Click here to view our Winter Newsletter for 2015-2016.
As a first year physical therapy student heading to Peru I didn’t know what to expect. Although we had spent months preparing our rural health care worker training, organizing logistics, putting lessons together, planning fundraisers, and improving our training method, nothing could have prepared me for actually stepping into the boat for the first time to head out the across the Amazon River.
I landed in Iquitos, a city enclosed within the Amazon Rainforest and home to nearly half a million people. We hit the ground running, prepping for the training to come, organizing food lodging and transportation for the 65 rural health workers that attend our trainings twice a year. We networked with the ministry of health and our partner organization Sociemap. We practiced our lectures and finalized the lesson plans. It is a great feeling to truly work as a team towards something each of us, as health professional students from various faculties with different backgrounds and expertise, is really passionate about.
In between all the work, we are managing to have some fun. We celebrated the new year with SOCIEMAP, a society of medical students focused on research and community outreach, who partner with us to host our trainings. It was so awesome interacting with students who are just like us. We have formed a really special connection with them.
My senses have become overwhelmed with colors, sounds, and smells of all kinds. At the Belen Market, I felt like I stepped into an alternate universe. As I sifted through crowds, spices, and every kind of meat you can think of, it really hit me how different my world is from the average Iquitoan.
At our training we will be teaching rural health workers called health agents. They travel by canoes with small motors as far as 75km from outlying communities along the Amazon and Napo rivers to attend our training. How beautiful it is to merge our worlds together through this mutual exchange of knowledge and culture.
After what seemed like an eternity of preparation work, tomorrow morning, we will finally depart from Iquitos for the small district capital of Mazán where we will host our training. I am nervous and excited to lead a physical therapy lesson in Spanish to the health promoters. I hope that my efforts will improve the lives of the health promoters and their communities even if it’s in a small way.
I am excited to bridge a gap between cultures and health workers because, as health professionals, we all share the same values, helping our communities through healthcare and education, whether that’s in the Amazon or at a clinic in Denver.
– Arielle Levy
I am Andrew, “The Intern,” from Texas. I am the first official intern for CU Peru. As a second year MPH student at Baylor University, I was searching for an organization to intern with to wrap up my last semester. I was looking for an established organization working in global/international health. I didn’t want to settle for just any internship to finish the MPH. I wanted to feel connected. I wanted to work with an organization where it felt natural to adopt their mission wholeheartedly. I wanted to surround myself with like-minded people, with friends, and with community. I wanted to fuel my passion for connecting with people through health, health education, and service.
I had visited Denver a few times before and always enjoyed it, so naturally I found myself looking here. It is a big city, yet close to the mountains. It has music, craft beer, coffee, bicycles, down jackets, down-to-earth people, and enough outdoor activities to satisfy every weekend warrior’s calling. When I found CU Peru, I was immediately riveted – it seemed to be everything I was searching for: community health education in the Peruvian Amazon, sustainable interventions starting with the community, it was community-based, and a collaborative project. I also have family in Iquitos. I am studying Community Health Education. I had been reading about work exactly like this in books and I have always want to be more involved, to serve, and to learn more about public health in a global setting. I realized this could be it. This could be the meaningful experience I was hoping and praying for!
First stop Iquitos, Peru for winter 2015 training.
Two months later I found myself on a plane to Lima. Five other members and I had volunteered to implement CU Peru’s second annual winter training. Despite the hustle and bustle of a fast paced city, we arrived safely at the Nativa Apartments. A couple of us were acquainted before, but for the most part our friendships started there in a small hostel room in Iquitos. We came from different places, we studied different subjects, and had differing backgrounds in Spanish. One thing was consistent: we were there together to serve Peruvian Community Health Workers (CHWs) and to further represent and carry out the mission and values of CU Peru. From that moment on I knew I had found my people (and there were 20 more back in Colorado)!
Broken down to its simplest terms, the goal of our trip was to deliver the curriculum in Mazán and to strengthen relationships with our partnering organizations. During the week preceding our training we were collecting supplies, finalizing documents, reading and re-reading curricula, having meetings with the Ministry of Health (MINSA) and with SOCIEMAP, and refining logistics.
Despite some minor logistical speed bumps associated with working in such a remote location, the promoters received the training well. MINSA and SOCIEMAP were both present and helped by teaching various topics; in addition, they both expressed an interest to be more involved in future trainings. We had 50 promoters in attendance and they were excited for us to be there. In the back of my mind I felt like they knew how far we had traveled and how much we had invested in making this trip possible. They were all eager to learn new topics and solidify old themes, and I am confident that they did just that. Some were new to being promoters, and others were experienced and had a wealth of prior knowledge. Most of the promoters are farmers or fisherman and volunteer their time and effort as promoters. As a promoter, they are unpaid government workers; they are volunteers with a huge responsibility. They work hard to provide for their families and they are also responsible for monitoring the health for their respective communities –they are selfless. This speaks volumes as to what kind of hearts and minds these people have. These men and women are the foundation of good community health.
On the last day of training we held a certificate ceremony where we presented each promoter with his or her official certificate of completing their health education training. This certificate is a source of pride and empowerment to them. You could see it in their eyes and faces. You could see the excitement. At that moment I realized why CU Peru does what it does and I realized how I came to be there. Simply put, there is a need. I am not just a young college mind seeing and experiencing the poverty and the health disparities in a developing country and saying these people need help. Promoters are the foundation for the health care system out in these remote villages. There is a need for these promoters to be supported with materials, supplies, and basic knowledge of the fundamentals of primary care in a remote setting (e.g. home visits, healthy practices, preventive measures, warning signs of serious diseases, basic supportive care, basic clinical assessments, first aid, water treatment, and hygienic practices), because without these basic tools it is difficult to serve and care casino for their communities’ health. Their jobs are indispensible. These men and women are humans with dignity and hearts and minds just like you and me and they deserve well-earned respect. Fulfilling a need in a place like this requires more than money and power. It requires approaching the situation/problem with the people and strategically thinking how we can work together to solve the issues in a culturally competent and sustainable way. I truly believe CU Peru is doing just that, and as an organization they are always striving for quality improvement. We are there to partner with the already existing local health care systems and deliver these trainings. We could not do this without the help of the local health officials and local medical students. We are therefore a collaborative project working together to provide health education essentials to these promoters. We are showing them the respect they deserve.
Every adventure starts with an idea, and every idea becomes a dream. My adventure to Peru started with an idea a few years ago that I one day I would go back as a professional and participate in community health work. I didn’t know the details, but I knew I would go back to serve. My classes didn’t prepare me for every aspect of being in Peru. Some things I just had to be there to experience. The work it takes to organize and host a training session for 50 people is tough. The cliché, “Teamwork makes the dream work,” proved to be true once again. This training could not have happened without CU Peru, SOCIEMAP, and MINSA working together. The people, the long days, the heat, the rain, the mosquitos, the tears, the joys, the triumphs, and the friendships made this a unique experience for all of us, even the promoters. I can step back and say I am proud to be a part of an organization that is doing such great work. The members of CU Peru are motivated by more than good intentions and the ‘idea’ of wanting to make a difference –they are making the difference and the passion is evident. This experience, the memories and the friends I have made, and the lives I have touched and been able to influence would not have happened without CU Peru.
Becoming the intern and traveling to Peru to kick off the internship have exceeded my expectations. I thank all the members and supporters (past and current) that have shaped CU Peru into what it is today and I look forward to being a part of carrying on the legacy.
After a one-hour motor boat ride to Mazan and then a two-hour slow canoe boat ride to Llachapa we pulled up at an idyllic green hill on the side of the Napo River. Eager children approached us to help carry all of our supplies up to the school where we were staying. One little boy was only 3 years old and carried 2 large sacks of bread up the hill. As we passed by two rows of little wooden houses on stilts with people peeping out, it hit me just how rural this community was. Our whole team was excited and moved by how welcoming and invested Llachapa was in our visit.
We quickly sprang into action getting everything ready for the arrival of the Community Health Workers (CHWs) and the first day of the training. Our new partner, Teresa Benedez, from the Peruvian Ministry of Health (MINSA) helped us register the CHWs as they trickled in. I was excited to meet all of them and see what they knew and how they practiced in their community. After a year of being on the Education Committee and preparing a curriculum for these trainings, I couldn’t wait to find out what they had retained from past trainings and what new things we would teach them. After seeing that many of them needed help with taking a pulse and a respiratory rate we immediately began reviewing those skills in small groups and facilitating the more advanced ones to teach their colleagues.
Now it was time for dinner. We brought a ton of food, so much that I couldn’t even carry the 300 eggs that we brought. I had eaten in the jungle before. I knew to expect bones in my food and strange Amazonian fish. However, I couldn’t stomach the fact that I had a cabeza (fish head) staring up at me with its pearly eyes while Lida sitting next to me had the other half of this creature including the tail. I looked around me and saw everyone else happily eating so I offered my cabeza, a delicacy, to one of the other CHWs who appreciatively ate it.
The next morning we taught the CHWs about nutrition. Each small group had topics such as malnutrition, diet and growth charts. After each group had learned their topic, they presented it to the entire group of students. My group made a meticulous example of a growth chart and then taught everyone how to read one. Jaime, one of the older promoters in my group, explained that if a child’s growth crosses 2 or more growth lines then that child is in danger. Afterward, he explained to me that he was so thankful to know that someone (CU Peru) trusted him enough to teach him and his colleagues how to read a growth chart since he was never entrusted with that capability before and never had felt empowered to even ask to see a child’s chart in his community.
On our third day of the training we taught about malaria. This topic was well received by the CHWs especially during a time of increasing cases. They were engaged and asked questions about the lifecycle of the mosquito. They even asked if malaria could be transmitted by drinking water that contains mosquito eggs (it can’t, in case you’re wondering). During this lesson was one of the many times when our new partnership with Sociemap, a medical student group in Iquitos, came into play. Guillermo a 3rd year medical student accompanied us and taught the mosquito life cycle and facilitated a discussion among the CHWs on different points at which prevention could be implemented. This new partnership has widened our circle of influence and provided a cultural and regional link between CU Peru and the CHWs.
Things got competitive when we started a game of jeopardy about malaria. The students would run up to us to buzz in on the imaginary “bell,” which was slapping our hand. They were so into the game and almost always knew the right answer, even down to the tiniest details.
At the end of a long day of learning about malaria we started a game of Volleyball with the CHWs and some children from the community. Soon it began to sprinkle, rain, pour and then thunderstorm. We all kept playing despite being drenched, screaming and laughing and jumping in giant puddles. This was when I finally felt a strong connection with everyone involved: the CHWs, the community, the children; everyone was ready and willing to stick things out and work as a team even though it was pouring buckets on all of our heads.
The final day I was filled with excitement to test what we had taught our students. When Rolando, one of my most attentive students, stepped up to take the post test, I felt excited and nervous for his performance. He answered the test questions with such confidence and so quickly that I was taken aback and had to check to make sure that I had heard him correctly. At the end of the test, I looked back and he had gotten nearly every question right! I felt so proud of Rolando when I handed him his certificate and said “Felicitaciones” (congratulations). As I got into our “peke peke” (boat) and waved goodbye to the people of Llachapa, I felt a pang of sadness to leave the community and all of the CHWs. As I waved bye to them, I was fully confident that they were to return to their community with the knowledge and capability to change the lives of their fellow villagers.
2nd Year Medical Student
It was barely 5:00 am when the alarm sounded. I sleepily found some clean shorts, brushed my teeth and slipped my pack onto my shoulders as I headed downstairs. I dropped my bag in a stack of rice, hundreds of eggs and countless five liter bottles of water. After almost an exact year since I first learned about Comunidades Unidas Peru, I was finally headed onto the river for the 4th Community Health Worker (CHW) Training of this young organization. As I stepped onto the motorboat that would take me to Mazan, I felt a pang of nervousness flutter through my stomach. What was I thinking that I, a barely 2nd year Physician Assistant student, could teach them? The thought never occurred to me how much they would end up teaching me instead.
Mazan is just 45 minutes from Iquitos by motorboat, with one small cement “road” piercing into the heart of it. We hopped onto a mototaxi, which is essentially a small motorcycle with a covered carriage rigged to the back of it. As this shirtless Peruvian man drove our taxi down the center of the pavement and swerved to avoid colliding with another, I realized the days of smoothly paved roads with bright yellow lines and traffic laws were behind me. We arrived at the Maloca, a beautiful pavilion made of tree branches carved into posts and a thatched roof, and began setting up for our trainings. Registration took nearly all day before it was completed and as the CHWs began trickling in I saw the excitement and nervousness in their own You don’t want to be competing on the same machine month after month. That will get boring faster than watching paint dry. We finished up the afternoon with a large vital sign review and then took a bucket shower and crawled onto our mats in the single hotel Mazan had, completely exhausted.
The days began to blur together as we moved through our curriculum from how to use the index in Donde No Hay Doctor (Where There is No Doctor) to creating a makeshift splint from whatever materials they could find in their villages. I was so impressed by their skill and knowledge but even more so by their desire and will to learn every ounce of material we were giving them. I had envisioned the lecture on women’s health and obstetrics being a complete failure. When I first read through the curriculum I envisioned us trying to give a lesson on using contraceptives and the average length of a woman’s period to a group of machismo middle aged men, completely uninterested in what these American women were telling them. But somehow this lesson evolved into a discussion in which the CHWs seemed completely enthralled. They wanted to know how late in life a woman could get pregnant, how well contraceptives worked compared to family planning, how to help with a birth in an emergency, and the list went on and on. These men that I had so thoughtlessly assumed would tune out every word of this lecture, were yanking notebooks out of their back pockets to jot down each piece of new information that was being flung at them. I realized how little credit I had given them, some of whom had been the sole provider of healthcare to a community of 250 people for often times longer than I had been alive. They knew the needs of their community far more intimately than I could ever expect to understand.
As the trainings began to wrap up I found myself reflecting on all the information I had gained from the promoters rather than what we had set out to teach them, how much my perception had changed and how intensely I now understand the barriers and challenges each of them face on a daily basis. It reignited a passion I had felt when I joined CUPeru, only this time it was not in the sense of a teacher guiding a student, but as a compañera de salud (partner in health) supporting and learning equally as much from them as they learned from us.
Caroline Freed, 2nd Year PA Student