PASEO Program Adventure—Day 17: El Porvenir y Trujillo, Peru

This morning (Monday—yes, still behind), I completed my final observation at another school in El Porvenir. It was definitely an interesting experience because the school I observed is a Catholic school (considered more private than the others), as opposed to a national school (or public school, which is what every other school I’ve observed so far is considered). Since students from the secondary school were on a field trip to local historic sites for the day, I was only able to observe students in primary school.

Upon speaking with a local social worker, I was informed that there is a lot of crime among the students, including extortion and theft. When I spoke to the director of the school, she mentioned that a lot of the children have difficulties at home that influence their behaviors, including lack of parental support and/or parents having to work long hours, leaving their children unsupervised upon returning from school. This recurring theme seemingly continues to make its way into every school that I observe. There are so many challenges that these children face both inside and outside of school, but especially once they leave school grounds each day. The risk factors are substantial, and we have to focus on fostering more protective factors in order to provide these children with substantial support so they can have the futures they deserve.

In the afternoon, we had our weekly meeting with a group of local women and family members in El Porvenir that I briefly discussed last week. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week, one of the other students and I were in charge of working with the group members’ children—some of whom have physical disabilities and/or difficulties with motor skills and/or verbal communication deficits. We had each child write their names and draw something that corresponds with each letter of their name. The creativity and abilities in these children are truly incredible.

After our group, we went back to Trujillo for our Psicología en Peru course. Tonight, we focused on statistics within the country, all of Latin America, as well as throughout the world. When we look at a global scale, depression happens to be the most common mental illness. However, in Latin America, only five percent of the adult population reportedly suffer from Depression. According to the NIH, “In 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode in the past year.” If so many people in the United States alone have experienced depression, why is the percentage so low in Latin America? It’s because so many people do not seek or receive mental health services. This number is merely what is reported.

Among so many other challenges, stigma is the biggest problem pertaining to bringing attention to mental illness in Latin America, and especially Peru due to discrimination against mental health. If you seek any type of help or treatment, you’re considered “weak” or “crazy.” You’ll likely be asked, “Are you weak? You’re not strong enough to deal with this?” Alongside stigma, shame and misconceptions about having a mental illness come into play as well.

Even if we were to put stigma aside, psychoeducation is another challenge. If someone does in fact have a mental illness, many times, they’ll go to the local clinic with the belief that it’s a physical illness as opposed to a mental illness. In a perfect world, hypothetically speaking, of course, let’s say that someone does in fact go to the hospital for an issue pertaining to their mental health. As I mentioned the other week, you would have to wait days in the hospital before getting an appointment, and when you finally do get one, your appointment would only last a few minutes, and would consist of being asked a few “yes” or “no” questions to determine if you have depression.

There isn’t enough time to converse with the patient, so the odds of someone actually getting the help he or she needs and deserves are slim to none. But first, you’d have to overcome the stigma and shame in order to even make it to this point. And you’d have to hope that your family wouldn’t abandon you due to shame as well. Now if you want to talk about services, there is about 1 psychiatrist per every 300,000 people in Peru. If we were to look at another country, let’s say Colombia for example, there, you would find 2.1 psychiatrists per ever 10,000 people. Pretty significant difference, right?

The following statistics have been taken from Según el Instituto Nacional de Salud Mental (INSM) (2014): Nearly 5 million people (11.8%) in Peru suffer from some type of mental illness. 700,000 out of 1 million Peruvians suffer from depression, while 200,000 out of 1 million Peruvians suffer from some type of anxiety disorder. Less than 4 percent of these individuals receive services in specialized centers. Why, you may still ask? Fifty percent of such individuals believe they can overcome their mental illness on their own. Thirty percent don’t believe in treatment, and thirty percent don’t know where to go to receive services. (Yes, the percentages overlap.)

This is why education is so important. We must spread the word about mental health because until we can do so, millions of people will not receive the necessary services they require.

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PASEO Program Adventure: Day 3 in Huanchaco y Trujillo

Today was officially the start of my new adventure. Upon waking up in the morning, it took me a few seconds to remember where I was. But after the initial shock of forgetting I just traveled abroad settled down, I quickly realized that I was in Huanchaco, Peru- a place I will eventually come to call my home. 

In my short time here, I’ve come to appreciate one of life’s treasures that I believe so many of us take advantage of back in the States. Yes, I’m talking about Charmin Ultra Soft. I’ll just leave it at that and let that resonate for some time. I’ve also come to find out that maybe more people are actually reading this than just my mother and possibly my grandmother too. That adds a whole new level of pressure, seeing as I’ll have to write more than just what I’m eating and how I’m keeping safe every second of every day.

To really push myself into this new adventure ordeal, I went for a run this morning alongside the beach. (I know- I’m just as surprised writing that as you probably are reading this). Not only is Huanchaco known as a fisherman city and for its seafood, but it is also known as a surfing town as well, since the waves appear to always be in full flight. In fact, we can even hear the sound of the waves crashing down from the house we’re staying in. Sometimes you have to make sacrifices in life, and I guess sacrificing Charmin for an oceanside view will have to do. 

This afternoon, I had a pre-evaluation to assess my current knowledge of the Spanish language. I read aloud a case study and was asked to answer questions solely in Spanish regarding how I could help normalize a teenage pregnancy, how to explain depression to a teenager, and an example of a technique I would use to help a teenager calm down from nerves at any given moment during a session. My responses were recorded and will be heard by four of our professors as well as the owner of our house who is not in the counseling field and who does not speak English. The purpose is to assess each student’s needs and to see if a local would understand our explanations and techniques. This will set the foundation of our learning goals throughout the upcoming weeks. 

I had lunch at a local restaurant, where I paid 10 soles (less than four dollars) for a tamale, pollo saltado con arroz y papas, and a sweet drink made from a local fruit. I wanted to take pictures, but my hunger got the best of me. 

Our evening was spent in Trujillo (what you are looking at in the pictures), where we had our first class- Psicología en Perú with a local psychologist. I’ll have to provide more concrete details once the PowerPoints are shared with us, but we learned about mental health care in Peru, and how while even though there are laws that entail for mental health care to be accessible for all, this most certainly is not the case. For someone seeking mental health care in a hospital setting, the psychologist only has 10-20 minutes with that individual to provide an initial intake. 

The initial intake covers basic information about the person, as well as a brief assessment, in which only one question really matters. Have you thought about or attempted suicide within the last three months? If the individual answers yes to that, and apparently only that, only then will he or she return for services. However, services entail follow-ups consisting of taking other assessments each session. And you only have 10-20 minutes total for your session, if even that. Imagine any time you describe a difficult day you had at work to a loved one, or the last time you complained about a coworker or someone who cut you off on your way home. Now imagine trying to get all of that out in 20 minutes at most. And now imagine trying to discuss symptoms and issues you are experiencing pertaining to your mental health in about 10 minutes.

There are 20 inpatient agencies and 21 community agencies (focusing on medical and mental health together) throughout the country that are meant to serve the millions of individuals living here. One newspaper article showed a lady who attempted suicide three different times, but was unable to be hospitalized due to a lack of beds in the agencies. Imagine that for just a moment. 

With regards to substance abuse, the main modality of treatment here appears to be through the church. If you can put your faith into a higher power, and a higher power alone, your addiction will be “fixed.” Social workers can be found giving brief prevention-based education in the schools to that it can be said that the material has been “covered.” And if you want to talk about an individual with a severe and persistent mental illness, let’s say schizophrenia, for example, such an individual would be asked to go in for medication once a week. He or she would then be expected to continue to go in for more medication on a weekly basis. And that is your mental health care, in a condensed version. As a side note, there are great providers trying to make a difference here, just like in other countries as well. But this is the general sense of how mental health functions throughout the country.  

If I’m not mistaken, the amount of money that would be required to get Peru to where it should be with regards to mental health care is 800 million soles (less than 245 million dollars). The actual amount being spent on mental health care by the government is roughly 69 million soles (a little over 2 million dollars). The wealthy people in Peru live (viven), while those without money survive (sobreviven). Having started this post talking about a quality of toilet paper, I can’t help but think how fascinating it is what so many of us take for granted.

(P.S.- if any of the information I wrote is incorrect, I will be sure to update it and blame it on jet lag.)

Snapshot Challenge Saturday

My brother and sister work in the floral industry, and as you can probably imagine, work has been somewhat hectic (to say the least) with the holiday season in full swing. However, as orders have been placed and shipped, they had a great deal of extra vases and flowers sitting around their warehouse. They decided to donate all of the remaining flowers to a local hospital, and they invited me to go with them to make the delivery.

They gave forty arrangements to the administrative nurse to hand out to the patients, and seeing how appreciative she was on behalf of the staff and patients was such a beautiful and fulfilling sight. It just goes to show that simple and thoughtful acts of kindness can make all the difference.

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Day 2 In Warsaw, Poland

This was our last day in Warsaw to take in all of the remaining sites, and our first stop was to the Old Town Market Square. More than 85 percent of Warsaw’s historic center was destroyed by Nazi troops during the Warsaw Uprising in 1944, but thankfully the Old Town was restored and has since become a UNESCO World Heritage Site.

There is a statue of a mermaid in the middle of the square, which happens to be Warsaw’s symbol. “Many legends exist that describe how the mermaid came to symbolize Warsaw. A popular version of this story tells of how the mermaid named Sawa was rescued from capture by a man named Wars. Because of Wars’ kindness, Sawa vowed to protect the city. Warsawa (Warsaw) became the name of the city and the mermaid is shown with a sword and shield in recognition of her promise to protect the city. In another story, a peasant man named Wars was directed to the location of the future city by Sawa, the mermaid. A related version of this tale explains how a prince, guided by a mermaid, traveled to a small village where he was given food by a mother with two children he named Wars and Sawa. The prince bestowed land to the family and the mermaid rose from the water to bless the future of the city that was to become Warsaw.” Regardless of whichever story one may choose to believe, the mermaid symbol can be found incorporated into some of the architecture throughout the city.

As we explored the surrounding area by the Old Town Market Square, we came across a museum dedicated to the discoverer of polonium and radium, Nobel Peace Prize recipient Marie Curie—who also happened to be born in Warsaw. We then came across a beautiful church, followed by a second church with an especially tragic history. During the Warsaw Uprising, the church served also served as a hospital, which was located in the crypt of the church. The church itself provided shelter to the civilian population during the bombing blitz. In Mid August, the church was bombed and destroyed, killing approximately 1,000 people. The hospital managed to continue to function in the ruined building until it was taken by the Germans in September 2nd. The invaders firstly executed the whole medical staff and blew up the hospital burying about 500 people alive under the rubble. After the war, it turned out to be impossible to exhume the remains of all the victims. Therefore, the ruined crypt was completely covered with a new marble floor with the remains entombed underneath.

After our brief exploration during our free time, we stopped at a small cafe for lunch, where I had a tuna sandwich and an incredible berry merengue pie. (Not to bore you with minute details, but I had to include this as well as a picture because it really was great). When we finished lunch, we headed over to the Wilanow Palace, a Baroque-style royal residence built between 1677-1696, and has been consistently changed and modified ever since. Each time a new generation took over the Palace, they either remodeled or added onto it in a personal favorite style, which is why parts of the palace may look different than others. Nevertheless, every aspect of the Palace is truly magnificent.

When the tour of the Wilanow Palace concluded, we had the rest of the day to ourselves. As we walked outside our hotel and continued down the street, my sister and I saw a crowd gathered outside a hotel. We asked a local what everyone was waiting for, and they told us that the Real Madrid soccer team would be leaving the hotel any minute. They had been in town to play against Fiorentina, and stopped at the hotel to pick up their belongings before returning home. With high hopes of seeing celebrities, my sister and I decided to camp outside the hotel with other fans of the team. When three hours passed by and no one left the hotel yet, my sister and I decided to return to our hotel a few blocks away so that we could change for dinner. Just two blocks before arriving to our hotel, a motorcade consisting of police cars and police motorcycles passed by, along with the busses filled with the players of Real Madrid. Had we stayed in front of their hotel for ten extra minutes, we would have seen all of the players…

We went back to the Old Town Market Square for dinner, and ate in a fifty-seven year old Kosher restaurant, with hopes of tasting traditional Jewish food from the area. I ordered a steak that tasted like it was fifty-seven years old, but even so, the traditional Jewish pictures throughout the restaurant and its long-standing history in the community was still impressive. After dinner, we stopped for a drink at a bar a few stores down and walked back to our hotel as soon as our tiredness kicked in. On the way back, we passed The Church of the Vistandines, a Roman Catholic Church from the 1700’s, and even made it in time to watch the changing of the guards at the country’s Tomb of the Unknown Soldier. The picture below is a little blurry, but the guards were just changing shifts at the top of the hour. With enough excitement for one day, it was time to go to sleep for the night, and prepare for our trip to Krakow in the morning.