Rachel Goldberg

Rachel Goldberg

Tim Zeitler, currently studying for his MA in architecture at Harvard, came to Lima last summer to help MEDLIFE out with our growing community development program, which aims to treat the root causes of disease by improving infrastructure. Here in Peru, he's put that academic training to good use, surveying future project sites with MEDLIFE and making plans for a variety of important public spaces. Last summer, he created the architectural layout for the now under-construction Wawa Wasi daycare project. Now he's back, working on some exciting new projects, including a ramp for Dixon. Find out more about Tim and his work:

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What was your first experience here like? Was there anything in particular that surprised you?

My first experience with MEDLIFE was during a week of mobile clinics. I had more interest in the ongoing development project that week which was the construction of a concrete staircase in one of the communities. To make the staircase possible in a place beyond where any vehicle could travel, it was necessary to lift the sand, water, and cement uphill, one bucketful at a time. This was tremendously hard work, and yet it was accomplished so joyfully by the community members.

One thing that surprised me was the extent to which the communities were self-organized. For their days of community service, they made sure that every family had a representative there to share in the work that would ultimately benefit the community as a whole.

Why are you back?

I am back here in Lima because there is much more yet to do. As a designer, I see so many opportunities to work with the communities that MEDLIFE serves. The projects I am involved in are wide-ranging in scale and complexity, and each one teaches me so much about architecture and construction. The practical construction experience is something that will always draw me into projects like this. It has complemented my education at Harvard in a way that is essential for my development as an architect.

What projects are you working on this summer here? How are they progressing so far?

My colleague Parisa and I are working on the design of an extensive ramp and community space in Nueva Esperanza, a community in Villa Maria del Triunfo. The project is unique in that it involves the opportunity to create a shared community asset in an unbuilt portion of the existing densely packed residential community. There exists a great opportunity for the community to rally around the new circulation path and green space. We have an upcoming meeting to present our design and discuss it with the community next week. We will get to see how it is received and what the community has to say about how we've worked within the constraints of the site.

How is being an architect here different from in the US? What are the challenges in working here from your perspective as an architect?

Being an architect here seems to be very similar to the US. Parisa and I have been meeting with and networking with as many local architects here as we can. Their firms seem to function similarly to firms in the US. The constraints that architects operate under are somewhat universal. In the US and in Peru, we are seek to incrementally improve the safety, functionality, and beauty of the built environment through the implementation of building codes, local construction best practices, and by working with project stakeholders to design and program meaningful projects.

For me, the challenges of working in Peru have revolved around climate and materials. I tend to approach an architectural project by first designing for climate and by immersing myself in the material possibilities of a project throughout the schematic design phase. The climate of Lima is so different from New England, and so the constraints of designing for climate are completely different. For an architect, these new constraints can be disorienting, but at the same time the loss of certain constraints that dominate architectural practice in the US can be quite liberating.

What has been your favorite part of traveling to Peru?

Peru is a very beautiful country in many different ways. My wife and I took a short vacation out to Cuzco and Arequipa last summer. We got to see the majestic Colca Canyon and Machu Picchu. Part of Peru's richness manifests itself through its historical and cultural layering. I particularly love to bear witness to this layering when it plays out in the realm of architecture.

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A few months ago, MEDLIFE intern Nandini Razdan wrote here about her experience visiting a follow-up patient in Villa El Salvador named Eduardo Espinoza. Due to brain damage caused by choking on candy as a baby, Eduardo, now 24, has lived almost his entire life in a near-vegetative state, unable to move or speak.

Though there is no cure for Eduardo's condition, the MEDLIFE follow-up team has been helping him and his mother for the last two years, providing supplies like diapers, medication, and even a bed, and taking him to doctors' visits. Medical Director Dr. Jose says it's a "miracle" that Eduardo has survived this long, and mostly thanks to the constant dedication of his mother, Leonarda. "Medically, it's inexplicable," he says. "But we've seen that he sometimes laughs or cries, and he's responsive to us and to his mother." After the recent death of her husband, Leonarda is doing double duty as both breadwinner and caretaker for her son.

In April, Nandini went with MEDLIFE field nurse Ruth to visit Eduardo and his mother in their home, and accompanied them to the emergency room because Eduardo was having trouble breathing. The humid winter air put him in danger of having his lungs fill with fluid, and one had already collapsed. About once or twice a month, they helped transport Eduardo to the hospital for a simple nebulizer treatment that would save him from choking to death.

When Nandini went that day with Ruth, she says it was a struggle to transport him to the hospital in his rickety wheelchair. "Eduardo left a huge impression on me, and I didn't want to forget about him after my internship. He still needed help," she says. So after she returned to the US, she told Dr. Jose she wanted to help him get a wheelchair. "He told me that what Eduardo really needed was a breathing machine," she says. So she created a campaign on the MEDLIFE website, contacted friends and family and posted on Facebook to ask for donations to buy the equipment.

In less than 24 hours, Nandini raised $325, surpassing her original fundraising goal of $300 and enough to buy the machine, an extra oxygen tank, and a dehumidifier for Eduardo.

Today, we went to visit Eduardo and his mother again, this time with the brand new gifts in tow. Dr. Jose and Ruth helped Leonarda set up the machine to use for the first time; from now on, if Eduardo has trouble breathing, his mother can hook up the machine to his oxygen mask for just ten minutes. The dehumidifier in his room should help Eduardo breathe better in the future.

Leonarda was delighted and grateful to hear that the new equipment was from Nandini and her friends in the US. "Thank you so much, from me and from Eduardo," she said. "People may think he doesn't understand, but I know he does."

To create a fundraising campaign and help patients like Eduardo, click here. Or donate to the MEDLIFE fund.

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Last week, MEDLIFE inaugurated our 100th community development project: a sanitary restroom for a preschool in San Sebastian de Wayrayaku, Muyuna, Tena, Ecuador. The school is a Centro Infantil de Buen Vivir (CIBV), part of a national program aiming to improve conditions in the country by caring for children under the age of 5 living in extreme poverty. At centers like this one, located mostly in poor rural regions, children are provided with meals, recreation and full-day care from teachers trained in child development.

In communities where many parents are working during the day or have emigrated to cities in search of better opportunities, many families are unable to afford the nutrition and sanitation young children need, and these new centers provide a vital service.  Unfortunately, many don't yet have the necessary resources and infrastructure.

Together with local authorities, MEDLIFE selected the center in San Sebastian de Wayrayaku, which means "wind of the water," as the site for our 100th project. The existing toilet was not enough for 42 children ages 1-5 and the four teachers in the center. MEDLIFE volunteers and community members constructed a new bathroom with two toilets, a urinal, sink and shower so that the children could wash if they need to. The parents worked through the night to get the project done so as not to miss work during the day.

On Friday, the completed bathroom was inaugurated with representatives of the provincial government, parents, teachers and MEDLIFE volunteers. The children and teachers sang and danced to traditional music from the region, and shared their customs with the student volunteers.

"It feels great to have completed project 100. It shows us that we can really help, we can make dreams come true, we can make hundreds of people happier and that we have to continue fighting for them," said MEDLIFE Director of Ecuador Martha Chicaiza. "Every project, no matter how small, matters because it helps someone who really needs it."

June 14, 2013 2:07 pm

Patient Story: Dixon Chavez

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At a recent Mobile Clinic in the steep hills of Nueva Esperanza, Renelmo Chavez arrived early in the morning and was first in line with his son, Dixon, riding on his shoulders. Dixon is 16, but he's unable to walk on his own due to severe rheumatoid arthritis that began when he was just five years old.

The causes of juvenile arthritis are unknown, though it is usually an autoimmune disorder, which means that the body's immune system mistakenly attacks healthy cells and tissues, causing inflammation and joint damage. In children, the resulting swelling, pain and stiffness severely limits growth and function. There is no cure; treatment focuses on maintaining quality of life and function with physical therapy and medication. Though Dixon's condition is currently in remission, it's left him with paralyzing pain in his hands and knees. He had a wheelchair, but it's useless in the treacherous terrain near his house.

dixon2For years, Dixon's dad carried him down the winding path to the paved street below each morning to take him to school. But now Dixon is too big and it's too much of a strain for his father to carry him every day. So while his dad still leaves early in the morning to work, Dixon stays home with his 13-year old sister Ruth, who goes to school in the afternoons. His mother works as a housekeeper in another district of Lima, while his other three siblings go to school and work to support the family.

Dixon likes to spend his time watching soccer games, and says he wants to be able to walk again. He'd also like to go back to school, where his favorite subject was English. He already knows the basics: "how are you?" and "my name is." Perched on a wooden chair at the doorway of his house, he helps his father to feed the chickens that run underfoot.

Renelmo, who moved with his family to Lima seven years ago so that Dixon could be treated in the national children's hospital, is completely devoted to his son's care. And between trying to earn a living driving a mototaxi in another part of town, and carrying Dixon to his various physical therapy and doctors' appointments, he stays pretty busy. "Life here is hectic," he says. "There are many things we need that we can't get."

MEDLIFE follow-up nurse Ruth Verona is on the case, accompanying them to appointments and making frequent home visits. She hopes medical specialists may help restore some of his range of motion. "The physical therapy is on hold for now, until we get his X-rays back," she says. "We have to make sure that it will not cause any further damage to his fragile joints and bones."

We're also working with Renelmo and volunteer engineers on a new project: building a wheelchair ramp outside the house that would give Dixon some mobility, and hopefully ease Renelmo's burden as well. "I just worry sometimes about what will happen to him when I can't take care of him anymore," Renelmo says. Though Dixon is nearly as big as he is, his father launches him onto his shoulders easily and without complaint as he heads out to yet another doctor's appointment.

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.

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In December 2010, Brandon Kuang came on a MEDLIFE Mobile Clinic to Lima, Peru. Now he's back, to perform a large-scale research study that he hopes will help shed some light on women's health issues in the pueblos jovenes of Lima.

A pre-med student at UC-San Diego with a minor in global health, Brandon was struck by the close-up view of poverty and lack of healthcare access that he encountered on his first MEDLIFE trip. But, he says, "The thing that sticks out in my memory the most was that despite all of that, the women in the communities were so warm and welcoming." He recalls that as the bus pulled away on his last day in the community, community members waved goodbye and shouted, "Don't forget us!" Brandon took those words to heart -- he continued to think about how he could help the people he met, even after he had returned to the United States.

His study began as an exercise in proposal writing for a class and gradually took shape over the course of the two years following his trip. As he researched women's health issues in Latin America, he found that although it is preventable and treatable, cervical cancer is the most deadly form of cancer affecting women in Peru, due to a lack of available information about detection. Very little scientific data exists about disease and healthcare in informal settlements like Pamplona Alta, where the problem is compounded by extreme poverty.

And so Brandon's project was born, named PAP ACCION, which stands for Pamplona Alta Peru Atmosphere for Cervical Cancer Intervention Opportunities Now. Through surveys and interviews with hundreds of women in Pamplona Alta, Brandon hopes to gain an understanding of the knowledge, attitudes and practices of women in the area regarding cervical cancer screening. In order to collect his data, Brandon has partnered with MEDLIFE, which is helping him hire local public health nurses who will administer the surveys and interviews and reach the inaccessible hills of Pamplona. The results of Brandon's study will also help us to refine our educational programs, which focus primarily on women's health. "To deal with the situation, you have to understand it, and I'm hoping that the information from this study can be used to improve education programs and direct them at the most prominent shortfalls," he says.

After writing and re-writing his proposal, Brandon was awarded a grant from his university to fund his work. Now he's finally in country and ready to get started. "I was always told by my professors that in global health research, you can plan what you want to do, but when you get on the ground, reality is going to dictate what actually happens," he says.

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He's looking forward to seeing the results, which he'll analyze and eventually hopes to publish. "It was a lot of hard work, but if it's something you want to do, I would definitely encourage other students to make opportunities like this happen," he says.

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.

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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.

University of Sydney Main Quadrangle

We're very excited to welcome the brand new chapter at the University of Sydney to the MEDLIFE family! After completing a monthlong internship with MEDLIFE in Lima, Peru, USYD senior Anna Laming decided to spread the word on her campus. Thanks to Anna's hard work this semester, this young chapter now has an executive board in place, and is currently in the process of planning upcoming meetings, fundraisers and community service activities.

usydAnna with the chapter's president and vice presidentStudent leaders at the University of Sydney said the new student group meets a growing area of interest on campus. "I knew I wanted to get more involved on campus, but I wanted to guide help to areas most in need," says chapter vice president Marco Leung. "MEDLIFE has mirrored my thoughts exactly. Not only does it have an established network that is growing very quickly at university campuses around the globe, but it also has a structured and friendly operations team to achieve its goals."

Students across Australia now have the chance to volunteer with MEDLIFE Mobile Clinics in South America, plus our future locations in India and Tanzania. For now, the Sydney chapter is focusing on raising awareness at their university and others in Australia in order to grow a national MEDLIFE network. We look forward to working with them!

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.

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