Journal, February 25

With Valentine’s Day on February 14^th, and the upcoming celebrations of International Women’s Day on March 8^th, countless events and workshops are being organized around women’s issues this month in Lima.   As Peru has one of the highest rates of sexual violence in Latin America, many of these events are seeking to address violence against women and families.  In 2011, the National Institute of Statistics and Information found that 4 in 10 women had been assaulted by their partners, with the majority being mothers between the ages of 26 and 35 with 1 to 3 children.  These alarming statistics speak to the culture of machismo and religious conservatism that permeates Peruvian and Latin American culture and perpetuates traditional gender roles and violence in society.  While the government is largely propped up by these values and has yet to seriously challenge them, it is beginning to work alongside civil society organizations to reduce violence, and has even been 

recognized internationally for its recent efforts.

As a volunteer at an Afro-Peruvian women’s organization, I have had the opportunity to attend several women’s events over the last few weeks, including two workshops on domestic violence organized by the Municipality of Brena, a workshop on identity and self-esteem organized by a women’s group in the poor urban district of Rimac, the launch party for a new book on Afro-Peruvian women’s slavery and resistance, and V-Day’s One Billion Rising. In addition, CEDEMUNEP is preparing to host our own workshop on identity and self-esteem later this week.  These events have provided me with a window into the contemporary and historical experiences of women in Peru, and some critical observations on approaches to women’s empowerment in the country.

While I commend the government for any efforts to reduce violence against women, I have to note the lack of men involved in these initiatives.  The workshops that I have seen have been directed at, and attended exclusively by women and children.  Participants usually receive a folder filled with brochures on violence and various community services, and they listen to short messages from representatives of various government and civil society organizations.  These messages generally focus on defining violence and helping women to recognize if they are in violent relationships, as well as informing them of the supports that are available to them in their area, such as help lines and free counseling services.  While this approach might help to empower women as individuals, I think that it is important that not all the responsibility for ending violence be placed on the shoulders of women.  As discussed in the literature on empowerment, successful empowerment initiatives must work to transform relationships and societal structures, as well as individuals.  If men, as the recognized perpetrators in most cases of sexual violence, are not educated and given the necessary tools to change their relationships with women, the situation will not improve.  One Billion Rising did a much better job of involving men, as the event was held on Valentine’s Day, and was attended by many couples. It also featured both male and female celebrities dancing side-by-side and spreading the message of non-violence.  However, I was concerned when the organizers celebrated the “safe space” that had been created at the event, thanks to all the (mostly male) police officers who were protecting us while we danced.  To me, male protection of women is just the flipside of male violence against women, because it perpetuates machista ideas of male dominance.  Therefore, their message seemed to empower men in the wrong way, and disempower women, which was unfortunately not at all what the organizers had intended.

It is exciting to see the growing women’s movement in Peru.  The countless groups that are emerging are making huge strides in raising awareness of violence against women and creating spaces for them to share their experiences and find support.  However, in the future I hope to see more widespread participation of women and men, and more careful attention to the underlying values that are perpetuated by the messaging of non-violence campaigns and programs.  Poco a poco.  Little by little.

Journal, February 11

            Over the last two weeks, CEDEMUNEP has been preparing to run health workshops in four Afro-Peruvian communities in Lima.  It has been interesting for me to work alongside my co-worker, Ada, who has volunteered as a community health promoter in Lima for over 10 years, and has a wealth of on-the-ground knowledge about public health in Lima.  On a quiet afternoon at work last week, I had the chance to interview her about her work, and it was an incredible opportunity for me to learn about the complexity of international development in the health sector.

In my 2^nd year urban planning course, People and Plans, we discussed the Social Determinants of Health (SDOH).  The World Health Organization (2013) defines the SDOH as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”  When it comes to diseases like Tuberculosis (TB), there is a strong direct correlation with unemployment, inadequate housing, malnutrition, social exclusion, and other dimensions of poverty.  In fact, when I asked Ada about the causes of TB, she never mentioned bacteria.  While she acknowledges that the most important part of her job is to take patients their medicines every evening, and supervise them to ensure that they never miss a dose, there is much more to her visits.  First, she observes her patients’ living conditions and communicates her observations to the health centre.  Second, she ensures that they have enough food, and provides them with baskets of rice, milk, and other staples if they are not receiving proper nutrition.  Third, she teaches them how to make simple handicrafts in order to take their minds off their disease, make them feel useful, and provide them with basic income-earning opportunities.  Fourth, she makes friendly conversation and provides emotional support and encouragement, as many patients are quite socially isolated and suffer from a lack of self-esteem.  Finally, she talks to patients’ families to dispel the myths and stigma around TB, and offer recommendations for how to prevent illness and support their family members through treatment.  All of these efforts contribute to a patient’s ability to complete their treatment regimen and recover. 

Socios de Salud in Lima, 2011

Ada's account of her daily work in community-based Directly-Observed Therapy, Short-Course (DOTS) illustrates the complexity of TB and its treatment.  For decades, the Peruvian government struggled to deal with the growing TB epidemic because of their simplistic, top-down approach. Not only did treatments fail in more than half of cases—many patients that failed to complete their treatment regimens developed cases of Multi-Drug Resistant TB (MDR-TB).  Fortunately, in 1994, the not-for-profit organization Socios en Salud (the Peruvian sister organization of Paul Farmer, Jim Yong Kim, and Ophelia Dahl’s Partners in Health) began to offer assistance to Peru’s Ministry of Health, based on their experience of successful community-based TB treatment in rural Haiti.  Socios first worked with poor residents of Lima’s shanty towns to conduct community surveys, which revealed many of the aforementioned social barriers to effective treatment.  The organization then began to train community health promoters in DOTS, and design individualized treatment plans for MDR-TB patients to help surmount these barriers.  These initiatives were highly successful, and went on to revolutionize TB treatment in Peru and around the world. 

The history of TB treatment in Peru, along with Ada’s account of her experience as a community health promoter, serve as important reminders that complicated solutions do not work for complex problems in international development.  When the Peruvian government and the WHO relied on best practices in TB treatment, they were unsuccessful in treating patients who faced more significant social challenges, and they were unable to respond to the unexpected emergence of MDR-TB.  It was Socios en Salud’s innovation that finally led to a solution for outlying cases.  Furthermore, Socios proved that treatment must be holistic, considering an array of medical and social factors that lead to sickness and impede treatment. They also demonstrated the importance of approaching complex problems from the bottom-up, treating cases on an individual basis so that people do not fall through the cracks of a large, impersonal health system.  And finally, they showed us that TB treatment requires constant attention and monitoring, because people’s lives and health are always in flux. Community health promoters must constantly collect information about their patients and their environments, in order to respond effectively to their situation and determine an appropriate course of treatment.  These lessons in solving complex problems are crucial for international development practitioners to understand, and they will stay with me as I continue to work in this field.

References

World Health Organization. (2013). Social determinants of health.  Retrieved 7 February 2013 from http://www.who.int/social_determinants/en/

Journal, January 28

Two weeks ago, I had the incredible opportunity to attend the 6^th International Congress of Youth Environmentalists in Concepcion, a small town in the central highlands of Peru.  Under the theme “Ecological Challenges in the New Millennium,” more than 200 people from Bolivia, Chile, the United States, Germany, Canada, and 6 departments of Peru participated in the event.  The main events of the conference included presentations by experts and youth, an educational fair, visits to the regional eco-protection centre and wastewater treatment plant, and a protest at a government health building.  As well, we enjoyed an exhibit of youth environmental photography, a play by a local youth theatre troupe, and a cultural night where all of us shared the music and dance traditions of our home countries.  It was thrilling to take part in this dynamic event, and come together with like-minded youth from all over the world who were working to address their local environmental realities.

As the conference took place in La Sierra (Andean region) of Peru, and many participants came from Andean communities in Bolivia and Chile, a common theme among these local realities was the environmental devastation caused by mining activities.  While the North American delegates were warmly welcomed to the conference, those from South America openly expressed their anger toward the North American mining companies that were contaminating their lakes and rivers, poisoning their children, and mutating their animals.  They did not understand how these companies could be allowed to cause this damage in South America, but not in their own North American backyards.  This was a difficult question for me to swallow, but it was one that I was prepared for.

For my presentation, I had chosen to discuss Idle No More, an indigenous movement that was consuming (or rather, being consumed by) Canadian media at the time, but that had hardly reached the Spanish-speaking world.  I had intentionally chosen this topic in order to start breaking down stereotypes about “development” in the North, and raise awareness about First Nations social and environmental issues.  Most importantly, the presentation allowed me to build solidarity and a sense of common purpose between the Northern and Southern environmentalists present at the conference. 

Through Peace and Conflict Studies courses I have taken at UW, as well as through my work with the Centre for Black Peruvian Women’s Development, I have seen how the work of building international solidarity networks is foundational to movement building.  Not only do these networks facilitate knowledge sharing and collective actions, they allow activists to scale up successes by strategizing together and turning isolated local activities into calculated steps toward structural reform.   And with the social networking tools that are now available to us, the 21^st century is a better time than any to build these connections.

While it is exciting to take part in this work, it is clear that the environmental movement is not yet at its peak.  We are still in an organizational phase, in which individual groups are working for limited reform.  Although some of these organizations are now forming alliances, they have yet to attain the transnational cohesion and power of the corporations they are trying to confront.  But at the conference, I could feel the winds changing, and I sensed that when the youth environmental movement fully emerges, it might be Southern-led.  While many Canadian activists like me struggle passionately on behalf of small island nations and vulnerable Inuit communities, the truth is that we tire easily, because in the end, it does not always feel like our own lives are at stake.  But the Southern activists that I met at the conference have everything to lose, and they have dedicated their lives to the struggle.  They are going to university with specific goals, and returning to their communities 5 years later to work passionately, tirelessly, and skillfully to protect the environment.  It was inspiring to witness their dedication and professionalism, and I am excited to see a global environmental movement with these youth at the helm.  

 

Journal, January 14

Water, water, every where, Nor any drop to drink. These words came to mind as I turned on the tap in the riverboat bathroom, and watched a brown stream of water wash down the drain, and back into the Amazon River. Although the other passengers readily washed themselves with the water, I could not ignore the fact that our raw sewage and garbage were being dumped into the same water. The situation hardly improved when I arrived in the city of Iquitos, where I was to be spending my New Year’s vacation. Even at the Camiri Floating Hostel, potable water was scarce and the toilets flushed directly into the water in which the hostel was floating. These experiences saddened me, but I was not prepared for the experience that was Belén.  

Belén is an extremely poor shantytown of 65,000 people in the floodplain of the Itaya River, on the outskirts of Iquitos. This city on stilts, also known as the “Venice of Latin America,” has become one of the tourism highlights of Iquitos, and visitors can hire guides to give them one-hour motorboat tours of the district.  It was certainly the most interesting part of my trip to the Peruvian Amazon, but I left with many concerns about the area. When we first got into the boat in the Belén Market, the smell of the polluted water was so bad that we were all holding our breaths. Garbage clogged the alleyways, and the stagnant water provided a perfect breeding ground for mosquitoes.  One can imagine our surprise when we saw children swimming. Our tour guide, a resident of the area, explained that residents regularly swim, bathe, do laundry, and wash dishes in the water. This leads to a high incidence of water-borne diseases and drownings. Besides these and many other profound health issues that result from a complete lack of sanitation and waste management, residents suffer from a lack of electricity, education, and employment, and encounter significant violence in their homes and communities.

Belén is a poignant illustration of the spatial dimensions of poverty. Around the world, the poor are found living in densely populated, marginal areas, where potable water and other natural resources are scarce. The residents of Belén are extremely vulnerable to natural hazards, and have suffered terribly from environmental degradation following the severe flooding of early 2012.  Not only was their infrastructure affected, there were thousands of injuries, and the floods brought malaria- and dengue-carrying mosquitoes to the area. The risk of natural disasters such as this will only increase as climate change continues to affect precipitation patterns in the Peruvian Amazon. On the other side of the poverty-environment nexus, the residents of Belén contribute significantly to environmental degradation through the disposal of garbage and untreated sewage into the river. Our tour guide explained that most people are unaware of the impacts of their actions, but even if they were aware, there is no waste management system. Consecutive mayors have been elected on promises to bring development to the area, but they have not followed through. One mayor apparently even had the courage to say that it was not his fault if people chose to live in marginal areas. This lack of political will leaves many residents feeling hopeless. It was hard to imagine that conditions would improve for them in the near future.

Our tour guide did seem to be optimistic when we asked him about the role that tourism is playing in Belén’s development and his own life. While his neighbours are struggling to find work in such a marginal area, he is thriving as a self-employed tour guide. This path, however, is inaccessible to many. When I asked him if most people in Belén work in downtown Iquitos, he said that it is too far away. In reality, it is only a few blocks away, showing that the class difference between the two areas is more of a roadblock to employment than geographical distance. He further explained that it is difficult for Belén residents to work in Iquitos because of their poor education. Even working in tourism requires knowledge of English.  It seems that economic development in Belén should be the government’s first priority, as it would bring much-needed income to the area, which would allow for taxation and services such as electricity and waste management.  In the meantime, however, the people of Belén have urgent needs for health services and education that could be met by NGOs.  I have hope that conditions in Belén will eventually improve as this young community becomes more established, and I think that aid could play an immediate role in Belén’s relief and development.