Culture, Gender And Health In Rural Peru
Republic of Peru is considered to be one of the largest countries in South America with population count of more than 32 million people. Two thirds of the population of Peru live in and around major cities and the rest lives in the rural areas like Amazon and Andean highlands. Large ethnic diversity makes this country a holder of many different cultures and languages, some of which are thousands of years old. Peruvian citizens living in the rural areas see illness as disharmony between body and soul and believe that these two entities are tightly connected to nature and surrounding environment. When illness takes place, they tend to seek shaman’s help. But this commitment to traditional medicine is not only due to the cultural difference. Majority of the rural Peruvians live below the poverty line and have very little access to healthcare facilities, which makes it difficult to use modern medical services. Indigenous women in Peru are some of the most vulnerable members of the society because of the social constraints due to gender hierarchy, poor nutrition and limited access to healthcare providers including perinatal and labor and delivery services. Maternal deaths in Peru related to child rearing were some of the highest among all South American countries with mortality rate of 214 per every 100, 000 live births in 2008.
Today Government of Peru successfully battling maternal mortality rates by implementing different social and healthcare programs as well as trying to combine deliverance of modern western medicine with traditional practices of indigenous population.
Peruvian culture takes its deep roots from the Incan Empire, which arose to power sometime in the 13th century. It was conquered by Spanish Conquistadors in the early 15th century. This event has changed the country considerably fusing Incan and Spanish cultures together. Peru is one of the largest countries of South America. Its population is about 32 million, two thirds of which reside in urban areas and the rest in the coastal highlands and in Amazon. Peru is a multiethnic country whose population consist of 45% of Amerindian (indigenous peoples of the Americas), 37% mestizo (of mixed European and Indian ancestry), 15% white (European descendants)and 3% of black, Asian, or other. We will explore culture of Amerindians because they are some of the most under cared populations in the country. Amerindians primarily reside in the rural areas of the country, like Amazonas and Andes. Catholicism is a predominant culture of Peru with 90% practicing followers, which was brought there with colonization by Spanish conquistadors in 15th century. Other 10% practice Protestantism. Indigenous populations created a symbiotic religion which is a mix of Catholic traditions and pre-Hispanic ancient form of practice. Even more so Amerindians believe in animism, where every person, animal, plant and object have a soul and that they all interact with each other. These interactions have influence on those entities that are weak or vulnerable and can negatively impact them. These weak and vulnerable are considered to be women and children and, thus, need protection. There is a considerable social segregation between men and women. For example, women are not allowed to go into the forest and rivers to avoid being harmed by spirits. Men are also usually sole decision-makers in the house. They work, attend community meetings, travel outside of the village to sell and buy supplies. Women are mostly confined to the premises of village and have less contact with outsiders. This practice limits women in vital information about their health and safe childbearing practices.
As I mentioned earlier, health in rural Peru is viewed as harmony between body, soul and nature. Since animism is the big part of Amerindian’s spiritual belief, they attribute presence of illness to the curse of tunchi, which are evil forces of underground world and the souls of the dead. Animistic spiritual beliefs shape Amerindian people’s helping them live with nature and protecting them from nature at the same time. Rural areas of Peru known for malnutrition, poverty and very limited access to healthcare facilities. This makes it very hard for people to utilize western medicine. In the last decades WHO in collaboration with the Government of Peru implemented several programs as part of the Millennium Development Goals to fight hunger, poverty, diseases and discrimination of women.
There are few projects oriented to battling maternal mortality in the rural areas. Some of the programs offer financial incentive, while other clinics provide women with government provisions like rice, potato, sardines for every kept monthly perinatal appointment. Pregnancy practices of Amerindian women. During pregnancy most indigenous women do not go to perinatal appointments to a clinic and often give birth at home with help of parteras (midwives with no formal training, but enough apprenticeship experience). It is hard to use healthcare services when woman have to travel for many hours to get to the clinic and when she does not have money to do so. But the consequence of this situation can be a higher risk of preterm birth, hemorrhage and many other health complications. Dozens of new clinics and birth centers have been opened in predominantly rural areas. Clinics provide delivery services, teach future mothers about proper nutrition, good hygiene practices, how to recognize if there is a danger to their health or health of their baby. Also, there are breathing, and other perinatal lessons performed in clinics. In addition to clinics there are child centers where pregnant mothers who live long distance away can come and wait until the birth of the baby. There is, however, a concern that indigenous women are very hesitant to trust healthcare providers due to cultural difference. Because majority of the healthcare providers are from urban areas, they tend to treat indigenous women as uneducated lower-class citizens. Clinicians often influence women by arguing that traditional medicine is not safe and should not be used while woman is pregnant. This creates disconnect between the woman and the healthcare provider and leads to feeling of inferiority and less likelihood of woman coming back to the clinic. This unfortunate factor however lead to a new method of care for indigenous women. Clinicians today combine modern and traditional medicine by allowing mothers to give birth in upright position and practicing other traditions along with being cared by methods of western medicine. During pregnancy women are not allowed into the forest or river, because it is believed that cutipar or spiritual forces can harm her or her baby. Labor and birth in rural Peru. Gender roles are very clear and defined in rural Peru. Men have a role as head of the household and woman is the caretaker. During woman’s pregnancy man does not have a role in her care and woman usually works almost until the last day of pregnancy. When woman feels that her contractions are intensifying, and she is ready to give birth, she usually isolates herself from everybody else, except the partera.
Usual place of birth in the rural Peru is the house. Woman positions herself either sitting on the floor on top of specially prepared blankets or she may stand with her knees bent and hands on her legs. Father or any other family members are not allowed into the room with an exception of woman’s mother in some cases. Women usually drink basil tea or mate to induce labor and chamomile tea to soothe the pain. Screaming during labor is considered embarrassing and is not a culturally normal behavior. Once mom is ready to push partera supports her from behind and encourages to push. Partera pushes on the belly of the woman until baby is born and then pushes yet again to expel the placenta. Even though husbands do not participate much in wives’ pregnancies and not at all in their labor process, there is a custom they have to abide by too. It is called cuvada and dictates that the father cannot participate in certain activities like killing a snake or eel and cannot operate a motor boat before and after the delivery. It is thought that doing such things can give chance to evil spirits to sicken or kill the baby. Once mom gave birth she usually stays bedridden for 4-5 days because it is believed that she has weakened during labor and needs rest. This is where dad steps in and starts caring for mom by preparing food and doing other house chores while woman rests and feeds the child. It is a cultural custom to attach or put on something red on a newborn, like red hat or to tie a red string around his/her wrist to avoid evil eye. Another interesting custom Peruvians have is to pierce baby girl’s ears almost right after birth. This is so they can tell her apart from the boy. It is an interesting practice and foreign mothers with babies often said that if their baby girls did not have their ears pierced, even if they were wearing distinct female clothing people would always ask if their baby was boy or a girl. All because these babies did not have their ears pierced. Breastfeeding the baby is a natural part of life for many ethnicities within Peru. Indigenous women usually breastfeed their children and might do it for longer than 6 months. One of the reasons of breastfeeding is they don’t have access to a formula; if mother does not have milk of her own she is forced to feed the child cow milk or may ask another feeding mother for some milk for her child. Women in the rural areas often do not wish to feed their children colostrum because it is believed that the milk is “dirty” and does not have nutritional value.
One more argument against colostrum states that “it brings bad luck”. Women who have an opportunity and desire to give birth with help of healthcare provider are encouraged to come and stay with their family at one of many child centers until they give birth. They are supported to give birth in upright position just like their ancestors did but in a controlled environment where higher chance of survival during complications is likely. Poor access to contraception in rural Peru. Access to modern contraception continues to be very low in rural areas of Peru. Despite the government’s attempt to provide more medical services to the population, the problem of cultural difference still arises and prevents efficient communication between the urban healthcare provider and the indigenous persons. Women here often obligated to have a baby because they do not have a reliable method of contraception. When go to the medical clinic they are often embarrassed to discuss their sexual life with a provider. And when they get prescribed a contraception, such as pill, they often are not given proper guidelines on how to take it, because many of them are illiterate. As a result, they may stop taking it in the middle of the cycle, skip days, and never come back for another batch. They often rely on special herbal teas which can “cool” the uterus and prevent woman from getting pregnant. Men are offered free condoms in clinics but are often embarrassed to take them. It is frowned upon to use condoms with your wife, because there is a belief that condoms are used with prostitutes. On the other hand, since men are decision makers in the household, they also do not want their wives to buy contraception from the clinic because they think they cannot afford it. Occurrence of abortion is very high in this population. It is known that abortions are done by drinking a special herbal tea which induces it. This is a big concern in the area because on one hand women are afraid to have many kids because they cannot support them, on the other hand, frequent abortion can lead to health problems. Peruvian women usually end up having many kids but giving birth without professional medical help can be very dangerous. To help ladies use women’s medical services there has to be established standard of care that fits this type of population.
First, cultural sensitivity has to be at its best when interacting with indigenous population. Many of them are embarrassed to talk about their sexual health and reproductive organs. Healthcare providers should be trained to be understanding, approachable and non-judgmental during the consultation. Second, many indigenous women are illiterate. Healthcare professional should strive to thoroughly educate about the contraception routine and all the benefits and implications of it. Proper adherence to the regimen is crucial for desired effect of the medicine. Explain to a woman that she needs to take it every day at the same time, that she should not pick back up at it after skipping several days and that she should not stop taking it in the middle of the cycle even if she does not like how it makes her feel. Third, access to the contraception should be better. Many women still cannot afford it. Government subsidies needed specifically for this issue. Fourth, healthcare providers should not downgrade or deny this population’s traditional medical practices. This only makes them less trustful to the western medicine and people who promote it. Instead, try to incorporate certain traditional practices into western medicine. This will make people at ease about the medical facility and unfamiliar processes. Symbiotic relationship of traditional and modern medicine can be effectively used to raise utilization of medical facilities. Nursing considerations.
Researching this topic helped me realize that cultural competence can be a key ingredient to drastically improve population health. In the United Sates it does not appear as dramatic as it does in rural Peru, but it is a reminder that often practices that are appropriate for one culture can be taboo in another and we as nurses have to respect it and strive to find a feasible way of delivering quality care. Cultural competency helps to put the patient and their family at ease. When people come to the hospital they might be nervous and stressed about their current situation. Respecting their beliefs and showing them your open-mindedness will in turn open them up more to a nurse. Undoubtedly, safety of the patient is the number one priority in nurse’s scope of practice. Therefore, we also need to be able to differentiate beneficial and benign cultural practices. One Peruvian practice nurse should not agree with is keeping the woman bedridden for several days after giving birth as it might lead to severe complications, among them the most common is development of blood clots.
As a future nurse I would like to improve in my understanding of other cultures and will strive to cooperate with a patient of different cultural background whether it is dressing a child in a particular ethnic outfit or certain color as well as piercing their ears if no contraindications are present. I would like to add that the world would be so dull and monotonous if not for the colorful variety of cultures and ethnicities.
