OVERVIEW

Thank you so much for taking time to look at our blog! We are a group of edical students who are passionate about training and in underserved areas. This January and February, we are in Peru, the Dominican Republic and Costa Rica internationally as well as locally in Flint and Lansing completing volunteer service, rotating in hospitals and clinics, and learning about international medicine and local underserved health care. We appreciate any time you take to read our reflections and any donations you might offer.

Please click the “Donate” link on the side for more details on how to give directly to these communities.


Saturday, February 13

Health Issues in Peru

After volunteering with different projects in Peru for 5 weeks and having the chance to work with doctors and nurses from La Merced and Huancayo, we have learned much about the challenges facing the Peruvian health system.  While our focus is more on teaching children about healthy habits and addressing nutrition issues, it has been very eye-opening to sit down with local doctors and discuss the issues they are facing and the different and similar issues that we face in the US.

Health Insurance - Most people in Peru are covered by public health insurance called SIS (Seguro Integral de Salud) that is available to all citizens.  It covers most of the basic things that health insurances cover, but there are some failings.  One major charge to patients is payment for supplies.  This may include basic things, like nutritional drinks (e.g., Ensure) for patients who can't eat solid foods and water to mix medications.  Families must go out and buy these supplies with their own money and give them to the hospital so they can be used to treat patients.  In rural areas, there is also the issue of transportation to larger hospitals.  One boy came into the health post after his hand was crushed by a machine in an iron-works facility.  One finger clearly had a fractured bone but the adult who brought him in insisted he be treated at the health post since the hospital was 30 minutes away and would cost about S/. 5 (quite a lot when weekly wages can be as low as S/. 30).  So the doctor did her best in a situation where there were no capabilities of getting an x-ray nor an available surgeon to treat the wound.  All she could do was suture the wound, place a splint, and ask him again to go to a hospital to get properly treated.

Health Posts - Most communities have a small health post which is similar to a community clinic in the US.  People come for routine well-child checks and urgent care type visits.  These health posts, however, are extremely under-resourced.  At one that I worked at, gloves were rationed to the point that they were only allowed for births and suturing and left over sutures were sterilized and re-used.  These health posts are also typically run by a recent medical school graduate.  All medical students are required to do a rural medicine year after graduating medical school and prior to starting residency.  These doctors are fresh out of medical school and are not overseen by a senior physician and are expected to handle the vast majority of cases that come through the door on their own.


Pharmacies - While most people in the US tend to head for an urgent care center or an emergency room when a cold or a pain comes up, the people of Peru often head first to a pharmacy.  Pharmacies are on ever corner and some offer medical consults for S/. 10 (or about $3 USD).  Often times, patients will come away with some pill which they take once and hope it works.  Patients rarely know what it is that they have taken and even when it is the right medication, they can only receive one days worth without a doctor's prescription, a dangerous thing when it comes to antibiotics and even more so when it is happening in a country where TB is prevalent and there are many cases of MDR and XDR-TB.

Traditional Healers - Traditional medicine is a very important aspect of Peruvian culture.  Traditional medicine practitioners are called curanderos.  One of their ways of detecting disease in people is by passing a guinea pig over the person's body and then performing a necropsy on the guinea pig to identify the disease.  There are also hueseros who are similar to chiropractors who focus on fixing pain through manipulating the bones.  Matronas are untrained midwives who help women deliver their babies at home, a very common practice.  Sometimes, these matronas provide women with an herbal drink to induce contractions, but these can sometimes induce placental rupture due to the strong contractions which tends to result in the death of the baby.

Obstetrics - Obstetricians face many challenges in Peru.  For one, pre-eclampsia and eclampsia are very common problems and deaths of pregnant women is a major public health concern.  For the obstetrician, however, there is added pressure as the death of the mother under their care can result in criminal prosecution.  Unsurprisingly, there are now very few obstetricians and women are having difficulty finding one when they need it.  Many women prefer to have their children at home, particularly in rural communities.  When they do, they often cut the umbilical cord using a rock or a roof shingle.  Abortions are illegal under Peruvian law and many women are at risk due to going to illegal abortion centers.  While contraceptive usage is fairly high nationally, the machismo culture sometimes forces women to say no to contraceptives since men feel that if their partner is using contraceptives, they would be more likely to cheat.

Pediatrics - Most of our focus has been with working with kids and being an aspiring Pediatrician, I had many opportunities to work with the Pediatric wards.  Many kids that we saw in the hospital were there due to accidents involving horses.  Broken legs, broken arms, and severe head injuries in several of our patients could be traced back to falling from a horse.  During our home assessments for our nutrition project, we also learned that safe sleep is not something that is done.  Parents almost always have their baby in their bed and none so far that we have met even own a crib, and very few babies sleep on their backs.

Other Diseases - Cancers, particularly stomach and cervical cancers, exist at relatively high rates in Peru.  Stomach cancers are likely linked to food preparations which often include very highly salted meats for preservation and fire-grilled foods.  Cervical cancer screening is increasing and more and more campaigns are being held to try and catch early cases.  Skin cancers are also common, particularly in Huancayo, where people live at high altitudes and there exists an ozone hole right over Peru.  People are also not very inclined to use sun protection.  Another disease that seemed more common in the rural areas was adermatografia, or the loss of fingerprints.  Some people who work in the farms or factories end up having their fingerprints erased due to constant manual labor.  These people must then get a medical certificate since fingerprints are used as an additional layer of identification on health forms and are required for a DNI, the national identification card that all citizens must have.

As you can probably tell, medical resources are severely limited in this country so I would like to thank all of you who have graciously donated supplies and/or finances to help us bring much needed items for the health care workers here in Peru.  Simple things like soap and toothpaste go a long way in helping kids stay healthy and a box of gloves can mean a greater sense of security for doctors when examining and treating patients.  We have seen these supplies go a long way in helping the people here have greater access to health.  Thank you for your generous support!

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