Wednesday, September 29, 2010

The Huancavelica Clinic

The events of my clinic visit are too funny to not make a post about. After stopping by the government clinic in town to see what I could learn of PARSALUD, I was immediately ushered in and invited to watch a education session for adolesents. The talk focused on clean food handling practices and personal higene and culminated in a parade... you guessed it I was one of the paraders carrying a sign through the centro of Huancavelica... people got a pretty good kick out of the gringa marching with a sign saying "dogs can transmit rabies." Was all in all a pretty good time and had the chance to talk to some of the 15 year olds marching, got the whole low down on the teen scene in Huancavelica and entertained them endlesly by translating spanish names in to english... of course most are the same with different pronuinciation, nevertheless they were entertained. Went to bed wiped and woke up this am to head back to the clinic for a day of observing and interviewing. Today was the clinic day for pregnant women and young kids. Got the chance to sit in on an education session on voting in the upcoming election (not about the electiion issues but rathe what the ballot will look like). Sitting next to a girl who looked like she was 15 and pegnant I couldn´t help but think how unimportant the informaition was and how irrelivant the session was to real life. After the election info. we learned about TB (currently there are 12 cases the clinic is treating) and then finally the women recieved a rapid result AIDS test- a deisease that has not yet arrived to Huancavelica.

I spent the rest of the day watching the daily goingsons and ended the afternoon with an interview with the doctora. Apparently respiratory illness is the most common illness in the area... wonder what the stoves look like... and levels of depression are increasing, the clinic even does mental health talks. It was really interesting to see how the clinic structures its week with different days that specialize their focus on different age groups providing daily talks on themes that most relate to that age group. The clinic (Peruvian Government) even provides food bags for all women with children under (I think) the age of 2 or pregnant, malnutrition is common and another topic the talks focus on.

The other interesting thing was the role of PARSALUD... while they say they work in Huancavelica they actually have done nothing for this city but rather work building clinics in the really rural areas... the doctora was clear that they provide no logistial help or management skills to their clinic, not the story I got from the PARSALUD guy. Tomorrow I plan to visit the local hospital to see what they have to say.

It was really interesting getting to see how the government run system works, while things at the clinic were really chaotic and the space was nothing like the super hospitals of the US the clinic was treating and seeing a lot of patients (30 per doctor a day), giving supposedly free medicine to those who need it (the consult was free but I did hear one woman paying for her meds), and even offering food aid to new mothers. While the classes could have been better at least there was some kind of education on healthy life habits and diseases to watch out for. I am hoping tomorrow I can get some more tangable numbers, did get some idea of the birth rate and maternal mortality rates but would like something more concrete.

Final interesting thing was about the natural medicine and how in the more urban centers like Huancavelica (this is no city but it is bigger than a village) folk medicin and modern medicine mesh while in some of the more distant rural areas people are more skeptical of modern meds. I think it points back to educating people that perhaps a ballance between the two is what is needed, incorporating rather than rejecting what people have believed in and have seen to work for a reallly long time.

Tuesday, September 28, 2010

Adios Guate, Hola Peru

It has been a while and so much has happened! Will give a very abbrevuate overview... After spending the last bit of my time in Guatemala, doing some interviews with people working for Mercy Corps in the Coban area and then traveling to one of their principle sites to see how things were going, I headed to Antigua and then finally out of the country to Peru.

The last 2 weeks have been spectacular. The heaping portions of food, the incredible scenery and the friendliness of the people have really made time fly. I started my time here spending a few days in Lima, seeing some of the sites, enjoying the city´s position on the clifsides above the ocean, and making some wonderful Peruvian friends- the friendliness first became obvious. What a wonderful city Lima was I really fell in love, found myself repeatedly thinking how I might be able to live there more permanently... thoughts for a later time...

The real success of my time there was that I got the chance to talk to one of the PARSALUD administrators. ParSALUD is a organization funded in part by the peruvian government and in part by the World and Interamerican development banks. Its goal is to reduce maternal and infant mortality in Peru and has clinics in 9 of Peru´s poorest "regiones." Firstly learning about their organizational structure- they work jointly with reignoal governments in an exchange system where the local govt builds and provides the clinic and PARSALUD offers technical and managerial advice often providing some of the equipment to the clinic as well. And secondly hearing also about their approach to actually lowering the maternal and child mortality rates- working in the clinic by proividing the equipment and managerial skills necessary, in the community through education, and in the governmment educating the "community leaders" on what must be done and demaning their cooperation and joint commitment to lowering the levels- I was left curious to see how things actually go... and out of Lima I went.

Traveling by train (what a freaking train ride) to Huancayo I made some friends from the area and learned about some of the really gross political corruption in the area-politics is really on peoples minds as the elections in Peru are coming up and there is plenty of campeighning going on. One such example was of a local guy with hopes to become mayor of Huancayo. He owns the enormous building in which the (incredible) local market is held, renting spaces to people who depend on the market for their livelihoods. He not only charges 1 sole per person- a friend estimated that makes about 1,000 to 2,000 soles everyday (500USD to 1000USD for doing nothing!)- but also holds an enormous power over a very weak and dependent population. I was told that this guy is essentially blackmailing the people with stalls in the market into voting for him, forcing them to rally and campeign at his meetings if they want to continue renting their market stalls. Pretty sick and it leaves me thinking government involvement in the PARSALUD approach might be really quite challenging... corruption seems to be quite an issue.

After spending 2 days in Huancayo, it has the biggest sunday market in all of Peru I think, I headed through shocking Andian scenery to Huancavelica... nestled in a valley sided by huge mountains it is the town where PARSALUD has as a project hospital. This afternoon I have plans to meet with people working in the hospital to see if I can learn more about what the problems are in Peru and how local culture is intergrated in their medical approach (I´m really interested in this as natural remidies are HUGE, people know so much about various herbs and medicnal plants and the markets are filled with such folk remidies). I am also curious to hear more about the mental health problems that are emerging in Peru, mentioned by the PARSALUD guy and the friend from Huancayo. Each mentioned emerging problems of alchoholsm and familial abuse, problems, interestingly enough that Guatemala also suffers from. I really believe that these issues to be linked to historical violence, the guerra civil in Guatemala and sendero luminoso here in Peru; the fact I am currently in one of the areas in which sendero luminoso violence was most centered makes me think mental health problems would be most noticeable... I have already seen several public education posters talking about ways people can deal with their depression.

All for now more to come perhaps in a few days!

Friday, September 3, 2010


I now find myself in Coban and man was it a trip getting here. Got to see some of the poorest and most isolated parts of Guatemala I have yet seen and talk to some really fantastic people allong the way. After leaving San Mateo for a town Barillas... another 2 hours down the dirt road, I spent the night in a hostel and then left the next am on pickup truck for Playa Grande... you have to take a pick up as the road is virtually impassable... dont think I understood what that mean until I was on it... It was really close to impassable, some months you actually cant take the road beacuse of the rain, as it was I dont know how the driver did it. It was 5 hours in the back of the buss with an assortment of other Guatemalans and the road wound its way down out of the mountains into the very hot humid and flat finca growing part of the country. It was really beautiful sceenery and was so shocking to pass through some of the towns along the way. Talk about poverty, people were living in thatched roof, wood walled, dirt floored homes bathing their children, washing their clothes and probably drinking from the same water source near the house. Those were the towns on the road too we passed numerous turn offs for pueblos a little bit off the track.

From PLaya Grande... a definite border town (I decided maybe I shouldnt spend the night there as I had planned) I hoppend on another bus on another dirt road... this one not quite so bad... for 4 hours to get to a town Chisec. Once in Chisec I satayed in the local cantina/hotel... felt not so great about all the drinks hanging out where I was living but what the hell it had a shower right... After 9+ hours of travel that was all I could think of... a shower... I made it into the dank bathroom and turn the knob and... NO AGUA. The town was out of water, closest I have come to tears I wander into the cantina in my towel begging the senora to tell me it isnt so. Tried another shower got enough water to soap myself up and again no water... finally the tough duena of the cantina dragged a bucket and ladel into the shower for me and I was able to rinse off for the first time in 3 days, I felt like a new woman getting the dust off of me.

The next day in Chisec I went in search of a local peace corp girl to see if I could get the sitch on the town- gone home for a visit- and had a really fantastic conversation with a cardamom farmer as he gave me a lift. We talked about the price of cardamom and how the little farmer really gets screwed by the middle men and big bulk buyers who set the prices but that these companies have elevated the wage 15 quetzales so there has at least been some benefit having these big companies (foreighn) come in. After talking about some of the issues in Guatemala and talking about what I was interested in he like so many others brought up education as essential. In a country where public schooling goes till 5th grade and most kids dont even go at all it seems to be such a centrally important thing. The farmer brought up another common theme I have come across, that of a lacking contiousness of the long term... he said people grow what they eat and hope to have some extra to sell for shoes or clothes perhaps but really dont think beyond that, their kids are for working- and they have a lot of them- and slowly as time goes on the amount of land per person just continues to shrink. There is no level of education that leaves people wanting more than what seems like this almost day to day existance.

If anything speaks to the need for education it was a 7 year old boy in a USAID sponsored tourist attraction. I stopped by some lakes in Chisec after waiting 4 hours for a pick up to take me there finding a ´´guide´´ and his son sitting in a wooden shack with a termite problem. I think they were shocked to see a tourist, they had to drag the kyack out of the underbrush for a float around the lakes, the whole thing was absurd, a big waist of USAID money on a place tourists couldnt even really get to. The man and his son basically sat in the hut all day in the odd chance someone might come by, the boy spent the day with his only stiimulation being a set of keys as his father definitely said nothing. By the time a pick up finally passed by they may have been as relieved as I was to get me out of there... nice investment USAID... at least they got to stick their sticker in another place.

Finally made it to Coban and a hostel that shockingly costs the same as the cantina but has hot shwoers and a comfy bed and doesnt give me the heebie jeebies... also the attached restaraunt has hamburgers (!) I thought I had died and gone to heaven. Hell of a journey to get here and man did I see a lot, minor excerpts inclided to give you a little taste... this country is so stunng, has some really incredible and friendly people, and some really serious problems that seem to only perpetuate themselevs. All for now again with stream of consciousness I hope it makes enough sense to be followable.