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March 25, 2010

The final days of work in Peru

Since returning from my rainforest trip to Tarapoto, it's been a time of mopping up some details, making final contacts with various people and holding discussions about possible future projects. I made a visit to Pamplona Alta, the poor zone on the edge of Lima that I've mentioned in the past. I went to this area with my colleague Jorge Cardenas and a group of young professionals who work on various development projects there. If you check out the picture album (link below), you'll see that this is a desperate area. Clean water availability is a problem, as well as any kind of sanitation system to speak of; many of the photos have shots of make-shift "latrines" near to homes, animals, etc.

To pursue projects in this area I met with leaders of Solidaridad en Marcha who would be able to help us coordinate transportation, etc. to work in Pamplona. It's possible to work in the polyclinic in San Juan de Miraflores (of which Pamplona is a part) and to participate in various projects in parasite control, clean water issues, etc. 

It was nice for me to continue conversations with faculty members at the URP (Univ. Ricardo Palma) in Lima. Prof. Mercedes Gonzales de la Cruz is the Director of the Museum of Natural History and was very gracious in providing me with lab space, students to help with projects and support. She's a botanist -- ethnobotany, to be precise -- and is very interested in future collaboration both in Lima, in mountain areas and in the rainforest where many of the people use traditional medicines to combat different infections.

I visited Prof. Nieves Sandoval at the Univ. Nacional Mayor de  San Marcos to discuss wetland research projects in which students could be involved. While there I was introduced to Prof. Amanda Chavez, another member of the Vet Faculty at UNMSM. Because a student of hers was beginning a research project on an important trematode parasite that infects many people in the mountain regions of Peru, they had numerous questions regarding patterns of infection that might be expected, the survivorship of the parasite in the external environment, and how to best collect, transport, and maintain the snail intermediate hosts in the laboratory.

 

 We were able to take a fun family day-trip about 3 hours south of Lima to the area of Ica. This was an area that had gotten leveled by a 7.9 earthquake back in 2007. Along the coast is the Paracas National Reserve, including the Ballestras Islands (sometimes called the 'poor man's Galapagos'); we took a boat tour around these islands which are covered by seabirds, sea lions and lots and lots of guano! It was fun to learn about how the guano was harvested in the past and the interactions that has had with the seabird populations and the fishing there. After touring around the islands we visited the Reserve and the beautiful scenes of this desert as it abuts the ocean. We stopped off for some great (and fresh!) seafood at a small restaurant before heading back to Lima. It was a great trip to an amazing place, and a nice opportunity for us to get away from the pace of Lima.

 

Here's a link to a photo album with pics from these different places:

http://www.facebook.com/album.php?aid=2052396&id=1450822311&l=55256bbfff

 

March 19, 2010

Pictures of Tarapoto

In case you're interested in viewing more pictures from my trip to Tarapoto, here is the link to photos on Facebook:

http://www.facebook.com/album.php?aid=2051045&id=1450822311&l=33dce90c39

March 14, 2010

Worms in the Rainforest -- A Trip to Tarapoto

I just returned from my fourth and last "side trip" while we're here in Peru. This week I was in the city of Tarapoto, a rainforest city in the northern part of Peru. Tarapoto is a wonderful place -- nice weather, relatively quiet (population of city is about 64,000 with about 118,000 in the broader area), friendly people and an amazing environment. While in Tarapoto I visited with an NGO named URKU Estudios Amazonicos (www.urkuperu.org) which works in several indigenous communities in the area, investigating possible ways that Wabash students could learn about issues surrounding the parasitic / infectious disease problems which exist in this area.

Like many places in rainforest regions, many of the people who live here suffer from a variety of parasitic diseases. There is a very high level of helminth (worm) infections in the people and, like many of the rural places I've seen in Peru, anemia and malnutrition are real problems; a local physician told me that malnutrition rates are about 50%.

Visiting with this physician (Dra. Rosa Giove, who happens to also be the mother of the director of URKU!) was very interesting -- sitting in her office late one night she brought out the medical histories of folks she had seen just in the last few days (a stack about 2" high). She was explaining that many of the people carry Ascaris infections (this is a large roundworm parasite) in addition to pinworm and other problems. She was very open to the possibility of helping teach visiting students and having guys help to document some of these problems. Moreover, she has some good ideas for health campaigns that could be done in the area, including education materials that could be developed as students learn about the different levels of health issues.

In addition, she's also very active in using tradition medicines to treat her patients, in combination with more "advanced" drugs. There is a vast amount of ethnobotanical knowledge which is being lost from indigenous communities in this region. Many people use different plants to treat ailments and infections, including their parasite problems even though there is a realization that these treatments are insufficient in the face of the problems (more on this below).

Probably my most memorable experience of this trip was a visit to an indigenous community near the town of Sisa (called Kawana-Sisa). We traveled there by motorcycle with Carlos (Daniel) Vecco, the Director of URKU, who holds a special place in this community. There my colleague and I received an incredibly warm welcome. We met in an open-air meeting house where the president of the community (and of others, as well) officiated at a meeting of the community leaders. We were served a drink known as masato in half of a coconut shell as the leaders took turns speaking words of welcome and thanks to us for our visit. (By the way, masato is alcoholic and made from manioc, or yucca. The traditional way this was prepared was for the 'cook' to chew the manioc -- the saliva moved the process along and reportedly improved the taste. We were told by Daniel later in the day that our batch was a non-saliva one, so we'll just go with that.)

After the folks in the community welcomed us, they spoke passionately about how their health (and the health of their children) is their biggest concern. These people do not have ready-access to health care; the hospital is a considerable distance away and there is no medical clinic in their small town. They spoke of how the hospital will often not examine their children unless they are extremely ill and about the parasitic infections that they have (but about which they know relatively little). Because of this and other reasons, they typically treat themselves with natural products unless it's an emergency. For example, for one of their ailments they use something from a boa (yes, the snake) to treat themselves. Conveniently, they had about a 5-foot live boa on a leash on a tree behind one their houses. An interesting cultural experience, to be sure.

After the meeting we were presented with special gifts (that we wore with pride) before we were invited to eat a special meal that the leaders had prepared for us. We retired to one of the homes to eat juani, an ancestral meal made of manioc and fish (along with some more masato!). This was a special honor. Many of the kids and others were gathered around just to see what was going on, and one of the women who had helped prepare the meal stood nearby simply to fan away flies while we were eating with some of the other men. Afterwards we participated in "sobre mesa" -- a culturally-important time of conversation around the table following the meal. The men of the community continued to speak of some of their struggles and the difficulty they are currently having with a petroleum company that is trying to take over some of their land. URKU helps this community in part by offering some legal advice and some large context for them as the community leaders prepare for upcoming meetings.

 

 

From my perspective, involvement with this community would be an amazing experience for students. There is a great deal to be learned here -- from information about various diseases and infections to ethnobotany to the tension that isolated local communities have with the regional and national government here. Moreover, the relative impact that students and the College could have on this area is significant. The shared involvement of students, other faculty (both from Wabash and potentially other institutions) and alumni -- including physicians -- from Wabash could result in great things. There's much to work on and to think about here.

 

 

March 07, 2010

Andean Adventure Part II -- Ayaviri

This past week was spent in the Puno region of southern Peru. Puno is the city adjacent to Lake Titicaca. I was fortunate to visit the Lake late in the trip and, as you might expect, it was beautiful. The visit there almost didn't happen -- a Peruvian colleague and I had heard that there was a strike along the road between the city of Juliaca (where we were staying in a hotel) and Puno, a distance of about 45 km. After getting varying reports, we were assured the road was open. Arriving in Puno was interesting, however, as we navigated around the clear evidence that there were some folks in Puno who clearly were not happy about something. Large and small rocks had been thrown across the road in several places, along with trash and broken glass. Much of it had been cleared earlier that day, apparently, but it was a good reminder of how quickly travel conditions can change.

Much of my time was spent in Ayaviri, a much smaller city / town about 100 km from Juliaca. Ayaviri is a bit over 13,000 feet and is about 275 km from the better-known city of Cuzco. Interestingly it's still possible to take a train from this area to Cuzco, despite the problems Cuzco and the region had with flooding about 1.5 months ago.

I was in Ayaviri to meet with Caritas-Ayaviri, an organization that does a great deal of community development work in about 3 districts in the Puno region -- districts that have some of the worst disease, malnutrition and anemia problems in the Andean zone. Among other things, Caritas works in large and small communities, focusing on education, various health issues (anemia, malnutrition, parasitic disease) in women and children, as well as trying to bolster the health care systems in the region. For example, because many of the people live in isolated regions, distances are sometimes a mystery. Thus, when folks make it to a local clinic (if one exists), it's often unclear to which hospital they should be sent. Most ambulances are covered pick-up trucks with a mattress in the back (but no medical equipment), and the level of technical training in highly variable.

There are several important parasitic diseases which impact the people in this vast region, but little baseline information exists on these infections. Moreover, a growing amount of evidence suggests that large-scale patterns of infection are changing quickly. One area of interest has to do with climate change. One of the trematode infections that is a major human health problem in the area (Fasciola hepatica) is truly an emerging infectious disease for the highlands of Peru, because the distribution of its snail intermediate host is shifting -- reports from the area point to the fact that host snails are showing up at altitudes where they've never been reported in the past. In any case, there are several opportunities for Wabash to participate in projects with Caritas in this area including education, basic diagnostic work, research, water projects.

I had the privilege of visiting one of the projects having to do with providing potable water for people in an isolated community. We traveled several hours in the mountains to reach the community, finally switching to a 4x4 truck to reach our final destination. What I saw was truly impressive and reinforced the impact that can be reaped from seemingly small changes.

In the mountains many of the people get and use water from the rivers. Even in isolated areas this water is not clean, in part because of the intersection of humans with animals, both wild and domestic (many of the people graze animals -- sheep, llama). As a result various parasitic and diarrheal diseases impact a large percentage of the population. In the project I visited, Caritas works to educate the community and then works to help them address the problems. Local committees are formed with Health Agents (and other officers) elected to run the program. Work projects build water collection stations and reservoirs that then serve the homes in the area. Members of the community oversee the chlorination and distribution of water as well as the construction of latrines, sinks, and showers outside the homes in the communities.

 

 

It's important to understand that these are areas in which homes lack electricity, running water or sanitation systems. Life is hard. Clean water means good health for people in these areas. To hear women in the community speak about how a sink with a faucet, along with an outhouse, means that their kids are not sick from infections and how that has changed their lives is a powerful experience.

My hope is that Wabash students will be able to learn about, and participate in, these kinds of systems in the larger context of global health. For me, this is one of the best ways that I could challenge students to act responsibly and live humanely.

 

 

 

 

 

 

 

 

 

March 04, 2010

Investigating work in the Puno region of the Andes

I'm writing this from Ayaviri, a town of about 25000 people in the Puno region of southern Peru. Puno (city) is next to Lake Titicaca, the highest freshwater lake in the work and a place I hope to visit tomorrow. Yesterday we flew to Cuzco then continued on to Juliaca. We then drove about 100 km to Ayaviri. The town is relatively quiet and surrounded by beautiful rolling mountains; elevation here is about 3900 m (approx. 12,800 ft.), so we weren't exactly sprinting around town.

 Last night I met for about 4 hours with an organization called Caritas-Ayaviri. This group has several ongoing projects involved with rural community development, particularly within 3 provinces surrounding Ayaviri; in fact, Ayaviri is included in one of those. They work closely with the Ministry of Health in Peru and were recently invited to expand some of their regional programs to the national level. That sounds good, but there are always "interesting" tensions with how the government allocates funds for this kind of work, etc. Shouldn't be surprising, I suppose, but it's one of the ways that politics and economics have an impact on the health issues; of course, this is not unique to Peru, but there are important cultural aspects to this.

Some of the issues addressed by Caritas-Ayaviri include work with the high levels of malnutrition in these mountain communities, the impact of anemia and diarrheal diseases on the mortality rate (particularly for expectant mothers and their small children), and accessibility to health care. Many of the "ambulances" here (of which there are only a few for the area) are just a covered pick-up truck with a mattress thrown in the back -- no medical equipment whatsoever. Local clinics struggle with the task of knowing the closest hospital to which to refer people, distances are sometimes a mystery, and the level of medical / technical training which exists in different areas is highly variable, to say the least.

Parasitic / infectious disease is a big problem here and one that contributes directly to the problems they have with anemia. Rates of malnutrition and anemia in children in many of the communities far exceed the averages for Peru (and even for the Puno region at large).

In thinking about a "global health program" I am sensitive to the issue of sustainability and whether bringing a group of college students to an area -- particularly for a short period of time -- is really any kind of help. In many ways it's easy to see how students can benefit; we can visit, learn, observe and experience a different culture for a time. In other words, the benefit is largely one-sided. What we can bring to the table is not as easy of an issue.

 

March 02, 2010

Teaching

Last week I spent a couple of days teaching a "mini-course" on Ecological Parasitology at the Universidad Ricardo Palma. Even though classes had not started officially, students from various universities can enroll in short courses for a certain number of credit hours; they pay a fee, participate in the course and then receive a certificate at the end. There are no exams, etc. (good for me), so my sense is that it's mainly for the experience and the diversity of topics to which they can be exposed.

 I had a mixed group of students, i.e., they came from various backgrounds, had different goals and varying levels of experience. I was under the impression that most of the students would be comfortable with english, but that was not to be. My spanish is not good enough to teach a course (far from it!), so my colleague Jorge Cardenas had to translate, which as you might imagine slows things down a bit.

Nevertheless, I covered some basic life history work in addition to a smattering of population and community ecology of parasites. I wanted them to have some practical lab experience as well, so the first afternoon the university provided a bus to take us to the Pantanos de Villa wetland to collect snails in hopes of finding some parasites.

The next morning we spent time examining these hosts for trematode parasites and were fortunate to find a healthy number of infections. Several of the students are interested in continuing work in this area and have been working on this project, as well as helping with another pilot project in Pamplona Alta, one of the very poor communities I've described in previous posts. There is great potential to work with some NGO groups in this area.

I'm currently in the Puno region (south-central Peru, in the Andes) meeting with another group that works in a large, multi-disciplinary project in poor mountain communities. Levels of anemia (related to parasite infection) are alarmingly high; among other things they contribute to a frightening level of neonatal mortality. More on this soon.