Clas Ttio

Sam and I outside the clinic

That´s the name of the clinic I´ve been volunteering at for the past couple weeks (thanks to many of you wonderful people!). I´ve been thinking a lot about how to sum up my experiences there. The interactions, lessons, and revelations are varied and intense. Mainly though, I´ve learned a lot, met some amazing people, and filled in some much needed man-power.

The clinic I´m working out is a state-funded, low-income health clinic. The government provides universal subsidised healthcare (People with no income are subsidized 100% by the state. In addition, those who make less than S/. 700 soles ($220) per month only have to pay S/. 10.00 for SIS coverage.) for its citizens, but many opt out for better, private healthcare provided by their employment packages.



The things I noticed when we went to the clinic the first day were the lines and lines of people waiting to be seen, the flies in the open air waiting room, and the fact that there was no soap or toilet paper in the bathroom (standard for Peru, but this was a clinic!). I had been prepared for less than stellar conditions, but seeing them in real life and trying to imagine that this was your only option for healthcare, was a harsh reality.



My first week there, I was stationed in the social work office with the tough-love-mama social worker Mariluz and her 17-year-old-bubbly-med-school-bound daughter, Andrea. There is no computer in the office (I´ve only seen one in the whole clinic so far) only $.20 notebooks with handmade columns, so there was plenty of paper work I could help them catch up on. It was a good place to be for the first week, getting my ears accustomed to the cacophany of Spanish, learning how the clinic and healthcare system ran, and putting together a bunch of paper work to sign up senior citizens for a support and social group.



Most of the people coming into the office were applying to receive SIS, the government insurance. They went through an application with such questions as: do you have electricity? do you have a radio? Do you have a refridgerator? Almost unimaginable questions to us. I´m pretty sure if they had a TV that put them in the elite bracket. A lovely trend I noticed was the gratitude many of these people had for Mariluz´s help in securing healthcare, they would give all of us big hugs and sometimes return with some home cooked bread or treat from a street vendor. Whatever the social work office lacked in technology to an extent it made up for with true human interactions.

This second week, I´ve been in ´Triaje´. When people come to the clinic, they line up to get a number. then they line up to come through Triaje to get their vitals (height, weight, blood pressure, pulse, and temperature) measured, then they wait for their number to be called to see the doctor. I was in charge of taking everyone´s heights and weights...so far, no one, man, woman, or child, has been as tall as me. Did I mention I was a giant in this country? It was good to get to interact with patients though. I love the idea of getting to take care of people and while it was a little frustrating to not be able to help as much as I wanted with the language barrier and my lack of training, it got me excited about the next 4 years at medical school and beyond.

It was also frustrating though, the thermometers used are glass ones that are marginally sterilized in soapy water that has been sitting there for who knows how long. The taking of the blood pressure was the rate-limiting step that had sick people waiting in line outside the door for 30 minutes because there was only one person taking it and it sometimes didn´t work. I worked for a couple days with 2 Peruvian med students who were there on one of their rotations and they were wonderful. One explained (in Spanish) to me how to take blood pressure during a slow time, and I got to quiz them about the med school process, the healthcare system, and their opinion of the clinic. I asked if they thought it was lack of man power or lack of equipment and resources that kept it this way, and they thought lack of organization.

I had to agree. Apparently the private clinics had appointment times. Why couldn´t this one to add a little ease and dignity to the process? I calculated the daily number of patients with the number of doctors and open hours, and it was definitely feasible. I found myself wanting to swoop in with American efficiency, but the specter of paternalism was leaving a bad taste in my mouth. I think the best way to make aid sustainable is for it to come from within the community itself. And if these people were happy enough to have their health clinic run as such, or at least not unhappy enough to do something about it (because we all know South Americans have no problem protesting), then who was I to judge? After all, much of the cultural and way-of-life differences in Peru are neither bad nor good, just different.

Then again, we haven´t exactly left Peru to its own communitarian devices. We´ve swooped in with globalism and left Peru scraping the bottom of the capitalism barrel. So to that end, if we as a country have reaped profit from entering Peru, do we not also have the responsibility to leave some good behind? It has definitely been an interesting and challenging experience, and as the best of experiences do, it has left me with more questions than answers. I realize this might not be as entertaining a post as our ones about BEEF HEARTS! or Dan, the international salsa man, but this is exactly the type of growth and exposure I was hoping for on this trip, I didn´t only come for the shopping in markets and chance to get dreadlocks. :) I loved meeting the people I did, seeing healthcare in a different country, and getting to help out patients where I could. I´m curious though about everyone´s thoughts on international aid, intervening in other countries, paternalism, sustainable aid, etc? Comment away.

p.s. Tried to post more pics...I even tried to do a whole Photo Montage! but alas Peruvian computers = uncooperative. I´ll keep trying though!