It’s been about two months into my yearlong journey to explore grassroots health initiatives and the locally motivated people who are pivotal to the functioning of these health initiatives. As you’ve noticed with my previous blog posts, I’ve mainly discussed my travels more than my project in itself. That’s because keeping my project journal and trace stories apart helps me distinguish among my discoveries and mentally paint a proper portrait of my findings. As I am preparing for the next leg of my journey to Rwanda, I have been looking back into my project journals and I am seeing more progress than I previously expected. In short, while compounding my explorations and discoveries under the essential theme of communal reciprocity (Ubuntu), I have come across some answers and many more questions. In the following subsections below, I will proceed to depict some aspects of what I’ve learned about health in Peru as well as give you a glimpse into my project journal.
The reality of my Public Health research
I have been fortunate to not have many difficulties throughout my journey in Peru but I would say finding health centered initiatives has been my toughest and challenge. It might be harsh of me to say that health- or health education- is not a priority in Peru but assessing my time in the country so far that seems to be the case. Imagine Peru as a coin with two distinctively different sides. As a foreigner, you mostly get to see one side which is impressive tourist attractions and a mixture of urban and traditional lifestyles. The other is a deep overarching poverty which is the reality of many Peruvians, which is also thankfully the focus of many local initiatives. In my studies and travels, I have always found poverty and poor health to be intertwined and often times inseparable. However, I haven’t found many organization solely dedicated to public health or any of its aspects. What I’ve discovered are mainly fair-trade or education initiatives with the later usually having a small public health aspect mainly dedicated to providing proper meals and improving basic nutrition.
I believe education and fair-trade efforts are absolutely important in impoverished areas and communities but I guess I am a bit disappointed at the scarcity of health related health initiatives and NGOs. Also, accessing information about the Peruvian healthcare system is very complicated and so far everyone I’ve spoken to seems to have the same view. To put it simply, the Peruvian healthcare system is divided into multiple sections with the notable ones being SIS, eSalud and Private insurance. Each section covers some aspect of the population or those who can afford it. From my observation, there seems to be a local clinic or posta in many communities, which is great but many people are not aware of what aspect of their health is insured or covered. Although the postas serve as good initial points of health access, I’ve noticed that the regional hospitals with considerably better amenities are usually out of the reach of those who might need it the most. Coupled with the lack of public health education or advocacy, it is very hard to get a sense of public health urgency or importance. Now imagine the impact of inadequate public health education and awareness on the many people that live in remote communities.
In such a situations, I’d imagine health initiatives would serve as the perfect intermediaries for health education and disease preventions but unfortunately there aren’t many of such initiatives. Furthermore, this reality has made it generally hard for me to assess the behaviors locals might have toward healthcare or their own health. I however do know that traditional medicines made from the coca plant are often utilized for many remedies. Additionally, this is not a criticism of the Peruvian government or society but I believe tourism garners the attention of social initiatives more than education or even health. With that being said, I believe there are initiatives and individuals out there who are doing their best to restructure this skewed picture – I will highlight one of such initiatives in the section below.
Does the concept if Ubuntu or reciprocity work in Peru?
To reiterate, Ubuntu, commonly known as “I am because we are” is a philosophy that emphasizes the importance of selflessness actions from the perspective that a sense of community shapes who we are. Simply put, I would frame the Ubuntu philosophy into my project as observing or assessing health related actions that benefit the community as well as the connection between those that provide health and the recipients. With that being said, I would say that a sense of Ubuntu in Peru is better understood from the perspective of what people do for their families rather than communities. I believe this is because family dynamics shape or nurtures the individual in Peru rather than his or her community. For instance, in the Sacred Valley region of Cusco, I came across an organization (Sacred Valley Health) that trains community health workers or Promotoras to spread health awareness in remote indigenous communities. The interesting aspect about these promotoras is that they are elected by the community because their families are known to be trustworthy and thus such individuals can serve agents of change and health advocacy.
The elected promotoras (SVH currently has 14 promotoras) receive training on how to deal with the main health issues in the communities which tends to be malnutrition, respiratory illness and diarrheal illnesses. They are also taught about vaccinations and how to negotiate with community members on ways they can adopt healthier lifestyles. One of the many things I found interesting about the promorotas is that they are unpaid and dedicated people who work hard to customize and make their health trainings more in tuned with the communal lifestyle. Additionally, some of the promotoras eventually become Docenetes within the organization to train other community members to become health workers to help fill in the gaps that they can’t fill. For many of the health workers, being involved with the organization helps improve the social status of their families and on an individual level, they feel a sense of internal satisfaction for being important role players in their tight-knit communities. Using the notion of Ubuntu as a lens, the selfless work of promotoras can perceived as making them open and available to others, which is the essential to promoting oneness and humanity through health advancement.
I would say the concept of Ubuntu does work in Peru but the nurturing aspect of the ideology is derived through families rather than communities as I had expected. The ideology doesn’t only apply to health initiatives, it does apply to the many development and educational initiatives aimed at improving the lifestyles of many impoverished Peruvians. Even though my main focus in this project was health related, living in communities among locals definitely helped me understand my daily learnings and experiences from broader perspectives. I didn’t have a homestay or any living arrangements planned out when I arrived in this country but I’ve definitely felt welcomed and at home in all the places I’ve stayed. More importantly, the people I’ve stayed with always treated me like family and I believe such experiences definitely made me understand the importance of family in this society. It was always bittersweet leaving each place but I moved on to the next with great memories and good expectations that were duly fulfilled upon settling in and meeting people. The unplanned nature of my time in Peru has definitely allowed me to learn so much more about myself as an individual and my project than I would have if everything was structured and ironed out. With that being said, I would have liked to get a more hands on look into my research because I would have been able to gather more organic data through participant observation- Anthro 101 🙂 .
I leave Peru with some answers and more questions about my project which works well for me because it will be weird if I had all the answers I sought. I believe I made the most of my time here between conducting my project and also making time to meet people and try new things. I am definitely going to miss the curiosity of Peruvians, the sense of pride they always showed when teaching me about their culture and the many savory Peruvian meals. This isn’t goodbye, I will definitely visit Peru again and hopefully my Spanish will be better by then. I am excited for the next chapter of my Watson journey which begins next week in Kigali, Rwanda. I will be working alongside HDI, an independent health initiative working to improve both the quality and accessibility of health care for Rwandans through advocacy, education, and training. In Rwanda, I look forward to learning about the people, their culture, what it means to be a post-conflict society as well as health challenges and initiatives. I might be off the map for a while but I will make sure to keep updating you guys about my journey and my discoveries. Until next time!