suggestions from the group about the various helpers involved with the
patient in the case study. As different people are mentioned, write them in the
corresponding column under the correct label. Note that some people may be
written in more than one column, e.g. cooperadores are involved in medical
service trips, first aid, education and the Chronic Disease Management Program.
Ensure that the roles of “vecina,” “cooperador,” “motoconchista,” “farmacéutico,”
“médico,” and “Directora de Programas” are included in the chart.
○ Explain that the heading of each column describes a different program of HHI:
medical service trips every four months with physicians and students from the
United States, a Chronic Disease Management Program that supplies
medications and check-ups to patients with chronic diseases, a referrals system
that connects patients with specialists at various local hospitals, and a
community health workers‟ program where cooperadores supply patients with
first aid and education.
○ Clarify that the cooperadores are not mini-doctors or nurses, but helpers in a
large system of people all working together to provide patients with medical care.
They are joining a staff of physicians, students, Program Directors, researchers
and other cooperadores, both in the United States and in the Dominican
Republic. Ask cooperadores to open their workbooks to El Directorio del
Personal.
● HHI Mission (30 minutes)
○ Post the following questions on a piece of chart paper: ¿Qué saben Uds. de la
fundación Horizontes de Salud? ¿Qué piensan Uds. es la misión de Horizontes
de Salud? ¿Cómo se apoya la misión por los programas que acaban de
aprender?
○ Divide the cooperadores into partnered groupings. Ask each pair to consider the
three posted questions. Set the timer for six minutes.
○ At the end of six minutes, ask each pairing to share what they discussed with the
larger group.
○ Post the mission of HHI on a piece of chart paper: “Nuestra misión es proveer la
atención primaria de alta calidad a los pacientes con escasos recursos en la
República Dominicana y enfortalecer la capacidad local de mejorarse la salud
comunitaria. Por los operativos médicos y las iniciativas comunitarias,
trabajamos juntos para promover el bienestar y el aceso al cuidado médico.”
○ Referring to earlier conversations about health equity, ask cooperadores what
“underserved” means to them. What does it mean to “build local capacity to
improve community health?” Referring to the chart about the various HHI
programs, how do these programs attempt to “build local capacity” and “improve
community health”? Which programs increase “access to health care”?
● Homework (5 minutes)
○ Ask cooperadores to open their workbooks to the homework assignment.
Explain the format of each question (e.g. multiple choice, short answer). They
should bring this back to class tomorrow.
● Collect all pencils and pencil sharpeners.
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Evaluación
1. Si un paciente se sienta una falta de respiración y un sarpullido después de tomar un
medicamento nuevo, necesita ir a la clínica inmediatamente.
2. Es posible bajar la presión alta por comer menos sal.
3. La claritromicina, la aspirina, y la doxiciclina son medicamentos que tratan la diabetes.
4. El enalapril, el atenolol y la hidroclorotiazida son medicamentos que tratan la presión alta.
5. Se transmiten las enfermedades crónicas, como la epilepsia y la diabetes, de persona a
persona.
6. Un cooperador de salud necesita tomar la presión sanguínea de sus pacientes cuatro veces
al mes.
7. Si un paciente con una infección grave se sienta un dolor de barriga después de tomar sus
antibióticos, esto representa una reacción alérgica y él debe dejar de tomarlas inmediatamente.
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8. La presión sanguínea normal es 120/80.
9. Si una muchacha en tu comunidad le cuente a Ud. que ella tenga una infección transmitida
sexualmente, Ud. puede decirle a su marido.
10. ¿Cómo se transmite el VIH?
un mosquito al caminar descalzo vegetales no lavados el parto
11. ¿Cuál es una síntoma de una reacción alérgica?
orinar mucho la lengua hinchada la vision borrosa dolor de cabeza
12. ¿Cuál es un factor de riesgo de la diabetes tipo 2?
TODOS!!
el sobrepeso edad más de 45 años falta de ejercicio todos los
anteriores
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13. ¿Cuál es un síntoma de la diabetes tipo 2?
urticaria la lengua hinchada dolor de cabeza heridas que no
cicatrizan en los pies
14. ¿Cuál es la frecuencia respiratoria normal para un niño?
12-20 20-30 30-40 120/80
15. ¿Cuál es la temperatura normal de la axila (en celsius)?
38 40 37.5 36.5
16. ¿Cuál es el pulso normal para un adulto?
60-90 70-120 100-160 120/180
17. Un ejemplo de la salud pública es:
prevenir las caries a la cirugía proteger un hueso tomar las pastillas
través de cepillarse roto con un yeso antihipertensivas
los dientes
18. ¿Qué significa “enfortalecer la capacidad local de mejorarse la salud comunitaria”?
TODOS!! entrenar a los apoyar a la Maternidad tener charlas todos los
cooperadores educativas anteriores
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19. Un paciente le cuenta a Ud., “Después de tomar mis pastillas de doxiciclina, tengo un dolor
de barriga y no quiero tomarlas nada más. Eso es una reacción alérgica, ¿no?” ¿Cómo Ud. le
respondería? ¿Por qué es importante la adherencia a los antibióticos?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
¿Qué son tres maneras de prevenir una enfermedad diarréica, como la tifoidea?
20. ___________________________________________________________________
21. ___________________________________________________________________
22. ___________________________________________________________________
23. Un paciente le cuenta a Ud., “Tengo un dolor de cabeza, pero no tengo ningún
medicamento para tratarlo. Mi abuelo tiene algunas pastillas - ¿puedo tomar ellas?” ¿Cómo
Ud. le respondería?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
24. Un paciente le pregunta a Ud., “Ya tomo medicamentos para tratar la hipertensión, pero
todavía tengo la presión alta. ¿Qué puedo hacer, aparte de tomar medicamentos, para bajar la
presión mía?” ¿Cómo Ud. le respondería?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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25. Escriba una raya entre el tipo de diabetes y sus características correspondientes.
el cuerpo no ocurre en los causado por una dieta ocurre en los
no produce adultos no saludable y el sobrepeso jovenes
insulina
una enfermedad las células del cuerpo 90% de las 10%de las
autoimuna no reconocen personas diabéticas personas diabéticas
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Unit 3: Los Signos Vitales y Primeros Auxilios
Objectives:
By the end of this unit, cooperadores will be able to:
● recognize the normal values for respiratory rate, pulse and temperature
● measure a patient‟s respiratory rate, pulse and temperature
● clean and bandage a wound
● explain the importance of using sterile technique when treating wounds
Necessary Materials: pencils, pencil sharpener, stethoscopes, three timers/stopwatches,
botiquínes, sample gauze rolls and squares, sample soap and cream, sample tape, sample
gloves, pictures of wounds, snack
Time: 95 minutes
● Before class, ask a member of La Cruz Roja and/or a current cooperador to assist with
teaching vital signs. It will be easiest if each of the three stations has a facilitator to
explain the background and technique for that vital sign.
● Before the cooperadores arrive to class, organize the room so there are three separate
“stations” of desks and/or chairs. Place stethoscopes and a timer at the “Respiratory
Rate” station and a timer at the “Pulse” station.
● Collect the homework from the previous day. Review answers aloud and answer any
questions. (10 minutes)
● Botiquínes (5 minutes)
○ Distribute the botiquínes. Explain that they will be using these kits to provide
basic first aid in their communities, and today they will learn how to use each
item in them appropriately. Review the items in the botiquín together:
○ 4x4 gauze squares (5)
○ Band-aids (50)
○ Tape (1 roll)
○ Gauze rolls (2)
○ Alcohol pads (20)
○ Antibiotic ointment (1 tube)
○ Antiseptic soap (1)
○ Gloves (10 pair)
○ Thermometer (1)
● Vital Signs (40 minutes)
○ Tell the cooperadores that they will have 11 minutes at each station to learn
about taking the vital signs of respiratory rate, pulse, and temperature. (They will
also be learning blood pressure, a fourth vital sign, later.) They should read the
informational section about that station‟s vital sign, watch the facilitator model the
appropriate technique, and practice that specific vital sign with the others at their
station until the timer rings.
○ Set the timer for 11 minutes three times, to allow the cooperadores to cycle
through all the stations.
○ At the end of 36 minutes, ask one volunteer from each station questions about
that specific vital sign: ¿Por qué es importante este signo vital? ¿Cuál es la cifra
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normal de aquel signo vital? ¿Qué puede causar un aumento en él? ¿una
reducción? ¿Cuáles factores importantes se necesita recordar al medir aquel
signo vital ?
○ Collect the timers and stethoscopes. Explain that each cooperador will receive
his/her own stethoscope at the end of the training.
● Accidents and Wounds (30 minutes)
○ Gather the cooperadores into one large group again. Lay out the sample gloves,
gauze roll, gauze square, tape, cream and soap. Tell the cooperadores that you
will show them a picture of a wound and they have to decide which materials on
the table they would use to treat each.
○ Show pictures of wounds, including: a head wound, a cut finger, an infected toe,
and a nosebleed.
○ Using the sample materials and a volunteer, demonstrate correct techniques in
cleaning and wrapping a wound. Be sure to use gloves and stress the
importance of sterility.
○ Set the timer for 20 minutes and allow the cooperadores the chance to practice
wrapping wounds on each other.
● Snack (10 minutes)
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Unit 4: La Presión Alta
Objectives:
By the end of this unit, cooperadores will be able to:
● define the terms “blood pressure” and “hypertension”
● explain the three mechanisms by which blood pressure increases
● measure a patient‟s blood pressure
● recognize the three antihypertensive medications used by HHI
● state five ways to decrease blood pressure without medication
Necessary Materials: pencils, pencil sharpener, timer, chart paper, markers, water pump,
basin of water, pictures of symptoms, pictures of HTN consequences, stethoscopes,
sphygmomanometers, double-sided stethoscope, halved cut-outs of pills, scraps of paper
Time: 85 minutes
Homework: Los Signos Vitales y La Presión Alta
● Definitions (15 minutes)
○ Ask cooperadores to open their workbooks to “La Hipertensión.”
○ Split the cooperadores into pairs and distribute pencils to each pairing.
○ Each pair should come up with their own definition of “presión sanguínea” and
“hipertensión” and write it in the appropriate space. Set the timer for four
minutes.
○ After four minutes, each pair will share their definitions aloud with the whole
group. Together, decide which definitions are most accurate.
○ After the cooperadores have decided upon the best definitions, share the medical
definitions of the two terms on chart paper (la presión sanguínea es la fuerza de
presión ejercida por la sangre circulante sobre las paredes de los vasos
sanguíneos; la hipertensión es una enfermedad crónica en cual la sangre viaja
por las arterias con una presión más alta que la normal). Cooperadores should
write these two definitions in the appropriate spaces on their worksheets.
○ Write “120/80” on the chart paper. Explain that blood pressure is divided into two
numbers: systolic and diastolic. Systolic pressure is the top number, at which
your blood is traveling away from your heart, out to your fingers and toes.
Diastolic pressure is the lower number, at which your heart is resting between
beats. >140/>100 is hypertensive. Cooperadores should write this information in
the appropriate lines on their worksheets.
○ Ask for any questions.
● Pathophysiology, Symptoms and Effects (15 minutes)
○ Use the water pump and the basin of water to explain the basic concepts of
blood pressure: how vasoconstriction increases blood pressure, how increased
heartbeat increases heart pressure, and how increased blood volume increases
blood pressure.
○ Ask for any questions.
○ Ask the cooperadores if they know the symptoms of severe hypertension.
Discuss their answers using the pictures (dolor de cabeza, palpitaciones del
corazón, el mareo, dolor del brazo izquierdo o la mandíbula izquierda, la
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debilidad), but explain that most of the time hypertension is silent.
○ Ask the cooperadores why hypertension is dangerous in the long term. Discuss
their answers using the pictures (derrame del cerebro, infarto del corazón, daño
a los riñones, la ceguera). Ask if they know anyone in their communities who
has suffered these complications.
● Blood Pressure Measurement (30 minutes)
○ Break the cooperadores into groups of three and hand each group a
stethoscope, a sphygmomanometer, and several small scraps of paper.
○ Model the correct techniques in measuring blood pressure, including cuff
placement, stethoscope placement, inflating the cuff to >200 mmHg and listening
for heartbeats through the stethoscope.
○ Cooperadores should take turns measuring a group member‟s blood pressure,
writing down their estimate on a slip of paper. A second cooperador in the group
should then take the same person‟s blood pressure, comparing the two values at
the end.
○ Switch roles within the small groups so that every cooperador gets a chance to
take multiple persons‟ blood pressures, checking their estimates with others.
○ Facilitators should monitor the cooperadores‟ technique by using the double-
sided stethoscope.
● Antihypertensive Medications (10 minutes)
○ Write the three HHI antihypertensive medications on a piece of chart paper.
Review the mechanism of action for each, referring back to the “water pump”
activity (enalapril = ensancha los vasos sanguíneos; hidroclorotiazida = quita el
exceso de líquidos del cuerpo por aumentar la cantidad de orina; atenolol = hace
más lento los latidos del corazón).
○ Distribute halved pills with the name of medication on one side and the
mechanism of action on the other. Cooperadores should find their correct
partner.
● Lifestyle Changes that Decrease Blood Pressure (10 minutes)
○ Explain that there are several ways to decrease blood pressure without taking
medicines. Ask cooperadores for their ideas.
○ Show pictures of each. (bajar el peso; hacer ejercicio; comer menos de 2300 mg
de sal diario; dejar de fumar; tomar menos de dos bebidas alcohólicas diario)
○ Ask cooperadores to fill in their worksheets in the appropriate spaces.
● Homework (5 minutes)
○ Ask cooperadores to open their workbooks to the homework assignment.
Explain the format of each question (e.g. multiple choice, short answer). They
should bring this back to class tomorrow.
● Collect all pencils and pencil sharpeners.
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Unit 5: La Diabetes
Objectives:
By the end of this unit, cooperadores will be able to:
● explain the basic pathophysiology of diabetes mellitus
● describe the differences between DM Type 1 and DM Type 2
● list the symptoms, long-term effects and risk factors for DM
● make healthy suggestions to diabetic patients regarding diet, exercise and the
prevention of infections
● identify the four medications commonly prescribed to diabetic patients
● measure a patient‟s blood sugar using a glucometer
Necessary Materials: timer, granola, sugar, image of pancreas, image of insulin, key, chart
paper, markers, labels of DM characteristics, tape, scale, measuring tape, pictures of risk
factors, pictures of symptoms, cut-outs of pills, glucometers, glucose strips, gloves, alcohol
pads, empty pill bottle, pencils, pencil sharpener, snack
Time: 180 minutes
Homework: La Diabetes
● Homework Review (10 minutes)
○ Distribute pencils as necessary.
○ Ask cooperadores to bring out their homework from the previous day.
○ Review answers aloud and answer any questions.
● Blood Pressure Practice (10 minutes)
○ Distribute blood pressure cuffs and stethoscopes and split the cooperadores up
into pairs.
○ They should take turns measuring each other‟s blood pressure.
● Picture Story (15 minutes)
○ Divide the cooperadores into pairs and ask them to open their workbooks to “La
Historia de la Diabetes.” Tell them they will have six minutes to determine what
story the pictures are describing.
○ Set the timer for six minutes. At the end, ask for a volunteer to tell the story of
diabetes using the picture story.
○ Explain, “El cuerpo cambia la comida que se come en una forma de azúcar
llamada glucosa. La insulina es una hormona producida por el páncreas que
permite que la glucosa entre a todas las células del cuerpo para usarla como
energía. La insulina es como una llave para la puerta cerrada de las células. La
diabetes es una enfermedad que ocurre cuando el cuerpo de una persona no
forma suficiente insulina, o no puede usar la insulina de la manera correcta. El
azúcar se acumula en la sangre en vez de entrar a las células y demasiada
azúcar en la sangre puede causar problemas graves.”
○ Ask for any questions and clarify information as needed.
● Role Play (10 minutes)
○ Set out granola, sugar, image of a pancreas (from the Facilitator Manual) and an
image of a bottle of insulin, and a key and ask a volunteer cooperador to use the
props to explain how food is usually converted into fuel in the body, and what
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happens in the body of a diabetic person.
● Type 1 and Type 2 (15 minutes)
○ On a piece of chart paper, write “Tipo 1” y “Tipo 2”.
○ Bring out labels of various characteristics and ask cooperadores to allocate each
characteristic to one type or the other. Tape the label in the corresponding
column on the chart paper.
○ At the end, correct the chart as necessary and tell cooperadores to fill in their
worksheets with this information. Explain, “Existen dos tipos de diabetes: tipo 1
se presenta cuando el cuerpo no produce nada de insulina y usualmente ocurre
en los niños y los jovenes. Después, necesitan insulina. El tipo 1 es una
enfermedad autoimuna. El tipo 2 ocurre cuando el cuerpo no produce suficiente
insulina, o cuando las células no reconocen la insulina. Es causado por el
sobrepeso y una dieta no saludable. 90% de las personas diabeticas tiene el
tipo 2.”
● Risk Factors for Type 2 (20 minutes)
○ Ask cooperadores to open their workbooks to “Tabla del Peso y El Riesgo de la
Diabetes” and have them find their heights and weights. If necessary, set out
scale and measuring tape to determine the heights and weights of all
cooperadores. If their weight is higher than what is listed on the chart for their
height and gender, they have an increased risk of diabetes.
○ Ask participants for other characteristics besides obesity that put people at risk
for diabetes. List these suggestions on a piece of chart paper.
○ Show pictures of risks (el sobrepeso, edad más de 45 años, familiares con la
diabetes, falta de ejercicio, una dieta con mucha grasa, quistes ováricos).
Review list from chart paper and edit as necessary.
○ Cooperadores should fill in their worksheets with this information.
● Symptoms (10 minutes)
○ Ask cooperadores what they think are the symptoms are of diabetes. List these
suggestions on a piece of chart paper.
○ Show pictures of the symptoms (orinar mucho y con frecuencia, siempre tener
sed, siempre tener hambre, siempre tener cansancio, problemas sexuales,
infecciones vaginales frecuentes, picazón de la piel, la visión borrosa, pérdida de
sensación en las manos o los pies, heridas que no cicatrizan en los pies).
Review the list from the chart paper and edit as necessary.
○ Cooperadores should fill in their worksheets with this information.
○ There is an extra poster about diabetes symptoms in their workbooks that they
can use for charlas and educating their community members about diabetes.
● Snack (10 minutes)
● Teach-Back about Problems and Suggestions (25 minutes)
○ Divide cooperadores into two groups.
○ One group should read “Problemas Causados por la Diabetes” in their
workbooks and the other group should read “Sugerencias para las Personas con
la Diabetes.”
○ The groups will have 15 minutes to read and review their informational packets,
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with the goal of teaching the other group what they learned. After 10 minutes,
each group should teach the other about their topic.
○ Set the timer for 15 minutes. Facilitators should help each group focus on the
most important themes and develop a teaching strategy.
○ After 15 minutes, each group will have five minutes to teach the other. Review
all main points and answer any questions.
● DM Medicines (15 minutes)
○ Bring out cut-outs of pills (insulina, metformina, enalapril, aspirina) and tell the
cooperadores to match the names of the medications on their worksheets with
the correct information in the next column.
○ Hold up the cut-out of insulin and explain, “La insulina abre las puertas de las
células para que el azúcar en la sangre pueda entrar. Cuando el cuerpo de una
persona no produce suficiente insulina, el paciente necesita inyectarse con
insulina, usualmente varias veces en un día. Es más común con los pacientes
que tengan el tipo 1.”
○ Hold up the cut-out of metformin and explain, “La metformina baja la producción
del azúcar en el hígado y aumenta la acción de insulina para que el azúcar entre
las células con facilidad.”
○ Hold up the cut-out of enalapril and explain, “el enalapril puede prevenir el daño
causado a los riñones por la diabetes.”
○ Hold up the cut-out of aspirin and explain, “La aspirina puede prevenir el daño
causado al corazón por la diabetes.”
○ Review the cooperadores‟ worksheets to ensure everyone has the correct
information.
● Glucometers (35 minutes)
○ Distribute a glucometer and 15 glucose strips to each cooperador.
○ Their worksheet has information about normal fasting blood sugar and diagnostic
criteria for diabetes. Read this information aloud together as a group.
○ Using gloves and an alcohol pad, model the correct techniques in measuring a
patient‟s blood sugar. Answer any questions and allow cooperadores time to
practice on each other.
○ Collect sharps in an empty pill bottle at the end.
● Homework (5 minutes)
○ Ask cooperadores to open their workbooks to the homework assignment.
Explain the format of each question (e.g. multiple choice, short answer). They
should bring this back to class tomorrow.
● Collect all pencils and pencil sharpeners.
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Unit 6: Las Enfermedades Infecciosas
Objectives:
By the end of this unit, cooperadores will be able to:
● compare and contrast infectious disease and chronic disease
● describe various modes of transmission for infectious agents
● give examples of parasitic, fungal, viral and bacterial infections
● list common risk factors and preventive techniques for infections
Necessary Materials: chart paper, markers, “Transmission” images, public health posters from
the Ministry of Health, timer, pencils, pencil sharpener, snack
Time: 90 minutes
● Homework Review (10 minutes)
○ Distribute pencils as necessary.
○ Ask cooperadores to bring out their homework from the previous day.
○ Review answers aloud and answer any questions.
● Blood Pressure Practice (10 minutes)
○ Distribute blood pressure cuffs and stethoscopes and split the cooperadores up
into pairs.
○ They should take turns measuring each other‟s blood pressure.
● Infections (25 minutes)
○ Ask cooperadores for all the examples of infections that they can think of. Write
down their suggestions on a piece of chart paper, adding any they forget (el
dengue, la gripe, la malaria, el tuberculosis, la neumonía, la meningitis, el SIDA,
la gonorrea, la clamídia, el herpes, la sífilis, la tifoidea). Cooperadores should
write these examples down on the “Las Enfermedades Infecciosas” page in their
workbooks.
○ Ask cooperadores to define an infection, i.e. what do all these infections have in
common? (se puede ser transmitida de persona a persona) This definition
should be written in their workbooks as well.
○ Review various methods of transmission using the “Transmission” images and
the infections they have suggested as examples (las relacionses sexuales, por la
piel, comer vegetales no lavados o hervidos, tomar agua sucia, el uso de drogas
intravenosas, por la sangre, el embarazo, el parto, el amamantamiento, los
mosquitos, de animals, de la tierra, del aire). Stress that not all infections are
transmitted in all ways (e.g. you cannot get HIV from a mosquito).
○ Ask cooperadores how these infections are different from chronic diseases like
hypertension and diabetes (la hipertension y la diabetes no puede ser
transmitidas de persona a persona, tienen diferentes síntomas). How are they
the same? (se puede tomar medicamentos para tratarlos, puede prevenirlos con
cambios del estilo de vida)
● Teach-Back (35 minutes)
○ Divide the cooperadores into four groups.
○ The groups will have 10 minutes to read through the information in their
workbooks and decide how to teach the other cooperadores about their specific
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infectious agent. They should include information about risk factors, examples,
modes of transmission, and preventive techniques. Assign one group “Bacteria,”
one group “Fungi,” one group “Viruses,” and one group “Parasites.” They can
use their “Las Enfermedades Infecciosas” worksheet and the public health
posters as a guide. (They will be learning about the treatments for infections
later.)
○ Set the timer for 10 minutes. Circulate throughout the room, answering any
questions and helping the cooperadores as needed.
○ After 10 minutes, ask each group to teach the other cooperadores about
parasites, fungi, viruses and bacteria.
○ Answer any questions.
● Snack (10 minutes)
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Unit 7: Los Medicamentos y la Adherencia
Objectives:
By the end of this unit, cooperadores will be able to:
● identify the most common antibiotics, antiparasitics and antifungals prescribed by HHI
● explain the importance of adherence with respect to antibiotic drug resistance
● describe the symptoms of a serious allergic reaction to a drug versus side effects
● demonstrate understanding of and respect for the potential danger of medications
Necessary Materials: cut-outs of pills, chart paper, markers, timer, pictures of allergic
reactions, 20 review questions, pencils, pencil sharpener
Time: 90 minutes
Homework: Las Infecciones y Los Medicamentos
● Antibiotics (15 minutes)
○ Divide the cooperadores into three groups.
○ On a piece of chart paper, draw three columns, labeling them with three classes
of drugs: Antibióticos, Antiparásitos, Antihongos.
○ Divide the cut-outs of pills equally among the groups (trimetoprima/
sulfametoxazol, doxiciclina, amoxicilina, ciprofloxacina, azitromicina,
claritromicina, metronidazol, clotrimazol, flucanozol, ivermectina, albendazol).
Each cut-out has the name of the medicine on the front and the class on the
back.
○ Each group should test themselves regarding the pill‟s class and mechanism of
action. Afterward, they should memorize the information about each pill to teach
the rest of the cooperadores about their pill.
○ Set the timer for six minutes.
○ When it rings, each group should tape their pill onto the chart paper in the correct
column and teach the rest of the cooperadores about how it‟s used.
● Drug Resistance (15 minutes)
○ Ask cooperadores to open their workbooks to “La Historia de la Resistencia a las
Medicinas.” Working individually, each cooperador will have five minutes to
determine what they think the picture story is about.
○ Set the timer for five minutes.
○ Ask 1-2 volunteers to describe the story in their own words, adjusting and editing
the main points as necessary.
○ Explain that drug resistance can occur when a patient does not take his
antibiotics at the correct time, in the correct way, or until the prescription is
complete. When antibiotics are introduced into the body, bacteria can learn from
them and change to become stronger if not enough antibiotics are taken to kill
the bacteria. For this reason, full adherence is absolutely necessary, and it is
part of the cooperadores‟ job to educate their communities about taking
medicines correctly.
● Side Effects vs. Allergies (25 minutes)
○ Ask cooperadores if they have ever had bad experiences with medications in the
past. Can they describe any side effects or allergic reactions they may have
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had?
○ As they relate their past experiences, create a chart on a piece of chart paper
distinguishing side effects from allergic reactions. At the end, explain that side
effects are bothersome, but frequently benign and the patient should usually
continue taking the medicine.
○ Show pictures of allergic reactions (la urticaria, problemas de respirar, la lengua
hinchada, el picazón). These are extremely dangerous symptoms and can lead
to death if the patient is not taken immediately to a clinic.
○ Cooperadores should open their workbooks to “Casos Prácticos de las Alérgias y
Efectos Secundarios.”
○ Ask a volunteer to read each one aloud. Cooperadores should determine, as a
large group, whether the patient is having an allergic reaction or a side effect.
○ Case #1 Answers: Ella debe dejar de tomar las pastillas; explícala por qué es
peligroso compartir los medicamentos; dile que vaya al médico para hablar de su
malestar estomacal y conseguir un tratamiento apropiado para ella; explícala un
poco sobre la resistencia a drogas, y dile que su hermano debe hablar con su
médico sobre el hecho que no cumplió la serie del antibiótico.
○ Case #2 Answers: Reconozca que él está teniendo una reacción alérgica;
encuentre alguien quien puede llevar el hombre al hospital o sala de urgencias
para que pueda recibir tratamiento; acompáñalo y explicarlo las diferencias entre
efectos secundarios y una reacción alérgica; asegurar que el no tome más
pastillas; después de recibir tratamiento, dígale que hable con su médico sobre
la reacción para que el médico no le diera pastillas así en el futuro.
○ Case #3 Answers: Decirle a la madre que los síntomas que tiene la hija son
normales; dile que no deje de dar los medicamentos a la niña; hablar con ella
sobre el tema de resistencia; explicar por qué es peligroso compartir los
medicamentos del padre con la niña.
● Drugs can be Dangerous (5 minutes)
○ Using allergic reactions as an example, explain that medications can be just as
harmful as they can be helpful. An allergic reaction to a medicine can kill
someone, especially if they did not know they had an allergy to the medicine
before taking it. With this in mind, sharing medications among family members
or neighbors is very dangerous.
○ Mention that medications are not always necessary; many illnesses go away on
their own or resolve with more exercise, sleep, or water. Sometimes water is
much more helpful than a pill!
○ Discuss the importance of size and age differences in medication dosage using
cooperadores/facilitators of different sizes and ages. A drug overdose can harm
or even kill a patient if he/she takes the wrong amount of medicine.
● Review (25 minutes)
○ Make a grid of four columns and five rows on a piece of chart paper. Label the
columns, “Grupos de Medicamentos,” “Medicamentos Espécificos,” “Efectos
Secundarios y Alérgias,” and “Un Poco de Todo.” Each row should be numbered
1-5, from top to bottom - these are the points available for each of the 20
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questions.
○ Divide the cooperadores into two teams. Explain that all the questions are about
antibiotics, antifungals, antiparasitics, allergic reactions, or side effects, but some
are more difficult than others. Teams will take turns choosing questions and
acquiring points. If one team says an incorrect answer, the other team has the
opportunity to steal those points.
● Homework (5 minutes)
○ Ask cooperadores to open their workbooks to the homework assignment.
Explain the format of each question (e.g. multiple choice, short answer). They
should bring this back to class tomorrow.
● Collect all pencils and pencil sharpeners.
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Unit 7 Review Questions
Grupos de medicamentos ● ¿Cómo se llama el grupo de medicamentos que tratan infecciones bacterianas?
Antibióticos ● ¿Cómo se llama el grupo de medicamentos que tratan las infecciones por levaduras?
Antihongos ● ¿Cuál grupo de medicamentos matan a los gusanos que viven en la barriga?
Antiparásitos ● ¿La ciprofloxacina es parte de cual grupo de medicamentos? Antibióticos ● ¿El mebendazol es parte de cual grupo de medicamentos? Antihongos
Medicamentos específicos
● ¿Cuál es un medicamento antiparásito? metronidazol, albendazol, mebendazol ● ¿Cuál medicamento se usa contra una infeccíon orinaria? ciprofloxacina, TMP/sulfa ● ¿Metronidazole trata cuál infección? la vaginitis, la gastritis ● ¿Cuál medicamento se usa contra la neumonía? azitromicina ● ¿Cuál medicamento es una crema se usa contra las infecciones de hongos en la piel?
clotrimazol Efectos secundarios y alérgias
● ¿Si se presente un signo de una reacción alérgica en un paciente, qué debería hacer? Dejar de tomar el medicamento e ir a la clínica
● Díganme un signo de una reacción alérgica. sarpullido, dificultad de respirar, lengua hinchada
● Díganme un efecto secundario que no es un signo de una reacción alérgica. Malestar estomacal, mareo, sabor amargo en la boca
● Denme un efecto secundario de la ciprofloxacina. dolor de barriga ● ¿A parte del sarpullido, como se llama la erupción en la piel que es un signo de una
reacción alérgica? Urticaria Un poco de todo
● Denme una razón que nadie debe compartir sus medicamentos con otras personas? un sobredosis, una reacción alérgica, la resistencia
● ¿Cuál medicamento tiene el efecto secundario de la orina rojiza? metronidazol ● ¿Cuáles son los efectos secundarios del clotrimazol? la picazon, el enrojecimiento
de la piel ● ¿Cuál medicamento es un antiparásito y un antibiótico? metronidazol ● Explícame como se forma la resistencia a los antibióticos. Cuando un paciente no
termine su receta de antibióticos o cuando no tome sus pastillas antibióticas correctamente, las bacterias puedan aprender como fortalecerse contra pastillas antibióticas usadas en el futuro.
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Unit 8: La Salud Pública y la Educación Comunitaria
Objectives:
By the end of this unit, cooperadores will be able to:
use examples to explain how public health and sanitation affect the health of a
community
prepare a well-organized, focused charla on a medicine- or public health-related topic
Necessary Materials: markers, timer, chart paper, pencils, pencil sharpener, informational
paragraph about diarrhea, snack
Time: 90 minutes
Homework Review (10 minutes)
o Distribute pencils as necessary.
o Ask cooperadores to bring out their homework from the previous day.
o Review answers aloud and answer any questions.
Blood Pressure Practice (10 minutes)
o Distribute blood pressure cuffs and stethoscopes and split the cooperadores up
into pairs.
o They should take turns measuring each other‟s blood pressure.
Public Health & Sanitation (30 minutes)
o Divide the cooperadores into groups of three and give each group markers.
Reviewing the Diarrhea Diagram from Unit 2, this time they will focus on
prevention. For each step in the old diagram, groups will draw a picture in the
new, empty diagram showing how the child‟s diarrhea could have been
prevented. After 15 mintues, each group will retell the story from the diagram but
change the ending using the preventive techniques depicted in their drawings.
o Set the timer for 15 mintues.
o As a large group, retell lthe diagram‟s story using the groups‟ pictures of
preventive techniques. Take turns asking the group to show their depiction of a
preventive technique at each of the eight steps in the diagram. (La enfermedad
se pudiera haber prevenido: si el hombre hubiera recibido una vacuna contra la
tifoidea; si el hombre hubiera usado un sanitario; si el cerdo hubiera usado un
sanitario; si el cerdo hubierdo estado en un área cercada; si el niño no hubiera
jugado con el cerdo; si el niño se hubiera lavado las manos en vez de limpiarse
con la falda de su madre; si la madre no hubiera tocado su falda sucia y luego
tocado la comida; si la madre se hubiera lavado las manos con agua y jabón; si
el gobierno hubiera construido algunos baños en su comunidad).
o Explain that these types of preventions that affect a whole population is the
definition of public health. Ask for other examples of public health programs.
Cooperadores should write these examples in the appropriate space on their
worksheets.
o Write the definition of public health on a piece of chart paper: ”La salud pública
es la ciencia de proteger y mejorar la salud a través del esfuerzo común de la
sociedad, el gobierno, las fundaciones, las comunidades y los individuos. Incluye
la educación, promoción de conductas saludables, investigaciones de
enfermedades, y prevención de conductas saludables, investigaciones de
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enfermedades, y prevención de enfermedades.” Cooperadores should write this
definition on their Public Health worksheets.
o Working individually, cooperadores should complete the matching section on
their worksheets, ”¿Medicina o Salud Pública?”
o Review answers as a large group.
● Model Charla (30 minutes)
○ Explain that education is a principle tenet in public health and the prevention of
diseases. As such, the cooperadores are responsible for having one charla a
month in their communities. Topics for the charlas can include what has been
covered in this training, such as hypertension, diabetes and nutrition. As part of
their ongoing monthly education, cooperadores will also be learning about new
topics in the future, such as HIV/AIDS, tuberculosis, and women‟s health.
Charlas can focus on any of these topics. Today they will focus on the
prevention of diarrheal diseases, to practice giving charlas.
○ Select two volunteers from the group and give one a paragraph to read about
diarrhea prevention, and give the other a picture of „community threats‟. Both
volunteers will try to educate the rest of the cooperadores about the transmission
and prevention of diarrheal disease, but one will simply read aloud from the
informational paragraph and one will use the diagrams and pictures to explain.
(If there are two facilitators, they can be the two volunteers to model good and
bad practices.)
○ After the two presentations, lead a discussion about the strengths and
weaknesses of each. (¿Cuál fue más interesante? ¿Por qué? ¿Cuál es más
fácil para entender? ¿Cuál va a recordar la comunidad? ¿Cuál va a afectar los
hábitos de los miembros de la comunidad?)
○ Discuss the characteristics of a good charla as a large group. Cooperadores
should write these in the appropriate spaces on their worksheets (escoja un tema
específico; planifique la charla con tiempo; use fotos y dibujos para explicar el
tema; anime al grupo por hacerles preguntas y hacer actividades activas para
que todos participen; haga una actividad después de la charla).
○ Break the cooperadores up into groups of three and give each group copies of
the „community threats‟ picture. Within their small groups, cooperadores should
individually practice explaining the transmission and prevention of diarrheal
disease, as if they were giving a charla in their community.
● Snack (10 minutes)
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El Parrafo de la Diarrea
La diarrea puede ser leve o grave. Puede dar en forma aguda (de repente y muy fuerte)
o crónica (que dura muchos días). La diarrea es más común y más peligrosa en los niños
chiquitos, sobre todo los que están mal alimentados. La diarrea tiene muchas causas. Las
principales causas de la diarrea son: una infección de virus, las amibas, los gusanos, el
envenenamiento con comida echada a perder y las condiciones sucias que ayudan a transmitir
los gérmenes que causan la diarrea. Algunos antibióticos y ciertos alimentos pueden causar la
diarrea también. Las causas más comunes son las infecciones y la mala alimentación. Al
cuidar el aseo y comer bien, se puede evitar la mayoría de los casos de diarrea. Hay que usar
letrinas, filtrar el agua y proteger los alimentos contra el polvo y las moscas.
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Unit 9: Responsabilidades de los Cooperadores
Objectives:
By the end of this unit, cooperadores will be able to:
● discuss the characteristics of an effective community leader
● match patient needs with available social services and clinics
● explain the importance of patient confidentiality
● demonstrate their knowledge of the role of a cooperador as a link between HHI, the
patient, and the community
Necessary Materials: chart paper, markers, pencils, pencil sharpener, labels of clinics, tapes,
20 cards with various symptoms/diagnoses, patient confidentiality role-plays
Time: 90 minutes
● Qualities of a Leader (15 minutes)
○ Explain that the responsibilities of cooperadores encompass the areas of
medicine, education and public health. An effective cooperador should be a
respected and trusted leader in his/her community in order to educate community
members, conduct public health projects, and deliver medicines.
○ Ask cooperadores to open their workbooks to “Caso Práctico del Cooperador”
and ask a volunteer to read it aloud.
○ Working individually, cooperadores will have five minutes to answer the
questions about Rubén. Set the timer for five minutes.
○ Afterward, lead a discussion about why Rubén failed and how he could have
been a better leader. (¿Por qué cree usted que fracasó su charla? ¿Qué haría
para mejorarsela?)
○ Discuss the characteristics of a good leader. Write the cooperadores‟
suggestions on a piece of chart paper. Include any characteristics they may
forget (escucha a los demás; digno de confianza; tiene respeto para los demás;
es compasivo; puede animar a los demás; puede comunicar con los demás;
sabe la misión de Horizontes de Salud y tiene metas para lograrla; tiene una
disposición positiva). They should write these characteristics on their
worksheets.
● Partner Clinics (15 minutes)
○ Hang labels of various partner clinics around the room.
○ Ask cooperadores to open their workbooks to “Clínicas Colaboradoras” and read
it aloud together. These are physicians and clinics to which HHI sends their
patients. Next week the cooperadores will be visiting these sites as a group so
they will know exactly where they are and how to describe them to their patients.
○ Give each cooperador a card with a symptom and/or diagnosis. When you say
„go!‟ cooperadores must stand under the label of the correct referral site. When
everyone is under a clinic label, the cooperadores should read aloud their card
and the rest of the group will determine if they are in the correct place.
○ Repeat until the symptom/diagnosis cards are gone.
○ Explain that they will be visiting a few of these clinics the following week.
● Patient Confidentiality (15 minutes)
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○ Explain that patient confidentiality is of utmost importance. As cooperadores,
they will be learning information about their community members‟ health and
families that should be kept private.
○ The facilitator(s)s and 1-2 volunteers should act out the role-play while
cooperadores watch.
○ Discuss the role play in terms of patient confidentiality. (¿A quién puede contar
de la enfermedad de un paciente? ¿A su esposo? ¿A su vecino? ¿A los
empleados de Horizontes de Salud? ¿Por qué es malo compartir la información
personal? ¿Por qué es bueno?)
● Responsibilities (30 minutes)
○ Ask the cooperadores to open their workbooks to “Contrato del Cooperador.”
Ask one volunteer to read the first number aloud, a second volunteer to read the
second number aloud, and so on. This list explains the various responsibilities of
cooperadores concerning first aid, case-finding, medical service trips, patient
follow-up and community leadership.
○ Split the cooperadores into four even groups. Assign each group one of the four
“Situaciones” from their workbooks. After reading through their scripts, the
groups will plan how to act out their own play and then perform it for the class.
○ Set the timer for five minutes to allow groups to read through the scripts and plan
their plays.
○ The first group should act out “Situación 1.” Afterward, lead a discussion about
their responsibilities, their patients, and the challenges of their work.
○ The second group should act out “Situación 2.” Afterward, lead a discussion
about the importance of patient education, hypertension, the mechanism of
action for antihypertensives, lifestyle changes, medication adherence, and side
effects/allergic reactions to medications.
○ The third group should act out “Situación 3.” Afterward, lead a discussion about
the treatment and prevention of typhoid.
○ The fourth group should act out “Situación 4.” Afterward, lead a discussion about
first aid and the risks of walking barefoot.
● Panel Discussion (15 minutes)
○ Introduce 2-3 current cooperadores as guest speakers. Encourage them to
discuss what they have learned by being cooperadores, how they have helped
their communities, and how they view the work of HHI affecting their
communities. New cooperadores should feel free to ask questions.
○ If cooperadores are ready, they can sign the bottom of their “Contratos del
Cooperador.”
This marks the end of the course‟s didactic portion. Next week the group will be visiting some of HHI‟s partner clinics, as well as completing the final evaluation.
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Patient Confidentiality Positive Role Play
Odille: Hola, ¿cómo estás? Cooperadora: Muy bien, ¿y tú? Odille: Estoy muy mala. ¿Puedo hablar contigo en privado? Cooperadora: Si, por supuesto. Hay muchas personas aquí en la calle, pero nadie está en la iglesia ahora. Vamos… Odille: Mil gracias, pues, por algunos meses, he bajado el peso. Me despierto todas las noches, sudando y con mucho calor. También, de recién he notado algunas heridas dolorosas en mi vagina. Mi novio acabó de aprender que tiene la SIDA, y ahora me preocupa que yo la tenga también. Cooperadora: Creo que necesitas una prueba para la VIH. Odille: ¿A dónde puedo ir para hacer la prueba? Cooperadora: Puedes ir a CEPROSH. CEPROSH ayuda a la gente que tiene VIH. Ellos pueden hacer la prueba, y si tiene un resultado positivo, ellos pueden proveerte con un consejero, vitaminas, y medicamentos. Si no tengas el virus, ellos pueden enseñarte cómo prevenirlo. Ofrecen un muy buen servicio que es muy confidencial. Odille: Que bueno. Y dónde se ubica CEPROSH? Cooperadora: Hay dos clínicas. Una en Muñoz y otra en Puerto Plata. Odille: Prefiero ir a Puerto Plata. Cooperadora: Bueno, déjame buscar más información sobre la clínica. Vuelvo pronto. Odille: Te espero. Cooperadora: Aquí estoy. La clínica se ubica entre el parque central y el Centro Sanitario. La dirección es Calle John F Kennedy, número 5. Está abierto lunes a viernes desde las 9:00 de la mañana hasta las 12:00 de la tarde. Su número de teléfono es 809-568-8987 en caso de que tengas más preguntas. He escrito toda la información en este papelito. Odille: Bueno, voy a ir a CEPROSH mañana. Gracias por su ayuda. Cooperadora: A su orden. Siempre puedes hablar conmigo y confiar en mí. Odille: ¡Gracias, dios te bendiga!
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Patient Confidentiality Negative Role Play
Odille: Hola, ¿cómo estás? Cooperadora: Muy bien, ¿y tú? Odille: Estoy muy mala. ¿Puedo hablar contigo en privado? Hay muchas personas aquí en la calle. Cooperadora: Pues, estoy muy ocupada ahora. ¿Porqué no puedes hablar conmigo aquí mismo? Odille: Está bien... pues, por algunos meses, he bajado el peso. Me despierto todas las noches, sudando y con mucho calor. También, de recién he notado algunas heridas dolorosas en mi vagina. Mi novio acabó de aprender que tiene el SIDA, y ahora me preocupa que yo la tenga también. Cooperadora: Wow. Es posible que tengas el VIH. Odille: ¿Qúe debo hacer? Cooperadora: Debes ir a CEPROSH. Oye, necesito salir. ¡Buena suerte con todo! Odille (muy confundida): Adios. Cooperadora (hablando con su vecino): Acabo de hablar con Odille, la morena que vive frente de la iglesia. ¡Me dijo que tenga heridas vaginales y su novio tiene el SIDA! ¿Lo puedes creer? Vecino: ¿Qué va a hacer ella? Cooperadora: No sé, pero espero que no tenga relaciones sexuales con nadie más si tenga el SIDA. Vecino: Sí, espero que no.
