In summer 2023, Dundee medics Angus, Jed, Lee and Jack spent 4 weeks at the health post LED supports in Quisuar, in Peru’s Cordillera Blanca. Here are the write ups from Angus and Jed (including PDF originals), together with some of their photos. Thank you all for all your hard work in Quisuar and surrounding villages. It sounds like you had a great time!

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Rural Medicine in the Cordillera Blanca Mountains, Peru – Angus Pinsky

Placement

We spent four weeks volunteering in the north of Peru, in a health post in the Cordillera Blanca mountains, and in the town of Acopampa, in the northern province of Carhuaz.

The health post is run by the small charity Light Education Development, located in the village of Quisuar. It is staffed by a single nurse, and we were also accompanied by a friendly guide/translator, called Juan. Here we ran clinics for the local people, who visited from the surrounding villages. We could take histories, perform physical examinations, and prescribe from the post’s small medication store (to which we contributed some donated medicines). The local people speak Quechua, and so we had to translate throughout each consultation. Each day we would see up to 25 patients, although the number of patients who visited the post would vary greatly, and they would arrive anytime between 7am and 10pm.

The ailments we witnessed most often were common conditions, such as UTIs, URTIs and GORD, as well as chronic conditions such as osteoarthritis. There was a distinct lack of public health knowledge, meaning our primary role was often educating patients on concepts such as curative vs symptomatic treatment, eating healthily, and drinking adequate quantities of water.

Alongside our general consultations, we also provided basic vision assessments and free reading or distance glasses for those who needed them.

In Acopampa we performed basic vision assessments on all the pupils at a local school, as well as some parents and teachers. Here we also provided free glasses, that had been donated to the charity.

Peru

Peru is a high-middle income country, located on the west coast of South America. It has a population of 33.72 million, and the capital is Lima.

Healthcare in Peru is provided by a mix of government and private organisations, with an insurance-based model. A majority of citizens receive some form of government coverage. However, there are many barriers to accessing healthcare, especially for those in poverty and those who live rurally. We witnessed this during our time in Quisuar, where the villagers who visited us would have otherwise had to travel a long distance to reach the nearest government- run health post, and even further for any specialist care. There are also difficulties for Quechua-speaking communities, as consultations are generally conducted in Spanish.

Organisation

In order to organise our elective, we got in touch with Light Education Development through the contact form on their website, which can be found here:

https://lighteducationdevelopment.org

We were then contacted by Val, the charity’s founder, who was our supervisor.

Pros

• Exposure to health practice radically different to that found in the UK
• Good immersion into the lifestyle and culture of local people
• People were always friendly, welcoming, and immensely grateful
• Program established based on a thorough understanding of local needs and issues
• Health post based in a strikingly beautiful mountainous region of Peru, well off the tourist track
• Opportunity to take on a lot of personal responsibility vs a more conventional placement
• Opportunity to travel in Peru, see Machu Picchu, and lots of other amazing sights
• Cost of living is very cheap compared to the UK

Cons

• Language barrier if you don’t have pre-existing Spanish knowledge
• Only basic amenities at the post, which could be challenging for those not prepared for a pared-back lifestyle akin to camping
• Could be lonely without a group
• Have to go through around a week of adjustment to altitude to avoid altitude sickness, as the post is located at around 3000m elevation

Tips

• Learn some Spanish!
• Take a four-season sleeping bag, comfy mat, and a water-filter
• Speak to someone who has been before about practicalities (I have a packing list I can pass on)
• Follow all the advice of the local guide
• If you’re interested in trekking, let your guide know

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Quisuar Health Post Report – Jed McIntyre

Volunteering in the Quisuar health post was something truly special. Better than just visiting Peru, working rurally in the mountains made us a part of the community for our time spent there and our welcome couldn’t have been warmer. Our days were kept busy and entertaining running clinics as a team, which consisted of ourselves (5th year students), Juan who acted as our translator/guide and the health post nurse. As students, the exposure and opportunities on this trip was invaluable and helped develop confidence in leading consultations as well as general medicine. From initial presentation to examination and management it was all student-led, great to get a taste for responsibility and we never felt too far out of our comfort zone. We saw a wide range of conditions from many specialities including arthritis, viral coughs, angina, UTIs and vision problems. This healthcare was a huge benefit to patients and with the community being so small, being able to see the impact felt great, from clearing up diseases to providing glasses – this was huge for quality of life as being able to see well enough to thread a needle is very important to the families.

We ran clinics from Quisuar offering our services to the locals who really appreciated our time. It always felt useful contributing our medical management as well as just information which meant a lot to patients who had worries or questions. We also took a couple visits to the neighbouring localities of Seccha and Pochgoj where we were put up in accommodation and held clinics for a slightly larger population of people. This was also where we were able to stock up on biscuits! These journeys gave us opportunities to see more patients and work as a more mobile unit of healthcare. Although our stay here had wifi it couldn’t match the beauty of our surroundings in Quisuar, at ≈2900m elevation the mountain landscape was breathtaking and so isolated.

We also loved the opportunity to get involved in the community by teaching English and running activities with the local kids some afternoons as well as joining in sport festivals who were always keen for some extra numbers to play football or volleyball. Along with my memories of our exciting clinical work and the beautiful location, I’ll never forget Jack’s flying volley from the halfway line to raucous applause from the crowd. My hero.

Our time in Quisuar offered a unique chance to visit the beautiful country Peru, to learn and develop our knowledge and skills in a new environment. And to contribute to and belong in a community on the other side of the world. To experience their hospitality, stories and culture was a treat!

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Photos

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If you’re a medical student interested in spending your medical elective at the Quisuar Healthpost, check out our How you can help page for more details.

In summer 2022, Leeds medics James Peaty and George Thomas spent their medical elective period at the health post LED supports in Quisuar, in Peru’s Cordillera Blanca. As well as providing healthcare from the clinic in Quishuar and undertaking home visits for local elderly people who weren’t able to come to the clinic, James and George also ran a mobile eye clinic to distribute reading and distance glasses away from Quishuar and provided English lessons for local children in Quishuar. Here’s James’ report.

Aims and objectives

The key aims of the elective were to:

• Experience healthcare provision in a developing country.
• Experience healthcare provision by an international charity.
• Contribute to healthcare provision in an area of need by fundraising for and purchasing a laptop as well as transporting glasses donated in the UK to be handed out on arrival.
• Learn a new language using audiobooks and Duolingo.
• Conduct English lessons for local school children.

Background and Organisation

I first heard about the elective form a friend, Hugh Harris, 3 years above me on the MBChB program at Leeds. He along with 3 other University of Leeds Medical Students had volunteered at the clinic based in the village of Quishuar in 2019. Through Hugh I was able to contact Val Pitkethly, the founder of the charity, Light, Education, Development (LED), that supports the clinic. After a short application process that involved submitting a CV and meeting with Val to discuss practicalities and get more information my elective partner, George Thomas, and I were accepted onto the elective.

The clinic itself is based in a mountain village on the eastern side of the Cordillera Blanca range in central Peru. It serves the people who live at the highest elevation at the western end of the province of Lucma who are furthest from the government run clinics that sit on either side of the range.

The main activity undertaken by the population served by the clinic appeared to be small scale farming and labouring jobs and the main form of housing was mud brick houses.

The clinic building consists of 4 rooms; the kitchen and nurse’s quarters, a waiting room, the consulting room and the bedroom. Running of the clinic is funded by the charitable donations mainly form the UK but also worldwide thanks, in part, to an international network built through Val’s mountain guiding clients.

There is a permanent Peruvian nurse stationed there throughout the year but all other medical staff are volunteers. Volunteers were mainly doctors and 5th year medical students from the UK but doctors from other developed nations had also staffed the clinic on a temporary basis in the past.

Type of work performed

The clinic functioned as a basic source of primary care. To fulfil this function the clinic was equipped with basic examination equipment including all the equipment necessary to perform observations, a few books including the BNF and Oxford handbook of clinical medicine and a large stock of various basic medications ranging from antimicrobial agents to proton pump inhibitors.

In the clinic our history taking, and examination skills were well practiced. Diagnosis based exclusively on these was essential as the only tests we had access to were urine dipsticks. Communication skills were also tested as none of the patients spoke English and many did not speak Spanish but instead only the Incan language of Quechua. Thus, all communication had to go through the translator working with us.

Other functions that were performed by the clinic included: distribution of glasses, English lessons for local children and home visits for local elderly people who weren’t able to come to the clinic. My elective partner and I were involved in all these functions. For example, one weekend we packed up enough for an overnight camping trip and drove across to an adjacent valley, hiked up to a village with no road access and set up a field clinic distributing glasses to the anyone who required them.

I had bought the glasses, which included both reading and distance prescriptions labelled as various strengths, in a shoe box from the UK. In the box there was also included a Snellen chart and reading materials of different sizes to help us determine, using a bit of trial and error, what strength of glasses each patient required. Over thirty people turned up to this mobile glasses clinic in both the evening and the morning of the next day. In the end we ran out of distance glasses.

English lessons were conducted after the children had finished school 3 days a week. We taught a small group of keen, primary school age, students basic things like the colours, animals, how to say their name and types of food in English. We also included games, songs (such as head, shoulders, knees and toes) and education about basic hygiene, sun safety and healthy eating. We tried to use as many visual aids as possible and to work form a rough plan.

Other tasks we performed while at the clinic included taking stock of and helping order medications, alphabetising medications, taking stock of equipment and helping purchase or replace equipment. We also helped purchase and set a laptop for the clinic that we had fundraised for by running the Leeds Half marathon.

Case report

During the elective I was fortunate enough to be exposed to clinical cases that were fundamentally different from cases I commonly saw in general practice in the UK. An example of this was a 5-year-old child bought in by his mother due to a month-long history of gradually worsening diarrhea and epigastric pain particularly after eating. He had also developed a chronic cough in the last month. On further questioning it was noted that because of the stomach pain the child wasn’t eating as much as normal. The key positive finding on examination was that the boy was underweight for his height and age measuring at the 50th centile in height for his age but only at the 2nd centile for weight.

On discussing my findings, I was told that this was a classic presentation of worms. One study done on the prevalence of parasites in rural Peru found that half of the participants (aged 3 and above) had at least one intestinal helminth or protozoan detected by microscopy. The most common parasite detected was Strongyloides stercoralis which infected 24.5% of the population studied. This nematode can produce symptoms of pneumonitis, chronic malabsorption, diarrhea and abdominal pain thus accounting for the child’s presentation.

I was informed that the standard treatment for this infection was Albendazole. Although the Oxford handbook of clinical medicine recommended Ivermectin as the first line treatment of Strongyloides stercoralis without access to stool microscopy or blood tests it was impossible to be sure of the causative organism. Albendazole has been shown to have good efficacy against a range of roundworms including others common to rural Peruvian populations like hookworm. So, using this broad-spectrum drug was more likely to be effective in treating this child.

In addition to pharmaceutical management, I learnt that it is important to educate patients on basic hygiene and protective measures to avoid re-infection. Many parasites are picked up by the faecal oral route but hookworms and Strongyloides stercoralis can also burrow through the skin. Studies have shown that those who do not wear shoes when leaving the house, and particularly when defecating are more likely to become infected with Strongyloides stercoralis. Therefore, education about regular handwashing is highly important but shoe wearing is also likely to reduce rates of nematode infection. However, this is easier said than done in an area where houses have dirt floors and there is poor access to proper sanitary facilities. Living in close proximity to parasite carrying livestock may also increase risk of infection.

Extra curricula activities

During my elective I was able to significantly improve my Spanish through a combination of immersion, Paul Noble audiobooks and the Duolingo app which I had been using to practice daily since January 2022.

Conclusion

Overall, I believe the elective met almost all of my aims. I was able to fully experience what it is like to work in an international charity and to contribute to healthcare provision in an area of need by: fundraising for, helping purchase and set up a laptop for the clinic; taking and handing out glasses donated in the UK to those who cannot afford them; and helping with the day to day running of the clinic. Furthermore, I significantly improved my understanding of Spanish and taught English to local primary school aged children.

I would have liked to experience the Government run hospitals and clinics to get a full experience of how their health system works. Although this was originally planned it did not end up coming to fruition.

Additionally, this elective had many learning points. These included: learning about diseases, like parasitic worms, that I hadn’t come across in the UK; learning what it means to live in a developing nation and how health needs in a developing nation are different from those of developed nations such as the UK; and the practicalities of healthcare provision in a resource poor environment.