We were fortunate enough to be able to connect with Joe Moore '06 and his fiancee, Juleen Rodakowski. Joe was a Biology major while a student at Wabash, then went to Chicago to teach in an inner-city school for two years through the Teach for America program. Joe and Juleen left the USA in September '09 to volunteer and couch-surf their way through Central and South America. Their story is a great one -- it would be impossible for me to try to summarize the experiences they've had over that time, so check out their blog if you want more: http://juleenjoeaventuras.blogspot.com/.

They were in Lima for a few weeks to volunteer at the Centro Ann Sullivan del Peru, a non-profit that serves individuals with a various developmental disabilities, in addition to helping their families. We were able to catch up with them for a day and to hear about some of their travels. It was a great time.

One really interesting and recent twist on this is that Joe has been willing to help out with what might evolve into a really interesting aspect of a global health project. Since Juleen returned to the States earlier this week and Joe has stayed on in Peru for a few more weeks, he volunteered to help out with some of the work that I investigated in Tarapoto, one of the rainforest cities in northern Peru that I had visited. He is currently working in Tarapoto with the NGO group at URKU and with Dra. Rosa Giove in attempt to gather some epidemiological data on parasitic infections that she has seen in her medical clinic He will visit the same indigenous community outside the town of Sisa that I had visited, and we hope that he'll be able to gather from them some information from having to do with their access to health care and their use of traditional medicines from the jungle.

It should prove to be a great experience for him and a great help from an alumnus on a budding project!

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

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

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.

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.

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.

 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.

This week I have worked in Huaraz, a city at the foot of the Cordillera Blanca in west-central Peru. Huaraz has a population of approximately 100,000 and sits at and elevation of about 3050 m (10,000 ft.). It's a beautiful area, with clear blue skies and views of snow-capped peaks. I travel with a Peruvian colleague of mine as a matter of course (since I continue to struggle with learning spanish), but an added bonus this trip was that my oldest two daughters came along to share the adventure.

Huaraz has its share of 'global health' problems. Many of the people in the mountains suffer from malnutrition, as their diet lacks protein. Potato and corn, corn and potato....these are the staples. Like every area I've seen thus far (and as is true all over the world), access to clean water is also an important factor in the levels and types of disease with which people suffer.

One of the areas we visited is Challhua, a small barrio on the edge of Huaraz. An interesting (yet alarming) note is that this community is located only about 2 blocks from the local Ministry of Health office. About 300 children live in this community, which is not recognized by the local government as it was the result of a land takeover by a group of people burdened by poverty.

Consequently, the area lacks electricity and ready-access to clean water; there is a raging (for now) stream that runs next to the community from which many people draw their water (in addition to using it to wash clothes, food, and who knows what else). Homes are of adobe, lack space and heat, and are highly susceptible to the rain and cold which exist in this area. While we were visiting, a steady rain came down making a complete mess of the roadways and in many of the homes.

One opportunity here for Wabash students is that of education for the kids who live in this community. This community (and most others we've encountered) lacks for good information on the causes, and prevention, of parasitic and infectious disease. Baseline data on infections do not exist, and there is a lack of understanding of the multi-faceted causes of the disease problems. Again, clean water and modest hygiene practices (e.g., it's a good idea to not live in the same room with your dogs, chickens, and pigs) are key.

The beautiful thing is that kids are the same everywhere. I had great fun in the short time we were there interacting with the horde of kids who were attracted to our small group of visitors. We were meeting in the "classroom" of a small community center / kindergarten and were surrounded by inquisitive and bright young kids. It was fun to have them swarm as they jockeyed for position to see their pictures on my camera.

Education and opportunities for sampling also exist in Llupa, a small village in the hills above Huaraz. This was another beautiful area that masks some of the struggles the Andean people have; a large percentage of the population suffers from malnutrition and diarrhea because of their diet and some of the parasites which can be found in the water. Access to this area is relatively easy as it's a short (but steep) trip from Huaraz.

We also took a trip further up the road to visit an inn (the Lazy Dog Inn) that's run by a couple of Canadian expats. They've been there nearly 10 years and have a registered NGO, the Andean Alliance. They do a good bit of education and community development work in addition to running an environmentally-conscious inn. They are striving to be totally off the grid in a few years; we had a great time talking with Diane Morris, one of the owners, about possible projects on which students could work, etc. Having previously lived in Ecuador and Colombia, they have a good on-the-ground perspective on global health issues and how those are approached at the local and regional levels. Their inn sits in an absolutely gorgeous area with amazing views all around them. It was an instructive and enjoyable visit.

This week was another eventful one. I met with a veterinary researcher from another of the universities in Lima about potential research projects with which students might be involved. He and his group are beginning work in an interesting "dry forest" near to Lima; basically, this area is a desert except for a couple of months of the year when it receives the thick fog of moisture that can be present here. When this occurs, it greens up and one can find a multitude of organisms. The importance of this for them is that they're working with the surrounding community (there's "city" all around it) to make it a green space that is protected, and one the community can use to attract tourists, increase business, etc. The twist is that they don't really know much about the biology / ecology of the area, so there is much work to be done there.

Later I met with an interesting new friend who is a risk manager and environmental specialist with one of the largest mining companies in Peru (and the world, I think), Antamina. Their company works in Huaraz, one of the very poor areas in more central Peru. There are lots of potential opportunities for us to work with studying the parasitic / infectious disease in this mountain area, and to be able to make a real impact on the people there through education, mostly.

I'm learning that there are (at least) two Perus -- there's Lima, and then there's the rest. Of course, it's more complicated than that, but as the economy here in Lima appears to be booming, the gap between rich and poor grows. It is a major challenge for Peru.

I also met with the chief health office with US-AID, Erik Janowsky. He was very helpful in giving me a sense of the work of the US government here, but also ways of thinking about working with NGOs here in Peru. Interestingly, he's from Indiana (Notre Dame grad) and has a diverse background -- worked with Peace Corps, spent time in Uganda, ran an NGO in Ecuador.....so he has some good experience.

The last meeting I had was with a group that is beginning work with malnutrition and parasitic disease in communities all over Peru. Collaboration with them may hold great promise, as they also have strong connections within the government, in the Ministries of Education and of Health. They already have data on many, many children (size, age, levels of anemia, etc.) that would be very helpful in targeting the areas that Wabash could work, learn, and study -- both as a Global Health group/class, but also in individual research projects in biology, economics, and political science, for instance.

In about one hour I leave for the Peruvian Amazon, so the next post might not be until next weekend. I hope to work in two spots there to continue to investigate another part of the country and the possible locations students might study and do research. I hope to have some great pictures and stories of this next adventure, so stay tuned.....

On Tuesday mornings my family and I have the privilege of helping at an orphan home here in Lima; it's a home for teenage moms (some as young as 12 or 13) and their babies. We've had a relationship with this place for the last 3 years or so, through work we do with our church in Lafayette. We help with various teaching projects and generally hang out and build relationship / community with the girls. They're awesome -- brave, intelligent, and responsible even though they've been thrust into situations they would not have chosen. Anyway, it's a joy for us.

On the weekends we try to get out and about. We've been to the beach, an archeological site (Huaca Pucllana, a pre-Colombian pyramid site in the middle of a neighborhood in Lima), the Indian market and Parque de la Reserva with (reportedly) the biggest water fountain park in the world. Check out the pics.

Oh....and in case you're not totally worn out on blogs, feel free to check out the one we're keeping as a family; it has more information on these fun sites as well as more of the day-to-day for us. (Truth be told, my wife Suzanne keeps on top of it for the most part, but I chime in every once in awhile....) The address is http://thewetzelsgotoperu.blogspot.com/

Here in Lima, we're fine -- basically, it doesn't rain here so there's no flooding.

But, the rains have caused huge problems in the broader Cuzco region -- what you likely have heard is that there have been up to 2000 tourists stranded at Machu Picchi as a result of the roads and railroad being washed out.

Reports are that the Vilcanota River has increased its normal volume from 600 cubic meters per second (the normal range in rainy seasons) to 1,100 cubic meters per second. Many of the stranded tourists are being airlifted out by helicopter after struggling for a couple of days with limited food and water. The progress is slow; one of the main newspapers in Peru -- El Comercio -- is reporting that they're starting to see some "outbreaks" of flu and stomach illness among stranded tourists at Machu Picchu.

However, the more difficult situations are in the broader region where the impact of this will remain for quite some time. Statistics such as "... 10,000 affected residents and more than 2,000 collapsed houses....in Apurimac, more than 4,000 families have been affected by the rainfalls, and several sections of the Abancay-Cusco route have been literally swept away by the rivers surge....in Huancavelica, some 30 mudslides have cut four spots of the Huancayo-Huancavelica railway, blocking the transit, and the situation in Yauyo, Acoria and Anta districts is getting critical.....[near Puno] more than 6,000 hectares are flooded, as well as 10 public schools...".   The mayor of Cuzco has said that said that 80% of agricultural activity in the region has collapsed and nearly 2,000 hectares of crops [have been] lost forever. 

(if you want to read more of the stories or see pictures, check out http://search.livinginperu.com/?q=cusco&s=news&r=week  or http://elcomercio.pe/noticia/404940/turistas-varados-comienzan-enfermarse-machu-picchu)

Many of the people in this region are extremely poor; these regions include some of the highest rates of "extreme poverty" in Peru. Things will continue to worsen for them before they get better; it's estimated the region is losing between $750,000 and  $1 million per day.

It's the last thing they need.