MEDLIFE

The house was packed at the educational workshop on Friday

Even though I've lived in Lima my entire life, it's hard to believe that this much poverty exists in some of its supposedly most "stable" districts. MEDLIFE usually works in the poorest districts of Lima. But we responded last Friday to a request from the municipality of Santiago de Surco, considered a model district of Lima, to hold educational workshops in two of its poorest neighborhoods.

Nobody would have imagined that so close to Surco's main plaza there exists a community, almost hidden, where though the houses are built with brick, the poverty was visible in people's faces. The second community was the same, though much farther away and more isolated. We received a warm welcome in both places; community members were interested and never stopped participating and asking questions during the afternoon.

The MEDLIFE summer interns prepared a presentation about nutrition, demonstrating how to measure body mass index (BMI) and giving advice about eating healthy. Our medical director, Dr. Jose Rodriguez, continued with information about diabetes and the importance of a balanced diet. Dr. Evelyn, the OB-GYN who has been working at MEDLIFE's Mobile Clinics, gave an excellent talk about breast cancer and cervical cancer screening, which were some of the most talked-about topics in the workshop. Finally, Maria, a health promoter who helps with the education station at our clinics, talked about domestic violence and encouraged those present to report abuse if they witness it.

These talks are the result of collaboration with the local government and a critical step in getting to know new communities prior to conducting Mobile Clinics. When we first arrive in new communities, the families there are unaware of what MEDLIFE does and why, and may be reluctant to visit the clinic, which is why educational workshops are an important part of our year-round work.

The MEDLIFE team

The visit was a first look at this process for our new summer interns, who will soon be helping to run a special Mobile Clinic just for children in Surco. "It was great to see the response from the community," said MEDLIFE Intern Hailey Bossio. "I was really nervous at first, but everyone listened attentively and really respected our efforts."

At a recent Mobile Clinic in the steep hills of Nueva Esperanza, Renelmo Chavez arrived early in the morning and was first in line with his son, Dixon, riding on his shoulders. Dixon is 16, but he's unable to walk on his own due to severe rheumatoid arthritis that began when he was just five years old.

The causes of juvenile arthritis are unknown, though it is usually an autoimmune disorder, which means that the body's immune system mistakenly attacks healthy cells and tissues, causing inflammation and joint damage. In children, the resulting swelling, pain and stiffness severely limits growth and function. There is no cure; treatment focuses on maintaining quality of life and function with physical therapy and medication. Though Dixon's condition is currently in remission, it's left him with paralyzing pain in his hands and knees. He had a wheelchair, but it's useless in the treacherous terrain near his house.

For years, Dixon's dad carried him down the winding path to the paved street below each morning to take him to school. But now Dixon is too big and it's too much of a strain for his father to carry him every day. So while his dad still leaves early in the morning to work, Dixon stays home with his 13-year old sister Ruth, who goes to school in the afternoons. His mother works as a housekeeper in another district of Lima, while his other three siblings go to school and work to support the family.

Dixon likes to spend his time watching soccer games, and says he wants to be able to walk again. He'd also like to go back to school, where his favorite subject was English. He already knows the basics: "how are you?" and "my name is." Perched on a wooden chair at the doorway of his house, he helps his father to feed the chickens that run underfoot.

Renelmo, who moved with his family to Lima seven years ago so that Dixon could be treated in the national children's hospital, is completely devoted to his son's care. And between trying to earn a living driving a mototaxi in another part of town, and carrying Dixon to his various physical therapy and doctors' appointments, he stays pretty busy. "Life here is hectic," he says. "There are many things we need that we can't get."

MEDLIFE follow-up nurse Ruth Verona is on the case, accompanying them to appointments and making frequent home visits. She hopes medical specialists may help restore some of his range of motion. "The physical therapy is on hold for now, until we get his X-rays back," she says. "We have to make sure that it will not cause any further damage to his fragile joints and bones."

We're also working with Renelmo and volunteer engineers on a new project: building a wheelchair ramp outside the house that would give Dixon some mobility, and hopefully ease Renelmo's burden as well. "I just worry sometimes about what will happen to him when I can't take care of him anymore," Renelmo says. Though Dixon is nearly as big as he is, his father launches him onto his shoulders easily and without complaint as he heads out to yet another doctor's appointment.

We recently wrote to you here about the artistic addition to a new staircase project in Buena Vista contributed by a community member, Ernesto. Last week, we were back to build another staircase nearby, but this time, we brought more paint! Ernesto created a brand-new mural depicting community life, and added some color to the previous week's painting. Check out the finished product below:

MEDLIFE field nurse and health promoter Meri Lecaros in the field. In addition to medical followup, she also provides social and emotional support for patients.

In the battle for basic healthcare for poor communities in Peru, the most dedicated fighters are local volunteers known as promotores de salud, or community health promoters. For MEDLIFE, these promoters are indispensable; they help us provide patient follow-up, communicate with the communities where we hold Mobile Clinics, and facilitate health education workshops.

The first modern health promoters in Peru began in the 1920s with a program started by Dr. Manuel Nuñez Butron, a Peruvian physician who had studied medicine in Spain and Lima. When he decided to return to Peru and serve the population in his native Puno, a rural province in the Andes mountain range, he realized that the scattered geography of the agricultural communities made it physically impossible to treat everyone who needed medical care. He also saw that ingrained attitudes and practices regarding medicine and sanitation left rural populations more vulnerable to disease. Though he traveled extensively on horseback through the area in an attempt to implement new health standards and vaccinate the population against the growing smallpox epidemic, the local population was suspicious and resistant to change. So Dr. Nuñez Butron formed partnerships with traditional healers, training them to provide basic medical care and education on sanitation methods in their native language of Quechua. The program expanded to include local schools, mobile libraries and theaters, and medical brigades aimed at spreading the word. Back then, there was no Peruvian ministry of health; these healers are considered the first health promoters. They were known as "rijcharis," from the Quechua word for "awake." This community-based model of healthcare has proved effective around the world, and informs the work of organizations like MEDLIFE.

An early version of the mobile clinic in Puno, Peru. Photo courtesy of Colegio Medico de Peru 

Health promoters were officially incorporated as a government program only about thirty years ago, and despite facing a low budget and lack of organization, they have been an important force in public health in the region. They are credited with successful vaccination campaigns, reducing infant and maternal mortality, and helping to stem the spread of diseases like tuberculosis, cholera and dengue. Thousands of community agents receive training from the Ministry of Health to work year-round on a voluntary basis. They may work as representatives in local health clinics, government offices, churches, or NGOs like MEDLIFE, though their primary responsibility is always in their own community. Though anyone can be elected by their community to receive training, they are primarily women, who tend to spend the most time with families and communities.

MEDLIFE's field nurse Meri, who was trained as a promotora, says that the program is empowering for women and their communities whose voices might not be heard otherwise. "We can teach that we are all equal, and that we all have rights and responsibilities to our health when we visit with families and hold community meetings," she says. "As community agents, our role is very important to ensure that the entire community works on health promotion and illness prevention." Most importantly, she says, health promoters can relate to patients in a way that others may not. "We are in direct contact with families, we live and share the same situations," she says.

Last week Meri attended an event held by the Ministry of Health to recognize these tireless volunteers for the official Dia de Promotor de Salud (Health Promoter Day). They shared stories and talked about the importance of strengthening health promoters in their communities by providing training that goes beyond just medicine, focusing on new programs to prevent malnutrition and infant mortality. "Now with MEDLIFE I try to link these elements that could help our patients receive a little more help, to be heard, and to see the social and human side of their cases," Meri said.

It's summertime, and you know what that means: a fresh crop of MEDLIFE interns! Sunita, Galen, Cristina, Chanee and Ashlan join us in Lima, Peru, to help out with Mobile Clinics, projects, expansion and patient followup. Get to know our first group of summer interns: 

Name: Cristina Salvador
Hometown: The Americas. I was born in Miami, and moved every three years to countries including Ecuador, Peru, Colombia, Mexico and the United States.
School: Pomona College
Major: Psychology and neuroscience

I'm looking forward to... Talking to the community members and learning from them to develop a more comprehensive world perspective. I am also looking forward to seeing how some volunteers may grow and find a different way of thinking thanks to what the communities and their experiences in Lima have taught them.

My favorite part so far... The inauguration of the staircase last Friday was by far my favorite part. It was where I felt the most genuine happiness I have ever felt by seeing the volunteers, community and MEDLIFE staff take the time to dance and appreciate each other.

Name: Sunita Kheterpal
Hometown: Montreal, Quebec, Canada (Yes, I'm Canadian)
School: McGill University
Major: Physiology with minors in management and international development studies

How I got involved with MEDLIFE: I went on a Mobile Clinic to Riobamba, Ecuador on New Year's Eve of 2011.  I then went on to become the Vice President of Fundraising for MEDLIFE McGill; this upcoming year, I will be our Vice President of Operations.

I'm looking forward to... Meeting students from around the world. Learning to speak better Spanish is my goal. If I succeed, then I will be able to speak five languages.

My favorite part so far... How can I possibly pinpoint my favorite part so far? I've loved every moment of being here so far. I've had the opportunity to spend time with people who work for MEDLIFE, meet follow-up patients, be on the other side of the MEDLIFE experience (not as a volunteer, but as an intern), and live in Lima! 

Name: Galen Burns-Fulkerson
Hometown: Chapel Hill, NC
School: UNC
Major: Nursing

How I got involved with MEDLIFE: I heard about the club at my school and came across the application for the internship and thought it sounded like a really amazing opportunity.

I'm looking forward to... Testing out the Mobile School model and the Project Corps. model and just seeing how everything works.

My favorite part so far... I love meeting the patients and hearing their stories. I think medicine has the potential to be such an interactive profession but that people sometimes forget that those being treated are people in addition to patients. MEDLIFE allows many opportunities to be reminded of this through direct interactions with people who attend clinics.

Name: Chanée Massiah
Hometown: Brooklyn, New York
School: Rutgers University
Major: Public health with minor in Spanish

My goals this summer... I really hope to establish a sound understanding of how poverty affects people in South America on a daily basis. In the few months that I am here, I hope that this internship gives me a little insight of what it will be like to pursue a career in global health.

My favorite part so far... Taking the tour of Pamplona has been my favorite part of my stay so far. Not only is physically attending to the needs of the community awesome, but it was a great educational insight to learn about the origin of the communities and experience the daily trek in the mountains.

Name: Ashlan Bishop
Hometown: Boca Raton, FL
School: College of Charleston
Major: Public health with minor in neuroscience 

How I got involved with MEDLIFE: I helped start the MEDLIFE chapter at CofC this past semester and now serve on the executive board.

I'm looking forward to... Improving my Spanish language skills and helping the organization grow!

My favorite part so far... Interacting with all the patients and community members at the Mobile Clinic and project sites, especially with all of the kids.