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 10: El Porvenir y Trujillo, Peru

If I could fast forward one day (in real time)… My phone fell out of my pocket today in a shared taxi cab, which explains why this post is picture-free. I’ll explain what happened in tomorrow’s post (which is today in real time). I just figured I’d let you know you’ll have to use your imagination for the next few days with regards to what I’m talking about. And for those of you who just look at the pictures and don’t read the post (which I imagine is most everyone), well, it doesn’t really matter since you wouldn’t have made it this far in the post anyways.

Today, we traveled to El Porvenir, where we met with a group of local women and family members. We will undoubtedly learn a great deal from those in the group, but the goal is to help teach these individuals relaxation techniques for them to utilize at any given moment. More importantly, these individuals will be able to teach these learned skills to others in the town, so that the cycle of knowledge can continue to be passed along.

Our evening was spent learning about Psychology in Peru, which focused on healthcare throughout the country. We watched various videos that showed the lack of resources and services that public hospitals are able to provide. People wait days in public hospitals before being able to be seen by the general doctors on site. Specialists are rare to come by, so you have to wait to see one of the few general doctors. When it comes to important procedures of surgeries, you may have to wait days before being seen, but being seen just means that you’re given an appointment to return months later. You’re also given a list of supplies that need to be purchased for your procedure or surgery—all of which you must pay for and supply yourself.

Hospitals receive government funding, but tend to find themselves on the side of corruption, as they have deals with local clinics. If someone needs an appointment, the hospital will likely send them to a private clinic. Regardless of whether or not it is an emergency, the individual will have to pay for his or her own transportation from the hospital to the clinic. Now add on the cost of whatever the private clinic will charge as well.

If you want to see someone for a mental health concern in the hospital, you’ll likely see a nurse because mental health professionals are just as scarce as good public healthcare. Imagine having a serious medical condition, all while having to wait days in a hospital (no exaggeration)—in a wheelchair (if you are lucky), on a chair (if you can find an available one), on the floor (if there is room), or outside on the street. Now imagine having said serious medical condition, alongside a mental illness. With or without a mental illness, you will likely come out of the hospital worse than when you went in.

While medical care is short-staffed and completely behind, you can only imagine what mental healthcare is like. For this reason, oftentimes the solution for those with mental illnesses is to go to the church, talk to a friend (if you’re fortunate enough to do so), turn to alcohol and/or drugs, or commit suicide.

It’s difficult and frustrating to discuss the corruption, mismanagement, and maltreatment that takes place for those without financial resources, which ultimately affects the lives of so many. How do you make a change from the bottom upwards, when real change needs to start from the top and work its way downwards? Unfortunately, I don’t have the answer just yet, but we have to start somewhere. And seeing local individuals gather together to try and help those in their community is definitely a start in the right direction.