Professor Frank Howland – This post is being written on Monday, August 15, two days after the Global Health class returned from Peru. I am an Economics Professor at Wabash who accompanied Dr. Wetzel and his class on the trip. Professor Wetzel invited me along because of my interest in global health; in fact, I am teaching a new course on health economics this fall. I am very grateful to Dr. Wetzel; his Peruvian collaborator, Dr. Jorge Cardenas, who did a great deal of the work setting up the trip; our main contact in Tarapoto, Dr. Rosa Giove Nakazawa, a forceful and intelligent medical doctor; the 14 Wabash College students in the class; the Americans working in Peru (including Kurt Pope ’83 and others at USAID and scientists at the Naval Medical Research Lab in Lima, also known as NAMRU-6); French scientists at Cayetano Heredia University; and dozens and dozens of Peruvians, including scientists, medical students, private aid workers, and, most especially, residents of poor slums in Lima and villagers in the jungle around Tarapoto.
Howland during one of the group's many trips into Peruvian villages.
The trip concentrated on the health problems facing two different groups of very poor people in Peru: on the one hand, former residents of the Andean highlands who had been forced by the terrorist violence of the 1980s and 1990s to leave their homes and ended up occupying dusty and unstable hills of brown dirt around Lima; on the other, indigenous people living in three villages in a jungle plateau east of the Andes about two hours away from Tarapoto. These two groups had much in common: no plumbing and usually no electricity, dirt floors, dogs, chickens, and hogs living in the home, very low income, and, consequently, the ills of malnutrition, diarrhea, anemia, parasites, lice, stomach, back, and kidney problems. All this was made clear to us in powerful ways at the health campaigns where we worked. We were very impressed by the warm reception we received from people living in close to desperate circumstances.
Two obvious questions: First, why are people living in such terrible conditions? Second, what can be done, and by whom, to make things better? Our trip offered some clues to the answers to both questions, and I intend to try to make some headway addressing these issues in the Global Health section of the course I will teach this fall. Here are some of the clues: 1) we saw significant differences in buildings, roads, and the availability of electricity and semi-clean water between different slums within Lima and between different villages in the jungle; 2) local government plays a big role in infrastructure, and some local politicians are more corrupt than others; 3) differences in local weather conditions lead to differences in crop yields (major crops in the jungle include corn, rice, cotton, bananas, cocoa, and coffee) 4) currently, the only source of water in the jungle is the local river, which is continuously contaminated by human and animal waste; 5) the level of spending on health care in Peru relative to national income is among the lowest in Latin America; 6) the people of the highlands and the jungle have lived with their domestic animals for hundreds of years; 7) alcohol abuse takes a terrible toll in both the city and the jungle; 8) knowledge of basic hygiene appears to be lacking; 9) traditional medical remedies are still very important; and, 10) in practice, women have limited rights and power in the family and the workplace.
To the question of what can be done? many economists have an all-purpose answer best summarized by the title of a well-known paper: “Wealthier is Healthier.” In other words, when people have more money, they will buy things that make their health better. This line of thinking suggests that efforts to improve the lot of the poor people we saw should concentrate on economic development. There is some truth to this argument, but it seems to me that there must be specific measures that public and private entities can take which would have dramatic impacts on the lives of the people we saw in the last two weeks.
An important component of our trip was a series of visits to institutions where people are indeed trying to do something about the health problems of Peru. In the interest of brevity, I will only mention one example where we took an active role. In Tarapoto, Dr. Rosa Giove Nakazawa, with help from Dr. Jorge Cardenas, designed family and individual health questionnaires and set up blood and fecal sample analyses to learn about anemia and parasites. In the villages, our students interviewed people for the questionnaires, measured their height and weight, drew their blood, and passed out little plastic bottles for the fecal samples. On the last two days of our trip the students entered the data they had collected into an Excel workbook that Dr. Rosa, a few students, and I had designed. Learning about the health status of the population is a necessary first step for any effort to improve their health, and our work will make a contribution toward that goal.