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Reflections from Peru & the Impact of COVID-19 on Lower-Middle Income Communities


As COVID-19 continues to change the way that we operate in the world, our staff and WISH Revolution Collaborators are reflecting back on a recent trip to Peru, just a week before the “Stay-At-Home” order was put in place. A few weeks ago we shared some details with you about the goals of this Peru trip in another blog post.

Recently Marlee Krieger, Executive Director for the Center for Global Women’s Health Technologies, interviewed Libby Dotson, Research Associate at GWHT, and Andrea Thoumi, Research Director at the Margolis Center for Health Policy. During this interview, the three discussed their experiences in Peru during Spring Break as well as how COVID-19 will impact both Peru and the United States.

This week and next week we will be sharing some key points from this interview as our team continues to think about the ways that COVID-19 is impacting the healthcare system.


 


COVID-19 has highlighted the paradoxes and inconsistencies that exist in every country. In Peru, the country has been growing at approximately a 6% growth rate. However, the healthcare rate has a huge inequality. This is because the Peruvian government has chosen to invest in the productive sectors of the economy, a strategy that is adopted in many lower-middle income countries.


The pandemic has highlighted the structural inequalities that are entrenched in the society. The Bass Connections students could see firsthand the roots of the health disparities in Peru. This disparity can happen in any country. In fact, in the United States we are currently seeing how social determinants of health are the root of the health disparities within populations.


In Peru, COVID-19 is hitting the lower income areas the most.

One of the Hope Peru Ladies who was able to test out the low-cost devices developed by GWHT.

Moving forward, essential services such as reproductive health and primary care will need to re-think the model of how care is being provided. This means not only strengthening primary care, but also imagining various interventions such as the Pocket Colposcope and the Callascope that can be used in different clinical settings.


It is important to think about tools that can be used in different locations, whether that is a tool for use in a nearby facility, or a tool that women can use in their homes.


In August of 2019, members of our team went to Peru and were joined with engineers from leading companies. We saw how the engineers took the time to identify local problems and then identify local solutions. This looked like developing low-cost technology that is based on addressing local problems.


Hope PERU has a partnership with Cayetano University and the Catholic University of Peru; this partnership is one pathway forward.



 

COVID-19 has shown that the majority of Peruvian households are not prepared. This ties back to the social inequities that exist across and within countries. In Peru, the average household only has 4–6 weeks of savings at best. The majority of workers in the country are day-laborers or workers employed in informal sectors of the economy.


What that means is that a family might have savings to cover a couple of weeks of food or rent. But beyond that, they are not going to have sufficient resources.


In Peru, a number of families have been evicted from their houses which has resulted in an internal migration; people are leaving the cities and going to live in rural communities.


Twenty to Thirty years ago, the reverse was happening: families were leaving the rural provinces and going to Lima to find work. Now, due to COVID-19, Peruvians are going back to the provinces where they might have a plot of land that is owned by their family.


COVID-19 has also highlighted the systematic challenge of food security in Peru. We see this with lines at the supermarket where people are now waiting up to 8 hours day to get food. Because of these lines, the Peruvian markets have also been the hotspot for COVID-19.


Despite calls to close the market, people still need food to eat. Closing the market is not a feasible option. The challenge is that the average household does not have enough money to purchase food for a long period of time.


Another structural issue revolves around refrigerators. Only ⅕ of households have a refrigerator in their house. Without a fridge, households cannot keep food fresh for a long period of time. This adds to the need to go to the supermarket frequently.

 


The pandemic is exposing a lot of issues in rural health care. There is a lot of tension right now with people having to make the decision of either going back to work during the Stay-At-Home Orders or deciding not to feed their families.


There is a lot of partisan divide around this issue. Accessing health care & being able to support one’s family are really valid concerns that people are having, especially if the economy continues to suffer. It is difficult to see both sides: those who are fighting for restrictions and those who are fighting to reopen.


We are seeing that in rural areas, access to health care is a problem. Many of the primary care visits are booked out three months in advance So trying to get an appointment for reproductive healthcare in a rural area would be pretty difficult.


Some things that we consider “preventive,” such as an annual visit and getting a pap smear, are falling by the wayside because of the rise in telemedicine. While major cities and hospital systems are benefiting from the surge of telemedicine, many of the rural primary care facilities do not have those capabilities, given that they do not have broadband access.


The pandemic has highlighted many inequalities that are harsh realities for rural communities; we are hopeful to see a rise in equitable access to healthcare in all communities both in Peru and Rural America.

 

We are thankful to Marlee, Andrea and Libby for sharing their expertise on the impact of COVID-19 on Peru and in Rural North Carolina. Head to our blog homepage & follow us to be the first to read next week’s post about the ways that the pandemic may facilitate much-needed structural changes to the healthcare system.


For more information on the work that GWHT is doing with Peru check out the resources below.


Visit our collaborator’s website, Hope Peru.


Watch two the Duke students reflect on their experience in Peru:





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