Yesterday morning I went with a pre-arranged taxi for the 45 minute trip to San Martin de Porras, a very economically depressed community with high population concentration. (In other words, an urban “shantytown“.) Unlike other barrios which ring the outsides of Lima, San Martin de Porras has a long history and cannot claim it’s existence from the boom of desperation and poverty triggered by the double-whammy of the years of terror in the 80s and “Fuji-shock” of the early 90s that resulted in a huge internal migration to Lima during the last 20 or so years.
Met by Ruth (a public health nurse often hired by my mentor, Valerie, to conduct surveys), I was introduced to Dr. Guzman, her boss and the Director of Health for SMP, Rimac, and Los Olivos (two districts around SMP). I spent a good hour or more with Dr. Guzman — a wonderfully helpful and interesting man. We talked first about his impressions of the health of the community, his thoughts on the current challenges and limitations in both the health of the community and in his work, and spent some time going over data from the last full collection of demographic and health indicators from the communities he serves. I was surprised to learn the incredible impact of respiratory infections in this community: respiratory illness (Tuberculosis, in particular) is terribly endemic here. Of the 10 items listed as top reasons for clinic visits, 4 were related to respiratory ailments — consistent with both sexes and all age groups. With more than 19,000 people per km square (in buildings tightly packed in one to three floors), he felt that the lack of clean air, good ventilation, and many people in the same living quarters gave these districts the rich environment for the disease and kept it that way, In fact, when we discussed the future of the community, he quickly noted that the limitations and challenges were structural: namely, political and economic. This was refreshing to hear! Other interesting tidbits: rubella is currently in huge outbreak here. (In fact, my spanish tutor’s 9 month old daughter just got over a serious case.) Although a vaccine is available, there isn’t much of it here, and as a result, “sarampions” are everywhere. The graph for tracking it looked sort of like a seismograph hitting a sudden earthquake.
After my great meeting with Dr. Guzman, Ruth joined me to visit a smaller clinic a few kms away, “Clinica Salvadore” where we met the head nurse, Grimanesa. (Interesting note: Grimanesa’s brother, Pedro, was the pre-arranged taxi driver for the day and now my “go to” guy for pre-arranged rides. He was very, very nice and drove very sensibly and safely — something you don’t always get when you pick up a random taxi!) At the clinic, I also met Blanca, who provides counseling for patients. All were absolutely lovely: if I end up doing a clinic-based study based out of a smaller maternity-focused clinic, I would want to be here. I immediately felt welcome and integrated. After our tour of the facility and general questions and talk, the four of us (Grimanesa, Ruth, Pedro (the driver), and I) went out into the neighborhood to find a 9 year old boy who, several weeks before, had been diagnosed with tuberculosis. It allowed me a vantage to see the most vulnerable areas of the community (ie: those without water tap, which is only provided after a certificate of ownership can be presented for the property — in other words, these are long-term squatters who have not gathered up the resources to collect on such a needed and necessary luxury — yes, water, unpotable as is may be, is a luxury here). The mission allowed me to ask questions about the community, the building, the process of living here, the development of the region, and the challenges of serving it. The bottom line: poverty in urban Peru means illness and suffering, staff do their best to help when they can and enjoy the moments of success when they are able to provide care. In this case, there was no reunion with clinic staff and dispensing of medicine (the first line of which would have been paid by the government) — the sick child and his family could not be found.
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