Defining Community Health: lessons from Piura, Peru
We are greeted in the narthex of Santísimo Sacramento parish each morning with a chorus of horns as motorcycle taxis, cars, and pedestrians mingle at the stop light in front of the church. This parish is teeming with life and activity; the expansive entryway that looks out onto the street is scattered with parents bringing their kids to school or moto taxi drivers waiting to chauffer their next passenger. With this in the background, our group of nursing students along with whichever group is staying at the parish on this given week, joins hands in prayer before loading up the vans or taking off on foot on our morning rotation.
This year marks the eleventh year that Marquette has offered a nursing study abroad program in Piura, Peru’s sixth most populated city. Ten of us nursing students are completing our community and maternity month-long clinical rotation guided by two phenomenal and global-health-conscious Marquette nursing professors. Our rotations include learning from Peruvian nurses and community health workers as we work alongside them at various clinical sites such as a hospice, prenatal clinic, nursing clinic, nursing home, physical therapy clinic, a hospital maternity ward & neonatal unit, school, and home visits. Our daily practicum is supplemented by weekly assignments and readings about global health as well as group reflections to process the encounters that we have with patients.
These past couple of weeks have taught me much about the values of this community, and have led me to reflect on my perceived differences between the Peruvian healthcare system and the healthcare system in the United States. Availability of resources is a constant theme. Back home, I take it for granted that the hospital supply room will be stocked with all the necessary supplies when I need to perform a sterile wound dressing change. Here, nurses are challenged to do the best that they can to maintain a clean environment for optimal wound healing. Much of the supplies that are utilized here come from other countries and their supply of medication relies on donations from the United States or local laboratories. Because of this, there is no guarantee that a certain medication will be readily available in stock at the parish. When this occurs, the clinic does their best to fulfill the patient’s needs with the medication that they have. This has brought up conversations about foreign aid sustainability and how to navigate being global citizens aware of health disparities around the world, active in working to eliminate disparities yet cautious as to not disrupt people and culture. This includes exploring ways to properly invest in the nation’s own healthcare resources to build up their economy.
Another difference that I have seen is the amount of attention that the Piura community places on community health. A few of our class discussions have centered on the question of whether or not healthcare is a right or a privilege and what the answer to that question is here in Piura. From my experience working in the community, I believe that healthcare is considered a right. Policy and politics aside, the people in this community value health and treat it as a right. The parish that we are staying at has a clinic in the basement for prenatal care and for nursing consultations. Additionally, they have an operating room that was utilized to perform operations that removed cataracts during our stay. The parish not only tends to the spiritual needs of its parishioners but also directly offers resources to optimize health at a free or reduced cost. The clinic consultations here are free and they work with local physicians to offer reduced prices for referrals to specialists or further testing. Home visits are also run through the parish in which a community health worker or nurse goes to check in on parish members. The collective sense of taking care of one another and in particular prioritizing health further reinforces the mindset that healthcare is a right. In the United States, health is not integrated into the community life as it strongly as it is here. Our culture back in the United States does not capture this same communal value for health. As I anticipate my return home, I will bring back a greater appreciation of the power that community has on health. My passion for preventive and primary health care has been strengthened through this experience and I believe that a greater urgency towards preventative care could transform how we view health in the United States.
I have held more hands here in the past few weeks than I have in the past year. I’ve held patients’ hands to ease pain of an injection of a nerve block in preparation for cataract surgery and to calm fears before a procedure. Hands stretched out in prayer. Hands held in comfort with a grieving mother when there simply aren’t words. Healthcare is more than treating a disease or fixing a problem; the most powerful lessons I have learned here have taken place with my hands clasped with another’s in moments of shared humanity, because that crosses cultural divides.
Maria Casey is a nursing student at Marquette University.