Peru: Improving Health Care for the Poor - Summary Three

Progress in Health Outcomes

In the 9 years after 1990, many improvements have been seen in the overall health status of the people of Peru. Child and infant mortality indicators increased by over 25% as a result of improved immunization efforts and control of diarrheal disease in children. Various educational campaigns promoted strong hygienic practices as well as Oral Rehydration Therapy. Additionally, there have been efforts concerted towards improving water and sanitation and malnutrition rates have decreased.

Even though progress has been made, the infant mortality rate was still very high in Peru in 1999. Many of the campaigns and efforts were directed towards the health of older infant and children so much less progress was made in the mortality of infants around the time of birth or maternal mortality. Hemorrhages, mishandled abortions, infections, and hypertension, are the primary causes are maternal death, all of which stem from inadequate birthing conditions both in the hospital and at home. In the population as a whole, about 50% of the births are overseen by skilled health professionals, while in rural areas as few as two out of nine mothers receive help and care during birth. In addition to the less-than-adequate conditions, there are other factors that also influence the health of the child and the mother, such as poor maternal medical and nutritional care during the pregnancy, which can result in low birth weight and prematurity.

The majority of infant and childhood deaths in Peru occur in the poorest 40% of the population where education is minimal and the living environment is worse. The biggest problem that I have noticed during my time working with the infants in the health center is a lack of education among the mothers, which is also addressed in this report.

"The extremely low levels of use of health services by mothers are partly a reflection of ethnic and cultural barriers, combined with low levels of female education and cost barriers... The cultural barrier in rural areas in heavily reinforced by staff that remain unprepared to deal with poor indigenous women, who especially object to unaccommodating birthing conditions and fear various other aspects of institutional care... Part of the problem was due to low quality of surgical care and part was due to the lack of capacity to communicate with mothers and especially indigenous mothers."

During the week and a half I've spent in the Santa Rosa Health Care Center, I have spent a lot of time weighing, measuring, and evaluation babies as they come in for their monthly check ups. I have seen a whole range of types of mothers and families come into the clinic. Some parents come in clean, well-dressed, and equipped with the latest toys and gadgets. There are other mothers who come in and look incredibly young, sometimes maybe 15 or 16 years old. More often than not, the young, poor mothers tend to have babies that are very small and malnourished. I often am often surprised that some of the older, "put-together" moms also have underdeveloped babies.

I have weighed countless babies throughout the past week and have taken note of the measurements I recorded. For example, I have weighed (at least) 5 babies who are one month of age. I saw a wide range of sizes from very small and thin to thick and chubby.
Here are the measurements I took:

Baby #1

weight: 3.300 kg

height: 51.9 cm

head circumference: 35.5 cm

Baby #2

weight: 4.100 kg

height: 54.8 cm

head circumference: 38.3 cm

Baby #3

weight: 4.300 kg

height: 55.6 cm

head circumference: 38.0 cm

Baby #4

weight: 5.000 kg

height: 57.3 cm

head circumference: 37.3 cm

Baby #5

weight: 5.200 kg

height: 58.9 cm

head circumference: 36.6 cm

According to the Weight-Age chart, the ideal weight for a baby boy is 4.500 kg, with a healthy weight ranging from 4 to 6 kg. The ideal weight is about 55 centimeters, ranging from 53 to 59 centimeters. Given this information, it is apparent that Baby #3, #4, and #5 all are within the health range of heights and weights. However, Baby #1 and Baby #2 are small in both the height and weight categories.

When Baby #1 came into the clinic for his checkup, I thought he was a new born baby coming in for his first control and was shocked to find out that he was one month old. His legs were very thin, instead of chubby health baby legs. His mother looked very, very young; I would say she was probably around 15 years old. When the doctor saw the measurements I had taken of the baby, she scolded the mother about the importance of adequate nutrition to promote health growth and development. She told her that her baby will sleep all day if she lets him, but she has to wake him up to nurse every two hours or so. The doctor showed the mother how to properly hold the baby while nursing in order allow the baby to nurse most easily. She also prescribed additional supplements and nutrients to give the baby every day to promote health grow and development. The mother was instructed to bring her child back to the clinic every three or four days for a few weeks so that the growth could be monitored more closely. I have seen Baby #1 and his mother twice since the initial one month checkup and am happy to report that he gained weight and grew a little each visit. His mother obviously took the advice of the doctor seriously and made the appropriate changes to her baby's eating habits. She was glowing when I told her that her baby had gained weight and looked much healthier.

I know that no mother would intentionally allow her child to become malnourished. The young mother of Baby #1 had tears in her eyes when the doctor was telling her about the condition of her baby. I honestly feel like the lack of education and knowledge about proper infant care is a huge issue that leads to cases like this. Many uneducated mothers might thing their babies are healthy without knowing about how they should be progressing in height and weight. Fortunately, the life of Baby #1 was probably spared because he mother chose to bring him in to the health clinic for the routine checkups. While a health care center with child control services was available to this young mother and her baby, I am sure that there are tons of other mothers who live in rural areas without access to routine checkups and care. Their babies may be malnourished and underdeveloped but they may have no idea that there is anything wrong, simply for lack of knowledge.

Peru: Improving Health Care for the Poor addresses the fact that the lack of education, especially in rural areas is a significant issue when it comes to infant mortality rates and maternal health. In rural areas, the report states that infant and child mortality rates are twice as high as in urban areas. While the main direct cause of death is infectious diseases, more often than not the effects of the diseases are exacerbated by malnutrition and a weakened immune system. The areas that experience the worse rates have both poor environmental conditions and low levels of education. Overall, in my opinion, improving the availability of education is essential in improving the health of people in both rural and urban areas in Peru.