As a medical student going on a MEDLIFE internship, I most looked forward to the chance to see the mobile medical clinics in action and help to provide medical care to families in need. We were encouraged to read about the issues surrounding aid provision and health inequalities, and in doing so we encountered quotes such as Dr. Martin Luther King Jr.’s:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.”

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With these famous words still resounding, I arrived in the communities ready to help in whatever way I could. I was humbled to find that my help could only make a difference thanks to the communities themselves who came out in full force to help us build a staircase in the hills.

Despite having 20 students from the UK working together to pass cement, paint the walls, and clear debris – the community members outnumbered us. Some helped with the manual labor while others fetched drinks to reinvigorate us under the Peruvian sun. 

The trust that these people had in MEDLIFE was clear as they brought out their children to meet us, let us play with their dogs, and joined in and laughed as we sang a range of well-known songs from the UK to keep spirits up while we worked.

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Vital to this is the role played by local community leaders who are employed by MEDLIFE. They understand the communities and help to foster trust. This really struck me after an educational meeting about women’s health, when a crowd of 30 or so people stayed late to speak to one of these local leaders and explain their different needs.

It is through these discussions that we begin to recognize the different problems that each community faces, and allows us to personalize the help we provide. It was through these discussions that the idea to build staircases first arose - a simple idea that would never have occurred to me living in the UK, but clearly made a huge difference to the lives of the people we met and helped to create a safer place to live. I am very grateful to have been a part of MEDLIFE’s work, and look forward to being involved again in the future, and continuing to put the community at the heart of it all. 

 As many of you know, MEDLIFE is expanding to India! We will be holding our first mobile clinics in India May 7-15 and May 14-22, 2016, in New Delhi India. MEDLIFE will partner with Mamta (MEDLIFE always uses local medical staff) to bring our Mobile Clinics to the community of Nihal Vihar, an urban slum made up of mostly migrants that began to grow rapidly in early 2000. Information on this community is difficult to come by, so I held a Skype interview with Sonali Maheshwari, Senior Program Manager at Mamta to find out more about Nihal Vihar and the work they do there.

*Not an exact transcription, edited for brevity and clarity.

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Jake: How do the Urban Slums in Nihal Vihar differ from India and New Delhi's other slums?

Sonali: It is a highly and densely populated area. Nihal Vihar has a highly migrant population, it is full of migrants, because of the nearby industrial areas, the nearby options for employment. So it majorly consists of migrants. We see that health and development indicators, like low birth weight, chronic malnutrition, anaemic pregnant women, which has not changed much over the last many years (last two decades).

Jake: But the population has grown substantially over the last 20 years right?

Sonali: Yes the population has swelled.

Jake: What kinds of employment opportunities are there? 

Sonali: With Nihal Vihar being surrounded by so many small industries- options for semi-skilled opportunities, semi-skilled employment are many, so that's why people are migrating there but still there is low- it is inadequate. Health complications are there, poor environmental conditions are there, you can say that people are migrating from villages where there are lesser opportunities for employment to tap these opportunities… manufacturing electric equipment, slippers, shoes, these types of small-scale industries that surround Nihal Vihal.

Jake: Is there environmental pollution from industry?

Sonali: Typical industrial pollution is not there, factories are not prominent in the area. Small scale making of shoes and electrical equipment with their hands, not through the machines is being done. So that kind of environmental pollution that you get with industry is not there. But yes, environmental conditions are not good for so many other reasons.

Jake: Yes, I have read that hygiene and sanitation are a big issue in New Delhi slums, because there are no sewage systems, people have to use open toilets.

Sonali: Yes, their practices are not that healthy and safe, all that adds to the poor environmental conditions. They all are like big families staying in one small, small area, because they can't afford bigger spaces, so many people staying in one room, creating those poor environmental conditions.

Jake: I know that there are lot of public health challenges, a lot more than we have time to talk about, but what are the main public health challenges that you see in Nihal Vihar.

Sonali: The Major health issues prominent in Nihal Vihar are malnutrition, diahria, anemia especially in pregnant ladies, malaria, typhoid, skin infections, and there is one more that we have recently seen is people complaining of pain in there joints.

Jake: What is the public health system like? What kinds of access do residents have to healthcare?

Sonali: In the last five or six years since Mamta has been intervening there, access has improved but there is a lot of room for improvement, the population being migrant. We have been continuously doing those practices and strategies to bring access. But because the population is migrating, seasonal migration is happening, the kinds of changes you want after five or six years of intervention is yet to happen. Facilities are there, facilities are operational, facilities are fairly equipped also. But because of not having that safe behaviour attitude, people don't go when they should. Working with the public health function, we are training them, making linkages, but access is an issue that still needs to be focused on.

Jake: What do you mean by safe behaviour attitudes?  

Sonali: Safe behaviour attitudes means that when you have symptoms, without any delay one should go (and see a doctor) without delay- for example if someone is having continuous fever for four to five days. Malaria and dengue fever being prominent diseases there, people don't have that attitude of getting a test as soon as possible. They will try home remedies or something.

Jake: So people know what is available to them in the public health centers but don't use it?

Sonali: People know, but because of that attitude they don't go when they should. But many people who are (recent) migrants don't know.

Jake: What kinds of stuff do you do to improve malnutrition in children. I've seen in my research on India that it is a huge problem.

Sonali: As I said that our program is mainly aiming at behaviour change, so we tap on their knowledge, attitude, practices through educating them on different components of nutrition, how it matters when it is a pregnant lady, lactating, infant, adolescent. And by linking them to the government schemes…. The government has programs that give out iron supplements, or supplemental food to lactating pregnant women or adolescent girls.

Jake: So you impact nutrition through education. Is part of the problem then that people don't know how to effectively use the little money they have to buy nutritious food.

Sonali: That is one, how can they change their diet patterns out of locally available food. Not telling them options that are not available to them, and then, telling lactating women how they can ensure child nutrition through exclusive breastfeeding. How important it is, exclusive breastfeeding for 6 months, then the supplementing (of the diet with breastmilk) after. This is where there are a lot of myths and misconceptions in the community that we are working on. To teach them how they can ensure their nutrition and their children's nutrition.

Jake: What kinds of places are these migrants are coming from? It sounds like living conditions are very difficult in Nihal Vihar, so I'm wondering what was life like for these migrants in these places? What made them decide to move to somewhere like Nihal Vihar where life is still very difficult?

Sonali: Delhi being centrally located, there are a mix of people from each and every state… But majorly from states like Rajasthan, Uttar Pradesh, Bihar… They come to Nihal Vihar, come to Delhi, get into some kind of technical or non-technical occupation, grow in that. It is the major reason why they are migrating, especially focusing on the informal sector. Plus, it's easy for them to manage their families, they come here they get a job, Delhi being an otherwise reasonable place to eat, to live, they can send a good amount of money back to manage their overall needs.

Jake: So a lot of migrants are sending money to their family in other parts of India?

Sonali: Yes usually when they come, they come alone. They first get themselves aligned in some kind of job and set themselves there. In some case then they get married there.

Jake: So even though these people are very poor the work they are doing in Delhi still pays a lot better than what they could do back home? Which is mostly farming right?

Sonali: Yes back in their hometowns, mainly their family would have the occupation of farming. If the next generation doesn't want to continue with the occupation of farming and they want to learn some kind of skill then they come (to New Delhi). This is a suitable place to get those kinds of skills and join a different sector. Many of them seasonally go back to help their families with the harvest. 

Read about one of our volunteer's experience organizing a highly successful 50:50 campaign for her trip to Lima, Peru! Find out more about the 50:50 campaign here.

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Name: Wesley Tomlinson

Amount raised: $1300

Are you a MEDLIFE chapter member?

I'm not actually in a MEDLIFE chapter. I decided to come alone with my best friend from med school. We both go into different universities so we thought it would be an amazing experience to meet up half way around the world to partake in a volunteer trip.

How did you hear about the 50:50 campaign and why did you decided to organize one?

It was on the website when i signed up to MEDLIFE. My sister who had previously been on a volunteer trip told me all about it. After reading up the benefits of the campaign on the website I knew thye campaign was for me. It became a clear decision once i knew that half of the money i raised would go towards funding my trip and the other half to helping out the community that I wanted to volunteer for.

How long before your trip did you start and finish?

I only started my campaign in October. I remember only having 60 days left until Lima, only starting the campaign a month or so before my trip. It was at this point that I started posting on social media websites and sending out e-mails. I was very lucky to have friends and family who would share my link to the page.

What did you do to be most successful with your judgment when you fundraised? Did you encounter any obstacles in the process and how did you over come that?

I tried to reach out to as many different people as possible, to see if they would be willing to donate. I was stunned with the feedback that i received, as everyone I reached out to were very supportive, financially and verbally. However, I did encounter a few obstacles. Some people chose not to respond to me, some people just ignored my requests, but you have to take these experiences on the chin and keep up the momentum.

What advice would you give to others who want to start their own campaign?

I would say just go for it! Even if you are worried about not raising any money, it can't hurt to try. You have to think and stay positive!

Read about one of our volunteer's experience organizing a highly successful 50:50 campaign for her trip to Cusco, Peru! Find out more about the 50:50 campaign here.

342-1-Aubrey-Kuester-5050Name: Aubrey Kuester

Amount raised: $1285

What are you studying? I study at Florida State University and I'm studying exercise science. 

How did you hear about the 50:50 campaign? I heard about the 50:50 campaign when I signed up through the MEDLIFE website. The campaign is advertised on the first page, and it seemed like the easiest and most effective way to raise money.

Why did you decided to organize a 50:50 campaign? I decided to organize a 50:50 campaign to not only raise money for my own trip but I also wanted to help the communities in any way that I could, and I know it would be easier for my relatives donate.

How many weeks did your campaign last? I started my 50:50 campaign roughly a month before my trip and I reached out to all my relatives and friends in my community to help me make this trip possible.

What did you do to make your campaign most successful? What I did specifically to raise money was send emails to most of my friends and relatives, also my old coaches and teachers that I've had in the past. I wrote a personal email, not just a generic one they provided on the website, and I sent it personally to all my relatives with their name and my own link to my personal page. I think it was really effective because half the money was donated to Cusco. People were more willing to donate rather than the money just going to me. It ended up being a great advantage for my campaign and I ended raising a lot of money that way.

Did you encounter any obstacles in the process? How did you overcome them? It was a little difficult getting people to donate online, some people were skeptical about putting their credit card through an Internet system, but I think the 50:50 campaign is a really secure and easy way to donate.

How was organizing a 50:50 campaign a positive experience? The 50:50 campaign was extremely rewarding, specially after I came here to Cusco and witnessed it first hand how little the people here are working with and the conditions that they have to deal with. Knowing that I personally raised a significant amount of money, enough for medicine for 90 people and supplies so they can use in a daily basis, just made it extremely rewarding.

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What do you think of your volunteer trip? Its been extremely rewarding so far, especially seeing the smiles on the kids faces and actually been hands on and experiencing the culture here. It has been extremely worth it.

How do you feel about the impact you have made by raising money to support a local community? Before I came to Cusco, I didn't know what to expect. Personally, witnessing the conditions that people have to deal with here, and how little medical attention they have, what little access they have to proper medicine and education makes an organization like MEDLIFE really important. It has such a positive effect on the community since we are not asking for any money, we are giving free medical attention to people that truly need it, that they might have to drive or walk hours to get just basic health care. It is something that is very close to my heart and I couldn't be happier about being here.

 

 

This week's volunteers brought us some surprises! Among all the 50:50 campaigns, over $4500 were raised for the MEDLIFE General Fund! Read below about two of the most outstanding campaigns to learn how they fundraised for the campaign and hear about their experience in Lima so far. Find out more about the 50:50 campaign here.

steph-5050-2014Name: Stephanie Wizner
Amount raised: $3530

What made you decide to do the 50:50 campaign? The campaign gave me a great platform through which I could pay for the volunteer trip, as well as raise some money for the different stair projects in Lima. I sent an e-mail with the staircase pictures showing potential donors how far their money could stretch, and where it was going exactly.

How did you raise the money for your campaign? A lot of it I have to thank my co-workersI'm not in school anymore, which means I'm not hustling poor students for donations. I started working in a corporate environment early this year. Fundraising in an office worked to my advantage since the vast majority of my co-workers were willing to donate to an aid trip across the world. Most of my work colleagues were middle-aged with families. A vast majority of my colleagues were eager to help fund my trip since they were not in the position to implement change physically. However, they could help financially by donating towards the 50:50 campaign as well as sending me out to Lima. My mother was a huge help too!

Why would you recommend that volunteers participate in the 50:50 campaign? When you're asking for donations, it's a lot easier to present a campaign to potential donators where they know where the money is going.

What is your favorite part about the Mobile Clinic so far? Definitely the children! Talking to the kids on clinic has given me an insight into their day-to-day lives. They all have so much hope, and aspire to be doctors, lawyers, veterinarians and chefs. They all had amazing dreams, which gives me real hope for their futures.

What were your impressions of Lima? It´s very diverse, some areas seem very Westernized like New York city; really up and coming. However, there are areas that I've experienced on Mobile Clinic that you would never normally see as a tourist in Lima, which has given me a whole new perspective on this economically diverse city.


martina-5050-2014Name: Martina L'Abbate
Amount raised: $2565

How did you first hear about MEDLIFE? I heard about MEDLIFE through my sister who studied at Cornell and plans on becoming a doctor, and she heard about the mobile clinic trip while at school.  She went to Ecuador, loved it, and came back with all these awesome stories, and since I want to be a physician assistant, I thought it would be a great life-changing experience, so I chose to go to Peru.

What made you decide to do the 50:50 campaign? If I was going to come to Peru, I figured that I would go all out since MEDLIFE needs the money to fund all of its programs.  Simply asking for five dollars from everyone really raised a lot of money not only for me,but for MEDLIFE as well, and I feel pretty good about that.

How did you raise the money for your campaign? I work at gymnastics gym, so I put up a flyer, and it ended up attracting a lot of the kids who kept showing their parents, "Mom, look what she's going to do!". Most of the money came from family members, my dad's boss, and others through word of mouth.

Why would you recommend that students participate in the 50:50 campaign? In America, we don't realize how good we have it.  My first day here I looked at the conditions that some of these communities are in and I almost was crying because back home I complain about trivial things like slow Wifi. We can donate so much without having to financially drain ourselves, and I think that we should give what we can when we have it.

July 16, 2013 9:43 am

Patient Story: Daniela Chimbo

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On the third day of clinic in Tena, Ecuador, an older woman walked in to the doctors' station with a crying child. The little girl's name is Daniela Belen Grefa Chimbo and she is one year old. The older woman, whom we later found out was the grandmother of the child, started to list off the child's symptoms as the doctor listened attentively. The grandmother told us the little girl had diarrhea for about a week and stomach pain. These are two common symptoms for illnesses commonly diagnosed in the jungle of Tena, Ecuador, where parasites are common. Yet, this case wasn't as simple as the common ones of the region.

For further examination, Daniela was put on the patient bed where the doctor palpitated her stomach. The girl began to cry uncontrollably, but no tears came out. The doctor Daniel told the volunteers shadowing him that she was completely dehydrated. He asked the volunteers if they knew how he diagnoses that just by looking at her. The volunteers gave him blank looks, until the doctor told them he could tell because she was crying, yet no tears came down. As he explained that he touched her cheeks and realized how completely dry they were. He asked me to get Martha Chicaiza, the director of Ecuador, for immediate follow up. I brought Martha to the doctors' station where the doctor asked if she could take the child right away to the health center to get rehydrated.

Martha walked the child all the way to the center since no car was to be found in the jungle region. The girl was taken to the clinic and was rehydrated with IV fluids immediately. When Martha returned late that day from the health post, she told us that they found that Daniela had an advanced dehydration. Luckily they were able to rehydrate her quickly in the health center. She explained to us that this girl was under the care of her grandmother since her parents live in Puyo, a larger city where her parents had to move to work.

Now, the little girl has recovered well. Since the visit to the health post, we have called her grandmother to follow up on her health condition. It has been hard for MEDLIFE staff to communicate with them, since they live in a community where there is no signal or telephone service. After multiple tries, MEDLIFE staff was able to communicate with the grandmother to hear that she is now stable, and although she is underweight she is now being fed properly and on the road to recovery.

Cristina Salvador is a MEDLIFE summer intern.

yovannaDr. Angie Vidal (left) and Yovana Taipe

When we first met Yovana Taipe at a Mobile Clinic in Villa El Salvador, she seemed shy and serious, reluctant to smile. And when she reached the dentist chair, we found out why; all of her front teeth had rotten and fallen out.

This level of damage would require more than the dentist could provide in one day at the clinic, so Yovana entered our patient follow-up program, with MEDLIFE dentist Angie Vidal overseeing her care. Angie performed multiple cleanings, extractions, fillings, crowns, root canals and created prostheses. Over the course of several visits, she developed a close relationship with Yovana, and ended up treating her children as well. "She's a person who has suffered a lot in her life," says Angie. "As I got to know her better, I was always impressed by how many obstacles she had overcome."

Yovana says she can't thank Angie enough. "She gave me my smile back," she says. "She gave me my life back." Her dental problems had left a severe dent in her self-esteem, making it more difficult to do normal activities and get a job.

Yovana lives with her two younger children, 7-year old Maricielo and 16-year old Julio, in a cramped quarter of her mother's house in Villa El Salvador. After leaving an abusive marriage, she lacked the financial resources to provide the basic necessities for her family. She works cleaning houses when she can, and hopes to support her children through school in the hopes that they can become professionals someday. Between taking care of her kids and working, it was hard to find the time to stand in line at the public hospitals and get medical attention. After seeing the positive impact that the Mobile Clinic has had in her life, she's taken an active role to coordinate future work with MEDLIFE in her community. The patient follow-up team will continue to support her and her family. 

She still worries about her childrens' future, but now, she says, "I know that [MEDLIFE] will help me through this, and I am forever grateful for that."

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The MEDLIFE Mobile Clinic was back in Cusco last week, and in addition to providing medical care to rural communities, volunteers all lent a hand to a community development project there. This week, that meant continuing the work of a previous MEDLIFE group, which had built the foundation for a brand new auditorium at the San Judas Chico girls' home.

The enthusiastic volunteers made up a diverse group of students and grads, including a large group from the UC Davis MEDLIFE chapter. They worked hard all week, digging, mixing and pouring cement to finish the five columns that the structure needed. They also created a small vegetable garden nearby, and planted the first seeds.

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cuscocolumns 

When they weren't busy working, the volunteers got to know the girls who live at the orphanage. With the girls practicing their braiding techniques, the volunteers arrived at the hotel each day with a new hairstyle. The young residents of the home, big fans of K-pop, were especially excited to find out that one volunteer, Justin, was Korean, and insisted on getting his autograph and photos.cuscojustin

At the end of the week, it was time to celebrate the completion of their hard work. Volunteers broke a bottle of champagne, and the girls got together to show their thanks with a special singing performance. Then it was time to say an emotional goodbye, with the girls asking when we would be back to see them. 

The next Cusco clinic group, in August, will be helping to construct a roof for the auditorium.

For more photos, check out the Facebook album.

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In December 2010, Brandon Kuang came on a MEDLIFE Mobile Clinic to Lima, Peru. Now he's back, to perform a large-scale research study that he hopes will help shed some light on women's health issues in the pueblos jovenes of Lima.

A pre-med student at UC-San Diego with a minor in global health, Brandon was struck by the close-up view of poverty and lack of healthcare access that he encountered on his first MEDLIFE trip. But, he says, "The thing that sticks out in my memory the most was that despite all of that, the women in the communities were so warm and welcoming." He recalls that as the bus pulled away on his last day in the community, community members waved goodbye and shouted, "Don't forget us!" Brandon took those words to heart -- he continued to think about how he could help the people he met, even after he had returned to the United States.

His study began as an exercise in proposal writing for a class and gradually took shape over the course of the two years following his trip. As he researched women's health issues in Latin America, he found that although it is preventable and treatable, cervical cancer is the most deadly form of cancer affecting women in Peru, due to a lack of available information about detection. Very little scientific data exists about disease and healthcare in informal settlements like Pamplona Alta, where the problem is compounded by extreme poverty.

And so Brandon's project was born, named PAP ACCION, which stands for Pamplona Alta Peru Atmosphere for Cervical Cancer Intervention Opportunities Now. Through surveys and interviews with hundreds of women in Pamplona Alta, Brandon hopes to gain an understanding of the knowledge, attitudes and practices of women in the area regarding cervical cancer screening. In order to collect his data, Brandon has partnered with MEDLIFE, which is helping him hire local public health nurses who will administer the surveys and interviews and reach the inaccessible hills of Pamplona. The results of Brandon's study will also help us to refine our educational programs, which focus primarily on women's health. "To deal with the situation, you have to understand it, and I'm hoping that the information from this study can be used to improve education programs and direct them at the most prominent shortfalls," he says.

After writing and re-writing his proposal, Brandon was awarded a grant from his university to fund his work. Now he's finally in country and ready to get started. "I was always told by my professors that in global health research, you can plan what you want to do, but when you get on the ground, reality is going to dictate what actually happens," he says.

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He's looking forward to seeing the results, which he'll analyze and eventually hopes to publish. "It was a lot of hard work, but if it's something you want to do, I would definitely encourage other students to make opportunities like this happen," he says.

Written by student volunteers from this week's clinic in Lima, Peru, and reposted from the MEDLIFE McGill blog.

Today was our first day of clinic. After a quick breakfast and wishing good luck to those of us that were headed to the grueling stairs construction project, we packed our materials and headed to a district near Pamplona Alta for the day.

My first station was general medicine with Cesar, a physician who'd specialized in geriatric care. Before the patients began rolling in, Cesar took those of us assigned to his station aside and began teaching. With humour and patience, he showed us how to distinguish abnormal heart and lung sounds from those of normal beats and breaths. He also introduced us to some ailments specific to the living conditions of the villagers; he directed our attention to the signs of anemia and vitamin A deficiency (discoloured gums and mucosa and white spots on the skin, respectively). As well, we got to see first-hand many cases of tonsilitis and parasite infections, as well as an older woman afflicted with ptosis, thus causing her to have a droopping eylid on one side only.

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By noon, I was getting hungry – my breakfast of bread, banana and egg was now long gone – but I didn't want to leave Cesar's side. There were always more patients to ascultate, more heart sounds to hear.

Eventually (and somewhat reluctantly), I did head for lunch and to my next station, but not before taking the time to pass over the knowledge I had gathered to the friends that were coming to replace me.

In the afternoon, triage proved equally interesting, albeit a bit more challenging since we were directly interacting with patients. My Spanish is far from perfect, but I was relieved to realize that I spoke well enough to be understood clearly by the villagers, even on my first try. Keeping a big smile on my face and using even larger gestures helped, too.

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