Student Spotlight: Nathan Anderson

School: University of Pennsylvania, class of 2011

What Nate’s up to now: Currently Nate is serving for Teach for America. With his free time, Nate tries to keep up with all things MEDLIFE and continue to help out when needed.

Nathan (far left) working on MEDLIFE's first-ever community development project in Peru,
a staircase for residents living on muddy hillsides in Pamplona, Peru.

Experience with MEDLIFE:

• MEDLIFE 2010 Summer Intern: Based out of Lima, Peru, Nate immediately immersed himself in MEDLIFE's mission and the Latin culture. Nate split his time between working on new chapter development in the United States, and helping our MEDVIDA staff extend healthcare services and deliver infrastructural development projects to families and individuals living in the urban slums (or “pueblos jovenes”) that surround Lima. Together with community members, the MEDVIDA staff, and fellow summer interns, Nate was part of the first-ever MEDLIFE Fund development project in Peru, which consisted of constructing two sets of staircases for families living on muddy hillsides.

• Expansion Team member 2010-2011: After Nate finished his summer internship with MEDLIFE, he continued to help the communities in need by becoming a valuable contributor to the Expansion Team. As a MEDLIFE Expansion Team member, Nate worked alongside motivated individuals from various universities to assist them in the process of founding a new chapter. This process involves hosting an official MEDLIFE presentation for interested students, arranging a MEDLIFE fundraiser, and coordinating the school's first Mobile Clinic. With Nate’s enthusiasm, he has helped students from University of Washington, UCLA, University of Maryland, and MIT found MEDLIFE Chapters. Nate's dedication to MEDLIFE has been directly responsible for the positive results achieved by those chapters.

• Accomplishments: Nate recruited 43 students to participate in a MEDLIFE Mobile Clinic this past year. Through his service as an undergraduate student, Nate was responsible for delivering care to over 1,200 patients on Mobile Clinics, and almost $4,000 raised for MEDLIFE Fund development projects!

Thanks for all your help, Nathan, and best of luck in the future!

Analyzing and Improving a Pilot Malnutrition Program in Ecuador

JP interviewing a community member about Desnutrición Cero

Ever since returning from our first MEDLIFE Mobile Clinic in Cebadas, Ecuador three years ago, fellow intern JP Gorham and I have been trying to figure out a way to give back even more to the communities we visited on that trip. After researching the major health issues facing Ecuador, we decided to focus our work this summer on malnutrition prevention. According to a 2004 report by the World Health Organization, 23% of Ecuadorian children under the age of five suffer from chronic malnutrition. This number jumps to 40% in the Chimborazo region, where MEDLIFE Ecuador is based. This health problem has the potential to exact an especially large impact on Ecuador’s development, as one of the effects of chronic malnutrition is cognitive damage. Chronic malnutrition is more likely to develop in children living in poverty, and may prevent these children from realizing their full potential. In this way, it continues to feed the cycle of poverty.

As MEDLIFE interns this summer, we finally got the chance to turn our ideas into action. Ecuador recently announced Desnutrición Cero, which is a new malnutrition intervention program that provides financial incentives to mothers who take their children to health centers every two months. Women are eligible to receive incentives from the time that they are pregnant until their child reaches one year of age. After meeting with health officials in Colta, a community high in the Andes mountain range that the government is using as a pilot region for Desnutrición Cero, we agreed it would be our role to analyze the pilot program and create a set of recommendations to help maximize the program’s impact nationwide.

Our objective was to ensure that Desnutrición Cero is accessible and easy to engage in. We hoped to analyze mothers’ understanding of the program, and identify any problems they may have with it. With this information, our goal was to recommend minor changes in both program structure and implementation. Between the dates of July 22 and August 9, 2011, we visited six health centers in Colta, Ecuador. We interviewed 42 women and various healthcare providers about general health topics and their opinions about Desnutrición Cero. After finishing our interviews, we wrote a report in which we described our research findings and outlined our recommendations for maximizing Desnutrición Cero’s ability to reduce malnutrition rates. On Friday, August 11, we will present the report to the health officials in charge of the implementation of Desnutrición Cero’s pilot program and discuss the feasibility of our recommendations. Hopefully, this meeting will prompt a more prolonged conversation and officials will ultimately incorporate our recommendations before implementing the Desnutrición Cero program throughout the country.

Although up to 40% of children under the age of five are chronically malnourished in the Chimborazo region, only one in three women in the communities we visited believed malnutrition to be a problem. We believe that Desnutrición Cero will not work unless these women receive further education regarding the causes and consequences of chronic malnutrition. If mothers do not believe that they should prioritize their child’s diet, they are unlikely to spend the monetary stipend they receive from the Desnutrición Cero program on healthier food.

We also found that most mothers did not seem to recognize their own ability to detect and treat malnutrition. Many mothers cited their local health centers as resources, but did not volunteer any methods they personally could use to counteract malnutrition. For example, only one in three women displayed awareness that increasing their child’s food intake would help treat malnutrition. This evidence of the mothers’ inability to detect malnutrition in their children, coupled with their belief that only doctors can improve their child’s nutritional status, suggests to us that these attitudes may lead to untreated cases of malnutrition.

Here are some more of our recommendations to increase participation and community buy-in:

• Instead of requiring mothers to complete their program requirements and assessments in the health center technically closest to where they live, we recommended that mothers complete their assessments at the health center of their choosing. We believe that an online registry system would facilitate this change.

• We recommended that the program be clearly publicized, in both Spanish and Quechua, in every government health center.

• We believe that healthcare providers must place a greater emphasis on education in order to convey to mothers that malnutrition is a problem. We believe that greater local government participation would be helpful in shifting attitudes regarding malnutrition. In addition, Quechua-speaking healthcare providers would ensure that all community members are able to fully understand health promotion discussions.

Post by Rachel Eggleston

Great work, JP and Rachel – working to improve existing government programs is a great way to use the MEDLIFE summer internship as a means to contribute to sustainable, long-term improvements. We’re proud of your work this summer and we hope to receive updates soon regarding the official response to your proposal!

Photo Updates of Our Mobile Clinic in Ecuador

Today, our Mobile Clinic group based in Riobamba, Ecuador visited the community of Colta -- a village inhabited by the Puruhá indigenous people. Colta is a small-scale milling industry where most people work in farming, growing potatoes, barley, wheat, beans, and quinoa (pictured below). Community members also raise cattle, sheep, poultry, and other types of wildlife.

Check out some photos from the community:

And some photos from our Mobile Clinic:

Language and Power in Ecuador

The Puebla Puruha, the indigenous population
MEDLIFE  works with in Colta, Ecuador.
Photo courtesy of CODENPE

It seemed just like any other workday as we walked into the panaderia to pick up our breakfast rolls on our way to the Dirección de Educación. As we entered the familiar meeting room, a ministry engineer and two education officials greeted us with a handshake and a kiss on the cheek. MEDLIFE had agreed to work in Colta, a region of the mountainous Chimborazo province, to significantly improve access to bathrooms. We were meeting that morning to decide which schools would receive bathrooms first.

MEDLIFE had teamed up with the government’s Escuelas Promatoras de Salud program for this effort. The Promatoras is a program that teaches school children about the importance of proper nutrition and hygiene. We felt that by working with this program, the bathrooms would be constructed near schools that were prepared to teach their students about the importance of hand-washing, thus maximizing the positive effect of our efforts.

As we began discussing possible project sites, an unexpected variable came into the equation: some of these schools under the Promatoras program umbrella were run by the bilingual education ministry, and others by the Hispanic education ministry.

Ecuador is an ethnically and racially diverse country. According to the Instituto Nacional de Estatisticas y Censos, Ecuador is only 6.8% indigena, but in the Sierra region MEDLIFE works, the percentage is significantly greater. Colta, where we will be building the bathrooms, is actually 85% indigena. The indigenous people have strong ties to their culture and their language, Quechua. The “bilingual” schools referred to in our meeting were those schools that teach both Spanish and Quechua.

As we continued our discussion, it became clear that the room was split regarding how we would proceed. One of the officials present cited a document which could have potentially disallowed us from working with the bilingual education ministry on this project. Martha, the head of MEDLIFE’s operations in Ecuador, felt that it was most important that we provide bathrooms to those schools with the greatest demonstrated need, regardless of language or ethnicity.

We worked to reach a solution for about an hour, after which we agreed to call an official from the bilingual education ministry. Once this official arrived, her staunch verbal commitment to our efforts led to a simple resolution: MEDLIFE will work with the schools in the Promatoras program that need the bathrooms the most.

I entered the ministry that morning thinking about the importance of working in conjunction with governmental efforts. I left with a much more complex and complete picture of collaboration. Not all governments may be seeking out the help that we provide, and each group -- governmental or not -- has its own interests. Additionally, it’s important to remember that each bathroom we construct or school we build represents a value judgment. Which nationality, gender or age group is worth helping? In the beginning of the summer, I would have thought a meeting to decide where to construct bathrooms would be a thirty-minute endeavor. Pick the schools with the greatest need and you’re done. Now I realize that aid decisions are complicated and sometimes political in nature. Often, all you have to guide you is your understanding of what is just.

JP Gorham is a MEDLIFE Summer Intern in Ecuador

Dealing with Tropical Disease in Panama

During the MEDLIFE Mobile Clinic in Panama this summer, student volunteers were shocked by the large number of patients who came in with ulcers on their skin. The doctor who worked with us on the clinic explained that these were symptoms of Leishmaniasis -- a disease which is rampant in the jungle and mountainous areas of Panama.

Leishmaniasis is transmitted through the phlebotomine sandfly, which thrives in the intertropical regions of the world and threatens the 350 million people living in these areas. There are an estimated 12 million current cases of leishmaniasis worldwide, with another 1.5 to 2 million people infected annually. Around 88,000 people die each year from the disease.

Cutaneous leishmaniasis, courtesy of
flickr user Armed Forces Pest
Management Board

There are three different types of leishmaniasis -- cutaneous, mucocutaneous, and visceral -- which each cause different symptoms. Cutaneous leishmaniasis is the most common and least dangerous form of the disease. Generally, several weeks after the initial bite by the sandfly the patient develops lesions on the skin. Though not generally painful, the lesions -- which look like ulcers -- can occur all over the body and can cause up to 200 sores at a given time. Though the lesions can heal on their own, they cause scarring, which can leave people disfigured and stigmatized.

Patients with mucocutaneous leishmaniasis develop lesions similar to those with cutaneous leishmaniasis, but the lesions occur in the mucous membranes rather than on the skin of the patient. These lesions generally occur between 1-3 months after the initial infection; however, there have been cases where it has been decades after the initial bite that the patient shows symptoms.

In some cases, the mucotaneous lesions are the first symptoms a patient will express; other times the patient will first have cutaneous lesions followed by mucotaneous sores that develop later in the course of the disease. The lesions can lead to partial or total destruction of the nose, mouth and throat. They also may cause nasal obstruction and bleeding. Not only is this very painful for the patient, but it can also lead to facial disfigurement. Often those who suffer from mucotaneous leishmaniasis are ostracized completely from their communities.

Mucosal leishmaniasis infection, courtesy of
flickr user Armed Forces Pest Management Board

The most serious form of the disease is visceral leishmaniasis. In some regions of the world this is known colloquially as Kala-Azar. Sufferers of this form of the disease have fever, weight loss, anemia, swelling of the spleen and liver, and a darkening of the skin. If untreated, visceral leishmaniasis has a 75-95% mortality rate, although it this rate may reach 100% in developing countries.

Leishmaniasis is a large problem in the communities in Panama with which MEDLIFE works; however, the disease affects people throughout the world. Visceral leishmaniasis is most common in Bangladesh, Brazil, India, Nepal, and Sudan. The mucocutaneous and cutaneous forms of the disease are found primarily in the Andean region of South America, Central America, and the Middle East.

One of the largest burdens of this disease is the social ostracization that many leishmaniasis patients face due to disfiguring scars. As the importance of community support is heightened in poor and rural areas, these social ramifications can be as serious for patients as their physical symptoms.

Though there are several medications which treat all three forms of Leishmaniasis, access to this medicine is severely limited for those without adequate health care coverage. If the disease is caught early, cure rates are incredibly high. Yet, as the disease progresses, it can harm the immune system, and eventually cause death.

During our Mobile Clinics in Panama, it became clear that many of our patients suffered from this disease. Seeing so many patients with Leishmaniasis underscored the importance of increasing medical care access in these incredibly rural communities so that people can get the treatment they need for such a common and treatable disease.

Post by Lisa Berdie, MEDLIFE Summer Intern in Panama

Photo Update: August Mobile Clinic in Lima, Peru

Check out our photo update from this week's mobile clinic in Lima, Peru! We're half way through the week, and looking forward to seeing more patients in different communities tomorrow and Friday:

How Does MEDLIFE Promote Health Education?

The first three letters of 'MEDLIFE' stand for Medicine, Education, and Development. Our work in Latin America seeks to improve the overall welfare of people living in poor communities by bettering access and services within each of these three pillars. Meredith McKay, MEDLIFE's media intern in Ecuador, created a short video to highlight the educational component of our Mobile Clinic program. Check it out!

Read our previous post on cervical cancer and the pap smear exam for more information on the work MEDLIFE is doing to combat cervical cancer in Ecuador and Peru.