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04/01/2014 // Tire Tracks // Uyuni Desert, Bolivia

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Four-wheelers full of tourists are just about the only vehicles that pass through to make these tracks, coming to and from the Uyuni salt flats.

Understanding Peruvian Progress Fighting Maternal Mortality

Co-authored with Gustav Cappaert at Latin Correspondent.

Even though most maternal deaths are preventable, every day 800 women across the globe die due to complications during pregnancy and childbirth.

Peru is one of only two South American countries expected to hit its maternal mortality Millennium Development Goal, one of a set of UN-backed global poverty reduction targets that culminate in 2015. Peru today has a ratio of 67 maternal deaths per 100,000 live births, down from 265 in 1990.

The Andean nation remains behind industrialized countries like Japan (with a rate of six) but way ahead of the world’s least developed nations: in Sierra Leone, which has a maternal mortality rate of 1,100.

Help for expectant mothers

“The principal problem Peru has had is access to maternal health services,” said Mario Tavera, Health Specialist for UNICEF Peru. “Global evidence demonstrates that the reduction of maternal mortality is associated with medically-attended birth in health care centers,” he said.

Peru has made strides on this front, 80 percent of women now give birth at a medical facility, compared to just one quarter in the early 1990s. Over 90 percent attend prenatal care visits.

According to Tavera, Peru has more than doubled the number of state-run health facilities in operation, greatly increasing access to care. Some clinics operate associated casas maternas which allow women who live in remote areas to stay for up to a week as they wait to give birth.

But perhaps the most important change has taken place inside of clinics. “There’s a set of very distinct customs” in rural Peruvian communities, Tavera said. “The people were permitted to bring into the clinic customs from giving birth in their homes.” Family members were allowed into the birthing room for the first time; women were allowed to give birth sitting or on their knees; they could bring a rope to hold onto — another traditional custom.

There are wrinkles in this success story, though.

One-size-fits all?

Creating a one-size-fits-all policy is uniquely difficult in Peru. Its three major regions: coastal desert, mountainous center, and Amazon jungle each demand a different approach dictated by culture and geography.

On the traditionally wealthy coast, the average maternal mortality ratio was 56.4 between 2007 and 2011. In the poorer highland and jungle regions it was considerably higher, at 152 and 137 respectively.

“Peru is one of the most unequal countries in Latin America…Parts of Peru have European levels of mortality, other parts have African levels,” said Tavera.

In the mountains, a long history of discrimination against the majority indigenous population makes some women reluctant to visit government health posts. For one, health care providers rarely speak Quechua, the native language in most of highland Peru.

“Those that speak Spanish ignore us, those of us from the town, from the communities that come down. They humiliate us sometimes or don’t treat us well,” said Teresa Echame Vargas, a health promoter in the rural community of Huilloc.

Home births

Perhaps not surprisingly, home birth is more common in rural areas. Although official policy is to support traditional birthing methods and attend home births if possible – a practice supported by medical evidence – in reality it depends on the clinic. “We would like the health posts to attend at home, but they say they can’t,” said Vargas.

Fueling claims of discrimination is the illegal but common practice of imposing fines on women who chose to give birth at home.

Keri Baker, the executive director of the health promotion organization Ayni Wasi, recalled a patient who suffered complications during a home birth, “She hadn’t expelled her placenta all the way which can cause hemorrhaging. We saw her at that point, and she hadn’t sought medical care because of the fact that she had given birth in her home.”

A 2009 survey of women in the coastal community of Huaycan – the majority of whom had migrated from the highlands – found that 46.5 percent of women who elected home birth did so because they’d had a bad experience on a previous hospital visit or knew someone who had. A majority of women in a similar study in 2005 cited discrimination and a feeling of violation by health care providers as reasons to give birth at home.

In a jungle region like Madre de Dios, in Peru’s southeast, communities’ distance to health facilities makes professional attention a challenge. The Spanish-speaking population is transient – attracted by the lucrative business of illegal mining. Women that live in mining camps rarely make the river trip to attend prenatal visits, said Nelva Miraya, the government’s Coordinator for Community Strategy and Reproductive Health for the region.

Indigenous challenge

The area’s far-flung indigenous population of 60,000 is another challenge. Communities in Madre de Dios speak 12 different languages, and live in settlements up to three days away from the nearest hospital. The lack of government presence in these areas raises the possibility that deaths go unreported.

“(Until recently), in the entire region of La Salvación, there was only one obstetrician. She was the only one to intervene in native communities that are two, three, four days away by boat,” said a nurse in Madre de Dios’ capital of Puerto Maldonado.

Although recent progress on maternal mortality is encouraging, Mario Tavera of UNICEF warned about diminishing returns. “(Peru is) starting from a very high rate,” he said. “A country like Chile had 30 (maternal deaths per 100,000 live births). Getting to seven is more difficult.”

04/30/2014 // Shoeshine // La Paz, Bolivia

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Many La Paz shoeshiners–of which there are many–wear ski masks while they work. Lonely Planet claims it’s because of the stigma traditionally associated with the job, but I could imagine there are respiratory reasons for it as well.

A Little Piece of Food Security Amid Bolivian Floods

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High water season on the San Martín River in Bella Vista, 2014.

Bolivia’s Amazonian lowlands have been hit with increasingly severe floods in recent years. This year’s flooding has been the worst ever, displacing thousands from their homes and destroying crops.

The missionaries I stayed with last year in Bella Vista dodged the worst of the damage, but the disaster has had rippling effects. One Bolivian told me that as much as a third of the country’s rice harvest was destroyed with last year’s floods. The nuns in charge of the boarding house in Bella Vista that supports 25 children have struggled with unavailable food staples and increased prices.

To make matters worse, about a month ago the missionaries told me that a power surge from the city’s shaky electric grid had destroyed the large freezer they use in the boarding house’s kitchen. With inconsistent food supplies in the muggy tropics, this equipment is crucial for storing the meat and perishables that feed the 25 growing children that the missionaries support.

This means the $1409.69 that friends, family, and strangers gave me to support the missionaries’ work came at a fortunate time.

Last week, one of the missionaries in Bella Vista was able to make the two-hour trip over muddy roads to the neighboring town of Magdalena, where she received the first installment of the donations by wire.

About $600 in donation money will be used to buy a new freezer, which will allow the missionaries to continue feeding the 25 orphans and children unable to attend school in their hometowns. It’s a small item that will make a big difference in quality of life for a group of kids who deserve the best.

Heavy rains are likely here to stay though. The recent spate of Bolivian floods was triggered by an unexpected shift in Atlantic trade winds. One Brazilian scientist says the floods could be a preview of the impacts of future climate change.

I’m hoping to continue to support my friends in Bella Vista as they deal with the challenges of a warming world. If you want to get involved in building economic security and climate resilience in eastern Bolivia, give me a shout.

04/28/2014 // Down to Earth // Cochabamba, Bolivia

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Airplane window shot. Cochabamba, Bolivia’s third largest city, is in the valley below the clouds.

04/28/2014 // Amazon Jungle // Beni, Bolivia

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Flying over Amazonia in Bolivia. Areas of thick forest like this are less and less common. In neighboring Peru, the rainforest became a net carbon dioxide emitter rather than carbon sink for the first time in 2012, as deforestation released tree-trapped CO2 into the atmosphere.

04/27/2014 // Río San Martin // Bella Vista, Bolivia

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During the wet season, this Amazon tributary is a prominent means of boat transportation, and thankfully so, since many roads are flooded. During the dry season it’s little more than a stream.

04/27/2014 // Chess // Bella Vista, Bolivia

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This photo taken by an eight-year-old.

Support Education and Medical Care in Bella Vista, Bolivia

I’m raising money to send to missionaries in Bolivia who provide free medical care and house children so that they can go to school. To donate and receive some prints of my awesome Bella Vista photos as a token of thanks, click here.

This year, I spent a month in Bella Vista, Bolivia with the Missionaries of the Holy Sacrament and Virgin Mary, teaching English and chess to children. The missionaries run a medical clinic, preschool and boarding house for about 25 students, aged four to 16, who attend school in Bella Vista. Each of the programs makes a big difference in the lives of people in this rural, agricultural region of Bolivia, and they do so with meager resources. I’m raising funds to send them so they can make some much-needed purchases to improve the quality of life for the people they serve.

The clinic offers its services free of charge, and even houses patients who have come from other towns. The preschool helps low-income families prepare their children for school and allows mothers extra free time to earn an income for their family. And the boarding house, in addition to giving children from rural communities a chance to go to school, has also provided refuge for children at risk of domestic violence or indentured child labor.

Your donation will be used by the missionaries in one of the following ways:

  • Purchasing medical supplies such as medicines or latex gloves, which are currently scarce.
  • Buying children’s literature, English books, clothes, and games for the boarding house, which currently doesn’t have a large supply of these materials.
  • Repairs to the preschool building, which has accumulated mold and structural damage from heavy jungle rains. Also replacing the wood stove kitchen, which is near classrooms and emits a lot of smoke that the children then breathe.
  • Reserves for basic goods. With global climate change, food prices in the fragile Amazonian ecosystem are unstable. For instance, flooding in eastern Bolivia destroyed most of the rice and sugar harvest this year, raising the cost of food at the boarding house.

Unfortunately, there is no registered 501c3 in the US supporting the missionaries’ work. I will gather the funds and then wire them to Bella Vista. The missionaries will compile a report of how the money is spent, which will then be sent to donors. Thank you so much for your support!

More photos of Bella Vista here.
Photos from my South America series here.