June 13, 2005

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Rebalancing Research and Human Development

Photo by Jeff Cleary Tarayn Grizzard

Despite this community having existed for about 20 years, it’s only in the last five or so that a lot of the infrastructure has been put into place. Now there are concrete stairs with railings that go up most of the hills, a welcome addition since mostly women and their children live up these 45 degree slopes. Some homes have running water, although they’re in the minority. Most families save water in jars and buckets from a neighbor’s source or a community pump. About 45 percent don’t have regular access to water at all and have to wait for city trucks that bring water around to them two or three times a week. Electricity is easily “shared” by tapping city lines, and with that, there are now more clinics, elementary schools, and nursery schools in the zonas.

Scientific Gains
Research also has flourished in this area. For the past 18 years, the Peruvian nongovernmental organization (NGO) I work with has done a mountain of projects whose subjects range from infectious diseases to child nutrition to community education. We’ve discovered risk factors for postneonatal mortality, prevalence patterns of microsporidium, and attitudes and practices about sex and illicit drugs among women. We’ve trained numerous medical and graduate students from the United States and Europe in the process.

It just seems that there should be a higher standard to follow in terms of community support, especially since nowadays we mainly do surveillance of common infectious diseases or survey projects instead of interventions.

But it strikes me anew every morning that, despite the paved road, there’s really not much that is different about these zonas from the way they must have been years ago. They’re certainly not that different from the newer, “younger” shantytowns in Lima: cardboard walls, outdoor showers and baths, and most notably, people standing around everywhere, jobless for lack of opportunity or ability. There are few jobs even for professionals here. I’ve seen more nurses, engineers, and teachers than I care to count unemployed and sitting at home or selling vegetables in a roadside stall. There are few libraries, youth centers, or other community gathering sites. Those that do exist—a volunteer library, some concrete soccer fields—were mostly donated by international organizations, including churches, which also work in the area. The only signs that our office is here are our small, unmarked entry and the band of nurses, about 30 in all, who roam the hills for study subjects—and, of course, the occasional gringo researcher tramping around behind them.

Standard of Care
I can’t help but be concerned by the relative lack of development, the slow march toward decent housing and real infrastructure, and especially the relationship that the NGO I work with seems to have with the zonas. It’s not that I don’t give us credit for what’s been done so far. It just seems that there should be a higher standard to follow in terms of community support, especially since nowadays we mainly do surveillance of common infectious diseases or survey projects instead of interventions. We do employ nurses, but at a low, local payscale, and usually without any benefits or security. And we don’t compensate our study subjects.

I can’t get past the fact that there’s nothing that I can point to that we’ve done here, other than train foreign investigators and contribute to scientific literature. It makes me question whether we’ve lost our focus. Maybe we do what we do because no one demands that we do any differently. After nearly 10 months conducting research here, it seems that we’ve incurred a debt to the community that our training and research have done little to repay. I would welcome a shift by funders and institutional review boards to require research programs to contribute more to developing countries, to make some kind of investment in the communities in which they operate to provide for human development in the long term.

—Tarayn Grizzard is a lactation counselor
and medical student at HMS.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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Copyright 2005 by the President and Fellows of Harvard College