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In Peru, local women take aim at dengue

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Pamela Santisteban, her son, and their mosquito net. At first people would laugh at her dengue-prevention efforts, she says, “but then they started getting sick, and the laughter stopped.” Photo: Elizabeth Stevens / Oxfam America

When a town in Peru became a hotspot for dengue, a debilitating and sometimes deadly mosquito-borne disease, women stepped up and put an end to the outbreak.

Dengue has a nickname: breakbone fever.

“Your head hurts, your body hurts, your bones hurt,” says Catherin Roque, a mother from Batán Grande, Peru, who has had it twice. “You feel very weak and you have a fever. Your eyes get heavy and you lose your appetite. You get nauseated and you have to vomit.”

But that doesn’t mean a woman can take to her bed.

“If you’re sick, who takes care of the kids? Who takes care of the parents?” she asks. “Even if they are sick, women cook for and take care of their husbands. We have no time to rest, no time to be sick.”

It is well known that when it comes to disasters, women and men have distinctly different experiences. And that gender inequalities can make women and girls particularly vulnerable in emergencies. For example, if they were never given the chance to learn to swim, they are at risk of drowning in floods. And if they don’t have a strong voice in decision making, their needs may be neglected in the chaotic aftermath of a disaster.

Disease epidemics are no exception: where gender roles are rigid, women often have an outsized responsibility for nursing the sick, even if it jeopardizes their own safety, as it did in the Ebola crisis.

Meanwhile, in far too many cases, women are expected to keep their mouths shut and leave the job of running things to the guys.

That’s where the women of Batán Grande broke the rules—and may have saved lives in the process.

Strengthening local leadership

Cathrin Roque stands next to a mural about dengue prevention. “When dengue broke out here, people didn’t know where to go. Now, they know that there are people willing to defend their rights.” Photo: Elizabeth Stevens / Oxfam America

When dengue erupted in northern Peru in February of 2015, the town of Batán Grande became a hotspot. Scores of people were diagnosed with the disease, yet according to local residents, health officials downplayed the extent and seriousness of the emergency.  Angered by the lackluster response, women took to the streets, making national news with their protests.

In March, Oxfam’s partner in the region of Lambayeque, CEPRODA MINGA, offered to help the community lower its risks.

“Oxfam’s role in emergencies like this isn’t to rush in with staff and supplies,” explains Elizabeth Cano, Oxfam’s humanitarian coordinator in Peru. “It’s to build on the strengths that are already here.” Which is what CEPRODA MINGA set out to do.

First, they proposed neighborhoods form health committees—each balanced by gender—and then they provided workshops on dengue prevention and community outreach. Initially, men opted for the most visible leadership roles in the committees, but they generally saw their other work as more important, so over time, women stepped in to take their places.

The top priority has been a practical one: eliminate mosquito breeding grounds, which is a tall order:  all the Aedes aegypti requires is a bottle cap full of water. With CEPRODA MINGA’s support, committee members have gone door to door explaining the importance of removing trash, scrubbing water buckets, and covering containers of standing water; helped local youth paint colorful, informative murals around the town; handed out mosquito nets and scrub brushes, and organized trash-hauling days, and they’ve advocated with the local health center to improve patient care.

But as the women assumed leadership, they often faced serious obstacles.

An uphill battle for women

“Through CEPRODA MINGA, we’ve finally understood the concept of gender equality - that men and women have the same abilities. Now, people understand that women must have a leading role.”-Carlos Olazabal, municipal civil defense official in Batán Grande, Peru Photo: Elizabeth Stevens / Oxfam America

“In March of 2015, over 100 children were sick with dengue in one school,” says Roque, who went to speak to the headmaster. “There was a lot of trash around, and I pointed it out. He said, ‘Who do you think you are to teach me?’ I explained that I was trained to identify the breeding grounds for dengue mosquitos.” Turning for support to parents and the municipality, committee members were able to carry out a successful campaign at the school despite resistance, and the number of dengue cases dropped to zero. “Now,” she says, they manage their water and garbage better.”

If a woman faces an uphill battle for respect in the public sphere, a young woman can face an even steeper climb. Pamela Santisteban is 27 years old, and she found it challenging to speak to older people about changing their habits.  At the start of the campaign, they wouldn’t even let her in the door, but the ravages of dengue have lent gravitas to her work.

“At first they would laugh,” she says, “but then they started getting sick, and the laughter stopped.”

“Now, wherever we go, they let us in,” says Santisteban.

Carlos Olazabal, a municipal civil defense official in Batán Grande, has observed a change over time. “Sometimes it’s difficult for women to step into leadership,” he says. “Through CEPRODA MINGA, we’ve finally understood the concept of gender equality—that men and women have the same abilities. Now, people understand that women must have a leading role. And we are seeing women in public positions of leadership.”

Success

Violeta Anton de la Cruz, right, talks to Rosa Rivero of CEPRODA MINGA. “Thanks to CEPRODA MINGA, I feel I’m well prepared and ready to help and lead. I don’t have to stay quiet, because I’m fighting for our rights.” Photo: Elizabeth Stevens / Oxfam America

Pressure on officials to under-report the number of cases makes it hard to measure the gains in Batán Grande. (“They don’t want to admit to outbreaks, because it means they’re not doing their jobs,” explains one community leader.) But signs point to a huge success.

“This time last year [March], the health center confirmed 78 cases,” says Violeta Anton de la Cruz, a mother of three who lives in Batán Grande, “but there were 200 for sure.”

The number of confirmed cases in March of 2016: two.

And thanks to their advocacy, the women are starting to see results at the health center: where once medical staff were available eight or fewer hours a day, now there’s a doctor or nurse on duty 24/7.

Heightened awareness around healthy practices, and growing respect for women’s roles as community leaders bodes well for the future.

 “It was women who had the passion for this work,” says Cano. “And they have the persistence to complete the job.”

Santisteban is proud of what they’ve done. It means, she says, “we haven’t worked in vain.”


The CEPRODA MINGA dengue program in Batán Grande reached around 5,000 people in 2015, and thanks to the efficiency of locally led emergency response, it is so far costing less than $1.50 per person. Similar efforts are now underway in three other communities; by the end of 2016, the program will have helped protect 25,000 people in four communities.

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