ditch your culture, the pig flu´s a´comin!!

22/08/09

The recent hysteria over the “Swine Flu” – or more correctly, “H1N1” (is it true that it wasn´t even caused by pigs in the first place?) – has led me to some pretty interesting cultural observations. The first thing that you need to understand is that (I hate to generalize but...) Peruvians tend to be a dramatic and exagerrating people, regarding everything from the weather to their children to…well, you name it. So you can imagine the national reaction when all the sudden this crazy, previously unheard of, killer virus hit Peruvian society. Almost overnight surgical masks became a fashion item, and la gripe was all anyone wanted to talk about. In August school was cancelled for two weeks by the government, and even health workers were prohibited from leaving their posts for fear of contracting H1N1 and bringing it back to their communities. Ridiculous rumors started circulating, like that all the pigs in Peru (and there are a lot of them) ought to be burned, that you shouldn´t eat pork under any circumstance, and that if you got the gripe, you were pretty much guaranteed a slow, painful death. It also created (yet another) excuse for not getting things done, replacing the crisis economica at the top of that list. I know that sounds sarcastic – and it is, a little – but people were, and are, seriously terrified by this thing.

It´s been interesting to watch the government´s response, which has been, predictably, dramatic and I would say exaggerated. From the billboards, public health advisories, and prevention campaigns, you´d never know the gripe pales in comparison to the common influenza, which kill ways more people every year. What´s more, to me it seems totally ludicrous that, in a country where solving it´s childhood malnutrition, maternal death rate, potable water, hunger, and straight-up poverty issues should be at the top of the governent´s priorities, they pull out all the stops for this international senstation that really isn´t that big a deal, statistically-speaking. Sure, they have to take all the necessary precautions, but maybe if they focused on getting people to wash their hands regularly, for instance, a flu wouldn´t be such a huge threat.

I was recently invited to an information session in Chalaco on the H1N1, put on by two nurses from the Piura office of the national Ministry of Health. The talk included all the basics on the flu, including its causes, symptoms, prevention and treatment. What was really interesting for me was the prevention section, during which I had something of a revelation about fighting disease in the developing world. You hear all the time, for example, about African communities being literally destroyed by HIV/AIDS, where the disease is almost impossible to control because of cultural practices or beliefs, like the idea that sleeping with a virgin will cure a man of AIDS. To most in the developed world, this sounds ridiculous, the the point of being completely unconscionable. And I count myself among them. But listening to this talk made me realize just how tough the fight can be. For instance, among the prevention techniques recommended by the nurses were the following: don´t greet with a kiss, hug, or even a handshake; don’t share glasses; and most of all, don´t self-medicate if you show symptoms. Now, all three of those would be pretty easy to do in the States or Western Europe, but in this part of the world, each one presents some very problematic cultural issues.

For example, in the States we could probably get by with a simple “Hello,” forgoing the customary human contact in the face of a recognized health threat. In fact, these days I´m sure a lot of people are doing just that, and I doubt it´s causing any real problems. I probably shake hands about 50 times a day where I live. You pass someone on the road, you shake their hand and make smalltalk for a minute or two, whether you know them or not. To do otherwise would be downright rude, end of story. And the way gossip spreads around here, the whole town would know that you´re a dick before you even got home. Asking people around here not to shake hands is like asking them to just please, try not to breathe for a few months.

Same goes for the glass-sharing. In the States this wouldn´t even be an issue, but here, sharing glasses is an elemental part of the culture. City life is one thing, but when drinking up here, to have your own glass or bottle is unheard of. Whether it´s beer, cañazo, or some other local spirit, you drink it in a group, pouring for yourself and then passing the bottle before you drink from the glass, and then passing that along to the next person as well. Like the hand-shaking and small-talking, it´s a show of solidarity and community. The tradition is so strong that it sometimes applies to non-acoholic beverages as well. One time I was offered peach-flavored liquid yogurt in a drinking circle (which I politely declined, but that´s beside the point.) The only time I don´t pass the vaso when drinking is when I´m exclusively with other volunteers, or sometimes in a large city where the tradition isn´t as ingrained. In Chalaco, not passing the vaso would mean not drinking, which is unthinkable just about anywhere. Alright, maybe not, like…Iran, but you get the pic.

And thirdly, the self-medication issue. Chalaco may not be as traditional as some other places volunteers live, way up in the heights of the Andes with llamas and those Peruvian winter hats and guinea pig farms and all. Actually, the people who live in the town itself pride themselves on being almost “coastal” (synonymous with “refined”) in their daily lives. But a five minute´s walk from my house will take you to families who still view modern medicine with suspicion, and turn to natural remedies (derived from herbs or other naturally-occurring plants) for all but the most serious illnesses. Plus, you generally have to pay by the visit, and subsistence farming isn´t real conducive to buying Tums. Not self-medicate?? A year ago, my gut reaction, too, would have been, “Why the hell would you self-medicate??” But the point is, you really have to live in a culture to understand the way its people think, and expecting them to chage because of some sensationalized but completely-irrelevant (thus far at least, knock on wood) sickness is pretty unrealistic. The H1N1 poses a health threat to the Peruvian population, sure. But the recommendations for preventing it, if followed, would pose an existential threat to the very culture of the place I live.

Which is why I´d bet the farm that people simply won´t follow them. And it helps explain why epidemiolody in the developing world is infinitely more complex than most Westerners probably realize.