Yesterday the Congress of Perú passed a confidence vote in the new government. The Congressional vote granted the vote of confidence to the ministerial cabinet headed by Alberto Otárola. This seemingly insignificant act of Congress has already brought wide spread demonstrations and increased agitation amongst the protestors.

Whatever hope there was for a peaceful resolution to the political and social unrest that began after the inauguration of President Dina Boluarte in December following the failed coup d’état of former President Pedro Castillo, have left 46 deaths. Around the country protestors have taken to the streets – blocking roads and marching in solidarity. The police and military have been in hours long standoff with a group of protestors attempting to take control of the Cusco airport. Differing groups of protestors have erupted into violent clashes with one another in the Puerto Maldonado. The media in Perú are now referring to the social and political unrest as Perú en crisis.

The people suffering the most are those that have long-lived in extreme poverty. The Peruvian Ministry of Economy estimates the impact from the protests to exceed S/.300 million so far this year. Some of the poorest regions in the country are also areas with the most protests and the greatest disruption to their economies.

What happens next is impossible to know. One thing is clear, the situation has gone from bad to worse. Please keep Perú and the Peruvian people in your thoughts.

Happy 2023!

I arrived in Lima a couple of hours ago. Leaving the airport in the taxi, I expected to see a large police and military presence on the road. I expected to see visible signs of unrest. Instead, I found an eery calm.

International news outlets have talked about the widespread civil unrest around Perú – with the most significant confrontations occurring in Arequipa, Ayacucho, Apurimac, Cusco, Moquegua, Madre de Dios, and Puno. More than 25 people have died, and hundreds have been injured. There was a lot of speculation about what the city would be like now that the protesters have regrouped and taken to the streets in the new year.

The main instrument of the protestors are paros – or strikes. With the transportation strike being the most effective. It is working. The city is on holiday. I just went for a run, and the customarily congested streets of the city are all but mellow. It feels that way, at least.

Many businesses are closed without workers to attend to customers and manage shops. Tourism is all but on-hold, and the feeling is that of the visitor-less pandemic. Livelihoods are being upended. The protests will have devastating impact on the 70+% of the Peruvian population working in the informal sector and struggling from the effects of the pandemic.

What does all of this mean? In many ways, the current social and political situation in Perú points to significant change. Change in the old guard. Change in the status quo. Change in politics as usual.

I am still determining where this change will lead. It is too early to say. One thing seems clear . . . change is coming. We will keep you posted.

There is no such thing as work without challenges. The more significant, demanding, and harder the work – the more the challenges. That doesn’t mean it’s time to give up or roll over with defeat. Instead, it is an opportunity to dig in and work harder.

This push and pull, give and take, up and down, is especially evident when working with families and children who have lived through the experiences of generational poverty, traumatic stress, and social isolation. The following story is about the power of resilience and one little girl’s journey to healing.

Standing in Daisy’s home was overwhelming. The stench was powerful. Dirty clothes hung from a makeshift line in the middle of the one-room hut. There was no running water, no bathroom, and no electricity. Instead – a dirt floor, a single bed, and a small table covered with discarded papers and empty medication containers.

We first met Daisy (not her real name) in 2013. Her story is about extreme poverty, family violence, and social isolation. Daisy suffers from uncontrolled epilepsy. She literally seizes every day. Her mother told us that she often seized for up to an hour. The uncontrolled and prolonged seizures left Daisy mentally altered and suffering from several complications. Daisy, as we quickly determined, was in a critical situation. She was at risk of dying with her subsequent seizure. Late in 2013, we arranged a comprehensive care coordination plan for Daisy. Unfortunately, after a few weeks of care coordination – we lost contact with Daisy and her family. It was heartbreaking.

Apparently, Daisy and her family moved. Her father got into a physical altercation with the foreman at the mine where he worked and was fired. The family moved to the small town where Daisy’s father grew up. The city, a remote mountain community, offered minimal resources. Daisy’s mother quickly left. She moved in with a new man. He did not want Daisy. Daisy ended up on the streets.

It took almost ten months to reconnect with Daisy. Trip after trip to the high mountain town continually led us to dead ends. Finally, our outreach worker (Charito) connected with Daisy’s grandparents. Finding Daisy abandoned on the streets, her grandparents took her in, and she lived in their dirt floor home. She has not been on any medications for months, and her seizure disorder was uncontrolled. At six years old, Daisy was seizing up to five times daily.

Her grandparents took her to the local health post, but the nurse in charge referred them to a larger city, two hours bus drive away. They have yet to follow up on his referrals. Fearful that the cost of having Daisy seen would be more than they could afford on their meager income as farmers – they turned to traditional healers. Now, Daisy is getting worse, and her family doesn’t know what to do.

Our plan was simple . . . and entirely complicated. We needed to link Daisy into care through the Peruvian government programs. To do this, she needed a formal transfer of care from the clinic in her hometown to the Hospital for Children in Lima. This was a challenging task. Daisy’s father and grandparents were scared. They were scared of the unknown. They were afraid of going to the big city of Lima, where their style of dress, form of Spanish, and general way of living make it pronounced that they are from the mountains – and, thereby, a lower socioeconomic class.

Our next step was firmly based on advocacy. Charito traveled back to Daisy’s home. She took the family to the health post to complete the necessary paperwork and then loaded everyone into a bus for the 2-hour trip to Caraz. In Caraz, Charito helped advocate for the family by transferring Daisy’s care to the Hospital for Children in Lima. The challenge, all the advocacy, and planning needed to happen in the next two weeks – or the original transfer of care will expire, and the process would need to start over. In addition to the logistical challenges – every day Daisy continued to seize, she was losing more and more brain function, and she was more and more vulnerable to death.

After months of advocacy and support, Daisy was finally seen by a pediatric neurologist in Lima. Her medication was dialed in, and her seizures were controlled. The family moved in with an uncle in Callao to be closer to Lima and the Children’s Hospital. We lost contact we Daisy. However, the last time we saw her and the family – she was walking, starting to talk, and receiving comprehensive care at the Children’s Hospital. She was reclaiming the life she deserved.

Daisy’s resilience taught us that we needed to be resilient. We are thankful for the life of Daisy and her resilience.

 At 24, Sra. Elizabeth (not her real name) had a complicated pregnancy with her third child and was advised to seek specialized medical support. She left her small town in the mountains, only to find that the nearest hospitals lacked the right specialists and equipment. She gave birth prematurely and her baby was diagnosed with metabolic disorder, a rare, inborn complication that causes weak muscular development and failure to thrive. Her quick-thinking doctors worked with a local politician to transport Elizabeth to a third hospital in Lima, where her baby received life-saving support. However, without access to medical specialists, the child was held for observation for a month then discharged with a general care plan that wasn’t sufficient to meet the child’s complex healthcare needs.

Elizabeth had no family or friends in Lima, but she was able to rent a small hut atop a motor shop by working informally as a clothes cleaner for her neighbors or by selling food on the streets. She was earning less than S/10 soles (approximately $2.50) a day, same as most families in the Ines Project. Elizabeth’s situation was not only challenging and isolating – it was dehumanizing. Although Elizabeth was working tirelessly to support herself and her children, she couldn’t meet all the demands. Eventually, her efforts to find the best care possible for her child, while simultaneously balancing childcare and work, brought her to the attention of an HBI Ines Project Health Ambassador, and she enrolled in the program soon after.

Our first step through the Ines Project was to assure Elizabeth that she was neither forgotten nor alone – she had a whole team helping her form and implement a clear medical plan of action. Together, they sourced medication, identified nearby medical specialists, and determined that she would relocate to Lima. Secondly, the team encouraged Elizabeth’s innate self-advocacy skills by teaching her how to talk to healthcare providers and request for her child’s needs. We connected her to a Spanish NGO through which she accessed mental health assessments and therapy, continuously engaged her in trauma-informed conversations, and supported her transportation, medical, nutritional, and financial needs. The Ines Project even worked with the Peruvian Ministry of Health to approve the importation of medicine her child needed and partnered with a US-based pediatric endocrinologist for more support.

As she spent more time in the program, Elizabeth revealed a background of deep trauma and abuse, and as a result, would abruptly leave and rejoin the program. It disrupted her progress towards graduation. Her deep lack of trust only worsened when her husband left her: he refused to move to Lima, sent their two older children to her, and stopped all communication. Elizabeth’s story demonstrates that people experiencing poverty are fighting deep personal, mental, and socio-economic challenges that cannot be solved just by pooling resources or connecting them with the right medical specialists. There needs to be systems-level change to offer people like Elizabeth – whose children need her more than ever – a stronger safety net.

While the Ines Project met the medical needs of the child, it could not erase the effects of trauma, abuse, and poverty on their mother. There is much more work to be done to ensure families like Elizabeth’s attain true empowerment and sustainability. We have seen that without systems-level safety nets or a wider variety of social service partners working with families to address their socio-emotional and economic challenges, their progress in the Ines Project (or any program, for that matter) will not substantially change their quality of life. Our plan now is to shift the Ines Project’s scope to ultimately prevent highly vulnerable children from entering child welfare programs.

Today, Elizabeth is still working closely with our team to graduate from the Ines Project by December 2021. Graduating means finding financial stability and permanent housing, independently connecting with community and public services, and doing so with confidence. We will keep learning from families like Elizabeth’s and helping them every step of the way. Even if it means that our programs have to evolve. We are determined to build a future where mothers like Elizabeth can sustainably advocate for their children.

Flexibility is HBI’s super power. We are thankful for the flexibility that allows us to truly respond in a holistic way to the ever-changing needs of the people we are called to serve.