MEDLIFE

Last week the President of Ecuador, Rafael Correa, announced that the country will eradicate malnutrition within the next four years. The government will focus on pregnant and breastfeeding women, as well as young children. The pledge is a response to the fact that Ecuador has the fourth highest rate of malnutrition in Latin America, hovering around 19 percent of the country's population. Yet, according to UNICEF, the Chimborazo region of Ecuador -- where MEDLIFE conducts most of its Mobile Clinics and patient follow-up work -- has an even higher malnutrition rate of 44 percent. The Chimborazo region is home to many poor, rural communities, as well as indigenous groups.

“Aliméntate, Ecuador" is a new program that provides pregnant women and mothers of infants with a small stipend to get regular checkups. The program also helps teach mothers about exclusive breastfeeding (when an infant only receives breast milk without any additional food or drink) as well as complementary foods (when additional foods are introduced into a child's diet). According to the program's website, "Aliméntate" has already been successful in reducing rates of anemia by 12 percent during the past year in the community of Manta.

Every year, pneumonia and other acute respiratory infections (ARIs) kill 50,000 children under the age of five in Latin America. According to the World Health Organization, at least 15% of the overall deaths in young children in Peru are caused by ARIs – diseases that are completely treatable, but that often go ignored. Unfortunately, this number may actually be even higher due to reporting inconsistencies in many developing countries. When patients with these types of issues are encountered during our Mobile Clinics, MEDLIFE helps to treat colds and other respiratory illnesses before they develop into more severe problems.



ARIs include viral and bacterial pneumonia, influenza, and respiratory syncytial virus (RSV). Bacterial pneumonia can be caused by Streptococcus pneumonia or Haemophilus influenza type b, among other bacteria and viruses. ARIs cause coughs, fevers, body aches, chills, headaches, suppressed appetite, nausea, and noisy breathing. When they reach an acute level, children have difficult or rapid breathing, blue lips or fingers, and a fever of over 102 F.



Children are especially vulnerable to these types of problems because they do not have fully developed respiratory tracts, and are often times unable to ask for the help that they need. In developing countries, problems such as pollution, overcrowding, limited medical access, poor nutritional status, and lack of vaccines also increase the risk. Furthermore, common health problems such as diarrhea decrease immune function and contribute to a child's risk of dying from a respiratory illness. A study by the Acute Respiratory Infection Atlas showed that children who have to share a room with four or more people have an increased risk of 2.5 times. Overall, in developing countries, (where 93% percent of children are not vaccinated) 7,300 of 100,000 children die from pneumonia.

On a recent mobile clinic in Lima, an interested student asked me what I knew about the state of sex education in Peru. Her interest was piqued by the video she had just watched in our education tent, one which attempts to underline for our patients the often misunderstood connection between the sexually transmitted Human papillomavirus and cervical cancer. My answer was that there was none.

During mobile clinics, female student volunteers often express shock that many of the young mothers they help to treat -- some arriving with two to three fidgety children in tow -- are frequently around their same age, if not younger. This polarization of lifestyles is for many of them one of the more impacting moments of their volunteer experience.

In a hunt for more tangible statistics, I began doing some research. Study after study corroborated a bleak picture of increasing STD transmission in Peru and other parts of Latin America, especially in large urban areas. Factors included risky sexual behavior, limited condom use, and a fundamental lack of education. The same misconceptions and cultural barriers that MEDLIFE encountered when first offering free Pap smears in Pamplona, discussed in detail in this blog entry, reappeared in my research. When it comes to information about safe sex, it seems that many communities in Peru were just never given the tools needed to identify the risks of STDs or to understand contraception options.

As urban populations continue to grow globally, there is an increasing need to focus on urban health. Metropolitan areas generally offer a more prosperous setting with greater health care, education, and economic prospects. Given their size and infrastructure, cities can often deliver better services more efficiently than rural areas. However, population growth and urbanization in many cities have surpassed the local government's capacity to maintain adequate infrastructure and environmental management. As cities continue to expand, an increasing number of urban residents lack access to basic public services, such as clean water, sanitation, and medical services.

Peru has not remained unaffected by such rapid urbanization. In fact, the percentage of the total Peruvian population living in cities has increased from 47% in 1961 to 77% as of 2010, and the population of the Lima Metropolitan Area stood at about 8.5 million in 2007. With greater access and proximity to heath care services (10 of Peru's 16 national hospitals are located in Lima), the move from rural to urban regions has generally proven to be promising for the health of migrants. Indeed, MEDLIFE has encountered a number of families who have come to Lima from the Amazonian or Andean regions of Peru in search of better healthcare. Research has shown that heath indicators in Peru are two to four times better in urban regions compared to rural areas (Table 1). Yet, urbanization is by no means a resolution to improve the health profile of Peruvian residents.

Table 1

On the final day of our our recent Mobile Clinic in Riobamba, Ecuador we visited the community of Lirio San Jose, a small village set deep in the rolling hills of Ecuador's Andean highlands. Upon arriving at the schoolhouse where our Clinic would be hosted, our student volunteers were surprised to find a small team of local health professionals that would also be visiting patients that day. This team was comprised of employees of Ecuador's state-run medical system, and they were in the community of Lirio San Jose conducting wellness checks on pregnant women and newborn children in the area.

After speaking with the team, our student volunteers found that Ecuador had recently introduced a new program designed to encourage pregnant women to give birth at local hospitals or health centers, rather than in their own homes. Another effect of the community's physicial isolation, in addition to limited access to general health services, is that many women deliver their children at home rather than traveling to a hospital. This program keeps tabs on pregnant women in the region, assessing their health as their pregnancies' progress, and providing education and incentives to encourage women to visit a hospital to deliver their child.