Reflecting on Mental Health and Social Services in the Peruvian and U.S. Context*

[the what] As I reflect on and observe my trip and experiences in Cusco, Peru, I notice that there are similarities and differences that can be exchanged between Peruvian culture and American culture.  My focus during the class in the Peru Program for study is mental health, and as such it is important to discuss and observe human behavior in social environments while in Peru and based on my experiences in the U.S. Understanding the importance of mental health and its strong connections to physical health is important, particularly when considering interventions in any culture.

American culture and society can be considered rich in available resources when dealing with any type of need for individuals.  The emotional and mental health needs of Americans are similar, if not the same in some circumstances, to those I observed in Peru, but the delivery of services can be considered dramatically different. The differences do not necessarily indicate negative or positive implications, but rather a better scope to decipher what is always necessary and what is secondary for any individual, regardless of culture. In Cusco, I observed a strong community and familial bond in every setting I found myself in.  Many individuals in Peru operate on a level of general care and concern for all of those around them.  Children were generally watched over by all, not just parents or immediate caretakers, many smiles were exchanged. Even when getting to know some of the locals in Cusco, I could feel the general caring and loving attitude that is practiced just from the behavior of those around me. While my American ethnicity was always an elephant in the room, the elephant was typically warmly welcomed and treated with general respect, even if there were questions for me to answer. While this experience for me may have been largely skewed by being American, I do believe there is a stronger bond among the people of Cusco as a whole.

In contrast, when speaking with a Peru Program service partner, Nestor, who is a psychologist and co-founder of AbrePuertas, I learned that mental health is still stigmatized and under-treated in Peru. Many individuals who suffer from any type of mental disorder are typically under-treated to the point of mental symptoms becoming largely physical leading individuals to their Primary Care Doctors. It is then that they realize the root problem is mental and then they are sometimes referred to a psychologist or mental health care professional. Early intervention and available resources do not seem to be as easily obtained in Cusco where it might be available in the U.S. more readily.

[so what?] Since mental health and physical health are so intertwined, it is through this experience, I sought to further look at what is necessary for any individual to live a high quality of life for them and those close to them, regardless of culture or ethnicity. Cusco appears to have an experiential type of learning and care-taking. This experiential learning and independent nature of children stayed with me beyond the trip into my thoughts here in America. I kept wondering why we care-take and parent so differently in the U.S. and questioned which method is better, and if either or both approaches led to different human behavior and mental health statuses both in comparison and in contrast.

An example of this is El Comedor, a site where myself and the other students worked during our time in Peru. The soup kitchen provided meals to any community members who were in need of food or nourishment. Whether it was a family or workers in the area, it was a general understanding that they come, eat a large meal for a small price, and leave with that need being met. This exchange demonstrating such a beautiful and useful way of indirectly tending to physical need, which cyclically improves mental health needs as well in a community bond strategy.

[now what?] In the U.S., community health is something that is constantly being revamped and improved in order to improve the overall health of individuals. Programs like El Comedor (the soup kitchen) and Corazon de Dahlia (a children’s after-school program) demonstrate a type of bonding among people and understanding of emotional and physical needs that Cusco seems to master through their innate human behaviors. On the other hand, there are systemic concerns that prevent some individuals in Cusco from achieving optimal health care and mental health goals in order to live a higher quality of life. While there may be very limited economic or government support in Cusco in comparison to U.S. for needs like emotional care or mental health care, the communities seem to take it into their own hands through bonding and affection—demonstrating true the public service value of community. Ultimately, the U.S. can benefit from the affectionate way that Peruvians care for one another and generally look out for each other when we are faced with challenges of apathy here at home.

The formal concern and understanding of the need for mental and physical health care in the U.S. would provide very beneficial change in the lives of many Peruvians on a macro level because of the need for a more resources and larger support. The formal health care that we provide in the U.S. could be useful if implemented in Peru for individuals suffering from behavioral dilemmas of any kind. However, U.S. mental health and social service might too have lessons to learn from Peru. A give and take from both cultures could benefit both greatly on mezzo/community levels and macro/systemic levels. If all human-beings are attempting to achieve optimal quality of life well beyond that of just surviving, then we can see the importance of using each other’s beneficial techniques in working with communities and its people.

Elizabeth Pisani-Woodruff

Master of Public Administration (MPA) and Master of Social Work (MSW) Dual Degree Student

* This CCPA blog series is by CCPA graduate students participating in the Peru International Service Learning Program led by CCPA Professors Susan Appe and Nadia Rubaii. The blog series allows participating graduate students to reflect on their experiences during their time in Peru in June 2015, using a what, so what, now what? model (see: Rolfe, G., Freshwater, D., Jasper, M. (2001). Critical Reflection in Nursing and the Helping Professions: a User’s Guide. Basingstoke: Palgrave Macmillan)

Profe! Profe! Profe! Y Cuando Regresan?

[the what?] We have now officially worked alongside all of the service partners that we had planned to work with. It has been a very enriching, different, eye opening and emotional experience for many different reasons, the most impactful one being that, now  that we have returned to the U.S., we no longer get to see the children we were working  with! Every time we finished at a service site, I could not help but hold back my tears and get a knot in my chest until we drove away. It would not have been fair to start crying in  front of the children who were doing perfectly fine before I arrived; my tears would have just made a scene and probably caused the children to get sad. In any case, it was a very draining experience when the time came to leave and say goodbye. I was saddened by the realities that many of the families of these young children were faced with. Most of my sadness stemmed from knowing that I was leaving so many children in the same situation that I found them in, and that I was unable to change anything about the way they are living their lives. Many of the people that we interacted with came from rural areas where there are limited resources, which limit the lifestyle that many of the families can have. One specific example was seen at AbrePuertas, one of the service sites we visited, where the program was located in a rural setting, surrounded by mountains and dealing with issues of poverty. Although the service site is there to help children in the neighborhood overcome challenges associated with poverty, I could not help but think that the work that is done is made so much harder by the lack of resources, sponsors and support that this service site receives. Along with AbrePuertas, Corazon de Dahlia and El Comedor were sites that lacked many resources and this limited the services they were able to provide.

[so what?] While in Cusco, I did make an effort to ask questions to the directors of the places we served to get a better understanding of what resources are available in Peru and get an idea of why the lack of resources exists. Many of the responses shared about the lack resources were accompanied with responses about lack of support—financial and  other—from the community and from the government. I think that a big problem Peru faces in its communities is that there are many concerns aside from service providers that need government attention and resources, for example, the issues related to malnutrition. Although the service sites that we visited provide very important services, sometimes they might not be considered the most important to most Peruvians. However, the service sites were creative. For example, Corazon de Dahlia has made sure to show up at all big town and community events to make its presence known and to inform the community of the importance in supporting educational initiatives like Corazon de Dahlia in the community. I think that although we were not able to help make changes or create a large impact on these service sites, we have definitely learned what it takes—the true dedication needed—to start, run, and keep a service providing program open and functional.

Coya plaza and mountains. This is the town, Coya, where AbrePuertas is located and serves.
Coya plaza and mountains. This is the town, Coya, where AbrePuertas is located and serves.

[now what?] Although our trips to these different service sites were pretty short lived, I think that the most important part of the experience is what the group from Binghamton learned from it. We might not have been able to make an immediate impact on the students that we were working with, or the communities in which we were in, but I am sure we all learned something. During our pre-departure classes at Binghamton University, we were assigned various articles to read that spoke about how volunteers should stay in their own countries and help the millions of people that may need help there instead of going across the world to provide this help. Even though I agree to a certain extent with that philosophy, I also think that being able to travel allows us to understand and see what it is that might be wrong in our own countries and how to fix it. Also it might help give us the tools to assess the strengths and weakness that our country has related to public service and how to make service to others even stronger and more impactful.

Carolina Garcia

Master of Public Administration (MPA) and Master of Social Work (MSW) Dual Degree Student

* This CCPA blog series is by CCPA graduate students participating in the Peru International Service Learning Program led by CCPA Professors Susan Appe and Nadia Rubaii. The blog series allows participating graduate students to reflect on their experiences during their time in Peru in June 2015, using a what, so what, now what? model (see: Rolfe, G., Freshwater, D., Jasper, M. (2001). Critical Reflection in Nursing and the Helping Professions: a User’s Guide. Basingstoke: Palgrave Macmillan)