Trude, Angela

Peru

Nutrition and gut function (field focus)

The projects underway include a large cohort study on the interactions of undernutrition, enteric enteropathy and child growth.  This study has been underway for 5 years and includes extensive detailed dietary history of over 200 hundred children .  This includes high resoultion data on breastfeeding practices (twice weekly) , infant feeding (monthly 24 hr recall data starting at 9 months and extending to 5 years of age) and child illness.  The amount of data that will be available is large and this allows for several avenues of research to be pursued, which depend in part on student interests.  Projects are always tailored to individual students.

As a Brazilian, I had not only a professional, but also a personal motivation to expand my knowledge about the food and health system in South-America. Cultural aspects of food behavior and different dietary patterns fascinate me and I was ready and super excited to learn from and get exposed to the Peruvian dietary behavior! Receiving the Global Health Established Field Placement Award allowed me to gain first-hand experience in Global Health, and I couldn’t wait to start my Peruvian experience.

During my time in Iquitos and Santa Clara de Nanay, I was able to gain a better understanding of how the MAL-ED cohort works. It was amazing to meet with the data collectors, who have been working for the project for 5 years. I thought it was remarkable to see how much they are passionate about the project, how hard they work everyday, and how much they care about the cohort of children living in the area.

I got to try so many different and exotic fruit from the amazon, not to mention the incredible Peruvian cuisine: lomo saltado, causa rellena, ceviche, tacu-tacu, papa a la huancaina, chicha morada, escabeche de pollo, parrilla...! Of course food is not the only thing that interests me. I had never seen so many friendly and good people before going to Iquitos. They are also very generous – with the little they have, Peruvians always find a way to share with others. For instance, the community workers often invite others from the team to eat at their place for lunch, and I was fortunate to be invited to some of their almuerzos! 

I had the chance to experience first hand how Peru has had great changes in its economy, a significant shift in immigration, demographical and also in eating patterns affecting the health status of the population. This has led to lifestyle changes reflected in higher obesity rates due to an increase in sedentary behavior and increased access to low-priced highly energy-dense foods. From my observations of the small food stores and while updating the Libro Regional of Santa Clara de Nanay, it was evidenced how the dietary pattern has changed over half a decade. I perceived that there was an increase in availability and access of galletas (crackers and cookies), gaseosas (sodas), and increase in size of bread. From the small food stores, commonly in front of families’ houses, it is possible to notice the great variety of bread being offered, many kind of cookies and crackers being sold, and sodas being purchased by everyone.

I could experience how industrialized foods are entering in rural areas, even those located in very remote places. While in the middle of the Amazon Forest, boats were often transporting people and…soda. While people often have limited access to potable water, soda and other juice mixes (high sugar drinks) were highly and readily available in all the villages. This stimulated me to propose another project while in the site – to measure height and weight of the residents of Santa Clara de Nanay and compare the findings with those from the previous census (2010 and 2012). After calculating the Body Mass Index of each individual, I found that obesity among adults, especially male, is really prevalent and has skyrocket in the past 5 years. Thus, I was able to show that among other health problems to be considered in rural Peru, overweight and obesity also deserves attention from public health experts.

I stayed in Iquitos during 6 weeks. Although it may sound little time for some people, I can say that I learned more than I thought I would have, and that these six weeks were really rewarding to me. By the end of my work there, I can affirm that I experienced health inequality, I gained a more holistic view and multidisciplinary understanding of health issues in developing country setting, I learned a foreign language, got to know interesting people full of stories and experiences, and felt in love by the country and the culture. I am immensely grateful for my Global Health Established Field Placement opportunity.

Part of my work involved measuring height and weight of the population living in Santa Clara. A smile of a child always makes my day happier! I was also excited to see that Morgana was growing very healthy!

I was lucky to spend my birthday in Iquitos. Athough I had been there for only couple of weeks before my brithday, they definitely made me feel special. In the morning, I was doing field work in Santa Clara and had a delicious lunch with the community workers. In the afternoon, I went to the lab in the city where they were waiting fo rme with this beautiful cake.

 

Motokar is not only the main means of transportation in the Peruvian Amazon, but also the most common employment type for men in this setting.

The community workers were happy and excited with el Libro Regional! They were very involved in the updating process and I wouldn't be able to do a good job if it wasn't for them!
 

El Libro Regional was one of my projects there - I updated it with the current food and beverages being consumed in the community, its portion size and weights. When I was updating the book (created in2011), I realized how much industrialized, high-energy dense food are nowadays in the community.

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases
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May 2018

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