If one only visits Lima’s developed and wealthier districts like Miraflores, San Isidro, Surco, or San Borja, in can be hard to tell that Lima is a city located in the desert and one of the driest capital cities in the world. But if you the continue driving into what are known as “los conos” on the city’s periphery, to the north, east, and south, within a few blocks the view changes dramatically and the realities of the desert are revealed as dusty hills covered in shantytowns stretching as far as the eye can see. In many of the low-income communities that cover the hills known as "pueblos jovenes" or "asentamientos humanos," the resources, community organization and urban planning are not capable of turning the desert green. Far from it, many people don’t even have adequate access to drinkable water. Overcoming significant barriers to access water is one of the most pressing daily hardships faced by the residents of Lima’s perpetually dusty slums.

screen shot 2016 12 14 at 4 03San Isidro, Lima, Peru.

.screen shot 2016 12 14 at 3 59Pamplona Alta in Cono Sur, about 11 kilometers across the city from San Isidro.

      The city has about 91% water coverage and 90% sewage according to the World Bank. However, the reality is that half of the population receives unsafe water and the poorest communities in “los conos,” at least half a million people are dependent on private water vendors that sell the water at up to 12 times the price of a public utility (2).

       To make matters worse, the poorest residents live in communities at the top of the hills that often have no road access or even a staircase to make the climb easier. The water trucks only drive to where there is road access and make infrequent trips to many communities, so residents are forced to walk long distances to get to the water trucks, and then carry the water up to their homes. In Lima, the poor pay the most for water economically and with their time and labor.

        Most of the communities that are not connected to Lima’s public water utility, SEDAPAL, because they do not have the land title to the land they settled on and are thus not legally recognized by the government. This is compounded by a total lack of roads, or by roads that are mere loose dirt paths and not driveable by construction limiting access into the communities.  

        The government has put in place several programs to attempt to improve water access, the most prominent of which was called “Agua Para Todos,” launched in 2007.  Despite a huge investment of public funds, the results have failed to reach vast stretches of the conos. Edomia Poma Pallcarcajo, a community organizer in Los Jardines has worked for years to try and get the government to connect her community to the public water utility with little success.

img 1134Director of MEDPrograms Peru Carlos Benavides and Edomia Poma Pallcarcajo planning a future staircase project in Jardines.

        “We tried to wait for the government to bring us “agua para todos,” but the years passed, and now we are old. Jardines has been here for 24 years. I got here when I was 19, now I am 42.”

In 2015, Jardines asked SEDAPAL how they could access the benefits of the program.  They told the community that in five or ten years, they could get connected.

“Then, I will be in my fifties,” Edomia said. “ I don’t want to still be without water.”

        In 2011 Agua Para Todos was investigated by the Peruvian National Congress and found that the program, along with the public utility SEDAPAL had been badly mismanaged with a cost of around $1.5 billion USD was accused of fraud. Antonio Iorvis, who has written extensively on the commodification of water and in particular Lima’s water system, concluded that Agua Para Todos clearly shows that a large investment of public funds does not guarantee improve water services or water scarcity. (1)

In light the dismal state of the public water service, Edomia and the community of Jardines decided to take matters into their own hands and contracted a private company to build the infrastructure for them.  One year later, Jardines is ready to connect to SEDAPAL. They will have water pumped directly into their homes for half the monthly cost of buying water from water trucks. The downside is that this project cost each household 1500 soles (about $500), a very high price to pay for low-income residents in Lima.

Privatized Water

Internationally, water privatization has been advanced as a solution to government failures to provide water, as seen in Lima. Joanna Robinson sums up the logic in her book about water privatization:

   “Some argue that water privatization was promoted as a lucrative investment for the private sector and a way for governments to allocate resources more efficiently, more recently private sector water delivery has been endorsed and encouraged by the World Bank and other global financial institutions, as a way of correcting the failures of public water management, including increasing environmental conservation, reducing social and economic inequities—particularly in developing countries—and providing clean water to the billions of people who currently lack access worldwide. Since the 1980s, public water systems have been under attack by proponents of market-based models of governance, who argue that “governments are less productive, efficient, and effective than markets.”With the massive governance failure on the part of the public sector, including poor planning, crumbling infrastructure, and pollution and degradation of water systems, private sector involvement in water systems has been hailed as a means of correcting those failures and increasing equity in terms of access to and affordability of water services by poor and marginalized populations.” (2)

In 2000, more than 460 million people had their water supplied by transnational water firms and that number has only continued to grow (2). The results of this effort have been mixed internationally and sparked heated debate, with many critics arguing that privatization is another form of neo-colonialism, and proponents on the other side of the debate arguing that it serves to spread access and increase efficiency.

In Lima, news that the government was considering privatizing SEDAPAL caused large protests that blocked traffic on major roads.  Protesters cited fear of increased tariffs, high buy in costs like those in Jardines and the extremely poor and expensive service for those currently being serviced by private water truck companies as reasons why privatization should be opposed.

Although some communities like Jardines have been able to construct their own water infrastructure, many cannot afford this, and high cost and constant struggle to procure basic necessities like water is a constant burden that holds communities back from moving forward. MEDLIFE recognizes that one of the best ways to empower communities is to alleviate this burden, and so help communities improve water access in whatever way we can.

How MEDLIFE Works to Improve Water Access

If a community can get the government to pay to build them the infrastructure, this is the best solution, but fulfilling the requirements is costly and there is no funding from the government for these sorts of projects. Along with being useful to communities in their own right, many MEDLIFE development projects serve to complete the requirements for both water connection and land titles.

Communities need road access and a safe entrance and exit from communities. This can be very difficult, as these communities were built without any urban planning oversight, and thus are often built on land that would never be chosen by a developer. Retention walls must often first be constructed to stabilize the land for construction and to prevent rockslides. MEDLIFE staircases fulfill the requirement of a safe entrance and exit.  

MEDLIFE is in the process of building a road in one of the communities we have worked in the most, Union De Santa Fe. This road, combined with the many staircases and the retention wall MEDLIFE has built should qualify Union Santa Fe for connection to SEDAPAL.  However Union Santa Fe Community Organizer Casani, who is working with SEDAPAL to organize the connection says that even after a six year development process process of building the staircases and the roads with MEDLIFE to improve infrastructure and help Union Santa Fe meet SEDAPAL requirements, the process will take around three years.

        We know that the families of Union De Santa Fe and countless other communities could not wait that long when they are thirsty today. We built a water pylon like the one in Jardines that connects to the SEDAPAL system down the hill and brings water directly into residents homes in Union de Santa Fe and now they have affordable water in their homes.

 screen shot 2016 12 14 at 3 56A photo of Urucancha taken from above by a drone.

However, sometimes, it is not possible to construct a Pylon to connect to the public utility, as many communities are located far away from connection points to the SEDAPAL system on very poor sites for construction. Meeting requirements would be extremely expensive and time consuming in these places, and then it could take years for the government to get around to doing the project.

In Urucancha, for example, a community in the Southern Cone that is located on the top of the hill that separates La Molina, one of the wealthiest areas, from Pamplona Alta, one of the poorest, a pylon project was not feasible. Yet Urucancha was badly in need of better water access, the water trucks only drove that high on the hill about every two weeks and residents had no way to store enough water to last that long. Recently, the water trucks have decided that the amount of water Urucacha was purchasing wasn’t worth the long trip up the hill, so they didn’t come for 6 weeks, leaving the residents with no option but to make the 40 minute steep hike from the next nearest water stop carrying their water.

Lack of water is Urucancha’s main problem, but storing water in sanitary conditions for long periods was also an issue. The big open barrels of water that can be cheaply purchased by residents to store water often become unsanitary and contaminated with “green fungus,” as reported to us by many residents.

img 1225Urucancha Residents next to the new water tank.

In this case, MEDLIFE constructed a huge tank that could be filled by the water trucks and leave the community with enough water to last between visits.  The tanks are sealed, and thus will keep the water clean from contamination. The trucks will make the trip often enough to keep the tanks filled, because they are now selling in bulk, which also reduces cost. This project brings water to 150 families.

We knew we could reach more people, so we are currently constructing a larger and more ambitious water tank project that will be able to service several communities at once higher on hillsides in Laderas. We are building three water tanks that will be filled by water trucks and then funnel water directly to the homes of 220 families and around 1000 residents. This will be our largest water project yet, and we won’t stop here.

 IMG 1145Water tanks under construction in Laderas

Sources:

1:Barajas, Ismael Aguilar, JuÃŒˆrgen Mahlknecht, Jonathan Kaledin, Marianne KjelleÃŒn, and Abel MejiÃŒa. "5."Water and Cities in Latin America: Challenges for Sustainable Development. Abingdon, Oxon: Routledge, 2015. N. pag. Print. 

2: Robinson, Joanna L. "1." Contested Water: The Struggle against Water Privatization in the United States and Canada. Cambridge, MA: MIT, 2013. N. pag. Print.

 

 

Voluntourism and medical missions have been heavily criticized both in the media and the academic community, and for a good reason: they often ineffectively funnel valuable resources and time into a trip that ultimately serves the participants instead of the community they set out to help. Simply put, one cannot effectively solve the complex and immense problems in global public health in a country and culture they do not know in a few weeks time. Progress in global public health is made on the timescale of years, not days.

Maya Roberts of Yale University summarizes the problem well in her critique of medical missions and what she calls “Duffle Bag Medicine.”

“I spot a young man, at most 19, smoking a cigarette, and leaning against the makeshift frame that converts the backs of pickups into the primary form of public transportation here in Guatemala. He is not a licensed medical professional; he is an American on vacation and he is about to distribute medication to patients… He has confidently slung a stethoscope around his neck, proclaiming an ability to provide medical care, an assertion that is at best questionable. He is from a small US town; all he needs to do to be part of this transient medical team is to finance his flight to Guatemala. He freely donates his time and energy, but he delivers “care” without the appropriate training, without knowledge of the predominant language, and without any clear accountability… This young man and his group are genuinely proud that they spend their vacation here and are especially proud of their contribution.  I worry that this pride prevents them from acknowledging that their actions may actually be harmful and do not necessarily address the complex needs of this community. Their short-term work is not integrated into a local infrastructure. Health promoters—local men and women trained to recognize serious ailments and to treat minor ones—are not introduced to these groups. Public health and preventive measures are not part of the overarching goals for the transient clinics; this inhibits the project’s long-term potential and puts the community at risk of receiving inappropriate care.”

MEDLIFE has taken the medical mission voluntourism model and fixed it by addressing these important critiques. We have local staff permanently based where we work who keep checking in with patients and build long-term relationships with communities to make sure that the valuable contributions made by volunteers on their trips are properly directed and able to accumulate into a lasting and sustainable change.

26334169914 abd4db06b6 zA volunteer listens to a patients heart murmur under supervision from an Ecuadorian doctor on a Mobile Clinic.

          Sometimes, on a Mobile Clinic, you really can just give a quick treatment and create a profound impact on a patient’s life. When a kid comes in with a bacterial infection or a parasite, pulling some antibiotics out of a duffel bag makes a big difference. However, being able to help that small number of easy patients isn’t good enough when many people who come into our clinics face much more serious and chronic problems.

When someone comes in with serious complications caused by diabetes, malnutrition, high blood pressure, or a tumor, things are more complicated. Sometimes on clinic, we run out of diabetes or high blood pressure medication and our volunteers are initially dismayed. MEDLIFE founder Nick Ellis explains that, in the end, it matters very little if we hand out a month’s supply of a diabetes medication. The impact on their overall prognosis will be negligible and the odds that they get more of the medication if they weren’t already taking it are slim. What really matters is that we found this patient.

27703185930 39248f1b74 zA patient's tumor being examined at a house visit after the patient was found in a Mobile Clinic.

 MEDLIFE works with local health care professionals instead of trying to replace them. Our Mobile Clinics use local doctors, this allows us to provide culturally appropriate care and provides greater opportunities for cultural exchange and for our volunteers to learn about how healthcare is practiced in the developing world.

Our follow-up program utilizes the parts of the existing local healthcare infrastructure whenever possible, so we are working together with local care providers. For example, the Peruvian health care system pays for tuberculosis treatment. The problem is that patients are often unaware that this is available to them and do not know how to access it. This is compounded by the well-known problems with proper adherence to tuberculosis treatment; medication must be taken regularly on a tight schedule or patients risk developing drug resistant TB, which is harder to treat and must be treated with medication that causes more severe undesired side effects. When we encounter a TB patient on a mobile clinic, we have our nurses visit them in their home and walk them through accessing the free treatment option, and often accompany them to their appointments. They continue visiting the patients in their homes to make sure they are following proper protocol.

We build a lasting relationship with communities; bringing clinics back to the same communities year after year to continue to address the root causes and allow our impact on the community’s health to accumulate over time. MED Programs staff was initially concerned when they noticed that the number of women coming in for Pap smears had dropped dramatically in communities we had been visiting for years. However, after speaking with community members, they realized that this was actually an encouraging indicator that our educational approach was working; the women had simply started going in for yearly pap smears on their own after learning about the importance of the screening in our clinics.

IMG 5051

We give our volunteers an opportunity to be a part of our long-term bonds to communities and patients. Volunteers often go back and fundraise for projects and patients that they encountered on their mobile clinics. Sometimes, that chapter is able to be present for the inauguration of a project they fundraised for. When that is not possible, we update them with videos and photos showing them where their hard work went and explaining why we need to fundraise to do a specific project or patient.

Voluntourism is a massive industry worth an estimated $2 billion with 1.6 million volunteers annually and it continues to grow. It is not going away. Despite shortcomings in results, it provides life-changing educational experiences to young students every year, fostering cultural exchange, a sense of global community, and inspiring young students to continue working to solve the problems they are exposed to throughout their careers. MEDLIFE has taken the broken model and fixed it. MEDLIFE Mobile Clinics and our patient follow-up program use a unique approach that ensures that the good intentions and hard work of volunteers produce life changing and sustainable results in the communities we work in, results our volunteers can be proud of. 

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September 13, 2016 9:21 am

Local Solutions to Anemia in Lima, Peru

Written by Jake Kincaid

2Theresa with all of her ingredients, ready to give the nutricion workshop.

          According to the World Health Organization, iron deficiency is the most common and widespread nutritional disorder in the world. Anemia, a condition resulting from iron deficiency, and malnutrition in general affects primarily impoverished populations around the world. In Peru, where about 50% of the population lives in poverty, chronic malnutrition is widespread, especially in the rural areas and urban slums where MEDLIFE works. In accord with MEDLIFE's commitment to working on solutions that are tailored to local realities, MEDLIFE held a cooking workshop designed to help residents fill their iron deficiency using an ingredient cheaply and widely available in local markets but not so easy to cook with- animal blood.

1Theresa with a bag of raw blood.

          Blood is extremely rich in iron and cheaply available in markets from local livestock, thus it is the perfect local ingredient to increase iron intake and avoid anemia. Anemia is a particularly insidious nutritional deficiency that exerts its effects subtley but in the long run exerts a great toll on populations. Some of the primary symptoms include fatigue, weakness, difficulty concentrating, dizziness, insomnia, muscle cramps, and rapid heartbeat which can lead to heart failure and death. Theresa explained during the workshop that your average anemic child will sleep during school, not want to play, and be very inactive.  These children are also more vulnerable to diseases like Tuberculosis. In contrast “A child without anemia runs and jumps, is a happy and active child,” Theresa said.

IMG 83244MEDLIFE Year-long Interns played a game that involved sorting healthy and unhealthy foods with the kids that came.

          Over 3 billion people, over 30% of the world's population, are Anaemic.  According to the WHO, “Iron deficiency exacts its heaviest overall toll in terms of ill-health, premature death and lost earnings... and reduce the work capacity of individuals and entire populations, bringing serious economic consequences and obstacles to national development.”

          In Peru, 37% of children under 5 with families in the socioeconomic bottom 20% suffer from chronic malnutrition. Union de Santa Fe is a community MEDLIFE has worked with extensively located in the poorest area of one of the poorest districts in Lima, San Juan de Miraflores, where 20% of the population lives in poverty.

          The MEDLIFE workshop was a great success, residents of Union De Santa Fe learned how to cook to improve their iron intake and avoid Anemia, as well as learned about general nutricion. 

          The crowd favourite was chocolate de sangre, or chocolate blood dip. Trust me it tasted a lot better than it sounds. The recipe included: Animal blood, vanilla crackers, vanilla extract, cinamon infused water, cacao and sugar all blended together.  

59A batch of chocolate de sangre, freshly blended.

6

7The kids could not get enough of the chocolate.

8 

“The day I remember most clearly was the day he caused this infection” Catalina Bailon explained in an interview about her experience with gender violence.  She is referring to the mastitis inflammation in her breast that MEDLIFE is treating her for, caused by a violent beating she received from her husband.   â€œIt was November 5 of last year,” she explained. “I remember the date because I remember seeing it and thinking ‘what am I going to do?'”  According to a United States Bureau of Democracy report on human rights practices, Catalina is one of around 25,000 women in Peru to be affected by gender violence every year.  This is a number that has been growing at a worrying rate.

 

MEDLIFE are currently working with several women who have been victims of domestic abuse; both assisting with their physical recovery and helping to empower them psychologically.  Catalina, 32, suffered in a violent relationship for nearly four years before finally standing up to her husband.  â€œIt is hard because you're not just thinking about your feelings and how it will affect you but you also have to think about your kids and the long term effects,” she said, explaining why she remained so long in an abusive relationship. “The important thing is being able to call out abuse; we need support from the government to do this.  If there is no support, there is nothing we can do.”

 

IMG 7744 2Catalina's two children, Brenda aged 4 and Milea aged 8, with their pets.

In recent months, the Peruvian government has been under heavy criticism from women's rights groups over its “incompetence” in bringing justice to women like Catalina who have suffered at the hands of abusive men.  According to a US special report on Sexual Violence and Justice, Peru has the second highest number of cases of crimes against women in Latin America and these activist groups are arguing that the government is not doing enough to try to change these statistics.     

 

On Saturday 13th August, hundreds of thousands of women and men gathered across Peru to march together in protest of the violent crimes committed against women on a daily basis.  The march, described by Peru's women's minister Ana María Romero as a “cry against impunity”, follows growing protests and demonstrations by women's groups across South America against governmental indifference to violent gender related crimes.  Over the past year, the tide of unrest against judicial incompetence in female abuse cases has been rising with a strong social media following under the hashtag #NiUnaMenos.  The hashtag refers to the words of Susana Chavez Castillo, a murdered Mexican poet and human rights activist who wrote of the crimes against women  â€œNi una mujer menos, ni una muerte más” (not one woman less, not one more death).

 

Catalina described how essential the march and the #NiUnaMenos campaign were, saying “I think it is very important to see so many women standing together to say ‘no more.'” she also went on to explain why she thinks calling men out on their treatment of women can be hard.  â€œAt the moment we often let it happen because we are thinking about our children and what calling it out might mean.  We have no guarantee that we will get the justice we need and deserve”  

 

13924965 980565375389736 8955344924746464235 n The #NiUnaMenos march reaching the presidential palace in Lima. Photo credit: Ni Una Menos Peru.

 

This was essentially the message of the march on Saturday with 50,000 people turning up in Lima alone to show their support for the cause.  Many were holding signs with either the ‘Ni Una Menos' slogan or “tocan a una, tocan a todos” (touch one, touch all) written across them.   Peru's president, Pedro Pablo Kuczynski was among those marching along with first lady Nancy Lange.  In an interview with the media after the march, he stated that his government had plans to develop more facilities for women to denounce violence. “Abuse flourishes in an environment where complaints cannot be made,” Kuczynski said. “The blows are absorbed in silence and this is not how it should be”.

 

This denouncing of gender violence was the focus of MEDLIFE's educational talk at our clinic last week in Villa María del Triunfo.  Women living in poverty are more likely to become victims of unreported gender violence as they are less educated about the implications of this violence and what they can do to stop it.  The talk, given by MEDLIFE nurse Teresa Ascate and psychologist Alfredo Zarate, focused on informing the woman and men of the community of what domestic violence was and what steps could be taken to prevent it.  Teresa explained how until 2015, violence against women had fallen into three categories; physical, psychological and sexual violence.  The law was changed in 2015 to include economic dominance as a form of domestic control.

 

According to ‘Brechas de Genero 2015: Avances hacia la igualdad de mujeres y hombres' (Inei), 31.9% of women in Peru don't have their own income compared to just 12.7% of men who don't.  In impoverished areas, the figure for women almost doubles with 47% having no income compared to only 13.6% of men who don't.  This makes the women of the communities that we work in especially vulnerable.  Many of these women have only a very basic education and no job.  The society they live in dictates that women are expected to stay at home all day to look after the children and clean the home while men go out to work.  This patriarchal lifestyle leaves these women highly susceptible to controlling behavior from a man, who uses the female's lack of money and inability to earn to take away her independence.  

 

IMG 7685Community members reading leaflets on domestic violence at MEDLIFE's educational talk.

Catalina said how glad she was to hear that this law against economic oppression had been passed. “When I worked, I didn't see my money as it went to my husband and my children,” she said. “ My husband was in charge of the money.  I have two children and therefore it was my view that their father should look after them and me.  It is his responsibility as a man.  This change in the law will mean we won't need to rely on men to look after us anymore, they can't use money against us.”  

 

2016 08 25

 

This opinion seemed to be shared by the community our staff were talking to.  Both the men and women were listening attentively to what was being said and afterwards they explained how important it was for their community to have the chance to be given information like this.  One community member, Sara Julios, described how she felt about the talk,  â€œthis is a topic that is very important for us.  Too often, violence of this kind turns to murder and it is important for us to hear about it as a community so we can look out for each other.”  MEDLIFE staff also informed the community about a helpline that has recently been set up in San Juan de Miraflores to provide a platform for women to talk confidently about abuse and seek advice and support about how to go forward.  Sara said how important it was for the community to be informed of the helpline that can be used to denounce this violence “I didn't know about it before and I don't think anyone else here really did.  It is so important to know that there are support networks we can look to for help.”

 

At the talk, Teresa also told the women about the march taking place the next day.  Many had not heard about it before but seemed determined to attend once they knew what was going on.  Another community member, María said how grateful she was that MEDLIFE had come to tell them about the march; “we don't have access to a lot of communication networks where we live.  We couldn't hear about the march on the internet or the news and so we easily would have missed it.  Thanks to you we now know that this important event is happening and many of us will be able to attend.”

 

IMG 7745Catalina being treated by MEDLIFE nurse Janet.

Catalina said she felt the biggest issue facing Peruvian women and causing such widespread domestic violence was a male abuse of power.  She said “when he was in there, in that moment, he felt powerful… I was just a little thing and that was how I felt, like that and nothing more.  At the time I felt there was nothing to be done.  There are many things that I didn't understand until long afterwards.  For women, in the moment, they don't think because they can't process what is going on in their home.  I had to think about my children, not about me.  Because of this I focused on moving forward and this was why he could push me and strike me and I would do nothing.”  It is this feeling of helplessness that means crimes of this sort can thrive.  

 

This is what women's rights groups across South America are so determined to change.  Last month, the media focused on three high profile cases that were widely considered to have given lenient sentences to perpetrators.  They used these cases to highlight the inequality in the justice system when it comes to crimes against women.  The major point of the campaign was that, without the support of the law and the government guaranteeing justice and safety, it is almost impossible for women to denounce the crimes committed against them.

 

The focus on these cases gave impetus to Saturday's march with many holding up signs with pictures of Marielena Chumbimune, Arlette Contreras and Lady Gullién, the three women the media focused on in the months before.   Many MEDLIFE staff also went to the march and described how important it was for Peruvians to see so many men and women marching together for their country.  Cristina Negron described how “it was amazing to see everyone united towards the cause because everyone knew someone that was a victim of gender violence.”

 

13895074 10154247046831628 4936405391263360730 nMEDLIFE staff marching through Lima for the #NiUnaMenos campaign.

The World Health Organisation recently released a statistic showing that around 69% of women in Peru today have experienced some form of gender abuse.  This is a statistic that is too big to ignore.  It is so important to see such momentous steps being taken to change the attitude of this country.   Catalina finished off by telling me how she viewed the #NiUnaMenos campaign as being more important today than ever before, “Everyday we work on this campaign we are improving.   It is so important to talk about these issues and show that it is not OK.  I hope that this will mean everyone will be able to see eye to eye and we will be able to provide a better, safer future for our children.”

 

Luckily Catalina is well on the way to recovery now.  On Thursday 18th August, MEDLIFE nurse Carmen accompanied her to the hospital where she was having her final operation, funded by MEDLIFE, to cure the mastitis.  The operation went well and Catalina is now planning to start looking for a new job so she can continue to support her children.  Catalina expressed how glad she was that this chapter in her life is over and said what advice she would give to other women in her position.     â€œI would say that now, I am fine.  It is a good thing to seperate, to have some distance so that there is no violence in front of the kids and so that I don't feel in danger.”  Catalina suffered for four years until she felt she was in a position where she had to stand up against her husband who had caused her serious physical and psychological damage.  Women should not have to suffer in silence for so long, it is so important that they feel supported and able to denounce gender violence and we can only hope that the new government under Kuczynski will at last act to prevent women in Peru from having to live in fear.  Catalina is now able to look towards a new future where she and her children can live comfortably and happily.   

 
August 15, 2016 11:57 am

Child Malnutrition in Ecuador

Written by Jake Kincaid

1Doris Guacho Jaya, 24, with her three daughters. The twins were diagnosed with chronic malnutrition at their 9 month checkup.

When Doris Guacho Haya brought her twin daughters into the local health post to get them their state required vaccines, the doctor told her they were healthy and normal for seven-month old infants. But at 9 months, the doctor delivered some bad news: Doris's twins were falling ill to the same condition that plagues so many other children in the impoverished farming communities of Ecuador's Chimborazo province- malnutrition.

“It's not their fault,” she said, as she stared at her twin girls simultaneously breastfeeding in her arms. She gives her twins breast milk 4 times a day, and sometimes some rice or soup when there is money. But the doctor told her she needed to feed them 5 times a day, not just breast milk, but fruit and meat. She didn't have money for that, the work she had one day a week cleaning houses and doing laundry only brought in about $30 a month. She didn't know how she was going to afford to get them more food. Despite her efforts, her kids hadn't put on weight 6 months later when Doris brought them into a MEDLIFE Mobile Clinic.

In Ecuador the minimum wage is $354 a month, the poverty line is $82 a month, and the extreme poverty line is $46 a month. Making only $30 a month, Doris sits well below all of these markers. Doris lives in a small agrarian community in Chimborazo, located in the heart of the Ecuadorian Andes. Doris's economic situation is not unique here. In Ecuador, 43% of rural people are living in poverty, and 19% are in extreme poverty, as compared to 24% and 8% nationally. The parroquia (a small subdivision within provinces with its own smaller local government) where Doris lives, San Juan, is particularly impoverished, with 84% of residents living below the poverty line.

Ecuador's population is comprised of 38% indigenous peoples, which makes Chimborazo the home of a large portion of Ecuador's indigenous population. This population continues speaking Quetchua, dressing in traditional clothing and living off the land much like they have for centuries.

3People doing field work in an indigenous community in the province of Chimborazo, Ecuador.

Families often have multi-generational roots to their land and homes, and these roots typically remain deep and unbroken. Doris lives in a small home with 4 rooms, two bedrooms, a bathroom, and a kitchen with a wood fire stove. She shares this home with 14 people, her parents, eight of her 10 siblings, and her own three children. Bedrooms are packed full at night, there is barely enough room for everyone to fit indoors at the same time. “We have never had a bank account or a credit card, a car, or even a donkey,” Doris's mother said. Doris was born there, her mother was born there, and so were her grandparents. “This is the home of our family,” she said.

2Doris with her daughters outside her four room, two bedroom home that they share with 14 people.

 Life is hard in these places. A subsistence farming lifestyle, harsh climate, physical isolation and lack of access to services contribute to a host of economic and public health problems. Here, the elderly hobble by with stooped postures and creaking joints swollen by arthritis created by years of hard physical labour, the mothers are young and the children are skinny, with cheeks cracked and scorched red from the cold dry air that sweeps across the hillsides where they live.

4An indigenous women climbs a hill to get home from a day of work in the fields in Chimborazo.

Doris is a single mother, her first daughter and her twins are from different fathers, both whom offer her no support and refuse to recognize the children as theirs. “One of them is married, and the other is poor,” she explained. She dropped out of school when she had her first daughter at 18 . She had her twins at age 23, now 24, she is left to care for the three children on her own with the support of her parents and siblings.

That is why there was never enough to go around- that is how everyone got so skinny, her young twins dangerously so.

Malnutrition is among the most serious of the many public health problems in this area. Government data from 2013 put national rates of chronic malnutrition in children under five at 26%, but it is much higher, at 52% in Chimborazo. Malnutrition, along with lack of access to health services are among the major factors that contribute to infant mortality and other developmental deficiencies. The government has put forth a plan to reduce malnutrition rates, but its effects often don't reach, or hit as a mere drop in the bucket, residents living in remote communities like Doris.

When her doctor told her that her nine month old twins were underweight, she was given a small packet of Chis Paz, a micronutrient supplement being handed out as part of the government's plan to combat malnutrition. She quickly ran out of it, and when she went back to the doctor, her twin's condition had not improved. Her kids were still underweight, but this time she was told there were no more vitamins.

6

Dayanera Guacho Jaya, being held by her older sister.

“They say that public healthcare is free with the government's campesino (peasant) insurance policy,” said MEDLIFE nurse Maria, who has lived in Chimborazo her whole live, and worked with MEDLIFE patients there for years. “But when you go to the health post, nothing is available, or the waiting list is so long you could die before getting the treatment you need.”

I heard this sentiment expressed whenever I asked about the local health posts in the Chimborazo region; “they didn't have what I needed, nothing is available,” people told me again and again. It is not uncommon for a single health post staffed with less than twenty people to serve all rural communities a three hours drive in every direction. Given the costs in time and money to make the often long and arduous trip to the nearest health post and the lack of available services, many don't bother going.

 After 6 months of working to help her daughters put on weight with no results, Doris brought her daughters into a MEDLIFE mobile clinic. We gave them supplements of milk and vitamins, and her daughters have finally begun to put on a little weight after a few weeks. When MEDLIFE encounters children who are experiencing chronic malnutrition in clinics, we give vitamins, try and give guidance to the mothers, and in more serious cases add them to our patient followup list. MEDLIFE followup nurses will continue to check in with Doris's family to monitor their progress and help provide them with supplemental nutrition to get their children back to good health.  

 Sources and further reading:

http://www.ecuadorencifras.gob.ec/documentos/web-inec/EMPLEO/2015/Marzo-2015/Presentacion_Empleo_Marzo_2015.pdf

http://www.ecuadorencifras.gob.ec/documentos/web-inec/POBREZA/2015/Marzo/Reporte_pobreza_desigualdad_marzo15.pdf

https://www.culturalsurvival.org/sites/default/files/media/ecuador.pdf

http://www.desarrollosocial.gob.ec/programa-accion-nutricion/

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