Barbara Fraser

Latin America's urbanisation is boosting obesity

For the past few decades, rural communities all over Latin America have been abandoning their traditional lifestyles and moving to cities. But while this migration has provided a variety of employment opportunities, it has also caused severe health problems. Barbara Fraser reports.

Latin American countries crack down on junk food

Sergio Escalante got a shock at lunchtime on the fi rst day of school this year. His school’s food kiosk no longer off ered the usual fare—potato crisps, cookies, sweets, soft drinks, and sandwiches dripping with creamy sauces. “He came home and said there was nothing to eat”, his mother, Miriam González, a nurse, recalled with a chuckle. “They were selling fruit and chicken sandwiches without mayonnaise—to him, that meant ‘nothing to eat’.” The food concession was lining up with Peru’s new healthy food law, which aims to tackle the country’s rising obesity rate by getting children onto a healthier diet. Peru’s law is the latest in a series of efforts by Latin American countries to tackle a public health problem that has accompanied the economic boom of the past two decades—more overweight kids and an increase in non-communicable diseases such as diabetes and cardiovascular problems. But although several countries have passed laws, implementing regulations have lagged, and some public health experts are calling for international measures—such as the ones used to tackle cigarette sales— to counter what they say is powerful lobbying by the food and advertising industries. Peru’s law immediately drew criticism from legislators, advertisers, and even the Catholic archbishop of Lima, who said that shaping children’s dietary habits was a job for parents, not the government. But the entire country will benefi t if the government can head off future health problems by reducing children’s consumption of salty, sugary, and high-fat processed foods, according to Luis Fernando Leanes, who heads the Pan American Health Organization (PAHO) offi ce in Peru. “Being able to decrease children’s exposure to these foods will mean more hospital beds free in the future to care for people with other illnesses”, he said on July 9 at a conference in Lima on public policy for promoting healthy foods.

Seeking a safer blood supply.

Perus blood bank system was derided as inadequate following a scandal in which seven infants were infected with HIV. Plans are now in place to stop similar incidents in future, but financial incentives for blood donors are hindering efforts to clean up the system. Barbara Fraser reports.

Traffic accidents scar Latin America's roads

Commentary: Traffic deaths are surging in Latin America as more and more cars, trucks, buses, and scooters fill the roads. Narrow streets and poor planning in towns are part of the problem. Recent trends towards more paved roadways are also pushing up accident rates.

Peru makes progress on maternal health

Peru has reduced maternal deaths by adapting health facilities to accommodate the cultural preferences of its rural population. But although this move has saved lives many mothers are still dying because of critical problems facing health care in the country. Barbara Fraser reports. Sunday is the busiest day of the week in the tiny health centre in Quiquijana high in the Andes Mountains of Peru. The town square fills with vendors from surrounding communities and the health centres dimly lit sparsely furnished waiting room fills with women wearing the fringed embroidered hats typical of this part of the Cusco region many with babies slung in woven blankets on their backs. Some are pregnant and Ninoska Mora and her staff bustle from person to person measuring the dilation of one patient and checking the histories of others. During a lull she slips around the corner to the Mamawasi (Quechua for mothers house) an old colonial-style building around a cobblestone courtyard where four womenwho are within days of giving birth are staying. While they await their deliveries the women cook their meals over wood fires and tend their children as they would at home. (excerpt)

Pedestrians at risk in Peru

Road infrastructure and attitudes toward safety have not kept pace with the growing number of cars in Peru, making pedestrian accidents a leading public health problem. Language: en

Earthquake highlights mental-health issues in Peru

3 weeks after an earthquake hit Peru, psychologists are providing support to the thousands made homeless. But ensuring people have long-erm help is likely to be challenge in the country. where community-based mental-health care is still in a fledhling state. Barbara Fraser reports.

Growing up in Rio's favelas

Children and adolescents living in Rio de Janerios shantytowns face a barrage of assaults on their health, including drug-related violence and sexually transmitted diseases. Barbara Fraser reports.

Providing medical care in the Peruvian Amazon

When the roosters begin to crow and riverboat motors grumble to life on the muddy Corrientes River, Gaspar Zamora Ramírez can never be sure what the day will bring to his tiny clinic in this jungle town. It could be typhoid fever, tuberculosis, yellow fever, a poisonous snake bite, or a child with an illness brought on by an enemy’s curse. Whatever it is, Zamora and his staff of fi ve nurse technicians, a nurse, and an obstetrician must handle it with a limited stock of medicines, basic laboratory equipment, and a large dose of ingenuity. In the vast Peruvian Amazon, chronically underfunded Health Ministry workers battle distance, loneliness, language barriers, and lack of equipment and emergency services. In this mestizo village of about 2000, the closest thing to an ambulance— indeed the only motor vehicle—is a motorised tricycle. The nearest hospital is in Iquitos, the departmental capital, a 2-day trip by riverboat. The spartan but spotless Villa Trompeteros health centre operates around the clock. On one wall is a map of the area for which he is responsible. About 7800 people live in dozens of communities scattered along the rivers that snake southward from the Ecuadorian border. Three communities have health posts staff ed by one or two nurse technicians. The most distant is 4 days away by riverboat. The system relies heavily on doctors who are assigned to work in the region as part of a year of public service required of graduating medical students. When a case of yellow fever was confi rmed this summer near the village of Pampa Hermosa, Zamora headed upriver with a stock of vaccine. Because there is no electricity—and therefore no refrigeration—in the villages, Zamora can usually do only 2-day vaccination campaigns before he must return to Trompeteros for a fresh stock of vaccine and ice. To handle the yellow fever outbreak, however, he hauled his backup generator to the health post in Pampa Hermosa. Most of the people along the Corrientes River are Achuar, and women and small children speak only their native language. Because indigenous women are the group least likely to use health-care services, partly because of the language barrier and partly because of a reluctance to be examined by male doctors or nurses, lowering maternal and infant mortality and morbidity is a constant challenge. Although such cultural diff erences often prove to be the greatest challenges young doctors and nurses face when they are assigned to remote jungle areas, they receive little or no cultural training in school. Instead, they learn on the job, says Mario Tavera Salazar, health offi cer for UNICEF in Peru, “and they learn very well”. But, he adds, “They’re always looking for a way to get out of there.” Zamora has adapted to the remoteness of Villa Trompeteros, but he speaks wistfully of classmates who are doing advanced studies and plans to ask for a transfer as soon as he is eligible. Others fi nd it harder to leave. José Baca asked for an assignment in the Amazon soon after graduation—“I liked Tarzan movies and thought that’s what the jungle was like”, he says. When he arrived at his post near the Brazilian border, he was afraid he had made a serious mistake. He changed his mind in the morning. “I bought a pair of rubber boots and went to work”, he says, making 2-week journeys by river to visit communities. Baca, who learned the language of the local Matsés people and gained an appreciation of their culture, now coordinates the regional health strategy for indigenous people in Loreto. The regional strategy is part of a national eff ort aimed at addressing infant mortality, overall mortality, malnutrition, and emerging and reemerging diseases such as malaria, yellow fever, and hepatitis B, with an emphasis on respect for indigenous cultures. In addition, as part of this national initiative, a series of studies known as the Health Situation Analysis (ASIS) is taking a closer look at the intercultural aspects of health care in each ethnic group. So far, seven analyses have been drafted by representatives of indigenous communities and teams that include Health Ministry personnel, anthropologists, and lawyers specialis ing in indigenous aff airs.

Getting drugs to HIV-infected children in Cambodia

In front of an airy two-storey house a dozen children pressing their hands together in the traditional Khmer greeting crowded around John Tucker a sandy-haired Texan. Tucker 57 puts an arm around a slender girl and introduces her. “When she came to us she was 7 years old and weighed 15 pounds” Tucker says. “She had been abandoned by her family. Today she’s riding her bicycle to school she weighs over 50 pounds and she’s in second grade. She’s one of our miracles.” Amid the chatter and laughter it isn’t easy to see what brought the children to Tucker in the first place: all had AIDS and no one to care for them. When the “miracle girl” arrived she had a CD4-positive T cell count of 39. At first glance Cambodia seems an unlikely place for such miracles. When the AIDS epidemic spilled over the border from neighbouring Thailand in the mid-1980s and the adult infection rate shot up to 3% the country had almost no resources with which to respond. At the time the country was still reeling from genocidal rule of Khmer Rouge leader Pol Pot whose reign of terror between 1975 and 1979 left nearly 2 million Cambodians dead. Virtually all of the country’s educated professionals had either been killed or had fled into exile. Of the roughly 1000 doctors who were in Cambodia when Pol Pot came to power only 14 were left by the time he was ousted. (excerpt)