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Our latest educational workshop was located in a small community in the Nueva Esperanza area of Via Maria del Triunfo. MEDLIFE will bring a Mobile Clinic to this same community in March of 2013.
During the workshop, MEDLIFE staff members presented on a number of health topics, including the importance of psychological health and sleep, preventative tests for breast and cervical cancers, and nutrition. Along with our usual preventative health topics, we also touched on – for the first time – the important issue of property rights.
As many of our supporters know, MEDLIFE Peru works primarily with low-income, informal settlements established just outside of the city of Lima. Poverty, terrorism, and a lack of opportunities in rural Peru have prompted thousands of residents to migrate to these urban slums. As these communities become bigger, more established, and better organized, residents begin to move toward legal formalization of their homes and communal spaces.
Yet, the country has struggled in developing a comprehensive plan for urban development. With changes in government administration, treatment of informal settlements has varied widely. The involvement of several different agencies, sometimes with conflicting policies, also makes the process of legalization a murky one to navigate.
Santos Abad, a government lawyer, explained the basics of acquiring land title, highlighting the primary agencies involved in the process: COFOPRI (government agency that deals with property formalization), the municipal government, and – in some cases – the court system.
Abad outlined an important law called the prescripción adquisitiva de dominio. This law states that an individual may gain legal land title simply by possessing the land, peacefully and consistently, for a minimum of 10 years. The government's 10-year rule is a seemingly adequate amount of time for legal owners to reclaim their land or, if they wish, take squatters to court.
Community members listened attentively and immediately began to ask questions. In addition to general information about legalizing their property titles, many wanted to know more about the intricacies of sharing property. What happens when you share a home but are not married? How can parents ensure that their homes get passed on to their children?
Residents have voiced a need for more education, in order to better understand their legal rights. MEDLIFE hopes to begin including this type of training, focusing first on property rights, in our upcoming educational workshops.
Stay tuned for more information on important issues regarding land rights in Peru, coming soon!
Last Friday we visited the community of 8 de Diciembre for a seminar on various topics regarding preventative health care, as well as to hand out the Pap smear results for patients who attended a previous Mobile Clinic. The turnout was a lot bigger than we expected, showing us that this community is eager to learn about preventative measures they can take to help protect themselves and their families. From the moment we arrived we saw a very organized community; they had taken the time to rearrange the room to be able to accomodate all participants.
Biz Shenk, one of our MEDLIFE interns, gave a short presentation about mental health, which the community appreciated enormously. Several residents had questions regarding psychological health, but felt ashamed to ask them publicly; for this reason, MEDLIFE is trying to organize visits so that community members can meet one-on-one with psychologists. Two representatives from Manuela Ramos, an NGO that works to secure women's rights, also helped MEDLIFE Field Nurse Meri Lecaros present information about sexual and women's health. Among the topics addressed were how to recognize and prevent STDs, how to prevent cervical cancer, and how to do a quick breast exam to check for breast cancer.
Although participants listened with interest to all of the topics, the one that seemed to interest them the most was malnutrition. Almost every mother in the room was asking for advice; they all wanted to give the best possible nutrition to their children. At the end of the seminar everyone was satisﬁed with the answers given to their questions, and conﬁdent that the information received was not just for them to keep, but to also be shared with others. This group's interest was so strong that they even asked for more meetings, and MEDLIFE plans to continue returning to the zone to provide information on additional health topics.
Inge is a Communications Intern based out of Lima, Peru
Savannah King, a MEDLIFE Summer 2012 Intern in Lima, Peru, writes about her recent work using preventitive nutrition education to combat some of the root causes of malnutrition:
Nutrition. A commonly used word. A commonly found problem. MEDLIFE has already written about it a few times, with good reason. According to UNICEF, of the twenty five regions of Peru, nine have a chronic malnutrition rate in children aged 0-5 of over 30 percent. Preventative and educational programs seem to be the leading campaigns for addressing the nutrition problems in areas like periurban and rural Peru and other South American countries, and many of these programs have seen measurable success.
Of the programs I have reviewed, education is always at the forefront of the battle against malnutrition, stunting and deficiencies. Rather than handing out bottles of supplements, the programs aim to make changes starting at the base: teaching a new mentality about food and providing lessons on basic health and diet knowledge.
For instance, one program stressed three main messages in the populations where they worked. The first message was that serving babies a thick puree at mealtimes will satisfy and nourish the child. The second suggestion was to add a small portion of liver, egg or fish to babies’ plates. These three food options are all inexpensive but bring large health benefits when added to a diet. It is not unreasonable budget-wise to suggest adding these items regularly into meals, and the extra protein and iron contribute largely to the children’s intake of nutrients. Lastly, the third message was umbrella advice about how to eat. The program urged the population to think about meals as a time to eat slowly, enjoy the food and spend time as a family. This simple change in mentality likely also encourages a more happy and positive household environment. Also utilizing tools like food preparation demonstrations and group educational sessions, this program saw a significant (⅔) decrease in the rate of stunting, increases in knowledge and preventative behavior and improved feeding practices and growth rates.
Another program focused specifically on pre-natal and newborn care by addressing not only nutrition, but hygiene and proper stimulation of newborns as well. After a four year implementation, the program saw measurable decreases in stunting, vitamin A and iron deficiencies and malnutrition.
Pre-natal nutrition education has both been proven effective by studies and specifically mentioned to me by local women as the type of education they see as most important to changing the health of their communities. During an interview with two women in Villa El Salvador about their families’ typical diets, the women informed me that pre-natal and newborn nutrition education in their community was significantly lacking. We discussed the young age of many mothers in their area and the vicious cycle of poor diets that is often the result. When a mother raises her children with poor eating habits, those children grow up lacking the understanding of what it means to eat balanced, healthy meals, thus increasing the likelihood that they will raise their children with poor dietary habits as well. The women were very insistent that nutrition education, especially for young mothers, would be a welcome and much needed help to their communities.
Along with other topics including the importance of cervical cancer screening and the risks factors of hypertension, infant nutrition has its own informational pamphlet that MEDLIFE hands out at sites during our weeks of Mobile Clinics. Recently, we went one step further and held a workshop on obesity, breast and cervical cancer and family nutrition. Carolyn, Maureen and I (three of MEDLIFE's Summer Interns in Lima) presented on the components of a balanced diet, suggested nutritional boosters to the daily diet and explained why each of the food groups is important to one’s body. We finished with a sampling of a fresh, colorful vegetable salad in the hopes of introducing all those present, including mostly mothers and a few children and men, to how tasty and economical a nutritious snack or side dish can be!
Nutrition is an issue not only in Peru, but all over the world. For the most part, though, it is not going unnoticed and, however slowly, non-profits and governments are addressing the problem through various programs and interventions. From the programs I’ve reviewed and the affected people with whom I’ve discussed the topic, it seems education -- starting at the pre-born stage -- is one of the most important battles that we can fight, and I believe that positive results are inevitable.
Villa El Salvador, one of the many districts in Lima, Peru where MEDLIFE operates, is characterized by a long history of diligence and self-sufficiency. The area was awarded the Price of Asturias Award for Concord in 1987 and was nomiated for a Nobel Peace Prize for excellence in social work and community growth in 1986. Even in the face of numerous challenges affecting all aspects of daily life, the people of Villa El Salvador have proven themselves to be stalwart and community minded.
MEDLIFE's relationship with the former shantytown over the past year and a half has grown significantly in the form of reoccuring Mobile Clinics, workshops and patient follow-up care.
This past May, MEDLIFE held another successful health workshop in the town's civic center with nearly 180 residents in attendance. MEDLIFE staff handed out pamphlets covering an array of health topics, including breast cancer, cervical cancer, diabetes, malnutrition, hypertension and cholosterol, fungal infections, and sexually transmitted diseases.
After discussing the risks of breast cancer, Dr. Jenifer Soto led an exercise in self breast examination which received enthusiastic participation from everyone -- even a small number of men. Dr. José Luis Rodriguez explained how to detect and treat malnutrition among children and senior citizens.
Workshops like these are a crucial component of our ever-expanding education program as we strive to teach patients about the importance of preventative care.
MEDLIFE Intern Amara Channell writes about a new facet of our educational programs -- health and nutritional workshops for the poor in Latin America:
“What can I do to make my child eat more?”
If you have ever attended one our Mobile Clinics, chances are you have heard at least one mother ask why her child is not eating and what medicine the doctors can give her to fix it. Each time the doctors patiently explain that picky eaters are not sick -- they just have a behavioral or taste issue.
Through our expanding educational programs, we have found that one of the biggest problems is that patients lack or misconstrue basic nutritional knowledge. Very few Peruvian schools offer health education, and even if they did, many of our patients have not completed school. The mothers we work with sincerely believe that the more they can make their children eat, the healthier they will be. Their goal is to have chubby children because to them it is a sign of health. Unfortunately, this means that these children are eating fattening diets, not balanced ones, with large amounts of white rice and potatoes, but not much else. Along the way they are developing greater risk of diabetes.
Although very few of our patients show signs of traditional malnutrition, Kwashiorkor or Marasmus, many of them do suffer from micronutrient deficiencies (or “hidden hunger”) which are harder to spot. Worldwide, over one billion children suffer from micronutrient deficiencies. Even though these children may seem perfectly healthy, they have depressed immune function, smaller attention spans, decreased muscle development, height stunting, and poor teeth. They are less likely to complete school because of increased illnesses and decreased brain development. As adults they continue to have issues because the lack of nutrients causes them to be more susceptible to obesity, illness, and muscle weakness. A recent Economist article states that these adults will end up with lower paying jobs, die sooner, and have poorer partners.
In the past few weeks, MEDLIFE has started trying to counter these problems with nutritional “talleres,” or seminars, for local Peruvian women. The seminars last about an hour and give women the absolute basics about nutrition as well as a chance to ask individual questions.
The presentations start by suggesting affordable changes that the women can make, such as eating eggs instead of bread for breakfast, and emphasizing how important variety is. There is an incredible abundance of affordable fruits and vegetables here, but it is not a cultural norm to include them in most meals. By adapting the new MyPlate program (developed by USDA), we can show them a healthy and balanced way to think about preparing their plates.