16 World Heolth • 47th Year, No.6, November-December 1994 Two faces of poverty Oswaldo Lazo Inequality and iniustice lie at the root of poverty in Peru. Yet ancestral principles of eru is a poor country, and 91 per 1000. There has been a getting poorer day by day. For survival based on solidarity decline in coverage by basic Pyears its people have lived in a and reciprocity that were the sanitation services; whereas at the kind of illusion born of the well­ end of 1960 it was estimated that known saying that Peru is like a basis of the social structure 60% of the urban population had a beggar sitting on a golden bench- a piped water supply, by the end of reference to the country's great in the pre-Hispanic world 1990 only 42% had this service and variety of natural resources and its have ensured that thousands in the rural areas only 36% had diverse ecology and climate. access to a household water supply The geographical diversity of the of mothers' clubs, educational source or connection. terrain is matched by ethnic differ­ groups and other associations Lack of access to health care and ences, making for a country in which the inability of such services as many different cultures coexist, are now working to improve existed to provide prompt and different languages are spoken and adequate care were brought sharply the population forms several health, sanitation and water to light with the outbreak of the different nations that are not yet fully supplies. cholera epidemic at the end of integrated, so that it can be January 1991 , for it is well said that Peru is a nation in known that cholera is a the process of formation. disease of poverty directly Inequality and injustice lie related to sanitary at the root of the poverty of conditions and the level of the Peruvians, which people's awareness of prevents the full unfolding hygiene. The epidemic pro­ of the country's potential duced 390 000 cases in the for human development. first year, with 4000 deaths, The deep global crisis in spite of the fact that a that began in the mid-1970s whole set of emergency led to tremendous hyper­ measures, including the inflation, high unemploy­ monitoring of food and ment and a huge contrac­ water and the early tion in government social detection and treatment of spending. These evils were cases, were introduced by In Peru, 60% of the population live below the poverty line. accompanied by an upsurge in organized political violence, in which an estimated by actions to offset their adverse 20 000 people died. effects on the living standards of the poor. Today we are facing a phenom­ enon of massive poverty affecting Still greater hardship 60% of the population. The extremely poor account for 22% and On this critical background, a set of are mostly found in the rural areas of extremely harsh measures of the Andes mountains, beyond the economic adjustment were applied at reach of even the most basic social the beginning of this decade, and services. various studies have shown that they The infant mortality rate of 55 per have substantially increased the 1000 live births is one of the highest numbers of people living in poverty, in Latin America, while the rate in as they have not been accompanied the rural Andean areas is as high as Tap-water in the home is an undreamed-of luxury for millions; th World Health · • 47th Year, No. 6, November-December 1994 17 the Ministry of Health and widely accepted by the public. Despair and hope Poverty in Peru has two faces. The first is synonymous with deprivation and marginality, which could simply inspire despair, and as such is an evil that must be overcome if the country is to go forward on the path to development. But the poor also constitute a reservoir of human potential - the second face - whose energies can be mobilized to give impetus to processes aimed at im­ proving living conditions. Important organizations have arisen, especially women's movements in defence of life and health which combine their everyday household preoccupations Preparing meals for collective distribution. with collective concern about the needs of the neighbourhood or the today 8000 milk distribution activities with them. It is largely community. It has been mainly the committees, bringing together these women, during the cholera organized women among the poor mothers from the poor sectors of the epidemic, who were the first to take who have joined their voices in legit­ community to prepare and distribute to the streets in their communities imate protest at past neglect and have nearly one million rations of milk and organize educational marches come up with concrete proposals and every day to children, pregnant that made people quickly realize the continuing activities for the health women and nursing mothers. In Peru seriousness of the problem. They and feeding of their children and as a whole some 900 000 lunches and were also the first to give prompt oral their families. 230 000 other meals are subsidized rehydration treatment, thus The poor from the Andean or distributed free of charge. preventing deaths and also saving the regions lean on ancestral principles Mothers' clubs, people's educa­ health centres and hospitals from of survival, based on the solidarity tional organizations, creches and being overwhelmed; ultimately only and reciprocity that were the basis of other associations now work for the 37% of cases were hospitalized. It is the social structure in the pre­ health of their children, ensuring the thanks to these women and to the Hispanic world. These principles community monitoring of children's health service workers that Peru had continue to sustain their activities growth and development; carrying a case fatality rate of 0.69% for today and have led them to form a out programmes of food supplemen­ cholera, the lowest in the world. variety of organizations that give tation for children with or at risk of These leaders of the social substance to the social fabric in Peru. malnutrition; acting quickly to give organizations that have emerged In the city of Lima alone, there are oral rehydration in cases of cholera from the struggle for survival and other diarrhoeal diseases; pro­ deserve to be recognized, for they moting health education and environ­ have gained experience and become mental hygiene in their communities; effective and efficient. Ways should and taking part in campaigns to be sought to enable them to collect garbage, install latrines, participate in the running of health chlorinate the water, and maintain services as legitimate representatives and clean the water reservoirs. of the people; they have a role to play These are just some of the many in sustaining the democratization of health activities in which the women Peruvian society and its development are involved, with support from in peace and justice. • nongovernmental organizations and other national and foreign charitable institutions. In daily practice they are now fully recognized by society and Dr Oswaldo Lazo is a Professor at the Universities of San Marcos and Cayetano the government, and the formal Heredia, Lima, Peru. ' wait for the water-truck is an everyday fact of life . health services are coordinating their .