June 21, 2016 12:06 pm

Elderly Care in Lima's Slums

Written by Sarah Bridge

The aging population is a worldwide issue that many countries are struggling to deal with.  Elderly patients who are suffering from rapidly deteriorating health issues form a large percentage of the MEDLIFE follow-up patient list.  In much of the developed world, residential homes guarantee the amenity, stability and care people need in their old age.  However, this is not a comfort that impoverished families in the slums of Lima can afford.  In Peru, the leading causes of death among people over 65 are untreated infections, influenza and pneumonia.  More often than not, these deaths come about due to neglect and isolation suffered by elderly patients who are unable to access the healthcare they require.  

1Ediberta Malpartida at home in her bed 

It can be easy to overlook these patients as their suffering is often less shocking as it is something people are familiar with all over the world.   Aging is, after all, a natural process that happens to everyone and is always difficult to face.  However, the real issue here is the condition the patients have to endure as a result of their poverty.  Without any real pension, medication and therapy cannot be paid for and so these patients become resigned to spending weeks at a time alone in their rooms.  Rooms without windows, corrugated iron roofs that let in all the elements and lumpy mattresses that cause discomfort and bed sores.  For these patients, sitting outside and feeling the sun on their faces is a rarity.

2Eulogio Orcottma

Ediberta Malpartida and Eulogio Orcottma Cardenas are examples of this suffering.  Aged 88 and 79 respectively, both have been MEDLIFE patients for over a year and both have spent almost the entirety of that time in isolation.  Jimena Torres, who lives with Edilberta, explained how “she doesn't walk for fear of falling over; she can't bathe herself, she can't cook for herself, she can't do anything on her own.”

  Being immobilized and bedridden often then leads to other health issues.  Lack of movement and basic exercises can result in muscle deterioration and infections.  Whereas in developed countries, these conditions are relatively easy to recover from, here in Peru it is not so simple.  Hospitals are often only a short bus ride away, but taking that journey can cost up to s/3.50 which is an expense many are unable to pay.  Furthermore, once at the hospital, it is unlikely treatment will be given straight away thus incurring the need for more travel.  This means more money wasted and more tiresome journeys that these patients struggle to make.

Eulogio has been bedridden since arriving at his son's house in Lima last year.  He suffers from arthritis and bladder obstruction and more recently has been losing sensation in his left side.   MEDLIFE has been providing him with medication and medical visits and is now funding therapy to help him regain his mobility.  

One of the most important processes for the elderly is to keep up basic exercise and movement.  Having a walker to enable travel around the house or a wheelchair for outside access can make all the difference to these people.  Furthermore, doctors visits and therapy sessions are crucial to keep track of a patient's progress and make sure they are not deteriorating or becoming isolated.  MEDLIFE is keen to invest in therapy and equipment that can enable patients to take part in much needed exercises to strengthen their muscles and rebuild their health.  Such equipment is often cheap to buy for the charity and can provide significant improvements to the quality of life of the patients.

IMG 6177Ediberta being visited at her home by MEDLIFE nurse Janet

Following the support given by MEDLIFE, both Eulogio and Ediberta are in much better health compared with last year though their treatments have been very simple.  As of January, following an MRI scan Eulogio has been put into a rehabilitation therapy programme in his home supported by MEDLIFE.  He is being given painkillers and MEDLIFE are now trying to get him therapy sessions at Hospital de la Humanidad, which is at the bottom of his street, now he is able to get there.  Ediberta is being given the medication she needs to make her more comfortable and make the living situation easier for the friends taking care of her.  

Old age is never easy to confront, least of all for the elderly.  However, even a little bit more comfort and mobility can make a world of difference.  For patients like Ediberta and Eulogio, just having medication to stop them from being in constant pain getting the therapy they need to be able to move from their beds can improve their quality of life.  With such a vast number of MEDLIFE follow up patients being over the age of 65, it is hugely important that we are able to fund the support these people need to live normal and healthy lives.      

April 21, 2016 2:53 pm

Earthquake in Ecuador Update

Written by Jake Kincaid

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Five days after the catastrophic earthquake that rocked Ecuador on April sixteenth, the death toll has risen to 570, along with 7000 injured, 2000 buildings damaged and 24,000 survivors left homeless in refugee shelters, according to government tallies.

            The government has estimated that the disaster caused between $2-3 billion dollars worth of damage, and could knock 2-3 points off of growth, already predicted to drop by the World Bank this year because of falling global oil prices, and lead to a shrinking economy. It will take years to recover.

            The president has unveiled a plan to finance parts of the reconstruction through raising taxes, sellings bonds, and federal loans, but alot of help will still be needed.

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            MEDprograms director Ecuador Martha Chicaiza arrived in Esmeraldas today, the afternoon of the 21st with 50 emergency kits full of non-perishable foods, soap, matches, and basic medical supplies. The kits cost $25 each. She has also made 100 kits to send to Pedernales, one of the hardest hit coastal towns. 

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“These tragedies have brought a lot of pain,” said Martha. “We needed to do something to relieve at least a little of the pain for those who have lost everything.”

Rescue personal are just beginning to reach many of the remote villages, the kinds of places MEDLIFE works, often finding few survivors and the towns reduced to rubble, like in this New York Times Article.

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Martha will be visiting affected areas in coming days with leaders of communities where MEDLIFE has worked in the past and meeting with authorities to figure out the best way to help.

“How can I give you a measure,” said Martha. “ In the days that have passed, observing more the dimensions of the tragedy- these cities are going to need help for a long time to clean and reconstruct. It destroyed houses, schools, and whole communities. We are going to have to work on this for a long time.”

MEDLIFE is collecting donations to put towards relief here.

            *Photos from Pinterest page collecting earthquake photos*

education-blog-alex-2014Education is a characteristic that people are usually quick to judge. What does it exactly mean when someone says they received a good or bad education? Can one quantify their entire education into two such categories? No matter what country, city, or community someone is in, each person is going to have a different meaning of “good” and “bad”. Someone may think that they have received a good education while another person at the same school taking the same classes may think they received a bad education. Therefore, some situations are hard to judge, but Peru's system is different. It is very clear and distinctive when observing the quality of education.

Private schools “… are not operated by a public authority but controlled and managed, whether for profit or not, by a private body such as a nongovernmental organization, religious body, special interest group, foundation or business enterprise” (Trading Economics).  Depending on what private school the family decides, it can cost anywhere from a couple of hundred Nuevos Soles to thousands of American dollars per month.  Many families in Peru try and make sure that they send their children to private school because the education and structure is generally better.

Every year, private enrollment continues to raise at least by 8% or more. Depending on whom you are talking to, it could be considered quite a stupendous increase or, conversely, a microscopic increase.The other type of school that Peru has is public schools.

There are two main types of primary public schools- regular teaching and multigrade schools. Multigrade schools are made up of students who are not in the same grade but are placed into a classroom with each other and one teacher. These types of schools are very popular in countryside and jungle schools. Public education is supposed to be free but sometimes there are fees that come along with it.  Many times the teachers are not paid properly so they are absent a lot. Protests are common, so when a protest occurs, class is cancelled until the protest is over or until the teacher decides to come back. Due to low budgeting the infrastructure is weak and materials are scarce.

Looking at a census done on public schools in 2010, only 18.3% of the public schools were considered to be in good condition. This means that 18.3% of the schools have working toilets, workbooks and materials for the students, electricity, and appropriate and qualified teachers. Peru has had a very difficult time setting standards for education with students and teachers. The Ministry of Education was the first to create standards for Peruvian education. They started to establish a so-called five-year education during the years of 1980 to 1985.

Nothing really big happened until 1993 when the minister spread a new regulation of the organization and functions of the Ministry, and is effective rationalization with leaving workers to reorganization. The office of Educational Infrastructure, which is a sub- division within the Ministry of Education coordinates the demands and needs for location, construction, equipment and maintenance of educational infrastructure (MINEDU).The office of Education Infrastructure works with the International Bank and Inter-American Development Bank when obtaining loans. Recently in 2004, a loan agreement was made called Education Program in Rural Areas.

The purpose of this loan was to raise the level of learning of children and youth in rural areas- trying to close the inequality gap between rural and urban areas. They designed intervention strategies organized into three components to improve educational quality and efficiency. These were, “increase access, improve quality, and expand the efficiency in education management” (MINEDU).

Thereafter, the Peruvian education system has undergone major changes and tremendous progress in terms of infrastructure and quality, although much still remains to be improved.  

June 20, 2013 12:38 pm

The Effects of Migration in Ecuador

Written by Lindsay Bigda

When our MEDLIFE Ecuador team came to visit our main office in Lima this April, we sat down with Ecuador Director Martha Chicaiza, Field Nurse Maria Chavez, and Project Director Luis Cartagena to talk about development issues in Ecuador, and the effects of recent government interventions on the work that they do. Check out what they have to say about rural to urban migration in their country:

ruralecuadorA child cares for his animals in a small village outside of Riobamba, Ecuador

When MEDLIFE brings Mobile Clinics to the small villages of the sierra, where MEDLIFE works in Ecuador, the line of patients is often made up primarily of women, children and older residents. This phenomenon has prompted several volunteers to ask, where are all the men? And what about the young people?

Migration from Ecuador's rural areas to its city centers, as well as emigration to other countries, has primarily been a result of two economic crises – a collapse in oil prices in the early 1980s and a subsequent economic downturn in the late 1990s. The 1990s crisis spurred an especially large exodus, with most people headed to the US or Spain. The majority of those who choose to migrate to bigger cities are young men chasing urban employment opportunities; they are often trying to support families in their hometowns by sending back remittances.

"The conditions then [in the 1990s] were really bad," said Maria Chavez, who works as a field nurse for MEDLIFE in Ecuador. "There was no money, no opportunity."

Many rural residents choose to become economic migrants because they are unable to pursue higher education or feel stuck in low-income agricultural jobs. Larger-scale migrations have also occurred recently due to globalization, which has made travel easier and allowed residents to become more aware of other opportunities.

The negative effects of migration are notorious and include: instability for children, economic distress, tension between migrants and locals, cultural erosion, worker exploitation, and other social problems."Women who are left alone sometimes feel that they must choose between taking care of their animals and fields and taking care of their families," explained Luis Cartagena, who organizes and oversees community development projects in Ecuador. "What happens when a child needs to see a doctor far away, but the mother feels that she can't leave her animals?"

But Chavez also noted that there are positive aspects to recent migration, especially for indigenous groups. "It exposes them [rural residents] to other realities and helps them to better understand and claim their rights," she said. "Lately, there has been a lot of consciousness-raising around personal rights."

Both the urban and rural experience for indigenous people in Ecuador is tied up in the country's deeply rooted racism. Many indigenous residents self describe their main issues with city life as exploitation in the workplace and the prejudice they face solely for being of a certain race or color.

In the sierra, MEDLIFE patients of indigenous descent are often ignored or made to wait longer than their non-indigenous peers when trying to access social services, according to Ecuador Director Martha Chicaiza. "Going to a hospital can be daunting for anyone," she said, regarding access to health care. "But imagine if you've never been to a doctor in you life, and you have no idea how the system works. It's easy to take advantage of other people's ignorance or fear."

MEDLIFE Ecuador staff members agree that the quality of rural life has improved recently thanks to a slew of new government policies initiated under President Rafael Correa. Aside from improving the infrastructure in Ecuador's countryside, the president has also begun an aggressive push for transnational migrants to come home. The national "Welcome Home" program encourages migrants to move back to Ecuador by reducing custom fees and providing tax breaks for starting new businesses; the "Hecho en Ecuador" (Made in Ecuador) campaign encourages consumers to buy locally produced products.

According to Chavez, the government also wishes to curb the rural to urban migration within the country and is working on policies to encourage rural residents to stay put. MEDLIFE Ecuador has also contributed to the development of rural areas of the Chimborazo and Napo provinces through our Mobile Clinics, hygiene projects, and school projects, and will continue to assist in raising rural living standards.

"Now, more people are coming back to the countryside," Chavez said. "There is much greater economic stability."

meripromotoraMEDLIFE 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.

punoAn 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.

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