The Dartmouth Center for Health Care Delivery Science

“I supported the bigger cause of helping a community develop its own emergency plan.”

During a leave-term from Dartmouth in the winter of 2013, junior Bridget Golob, a Geography and Romance Languages double-major and Government minor, worked in Peru under a Dickey Center Global Health Initiative Fellowship. Here are some excerpts from her report describing the experience.

I was in Lima working to research, write, and help implement a natural disaster preparation and response plan for a poor, developing sector of the city. I worked primarily with the Hospital Nacional Cayetano Heredia ER Chief Dr. Raul Acosta Salazar (and Director of the New England Center for Emergency Preparedness, Dr. Robert M. Gougelet) to bolster the hospital’s response plan and to engage the community in creating a unified contingency plan in the case of a catastrophic emergency or natural disaster.

In the “invasive communities” that populate the arid, highly vulnerable hilly regions of Lima, more and more people have settled to evade terrorist groups in the jungle or the highlands, to find work that will sustain them and their families, or to gain better access to medical attention. Unfortunately, they are seen as “invasive” since the land they inhabit has been developed through an informal process as family cluster after family cluster attempt to relocate. The city of Lima does not provide services to these communities since they do not pay taxes. In San Martén de Porres there are several such slum locations, many with populations of around 10,000. Those who live at the top of the hills or in the newer communities may be forced to connect wires and hoses from their places of residence to the older communities below them in order to gain access to basic services. Since the general population has such limited access to water and power, health standards are significantly jeopardized.

Notably, I learned that the leaders of many local, national, and international health and response groups I visited while in Peru had never met each other or interacted, let alone started to tackle large-scale emergency plans. I came to feel empowered by the project and the fact that little by little we had started a conversation...

One ethical dilemma I ran into was how to balance my budding knowledge of disaster planning and academic training with my lack of professional expertise and local credibility. I constantly found myself questioning: Who am I to be leading this community? I determined that this fellowship was my opportunity to support the bigger cause of helping a community create its own emergency and disaster response plan. Instead of giving commands to those working with me about how best to bolster response efforts or raise safety standards or the like, I shared contact information of potential collaborators, and brought in members of other organizations to demonstrate the directions that I thought would be most beneficial to all. Every piece of the project I purposefully turned into a dialogue.

I came to understand how global health dilemmas are truly affecting humans no different from me. While I know not to romanticize development initiatives, working with different communities in Lima helped me to understand through which avenues and by which methods global health crises can be dealt with and how a few dedicated individuals can make a difference.