March 07, 2010

Andean Adventure Part II -- Ayaviri

This past week was spent in the Puno region of southern Peru. Puno is the city adjacent to Lake Titicaca. I was fortunate to visit the Lake late in the trip and, as you might expect, it was beautiful. The visit there almost didn't happen -- a Peruvian colleague and I had heard that there was a strike along the road between the city of Juliaca (where we were staying in a hotel) and Puno, a distance of about 45 km. After getting varying reports, we were assured the road was open. Arriving in Puno was interesting, however, as we navigated around the clear evidence that there were some folks in Puno who clearly were not happy about something. Large and small rocks had been thrown across the road in several places, along with trash and broken glass. Much of it had been cleared earlier that day, apparently, but it was a good reminder of how quickly travel conditions can change.

Much of my time was spent in Ayaviri, a much smaller city / town about 100 km from Juliaca. Ayaviri is a bit over 13,000 feet and is about 275 km from the better-known city of Cuzco. Interestingly it's still possible to take a train from this area to Cuzco, despite the problems Cuzco and the region had with flooding about 1.5 months ago.

I was in Ayaviri to meet with Caritas-Ayaviri, an organization that does a great deal of community development work in about 3 districts in the Puno region -- districts that have some of the worst disease, malnutrition and anemia problems in the Andean zone. Among other things, Caritas works in large and small communities, focusing on education, various health issues (anemia, malnutrition, parasitic disease) in women and children, as well as trying to bolster the health care systems in the region. For example, because many of the people live in isolated regions, distances are sometimes a mystery. Thus, when folks make it to a local clinic (if one exists), it's often unclear to which hospital they should be sent. Most ambulances are covered pick-up trucks with a mattress in the back (but no medical equipment), and the level of technical training in highly variable.

There are several important parasitic diseases which impact the people in this vast region, but little baseline information exists on these infections. Moreover, a growing amount of evidence suggests that large-scale patterns of infection are changing quickly. One area of interest has to do with climate change. One of the trematode infections that is a major human health problem in the area (Fasciola hepatica) is truly an emerging infectious disease for the highlands of Peru, because the distribution of its snail intermediate host is shifting -- reports from the area point to the fact that host snails are showing up at altitudes where they've never been reported in the past. In any case, there are several opportunities for Wabash to participate in projects with Caritas in this area including education, basic diagnostic work, research, water projects.

I had the privilege of visiting one of the projects having to do with providing potable water for people in an isolated community. We traveled several hours in the mountains to reach the community, finally switching to a 4x4 truck to reach our final destination. What I saw was truly impressive and reinforced the impact that can be reaped from seemingly small changes.

In the mountains many of the people get and use water from the rivers. Even in isolated areas this water is not clean, in part because of the intersection of humans with animals, both wild and domestic (many of the people graze animals -- sheep, llama). As a result various parasitic and diarrheal diseases impact a large percentage of the population. In the project I visited, Caritas works to educate the community and then works to help them address the problems. Local committees are formed with Health Agents (and other officers) elected to run the program. Work projects build water collection stations and reservoirs that then serve the homes in the area. Members of the community oversee the chlorination and distribution of water as well as the construction of latrines, sinks, and showers outside the homes in the communities.

 

 

It's important to understand that these are areas in which homes lack electricity, running water or sanitation systems. Life is hard. Clean water means good health for people in these areas. To hear women in the community speak about how a sink with a faucet, along with an outhouse, means that their kids are not sick from infections and how that has changed their lives is a powerful experience.

My hope is that Wabash students will be able to learn about, and participate in, these kinds of systems in the larger context of global health. For me, this is one of the best ways that I could challenge students to act responsibly and live humanely.

 

 

 

 

 

 

 

 

 

Posted by wetzele at 09:31 PM | Comments (0) | TrackBack (0)

March 04, 2010

Investigating work in the Puno region of the Andes

I'm writing this from Ayaviri, a town of about 25000 people in the Puno region of southern Peru. Puno (city) is next to Lake Titicaca, the highest freshwater lake in the work and a place I hope to visit tomorrow. Yesterday we flew to Cuzco then continued on to Juliaca. We then drove about 100 km to Ayaviri. The town is relatively quiet and surrounded by beautiful rolling mountains; elevation here is about 3900 m (approx. 12,800 ft.), so we weren't exactly sprinting around town.

 Last night I met for about 4 hours with an organization called Caritas-Ayaviri. This group has several ongoing projects involved with rural community development, particularly within 3 provinces surrounding Ayaviri; in fact, Ayaviri is included in one of those. They work closely with the Ministry of Health in Peru and were recently invited to expand some of their regional programs to the national level. That sounds good, but there are always "interesting" tensions with how the government allocates funds for this kind of work, etc. Shouldn't be surprising, I suppose, but it's one of the ways that politics and economics have an impact on the health issues; of course, this is not unique to Peru, but there are important cultural aspects to this.

Some of the issues addressed by Caritas-Ayaviri include work with the high levels of malnutrition in these mountain communities, the impact of anemia and diarrheal diseases on the mortality rate (particularly for expectant mothers and their small children), and accessibility to health care. Many of the "ambulances" here (of which there are only a few for the area) are just a covered pick-up truck with a mattress thrown in the back -- no medical equipment whatsoever. Local clinics struggle with the task of knowing the closest hospital to which to refer people, distances are sometimes a mystery, and the level of medical / technical training which exists in different areas is highly variable, to say the least.

Parasitic / infectious disease is a big problem here and one that contributes directly to the problems they have with anemia. Rates of malnutrition and anemia in children in many of the communities far exceed the averages for Peru (and even for the Puno region at large).

In thinking about a "global health program" I am sensitive to the issue of sustainability and whether bringing a group of college students to an area -- particularly for a short period of time -- is really any kind of help. In many ways it's easy to see how students can benefit; we can visit, learn, observe and experience a different culture for a time. In other words, the benefit is largely one-sided. What we can bring to the table is not as easy of an issue.

 

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March 02, 2010

Teaching

Last week I spent a couple of days teaching a "mini-course" on Ecological Parasitology at the Universidad Ricardo Palma. Even though classes had not started officially, students from various universities can enroll in short courses for a certain number of credit hours; they pay a fee, participate in the course and then receive a certificate at the end. There are no exams, etc. (good for me), so my sense is that it's mainly for the experience and the diversity of topics to which they can be exposed.

 I had a mixed group of students, i.e., they came from various backgrounds, had different goals and varying levels of experience. I was under the impression that most of the students would be comfortable with english, but that was not to be. My spanish is not good enough to teach a course (far from it!), so my colleague Jorge Cardenas had to translate, which as you might imagine slows things down a bit.

Nevertheless, I covered some basic life history work in addition to a smattering of population and community ecology of parasites. I wanted them to have some practical lab experience as well, so the first afternoon the university provided a bus to take us to the Pantanos de Villa wetland to collect snails in hopes of finding some parasites.

The next morning we spent time examining these hosts for trematode parasites and were fortunate to find a healthy number of infections. Several of the students are interested in continuing work in this area and have been working on this project, as well as helping with another pilot project in Pamplona Alta, one of the very poor communities I've described in previous posts. There is great potential to work with some NGO groups in this area.

I'm currently in the Puno region (south-central Peru, in the Andes) meeting with another group that works in a large, multi-disciplinary project in poor mountain communities. Levels of anemia (related to parasite infection) are alarmingly high; among other things they contribute to a frightening level of neonatal mortality. More on this soon.

 

 

 

 

 

 

 

 

 

 

Posted by wetzele at 09:55 PM | Comments (0) | TrackBack (0)

February 27, 2010

OK here in Lima from another natural disaster!

Regarding the 8.8 earthquake that has hit Chile early this morning....Just a quick note to say that we have felt nothing here in terms of tremors, etc. There are mixed reports on the tsunami warnings (we've been watching CNN like many of you probably have, but those differ a bit from what we've picked up from the Peruvian Navy reports, for example); we'll have to wait on that. Even though we're relatiavely close to the beach, our apartment is situated quite high above the ocean. So...perhaps there will be more to report later. Enjoy the photo of a beautiful sunset we took just a couple of days ago.

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February 21, 2010

Pictures and Teaching

 Some pictures --

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February 12, 2010

Mountains Beyond Mountains

Many of you may know the book by Tracy Kidder, Mountains Beyond Mountains, which tells the story of Dr. Paul Farmer and his work in Haiti. It's an exciting and inspiring read and one that's been very challenging to me, as well. I have recently been reminded of this title by what I've seen the past few days.

 

This week I have worked in Huaraz, a city at the foot of the Cordillera Blanca in west-central Peru. Huaraz has a population of approximately 100,000 and sits at and elevation of about 3050 m (10,000 ft.). It's a beautiful area, with clear blue skies and views of snow-capped peaks. I travel with a Peruvian colleague of mine as a matter of course (since I continue to struggle with learning spanish), but an added bonus this trip was that my oldest two daughters came along to share the adventure.

Huaraz has its share of 'global health' problems. Many of the people in the mountains suffer from malnutrition, as their diet lacks protein. Potato and corn, corn and potato....these are the staples. Like every area I've seen thus far (and as is true all over the world), access to clean water is also an important factor in the levels and types of disease with which people suffer.

One of the areas we visited is Challhua, a small barrio on the edge of Huaraz. An interesting (yet alarming) note is that this community is located only about 2 blocks from the local Ministry of Health office. About 300 children live in this community, which is not recognized by the local government as it was the result of a land takeover by a group of people burdened by poverty.

Consequently, the area lacks electricity and ready-access to clean water; there is a raging (for now) stream that runs next to the community from which many people draw their water (in addition to using it to wash clothes, food, and who knows what else). Homes are of adobe, lack space and heat, and are highly susceptible to the rain and cold which exist in this area. While we were visiting, a steady rain came down making a complete mess of the roadways and in many of the homes.

One opportunity here for Wabash students is that of education for the kids who live in this community. This community (and most others we've encountered) lacks for good information on the causes, and prevention, of parasitic and infectious disease. Baseline data on infections do not exist, and there is a lack of understanding of the multi-faceted causes of the disease problems. Again, clean water and modest hygiene practices (e.g., it's a good idea to not live in the same room with your dogs, chickens, and pigs) are key.

The beautiful thing is that kids are the same everywhere. I had great fun in the short time we were there interacting with the horde of kids who were attracted to our small group of visitors. We were meeting in the "classroom" of a small community center / kindergarten and were surrounded by inquisitive and bright young kids. It was fun to have them swarm as they jockeyed for position to see their pictures on my camera.

Education and opportunities for sampling also exist in Llupa, a small village in the hills above Huaraz. This was another beautiful area that masks some of the struggles the Andean people have; a large percentage of the population suffers from malnutrition and diarrhea because of their diet and some of the parasites which can be found in the water. Access to this area is relatively easy as it's a short (but steep) trip from Huaraz.

We also took a trip further up the road to visit an inn (the Lazy Dog Inn) that's run by a couple of Canadian expats. They've been there nearly 10 years and have a registered NGO, the Andean Alliance. They do a good bit of education and community development work in addition to running an environmentally-conscious inn. They are striving to be totally off the grid in a few years; we had a great time talking with Diane Morris, one of the owners, about possible projects on which students could work, etc. Having previously lived in Ecuador and Colombia, they have a good on-the-ground perspective on global health issues and how those are approached at the local and regional levels. Their inn sits in an absolutely gorgeous area with amazing views all around them. It was an instructive and enjoyable visit.

 

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February 07, 2010

Work in the Amazon

This past week was spent in the Peruvian Amazon. Last Sunday I flew to Iquitos, the most important city in the Peruvian Amazon. Iquitos is an incredibly interesting city. It’s relatively large (pop. About 500,000) but has somewhat of a small-town feel with a fun center city, a river-walk, etc. (Being somewhat of a frontier-town, it does have some serious problems, as well, but I’ll not go into those.) For its size, it’s interesting to note that Iquitos is not accessible by road – everything (and everyone) needs to come by boat or by plane, given that it’s pretty much surrounded by the Rio Amazonas -- Amazon River -- or associated wetland. Iquitos is located in the “state” of Loreto, Peru’s largest administrative unit; Loreto is roughly the size of California but only has about 1 million people (half of which live in/around Iquitos).

 

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