Living in Peru : your everyday companion

By John Glick, MD

Iquitos is the world's largest city accessible only by air or water. Its poorest district, Belen (population 65,000) serves as a river port for lumber, charcoal, fish, vegetables, fruits, and produce from the surrounding Amazon jungle. The Belen neighborhood nearest the river, Pueblo Libre (population 15,000), is the poorest neighborhood in Iquitos and has been described by Peruvian government officials as "the horror of Peru." High population density, unemployment, lack of clean water and sanitation, and inadequate housing, healthcare and educational services create a setting where family and community violence, alcoholism, malnutrition, HIV, teen pregnancy, prostitution, child sexual exploitation and many other horrors of poverty and oppression are rife.

The Belen Project began in 2006 by Gesundheit! Institute (G!I) and Bolaroja Clown Doctors of Peru (BR), was developed after a clown visit to Belen in 2005. Working in collaboration with Pueblo Libre citizens, G!I and BR, a project was enacted April 2006 in an attempt to address the many complex problems of Pueblo Libre with simple low cost interventions. In 2007, the project was joined by the Pan American Health Organization/World Health Organization (PAHO/WHO) and University of Peru Cayetano Heredia Medical School (UPCH), and a network of organizations was established with an interest in helping Pueblo Libre. 

The red nose gave us access to Pueblo Libre hearts and minds
Through clowning, art, play and a comprehensive socially, ecologically sensitive system of health care, The Belen Project represents an innovative, low cost, replicable approach to community development that has drawn the participation of the PAHO through “Art, A Bridge to Health”, (“Faces, Voices, and Places” of the Millennium Development Goals), and other international, non-government organizations.
       
Gesundheit! Institute Service Clowning: A Brief History
Patch Adams led his first international clown trip to Russia in 1988, G!I’s first step towards expanding the scope of Gesundheit’s mission from a future, community-centered, free hospital in rural West Virginia to encompass world-wide humanitarian service. Since then, G!I’s local, national, and international work has been characterized by creative, playful, mutually-interdependent interactions between doctors, patients, clowns, and the sick and poor worldwide. Our clown volunteers have witnessed the magical therapeutic benefits of laughter, smiles and play, in tens of thousands of patient, family, and hospital staff interactions in over 40 countries.  

Bolaroja Clown Doctors of Peru:  A Brief History
In 2001, Wendy Ramos, a popular Peruvian actress and founder of Bolaroja, began researching the work of clowns in hospitals.  She was influenced by Patch Adams, who encouraged her through many supportive and enthusiastic letters.   

After much hard work, research and organization, Doctores Bolaroja was born, a non-governmental organization, embraced by the Children’s Insitute of Health of Peru (Institute de Salud del Nino).
 
On January 2, 2002, Doctores Bolaroja made their first visit to the nephrology and dermatology departments in a pediatric hospital. The response was overwhelming.  Today, their rounds also include the departments of rheumatology, traumatology, thoracic and cardiovascular surgery, gastroenterology, among others. They also were early responders in the humanitarian relief effort after the earthquake in Ica, Peru, August 2007.

Compassionate Clowning: Is it Enough?
Most media coverage of our work has emphasized "Smile Therapy" or "Laughter is the Best Medicine". Smiles help, most certainly, and we have many remembrances of times when a clown and a sick person playing together altered the course of a chronic illness or restored wholeness. Without question, suffering humans benefit from clowning in many ways: the momentary reduction of suffering during a clown interaction; an altered clinical course in the face of serious illness; precious moments of fun during a terminal illness; the resuscitation of the lost spirit of a community after war, disaster, displacement. Compassionate clowning also benefits the clown volunteer. The clown's authenticity of presence allows a free exchange of human warmth, intimacy, and acceptance. Clown medicine is bi-directional. 

Yet, is clowning enough? Clowning opens doors through which flows love and care.  But with all the problems facing the world's poor (lack of food, water, sanitation, health care, shelter, security, education, jobs, human dignity), we ask ourselves again and again, “How can we best help?”

Gesundheit! Institute International Community Development Projects
In 2005, with BR Clown Doctors of Peru, on a clown mission to Iquitos, in the Peruvian Amazon, G!I clowns visited Belen, one of Latin America’s most destitute communities where Patch met a 5 year old girl with gonorrhea. We decided to return and try to help somehow. We had no clear idea at the time of what that help would look like, only that we were willing to try. 

With BR, G!I collaborated with community members months later, and came up with a plan. We decided to begin by attempting to paint, in beautiful colors, every one of the 1500 houses in Belen’s most poor district (Pueblo Libre), one street at a time. We chose this from a long list of projects dealing with very serious and urgent needs because 1) it was possible; 2) it allowed us to establish friendly, playful and working relationships with each family in Pueblo Libre; 3) we could afford to do it; and 4) the visual impact of colorful houses could influence the collective psychology of Pueblo Libre, making it a more child friendly place – imagine!
 
Every August, since 2006, G!I and BR have gathered together clown volunteers from around the world and, in collaboration with Pueblo Libre citizens, painted every house on three of the longest streets in Belen. 

The Belen Project was presented to a press conference at PAHO headquarters in Lima, Peru, August 13. A film documentary by PAHO preceded a panel discussion on “Art, A Bridge to Health.” Wendy Ramos, Executive Director of Bolaroja, and physicians from Bolaroja (Tato Guerra Garcia and Alfonso Silva-Santisteban), Gesundheit! (Carl Hammerschlag, Patch Adams and John Glick), and PAHO (Manuel Pena and Adrian Diaz) discussed the theoretical and practical elements of clowning (as a form of improvisational theater) and its role in opening dialogue and collaboration in Belen, as well as its role in raising the spirit of traumatized communities throughout the world. Effective health care requires the formation of vibrant and collaborative relationships between all participants. In The Belen Project, clowning is one way these relationships can be formed.

In summary, the collaborative humanitarian process based on clowning, art and volunteer work has activated the community spirit in Belen. In keeping promises we have gained trust. In asking for nothing in return we have been given their confidence and support. In our enthusiasm for fun, we draw people to us. In art we have stimulated creativity and opened means of expression denied to those who cannot read, or write. These channels of expression point the way to a better future for Pueblo Libre, a future increasingly in their own hands.  

The Belen Project Partners
We also have drawn partners to The Belen Project:  
• Airline Ambassadors – a non-governmental organization (NGO) providing humanitarian aid for children worldwide) University of Peru Cayetano Heredia (UPCH), one of Peru’s most respected medical schools
• Selva Amazonica - NGO providing HIV/AIDS treatment and education
• La Restinga - NGO in Iquitos targeting child sex workers and street children, providing counseling, support and education
• Taetro Vivo - NGO promoting therapeutic play 
• Pan American Health Organization (regional office for the Americas of the World Health Organization),  - International public health agency working to improve health and living standards throughout the Americas
• Amazon Promise - NGO providing free primary health care in the Peruvian Amazon
• Municipality of Belen - providing cooperation, material and logistical support 

The Belen Project Collaborative Network: What now?
With the people of Belen, G!I, BR and partners working together, the project goals expand and become more comprehensive. We strongly believe that programs targeting specific needs for the health, education and well-being of the Belen community can be provided by experienced local and international groups. Resources can be directed towards where they can be more effective. Pueblo Libre can organize through the painting and workshops, through the planned health care network and community center. 
•    BR provides experienced clown artists, teachers, performers and clowns for education and team building. Two BR clown/public health physicians from UPHC will do epidemiologic research and community development throughout the year.
•    PAHO and Amazon Promise will provide health care and develop health care infrastructure.
•    G!I supports these initiatives and some of its own (women’s microcredit program, child scholarships for children of destitute families).
 
We are proud that G!I’s unique talents in art, play and community action and healthcare have influenced the spirit of The Belen Project. Our practice of community based health care has brought together hard working volunteers to work with Pueblo Libre citizens, to build a healthy community. 

Conclusion
The Pueblo Libre, Belen community in Peru has many serious problems: violence, crime, sickness, unemployment, lack of health care, adequate housing, unhealthy living conditions, and more. International clowns have created a collaborative relationship with the people of Pueblo Libre. This collaboration has two steps; first, acknowledging the reality of the many problems and second, enabling creative responses to these problems. Assistance from local and non-local resources can be directed in a timely, specific way. The effectiveness of technical/logistic solutions is thus enhanced by intimate, inspirational and friendly relationships established through mutual play and work. Gesundheit! clowning is one way to facilitate the development of low cost, grassroots social change in poor communities worldwide. The World Health Organization, through PAHO, takes clowning seriously, and is partnering with G!I to study the effectiveness of this intervention. 

To view more of what went on during the Belen Project click here.

How to Help The Belen Project (supporters, participants, donations):
In the USA and abroad: Gesundheit! Institute
      John Glick, MD at jawkneemail@comcast.net or by calling 540-421-6421.
      Tax deductible donations can be made by check (made out to Gesundheit! Institute/Global Outreach) and mailed to:
       John Glick MD
      15250 Hammer Lane
      Elkton, VA 22827, USA
Visit:  http://www.patchadams.org/campaign/clown_trips/peru_aug_2008
In Peru: Bolaroja Doctores
      Wendy Ramos, doctoresbolaroja@gmail.com  or by
      calling +011 51 1 445 2981
      Av. Reducto 1365
      Lima 18 (Miraflores), Peru
      Donations can be deposited in savings account No. 128-3001723459, Banco Interbank, Peru.
      Visit:  www.bolarojadoctores.org website
Other links:
Gesundheit! Institute - http://www.patchadams.org/campaign/
Pan American Health Organization (PAHO) - www.paho.org/
Pan American Health Organization, Lima, Peru - http://www.per.ops-oms.org/
Bolaroja - http://www.doctoresbolaroja.com/

Photos © Sonia Mey, PAHO/WHO