Lima's pueblos jóvenes are not like Brazil's favelas, or Argentina's villas, or the slums of Mexico City. While most of Latin America's shantytowns have been haphazardly thrown together, without state assistance, the founding of Lima's Villa El Salvador (VES) in the 1970s was unique.

The creation of Villa El Salvador, a formal settlement for urban squatters, was a response to the housing needs of over 4,000 families that had invaded land in an area known as Lima's Southern Cone. Under the Velasco regime, the central government partnered with the community to mutually create an urban plan and assign legal plots to families. Lima's desert location, with ample unused land, also contributed to the city's initial success in providing lots for low-income communities. VES remains an important case study for participatory democracy, and marks the first example of government-aided slum development on the continent.

VES old collage

Government officials, community members, and scholars alike recognize the importance of legal land ownership and well-planned urban development. Officials in Peru note the many benefits that property rights bring their residents, including access to credit, access to home improvement loans, and the ability to start new home businesses. Community members themselves are also acutely aware of how it can change their quality of life, especially by connecting them to permanent – not provisional – electricity, water, and waste disposal services. Residents we speak with often cite obtaining land title as a primary concern; without it, they worry that they will have no assets to pass down to their children.

World Bank report regarding a pilot land titling program in Peru indicates that "strengthening tenure security through property formalization in urban squatter settlements has a large positive effect on investment." A new document released by the U.N. In May of 2012 also highlights the issue of land title, linking it to food security and economic empowerment.

Yet political treatment of new settlements in Peru has varied widely since the 1970s with changes in government administration, swinging from absolute recognition of urban slum communities to their forced removal. These changes have resulted in a patchwork of settlements, rising up from the outskirts of Lima, which remain in various stages of development and legal recognition.

CorreaAs the February 17th presidential election approaches in Ecuador, many are taking a longer, reflective glance at what President Rafael Correa has achieved since he took office in early 2007.

A recent Reuters article reports, "Correa has won broad popular support by expanding access to healthcare, doubling state spending on education and turning rough dirt paths into proper paved roads." It also notes that, according to the government, Correa has "built 18 hospitals and 250 health centers across the nation."

Indeed, Correa – who describes himself as "left-wing" – has made it a top priority to increase spending on social projects. Many believe Correa is on track to winning the upcoming election.

Yet, implementation of Correa's health care plans has been slow. Like many other countries in Latin America, Ecuador's health care system is taxed by overwhelming demand and a lack of resources. Since the country began providing free public health services in 2007, it has struggled to keep up with a growing body of patients; MEDLIFE staff members in Ecuador have often seen residents begin lining up hours before dawn in order to seek medical treatment.

The health system in Ecuador is comprised of a private and public sector, with the public sector guaranteeing, as stated in the revised 2008 Constitution, "permanent and timely access, without exception, to all comprehensive health care programs and services" for all citizens. However, overall, this covers the health care of only 51 percent of the Ecuadorian population, according to a June 2011 paper by the Ministry of Social Development in Quito, the nation's capital.

The government funds 47 percent of outpatient and hospital services in the nation, in addition to the nation's largest hospitals for referrals. But according to World Health Organization (WHO) standards, there should be between 8 and 10 hospital beds available per thousand people. The number of available beds in the Ecuadorian hospital system in 2011 was only 1.7 per thousand; many hospitals remain at full capacity.

MEDLIFE's work in Ecuador has also changed under Correa. On the one hand, better government coverage of medical costs helps lift the financial burden on low-income families, as well as on MEDLIFE as an organization. On the other, quality is often poor and waits may be extremely long. A 2011 Wall Street Journal article said there were, at that time, "4,500 people on waiting lists for surgery."

These problems are evident in this excerpt from a recent blog post written about a current MEDLIFE patient in Ecuador:

Jose's first consultation for his condition was the entire family's first visit to a hospital. It then took three months to schedule a surgery for him.

A nurse walks by and says the doctor has arrived at the hospital. He is the only pediatric surgeon, working four days a week, and it is obvious. Dozens of families rise to their feet at the news, standing around the exam room door, silently hovering in a semi-circle of anticipation. Eventually, people grow tired and sit back down.

When patients are referred within the public system for treatment, many times they still fail to receive the treatments they need due to lack of resources, lack of confidence, cultural insensitivity, or a lack of understanding about how to navigate the system. For all of these reasons, MEDLIFE's role of advocating on behalf of our patients has become even more important.

You can read more about MEDLIFE's patient follow-up process here.

We first met Rosa Muñoz, the leader of a small community called Santa Cruz, when she approached us with a proposal. Having learned of MEDLIFE's staircase projects in other urban areas surrounding Lima, Rosa sought out MEDLIFE Project Coordinator Carlos Benavides in July of 2011 to suggest that her burgeoning community be the next to receive assistance.
rosa santa cruz
Rosa knew exactly what she wanted. For her community, she proposed a set of three staircases that would allow residents to safely access their homes. Although MEDLIFE staff members were at first hesitant to undertake the project, due to the community's daunting altitude and distance from navigable roads, we eventually agreed to begin construction.

Rosa headed weekly meetings in Santa Cruz in the months leading up to the projects, inspiring community members to participate and volunteer. Wearing her characteristic black hat despite the heat of Lima's summer, she worked tirelessly toward the completion of all three staircase projects by carrying buckets, mixing cement, positioning handrails, painting, and planting trees.

For many foreigners, several of whom are taught to value autonomy and individual achievement, the way that leaders like Rosa mobilize their communities to enact change – passionately and without pay – is striking.

"I suppose it's like why you are here in Peru," said Daniel "Amoy" Chirinos, a member of the 12 de Junio settlement in Lima, attempting to explain how his community organized the resident-led construction of a new public bathroom. "Some people just have a desire and commitment to help." Daniel explained that his neighbors nicknamed him "Amoy," a derivative of the Spanish word for love, because it's something that he tries always to reflect.

daniel chriniosDaniel works as a bus driver, but has also helped organize several neighborhood projects, such as a new comedor – a low-cost community cafeteria. His next project is to renovate his home to create a public space he describes as a "center for prayer and meditation." Daniel, who never stopped smiling, spoke with incredible optimism about his progress and prospects for the future.

Although community members don't tend to articulate it, there are words that describe this tradition of mutual support. Minka, or minga, is a Quechua word meaning collective work for the common good. Dating back to the original migrants from the Andes and jungle regions of South America, mingas were used to construct communal facilities and irrigation canals, to harvest on shared land, or to care for the sick and aging population. Due to heavy migration within Peru, it has also spread toward cities on the coast, creating a cultural commitment to mutual aid that many residents feel has always been there.

Residents in the asentamientos humanos (informal settlements) surrounding Lima, where MEDLIFE works, also use an inclusive approach to community decision-making. By means of general assembly they jointly elect a group of 10-12 community leaders and promoters; these individuals are in charge of distinct areas ranging from neighborhood security to social assistance. Because development of these urban communities required, and continues to requires the help of all participants, female participation has been relatively easily accepted. A Centro de Estudios y Promoción del Desarrollo (DESCO) report noted that by the 1980s, women were already serving in important community leadership positions.

The community's overall main leader or leaders, called
dirigentes, also meet once a week with a representative from the local government assigned to their district. Although these settlements were not always formally recognized by the government, residents have learned how to lobby for official recognition and resources.

Community leaders can serve an unlimited number of two-year terms in these voluntary roles, as long as they are elected by popular consensus. Prior to acting as MEDLIFE's own Project Director, Carlos Benavides spent 12 years working as a community leader. During this time, Carlos served as head of his household, community leader, and as a volunteer watchman working alongside local police forces. This high level of family and neighborhood organization provides the settlements with a great amount of social capital -- one of the communities' main assets. 

Yet, since MEDLIFE began working in the urban slums of Lima in 2010, we have seen many different kinds of community dynamics. Alongside dedicated leaders, we have also encountered dirigentes who don't care about improving their communities, or worse, who lie to and steal from their residents.

One community leader from 12 de Junio repeatedly pointed out that each community, although structured similarly, is unique. "When you speak about Peru, or Lima, or even this district," he said, "it's impossible to generalize."

Carlos also attributes our most successful initiatives to solid community leadership. "The first thing I look for [in starting a development project]," says Carlos, "is the need. Then I meet with the community leader(s) to find out how they work, to find out how well they are organized."

carlos community

For many community residents, the structure they have developed seems to be a simple matter of mutual respect and common sense. Yet for those in international development, it is a unique leverage point in the effort to upgrade urban slums. A 2003 World Bank report lists Peru's "long tradition of mutual help" as an important factor in why Lima's informal settlements have experienced more rapid urban development compared to other Latin American cities. A research paper presented at the American Sociological Association Annual Meeting also notes that "reciprocity is considered a key characteristic of traditional Andean society," and that "reciprocity remains a uniquely appropriate practice that contributes to individual livelihood making, group solidarity, and community development."

Likewise, MEDLIFE capitalizes on this value of shared responsibility, leaning heavily on motivated local leaders to organize, plan, build and maintain our community development projects. We have developed strong ties with many residents who remain an integral and often under-recognized element in the promotion of our Mobile Clinics, execution of our educational workshops, and completion of our development projects.

The importance of these leaders is not lost on our volunteers. Last week, on the last day of our most recent Mobile Clinic in Lima, a student gave a short speech on behalf of his university's student group.

"Thank you," he said to the community residents who had gathered to inaugurate our newest staircase project, "for all of your hard work and organization. Thank you for letting us be part of this experience."

"But most of all, thank you for showing us what it means to be a community."

December 27, 2012 12:19 pm

Inequality and Health Care in Peru

Written by Rachel Goldberg

clinic-scene-2

In today's issue of El Comercio, Peru's main daily newspaper, this headline caught my eye. It reads, “Only 39.6% of the budget allocated to healthcare was used in 2012.” Though it doesn't have the answers, the article may provide some insight into one of the questions students always ask when they first see the communities where Mobile Clinics take place.

November 8, 2011 5:23 pm

Ecuador Vows to Eradicate Malnutrition

Written by Amara Channell

47-1Last 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.

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