Getting to the Town above the Clouds

The locals call Pampas Grande "El Balcón Suspendido entre el Mar y el Cielo," translated as "The Balcony Suspended between the Sea and the Sky." Once you're there, you understand why. On a clear morning, you can see all the way to the Pacific Ocean. But later in the afternoon, when the clouds roll into the valley below, you realize that you're quite literally standing in the sky.

Getting to the balcony is no piece of pastel. This year, Sean Byrne collected GPS data on the last leg of our drive up the mountains, which is summarized in the image below. As you can see, while this portion of the drive was just over 57 miles, it took us about 4 hours to reach Pampas Grande-- meaning that our average speed was 14.5 mph. This tortoise's pace is more understandable when you see that we actually went 2 and a half miles upward. (See all the zig-zags?) It's no wonder that we're gasping for oxygen by the time we arrive.

Sean's GPS data shows us just how geographically isolated our site is from...well...everything. For people that live here, this makes finding and getting to health care a challenge. Even people that live just a 15 minute's drive from Pampas Grande often travel over 2 hours by foot or donkey to see the physician in the health post in Pampas Grande.

We've been trying to come up with ways to combat this geographical barrier to health care. For instance, this year during our visit, Dr. Paula Tamashiro, a physcian from Peru with whom we work closely, arranged for our van to go to each of the nearby villages to transport people to the health post. Additionally, University of Richmond students have donated a truck to be used as an abulance, should anyone from the community need to be transported to the hospital in Huaraz.

Check out this article about the efforts of the Institute for Electrical and Electronics Engineers to set up an infrastructure for telemedicine in remote areas of the Peruvian jungle: Providing Telemedicine to Peru's Medical Outposts. Perhaps this model could be used in Pampas Grande to increase access to medical specialists in Lima or other areas of the world. It is certainly an idea to explore further!

Our Experience in Photos

On this year's trip, so many people in our group went above and beyond to capture our experience in Peru. In fact, two students, Jigna Solanki and Stephanie Stahl, have entered some of their breathtaking photos into the University of Richmond's Spiders Abroad Photo Contest (found here.)

Enjoy these photos, and visit our Facebook page for more!

Lessons from Pampas Grande, Again

Blogging now from La Paz airport (13,000 ft above sea level), where--like Pampas Grande-- we're once again having to work a little harder for our oxygen. We're waiting here for another 4 hours or so, when our plane will embark on a 9 hour flight to DC.

This year's quest to Pampas Grande and back was another empowering, insightful, uncomfortable, frustrating, sometimes disturbing, wonderful experience for me. This trip marks my third visit to Pampas Grande, and for the above-mentioned reasons, it has been the most fulfilling yet.

I know I'm sounding counter-intuitive here. Uncomfortable? Frustrating? Disturbing? Immediately, It doesn't make sense that these feelings can untimely culminate in fulfillment and accomplishment. That's the funny thing about Pampas Grande-- each time I go, I learn a new public health (and life) lesson that I never saw coming.

My time in Pampas Grande was uncomfortable because I had to adjust nearly every nuance of my voluntary and involuntary behavior. Seriously, you name it-- speaking, eating, sleeping, getting from place-to-place, being on time, showering, and especially breathing--it's all done differently than back at home. It seems simple, but it genuinely takes up so much energy.

My time in Pampas was frustrating because I couldn't communicate as proficiently as I would have liked. Although I can hold a simple conversation in Spanish, there is definitely room for improvement with my language skills. Still, language isn't the only barrier here; there's a cultural one, too. If you can take a moment to picture a modernly-dressed, blonde-headed, Spanglish-speaking girl in an isolated, rural, Andean community in Peru (where many people have never traveled outside their district) you can see where I'm going with this. Plus, with no cell phone reception and RGHA team members constantly working at different places in the community (school, library, clinic), it was extremely difficult to communicate with one another. Maybe next year we should figure out a smoke-signal system or something. Someone proposed guinea pig couriers. Just a thought.

My time in Pampas Grande was disturbing because I saw serious health outcomes that are completely preventable. For instance, a two-year-old boy came into the clinic with six teeth rotten below the gum. The dentists extracted each of them over the course of two days. The damage was so bad that the dentists predicted that his developing adult teeth were already harmed. I wish I could say this is uncommon, but the dentists most frequently performed cavity fillings and extractions, from people aged 2 to 90 years old. Seeing the two year-old with a mouth-full of dead teeth just irked my core because it didn't have to happen. We know easy, relatively inexpensive behaviors that can prevent this. So why is dental health so poor in Pampas Grande?

For me, each element of my discomfort, frustration, and disturbance yielded an over-arching reaction: Do I understand how people live here, and how can I work to help people here lead healthier lives? To get to this point, I've had to experience a small slice of the lifestyle in Pampas (I say "small slice" because our living quarters are quite comfortable and clean and we get to eat three square, delicious meals a day). I've had to work alongside the communication challenges that often hinder health intervention programs from working. And finally, I've had to see with my own eyes the preventable health disparities. With this experience, I am more equipped to analyze what I can do to help the people in Pampas Grande achieve better health and wellness.

I believe that our group is on the right track with making better possible in Pampas Grande. We saw more patients in clinic (in Pampas and nearby Shancac) than ever before. We have implemented long-term, evidence-based health prevention efforts for skin damage and joint pain. We interact with the community through projects, meals, art, and festivities in order to build trust and cooperation. We are collecting survey data in order to form hypotheses about future health interventions. And finally, we are preparing for a longer-term visit to the community.

Personally, I know that what I have learned on this trip is an invaluable tool that I will use in all of my endeavors in public health. I don't have the answers yet, but this summer, I hope to put this tool to good use for Pampas Grande as I take the position of the first employee of the Richmond Global Health Alliance.

Salud para todos.

Blair Armistead, B.S.
Candidate, Master of Public Health
Virginia Commonwealth University
RGHA Intern, Summer 2012

P.S. - Pictures to come, I promise.

Arrived in Peru!!!

(David excited about the bus ride while everyone sleeps)

After a long plane ride with a short stop in Bogota to switch planes, we arrived at Jorge Chavez Airport in Lima, Peru where we were greeted by our favorite dentists - Sandra and Erika - and our favorite doctor - Paula.

We met Clemente - our driver this year and highly recommended by Gustavo (our driver of our previous trips) and started the long process of loading our bags to the roof of the bus.

We are traveling tightly this year with all seats taken. There are 18 of us from the USA, our 2 dentists - Sandra and Erika, a translator - Adela (younger sister to Carla - our translator last year), and a five member band - Motif. The band will be doing a music workshop with the kids in pampas and its exciting to share music tastes with them. (Antonio - the lead singer - and I bonded over our love for Dispatch and I shared some live albums I have!).

(The sleeping students.)

After a long trip from 3 am to 11:30 am, we made it Huaraz! Checking in, lunch at a familiar restauarant, some opted to sleep, but most went for exploring. We checked in at Cafe Andino and enjoyed coffees and local Huaraz microbrews and followed our beverage break with a visit to the Regional Archaeology Museum of Ancash which has an impressive collection of ancient stone sculptures.

Right now, we are resting in the hotel and getting ready to head to dinner. We can feel the altitude here at 8000 feet so some acclimatization is already needed. We'll meet over dinner to finish prep on our projects and then break for the night. Tomorrow we face a 5 hour climb to Pampas Grande. The true distance is very short but the roads make the trip long.

We will post some pictures tonight!

Sid Dante
M4, VCU School of Medicine
Vice-Chair, Richmond Global Health Alliance

High Altitude and Healthy Skin: A Public Health Concern

Last spring, education officials in Cusco and Arequipa, Peru issued a mandate for all school children to wear hats during the day in order to protect children’s skin from sun damage. The education officials made this decision in response to a recent study released by the Peruvian Dermatological Society, which showed that over 70% of randomly selected young adults in the region had abnormal skin pathology. Elevations in these mountainous regions reach around 12,000 feet above sea level, and UV levels often exceed those that are considered dangerous to the skin.

In Pampas Grande, where the altitude is around 13,000 feet above sea level, many children who visit the clinic complain about lesions on their skin, most commonly blotchiness on their face and cheeks. In a group discussion, the Richmond Global Health Alliance came up with the hypothesis that sun exposure is causing this skin damage. Under the leadership of first-year MCV medical student Morgan Vargo and pediatrician Sean McKenna, RGHA organized an observational study looking at the effect of sunscreen on the symptoms of damaged skin. For the study, a group of volunteer middle school-aged girls agreed to apply sunscreen to their faces every day before school and to be photographed periodically at the clinic. Changes in skin symptoms will be compared to girls who did not apply sunscreen every morning.

Sean Byrne with two brothers in Pampas Grande. Like many children in Pampas Grande and surrounding communities, these boys have slight red irritation on their cheeks. RGHA is actively seeking a solution to help reduce these visible symptoms of skin damage.

In the future, RGHA hopes to continue increasing awareness in high-altitude Peruvian communities about the possible negative effects of sun exposure to the skin. Although few data exist on the effects of sun exposure at high altitudes and skin cancer, RGHA will work go gather information about this serious health outcome in these regions.

Experiences in Peru: Medicine, Education and Life in the Andes

Our upcoming fundraising event, Experiences in Peru: Medicine, Education and Life in the Andes, will be held on Saturday, November 12 from 6 to 8pm at the Lora Robins Gallery (next to Boatwright Memorial Library) on the University of Richmond campus. Come and enjoy light refreshments along with a brief lecture from pediatrician Dr. Sean McKenna (top vote-getter for Richmond Magazine's Top Docs of 2011) and a gallery of beautifully embroidered Peruvian tapestries (achachis) and breath-taking photographs of our adventures in Peru. Donations are greatly appreciated, and checks can be made payable to the Richmond Global Health Alliance.

We look forward to seeing you there!

Our Projects in Pampas Grande in the Spirit of the Girl Effect

The Nike Foundation’s Girl Effect places its focus on the potential of young women to transform the developing world. The Girl Effect presents strong evidence that investing in a young girl will not only help break the cycle of poverty, but will give her the chance to dictate her own future.

Just watch one of the Girl Effect’s videos, and you will be moved by this organization’s message—that girls are the most powerful force of change in the world.

RGHA too believes in the power of young women to have significant positive impacts on their communities. Three years ago in Pampas Grande, University of Richmond students saw leadership qualities in Leidi, a high school student. The students met Leidi when she performed songs to welcome and thank RGHA for visiting Pampas Grande. Later in the week, during UR student-led discussions in the Pampas Grande high school, Leidi courageously voiced her concerns about her community and how it could be improved. A year later, in a UR student-led interview, Leidi expressed her desire to go to college to study music, and then return to Pampas Grande to be a teacher and a leader in her community.

Led by 2011 University of Richmond graduate MaryGrace Apostoli, RGHA raised enough funds to pay for Leidi's tuition at Jose Maria Arguedas' National Superior School of Folklore in Huaraz, Peru, to which she is expected to apply upon her high school graduation in December. If accepted to the program, Leidi will be the first person in her family to leave Pampas Grande to pursue higher education.

RGHA is looking to continue its investments in girls' potential to create positive outcomes for themselves and their communities. Projects involving microcredit loans and other entrepreneurial aid for women are in the works, so keep an eye out for updates.

Note: Although RGHA believes in the transformative power of young women, it is not officially involved with the Girl Effect or the Nike Foundation.

Pampas Grande's Food Revolution Could Present Challenges

Jamie Oliver, a Food Network chef and vocal advocate for fresh, nutritional food, is dedicated to educating people on how food affects health, happiness, and finances. His Food Revolution project, created in response to the obesity epidemic throughout the United States, places life-saving power on cooking good, fresh, non-processed foods. In 2010, Jamie Oliver was given the TED Prize for his ideas about the significance of cooking skills in the effort to create a healthier nation. (You can find Jamie Oliver's TED talk here.) According to Jamie Oliver’s Food Revolution website,

“The [obesity] problem stems from the loss of cooking skills at home and the availability of processed foods at every turn, from the school cafeteria to church function halls, factories and offices. This Food Revolution is about saving lives by inspiring everyone: moms, dads, kids, teens and cafeteria workers to get back to basics and start cooking good food from scratch.”

Pampas Grande, Peru is a community that does not have a high prevalence of obesity or processed foods, but could most likely benefit from a food revolution of their own. In Pampas Grande, and in many rural Peruvian communities, food is obtained from subsistence agriculture. The climate and soil conditions in the Andes Mountain region, however, are not suited for the sustained growth of highly nutritious fruits and vegetables. Instead, high-starch and carbohydrate crops like potatoes, which can grow through the temperature changes and low moisture conditions, make up a large portion of Pampas Grande villagers’ diets. In general, meals in Pampas Grande (and in other similar communities in Peru) often consist of a potato, a meat (chicken, beef, pork, rabbit, or cuy…if you’re lucky), and a carbohydrate (such as rice, noodles, or bread). Most of the people in the community receive only a fraction of the USDA’s recommended nutrient intake during mealtimes.

Chicken noodle soup prepared for us in Pampas Grande. They have this stuff down to a science.



Along with Pan Peru, the Richmond Global Health Alliance is looking to combat the lack of available nutritious foods in Pampas Grande through building community greenhouses. The hope is to make more fruits and vegetables available to the people in the community so that they can cook with them throughout all seasons of the year. In accordance to Jamie Oliver’s Food Revolution, making good, nutritious food available can help people lead healthier lives. Jamie Oliver adds to this goal by empowering people to learn how to cook delicious meals with these foods—not just making healthy foods available, but teaching people how to cook them.

In Pampas Grande, implementing a cooking skills program to the greenhouse project could bring up some ethical and cultural challenges. When Jamie Oliver visits communities in the United States and teaches people how to cook, he is arguably teaching people how to put a healthy twist on the foods they already eat (even though he is technically a foreigner). For instance, instead of eating heated up, frozen, processed pizza, he might encourage someone to bake their own pizza, using natural crust, tomato sauce, and lots of veggies. Or, instead of a milkshake ordered from the fast food window, he might suggest a homemade fruit smoothie.

For us, though, teaching others how to cook with different ingredients might be a little bit more challenging. The people in Pampas Grande and similar communities have been eating these foods and dishes for generations and have strong cultural ties to them. When we visit Pampas Grande, all meals are prepared for us by women in the community. They use a tremendous amount of their resources making traditional Peruvian dishes for us, for which we are so grateful. They are proud of their food, and should be, since it tastes delicious and reflects a part of their daily lives. How could we, then, enter this community kitchen and say, “here, try cooking like this,” or “try adding this ingredient to your dish”?

It’s a difficult predicament to be in. We most definitely want people in the community to place healthy, nutritious foods into their diets for their health and wellbeing (which undoubtedly involves changes in or additions to recipes). However, we would never want to show them disrespect by conveying a message that a cultural staple in their lives (of which they are experts) isn’t good enough. It is possible to help people in Pampas Grande have more nutritious lives, but as we implement our greenhouse program, we must be aware of the cultural ties that are linked to food preparation and mealtimes and that we are but guests in the community.

Do you agree that efforts to promote nutrition could bring up some of these issues? What are your ideas for helping people have healthier diets in Pampas Grande? How is Pampas Grande similar and different to communities in which Jamie Oliver has worked with his Food Revolution, such as Huntington, WV? We’d love to hear your thoughts. Feel free to post and leave links to other sources about this topic.

Here's a picture of a dish we were served at lunch in Pampas Grande. Cuy with rice, alongside chicken noodle soup. Very tasty!



Jamie Oliver's Website: http://www.jamieoliver.com/
Jamie Oliver's TED Talk: http://www.ted.com/talks/jamie_oliver.html
Jamie Oliver's Food Revolution: http://www.jamieoliver.com/us/foundation/jamies-food-revolution/home
USDA's My Plate: http://www.choosemyplate.gov/