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
