Getting to the Town above the Clouds

The locals call Pampas Grande "El Balcón Suspendido entre el Mar y el Cielo," translated as "The Balcony Suspended between the Sea and the Sky." Once you're there, you understand why. On a clear morning, you can see all the way to the Pacific Ocean. But later in the afternoon, when the clouds roll into the valley below, you realize that you're quite literally standing in the sky.

Getting to the balcony is no piece of pastel. This year, Sean Byrne collected GPS data on the last leg of our drive up the mountains, which is summarized in the image below. As you can see, while this portion of the drive was just over 57 miles, it took us about 4 hours to reach Pampas Grande-- meaning that our average speed was 14.5 mph. This tortoise's pace is more understandable when you see that we actually went 2 and a half miles upward. (See all the zig-zags?) It's no wonder that we're gasping for oxygen by the time we arrive.

Sean's GPS data shows us just how geographically isolated our site is from...well...everything. For people that live here, this makes finding and getting to health care a challenge. Even people that live just a 15 minute's drive from Pampas Grande often travel over 2 hours by foot or donkey to see the physician in the health post in Pampas Grande.

We've been trying to come up with ways to combat this geographical barrier to health care. For instance, this year during our visit, Dr. Paula Tamashiro, a physcian from Peru with whom we work closely, arranged for our van to go to each of the nearby villages to transport people to the health post. Additionally, University of Richmond students have donated a truck to be used as an abulance, should anyone from the community need to be transported to the hospital in Huaraz.

Check out this article about the efforts of the Institute for Electrical and Electronics Engineers to set up an infrastructure for telemedicine in remote areas of the Peruvian jungle: Providing Telemedicine to Peru's Medical Outposts. Perhaps this model could be used in Pampas Grande to increase access to medical specialists in Lima or other areas of the world. It is certainly an idea to explore further!

Our Experience in Photos

On this year's trip, so many people in our group went above and beyond to capture our experience in Peru. In fact, two students, Jigna Solanki and Stephanie Stahl, have entered some of their breathtaking photos into the University of Richmond's Spiders Abroad Photo Contest (found here.)

Enjoy these photos, and visit our Facebook page for more!

Lessons from Pampas Grande, Again

Blogging now from La Paz airport (13,000 ft above sea level), where--like Pampas Grande-- we're once again having to work a little harder for our oxygen. We're waiting here for another 4 hours or so, when our plane will embark on a 9 hour flight to DC.

This year's quest to Pampas Grande and back was another empowering, insightful, uncomfortable, frustrating, sometimes disturbing, wonderful experience for me. This trip marks my third visit to Pampas Grande, and for the above-mentioned reasons, it has been the most fulfilling yet.

I know I'm sounding counter-intuitive here. Uncomfortable? Frustrating? Disturbing? Immediately, It doesn't make sense that these feelings can untimely culminate in fulfillment and accomplishment. That's the funny thing about Pampas Grande-- each time I go, I learn a new public health (and life) lesson that I never saw coming.

My time in Pampas Grande was uncomfortable because I had to adjust nearly every nuance of my voluntary and involuntary behavior. Seriously, you name it-- speaking, eating, sleeping, getting from place-to-place, being on time, showering, and especially breathing--it's all done differently than back at home. It seems simple, but it genuinely takes up so much energy.

My time in Pampas was frustrating because I couldn't communicate as proficiently as I would have liked. Although I can hold a simple conversation in Spanish, there is definitely room for improvement with my language skills. Still, language isn't the only barrier here; there's a cultural one, too. If you can take a moment to picture a modernly-dressed, blonde-headed, Spanglish-speaking girl in an isolated, rural, Andean community in Peru (where many people have never traveled outside their district) you can see where I'm going with this. Plus, with no cell phone reception and RGHA team members constantly working at different places in the community (school, library, clinic), it was extremely difficult to communicate with one another. Maybe next year we should figure out a smoke-signal system or something. Someone proposed guinea pig couriers. Just a thought.

My time in Pampas Grande was disturbing because I saw serious health outcomes that are completely preventable. For instance, a two-year-old boy came into the clinic with six teeth rotten below the gum. The dentists extracted each of them over the course of two days. The damage was so bad that the dentists predicted that his developing adult teeth were already harmed. I wish I could say this is uncommon, but the dentists most frequently performed cavity fillings and extractions, from people aged 2 to 90 years old. Seeing the two year-old with a mouth-full of dead teeth just irked my core because it didn't have to happen. We know easy, relatively inexpensive behaviors that can prevent this. So why is dental health so poor in Pampas Grande?

For me, each element of my discomfort, frustration, and disturbance yielded an over-arching reaction: Do I understand how people live here, and how can I work to help people here lead healthier lives? To get to this point, I've had to experience a small slice of the lifestyle in Pampas (I say "small slice" because our living quarters are quite comfortable and clean and we get to eat three square, delicious meals a day). I've had to work alongside the communication challenges that often hinder health intervention programs from working. And finally, I've had to see with my own eyes the preventable health disparities. With this experience, I am more equipped to analyze what I can do to help the people in Pampas Grande achieve better health and wellness.

I believe that our group is on the right track with making better possible in Pampas Grande. We saw more patients in clinic (in Pampas and nearby Shancac) than ever before. We have implemented long-term, evidence-based health prevention efforts for skin damage and joint pain. We interact with the community through projects, meals, art, and festivities in order to build trust and cooperation. We are collecting survey data in order to form hypotheses about future health interventions. And finally, we are preparing for a longer-term visit to the community.

Personally, I know that what I have learned on this trip is an invaluable tool that I will use in all of my endeavors in public health. I don't have the answers yet, but this summer, I hope to put this tool to good use for Pampas Grande as I take the position of the first employee of the Richmond Global Health Alliance.

Salud para todos.

Blair Armistead, B.S.
Candidate, Master of Public Health
Virginia Commonwealth University
RGHA Intern, Summer 2012

P.S. - Pictures to come, I promise.