My six weeks in Peru are based in the Río Urubamba Valley, also known as El Valle Sagrado (the Sacred Valley). A region surrounded by the Andean mountains, inhabited by descendants of the indigenous Incan people of Peru. The Peruvian health care system is considered a model for most South American countries- it is a blend of public and private services. This region has Health Centers, which are staffed by a physician, and rural Health Posts staffed by a nurse and a midwife- these posts were created to increase access in rural communities, but most of the time are not staffed by a physician. However, the people of indigenous and rural communities continue to have significant barriers in terms of access to care. This is where FNE International comes in- they have developed a strong relationship with the communities in the Sacred Valley as well as the Peruvian nonprofit Asociación Wiñaypaq Pro Desarrollo Human. Their goals are similar as well; to increase access to healthcare and create sustainable change through health education projects. Twice a year FNE International runs a week of clinics in these rural communities with PA students and American healthcare providers, providing free quality healthcare. They also provide support for the projects of Asociación Wiñaypaq- currently FNE is helping to fund a “psychoprophylaxis” class for pregnant women of these regions that helps prepare them for birth and motherhood.
But first, some background- my familiarity with Peru began with FNE International in June of 2015 during one of these week-long medical trips. It was the summer after my first year of PA school- I had traveled to Nicaragua with FNE for the first time a few months before, and had been inspired by the quality and sustainability of the work to return as soon as possible, this time to Peru. We ran a week of clinics, traveling for hours each day to reach communities in the Andes that do not regularly have access to health care. A year and a half and two more trips to Nicaragua with FNE later, I returned to the Sacred Valley in December 2017 with FNE once more, but this time as a third year PA student for both an FNE medical trip and one of my clinical rotations. FNE International helped facilitate an Internal Medicine rotation for us with the physician they work with in the Sacred Valley- Dr. Francisco Morales.
Our first week this year was a week of clinics run by FNE International, again with American health care providers and PA students, with the same goals of providing free and quality healthcare to those that do not regularly have access to care. These days are long and hectic- crowds of people including pregnant women, the elderly, infants, and many many children. They come from nearby towns or mountain villages- many on foot hiking for hours. They come with a variety of complaints ranging from acute illnesses needing immediate attention to years of chronic pain. We found new heart murmurs in the very young and the elderly, and performed transthoracic echocardiograms with our portable ultrasound to see if there was a structural heart defect. (Lacking a cardiac probe, the incredible Brigham and Women’s PA Hana Dubsky performed these with an abdominal probe on an ultrasound screen half the size of a laptop). From a 10 month old with a likely Ventricular Septal Defect, to a 70 year old with Tricuspid Regurgitation due to her severe lung disease, we were able identify the source of their murmur and make appropriate cardiology referrals. With this ultrasound, we scanned over 50 pregnant patients to ensure the fetus was developing normally. We helped explain to parents of a child with newly diagnosed Autism what to expect, and where they can find resources. We provided wound care to a girl in her 20s that was dragged by a bull, and a woman in her 50s with a recent above the knee amputation. We also were faced with a case of domestic violence. These cases were intense, but just as important were the hundreds of UTIs, cases of dehydration, viral illnesses, parasites, chronic arthritis, GERD, and plantar fasciitis that we treated. No matter the severity, each patient had a complaint that interfered with their quality of life in some way. Giving quality care and treating each individual with importance is the first step in making a sustainable change- a concept my work with FNE International has taught me the true importance of.
The following five weeks would be an Internal Medicine rotation with the same physician FNE International works with to coordinate these clinics- Dr. Francisco Morales. I am currently on the fourth week of this rotation, along with Lauren Mazzola, the PA student that brought FNE International to our PA school and organized all of our medical service trips from the very beginning. We mostly work at Centro de Salud Pisac- a health center in the Sacred Valley, but also participate regularly in medical campaigns organized by Dr. Morales. The medications we use during these campaigns are fundraised for and provided by FNE International- therefore we are able to continue to provide free quality care, while experiencing an unparalleled learning experience. We have run a campaign for the elderly in the region of Calca, attending to over 100 older adults. Just as important as these large clinics have been our smaller trips to villages in the mountains. In the Andes village of Umachurco, we attended to only 15 patients, but for the most part those patients do not have means of travel to get to a health post for care on a regular basis. The impact is bigger than the numbers- it is in the quality of the care provided.
My time in Peru with FNE International and Asociación Wiñaypaq has taught me that the meaning of sustainability. That the smallest changes made over time can impact the quality of life of a patient, their family, and even an entire community. And sometimes the education you give the patient is what makes the true long term impact, not the medications. Working within the established healthcare system will encourage the utilization of said system and increase its strength. The need for access to care is a concept transmittable to the United States as well- learning how to be involved in public health issues will make us better providers as a whole. I will always be thankful for this opportunity, as it has and will continue to shape my career and who I am as a person.