TB treatment is bad.  It’s hard on you.  It’s hard on your family.  It lasts six months.  You have to take a cocktail of pills everyday for at least the first two months.  The pills make you weak and unable to work.   And that’s the most amicable treatment for regular TB.  There also exist longer, more arduous treatments for MDR TB and XDR TB.  Here I profile three cases of TB treatment which I’ve seen (The names have been changed to generic Spanish names to protect the patients).

Case 1: Susceptible TB

José started his treatment a month ago.  Everyday he goes to his local health clinic down the street to take his pill-cocktail.  He got diagnosed with TB when he was hospitalized because of the TB effects on his lungs.  It had spread to his extrapleural tissue.  Before he was hospitalized, he was working as a painter.  He can’t work now, because the treatment makes him weak.  More than that, ever since he started treatment, he has gotten a fever in the afternoon.  He has tried numerous times to see a doctor about this, but he has yet to successfully see the hospital’s doctor. His wife cannot work, because she is nearly blind from glaucoma.  His daughter is studying, but might have to drop out because they can’t afford to pay the fees for school.

Daily dose of TB drugs: Isoniazid, Rifampicin, Pyrazinamide and Ethambutol

Case 2: MDR TB

MDR TB is labeled as such because it is resistant to the two most common and effective first-line drugs: Isoniazid and Rifampicin.  Patients with MDR have a treatment that lasts anywhere from 18-24 months.  Juan has MDR TB.  Before he was diagnosed with TB, he was a tour guide for the Paracas nature reserve.  He has been receiving treatment for 6 months.  Which consists of daily injections of the second-line TB drugs.  He has got injections in his legs, his butt, and now he is getting them in his arm.  He has had several negative TB tests, and he hopes to change treatment from receiving shots to taking pills.  He says he doesn’t mind the shots (although the way he says it makes me question if he’s telling the truth), but the  dolorous side effects causing his legs to feel heavy and immobile is what he can’t stand.  But in order to be approved to leave treatment, he needs a doctor’s approval, and he has been waiting all month for his appointment, which he has this week.  There is no guarantee that the doctor will say he can change his treatment.  If he has to continue with the shots, he might abandon treatment.

Case 3: XDR TB

XDR TB, extremely drug resistant TB, is resistant to Isoniazid and Rifampicin, as well as several second-line drugs.  The cure rate for XDR is much lower than MDR, but it is still curable in some cases and treatable in all.  Miguel has XDR TB.  He has been in chemotherapy treatment for his TB for the last five years.  And he is still not cured.  The drugs are fighting the TB, but they can’t kill it.  He is weak and in a wheelchair–more so because of the drugs  than the TB.  He is mostly deaf, and has communicates by writing.  All these side effects are because his TB is resistant to the drugs with fewer side effects.  He had know choice but to take these damaging drugs.  His mother takes care of him, and for now, the government is still providing treatment for his TB.

I tried as best I could to represent these cases as I see them.  I try not to make them worse than there are, and I do not want them to be looked at as pity cases, but rather a snapshot of reality for three people with TB here in Peru.

Why aren’t there better drugs?

Well, TB is particularly tricky disease, different from normal bacterial infections  so simple bacterial drugs don’t work.  If you want some more in depth biology, check out the wikipedia page.  But also, Tuberculosis is largely a disease of the poor.  In the past, there had been little research money dedicated to the disease, because who would pay for the better drugs that can cure TB faster with less side effects?  In recent years, partly because of PIH, TB has started to get more publicity.  There is now a greater push from organizations such as TB Alliance.

Also interesting is perhaps the most important discovery I’ve ever seen: A self-replicating synthetic DNA cell.  This may not mean too much to you non-science folk, but I think with this achievement, the possibility for vaccine development is wide open.  We can now explore the possibilities of developing a vaccine that evolve to combat a constantly-mutating disease, such as TB.

The patients in Pisco whom we work with are poor. Most don’t have the money, let alone the time, to take a day of travel for pleasure. This weekend, we took a group of patients and their kids to various attractions around the Ica area. One patient said to me, “The only time I have been to Ica, is when I was hospitalized because of TB, and need surgery.” For you Michiganders, that’s like living in Ann Arbor all your life and never visiting Detroit.
The patients we brought were participating in group therapy sessions in dealing with TB treatment. TB treatment is a long, taxing process that can last anywhere from 6 months to two years. As you can imagine, taking daily medicines that have debilitating side effect can be mentally tough. Add to that the stigma from the disease–which is still a huge problem–and you get a disease that attacks the body and the mind. PIH has group therapy sessions with current and former patients to help work through these issues.
Saturday was a day of fun. The patients, their kids, the PIH workers, and the government health employees piled into a bus to go from Pisco to Ica. First we stopped at Ica’s town square. Taking pictures in front of the fountain and enjoying the sights. Next we went to tour a bodega, a winery. I got to play with the kids a bit while the adults tasted some sweet Peruvian wine. But when I was chasing one kid, he fell down and scraped his knee. The next day, he claimed he fell because he was scared of me because I’m so big.
Later we had duck at a nice restaurant. And when eating meat in Peru, they don’t typically give out knives. So it was a fork-and-hand-to-mouth process. To those who know me well, this form of ingesting suits my style of eating better than the “more civilized” form.

A photo outside the restaurant with me and two nurses.  This was taken to show my height.

A photo outside the restaurant with me and two nurses. This was taken to show my height.

After lunch, we went to La Huacachina, an oasis that has been so built up, it reminds me of Niagra Falls. People are climbing the sand dunes, sand boarding down them, taking dune buggies. It is a cheesy attraction, but it’s pretty nonetheless. To see trees growing in the middle of the desert is cool. The patients were taken out in row boats, which most , even though they live next to the ocean, don’t have the opportunity to do.

La Huacachina

La Huacachina

And so went the day. But more than the sites we went to, the best part was giving the patients an opportunity to relax, away from the harsh poverty in which they live. Who doesn’t need a vacation?

When I think of rural poverty, I imagine lush,  mountainous countrysides with windy dirt roads.  And that’s pretty much what things looked like along the coast of Peru.  Except there was nothing lush, and the mountains were made sand instead of rock.

Laguna Grande is a small fisherman’s town 2.5 hours drive from Pisco, its nearest city.  Its population varies according to the fishing season, but around 500 people are permanent residents.  The directions to get out there are as follows: stay as close to the ocean as you can, past the rock that looks like a turtle (Land Before Time, anyone?),try to find sticks  jutting out of the sand.  Sometimes we had to stop completely to just spot the next marker in the desert.  Twice we had to back track because we had gotten lost.  It was a pretty hard place to navigate, but we finally made it.

Fishing town, Laguna Grande

Fishing town, Laguna Grande

The purpose of our visit was to visit the government health post in Laguna Grande.  We greeted the nurse–one of only two that worked there.  We chatted for a while about how things were going.  Most of her patients are seasonal migrants, only living in Laguna Grande for part of the year.  They hadn’t seen a TB patient in ten years.  But they can’t really do tests for TB because they don’t have a fridge.  They also have no way to do tests for HIV, but she said she has seen symptoms of the disease in some of here patients.    They also have to import all of their water from Pisco.  A 2.5 hour journey, just for water.  The government gives the health post a monthly ration of water, but it is hardly sufficient.

Laguna Grande's Health Post

Laguna Grande's Health Post

Laguna Grande is a geographically isolated community.  Many questions come to mind in this situation.  How can a health care facility not have enough water?  And no fridge?  Well, part of our goal in the next coming months will be to work with the  government to see that a fridge arrives, sufficient water is supplied, and HIV tests become available.  Our commitment is to providing the community with  sustainable sustainable structural development.  We will work  with the fishermen, with the nurses, and with–not around–the government.

“Taking medicines without food is like washing your hands and drying them with dirt”- Haitian Saying

Partner’s In Health’s slogan is a preferential option for the poor in health care.  They target underserved populations, much like many other health care non-profits.  So what’s different about PIH?

The difference is in how they define “health care.”   It is not simply that they give medicines to people without explanation, expect them to be cured, and then leave the community (like what  happened during the much acclaimed WHO’s Smallpox Eradication Program).  Health care to PIH is the mental well-being of their patients.  Health care to PIH is giving out baskets of food for their patients that are too weak to work.  Health care to PIH is delivering beds to patient’s homes so that they can sleep well.  Health care to PIH is ability of their patients to lead lives that they can be proud of.

Socios En Salud (Partner’s In Health in Spanish) works towards this definition of health care.   That is why they have microfinance program with zero interest loans.  I’m down here working with that program, that is in no way a sustainable program (because of not charging interest), but is nevertheless successful at helping the people who have just finished TB treatment in a way that a sustainable program couldn’t be.  These people take loans, and pay them back in monthly installments.  The money that they pay back goes into a socioeconomic fund, which is then used to provide support such as food baskets or beds.

If we give people treatment for one issue, but fail to address another, what is it we really care about?  The issue we treat, or the people?  You can’t solve every issue, but you can sure try to care more for the people you are treating than the issues you are treating.

A street in Pisco after the earthquake in 2007

A street in Pisco after the earthquake in 2007

Next week, I’ll be heading to Pisco, a town of 100,000 that was destroyed by a 2007 earthquake that was  stronger than the one that happened in Haiti this past January.  As most of the town’s structure and industries crumbled along with its buildings, there is dire need for economic opportunities.  We’re hoping to start our microfinance program down there.  Hopefully I’ll have some cool experiences to write about.  But more than that, hopefully we can work with the people so they can continue on their never-ending road to recovery.

(For those who are wondering why we are having so many earthquakes these days, I happened upon a neat little explanation)

As you may know, it was Easter this weekend. Which means everyone in Latin America takes Thursday and Friday off. The other volunteers and I decided to go to Arequipa, a 15 hour bus ride to the south. It’s known as Canyon country. I spent Friday and Saturday hiking, climbing ruins, seeing condors, and seeing the second deepest canyon in the world. It was a lovely extended weekend.
Then came the fifteen hour bus ride back. We made seven hours of the journey. We stopped at two in the morning, and did not move for the rest of the night. I saw lines of cars around us, so I knew we were not in trouble. If we had been reading every piece of Peruvian news, we would have known that the miners were planning on striking; however, we had not been up to date on the current events. We woke up in the morning to find ourselves in a line of buses, filled with people like us, trying to get back to Lima after the holiday.
We were in Chala, a small finishing/mining town. We learned why we had stopped. The government wanted to legitimize an illegitimate mining industry, meaning creating environmental restrictions, and, presumably, taxes. It was seven in the morning, the word on the street was that we might get through the blockade by 1pm. And by blockade I mean 8,000 miners blocking the road, with only 500 policemen.

I heard shots being fired. I saw a helicopter arrive on the beach (at least we were at the beach). I saw tear gas fired. I saw tires burning. I saw 5 buses pass through that had been at the front of the strikes, their windows smashed as concerned Peruvians looked through the broken glass. Thankfully, I was not near the front. Then we heard rumor that some miners had died. The protests had just been moved up a notch. I could see armed military men standing on top of the police station. We would have turned around, but around 100 km behind us, there was another blockade. So we were kinda stuck. The miners never wanted to hurt us, but they did want to make their voices heard. I was never in trouble, just uncomfortable and on edge.
We decided to move 5 km back to a what I would call a trucker stop. Along with about 20 other coach buses (1000 people) we cleaned out the restaurant, the food, and desanitarized the toilets so you couldn’t go to the bathroom without holding your breath. We were in the desert, next to the ocean. I went to bed having eaten one meal that day, but having stocked up on plenty of water. I went to bed calmly, knowing the miners would not come to where we were. I went to bed almost positive that in the morning, we would be on the way to Lima.
The next morning, things started getting ugly, people were screaming at each other about what to do. The bus company wanted to just wait it out. There was not food. Only a small portion of cheese for children. Our bus collectively decided to go back to Arequipa. Some people couldn’t afford to go back and pay for another ticket, so they decided to wait it out. The place was a disaster–no clean toilets, no food, hardly any water. Unfortunate that people were forced to stay there (voluntarily or not). There was no news as to when the blockade at Chala would stop, but it was rumored that things were ugly there. On the other had, it wasn’t clear that we would actually be able to make it past the blockade that was behind us, but we had heard that other buses had made it through the less severe blockade of only 3,000 miners, and no deaths.
We made it back, with only a 45 min stop at the other blockade, and relatively peaceful passing.  Seven hours later we, were in Arequipa. And thus ended my over 48 hours on a bus. We went to the airport, where the government was giving out free military flights back to Lima for those who had been on buses. Why was the government was investing their money in that, rather than in quelling the protests? Well, they didn’t want to give into the miners demands. And they decided to just wait it out. So Monday night, at 12 in the morning, I got on a Peruvian air force plane and flew home. The main reason I got a flight so rapidly, was because I was American. I felt bad.  So did the other volunteers, and two of them stayed behind, to wait there turn in line. I felt it was a situation that did not have a correct response. Any Peruvian would have lambasted me for giving up my opportunity to go home. Yet I didn’t feel it was right. I wanted to stay. Then I started thinking about what would happened if I stayed. Well, I would probably just be getting on a flight the next morning, in front of some other Peruvians, and still feel bad. Really, there was no right answer. I got my house at 3 in the morning, and crashed.

I spent thanksgiving in Costa Rica with four other Kiva Fellows who are placed in Central America. Before going, the Guatemalans who I had spoken with about my trip mentioned two things: Costa Rica is safer than Guatemala, but it has less of it’s own culture. Having spent only five days in Costa Rica, I can hardly make any judgments about Costa Rica’s culture, but I can confidently confirm that Costa Rica is safer than Guatemala: walking down the street feels more comfortable, people aren’t afraid to ride buses, and you can drink the tap water. One thing did feel the same as Guatemala: the pervasive placement of American chain restaurants.

The security in Costa Rica is something that I am sure most Guatemalans would love to have. How did Costa Rica get to be so safe? I am sure that not having a civil war for a third of a century (Guatemalan Civil War) and multiple public works projects that bring electricity and clean water to all have helped. But the economic stability that Costa Rica has been able to find in the tourism industry must also be included with an the how safe Costa Rica is. And with this high level of tourism that Guatemala has yet to be able to harness, comes an exchanging and adopting of cultures. It is from the apparent adoption of so many foreign customs that the Guatemalans whom I spoke with derived their idea that Costa Rica had no culture of its own.

My intent of this post is not to evaluate Costa Rica’s culture, about which I know next to nothing, but rather it is to ask what is the destination of

Will Guatemalan blankets such as these made by a Kiva entrepreneur soon be extinct?

Will Guatemalan blankets such as these made by a Kiva entrepreneur soon be extinct?

the rich Mayan culture that exists in Guatemala. Learning about this vibrant land was the main reason I had interest in being a Kiva Fellow. And I have seen the colorful dresses and blankets that many Kiva entrepreneurs weave.  These artesinal products, are in a large part, bought by tourists. As tourism increases in Guatemala, which it will no doubt do, will Guatemalans be looked at from the outside has having no culture of their own?
If Guatemalans what to incorporate foreign tradition into their own, that should be their prerogative, and that is not what worries me. What worries me, and many people who study globalization, is whether the permeation of outside cultures will cause the extinction of those currently present.

What role does Kiva play in all of this? Surely, it is not for Kiva, nor anyone besides Guatemalans to decide what makes up their culture. But it is undeniable that Kiva brings a degree of foreign culture to the MFIs that they work with, and the entrepreneurs that they support. By sending fellows to other countries, they are ensuring the input of foreign culture into these communities; however, I tend to believe that Kiva’s influence might play a role in enhancing the cultures they serve.  By documenting, sharing, and learning from our entrepreneurs, it seems to me that Kiva play a role in strengthening the culture here in Guatemala, and in other parts of the world where Kiva works.

I’m not completely comfortable with this theory, and in may be that indeed Kiva is contributing to the steady process of dissolving and homogenizing cultures.  Does the union of two cultures mean something is lost?  Since this process is unstoppable, what is it that we should personally do when desiring to learn about other cultures?  Would the beautiful Guatemalan blankets still exist as they do without the tourism that supports them? Does that tourism simultaneously destroy them?

Questions, questions that need answering. Sorry for being angsty.

I am the visitor. I am from Kiva. I am Jeremias. This has been my introduction for my first days in Guatemala.

Tueseday, we went to San Martin. It is a two hour drive from Guatemala City: thankfully it was Marco and not me who was driving so I could observe the scenery as we passed through beautiful rolling hills covered in forests. In the distance we could see small peaks, and each one was covered in trees.

Once we arrived, we were greeted by Bertha Carmelina Tohon, who just finished fundraising on Kiva.  She gave us a warm weBertha with her typewriters lcome and insisted that we have tea before we leave her comedor (eatery).  She was not shy to share her life story.  I quickly learned that her kids attending college, one studying psychology and the other chemistry.  I learned that she thought the Guatemalan school system did not teach the children anything practical, and that she has a typing school where kids learn using typewriters.  I learned that she was hard working: “There is time to rest when you die,” she said.

But not all of our visits on this day would be this happy. Read the rest of this entry »

I have arrived, and am continuously amazed by the friendliness and hospitality of everyone here. I am staying with the director of FAPE for this week, after which I will be moving to the seminary. He has a wife, who he only refers to as his amor, and a two year old son.  You  know how sometimes kids are hard to understand while they are learning to talk?  Well, it’s near impossible to hear anything other than jibberish when they are learning to talk in another language.

Today, I went to the organization’s office, and was intorduced to loads of people, from the loan officers, to the accountants, the secretaries, and everyone else.  Except for the people who get loans.  Tomorrow, I am going to San Martin to see this and collect some payments.  Also today, I discussed how to better use Kiva, and how everything works in the office.  On the way home, I drove a diesel pick-up truck through the streets of Guatemala City.  In order to change lanes, the turn signal and hand wave out the window are both requirements.  It was a little nerve racking, but all things considered not too bad.  Sorry I don’t have any pictures or video, the day was too packed.  Hopefully later this week I will have them.

At the end of every meal we say, “gracias,” to which someone responds “buen provecho.”  To you all, I say gracias and good night.

The people I come in contact with

The people I come in contact with.

This is how Kiva works.  You give a loan.  The loans goes through Kiva.  It goes to an microfinance institution.   They give money to a lender.

I will working with a microfinance institution Guatemala City (FAPE) to help them better work with Kiva, and get more loans to those who need them.  Most of what I will be doing is helping FAPE understand the way Kiva works better, and helping them to post more loans on Kiva’s websites.  The barriers will be cultural, financial, temporal, and who-knows-al.

Another important job of mine is maintaining transparency.  I am going to work with FAPE to help them put more information on Kiva’s website on exactly who their borrowers are.  In this role, I will be meeting and interview the individual burrowers.

A social critic named David Rodman has recently written about Kiva, critisizing its transparency.  Among his points, many of which I take issue with, he takes aim at the Kiva Fellows program and the process of interviewing borrowers: Read the rest of this entry »

It’s about a week and a half until I takeoff,  and I have recently found out that when I arrive, I will be living in a seminary.  I don’t know who I’ll be living with or what my living quarters will look like, but I’m sure it will be a learning experience.  Despite these uncertainties, I keep finding myself more inspired the more I learn about Kiva.  Here’s a link to my bio on Kiva’s website. Scroll down about a quarter of the way.

In reading an article by the founder and CEO, I was reminded off this core principle: Kiva is committed to transparency.  If some sort fraud occurs with one of their partners in another country, they do not hide from it, but rather they proactively tell their lenders and supporters about it.  And lenders in turn respond with a greater devotion to Kiva as a result of their honesty, instead of looking at this setback as a sign of weakness (if only governments also held this belief).  I will be proud to be a part of this  organization.

I also stumbled into a little more clarity of what my life interests may be.  Nobel Prize winning economist Amartya Sen claims that although life expectancy increase is correlated with GDP increase in developing countries, that when two factors are taken into account, that correlation disappears.  Those two factors:  incomes specifically of the poor and public health expenditure.  My experience doing health education in Argentina and working with microlending to poorer communities with  Kiva fall right in line with those two factors.  Maybe what I most interested in global development, and health and microfinance are just two ways at which I have approached that field.  Here’s a brief Amartya Sen article or check out his book, Development as Freedom, for a really good read.

Meg Gray, a current Kiva Fellow in nearby Nicaragua wrote a very interesting blog entry on how different businesses in other places look.  It’s a really cool read about breaking preconceptions

In case you missed it, here’s a little more information on what I will be doing.  Also, for those still wondering what Kiva is, be sure to check out their website.  It explains things very simply.

Finally, I’d like to thank everyone who has contributed so far.  I’ve been able to raise over half of my goal of $2,000.  Thanks for all your support.