August 5, 2013 10:03 am

Intern Journal: Pockets of Poverty

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Ben and I decided to eat a sturdy lunch that day. We didn't know what Carlos had in store for us in the field that afternoon. In the past we had done all kinds of things under Carlos's guidance, from hiking way up the hills of Pamplona Alta to visiting patients in distant areas. What we hadn't anticipated was visiting the old part of a particularly green area within Lima called Surco, which Carlos fondly referred to as the "lung of the environment." This was swiftly followed by a trip with two men from the municipality to a little patch of land in the outskirts of Surco that overlooked greenery, but had none itself.

Published in Intern Journal

nightmeetingCommunity members gathered at a nighttime meeting in Villa Maria del Triunfo.
Photo by Benjamin Ostrander

The number of communities in need of staircases and other infrastructure projects in the shantytowns of Lima can be overwhelming. In order to decide where to work next, the main factor that MEDLIFE Peru Director Carlos Benavides considers is community organization. When the community can rally around a strong leadership, we know that they will be up to the challenge of building and maintaining a project with us.

Published in Community Profiles
July 18, 2013 9:18 am

Intern Journal: A Day of Firsts

This week, the MEDLIFE interns are working on building a new staircase with the community of Jesus Obrero in Villa Maria de Triunfo. Intern Lara Chambers, a student from the UK, writes about the process leading up to this project: 

internstairsThe interns carrying materials up to the staircase. From left: Swathi, Sunita, Chanee and Lara

Having arrived in Lima at the beginning of the week, Benjamin, Karolien and I got our first opportunity to go into the field on Thursday afternoon.

We rode on combis with Carlos, the director of MEDLIFE in Peru, and Inge from the communications team to the community of Jesús Obrero. It was our first experience of Peruvian transport, and it was certainly different from what we were used to! The bumpy ride, on an old bus, filled to the brim with people is a far cry from the established, modern bus system which exists in Great Britain. However, the bus had character, it was typical of Lima, and as Carlos said "así es Perú!"

We visited a part of Lima where people live without running water and without lights up in the hills. For me, it was my first experience of such poverty and I was struck by the contrast between this poverty and the bustling, modern Lima we had experienced earlier in the week. Here people live in houses they have made for themselves, dogs roam the muddy streets which have become quite treacherous as winter has set in here in Lima, bringing with it the rain on these hilly communities.

Carlos did a very good job of explaining why we were visiting this community and what we were going to be doing there. The idea is for the interns to undertake a development project whereby we will help this community to build a staircase later in July. This particular group of "vecinos" live in houses which are scattered down a very steep hill and they have no staircases by which to access their properties. As we witnessed on the day, they are remarkably skilled at scaling the hill without falling, but this will become much more difficult to them as the damp winter makes the path very muddy and dangerous.

jesusobreroThe site of the future staircase

Carlos had already engaged with the community and they have rallied together a group who will help with the construction project. They have cleared the pathway and stones so that construction can begin without any problems. On this day we were visiting the community to make sure everything was in order and that they had established a group to help out. We explained how the project would function and together we came up with the idea of having "almuerzo" (lunch) all together every day to ensure a united team effort during the project.

The people here struck me as a very happy and clever bunch. They worked very well together under the leadership of the matriarchs of the community and I felt a true sense of community amongst them. They were keen to interact with us and to show us around.

We met the local baker and his wife. He bakes bread in a little stone oven on their plot of land and then his wife visits the other houses in the community selling their bread products. This is how they make their living, yet I was struck by their generosity as they shared their bread with us. After speaking with them about what they do for their community and tasting their delicious bread, Carlos was so impressed he said we might be able to help them out with a few essentials in the future!

I really enjoyed my first experience in the field with MEDLIFE. I was struck by the positive attitude, the sense of community and the generosity of the people there. I am really looking forward to building the staircase with them, it is a really exciting project for this community and their enthusiasm is infectious.

The staircase in Jesus Obrero is now almost complete! Stay tuned for more updates. 

Written by Rosali Vela and translated by Rachel Goldberg

tallerThe house was packed at the educational workshop on Friday

Even though I've lived in Lima my entire life, it's hard to believe that this much poverty exists in some of its supposedly most "stable" districts. MEDLIFE usually works in the poorest districts of Lima. But we responded last Friday to a request from the municipality of Santiago de Surco, considered a model district of Lima, to hold educational workshops in two of its poorest neighborhoods.

Nobody would have imagined that so close to Surco's main plaza there exists a community, almost hidden, where though the houses are built with brick, the poverty was visible in people's faces. The second community was the same, though much farther away and more isolated. We received a warm welcome in both places; community members were interested and never stopped participating and asking questions during the afternoon.

The MEDLIFE summer interns prepared a presentation about nutrition, demonstrating how to measure body mass index (BMI) and giving advice about eating healthy. Our medical director, Dr. Jose Rodriguez, continued with information about diabetes and the importance of a balanced diet. Dr. Evelyn, the OB-GYN who has been working at MEDLIFE's Mobile Clinics, gave an excellent talk about breast cancer and cervical cancer screening, which were some of the most talked-about topics in the workshop. Finally, Maria, a health promoter who helps with the education station at our clinics, talked about domestic violence and encouraged those present to report abuse if they witness it.

These talks are the result of collaboration with the local government and a critical step in getting to know new communities prior to conducting Mobile Clinics. When we first arrive in new communities, the families there are unaware of what MEDLIFE does and why, and may be reluctant to visit the clinic, which is why educational workshops are an important part of our year-round work.

tallergroupThe MEDLIFE team

The visit was a first look at this process for our new summer interns, who will soon be helping to run a special Mobile Clinic just for children in Surco. "It was great to see the response from the community," said MEDLIFE Intern Hailey Bossio. "I was really nervous at first, but everyone listened attentively and really respected our efforts."

We recently wrote to you here about the artistic addition to a new staircase project in Buena Vista contributed by a community member, Ernesto. Last week, we were back to build another staircase nearby, but this time, we brought more paint! Ernesto created a brand-new mural depicting community life, and added some color to the previous week's painting. Check out the finished product below:

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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.

stairsnewPhoto by Wim BoudenFrom a distance, this MEDLIFE staircase high in the hills of Pamplona looks much like all the others. But take a closer look and you'll see this one has something special: a mural depicting the construction process, the original artwork of one of the community members who spent the week building the stairs.

ernestoErnesto Liendo, 25, an art student who has been living in Buena Vista for just less than a year, says he was glad to contribute to the project, which he sees as an important step in the advancement of his community. "I wanted to represent the process, the hard work and the spirit of solidarity that we experienced this week," he told us.

Indeed, the team spirit of this week's group was undeniable. Ernesto, along with many of his neighbors, worked hard in the weeks before the project to get this staircase finished in record time. During breaks in the construction process, he sketched out a design, using the student volunteers as models, and once the staircase was complete on Friday morning, he painted the life-size figures onto the retaining wall of the staircase, above the MEDLIFE logo. When the student volunteers arrived to inaugurate the staircase on Friday afternoon, they were thrilled to see the painting immortalizing their experience this week. After much cheering and prodding, they managed to convince Ernesto to say a few words, and he proved to be a natural politician, reminding everyone of the need to continue fighting to improve their living conditions.

For Ernesto, who came to Lima to follow his dream of going to art school, the drive to create art and the struggle to overcome poverty come together naturally. "Art accuses, art is an expression of the people that generates consciousness, creates a change in ideas and in structures," he says. In a single conversation, he goes from talking about Picasso's Guernica, to the contemporary art scene, to Peruvian public policy. He sometimes struggled in art school, he says, because he preferred to depict the realities of living in poverty rather than the more conceptual or abstract work favored by his professors.

Ernesto studied at the Escuela de Bellas Artes in Lima, a prestigious institute that attracts talent from all over the country, and says that his time there gave him valuable studio experience and the chance to share ideas with artists from other parts of Peru. Unfortunately, he had to leave school before he finished his degree, because he could no longer afford tuition and rent in Lima. That's why he moved to Buena Vista, where he says, the rocky land is nearly uninhabitable, but at least it's his. "What I spent there I could invest here and keep for myself, to be able to make my own studio," he says. "Right now I just have my whole life in a tiny room with no electricity. But I have this vision."

"I think one always dreams of a better world," he continues. "But you also dream by doing. Just look at this staircase." Before, it took half the day to walk up to his tiny home, and now he says, he runs up and down the stairs. "It gives me a lot of joy because it's something the people have done," he says. "And well-being is achieved little by little, with small steps." For him, the staircase represents more than a path to reach his home; it's another battle won in the people's fight for a decent standard of living. Neighbors stop by now as they pass the stairs to marvel at the change it makes in the landscape. Ernesto says it gives them hope that if they organize and unite, they too can make a difference in their communities.

stairsgroup

Jose, the president of the community, thanked student volunteers and told them that they were welcome to come back to Buena Vista any time. The staircase was inaugurated with festive dances and snacks from the various regions of Peru represented in Buena Vista. Community members and student volunteers alike cried when it was time to say goodbye. As for Ernesto, we haven't seen the last of him; he and his neighbors are already laying the groundwork for the next set of stairs, as well as a new community meeting space.

comedorsign
A strong sense of solidarity in poor communities can sometimes give rise to innovative solutions in the face of extreme hardship. One example: the case of comedores populares in Lima, Peru -- community kitchens that provide nutritious meals for everyone, and that also play an important role as a local gathering place. Anyone can eat at a comedor, but they are especially important for the most vulnerable populations -- namely children, the elderly, and handicapped -- who may not have the means to obtain a healthy diet. At the Comedor Hijos de Brillantes in Pamplona Alta, Lima, the handicapped and elderly get a free meal every day. For everyone else, it's just S/1.50, or 60 US cents.

Roberto Huayhuapuma Vasquez, President of the Association of the Disabled in Pamplona, recently invited the MEDLIFE team to visit the Comedor Hijos de Brillantes to learn more about their work and how we could help. Roberto, who was born with only one functioning leg, started the association for the disabled after facing discrimination and seeing the limitations it placed on others like him. "I realized that together we could do a lot to change the world for disabled people in my neighborhood," he said. "We are capable of doing much more than we are given."

The group began serving meals to the handicapped in the area two years ago, and has managed to accomplish a great deal with very few resources. They started out cooking on a wood fire; now they have a small stove, which prepares meals for about 50 people a day. Of those 50, about half eat for free.

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comedorint

The cramped shack that serves as a comedor is ill equipped for people with disabilities, with a dirt floor, narrow entryway, and no handrails. They're asking our supporters for help with improvements to the structure to make it more accessible so they can continue serving the population of men, women and children who depend on them. If you'd like to contribute to this project, donate to the MEDLIFE fund.

What is a comedor?

Comedores populares began informally in the 1960s and 70s as a survival strategy in the fast-growing pueblos jovenes, or urban shantytowns of Lima. Women came together to form neighborhood organizations, pooled their resources and collectively prepared and distributed meals to their families. As economic conditions worsened, their numbers exploded.

The comedor model of social organization found in Peru is a unique one. It started with grassroots action, driven primarily by women in the poorest communities. The introduction of the Vaso de Leche government assistance program in the 1990s, which guaranteed a glass of milk for children and pregnant women every day, was made possible by using the existing networks of comedors. The women leaders in the program gained organizational skills and experience that empowered them to fight for a more active voice in public life. Sadly, they also became targets of political violence by the Sendero Luminoso (Shining Path) terrorist group in the 90s.

Today, thousands of comedores populares are still active and vital to the growing populations in pueblos jovenes. Many are subsidized by the Peruvian government, which provides some raw ingredients in bulk, with some also receiving donations from church groups and NGOs. They are staffed in shifts by local volunteers, who receive food for their families in exchange for the hard work of preparing meals for large numbers of people. The network of women and men who run the comedors are important allies for MEDLIFE in the battle against malnutrition and other health problems, spreading the word about programs and resources to the entire community. They're often where we hold our preventative health workshops and public forums throughout the year, and sometimes even double as improvised doctors' offices at our Mobile Clinics.

February 19, 2013 10:45 am

Medlife Role Models: Meet Nancy

This past year, we've completed six staircase projects and numerous Mobile Clinics in the community of Laderas de Nueva Esperanza, in large part thanks to the persistence of the community's dirigente, or elected community leader, Nancy Helguera. Read more about how she is inspiring positive change in her neighborhood below:

nancy

Nancy came to Lima thinking she was going to retire. She had worked for years as a dirigente in her native Piura, where she supervised a number of public works projects and worked to reduce crime and help at-risk children and teens. When she arrived in Lima, she opened a small restaurant in Villa El Salvador, and planned to spend time with her grown children and grandchildren. But her calling soon found her again.

It was her daughter, Vanessa -- who had moved to a new community called Laderas de Nueva Esperanza -- who proposed the idea. Vanessa was serving as the secretary general there at the time, and told her mother about the problems the community was facing. "There were a lot of problems with stealing, embezzlement and corruption. People didn't trust the dirigentes," says Nancy. So she left the restaurant and moved in with her daughter in Laderas. Nancy found little resistance to her election among locals, who were tired of bad dirigentes and knew of her past experience in Piura.

But what Nancy found there was a harsh reality, with fraud, bribes, and other corrupt practices already in place. "It was very hard at the beginning, the damage had to be fixed from zero. That's why I understand why people are distrustful, even now, saying that I steal," she says. "But you have to understand, they were very hard times."

Nancy accepted the challenge, but first she had to clarify a few things. "I was clear about how things work. I have my own way of working, and if they wanted my help, they had to accept my conditions," she says. "Obviously they accepted; they did not have many other options."

With five years of hard work in office, she's overseen many finished projects and the community continues to grow each year. "Five years ago, we hardly dreamed of the stairs or playground that we have now," she says. Nancy's charisma and commitment got the attention of not only her community, but the municipal government as well. 

Published in Community Profiles
December 11, 2012 11:40 am

Holiday Cheer in Unión Santa Fe

This week's Mobile Clinic, made up of students from Florida International University, got off to an early start Sunday with a special holiday event in Unión Santa Fe. As you may know, Unión Santa Fe is an asentamiento humano (settlement) in Pamplona where MEDLIFE has been working for the past few years. MEDLIFE has aided Unión Santa Fe by bringing Mobile Clinics and completing staircase projects; we're also currently in the process of constructing a new day care center and water system. Over the course of many visits, we've gotten to know the kids of Unión Santa Fe and the surrounding communities. We wanted to do something to make their Christmas special, and what better time than with the arrival of 25 MEDLIFE student volunteers?

playing

Chocolatadas are a holiday tradition in Peru where families get together, often with hot chocolate and panetón (fruitcake), and the children receive gifts. For poor communities, these events take on a special significance, since they often provide one of the few or only occasions all year where children receive toys. This week, we teamed up with the local Rotary club, who held a toy drive, and distributed presents to about 300 children in the region.

The students arrived to the muddy soccer field in Unión Santa Fe on a morning covered in typical Lima fog. Despite the gloomy weather, the kids there were thrilled to see them and immediately started playing both American and Peruvian games together. The bus carrying all the presents broke down on the way, but luckily the students managed to distract the children while they waited.

Even with the unexpected setbacks, the chocolatada was a successful start as our student volunteers prepare to jump in to a week of nonstop Mobile Clinics. And the kids' smiles as they opened their presents were the ultimate reward.

presents

This holiday season, you can help us help communities like this one by donating to the MEDLIFE Fund!