Chapter 9: Global Health Workshop

June 28, 2011

 Notice regarding donations: In an earlier e-mail I made it possible for readers to help defray costs for my two weeks of public health service in Peru. I was inviting modest participation, but one donor was particularly generous – and has graciously resisted my protestations that the gift was too large. So, if there are others who want to participate, allow me to suggest a maximum: Any participation is appreciated, but please no gifts greater than, say, the price for a dinner out for two – about $50. 

 Last Saturday, at a workshop at North Seattle Community College, a volunteer with Global Impact described the building of a clean burning stove for one Peruvian family: The man of the house took off his footwear, then mixed up some mud with his feet. Into that he threw straw, pig hair and llama dung, as he continued to stomp around in the mixture. Then, because there is a limited supply of tools and containers, the volunteers picked up the mixture with their bare hands (the clay-like mud tends to tear rubber gloves up) and packed it around the tiles that make up the cook stoves we install in the small homes of indigenous Peruvians. (“You work with what you have.”) You do this while trying not to step on the guinea pigs which are both pets and a source of protein for the villagers. Sometimes as you smack the goop between the tiles you end up with freckles. Yum!

The tile stoves are pretty inexpensive (estimates range from $3-$15) and are preferred over shiny metal stoves. The reason: The natives hate to dirty up those shiny stoves by actually using them, and sometimes when they are pinched for money there is a temptation to sell them for cash!
 When the installation is complete, it’s not unusual for the lady of the house to cook potatoes for the volunteers. Peru is where the potato originated, and there are many varieties there to choose from. And while it would be rude to turn down the offer of hospitality it’s important to remember to just eat the inside of the potato and leave the cooked skin behind.

 If that sounds a little challenging, consider this recollection of a senior citizen volunteer who was an experienced traveler before he became involved in Global Impact. His prior travel experience had many comforts.  He misted up as he told the story of a group of villagers dancing around him and singing because they appreciated so much what his group was doing for their village. He learned the song and later on he sang it for them. He shared his memory of walking past a five star resort on one of his trips and feeling sorry for the tourists inside: they had no idea what they were missing.

 For six years, Seattle’s Community Colleges have been involved in Global Impact, a program to deliver health-care services to the most vulnerable populations in four countries: Vietnam, Tanzania, India and Peru. Pity the volunteers to India, where they may be working in 100-degree heat under humid conditions. In Peru, the temp will vary from freezing to about 70 degrees Fahrenheit. Instead of worrying about the heat, we’ll be dealing with dirt and darkness. We will wear headlamps, because the homes we will be working in may be as small as a one-car garage and quite dark. Some of us likely will rely on disposable coveralls or Valu-Village clothing we’ll simply leave behind.

 Peru has fairly good public health for 90 percent of the population. But the childhood mortality rate tells a story: 93 deaths per thousand live births for the poorest segment of the population, 18 for the upper classes. (In the United States in 2011 it is approximately 6.7 for males and 5.4 for females.)
 Not all the Peruvian work will involve installing clean burning stoves. We’ll also be making some ingenious water filters: You break up clay, mix it with water, and squeeze it into a mold, then bake it. Then you place that mold in a plastic bucket. The clay is porous enough to allow water to pass through, but fine enough to trap parasites.

 There will be about 10 of us in the Peru contingent. Part of the time we will be setting up a health clinic. Some of us will be responsible for controlling the crowd that lines up for examinations while others will be varnishing the teeth of 6-8 year olds with fluoride to “remineralize” those teeth. And some members of the team will be performing triage by taking vital signs – blood pressure, heart rate, breathing rate. Sometimes the clinics have wound stations. Sometimes a small tabletop pharmacy is created to dispense medicines with the help of an interpreter. Sometimes the clinics are in schools, but not always. We find out when we get there.

 Global health doesn’t just deal with disease. It deals with “changing outcomes” by paying attention to “social determinants”—the network of interacting exposures that put people at risk. Examples are unclean water, insufficient food and insecurity—whether people are safe in their own home and in their community. For example, while no-one has died from measles in the Americas so far in 2011, 190,000 children have died elsewhere – not from measles itself, but from the conditions that prevented them from fending off the disease. In Burundi, of five children born, one will die in the first year and the average life expectancy for the group will be 50. In Sweden, the youngest to die will be 63.

 Altogether, eight goals have been identified to improve global health. Several of them apply to Peru:

• Eliminating hunger and poverty
• Gender equality
• Reducing childhood mortality
• Improving maternal health and diminishing risk from childbirth
• Environmental sustainability and water sanitation

 The changes that address those goals can seem pretty inconsequential. In Rajastan, India, a 5-hour drive from Delhi ,Global Impact will show the locals how to create composting worm bins. In Tanzania, where ox-drawn plows are still in use on half the arable land, Global Impact teaches locals the benefits of “double-dug” beds that increase crop yields 2-6 times, while reducing the use of pesticides. Other changes involve teaching children to wash their hands and brush their teeth – and the fluoride painting program.

More to come…

Love,

Robert