If it hasn’t already been mentioned within the first two minutes, I usually start the interview off with a joke about how tall and awkward I am. A joke that has been well received wherever I have traveled. Nothing like good physical humor to make up for my inadequate language abilities.
Most of my day-to-day work in the field involves doing a socioeconomic assessment of incoming TB patients. This involves about 45 minute interview in which I insert myself into their living situation, their education, their family members, alcohol abuse, monthly income, and health history. Their personal life is my interest, and I need them to want to share it with me.
The newly diagnosed TB patients are usually in a state of disbelief that this could happen to them–that is, if they don’t already know someone with TB. Most don’t know what to expect during their treatment or if what they are feeling is normal. That’s when I show up to explain that I’m from the health post and want to do an interview with them to see if we can support them in addition to the medication they already receive (with extra food or an extra room with good ventilation perhaps). This explanation and their fragile desire to learn more about their disease is enough to get me in the door. But that’s the easiest part. Getting the information is the challenge.
An example of house people now live in after the earthquake
I’ll understand that they don’t completely trust me right away. After all, when’s the last time I willing answered the questions of people who have appeared at my door and stated their good intentions? That’s where the joke comes in. Maybe it’s about my height. If there is a little girl in the room, I’ll ask her what her age is and then claim to be five-years-old as well–always good for a shy smile. And there’s no better way to get mother to open up than to show your care for her kid(s). All I really want to do is show the patients that I care about them; that I’m not just there to fill out some stupid form and leave as fast as possible; that I’m interested in what they have to say.
If I’m successful in getting a person to open up, instead of hearing that she’s bored all day at home (because TB patients can’t work because of treatment), I get her to tell me that she hates being alone for three days at a time, waiting for her husband to come home from a fishing expedition, only to have him mistreat her. I get her to give me the details of how she wishes her family, who lives ten hours away, could come see her but they can’t because she might give them tuberculosis. I get her to tell me that she cried the entire first week after she found out she had tuberculosis. Then I can recommend her to the women’s advocacy center in town. Then I can use her family as motivation for her to continue with treatment. Then I can recommend her to a psychologist and to group therapy. Then I can do what I came there to do: provide support for her outside of the medication which she receives in the health post.
This approach is one which I take on an individual level, but it also can be extrapolated to a community level. Do you care about the people of the community? Or just the disease which you are trying to treat? Why should the community welcome an organization whose goal is not centered around its people, but instead centered around appearing to good? PIH uses TB treatment as a method for entering into the lives of the community, but from there, once we’ve gotten through the door, we direct our efforts and care toward the entire community.
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.
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
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
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 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
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)
