Peru - Medical Volunteer (Summer 2012)

I'm back home now and all the first world problems are reaching my ears.  The air conditioner is broken, I misplaced my keys or the television remote is too far for us to reach, what are we going to do?

In Peru, I worked alongside a student run project consisting of two groups of medical students and doctors, from Case Western and Stony Brook Medical Schools, and a few non-medical people as well.  I'm a recent graduate of NYU with a Media, Culture and Communications degree and I have various volunteer experience across the world from Ghana to China.  The Peruvian patients we saw had more problems than just not being able to reach for the remote.  But that still won't stop us 'first worldians' from complaining and taking every aspect of life for granted.

To sum up, the trip's core mission was to go to remote villages in the Cusco region of Peru, set up clinics, see patients and treat them as much as we could or refer them somewhere else.  Our home base was the La Quinta Eco-Hotel in Urubama run by Edwin Gonzales (a Peruvian man who ran for congress but lost).  He was instrumental in providing us with transportation, food and other various connections and informational tidbits on the trip.

We had different stations we would set up.  One was intake, where we would ask them questions such as 'How old are you, what's your name, what's your problem, where are you from, when did you last get help or see a doctor?'  We would then take their blood pressure, pulse Oximeter and/or temperature if they had a fever.  It was not necessary to take the blood pressure of a kid or the height of a adult but everyone was weighed in kilograms to determine dosage for medicine if they were later going to be given some.  From there they would enter a long waiting line/area.  Once called they would see one of the doctors alongside a trained medical students who would talk about their problem and decide the best remedy for it.  From there they would either see a physical therapist, go to the vision clinic where their eye sight would be tested from a distance with an eye chart or be given sun glasses.  I personally, ran a shoe station.  If the kid needed new shoes or shoes at all, I would measure their feet, write down their village, name, age and shoe size and then I would give them a Tom's brand shoe. The information I collected would be used so Tom's could donate the next shoe size to them in a few months when their feet have grown. The last station they could go to was the pharmacy to pick up some medicine.  The medicine was nothing too crazy, mainly Tylenol, aspirin and vitamins.  And it was basically a table with a couple of med students with an arsenal of pills, which we would restock the night before the next clinic.  All our supplies were donated or collected before coming down to Peru. Weekends were free for travel or to do whatever we pleased.

Some critique on the whole process:

With all processes, there are human errors, especially when first-year medical students are leading the charge. This does not mean we purposely meant to harm anyone, were not intelligent enough or were not trying our hardest.  It means we were still learning and adjusting accordingly. 

Vision Station: The majority of people we saw had vision problems or at least thought they did.  The vision issues are common from working at such high altitudes with no sun glasses, making the suns rays very harmful to their eyes.  So we would make them use the eye chart to determine their prescription and/or give them eye drops and tell them how to use it.  The problem was that the donated glasses had the same prescription in each eye.  This simplified the process, but technically, by giving anyone glasses we could be helping one eye and harming the other.  I heard reports that the wrong eye drops were given out, the ones that make your eyes yellow to see into them better.  We told everyone to put eye drops in your eye 3 times a day to help clear them out.  So the people with the wrong eye drops (this only happened a couple times) will be damaging their eyes with the yellow fluid instead of clearing them out.

The big question: Were we just putting a band aid on a big situation/giving short term aid when we really wanted to make a long term impact? It took us a week to implement education as a station. We realized there was no point in just giving handouts.  We needed to educate the kids and adults on how to properly brush their teeth, use medicine, and pick various objects up correctly (a lot of people had back pain).  Back pain was caused by women carrying babies on their back and men were heavily involved in construction or field work all day long.  But the advice we gave them was probably more crucial than giving out a pack of Tylenol or aspirin that would only relieve the pain for a very short time from the Pharmacy Station.  There definitely was more room for educational expansion with more education, Peruvians could become more self-sufficient and less dependent on their North American brethren.

Even though it made us feel good to be in Peru helping out the locals or indigenous, we did not want them to become dependent on our clinics or on 'gringos' from the United States.  We did not want to hurt the local medical businesses and pharmacies, which we might of.  In reality, the medicine in Peru is plentiful and more cheaper than in the States, at least in the cities such as Urubama and Cusco, probably not as much in the remote mountain villages we visited.  Some of us discussed that next time we are going to buy most of our medicine in Peru to help out the local economy.

Shoe Station: Sometimes kids wanted shoes to get something free or just to have.  And believe me I wanted to give shoes out to anyone who wanted them because I know back home I have a friend with 100 pairs of shoes.  But we only had 5 sizes and only for kids. Some of the places we visited, kids had warty, and bloody feet from the small sandals they wore.  Others had leather shoes. My biggest concern was not having enough sizes to provide for all feet, including adults.  And not being able to transport enough shoes to a clinic (they take up a lot of space).  In addition, kids would often lie and say they haven't got a shoe; same with the pharmacy, they would lie to get more medicine.  They were smart.  But we were smarter, so we would 'X' their hand with a sharpy or ask to see their papers.

Language Concerns: Only a few of us could speak Spanish and we all had our station or role; yes we would rotate stations once in a while and try a new position out.  I usually preferred to be on shoe station or intake but I knew minimal Spanish.  The issue was if you did not have a decent Spanish speaker in your station it would cause the whole process to slow down. I personally could not spell the majority of their names unless I saw their ID or had them correct me.  Also in the remote mountain regions they would all speak their own language 'Quechua' and very few of them know Castellano  or we know as Spanish. They would not identify with Spanish, you had to ask if they knew 'Castellano'.  So we would need to find a local who knew both Castellano and Quechua to translate it into Castellano (Spanish) and then we would translate it into English.  So, I wonder if there were any translation mistakes? Not sure, but either way it would get frustrating and complicated at times waiting for a translator. 

Having a Stake: The volunteers were often fresh recruits, and there weren't many veterans from the year before (trip has been going on for a few years now).  And often people stay for only a week or two then the power and organization would be transferred to new people.  So the organization is always changing or adapting to the current team's preference or ways.  It would be nice to see more consistency with the volunteers, even though the med students probably don't have enough time to come for a second time next summer due to academic/personal restraints.

Michael Cippoletti, Director of Friends NE, who helps out with community development in Nicaragua, such as providing means to build people new homes, makes sure the recipient has a stake in the process.  For example, the person getting the house would need to pay 25% of the cost and would need to be active in the negotiations/overall process.  I wish we could implement a similar measure for these clinics, perhaps so locals would promise to seek medical attention or come to our clinic only if they couldn't afford otherwise.

Time duration of Clinics: If we were in a remote area or even locally we would once in a while get tired or have to start closing down to get back to home base for dinner or before dark.  This would mean we would turn people away who would walk hours just to seek any form of treatment for their ailment. In addition, most of the patients we saw were older women or kids. Very few adult men.  This was because our clinics were only open during week days, in the middle of the day.  Therefore, the adult men, especially those working in the fields all day, probably needed the most medical attention or advice, could not get it.  I suggest clinics should once in a while take a Monday off and tack on a Sunday, every other week in the rotation so adult men could get checked out.  And we should try and keep the clinics open until we help out every  person possible.  Our being tired or hungry is nothing compared to the needs of a local who made the effort to seek out our clinic.

Organization: Like I said, due to people coming and going/constant change in leadership, being in a foreign country, us learning as we go and being reliant on Edwin (the hotel owner) to call and arrange transportation, a lot would be disorganized, a ride would be late or non-existent. People would become confused, but in the end, the mission would be completed or our plan B would be implemented.

There is always room for improvement and more consistency.  For example, Case Western used a completely different intake/circulation form from Stony Brook. Perhaps, the two schools could work together to agree to a standardized form. Occasionally, we would forget who was next in line if there were a lot of people waiting, so numbering their forms in the order they came in helped. Some places we visited were well off and should be removed from our clinic rotation list, but sometimes we went to a well off place because our plans with the place that really needed our assistance stopped responding to us or something went awry in the communication/planning process.

Only so much we could do: There was only so much we could do or recommend. We did not have a spectrum of drugs.  Sometimes we had the wrong type of doctors.  All the doctors were very intelligent and helpful but that did not make them specialized in all areas.  For example, a kid who told an eye specialist doctor he had been throwing up 5x a day for 3 years, what would a eye doctor recommend? And some days we did not have enough doctors or they were too swamped, so medical students would try their best to assist the doctor. The more people we would have the less quality the patient would get. A day where we had 250 patients, we were overwhelmed and trying to speed up the process by rushing people through.  Another day were we had only 60 patients, 3 doctors would attend to one patient and he or she would be in great hands.

Conclusion
As soon as I landed in Miami airport, I noticed the napkins are thicker, the food and water is plentiful and more nutritious and I'm finally allowed to put my toilet paper in the toilet instead of a trash can.  

What I'm trying to say is: We are the lucky ones. We grew as a team and a program. A huge impact was made on Peruvian locals who needed our help.  We are providing them with sunglasses to protect their eyes against the sun, shoes, prescription glasses, eye drops, medicine, valuable advice or referrals and now even education.  We made a ripple effect.  Soon the people we saw will become self-sufficient, that is our goal to deliver long term change instead of simply band-aiding the situation. 

My critiques were not written to undermine the program or the great work we did and will continue to do.  But instead, provide ways to improve upon the existing structure of the program. 

I highly suggest coming on this trip if you want to make a difference and be engrossed in Peruvian culture.  I still remember when I gave out a pair of shoes to a girl; she took off her old sandals, put on her new shoes and then she lit up with a giant smile.  The smile made me smile and then I looked at her parents who had massive grins across their face as well.  A smile is really contagious and you have the power to give one through the work you do here.

I plan to go back eventually. If you have any questions, concerns or want to find out how you can get involved in this amazing project, please contact me at dtodrys@gmail.com

Let's continue to make a difference,
-Drew

Reflecting from the other side of the world

I used to read news headlines about China on how the country was, and still is, becoming a world power, an economic powerhouse and a military steam horse. China is often portrayed in our media as a potential threat to the United States and its interests. It is almost as if a battle is being played out between communism and democracy in the pursuit of being Number One. However, so much is unknown. The two countries are both paranoid and intrigued with each other. Yet, beneath each governmental mask, there are citizens who are not that different from each other; both are just curious. I came to China to learn firsthand about its people and government, and to share this knowledge with others.

I wish to start this reflection paper by discussing the movie, Last Train Home, directed by Lixin Fan. I have always been interested in helping others and doing community service work. But, after watching that movie, I decided to ‘be the change I wish to see in the world,’ to borrow from Mohandas Gandhi. I acted immediately by bringing people together who were also inspired from watching that movie, which explored in depth the hardships faced by migrant factory workers in China. I then brought NYU Shanghai students together over the web by forming a Facebook group, and within less than a week, I was able to get together 15 dedicated members with the common goal of helping migrant factory workers. Our aim was not to just talk about the issue, but to actively fundraise and spread awareness. By week two, I had found a factory and gotten permission from its owner to visit. I recruited three of my members to come with me to investigate in person. Our goal was to talk with workers to figure out their needs and then raise money. I wanted to provide a long-term functionality to improve their workplace. It would be a win-win for the factory owner and the worker.

When we met with the workers and factory manager, we were shocked by the work conditions. Some of them work 14 hours a day, six days a week, and haven’t been home in one to six years; and even when they do go home for a visit, it is only for a week. Their families are poor, and many have a sick family member back home. One worker said she yearns for more education. Some of the workers have no form of entertainment and want an entertainment common room with a projector and screen to watch movies on. Others just want a heater in the production and living areas, so they can stop shivering while working in the cold season, and even a fan in the warm season to reduce the chance of heatstroke, which apparently is a common phenomenon at that factory. What shocked me the most is that these conditions are better than most of the factories in China, and yet still disturbing and terrible by American, or at least by my own, standards. My team and I are now sharing what we learned and going full force in brainstorming and coming up with ways to fulfill the workers’ needs. Time is running short with the end of the term near, but our compassion is just starting to blossom and there will be change. I am also hoping that students who are here for the rest of the school year will carry on this task.

Working with the factory manager and fundraising are the solutions to reaching our goal to help these workers. I personally raised 13,200 RMB (2,200 USD) for factory migrant workers in a matter of days from family and friends back home. The factory promised they would match any money we raised. If it is up to my team and I, the workers in this factory will no longer be shivering in the cold season and suffering heatstroke in the warm season. Improving these conditions, as well as providing a recreation room for fun and relaxation, will also lead to more productivity, which will make the factory owner happy as well. Win-win.

Moving on, one of the lectures, “The sexual revolution in twentieth century China” by James Farrer, reminded me of a long conversation I had with two ECNU students. It seems from the data that China is more ‘prude’ than the United States or Japan. They often do not date much in college and they have an insane amount of parental pressure to get married in their early 20’s to the best candidate. Even though Chinese people say that love comes first and is essential to a relationship, people are often pressured to marry someone with more economic backing, superseding the notion of love. I spoke with two Shanghai ECNU male college students about what they think about their culture and dating in China. They said it is viewed as bizarre to go out with someone of the opposite sex one-on-one in college, unless you are 'in love' already. I asked, “how does one fall in love then?” They looked at me bewildered.

Unlike the typical NYU student, the average Chinese student cannot afford alcohol, clubs or bars. They also think Shanghai is growing too fast, and they view nightclubs and bars as places where people just go for sex or to get into a fight. Chinese students experience competition in all aspects of their lives. They have to do well in school, so most don’t have time for nightlife. If they do well in school, they can get a good job, and with that good job they can buy an apartment and live a decent lifestyle. Without that, they are less likely to find a girlfriend or get married because the girl’s parents will not approve of them. Online dating is also very rampant and available in China. And in China, one can argue that the girl has the upper hand due to the uneven population ratios. There are around 20 to 30 million more men than women. In Shanghai at least, the groom’s family has to pay for the wedding, unlike in the U.S., so this is another huge family burden on the male side. Perhaps soon, people will prefer having girls to save money, as long as they don’t mind losing their family name, thus balancing out the uneven ratio in the future.

The lecture “Translating Between Operating Systems: Challenges and Opportunities for NYU Shanghai students-and some clues” by Dan Guttman reminded me a lot of my experiences and confusions in everyday social and commercial life in Shanghai. One of his quotes “fake markets; from which what follows? Is China all bargaining and discrimination-and is the US different?” (Guttman 13) reminded me of, and linked perfectly with, one of my field trips to a fake electronics market. It is a fascinating place, with many illegal actions taking place right next to police or security guards. My visit to this shady place was extremely informative. As I tried to bargain, I wondered whether or not Westerners are discriminated against, and if prices aren’t dropped as much for them. It was also interesting to ponder whether the stores and their products were legitimate or 100% fake and therefore a rip-off. And it seems that, if confronted, the government would at least pretend to try to put an end to the illegal actions. But, at the same time, the government needs markets like this for its economy to function.

I remember trying to take a photo of a stall and the clerk giving me the middle finger. In Chinese, he said, 'Don't take photos,' and immediately another clerk put clothing over the glass counter to hide the goods. At another stall, the store clerk said all the products were real and he let me take any picture I wanted. We witnessed the shadow economy first hand. It was fascinating and left me with a lot of questions that probably will never be answered (at least not on the record). I’m not sure if the United States has an equivalent to a Chinese electronics market full of fake, stolen or copyright-infringed goods, aside from the typical Haymarket’s in the United States or Canal Street in New York City.

Even the back gate on campus bewilders me. As learned from the lecture and my Global Connections class, retired city inspectors and laid off workers, who are employed by the government to keep the streets in order, are allowed to seize illegal vendor goods for themselves, even though they have no power to arrest anyone. So, this leads to abuse and terrible governmental regulation on some of the corrupt city inspectors. But, it also leads to fascinating under-the-table deals. The city inspectors know that unlicensed vendors are selling goods at the back gate and some other areas, but they allow it to occur because people want the vendors to be there. So, what ends up happening is that when the city inspectors are on duty, the unlicensed vendors agree to go away until the inspector is off for the day or on a break.

Most of China operates like this: it knows illegal, unlicensed action is occurring all over the place; however, in an strange way, the government and the street shadow economy coexist. It is another win-win situation because the government gets to say the streets are cleaned up of these illegal actions, while in reality they are still going on beneath the surface. The United States is not as lenient, which has its pros and cons. A lot can be learned from a more bottom-up approach than a top-down one. As professor Guttman points out in his lecture, street vendors are entrepreneurs; and nourishing the growth of the shadow economy, street culture and bottom-up approach often yields unforeseen innovation.

The Newsweek article, “The Rise of the Rest” by Fareed Zakaria, reiterates my introduction; the United States is paranoid of China coming into the world as a new power. The U.S. is afraid of the unknown, afraid of being knocked off the throne. The media at least makes it seem that there is room for only one real superpower; and that if China comes to power, the world will plunge into darkness. But, this notion obviously isn’t true. As stated “The post-American world will not be a world defined by the decline of America but rather the rise of everyone else […] the Immediacy and intensity of the 24-hour news cycle combine to produce constant (pessimistic) hype” (Zakaria 3). The article argues that this is the normal trend for powers to emerge and disappear. The United States has nothing to worry about. The world is relatively peaceful. The media exaggerates and reports on almost every negative event. The United States’ paranoia leads to false pre-emptive strikes, ridiculous military spending and world involvement.

The future is unknown but one aspect is certain: China is on the rise and the media is amplifying the anxiety felt by the United States and its allies. As Zakaria points out, “American Society can adapt to this new world. But can the American government?” (Zakaria 8). As a New York University student studying abroad in Shanghai, I cannot answer this question. But, what I can do is pass on what I have learned to my friends and family back in the States. Ignorance may be bliss, but I refuse to sit back and believe all that is disseminated to me. I’ll continue to be a global citizen by investigating and judging the situation for myself as a neutral party. But, after three months of living in Shanghai and exploring China, I at least welcome China into the new world order. After all, the world is becoming more and more globalized each day. China and the United States are more intertwined than they may want to admit.

Works Cited

Fan, Lixin, dir. Last Train Home. EyeSteelFilm, 2009. Film. .

Farrer, James. "The Sexual Revolution in Twentieth Century China." Introduction to Contemporary China. NYU. Shanghai. Lecture.

Guttman, Dan. "Translating Between Operating Systems: Challenges and Opportunities for NYU Shanghai students-and some clues." Introduction to Contemporary China. NYU. Shanghai. 31 August 2011. Lecture.

Zakaria, Fareed. "The Rise of the Rest." Newsweek. (2008): 1-9. Web. 21 Nov. 2011. .