Living in the Third World

While living in what is sometimes called a "Third World" country (though that is now becoming a very antiquated term), I have had to readjust to many realities of daily life here. To name a few of the trickier scenarios I have had to get used to, I have learned to: take cold 2-minute showers when the electrically-run hot water gives out; sleep in long underwear, scarves, and wool socks at night to bare the 30 degree weather with the lack of a heating system; watch my step while walking through the streets to avoid running into piles of accumulated trash; wash my laundry by hand and hang-dry it on our roof; stand quietly by as a Peruvian toddler relieves herself in front of my clinic to avoid using the dirty public bathroom provided in the health center itself. And the list goes on.

One day during my rotation in pediatrics, I went with two nurses to an elementary school near the clinic to weigh and measure the students in addition to checking their vision and general hygiene. I was astounded to discover that almost 100% of the children did not have dental care and thus had horribly advanced cavities. Most of the kids did not maintain what a U.S. doctor would consider "adequate hygiene," subjecting themselves to our examinations with unwashed bodies, sunburnt faces, and uncut fingernails.What impacted me most perhaps was the mere fact that the nurses and doctors here have to go to the schools to give these kids regular checkups and integral vaccinations. Although that particular day we were not giving any injections, I have on several occasions traveled with a nurse to vaccinate young children in the communities inhabiting the hills above our clinic. What I soon learned (and what the nurse lamented openly to me as we trekked up the trash-ridden dirt paths) was that many parents wont bring their children to school the day of a vaccination, in order to avoid short-term side effects such as crying, screaming, and temporary fever. Because of these common absences, the nurse has to regularly travel from door to door, practically harrassing the families until they consent to vaccinating their children (which is often done in the middle of the dusty roads with no more than a soapy cotton ball to clean the injection site).I have talked with several nurses and doctors in my clinic, and nearly all agree that the root problem in these communities is a lack of information, education, and consistent communication about the importance of vaccines like those that fight influenza, polio, measles, mumps, and rubeola.

One slow morning in the clinic, as I was waiting in general medicine for patients to arrive, I borrowed one of the nurses medical books and began reading about main health problems in the area. Many prominent health issues in Peru, such as respiratory infections and malnutrition, are systemic, due to lack of education or extreme poverty, etc. In addition to the resistence to vaccinate described above, family planning is a huge issue that is often avoided among the more impoverished communities in the campo. The doctor explained to me that is not because of Catholic doctrine that these families end up having 8 or 9 kids they cant feed, but rather, a lack of resources and a failure to communicate information on methods of family planning. For example, most Peruvian women believe that birth control pills cause cancer. In fact, in my lesson on Family Planning during my 1-on-1 Spanish class last month, nearly all the scenarios presented in sample conversations between patients and doctors involved the patient asking the doctor for other methods of birth control, "since the pill causes cancer"; in none of these scenarios did the doctor ever correct the patient or hint that the pill is a "safe" method of contraception.

As these same systemic issues come up again and again, I got to thinking: what is the best way to communicate with the Peruvian populations? In the US we can send mail, insert informational pamphlets in the newspapers, make announcements on TV or the radio, etc. Here, where a huge percentage of the population does not have running water, electricity, or a mailbox, the most effective way to reach these communities is to go door to door, to hold charlas (or information sessions), and give demonstrations. But even this isnt easy. The doctor at my clinic explained that the only way to incentivize people to show up for the charlas or socio-dramas is to provide some sort of giveaway, which can get expensive for small clinics and health centers. Since coming here, I think I know now that I dont want to be a doctor, but that I am fascinated by the medical industry. Maybe I can pursue a degree in Public Health somewhere down the road, and help discover a better solution to reach the people of Peru.

One last thing I do want to mention is that I have been amazed and perplexed by the perception many Peruvians have of the US. One day I was talking with Jaqueli about "The Pursuit of Happiness," a movie starring Will Smith in which he loses his job and ends up living on the streets while trying to provide for his young son. Jaqueli told me how much she loved the movie and then assured me that she knew it was just made-up, a fantasy. I thought at first I had misunderstood her, so I asked for clarification. But no, my host mother explained that this situation doesnt actually happen in the US. People arent poor, everyone has a home and a job. This movie was purely fiction. Obviously this turned into a much longer conversation, in which I explained to Jaqueli that YES, this was real, that there are many people in my country without jobs or homes or family. However, I was very much taken aback that this was her perception of the US. I have run across several other Peruvian people who have held similar beliefs, some convinced that there is no crime in the US as well. Though I feel somewhat bad being the one to shatter their visions of the American Dream, Ive felt its only right to paint an accurate, unpolished picture of our country. Because being here, I have come to realize that the poverty, illiteracy, and hunger that I see every day here is also very much present in the US, though assuredly on a smaller scale. It has become so important to me to remember the difficulty and suffering that exists within the borders of our own nation, especially while we try to help others overcome similar issues in other corners of the world.