August 5, 2013 10:03 am

Intern Journal: Pockets of Poverty


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

yovannaDr. Angie Vidal (left) and Yovana Taipe

When we first met Yovana Taipe at a Mobile Clinic in Villa El Salvador, she seemed shy and serious, reluctant to smile. And when she reached the dentist chair, we found out why; all of her front teeth had rotten and fallen out.

This level of damage would require more than the dentist could provide in one day at the clinic, so Yovana entered our patient follow-up program, with MEDLIFE dentist Angie Vidal overseeing her care. Angie performed multiple cleanings, extractions, fillings, crowns, root canals and created prostheses. Over the course of several visits, she developed a close relationship with Yovana, and ended up treating her children as well. "She's a person who has suffered a lot in her life," says Angie. "As I got to know her better, I was always impressed by how many obstacles she had overcome."

Yovana says she can't thank Angie enough. "She gave me my smile back," she says. "She gave me my life back." Her dental problems had left a severe dent in her self-esteem, making it more difficult to do normal activities and get a job.

Yovana lives with her two younger children, 7-year old Maricielo and 16-year old Julio, in a cramped quarter of her mother's house in Villa El Salvador. After leaving an abusive marriage, she lacked the financial resources to provide the basic necessities for her family. She works cleaning houses when she can, and hopes to support her children through school in the hopes that they can become professionals someday. Between taking care of her kids and working, it was hard to find the time to stand in line at the public hospitals and get medical attention. After seeing the positive impact that the Mobile Clinic has had in her life, she's taken an active role to coordinate future work with MEDLIFE in her community. The patient follow-up team will continue to support her and her family. 

She still worries about her childrens' future, but now, she says, "I know that [MEDLIFE] will help me through this, and I am forever grateful for that."

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:



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.


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.

Written by student volunteers from this week's clinic in Lima, Peru, and reposted from the MEDLIFE McGill blog.

Today was our first day of clinic. After a quick breakfast and wishing good luck to those of us that were headed to the grueling stairs construction project, we packed our materials and headed to a district near Pamplona Alta for the day.

My first station was general medicine with Cesar, a physician who'd specialized in geriatric care. Before the patients began rolling in, Cesar took those of us assigned to his station aside and began teaching. With humour and patience, he showed us how to distinguish abnormal heart and lung sounds from those of normal beats and breaths. He also introduced us to some ailments specific to the living conditions of the villagers; he directed our attention to the signs of anemia and vitamin A deficiency (discoloured gums and mucosa and white spots on the skin, respectively). As well, we got to see first-hand many cases of tonsilitis and parasite infections, as well as an older woman afflicted with ptosis, thus causing her to have a droopping eylid on one side only.


By noon, I was getting hungry – my breakfast of bread, banana and egg was now long gone – but I didn't want to leave Cesar's side. There were always more patients to ascultate, more heart sounds to hear.

Eventually (and somewhat reluctantly), I did head for lunch and to my next station, but not before taking the time to pass over the knowledge I had gathered to the friends that were coming to replace me.

In the afternoon, triage proved equally interesting, albeit a bit more challenging since we were directly interacting with patients. My Spanish is far from perfect, but I was relieved to realize that I spoke well enough to be understood clearly by the villagers, even on my first try. Keeping a big smile on my face and using even larger gestures helped, too.

The summer Mobile Clinic trip season is officially underway, with simultaneous clinics and development projects happening this week in Lima, Peru and Tena, Ecuador. Check out some photo highlights from the past few days in Lima:

collagelimaclinicYesterday's clinic took place in Ventanilla, north of Lima, Peru. 

collagestairsStudents from schools including WVU, VCU, North Dakota and Purdue worked tirelessly to help build the first staircase in Buena Vista, a new settlement in Lima, and enjoyed getting to know the neighbors as they worked together.

Milagros Ponte, known to her parents as "Milly," kicks up clouds of dust as she runs up the rocky hill ahead. "Minnie!" she suddenly shouts, and scoops up a small black-and-white cat, who reluctantly puts up with the attention. Showing visitors around the small one-room house she shares with her parents, Milagros sounds much like any other 5-year old, proudly pointing out of her neatly arranged collection of Barbies and stuffed animals. An only child, she likes to play with her cat and neighboring children and help her mom water the flowers in their small garden plot.

milagrosBut Milagros, who lives in a high extension of the Virgen de Cocharcas community, was born with congenital auricular atresia -- a birth defect that left her with only a partially developed ear on one side, and a small vestigial structure on her cheek. Though her inner ear was healthy, her hearing could be affected as she developed because the sound would not be able to travel into the ear canal.

Despite their humble circumstances, her parents have done their best to give her everything she needed for a happy childhood, sometimes going without themselves. "Life can be really sad here at the top of the hill," says her mom Glorinda. "But at least now we have our own home, our own little plot of land. Sometimes we worry, but never in front of her. We just want a better future for our daughter, like any other parents."

But when they tried to get Milagros's ear corrected, they were stuck. They couldn't afford to pay for the operation, and SIS, the state insurance for the poor, wouldn't cover the procedure because it is largely cosmetic.

We already knew Milagros as the high-energy, happy-go-lucky little girl who always came running up to meet us when we visit her community. So when her parents asked us for help, the MEDLIFE follow-up team made a plan. 50% of the cost of Milagros's surgery, as well as necessary medications, were covered by the MEDLIFE fund in order to make the operation a reality. She finally received the operation just two weeks ago, and is now back at school after staying home for a week to recover.

Even right after the surgery, she never lost her high spirits. "It hurt at first, but now I'm fine," she says, smiling widely as she turns her attention back to playing with her toys. "She's very brave," says Glorinda. "She was so happy that she was going to get the operation, she didn't even cry or complain." In the operation, the extra tissue on her face was removed, and the fold covering her ear canal was opened. In a few years, she will have an additional surgery in which doctors will take cartilage from another part of her body and use it to form the outer structure of the ear.

For now, Milagros is looking forward to going back to school to play with her friends. "She's very excited," Glorinda told us. "She can't wait to be able to use earrings."

May 8, 2013 3:02 pm

Intern Journal: Nandini

Nandini Razdan recently returned to the US after completing an internship with MEDLIFE in Lima, Peru, and is now applying to go to medical school. Read more about her experience with patient follow-up in her Intern Journal entry below.

eduardonandini2Nandini with Eduardo and his mom

Over the course of routine patient follow-up appointments, I had the opportunity to meet a very special patient named Eduardo. We met with Eduardo's mother near his house in an extremely dusty and desert-like community on the outskirts of Lima. While walking to their house, Eduardo's mother took the time to stop, pick-up, and drag a large piece of cardboard all the way to the front of her house, where there was already a growing pile of trash. I later found out that selling recyclables was the primary means that Eduardo's mother earned money, as most of her time was spent caring for Eduardo.

We entered the humble dwelling and made our way to the bedroom that Eduardo and his mother shared. Before embarking on our journey to Eduardo's house, I had failed to ask MEDLIFE doctor, Dr. Jose, about the patient's condition and history. My jaw gaped open and my breathing stalled as I entered the bedroom and saw what seemed to be a breathing skeleton.

Eduardo had the misfortune of developing Cerebral palsy (CP) as an infant. Cerebral palsy is a group of non-progressive conditions caused by damage to the motor centers of the brain. CP causes physical disability in human development, primarily concerning bodily movement. Limited movement leads to limited activity, which can be accompanied by lack of sensation, sight-based perceptual problems, communication problems, and sometimes impaired cognition. In the unfortunate case of Eduardo, he choked on a small piece of food as a baby, and for an extended period of time was unable to breathe. The hypoxia caused cerebral damage, and from then on, his life would never be the same. Eduardo is now in a near vegetative state -- unable to talk and minimally able to move. The years of lack of movement have caused his body to become deformed; he is all skin and bones with no muscle or fat to be seen, and his hands are completely bent forward due to lack of usage over the years. He is unable to speak and his inability to control his bowel movements forces him to wear a diaper. Eduardo does have some level of remaining cognitive perception. He smiles when he is happy and whimpers when he is sad. He recognizes his mother and is able to understand basic conversation, even though he is unable to respond.

Eduardo's story really hit home for me in various ways. I had an older sister who for ten years of her life was also in a vegetative state, but due to a genetic disorder, not Cerebral palsy. Living in the US, my family struggled with dealing with my sister's condition, but still had access to some of the best home-care possible for her from the first day of her illness. My sister had a comfortable hospital-style bed, a state-of-the-art wheel chair, access to any medicine she needed, and nurses at her bedside day and night. Eduardo had a simple bed with a quilt and few pillows, and a second-hand wheelchair that looked uncomfortable for his bony body and that caused his feet to drag on the floor.

The purpose of our visit to Eduardo was to give him a nebulizer treatment because he was having trouble breathing. As I held him in my arms during the treatment, I looked above and saw a roof full of dust, which clearly was not helping his breathing. Had we not come to bring the treatment, Eduardo's mother would not have been able to afford paying for the treatment in the hospital. My sister's illness was incurable, but CP has the potential to be prevented from worsening through years of care and therapy with specialists. With the lack of resources living in poverty in Lima, Eduardo's family had little to no chance of accessing the specialists needed to prevent his condition from developing as it had. When MEDLIFE first met Eduardo several months ago, extensive damage had already occurred and follow-up treatments were limited.

Eduardo's mother told me about Eduardo's history, and I was shocked to find out that the small body I held was that of one who was a whole year older than me! I thought Eduardo was no more than 10 years old, and he was actually 23. Two things struck me with this new finding; firstly, how much life and will to live was in this human to have made it to 23 years in such a physical condition? Secondly, I noted how different our lives were despite our similarities in age -- simply due to fate. I am a 22-year-old enjoying my time in Peru and trying to add to my experiences in order to enhance my career. Yet this 23-year-old was simply trying to live another day and breathe a bit better. Furthermore, Eduardo's mother told me that Eduardo's father had passed away from liver disease just two weeks before, making her the primary breadwinner. Eduardo's father had been an alcoholic, and one can imagine that the stresses of poverty and caring for a handicapped child contributed to his drinking problem. Also, she had another daughter who was 16 years old, but who lived with another family because she was unable to take care of both Eduardo and her daughter. Had my own family been in this family's position living in poverty in Peru, I could have easily been that daughter who was forced to live with another family because my own could only take care of my sister.

Dr. Jose has been taking care of Eduardo for two years, visiting him whenever he needs medicine or when he is sick. A few days after my first encounter with Eduardo, I accompanied MEDLIFE nurse Ruth Varona to take Eduardo to the hospital because he potentially had pneumonia. Being seen by a doctor in Peruvian public hospitals can be a very lengthy process. It took approximately six hours for Eduardo to finally be seen by a doctor in the emergency department, yet nurse Ruth stayed and waited with Eduardo and his mother the entire time. Eduardo might not have access to the home care that he deserves, but having his devoted mother by his side at all times and MEDLIFE doctors and nurses ready to help are the only reasons I can think of for the smile on this fighting 23-year old's face.

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