It’s the middle of November in Lima, summer is just around the corner. For the first time in weeks the sky was blue and the sun was baking the vast expanse of sandy, shack dotted hillsides that surround central Lima. We were trying to find the second patient on our visit list for the day.

In order to do that, we had to take three busses, hike across garbage-strewn dirt roads, past a massive cemetery up to a footpath (which would not even pass as an acceptable hiking trail in the United States) which led to the communities high on the hillside that no car could drive to.

We slipped on the gravel, occasionally passing trees that shocked the desert with a bright green. This was the site of a future MEDLIFE staircase, but for now it was still just another one of the slick and steep gravel paths that cut the hillside into a disorderly maze of homes and communities.

We finally arrived at Carmen Castro’s house, sweating under the blazing sun. MEDLIFE nurse Carmen knocked on Castro’s door. No answer. I sighed, feeling exasperated- this was a long way to come to not even see the patient.

We had already gone all the way to see another patient, Nery Huaman Salas, in a different community to review her test results with her- but she still hadn’t gone to pick them up yet, so Carmen asked her to please get them and said we would come back.

MEDLIFE walked her through breast cancer treatment, she had an operation and the tumour was removed. When we saw her today she was working at her tienda, something she couldn’t do before the operation. She said she was feeling better, despite a few aches and pains. But she still needed to get that test to make sure that the cancer was totally gone.

The patients that make it into the MEDLIFE follow up care system are the tough ones-patients who were already in a hard situation before they got really sick, patients who needed far more help than could be provided in a mobile clinic. When treatable patients like these get put in the MEDLIFE patient follow up system, nurses stick with these patients through every step of care.

That is not as easy as it sounds, even basic logistics like meeting the patients can be a huge challenge.

Most of our patients do not have phones or email addresses. That means there is often no way to prearrange a meeting with them. That means that our nurses have to go all the way to their homes to check on them, see if they are there and make sure they are following through with their treatment.

When living day to day is a struggle, like it is for our follow-up care patients, people tend to take care of whatever current need is most pressing. They think about things like making enough money to feed their kids and getting drinkable water. When you are not currently feeling ill, it makes sense that such concerns would trump future health, especially when you have to travel a long ways to get from your home to a doctors office, sacrificing valuable time and energy.

Once our follow-up patients start feeling better and can start working again, their health becomes abstract, they are no longer directly suffering because of it and thus the final stages of treatment are not a top priority.

In many cases, this is a critical moment; patients need to stick with treatment after symptoms have subsided to ensure continued health, to ensure they don’t relapse.

Carmen Castro had Hyperthyroidism, which had caused her thyroid gland to swell into a large and visibly painful goiter on her neck. It had gone down, she was feeling better and back to caring for her family, but if she didn’t go get a blood hormone test and take the medicine she needed, her symptoms would come back.

She had already been visited a couple of times by MEDLIFE staff, and had continually told them she had not gotten the exam. So we were back again, hoping she had gone.

We soon encountered one of Castro’s young daughters who led us around the families small rusty-green home to Castro’s sister. She apologized, Castro wasn’t here. She had gone to get her blood exam. Carmen smiled at her and asked her what day she could return to discuss the results- she would be back.