Well, today was my last day working at Loayza. It has been quite the ride, getting to know the interns, making friends with the patients, and learning a ton about medicine in Lima and Peru. Oh and playing my guitalele for patients and doctors – can’t forget that! This little guy is coming in handy:
Looking back on these last two weeks, I have really immersed myself in the Peruvian health care system. First, some background. 90% of Peruvians have one of two government sponsored insurance programs, and which one you have depends on your job. Needless to say pretty much everyone in Peru has some health insurance, although access may not always be easy. Loayza is a national hospital catering to people with MINSA insurance (ministry of health). Anyone in the country with MINSA can come to Loayza and be treated for pretty much anything.
Because of this, I saw a ton of crazy cases from all over Peru. From parasites to cancers, STDs to jaundice, I pretty much saw everything Peru has to offer in this one hospital. This is due to the fact that nearly all health care, and by far the best and most advanced care, is in Lima, so people do travel far to get care here. I was working in an internal medicine ward, where inpatients were housed for days, weeks, sometimes even months:
So what did I see here? Overall, my working hypothesis, that diseases in Lima would look somewhat like the United States, and that diseases in other, more rural areas would look like those in premodern times, was confirmed. Lima, with its growing fast food industry, new supermarkets, and polluted skies, has plenty of diabetes, heart problems, and is starting to become more obese. Furthermore, Lima’s location adds a few other interesting things to this slew of chronic illnesses. Lima is in a desert, and is actually in a valley (much like LA) so the air doesn’t really move much and is full of sand and pollutants. This manifests itself in a bunch of lung problems, including high rates of asthma, pneumonia, and some pretty nasty multi-drug resistant tuberculosis.
The patients from the Andes seemed to have different things. According to a number of doctors at Loayza, Peru has a high level of gastric cancer, which to them, seems to be from the populations in the Andes and jungle. A few had the hypothesis that this is due to cooking with open flames, which is the primary way these people cook because they don’t have modern stoves. The smoke from fires contains carcinogens which could potentially lead to cancers in the gut. Another thing with the people from the Andes is diet, which consists largely of potatoes and corn. This combination is not necessarily the most nutritious, and one manifestation of this is height: the people of the Andes are generally pretty short.
Actually, most Peruvians are pretty short. I don’t have any hard numbers to back this up, but I was the tallest person working in the ward and I am 5’9″, if that gives you an idea. In part, I am sure genetics plays a role, but I can’t help but think the diets also play a role. This is by no means conclusive, but the tallest patients were from the jungle, where they eat plenty of fruits, vegetables, and meat. And just for completeness, the people from the jungle seem to have (as I suspected) a lot of infectious diseases.
Pretty much all of my impressions were confirmed by an interview with a public health specialist and her husband who is a physician. They generally agreed with the trends I saw, and gave me a bit more food for thought. In a recent study of theirs, they found that opiate prescriptions had increased about 20 times in the last five years. At Loayza, I don’t think any of the patients were taking pain pills. Indeed, most from rural areas probably don’t know that these things exist. But what is bad is that in the U.S., when opiate usage increased, a cross country addiction developed, adding to the heroin problems we see today. So, in the next decades, we might very well see Peru take this same course.
Lastly, a historical factor influencing health. In the 1980s and 1990s, a violent terrorist group, the Sendero Luminoso (Shining Path in English) was committing atrocities across the country in attempts to turn Peru into a communist nation. Although they did not succeed, Peru was in a state of emergency for a few years, during which rationing was common. The cultural effects are still visible, as everyone drinks instant coffee and evaporated milk. Yet the population in this generation seems to be physically smaller, due to the rationing. In an odd twist of culture, many parents think that girth is good because their skinniness was bad, so there is a trend in my generation of obesity.
All in all, this experience has been absolutely wonderful. The people have been great, and I’ve learned a ton so far! Although I hate to leave all my new friends and improving patients, I am excited to head to the jungle! Until then, Ciao!