OzTREKK student travels the world – Part 3

Continuing her tour of the world, future University of Sydney Master of International Public Health student Jennifer Avery takes time out to discuss the public health issues that affect Central and South America.

And if you’d like to see bigger photos, just click on them!

Sunny day in the plaza in Quito
Sunny day in the plaza in Quito, Colombia
What was your favourite location in South America and why? 
This is a tough one. I have to at least state our top three, which are Chile, Argentina, and Colombia. Chile was our number one for many reasons. It is developed and modern yet it also has more rugged and desolate areas like the Atacama Desert and Patagonia. We loved how we could visit lush forests, shop in trendy boutique stores, bike through the world’s driest desert, and camp out beneath snow-capped mountains. I am not sure if there are many countries as geologically diverse as Chile, and with such warm people!

Your least favourite? Why?
There wasn’t a single country where we were not enjoying ourselves the entire time, but one that stands out as a not-so-pleasant experience is Bolivia. Some comical but serious advice from people prior to going there was to “eat nothing” there to avoid getting sick. Well, this was the only place on the trip that one of us was unwell—Ted had some gastrointestinal illness for about two weeks, so that put a damper on things!

“Spending so much time in South America helped me begin to witness and understand people’s day-to-day lives in so many different areas.”

 

Bolivia was admittedly less comfortable than other places we’d been, including Peru, Ecuador and Colombia. It was not uncommon for us to see people blatantly defecating or urinating in the streets (watch where you step!) and there was garbage everywhere. There were also a couple incidents where we were sure we were going to be robbed (not uncommon), but thankfully we dodged it in different ways.

The famous South American celebration, Carnaval, was going on while we were in La Paz, Bolivia. In many places throughout the continent this is a big celebration, but in La Paz it meant a parade one day followed by the entire city shutting down for about five days. And when I say the entire city—I mean pharmacies, tiny street stalls, restaurants—everything. It was an absolute ghost town. We had already spent more time than we wanted in La Paz, but each day we went to the bus station it was either completely empty or it was filled with employees drinking in the bus ticket sale booths (but refusing to sell any actual tickets since all the drivers were home drinking!). All that being said, Bolivia still had one of the highlights of our trip—the Uyuni salt flats. After being stuck in La Paz for days on end it was a refreshing surprise to our trip.

Carnaval in Bolivia
Carnaval dancers in Bolivia

Which was the poorest location, and what issues (health, poverty, etc.) did you notice?
Bolivia was the least developed place we visited and it begrudgingly holds the title of the poorest country in South America. This is evident by things like the number of people using the streets as a public bathroom (perhaps because most toilets you must pay for), and also the number of young children working in stores and restaurants instead of being in school. One of the sad things I remember seeing is people living in their shops—the mattresses they slept on were inside their tiny stores, their living space no bigger than 6 by 7 feet. Lack of clean drinking water is a definite issue there, and the cheapest thing to eat is always candy and junk food. Dental problems are rampant there, too, which is evident by toothless smiles, blackened teeth and for the few who could afford it, metallic veneers. I am sure there are astronomically high rates of diabetes and heart disease, but due to the poverty, I’m sure it’s hugely underdiagnosed.

Valley of the Moon
Optical illusion in the Valley of the Moon, Chile (salt flats)

How did your experiences in South America reflect your interest in public health/nursing and what did you learn?
I have always been interested in South and Central America culture and people. Parts of it are rugged and so worn down but people’s spirits are incredibly bright despite their adversities. I really want to work in places like that, which is why we spent so much time exploring the culture there. If you have any interest in public health in developing countries, I think it’s valuable to immerse yourself in it to understand it better before trying to generate solutions that may not realistically work or be well received by locals.

“…you realize how global public health efforts need to be creative, realistic and address issues at different levels.”

 

Spending so much time in South America helped me begin to witness and understand people’s day-to-day lives in so many different areas, all with varying socioeconomic levels. I learned a lot about how and why people make the decisions they do—especially with unhealthy food options that are definitely detrimental to one’s health. We saw firsthand how healthy greens and produce were hard to buy, but once found were always wilting, fly-ridden, and really overpriced. But shiny, colourful junk food was everywhere and unbelievably cheap! Being on a backpacking budget, we totally fell victim to this and could really understand why people make the choices they make. I gained 10 lbs just in the first month being there (I can’t imagine how I’d look if we stayed longer!).

Jennifer performing a glucometer check
Streets of South America

The day I finally found whole wheat bread, a whole two months into our trip, I squealed in excitement. There’s seemingly no encouragement to eat wisely and little affordable options to do so. It definitely sparked my interest as to how to target these kinds of problems, which are much more complicated than simply teaching someone how and what healthy foods are. The reality is the options aren’t there, but we can help work toward making them exist with different strategies. The whole experience—especially my own frustration in a lack of healthy options or clean drinking water—it all really made me interested in helping improve the situation for people.

Galapagos Islands
Jen and Ted explore the Galapagos Islands
Why do you think your travel experience is going to help you in your career in public health? 
Visiting so many different countries, each with differences in culture and poverty level really showed me how we need different approaches to helping improve health in different places. No two countries are the same: even if the language and customs seem similar, there are always subtle but important differences that affect how and why people make choices that can affect their health, perception of wellness, and how they treat ailments. We experienced firsthand the lack of things like clean drinking water, toilets, soap, and nutritional food options. It just really makes you realize that in many third-world countries, health is not a conscious decision. That is something we take for granted in developed places. It really helped me see how health is a very complicated system. You can educate people all you want about making healthy food choices, but once you see firsthand that those choices are nonexistent, or truly unaffordable, you realize how global public health efforts need to be creative, realistic and address issues at different levels.

Machu Picchu
Jen and Ted atop Machu Picchu

In our travels and talking with locals, we learned about many places that have corrupt governments, which prevent money from trickling down to clinics, pharmacies, and communities. It’s something we know exists in the world, but seeing it in person made it more real, and it couldn’t be ignored. (Let’s face it: we often all turn a blind eye to many global issues.) Repeatedly, we saw huge divides in socioeconomic classes; you could drive by barren wooden shacks falling apart and then just 10 minutes up the road be whizzing past elaborate mansions. Our experiences will help me as I continue to understand the complexity of health in developing countries. It’s certainly not something I will oversimplify. There are so many components to addressing global health issues, and that is something I want to always remember in my studies and career in public health.

Jennifer performing a glucometer check
Jennifer performing a glucometer check

Tell us a bit about your medical experiences in Nicaragua.
Last year, I volunteered as a nurse for two weeks in Nicaragua with a medical volunteer trip with an organization called Friends of the Orphans Canada (FOTOCAN). Our work involved providing medical check-ups, vaccinations and health teaching to children at the orphanage. With the support and donations of hospitals and clinics, we were able to bring in lots of equipment, medications (including the vaccines that many of the children were behind on due to lack of money from the government to buy these items), eyeglasses, clothing, and much more. Fortunately, the kids at the orphanage are generally very healthy and enjoy a higher quality of life compared to those in the community as they receive food, education, and job support. For this reason, many of the children aren’t actually orphans, but are voluntarily enrolled by their families so that they can live a better life.

“I knew after this experience that I wanted to devote my career to improving global health.”

 

Nursing duties in Nicaragua
Nursing duties in Nicaragua
In addition to providing health care to the kids at the orphanage, the other main goal of the trip was to provide supportive care to the nearby communities, which were extremely poor. We set up mobile clinics (literally tent tarps and folding chairs) each day in remote villages and also returned to them in the second week to see follow-up patients (i.e., ones with a first-time high blood sugar or blood pressure reading). In churches or homes, we triaged and conducted hundreds and hundreds of medical exams on local people, screening them, diagnosing illnesses and infections, and prescribing medications when needed. Many of the people we saw I am certain have never even seen a doctor in their lives. Our most common diagnoses were diabetes and hypertension (one patient I saw had a blood pressure of 202/100. A healthy adult should be around 120/80!). Some people were already aware that they had certain illnesses like diabetes or hypertension, but their local pharmacy would often not have the stock of the medication they needed. Locals and health care professionals in these communities attributed this primarily to corrupt government. Thus, another big part of our trip was bringing mass supplies of medication to help restock pharmacies and providing people with adequate amounts of the medicine they needed.

We provided other valuable services including optical check-ups, providing eyeglasses and much-needed dental care. I’ll always remember when a volunteer called me over to help because while as they were brushing a child’s teeth, they were all falling out because they were so decayed. Prior to arriving in Nicaragua, our group connected with local health care professionals and specialists who also accompanied us in our clinics. This was extremely valuable since many people required specialist services and/or follow-up care after our departure. We had a local gynecologist, optometrist, many nurses, and a dentist volunteering with us. Combined with our own group of doctors, nurses, dieticians, and many other health professionals, we were able to efficiently see huge numbers of people in a short period of time and subsequently connect them with specialists if needed.

Nursing duties in Nicaragua
Enjoying a quick nap in Nicaragua

This volunteer trip was the first type of experience I had done like this. It was humbling and fulfilling to say the least, and I knew after this experience that I wanted to devote my career to improving global health.

Check out our next installment of Jennifers travels, when the soon-to-be Sydney International Public Health student chats with OzTREKK about their trip through Spain, her camel ride in Morocco, Paris museums, and Abbey Road mimicry! 



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