By Geoff Gusoff
Geoff Gusoff hiking to visit patients in Lima.
After almost a full year in Lima, I arrived in a quite different “bean town,” Boston. It’s been nice for a change to take public transportation that doesn’t feel like an hour-long game of Twister, but I still sometimes have no idea what people are saying (I spent an hour last Sunday praying to someone named “Lawd Gawd”). Being in Boston these past few months has allowed me to get some perspective on my time in Peru.
What initially struck me most about Lima was its geographic and economic landscape. Class was largely divided by altitude, with the poorer residents occupying increasingly higher segments of the city’s many hills or cerros. The vast majority of the people I worked with lived in these cerros, including two who lived in the very last houses on a massive hill affectionately referred to as Machu Picchu. When I would trek to their homes two or three times a month to check on their micro-businesses, I’d always wonder, between panting breaths, how seriously ill patients made this trek everyday.
My main job in Lima was to help run a micro-enterprise program, which provides small loans to former patients so they can establish small businesses and have a sustainable income after their treatment ends. The program was something of a radical experiment: to create a micro-enterprise program with a preferential option for the poor. Unlike other micro-finance organizations, we took on many clients considered high-risk because of their history of illness and we committed resources to intensively train each participant. We also provided no-interest loans because we found that for many patients paying interest would mean drawing from the food budget or other necessities, raising their risk of becoming re-infected with TB.
I was responsible for making regular visits to mentor and collect loans from thirty-five (roughly half) of the businesses. Through these visits, I gained a deeper appreciation for Lima’s economic landscape. I learned how precarious it was to live in the hills, with many residents suffering injuries from terrible falls or from carrying heavy items. I also learned that the landscape was not completely static. People occasionally moved downhill to higher economic ground, and employment was a key factor in making that transition. Through the success of their businesses, the two residents of Machu Picchu were both able to move lower down on the cerros. Others were able to make improvements on their homes, adding a bathroom or a roof. Perhaps most importantly, many used their business revenues to pay their children’s educational fees to help break the cycle of poverty.
As I left Lima in August, I looked down at the same city I had seen from the plane a year before, with its mountains of poverty. I felt the same sinking feeling in my stomach, but this time there was another image to accompany it. I thought of my co-workers, the community health workers, the patients, and their family members, traveling through that massive city, each armed with little spoons for leveling those mountains. It was a painstakingly slow process, and yet, you could see progress if you looked close enough. Kids graduated high school, houses were built, people were cured for good. I thought of how much that army of spoon-holders had grown even during my brief time there, and I couldn’t help but feel some hope. Hope, and gratitude, for having been able to share a small part in that process.
[posted November 2009]