Nourish and the Health and Sanitation Campaign

The disturbing sight of two dogs viciously biting, snarling, and clawing at each other was not part of the plan.

Before setting foot in Peru we had multiple pre-departure meetings to solidify the project’s main objectives. While discussing the prospect of health assessments and sustainable latrines for the villages of the Moche valley, a secondary goal emerged: to provide a health fair with basic education to the community members with whom we would be working.

Last week was exhausting. While digging holes in hard clay during the day, we also made posters, pamphlets, and curricula. We learned how to take blood pressure and blood sugar during our downtime. Although many community members had heard about the fair by word-of-mouth (which travels fast here), last Friday, the day before the fair, we placed flyers all around Ciudad de Dios:

Even though we were all exhausted that night, every person in the group actively worked to help finish the last tasks to make the health fair a success. We hustled to finish the posters, rushing to internet cafes and copy shops before they closed for the night.

Robby and Abe taught kids how to clean their teeth the fun way.

The next morning, 5:45 a.m. felt earlier than usual, but I was still excited. I added extra coffee concentrate to my cup and extra jam to my rolls.

Once in Ciudad de Dios, we started to set up our stations in two dusty rooms of the four-room schoolhouse. When we met the first family from a nearby village making their way up stone steps, they smiled and asked us quietly if this was the health fair.
Thus, our stations began rolling and people started arriving in droves.

This was one of the kids games that taught them nutritious eating skills, behind which is line for the doctor's free consultation.

When a Peruvian doctor and a visiting American nurse practitioner arrived mid-morning, a line was formed out the door for free health consultations. After making their rounds through the health stations and receiving a consult, each visitor got a bag of lentil beans and a hot chicken empanada.

The children were a handful, but luckily there were many of us to deal with them.

This was a puppet show scripted by Melissa and Britney that was put on as part of the children's games.

While from a far the fair looked like clockwork, every one of us worked hard and dealt with multiple small problems throughout the day. At one critical moment during the fair, two dogs tore at each other ferociously. The people turned silent and everyone exchanged nervous glances. Luckily, Katherine Burns, or la jefa (the chief), arrived a minute later to save the day.  Like a pro, she grabbed one of the growling mutts by the back of its neck and yanked it off of the other. It was no surprise to find that along with being Director of Public Health programs for MOCHE Inc., Kat is also a dog whisperer.

Despite putting out small fires throughout the day, we put on a rowdy and fun family event and provided health advice to over 100 Moche Valley residents.

The group after setting up the health fair. From top left: Michelle, Olivia, Melissa, Linda, Katie, Paula, Britney, Paul, Vera, Abe, Becky, Robby, Kevin

Peru has among the highest rates of infant mortality and maternal mortality during childbirth in Latin America.

In turn, the department of La Libertad, which includes the Moche Valley, has the highest rate of maternal mortality in Peru. Leading causes of death like preeclampsia are largely preventable if diagnosed and treated during routine prenatal checkups.

Dra. Campos, the obstetrician at the clinic in Menocucho, brought up this sobering fact during a meeting for our upcoming prenatal classes. Despite Dra. Campos’ evident devotion to her patients and the proximity of the clinic to many valley communities, a striking number of women do not receive potentially life-saving prenatal care. The most important barriers to care are economic: few families can afford the short combi ride down the valley, let alone the fees for consults, vitamins, and medications.

Our meetings at the clinic and our health assessment surveys have reiterated the local need for better information about prenatal health. Since we cannot hope to address the issue of affordable care during our time here—a symptom of a broader, systemic problem—the classes will focus on how women can take charge of their own health and that of their families, in addition to the vital importance of monthly prenatal checkups.

Healthcare in Peru is subsidized, but not free, so patients must pay out-of-pocket for services at public hospitals and clinics. The government has resisted privatizing the health sector, but austerity measures imposed by international financial institutions like the IMF undercut funding for social services. External financial obligations prevent the state from providing its citizens with basic needs like clean water and primary care.

Our global political economy systematically undermines health, favoring corporate welfare over social justice by leveraging poor countries’ debt for private gain. The struggle for change needs the voices of those most deeply exploited by this system demanding justice for their families and communities. That means healthy moms and healthy babies.

Have you ever seen a guinea pig killed, skinned and gutted mere moments before it was placed before you as lunch? Today I did.

But before I talk about that, I should backtrack and explain how we got there. As part of our group tackles health assessments, the rest of us are getting our hands dirty, designing and constructing pilot latrines. Many of the families in Ciudad de Dios and the surrounding area don’t have any kind of infrastructure set up to use as a bathroom and those who do generally only have a hole in their backyard.  Without getting too explicit, any permeable structure threatens the health of residents in the village, as bacteria can seep into the ground water and even into the water pipes.

We’ve decided to build four latrines and thus far, we have chosen two beneficiary families. The first is a single mother with two young children. They don’t have any bathroom structure, so the erection of this latrine will hopefully mark a significant improvement in their lives. Her two brothers were kind enough to help by digging a hole of 2.5 squared meters in the compact Peruvian soil for three hours.

Although we were impressed, we thought our group of six could complete a similar sized hole in, perhaps, twice the time—until today.

Today, we visited Senora Maria, head of the second family for whom we decided to build a latrine. Senora Maria is a small, spunky 70-year-old woman living in absolute poverty who, despite missing a few teeth, looks at least 20 years younger. She spent the vast majority of her life without electricity, which she acquired only a few months ago, and running water, which she was able to access after last years MOCHE-Nourish International service group’s installation of a clean water system. Unfortunately, the backyard of her house is ridden with trees, rocks, and animals, and we soon realized the difficultly of finding a viable location. Luckily, her daughter lives less than a minute away with her children, and we decided that her daughter’s spacious and cleared backyard would be a safer spot for construction.

Two young neighbors of Senora Maria watch as we dig.

So we dug. And dug. And dug some more. Three hours later, we were about 1/3 of the way through and utterly exhausted. Needless to say, when Senora Maria offered us a hot lunch, we happily accepted.

Covered in dirt, we trekked up the rocky trail leading to the house and salivated with thoughts of steaming rice and spicy soup. As I made my way through the brush, I had expected to see Senora Maria leaning over a pot, stirring our lunches on a stove. Instead, I found her fragile little arms whacking dead guinea pigs with a polished knife. She smiled at our initial horror (which may or may not have been well hid) and informed us that she was cooking all of her adult cuys, or guinea pigs, for us as a token of her gratitude. To be the recipient of such amazing kindness was a real honor.

And truth be told, guinea pigs don’t taste all that bad.

After a frustrating week of planning, our health assessment surveys are finally underway.

Yesterday we began our surveying in Cerro Blanco, the first village on our list in the middle valley. Equipped with the map we made last week, which after several drafts was incomplete at best, seven of us partnered up with Peruvian nurses and volunteers to conduct the assessments. We had chosen a random sample of households and quickly found that sticking to that sample was harder than we had hoped. We found ourselves traipsing narrow paths through sugar cane fields and up the craggy slopes of the cerro in search of the next house, which was often unoccupied.

A view of the valley from the hills.

Still, having spent the last week going back to the drawing board to redesign the latrines, redraw the maps, and rewrite the health surveys, it was a relief to finally start the assessments. I was surprised and moved at the openness of the participants, who without exception have welcomed us into their homes to share details about their families’ health. The questionnaires, designed for female heads of household and female interviewers, probe on sanitation and hygiene, common illnesses and injuries, pre- and post-natal health, domestic violence, access to care, and other topics.

 Our work over the past few days has given us insight into the difficult process of community-based health research, especially as a team with a diversity of backgrounds and experiences. We are continually learning from each other about how best to conduct these surveys with professionalism as well as with compassion and respect. The interviews themselves provide a window for understanding the communities we serve, their strengths and needs, and the potential for improvement of preventative health services like latrines and education programs.

From left: Kevin, Katie, Vera, Paula and Linda in Bello Horizonte for a community meeting.

Talking to community members outside of the survey context has encouraged and energized us. We had the serendipitous fortune of meeting Sr. Rodrigo in Quirihuac, who offered us maps of most of the villages in the Moche, thus saving us days of mapping. Still dumbfounded by our good luck, we listened to his story about another group of gringos who had come to Ciudad de Dios last year to build a water system. “Do you know that place?” he asked. “It’s like it’s received a touch of light, un toque de luz.” 

Looking over the new-found maps of households in the valley.

Little known fact about Peruvian transport: 12 people can fit (barely) in an 8 person van.

As our 12 person team squished into the van for the first time Monday morning, everyone talked about our schedule for the day. We headed to Ciudad de Dios to begin our 6 week project. After seeing the sites briefly over the weekend, we were excited about getting to work and discussed how our ideas would neatly work within the community. Our plans included building pilot latrines in a least one home in Ciudad de Dios. Before we got to Ciudad, we were convinced our approach was the best… little did we know.

As soon as we began talking to folks around the village, we found out many more homes than we thought already had latrines. We visited the community leader’s home to see how his latrine worked. His family taught us about how the upper class within the community is lucky enough to have their own, functional bathroom facilities. We noticed some major differences. Their design seemed perfect…but it was too close to the waterline to be completely sanitary.

Our previous design was not exactly the same and we wondered how accepted it would be within the community. After much discussion, we decided to go ahead with our VIP design that we are still currently working on perfecting. And so ended the first day of the first week…

This was part of the area where we mapped, which had an amazingly intricate irrigation system.

Tuesday brought our group to another village called Cerro Blanco. Many of the villages are close together but no one knows for sure who lives there. Another element of our project is knowing how many people live in each part and where they live. We will be giving health assessments to the citizens to see where their health needs concentrate so we can later build a clinic serving those needs. The task of the day was to map out the different zones…this proved to be a little more challenging, but with the help of locals, it was done quickly and efficiently.

For the first time, we all were able to interact with local people as we walked around and observed the place they call home. Many people told us how much they appreciated what we would be doing. Simply hearing that what we are doing means something to the citizens gave me a renewed energy for the day and hope for the rest of the project.

Even with all the planning and strategizing, we had time to see the miracle of life. The dog at our hostel gave birth to 5 pups. The dog had been sporting a fashionable yet oversized plaid sweater since we got here. Unbeknownst to us, she had begun having contractions. We finally discovered what the jacket hid as 5 small puppies became new members of the Nourish International family.

Now that we have a clearer idea of what we need to do, we can visualize our final project and who it will benefit.

The Peruvian government and indigenous groups in the north of Peru have been at odds in recent months regarding the government's licensing of drilling and mining by foreign companies. This unease erupted in the last two days as protests and riots which have rattled the area near Bagua, many miles north and inland from where we are currently.

Today, BBC News reported that the riots have resulted in missing people with witnesses blaming the government, and the government calling for the arrest of indigenous leaders.  

While these events have sparked lively conversation among the people we have been working with-- politics are always on the discussion table in Peru-- we are not worried about our safety in Huanchaco or the Moche Valley.

Living with the dead is a strange idea.

But while this concept might be foreign to us, the people who occupied the Moche Valley from 100-800 A.D. gave dead ancestors their own rooms in the houses. They believed the spirits of those dead still lived with them, while their physical bodies slept in the back rooms. These dead bodies might have even been given new life during rituals and brought out of their tombs.

These stories were told to our group on Saturday when we visited the Moche Valley archeological site. The work that we will soon be doing with the small communities now occupying the valley helps protect this and other archeological sites. UNC professor of archeology and co-founder of Moche Inc., Brian Billman, set up this exchange with the local Peruvians. As Moche Inc. helps to develop the surroundings, the locals hire people to protect the sites from potential looters and squatters who can damage the area and permanently erase the surviving history.

The atmosphere of the valley, dry and desert like, has not affected most of Moche’s historical presence. Walking from the bottom of the valley up one mountain, we all saw numerous fragments of clay pots, some still with distinct paint on them, bones, and large rocks with extremely smooth tops that had been used as grinding stones.

During the period of the Moche civilization, women would have gathered around this stone, using its surface to grind their food.

After leaving the site, we visited Ciudad de Dios, the village where the previous Nourish International group developed a clean water system. The children and women all knew Juliana, an archeology graduate student who has previously worked with the village, and would shout her name and embrace her as we walked around. The village has a small central plaza of irrigated concrete squares, designed to someday be gardens, a four room school, one small village bathroom, and a soccer court also made of concrete. Due to my lack of fluency in Spanish, I communicated best with the children under age 5, playing with them in the sand and climbing on the soccer goal.

Vera and Rosa hang around the soccer goal at Ciudad de Dios.

Returning to the beautiful beach town of Huanchaco, where our hostal is located, adds a thought provoking contrast to the lives of the villagers with whom we had been playing and conversing. Although, I know we will all appreciate the comfort of our hostal’s luxuries, heated running water, mattresses, nutritious food, much more once our work starts.

With the villages and area now visualized, our project meetings have taken on a new strength of ideas as the benefits of our projects now have a face.