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Evaluating Current Public Health Practices in Villa El Salvador, Peru

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Evaluating Current Public Health Practices in Villa El Salvador, Peru

Abstract

Initiatives in public health have gained more popularity in recent years due to their simplicity and effectiveness. The success rates of such projects depend heavily upon their adaptability to the community’s needs, which in turn depend on pre-existing health data. The purpose of this study was to formally quantify and evaluate the current health practices in Villa El Salvador, Peru. The study formally verifies the need for clean water and preventative care education public health projects to address the growing health concerns in this specific community.

Introduction

Public health is defined as the science and art of preventing disease, prolonging life, and promoting health and well-being through organized community effort for the sanitation of the environment.1 While such practices can enhance health in many settings, recently the trend has been to study and apply these principles to smaller communities. The motivation in targeting smaller communities lies in enacting grassroots health movements, spreading awareness of basic, yet essential health measures to a specific population. By tailoring these efforts, specific areas of health salient to the community are emphasized. While their level of success has varied, the inception of such projects has drawn awareness to the field of public health and basic health issues worldwide.

Successful and sustainable public health programs must be well adapted to the unique needs of their target community.2 However, a component frequently overlooked is feedback from the community. Prior data describing community needs is essential when planning and piloting person-specific initiatives. Despite the correlation between the availability of current public health data and the success of public health initiatives, many small communities do not have the resources to enact widespread studies.

One such example is Villa El Salvador, a community of over 400,000 people in Lima, Peru.3 Founded on May 11, 1971 by a group of nearly 200 families, Villa El Salvador continues to remain as a “self-managed” community with both commercial and residential areas. After many organized protests, most of Villa El Salvador today now has electricity and water. However, poverty is a major issue in the community. An estimated 21.9% and 0.8% of the population falls into the categories of “poverty” and “extreme poverty” respectively, according to official Peruvian standards: these levels correspond to a family of four members living with $2/$1 daily, respectively.4

As a result, nonessential “luxuries” are often spared from the budget. Healthcare is often one such example. Most people cannot afford the medical services offered by the four major hospitals in the area.5 In response, smaller community health clinics including “San Martín de Porres Centro de Salud” have attempted to bridge the socioeconomic gap of attaining quality care. People attend these clinics to receive affordable, and sometimes even free, medical attention. While such establishments have continued to serve the people of Villa El Salvador, many are unable to periodically seek medical assistance. A heightened awareness of preventative care is severely lacking in the community, which can be addressed through targeted public health initiatives. Unfortunately, accurate and current health data for Villa El Salvador does not exist.

The purpose of this study is to formally evaluate the health practices of people in Villa El Salvador. Through this initiative, I aim to provide basic, yet meaningful data through the use of surveys for future campaigns in public health and preventative care. Through the information attained from this study, I aspire to provide insight into valid points of focus for the overall improvement in community health. By attaining specific, quantifiable data firsthand from the citizens, future public health projects will be able to mold their initiatives based off of specific community needs and therefore enact consequential and sustainable change.

Experimental

I designed a public health survey to study potential factors contributing to the health issues in Villa El Salvador. After researching prior literature and assessing community needs I targeted several factors: exercise, nutrition, sources and amount of water, hindrances for medical attention, time spent washing hands, and vaccinations. The final version of the survey featured seven questions targeting the areas mentioned. All seven questions featured multiple-choice responses to minimize time spent completing the survey and maximize regularity to yield meaningful results.

I first distributed surveys on June 19, 2012 during the San Martin de Porres Centro de Salud Health Campaign, which offered free healthcare at a local park in Villa El Salvador. This event was specifically chosen as a starting point of the study to collect an accurate sample of the population, minimizing socioeconomic inequalities. The surveys were then distributed in San Martin de Porres Centro de Salud in the mornings for the following week to collect more responses. Respondents were randomly chosen as they waited for medical services offered at the center. After giving informed consent, subjects were told to mark the best response for each question with the exception of the final vaccine question, where all pertinent answer choices were selected.

A total of 98 responses were attained in the two-week span. Thirty-six respondents were between the ages of 15-30, 53 from the ages of 31-50, six from the ages of 51-65, and three from 65 years and above. Since most of the patients of the clinic are females, 19.4% of males were surveyed. Besides the differences in gender, the sample population accurately reflects the demographics of Villa El Salvador.

Results

From the population sampled, 19.4% of participants reported consuming more than two servings of fruits and vegetables combined (Figure 1). The majority of the population reported consuming 1/2 or one serving (35.7% for both categories, respectively). Furthermore, only 12.5% of the population above the age of 50 reported consuming more than one serving of fruits and vegetables daily. Finally, two percent of the respondents reported consuming no fruits and vegetables.

Forty percent of the sample population reported consuming eight or more glasses of liquid daily (Figure 2). According to the results attained, 33.7% of the people consume less than two servings of liquid. The most common source of water for the population sampled was tap by an overwhelming percentage (53%, Figure 3). Both bottle and cistern options yielded 23.5% respectively.

Cost served as the biggest obstacle to periodically visit a doctor for 38.8% of survey participants (Figure 4). However, many 17.3% of the respondents (17.3%) reported distance from a medical facility as the most significant hindrance, while fear for seeing a medical professional was the next most selected response (11.2%). It is important to note that when presented with this question, 9.2% of the respondents reported “trabajo” or work as their answer even though it was not an answer choice.

The majority of the population (52%) reported spending 10 seconds or less washing their hands per attempt, while the second most common response (30.6%) reported was up to twenty seconds (Figure 5). Only 11.2% reported spending up to 30 seconds per attempt, while more than 30 seconds was the least common response (6.2%).

Discussion

A majority of the respondents reported consuming either ½ or 1 serving of fruits and vegetables together. According to the United States Department of Agriculture, individuals should consume at least five to seven daily servings of fruits and vegetables combined, depending on factors such as gender and age.6 This survey finding contrasts the steady decrease in malnutrition Peru experienced nationwide from 2005-2010 and most significantly in small, semi-urban areas such as Villa El Salvador.7 It is clear that the majority of Peruvians are getting something to eat, at least from the perspective of the Peruvian government.

The issue then arises of what is being consumed. According to the World Health Organization, Peru is expected to have about two million people with diabetes by 2030, triple of what it had in 2010.8 The increasing prevalence of heart disease has also been documented9 An unhealthy diet may point to the rise in noncommunicable diseases in this community. The data I acquired from the study points to the reduced consumption of fruits and vegetables could serve as major reason for why this disturbing trend is present.

The third question on the survey originally asked for asked for a respondent’s daily water consumption, but much of the Peruvian diet involves juice, soup, and other milk-based products that contain water. Hence, to get an accurate tabulation of water intake, I included juice and milk in the survey. Experts recommend drinking seven to eight glasses of water daily. The majority of people consume two to five glasses of water-based liquids according to the data I attained. In addition, most people cited “tap” as their major source of water. While initiatives promoting the healthy benefits of drinking water would prove to be helpful by emphasizing the importance of increased water consumption daily, the issue of attaining clean water sources must also be addressed.

The principle of preventative care is often deemphasized in many small communities worldwide, regardless of socioeconomic status. For a community such as Villa El Salvador, the importance of this concept multiplies. Realistically, the majority of people in Villa El Salvador cannot financially afford to see a specialized healthcare professional. Hence, regular checkups with a physician to help monitor physical well-being serve as paramount health checkpoints for patients. The real issue is when even these checkups become too expensive. As discussed in the results section, this is unfortunately the case; the majority of people reported cost as their biggest obstacle to seeing the doctor periodically. Keeping in mind that they surveyed population is from a clinic that already provides relatively inexpensive medical services compared to those provided “on the street”, or outside of the clinic, the results are quite discouraging.

The health clinic cannot do much to reduce the cost; most of the employees are volunteers that work for little or no money, making layoffs and reductions in salaries imprudent. Paperwork and other administrative tasks could be streamlined via computers to help improve efficiency, but such a change would not occur overnight. Furthermore, there is always the issue of funds. While places such as the health clinic could redistribute their prices towards their more popular revenue streams and incentivize those that come often, simple public health outreach solutions could prove to be quite effective. Demonstrations in the community focusing on self-check and self-evaluations would increase accountability while upholding the idea of preventative care. In addition, other healthcare professionals besides doctors could make periodic home visits to “high-risk” patients as part of the care they receive from the Centro de Salud. While the latter would require more human resources, it could potentially give students from nearby universities the opportunity to engage in basic physical examination practices. This would be a unique outreach initiative the Centro de Salud could pilot to reduce its own patient inflow.

Hand washing is one of the most popular public health topics in terms of universality and applicability.10 Preventing the spread of infections and illnesses is key for a preventative care approach. The Centers of Disease Control and Prevention recommends washing hands for at least 20 seconds, and up to 40 seconds depending on the drying mechanism. Over 80% of the sample population reported washing hands for less than 20 seconds. This helps to explain the spread of sicknesses and parasites in Villa El Salvador. The frequency of hand washing could also play a role, though this was not evaluated in this study. There have been initiatives involving hand washing in Villa El Salvador (Centro de Salud has one once a year), but these projects are targeted towards children. While it is important for children to learn the proper technique, it is just as important (if not more) for adults to learn as well. The adults usually prepare the food, the latter serving as a major source of illness. Furthermore, they serve as role models for their children; if they engage in proper hand washing, their children are more likely to as well11 In essence, while the community has shown its support for hand washing, the older generation must take the issue more seriously.

While access to care has improved significantly in Villa El Salvador with the emergence of smaller clinics, there is still room for much improvement for the overall health of the community. The aim of this study was to quantify the current health practices of the people of Villa El Salvador to provide community-specific data. The effectiveness of follow-up studies would increase if more people were surveyed in different areas of Villa El Salvador, particularly people over the age of 50 and males. Furthermore, delving into one specific topic, such as nutrition and hand washing, would provide more depth for the respective facet of health than this study presented. Regardless, the study was successfully completed and conveys tangible information concerning the health practices the target community. It is the hope that the investigation served as a solid starting point for prospective public health initiatives in Villa El Salvador and Peru at large.

Acknowledgements

I would like to thank Enrique Bossio Montellanos, Director of Cross Cultural Solutions in Lima, Peru and Carol Soto, Head Coordinator of the San Martin de Porres Centro de Salud and the entire San Martin de Porres Centro de Salud staff for all of their support. Also, I would like to thank The Rice University Loewenstern Fellowship, and the Rice University Community Involvement Center for funding my trip. Finally, a special thanks to Sarah Hodgkinson and Mac Griswold for all of their guidance.

References

  1. Clinton County Health Department website. http://www.clintoncounty      gov.com/departments/health/aboutus.html (Accessed Jul. 7, 2012).
  2. Trust for America’s Health: Examples of Successful Community-Based Public Health Interventions (State-by-State). http://www.cahpf.org/GoDocUserFiles/601.TFAH_Examplesbystate1009.pdf (Accessed Jul. 7, 2012).
  3. Participant Handbook: Lima, Peru. New Rochelle: Cross Cultural Solutions, 2012.
  4. Perspectivas Socioeconómicas para Villa El Salvador, Observatorio Socio       Económico Laboral, Lima Sur, Lima, Peru, Jul. 2009.
  5. Portal de la Muncipalidad de Villa El Salvador. http://www.munives.gob.pe/index.php (Accessed Jul. 7, 2012).
  6. Vegetables: Choose My Plate. USDA. http://www.choosemyplate.gov/food-groups/vegetables.html (Accessed Jul. 22, 2012).
  7. Acosta, A. M. Working Papers at IDS. 2011, 367.
  8. WHO Country and Regional Data on Diabetes. http://www.who.int/diabetes/facts/world_figures/en/ (Accessed Jul. 7, 2012).
  9. Fraser, B. The Lancet. 2006, 367, 2049-50.
  10. Vessel Sanitation Program. Centers for Disease Control and Prevention, http://www.cdc.gov/nceh/vsp/cruiselines/hand_hygiene_general.htm (Accessed Jul. 20, 2012).
  11. Stephens, K. Parenting Exchange. 2004. 19, 1-2.

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The Bridge from Discovery to Care: Translational Biomedical Research

Comment

The Bridge from Discovery to Care: Translational Biomedical Research

Since the 1970s, both the number of molecular biology PhD scientists and the amount of biomedical research have grown rapidly, greatly expanding our knowledge of the cell.1 This explosion has led to incredible scientific achievements, including development of the polymerase chain reaction in the 1980s and completion of the Human Genome Project in 2003.2-4 The focus of research has shifted from single genes to all genes, from single proteins to all proteins. Neither scientists nor pharmaceutical companies, however, have been able to keep pace with the sheer quantity and complexity of modern biomedical research. Additionally, while the majority of medical researchers were once physician-scientists in the 1950s and 1960s, they are predominantly PhDs today.1 Questions of basic and clinical research, once addressed side by side, are now separate.

The widening gap between scientific discovery and therapeutic impact is a result of these changes. In the United States, the dramatic increase in spending for pharmaceutical research and development has been offset by a disappointing decrease in therapeutic output (Figure 1). As this paradox becomes more apparent, translational research, which aims to convert laboratory findings into clinical successes, emerges as an increasingly important endeavor.5,6

In 2006, the U.S. National Institutes of Health (NIH), the largest source of funding for medical research in the world, focused its attention on translational research by launching the Clinical and Translational Science Awards program.7,8 However, implementing effective translational research is both time- and labor-intensive. According to Dr. Garret FitzGerald, Director of the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania, challenges include a lack of human capital with translational skill sets, relevant information systems, and intellectual property incentives.9

During his leadership of the NIH from 2002 to 2008, Dr. Elias Zerhouni witnessed the consequences of clinicians lacking in training on the speed of scientific advancements for patient care.10,11 Beyond the need for manpower, an open culture of communication between scientists and clinicians is necessary.

Drug development is a one-way process from benchside to bedside in which scientists identify drug targets, conduct clinical tests, and develop marketable drugs. Many argue, however, that the communication must run in the opposite direction, too; feedback from clinical trials and doctors is valuable because understanding their concerns allows researchers to improve drug development.12 The third challenge derives from current institutional practices and regulations. An investigator’s publication record rather than their efforts to advance medicine determines success.13 Research funding is also granted on an individual basis, which does not promote the collaboration necessary for successful translational research. Lastly, the regulatory and patent processes governing drug development require much expertise and time to navigate, which offer little incentive for researchers to become involved.1

To better integrate basic science with clinical science progress, countries such as the United States are building a new team of leaders in all aspects of clinical research: medicine, pharmacology, toxicology, intellectual property, manufacturing, and clinical trial design and regulation.13 Dr. Francis Collins, Director of the NIH since 2009, has called for a partnership between academia, government, private, and patient organizations to repurpose molecular compounds previously failing in their original use.15,16 Historically, Collins referred excitedly to azidothymidine, a drug originally developed to treat cancer that later treated HIV/AIDS.14 Tremendous potential lies in applying scientific developments to other contexts, and the NIH has already drafted policy for this purpose.15

However, the growing support for translational research does not diminish the importance of basic scientific research, which poses the most interesting questions. Translational biomedical research creates an efficient environment for scientists to work at the interface of basic science and therapeutic development and to help fulfill the social contract between scientists and citizens. The full impact of translational initiatives has yet to be seen because the success of drug development, which can take up to 20 years, cannot be evaluated easily or quickly. For now, we can hope that integrating the work of scientists and clinicians will benefit both the patients, who await treatment, and the researchers, who only dream of seeing their discoveries transformed into new therapies for disease.

References

  1. Butler, D. Nature. 2008, 453, 840–2.
  2. Smithsonian Institution Archives. Smithsonian Videohistory Collection: The History of PCR (RU 9577). http://siarchives.si.edu/research/videohistory_catalog9577.html (Accessed Jan. 15, 2013).
  3. National Center for Biotechnology Information (NCBI). Probe, Reagents for Functional Genomics: PCR. http://www.ncbi.nlm.nih.gov/projects/genome/probe/doc/TechPCR.shtml (Accessed Jan. 15, 2013).
  4. Human Genome Project Information. About the Human Genome Project. http://www.ornl.gov/sci/techresources/Human_Genome/project/about.shtml (Accessed Jan. 15, 2013).
  5. CTSI (Clinical and Translational Science Institute) at UCSF. Translational Medicine at UCSF: An Interview with Clay Johnston. http://ctsi.ucsf.edu/news/about-ctsi/translational-medicine-ucsf-interview-clay-johnston (Accessed Jan.15, 2013)
  6. Helwick, C. Anticancer Drug Development Trends: Translational Medicine. American Health & Drug Benefits. http://www.ahdbonline.com/article/anticancer-drug-development-trends-translational-medicine (Accessed Jan. 15, 2013).
  7. National Institutes of Health (NIH). About NIH. http://www.nih.gov/about/ (Accessed Jan. 15, 2013).
  8. National Institutes of Health National Center for Advancing Translational Sciences (CTSA). About the CTSA Program. http://www.ncats.nih.gov/research/cts/ctsa/about/about.html (Accessed Jan. 15, 2013).
  9. Pers. comm. Dr. Garret FitzGerald, Director of the Institute for Translational Medicine & Therapeutics at the University of Pennsylvania.
  10. NIH News. Elias A. Zerhouni to End Tenure as Director of the National Institutes of Health. http://www.nih.gov/news/health/sep2008/od-24.htm (Accessed Jan. 15, 2013).
  11. Wang, S.S. Sanofi’s Zerhouni on Translational Research: No Simple Solution. The Wall Street Journal. Health Blog 2011 http://blogs.wsj.com/health/2011/05/20/sanofis-zerhouni-on-translational-research-no-simple-solution/ (Accessed Jan. 15, 2013).
  12. Ledford, H. Nature. 2008. 453, 843-5.
  13. Nature. 2008, 543, 823.
  14. TEDMED 2012. Francis Collins. http://youtu.be/spUoPC_TU_8 (Accessed Jan. 15, 2013).
  15. Wang, S. Bridge the Gap Between Basic Research and Patient Care, NIH Head Urges. The Wall Street Journal Health Blog. http://blogs.wsj.com/health/2012/04/11/bridge-the-gap-between-basic      research-and-patient-care-nih-head-urges/ (Accessed Jan. 15, 2013).

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