Peru 1998

International staff: 20 National staff: 70 Focus on victims of violence Peru, one of the most impoverished countries of South America, experiences widespread terrorism and guerrilla activity and now suffers from the compounded physical and economic effects of El Ni-o. Although Ministry of Health cover is improving, most of the population has no access to basic health care. MSF focuses on displaced populations and returnees in remote communities in the Andes mountains and adjacent jungle areas, which are geographically isolated, suffer cultural and ethnic discrimination and are affected by violence resulting from political unrest and contraband trading. Teams work on behalf of 150,000 people in the departments of Ayacucho, Huancavelica, Junin and Cuzco, training community health workers, including traditional birth attendants, in order to upgrade the quality of care, and providing management support to the Ministry of Health at the local level. Additional support is provided during immunisation campaigns. In 1997, health structures were renovated and supplied with basic drugs and medical material. Water and sanitation support was also given. MSF provides primary health care, focusing on mother-and-child health and training, to 50,000 in Satipo province, including 15,000 members of the marginalised Ashaninka ethnic group. Originally operating in three provincial districts and two Ashaninka communities, the project was extended in September 1997 to the Rio Tambo region. A similar project on behalf of a further 55,000 people operates since June 1997 in Acobamba and Angaraes provinces, Huancavelica department, and there is another in Rio Apurimac. MSF continues to run several long-term projects in Amazonas, a vast area crossed by six rivers presenting huge logistical challenges. Teams visit villages with a houseboat. In Ucayali province, activities include training health staff for indigenous communities, mother-and-child health, construction, refurbishing and equipping health structures, and logistical support for Ministry of Health vaccination programmes. MSF is also involved in creating a community pharmacy and a project to provide wells. A similar project was completed in Requena province and handed over to a local NGO in January 1998. Targeting AIDS Health and sexual education directed towards children and adolescents in the marginal urban district of Villa el Salvador, Cono Sur, aims at reducing the growing incidence of STD/HIV/AIDS and very high TB levels, as well as unwanted pregnancies, violence and child abuse. Medical and psychological consultations are also provided and a network of agencies and institutions is being established to co-ordinate referrals. Another project, implemented with a local NGO, raises community awareness and knowledge of HIV/AIDS, particularly among adolescents, in Villa el Salvador and two districts of Cono Sur. Activities include street and school education programmes, and a televised counselling programme. Four Cono Sur districts are targeted in another HIV/AIDS programme assessing pregnant women aged 15-24 and counselling those at risk, HIV-positive and AIDS patients. El Ni-o-related cholera outbreak Exceptionally heavy rains caused extensive flooding, which led to a cholera outbreak in coastal areas from Lima northwards that so far affected around 30,000 people. An emergency intervention began in March 1998 and was still required at the beginning of June, when another outbreak occurred in Iquitos.