Jeremy's Journeys

There are about twice as many taxis in Lima as are necessary.  It’s a buyers market.  If you don’t like the price of one taxi, you can easily wait for another.  Bargaining generally works out well for the traveler.  But on Saturday, I wish we had waited for a different taxi.

My volunteer friends and I were going to see a Cumbia concert (Peruvian Cumbia is a mix of Pop and Latin music that everyone here is obsessed with).  After bartering for a few moments, we decided that we had a reasonable fee, and we wanted to just get to the concert.  The fee was 28 soles (Peruvian currency, about 10 dollars).  We told him we were going to a place near the Megaplaza.

While conversing, we told him we were Americans.  He asked if we were Christians, we told him no.  Our conversation was short, and in our opinion, he was a bit rude.  But that happens with taxi drivers and it’s no big deal.  We ended up driving a little past Megaplaza, by about 1 km.  When we got to our destination, the driver asked for a little more money because we had passed our stated destination.  This is a common taxi tactic: They ask for a landmark, and then when you don’t go exactly to the landmark,  they attempt to charge you extra.  Usually, I don’t give them anything, but this time, we gave him 30 soles just to make it an easy payment and avoid asking for the two soles back.

The extra two soles were apparently not enough, he wanted an five extra.  To which I responded that we were not going to pay.  If I were by myself, I would have gotten out of the car, and that would have likely been the end of it.  But, my friend wanted to avoid an argument, so she wanted to pay.  But she didn’t have the money.  Which led to me arguing with the taxi driver for a couple of minutes while waiting for my friend to get out.  This was the opposite of the intended effect.

Right before she had gathered up her change to pay, the agitated taxi driver implored me “But this amount of money is nothing in your country, it’s only 10 dollars.”  And that’s when I really got upset.  But my friend was paying, so I we got out, and I was left to stew on it.

I don’t mind the extra haggling, nor the extra haggling because we are Americans, but it was the incessant rudeness which he demand his money because we were Americans that bothered me.  And we knew it was unfair.  But it does beg the question, just because we can pay more, should we pay more?  Is it right for places to charge foreigners more for things?  I like to consider myself more than a tourist, I am a person  who lives in Peru.  I don’t feel I should pay more for a taxi than a Peruvian does, but in the end, the taxi driver probably needs the money more than I do; however, he should not feel entitled to it any more than I feel entitled for my opportunities because I’m American.

Conversely, I would argue that those who can’t afford to pay should pay less than those who can.  My job here, for example, is dedicated to giving a preferential option for the poor in health care.  That is something I believe in.  And maybe if I thought that the taxi driver were in the business of giving a discount poor people, which was covered by his taking advantage of foreigners, I wouldn’t have minded.  But I doubt that was the case.

For those of you who don’t know, PIH has been a pretty influential organization in the Health World.  Its charismatic co-founder, Paul Farmer, is working with Bill Clinton to be a Special Envoy to Haiti (whatever that means, but it sounds important).  They have treated patients all over the world, in areas that, because of geographic isolation, were once thought impossible to reach.  They now work in 11 countries around the world.

Probably their first large-scale policy change came in their treatment of multi-drug restistant tuberculosis (MDR TB) in the mid-nineties.  The World Health Organization’s (WHO) official stance on MDR TB was that it was not cost effective to treat, and did not pose a major threat (potentially because those who had MDR TB were dying without treatment).

PIH’s contacts in Peru begged to differ.  They knew many people with MDR, and they knew it was spreding rapidly throughout  the marginalized areas of Lima. So they went about studying and treating a group of people with MDR TB, the largest cohort ever treated up to that point: 10 patients.  And they found cure rates better than those in the United States.  They were able to barter with drug companies to lower the prices of MDR TB drugs and, in 1998, change the WHO’s policy on MDR TB.  Furthermore, they have been working with Peru’s Ministry of Health to have them adopt their MDR TB treatment program nationally.  In March, PIH in Peru held the a week-long conference training the WHO in TB treatment.

Yes, so they’re kind of a big deal. But the idea behind their success is not revolutionary. They use community health workers.  What that entails is training members of the community to visit patients, make sure they take their medicines, and provide them with support.  This idea works so well because these health workers have either been patients in the past, or have had someone close to them who has had to get treatment for TB.  They know what it’s like to take medicine every day for 6 months, or in some cases of MDR TB, a year and a half.  They know what the patients are thinking and feeling.  They know what the community needs and have ideas how to help with that.  They know it’s worth it to treat patients. They are not doctors, nurses, or statisticians from outside, but people who have grown up their entire lives walking the same streets that they walk to visit patients.  They can’t meander five minutes through the community without getting stopped and asked for help.  And they do help.  It is because of this community-feedback mechanism that PIH has developed it’s mission of integrative health, a topic which I will touch on next week.  But just so you know, these big policy changes and idea shifts did not come from Paul Farmer, they came from people in the community.

I must first apologize for being MIA (not the musician) for the past month or so. I’ve been getting my feet wet in Lima, Peru, which is considerably larger than Guatemala City. I meant to have a get together in Ann Arbor before I left, but since my turnaround was so quick, I did wasn’t able to get that together.
So what am I doing in Peru? Well, I’m working for Socios En Salud (SES), Partner’s In Health’s Peruvian sister organization (You may have heard of Partner’s In Health through the book Mountains Beyond Mountains or through their work in Haiti). I’ll be working with microfinance again. But with a different twist. These loans will be zero interest loans for patients who have recovered from tuberculosis. Tuberculosis (TB) is a particularly debilitating disease because, for the first month or so of treatment, you have to stay in your house, without having much contact with the outside world so you don’t spread the disease. And that is for the people who catch TB before it is bad. If they are already have coughing up blood and very weakened or if they have Multi-Drug Resistant TB, that rehabilitation is longer and tougher.
It’s not too hard to imagine that many of these patients loose their jobs and ability to generate income for their families. Well, my arm of SES works to help them get back on their feet after they have been cured. Here is a PBS video on what we do:

I’ll be sure to take a more in depth look at things as I get a better idea of what work I will be doing on the ground. Feel free to email me with any questions or comments. Later this week, I’ll be posting about my experience getting caught in a miners’ strike. Have a good day.