Lauren here, excited to be bringing you another update from Lima!
Today, Briana, Cindy, and I got up on Peruvian time, and headed out for a quick breakfast around noon. We then returned to our hostel to await the arrival of Melecio, who came by around 3:00, after finishing up his meeting with several members of the Ministry of Health. Due to the late hour, we deemed it inefficient to head out to Callao today, and instead, we spent the next several hours talking with Melecio. First, Melecio showed us this pamphlet that ASPAT had created to spread awareness of their cause and organization.
Then, we moved on to discussing a plan for our internship. Ideally, Melecio would like to implement several projects with the members of the GROW Team. ASPAT’s most important current projects involve the provision of food baskets to extremely poor patients and the construction of several modular homes to quarantine the extremely drug resistant.
In the next couple of weeks we will be:
(1) Equipping and delivering five food baskets for patients suffering from multi- and extremely-drug resistant TB.
(2) Visiting a children’s hospital (see our blog post on the paper stars for more details)
(3) Meeting with members of the Ministry of Health to discuss future plans for the prevention of TB
(4) And, depending on whether ASPAT receives the finances in time, we will be constructing 8 modular homes to separate patients from their families, reducing the risk that their TB wills spread to their loved ones
But what members of GlobeMed will be most interested in is Melecio’s account of the struggles ASPAT has faced in their fight to raise awareness:
(1) Peru, like many other governments in South America, has spent many years denying that TB is a recurring problem in their country. Because there is such a strong correlation between HIV and TB, there is a pervasive stigma surrounding the disease. Many believe that those who contract TB are either HIV-positive drug users or the very poor, who have contracted it due to lack of sanitation (and obviously, the two categories overlap). As such, the government feels that if they admit that they have a TB problem, they are also admitting to having problems with extreme poverty and potential drug abuse.
(2) As a result of this denial, accurate statistics are extremely hard to come by. Statisticians receive their data from the Ministry of Health, which has a vested interest in reporting skewed numbers. These numbers are easily falsified: for example, it is said that in the wealthier districts of Miraflores or San Isidro, TB is nonexistent. But if one were to investigate more thoroughly, one would find that every pharmacy in Miraflores sells TB medication. As it turns out, because the citizens of Miraflores and the surrounding neighborhoods are wealthier, they are able to buy their meds directly from pharmacies without prescriptions from doctors. Thus, they are never entered into any medical records, and the perception that only the poor get TB is perpetuated.
(3) Melecio, the members of ASPAT, and other TB-related organizations have spent the last couple of years petitioning the government to take a more active role in TB awareness and prevention. Unfortunately, because Peru does not have a particularly centralized government, such a task is very complicated. Melecio explained that ASPAT has had to gain the attention of the governments of the various municipalities of Lima and work their way up to the so-called central government. It is the central government that passes the laws, but the municipal governments that enforce them – thus, ASPAT truly needs the cooperation of all to implement change.
(4) To do so, Melecio has moved TB out of the realm of infectious disease and into national security. The rise of multi-and extremely-drug resistant (MDR and XDR) TB is very alarming, because currently, there is no way to treat extremely drug resistant TB. With the rise of globalization, the possibility that XDR-TB could spread throughout the world is unfortunately likely. As such, the time to act is now, to prevent XDR-TB strains from taking hold before the problem gets even worse. The response from the government in the past year or so seems to indicate that this tactic is working, as the government has begun taking a more active role in TB education and prevention.
The lessons Melecio has to offer GlobeMed members are many, but for the sake of time, we will talk more about Melecio and his experiences in later blog posts as we get more deeply involved with ASPAT. Here is a brief teaser:
(1) How one can use the lessons one learns in professional life to run a non-profit
(2) How a system of responsibility (society to patient and patient to society) is necessary to teach people to take control of their lives
(3) How to target a seemingly-narrow message to various interest groups
(4) How to increase visibility of a non-profit and of an issue
After our very productive conversation, we headed out for a couple of hours to continue exploring Miraflores. Below are a couple more pictures of the various sights of the city:
We walked in the direction of the ocean and stumbled upon a number of parks, including the Parque del Amor (Park of Love).
The parks bordered the cliffs that overlooked the ocean, so the view was jaw-dropping.
And finally, we discovered several fountains and plazas tucked within the streets of Miraflores.
More photos on Cindy’s Facebook if you’re curious.
Tomorrow, we head out to Callao bright and early to meet with Melecio, the members of ASPAT, and several representatives from the Ministry of Health to discuss the current situation and brainstorm ways in which TB can be reduced. It should be an interesting day!