Callao, Here We Come!
We awoke bright and early at 7:30 (!) this morning to prepare to head out to Callao for a meeting with members of ASPAT and several officials from the Ministry of Health. While waiting for the taxi to take us out to the meeting, we faced our first true example of ‘Peruvian time.’ Peruvian time is perhaps best characterized by the idea that although appointments may be made at specific times, they actually begin whenever the participants feel like showing up. Here’s a hint: no one’s ever early. Our taxi was no exception to this rule. As we watched the clock hit 8:30, we began to get a little nervous – we’d booked the man for 8:00. As it so happened, the taxi was en route to our hostel when it got into a small accident, so we had to ask the friendly receptionist to call us another one. We ended up leaving the hostel at 9:00 for a 9:00 meeting, arriving in Callao at 9:30. Hopefully, this endeared us to the participants of the meeting as true Peruvians, not late, hapless Americans!
The meeting ran from about 9:00 to 2:00. Judy, ASPAT’s treasurer, was there as its representative, and she welcomed us warmly. Also present were Dr. Christian, the regional head of hospital-sponsored TB programs in Lima, several head doctors in Callao, and multiple officials from the government.
Judy is the woman in purple, while the man next to her is a government official. There were around 10 people at the meeting and many are not seen here, but the GROW team felt self-conscious taking photos. Please be content with this photo and the following description!
The details of the meeting are as follows:
(1) Callao is divided into three major zones: Bonilla, Bepeca, and Ventanilla. The heads of each zone were represented at the meeting. Currently, Callao is considered a high-risk zone for TB, because both Bonilla and Bepeca are high-risk (and Ventanilla will soon become high-risk if steps aren’t taken to control the situation).
(2) Bonilla is currently the zone that has been hardest hit by MDR-TB, with 50% of all cases being multi-or extremely-drug resistant. Bepeca is not far behind, with 44% of cases being MDR-TB. Ventanilla is doing the best, with only 26% of all cases being multi-drug resistant, although unfortunately, even in Ventanilla up to 50% of new cases are MDR-TB. Overall, about 50% of all cases in Callao are MDR-TB*. These statistics are appalling. Right now, the incidence rate of MDR-TB in Callao is 8 times the national level.
*Note: these statistics are collected by the local health clinics and hospitals that the patients check into and may not be recognized by the government at the municipality or national level.
(3) Most people contract TB from their contacts (family, close friends, and neighbors) who interact with them regularly over an extended period of time. Every TB patient has about 20 potential contacts. These contacts can be put on prophylactics to prevent them from contracting TB, but unfortunately, the rates of contacts actually put on prophylactics can vary anywhere between 30 and 70 percent. Children are especially likely to contract TB if they aren’t put on prophylactics (due to their weaker immune system), so there has been a rise in the number of very young children coming in with MDR and XDR-TB.
(4) Dr. Christian and his associates have proposed a three-step system for rectifying the situation. First, money has to be diverted to the cause of TB, to compensate for the critical lack of personnel and resources. As the situation now stands, there are very few nurses and technicians who are qualified to work with TB patients – sometimes, there are as many as 250 patients cared for by 1 nurse, and in the very poorest districts, there may only be one doctor. Thus, even patients who could otherwise be saved are dying due to the lack of resources. Second, doctors need to standardize the diagnostic test for TB, because too many cases of asymptomatic TB are going uncaught until very late in the game. Third, and most important, doctors must ensure that patients comply with all treatments and complete a full course of antibiotics, or the first two steps are worthless.
The government officials were enthusiastic about Dr. Christian’s proposals in the abstract, but were mostly interested in congratulating everyone on the steps already taken to combat TB (such as the formation of a regional council to deal with the different districts). The officials were not enthusiastic about providing more money to fund projects (the provision of food baskets to the impoverished was a particularly contentious point). Eventually, the officials agreed to provide 70 food baskets with government money, which is a step in the right direction, but probably still means that only 60% of the needy in Callao are actually receiving supplemental nutrition.
ASPAT’s role in this discussion was very interesting. It seems that because the members of ASPAT work so closely with the patients, they are considered the representatives of the people on the council, really vocalizing their needs and the circumstances of their lives. The doctors had a great deal of respect for the work that ASPAT is doing, especially the construction of the modular homes.
After the meeting concluded, Cindy, Briana, and I met up with Judy, who took us to the Hospital Carrion, another building in the hospital complex where the meeting was held. The hospital complex – like those in the US – was a veritable maze, and we were very happy to have Judy guide us.
In the last photo, you can see a sign pointing to the TB ward of Hospital Carrion. This is where we met Esther, the nurse in charge of the Ward. Esther had some really great insights into the problems associated with caring for TB patients long-term. This post is already fairly long, so I’ll relay more of the interview with Esther on Monday, when we see her again to visit the patients with Judy.
This is Esther. Here are a few teasers from our interview with her:
(1) A discussion of the make-up of the staff at Hospital Carrion’s TB Ward
(2) Esther’s guide to overcoming a sense of impotence at the enormity of the problems that TB poses
(3) The difficulties of performing triage
(4) How the lack of mental health facilities impacts TB patients
(5) The role of ‘indifference’ on the part of doctors, patients, and families
After our interview with Esther, the three of us went out to lunch with Judy, who took us to a hole-in-the-wall restaurant in Callao. I think all three of us were really looking forward to finding a restaurant like this one for some time (very authentically Peruvian). The food was absolutely delicious, and wonderfully inexpensive. Judy herself was a very pleasant lunch companion, telling us all about Callao, her work with ASPAT, and her baby son Sebastian (who I believe we will be meeting in the future).
Photos of food, per Ethel’s request:
Done with lunch, we said goodbye to Judy and headed back to Miraflores for the rest of the afternoon/evening, which we once again spent exploring. I think we’ve seen an awful lot of the neighborhood at this point – fortunately, Cindy has an excellent sense of direction so we’ve managed not to get too lost along the way! (insert from Cindy: I think I actually have an awful sense of direction, but getting lost is fun and I eventually locate us on the map and get us back to the hostel one way or another)
Tonight, we made our way down to a touristy park and shopping center on the side of a cliff overlooking the ocean.
Saw a fantastic sunset.
Tomorrow, we’ve got the day off, so we’re planning on heading into Central Lima, which should provide some great picture opportunities in the next couple of blog posts! Until then, buenas noches.