A Weekend in Tacna

For the weekend, our group hopped over the border to Tacna, Peru, so that we could see what medicine looks like in a developing country. (Chile, particularly their medical system, is considered developed). We toured a few clinics, sat in on “domiciliarios” (house visits), and volunteered in a free health fair in the neighborhood of Viñina, one of the poorest in Peru. We also made a day-visit to one of Tacna’s nightclubs and sat in on an STD education and protection class with some of the girls (most of them under 21 and some of them as young as 14 or 15) who worked in the club.

The house visit was by far the most interesting experience. We walked four blocks from the health center to a patient who the obstetrician was checking up on two weeks post-partum. Her baby had jaundice and we were going to clear up some myths the woman and her family had heard about this condition. I think my favorites were that the baby was yellowish because the mother had eaten too many mangoes during her pregnancy and that if you sat the baby in the sunlight it would become even more yellow (sunlight actually helps the color return to normal). We were also coming to talk to the woman about contraceptive options open to her. The new baby was 11 years younger than his oldest sibling and had been unplanned. When the pregnancy was first announced, the rest of the family who lived in the house, grandparents, 4 other siblings, and the father rejected it and blamed the mother. This is the third time during a patient interaction where I’ve ran into the concept of a pregnancy being solely the woman’s fault and not partially the man’s. As a Westerner the idea is absurd, but here, especially in lower economic situations, it is unfortunately the more common viewpoint. The rejection and blame had huge psychological and physical tolls on the mother. Early on in her pregnancy, she lost the will to eat, slipped into depression, and became severely anemic. Luckily her family came around when they started to see how their negativity was endangering her health and attended special classes at the health center to help support her through the rest of her term. It felt really good to see how a little counseling and intervention could change a tragic, hurtful situation into reconciliation and joy.

The trip was a real eye-opener on how many obstacles there are to keeping a poor population healthy. Unfortunately, economics is the biggest one both on the side of the patient and the side of the health professionals. Many people couldn’t make it to the health fair because they were working, and the health fair itself was lacking in equipment and doctors to able to treat those who did come. Poor organization was another big factor. Someone forgot to unlock the pharmacy and because of this the pharmacist I worked with had to tell almost everyone who came to come back tomorrow (which for most was impossible). I could not imagine waiting in line for hours only to be told my medicine wasn’t there. Among some, there is also a stigma against medicine that comes from “white coats” and not traditional community members. Despite the fact that the health fair was 100% free and right in the center of Viñina, many people from the neighborhood (even some patients that doctors had previously identified as needing care such as children who needed vaccinations) chose not to go.

On a shallower note, Tacna is an excellent place to shop and eat out. A. Tacna has some really hilarious styles (see aboe). B. There are no enforced copy-right rules in Peru, so designer brands, soccer jersey knock-offs, cds and dvds are marked down to about 1/10^th of what you’d find them for in the USA. Make sure you’re getting the local price though. Most of the things I bought started out 3x as expensive as what I actually bought them for. I think my best buy was 10 cds for 10 soles (about 4 bucks). This doesn’t mean you’ll actually save any money when you go though. You’ll just come home with more stuff J.