Volume 43 | Number 2 | Spring 2013

Photo by Dylan Cole

Crescendos Alliance Creates New Health Care, Learning Opportunities in Peru's High Andes

Spring 2013 Issue | By Andrew Taylor

Idaho State University students have a new place they can learn about and help solve global health problems at a remote village in Peru that is "way up and way out there."

This village is Kacllaraccay, which sits at an elevation of 13,000 feet in the high Andes Mountains and is located near the town of Cusco near Peru's famous Machu Picchu region. It now has its first health clinic, due in a large part to efforts of an Idaho State University professor, a former ISU master's student and an emergency room doctor from Pocatello.

So far, one resident from ISU's Family Medicine Residency program has volunteered his services to the clinic and more ISU students will be involved in the future.

"Other projects organized by ISU and Operation Condor to help out in Peru do short-term interventions," said ISU Dylan Cole, a second-year resident in the ISU Family Medicine Residency program who spent a month in late 2012 working at the new clinic. "Those projects set up shop for a week or two and provide a ton of care and see a bunch of people.

"Our project has a different focus and adds to that work," Cole continued. "We are working with the people of the region and the people of the villages to create something that is sustainable, lasting and ongoing, even after we are no longer there, staffing the clinic, providing care or teaching."

While visiting Peru, Cole did everything from helping to lay tile at the new building, to helping train some of the new health care providers and giving villagers medical examinations.

The physical creation of the clinic came together relatively quickly, according to Elizabeth Cartwright, an ISU anthropology professor. Cartwright, along with Diana Schow, who earned her Master of Arts in anthropology and Master of Health Education degrees from ISU, and Justine Macneil, an emergency department physician at Emergency Physicians in Pocatello, are co-founders of Crescendos Alliance, the non-profit organization that created the clinic.

Cartwright, Schow and Macneil joined with villagers, local authorities from the Peruvian Ministry of Health, and with representatives from the Northwestern Global Health Initiative to plan the building of the clinic.

In November 2011 villagers began making the bricks for the building and ground was broken. By May 2012 a cement foundation was completed and the walls were started. Local villagers provided most of the labor. With the help of the Northwestern Global Health Initiative from Northwestern University a roof was put on in November and the clinic had its inauguration on Nov. 26, 2012.

For more information on the project, visit www.crescendosalliance.com.

"All the different people pitched in and made it happen," Cartwright said. "Now there's a clinic for villagers who previously had to walk two hours down a trail to get health care. This is the first time they have access to any kind of permanent health care in their own village."

The clinic will be staffed by a Peruvian nurse and local health promoters, who are local villagers trained in basic health care. Trained doctors will also visit the clinic to provide care. The clinic will provide basic first-aid health screenings and treatment for chronic illnesses. It will also provide basic health care education and help facilitate people who need more health care to get to the nearest health clinic. Currently, Joseph Brown, a fourth-year medical student from Northwestern University in Chicago, is spending six months in residence in Kacllaraccay. Brown, working with the other members of Crescendos, is developing a culturally appropriate health promoter training curriculum. Over the next few months, the three new village health promoters will be trained by Brown in basic first-aid and health prevention topics.

"We're working up to training the health promoters as emergency first responders," Cartwright said. "There are lots of accidents from heavy labor and agricultural work, things like bull gorings, that they'll be trained to treat, but we will also will be working on things like nutrition education, prenatal education and prenatal screening, catching emergencies before they happen."

Schow, one of the other cofounders, noted that community involvement is critical to developing stronger, more sustainable projects.

"We rely heavily on the communities we work with to guide their own interests and goal setting," Schow said. "We do not make assumptions about what they need or can achieve in relation to health and quality of life. We are simply there to assist with knowledge and options. They are the experts regarding their realities, trials and successes.

"Crescendos Alliance," Schow continued, "is trying to incorporate the best, most promising approaches to improving health and quality of life. I do believe what we do is transferable, because at its core, Crescendos' work is about listening, learning and innovating. You can do those things anywhere."

The Crescendos Alliance clinic may also become a model for other villages in the high Andes.

"Our focus is teaching promoters and getting infrastructure in place and gathering data on different health indicators," Cole said. "Later, we'll be able to assess the impact we've made, and hopefully have the data available on why we should expand this project to reach other similar villages in the region."

The clinic will be able to provide a broad range of opportunities for ISU health and social science students.

"I will continue carrying out my community-based participatory research on the health care needs of these Quechua speaking villagers and we will be having students from the ISU Department of Anthropology joining the research team down in the village this summer," Cartwright said. "This is a very, very exciting new research and service project. We will be involving students from the Family Medicine Residency, nursing and other health care professions, too. We are on our way to creating a really superb place for our students to learn about global health in a truly inter-disciplinary fashion."

Dylan Cole, DO, tends to an infant patient.

Photo by Joseph Brown, MS4