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.

45 1

Although pneumonia itself is not contagious, the viruses that cause it are. These viruses can spread rapidly in overcrowded houses, where it is difficult not to share germs. In the communities that MEDLIFE works with in Peru, many families live in small, one-room houses that they sometimes share with more than one family. They have high rates of indoor pollution because their houses lack proper ventilation, and their communities lack basic services such as garbage collection and plumbing systems. In addition, families in Lima also deal with the health challenges that accompany rapid urbanization, such as air pollution and dust. As a result of these challenges, acute respiratory infections in Peru have increased by 30 percent in the last four years despite government programs to educate parents about prevention and symptoms (The Guardian, 2010). Over 76,000 children in rural areas of Peru were treated last year for ARIs (Solaris). MEDLIFE attempts to address the issues of sanitation, hygiene, and indoor pollution through educational workshops, such as our parent education programs at local day care centers.

Some of the most important factors in preventing ARIs are providing children with proper nutrition so that they have optimal lung health, and increasing zinc consumption so that they are better able to fight off infection. A study by Sazawal et al. found that Zinc supplementation can decrease respiratory infections by as much as 45 percent. Encouraging women to breastfeed exclusively for 6 months and partially for at least a year will also help protect infants. MEDLIFE also addresses this subject of nutrition in our Mobile Clinic education station, and in community workshops.

Most of the time, treating pneumonia is just a simple and cheap course of antibiotics – yet, parents do not seek out or do not have access to help. Most of the factors in preventing child deaths are relatively simple, but because ARIs are not a current health trend, they are not getting the funding that they need. According to the Acute Respiratory Infection Atlas, donors are currently prioritizing diseases such as HIV/AIDS, malaria, and tuberculosis over respiratory problems. Although MEDLIFE does not currently have a specific campaign against ARIs, we are working to combat them through treatment during our Mobile Clinics and through education programs that address several of the root causes of these diseases.

September 27, 2011 5:50 pm

Sex Education and STD Transmission in Peru

Written by Laura Keen

37-1On 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.

September 20, 2011 1:42 pm

Urban Health in Peru

Written by Zenobia Gonsalves

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

Indicator

Urban

Rural

Child Mortality Rate, 2003-2009

26

40

Percent of births assisted with skilled birth attendant, 2004-2005

89.1

42.9

Chronic malnutrition in children

9

40

Percent of population using improved drinking-water, 2008

90

61

Percent of population using improved sanitation facilities, 2008

81

3

September 7, 2011 2:59 pm

Focusing On Maternal Health in Ecuador

Written by Tommy Flint

29-1On 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.

September 5, 2011 12:15 pm

Dental and Oral Hygiene in Peru

Written by Minnie Dasgupta

27-1Dental care and oral hygiene education are important components of the medical services we provide to our patients on MEDLIFE Mobile Clinics. During a recent Mobile Clinic in Lima, a large number of patients presented a number of serious dental conditions. This led myself and the other interns to ponder a rather simple question: what exactly is the state of dental and oral hygiene in Peru? After spending a few hours on various search engines and finding little to no results on basic dental care, I began to realize an answer to this question.

As is the case in many developing countries, Peru simply does not have sufficient resources to provide quality dental services to communities in need. The limited funding in the health care sector is often allocated to the more "prominent" issues – diseases such as tuberculosis, malaria, and hepatitis. A 2008 research paper highlighted many of the oral health issues poor Peruvians currently face, as well as the inadequacies of the existing infrastructure. At present, there exists one dental professional per approximately 9,000 people in Peru, a statistic which only begins to describe the overall lack of availability of dental care in the country. As a result of the general lack of public resources, there has been a shift toward the privatization of oral health services. This shift, though aimed to improve quality and access, has led to a surge in less-affordable private practices. The remaining public hospitals focus mostly on emergency care and pain relief, and, lacking additional funding, are forced to ignore preventative or restorative care methods altogether. For areas like Pamplona Alta in Lima, much more remains to be done to help improve the community's level of oral hygiene.

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