Fellowship Site: Peru

The Universidad Peruana Cayetano Heredia (UPCH), founded in 1961, is a private non-profit university and one of Peru's premier medical and public health schools. The university and its affiliated hospital are located in San Martin de Porres, a neighborhood of Lima easily accessible by bus. The university is committed to promoting social change and contributing to the scientific, political, economic, cultural, and social development of Peru and the Andean Region.

The Peru-Johns Hopkins site has numerous laboratory and field facilities. We are based in Lima but have research projects throughout the country. Our main laboratory is the Laboratory of Infectious Diseases (LID) at UPCH, which includes a level 3 tuberculosis lab, PCR and immunohistochemistry technology, and extensive computer resources. In their first month in Peru, students do a lab rotation to learn basics techniques of parasitology, bacteriology, mycobacteriology, immunology, molecular biology, and tissue/cell culture. We also have a laboratory in Iquitos and work with local university and Ministry of Health laboratories in Arequipa. The Hospital Dos de Mayo is a large public hospital in central Lima that serves Lima's poorest citizens and is one of the oldest hospitals in the Americas, founded in 1538. The infectious disease ward includes a 32-bed HIV/TB ward that is a resource for research projects and clinical educational opportunities for visiting students. PRISMA, a Peruvian non-governmental nonprofit organization is our base for most epidemiological studies, helping students coordinate with field sites such as Las Pampas in a Lima shanty town and our Chagas field sites, Arequipa and Santa Cruz, Bolivia. PRISMA also assists students with living issues and travel.

Our largest field site is in Las Pampas de San Juan de Miraflores, one of Lima's poorest neighborhoods. The 40,000 residents of this neighborhood have collaborated as participants in a variety of studies for more than a decade. The field site has an office with computers and copiers for research purposes. We have smaller sites in other areas of Lima that study tuberculosis and diarrheal diseases. We also have established urban and rural field sites in the cities of Iquitos and Arequipa supported by collaborations with local academic and health institutions. Other projects outside of Lima include cysticercosis on the northern coast and throughout the mountains and high altitude physiology in Cerro de Pasco at 16,000 feet.

The NIH-funded clinical research includes the following projects:

1. An Integrated Approach for Control of Taenia Solium Cysticercosis-In collaboration with physicians and veterinarians, we are studying diagnosis, epidemiology, and control of cysticercosis, the most common cause of seizures in Peru.
2. Tuberculosis-The lab has developed MODS, a rapid technique to culture Mycobacterium tuberculosis and perform sensitivity testing. Tuberculosis projects include development of improved diagnostic methods, laboratory research, epidemiology, prevention, and HIV/TB.
3. Chagas disease-Based in Arequipa and currently expanding to Santa Cruz, Bolivia, this project includes projects examining epidemiology, focusing on the urbanization of the disease, risk factors and entomological aspects of the disease, congenital transmission, clinical manifestations of latent infection, and improved diagnosis.
4. Helicobacter pylori-The majority of the Peruvian's are colonized with H. pylori by adulthood. This is a multi-faceted project that includes diagnostic techniques, molecular and genetic characterization of the bacterium, and clinical manifestations of colonization by H. pylori. This project is based in the communities and hospitals of Lima. In addition, we are currently finishing a project with indigenous populations.
5. Malaria-This project is based in Iquitos and focuses on the ecology and molecular epidemiology of malaria and its vectors in the rain forest.
6. Diarrheal diseases-Projects in this field stem from established work in Las Pampas and other neighborhoods of Lima with a focus on molecular epidemiology of intestinal pathogens including Giardia, Cryptosporidium, Cyclospora, and Microsporidium. Other recent work has examined the effects of childhood diarrhea on children's nutrition and development.

Please see the CRISP database (http://crisp.cit.nih.gov/) for more information about NIH-funded projects at our site.

Possible additional research: Cardiology

Additional research conducted at the site may include the following projects:

1. Chagas disease studies in cardiac conditions associated with this disease as well as early warning signs and autonomic dysfunction.
2. Transition disease in pueblo jovens including hypertension, coronary artery disease and CHF and associations with obesity and diabetes. These will be both community and hospital based studies.

Possible additional research: Oncology

Project example: Premalignant disease associated with Helicobacter pylori and gastric cancer Esophageal and colon cancer.

Housing Availability:
The Peru program has a student house available for $100/month in San Miguel, which is a 45-minute bus ride from UPCH and a 1.5 hour bus ride from Las Pampas. Many recent students have also chosen to find apartments on their own or with roommates; it is not difficult to find good housing in safe neighborhoods with rents ranging from $150 to $500 per month. Students at sites outside Lima can find apartments or student housing in those cities, where the cost of living is even lower than in Lima. Distance from housing to the training site depends on the particular site assigned and the student's choice of housing. Public transportation by bus is easily accessible (bus fare is approximately $0.50) and taxis are also ubiquitous and quite cheap (less than $5 to most destinations). The cheapest option for travel to other cities is by bus; Peru also has several reliable and affordable domestic airlines.

Immunizations Needed for this Site:
See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel.

The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad (diarrhea prophylaxis, hepatitis A, yellow fever, typhoid fever).

Safety and Danger Issues:
See the U.S. State Department Web site for information. While pick pocketing and other petty crime are common in Peru, using common sense, students will rarely find themselves in personal danger.

Language Requirements Other than English:
Yes. A knowledge of Spanish is necessary. Language schools are available in Peru for those wishing to take classes.

What is it like to live in Peru?
Living in Peru is a diverse, fascinating, challenging, and fun experience. The country is divided into the coast, the mountains, and the jungle, each with unique culture and geography. A large portion of Peru's population lives in poverty, and the poor housing conditions and presence of beggars and conspicuous child labor may be discomfiting to those with little experience traveling in the developing world. Peruvians are an outgoing, warm, and friendly people who are invariably curious about Americans' lifestyles and often want to share their life experiences with visitors. Family is highly valued, many young adults live at home until marriage, and marriage and children are frequent topics of conversation. Although women are respected in the workplace, there is a strong culture of "machismo," and women often find themselves attracting unwanted attention and comments; however, Peruvian men are rarely aggressive and ignoring these comments, as Peruvian women do, is sufficient. Peruvian food is among the best and most varied in the world, with each part of the country having its own distinctive cuisine. Seafood such as cebiche, made of fresh raw fish marinated in lime juice, is ubiquitous on the coast while pork, alpaca, and guinea pig are common dishes in the mountains. Travel is easy and safe throughout most of the country, and Peru's tourist industry is constantly expanding.

Almost a third of Peru's 27 million people live in Lima, and as such, it is the cultural and political center of the nation. Lima and the neighboring city of Callao were developed as the colonial capital and port and today are a fascinating mix of colonial and modern architecture interspersed with ancient temples and fortresses. The wealthy neighborhoods of San Isidro and Miraflores are filled with parks, restaurants, nightclubs, and shops comparable to those in the world's other great cities. Central Lima is the seat of the national government and site of myriad colonial churches and mansions. On a bus ride through the chaotic streets of the city, you can pass from skyscrapers overlooking the Pacific Ocean to shantytowns built along unpaved roads on the hills outside the city. The weather is cloudy and cool (about 55 degrees) from May to November and warm (85 degrees) and sunny from December to April, when the city empties to the nearby beaches every weekend; it almost never rains in Lima.

Arequipa, site of the Chagas project, is Peru's second-largest city with a population of about 850,000. It is a unique and beautiful city seated at the base of an active volcano in the southern mountains. Arequipeños are somewhat reserved and conservative but generally welcoming; they are fiercely proud and independent and love to show off their city. Arequipa is cool, dry, and sunny for most of the year, and the little rain it receives falls from December to February. Iquitos, our jungle site, sits on the Amazon and is said to be the world's largest city that remains inaccessible by car-visitors must arrive by boat, or more commonly these days, by plane. The approximately 400,000 residents of Iquitos are outgoing and fun-loving. The city is noisy due to the innumerable moto-taxis that race through the streets. The climate is hot and humid year-round, and the city's location on the Amazon makes it a good starting point to explore the surrounding rain forest. We have projects in many other sites as well in the northern coast, the jungle, and throughout the mountains.