Lindsay Sprague

New Hamburg, Ontario, Canada
Junior/Anthropology
University of Waterloo

"Attending the field school teaches the ethnographer the most practical and useful methods in the anthropology discipline but even more importantly it challenges the student everyday to expand their mind in ways that could never be obtained in a classroom setting."

A Discussion on Caring for the Elderly in Peru
Written by Lindsay Sprague

Introduction:

In our increasingly busy and complicated world it is difficult to imagine caring for one’s elderly or dying parent in the home. Sickness, death and old age are not issues that we are comfortable encountering on a daily basis especially when they are present among the people we love. Often the thought of caring for a parent seems all too consuming or even impossible when placed against our individual needs. In many ways our North American culture caters to the mentality that caring for aging and dying parents is not directly the responsibility of the family. While the family of the elderly person may be responsible for finding appropriate care for their loved one, they are often not expected to provide care themselves or in the home. In North America, specifically Canada, it is socially acceptable and socially expected that when elderly persons can no longer care for themselves they will retire to a facility that can care for them. Our society has in turn made nursing homes and retirement homes available to meet the differing financial needs of most Canadian citizens. Elderly persons, or their families in many cases, can choose which type of care is most appropriate for them; some may only need help cooking while others may require long-term nursing care.

Whatever the reason for not wanting to provide care in the home, in Canada options exist for those who feel that caring for an elderly or dying parent does not fall within their capabilities or desires. However, in many parts of the world an entirely different mentality exists. In most Latin American countries the family is seen not only as a financial and social support group but also as the main form of organization.

Different values and expectations arise from the family unit in countries where it is so highly valued. An individual primarily has a responsibility to their family, in fact they may not even see themselves as an individual but rather as an incomplete part of the whole. Because of tradition and cultural attitudes most families would care for their elderly members in the home; to neglect to do so would seem socially unacceptable. For these reasons, nursing homes have not been embraced in Peru with the same vigor as in Canada.

In Peru, nursing home care is rarely considered an option when deciding how to care for the elderly and the dying. In this paper I will discuss why nursing home care is not seen as an acceptable option for the elderly as well as the advantages and disadvantages to providing care for the elderly in a home environment. This paper will also include cross-cultural comparisons of the treatment of the elderly between Peru and Canada, since I have some personal experience in dealing with the elderly in my home country.

Background:

My own interest in the care and treatment of the elderly began after I undertook a job as a nurse’s aide in my local nursing home. The particular nursing home I worked in provided three distinct levels of care. The least amount of care was provided for the most independent patients, and included providing meals and medications. The intermediate level of care included bathing, meals, dressing and medications. The highest level of care was provided for the palliative patients and included dispensing medications, toileting, constant supervision, feeding, dressing, and bathing.

While working in the nursing home I was exposed to a particular stage of life that was entirely foreign to me, yet sparked my interest. Since I spent most of my time working with the palliative and Alzheimer’s patients I was able to witness the relationship between the patients and their families over the three years I worked there. As time went on, I realized that many patients, particularly Alzheimer’s patients, did not receive visitors or if they did it was often not their immediate family. I also noticed that many patients did not receive visitors until we informed their families that they were nearing death. This phenomenon confused me at first. However, after a certain amount of time I realized that it was difficult for many of the families to watch their loved ones deteriorate mentally and physically. And since it was not the direct responsibility of the family to provide care it became easy for them to stay away.

As well as being a life altering adventure my experience as a nurse’s aide encouraged me to think about how I would deal with the treatment and care of my own parents when it became necessary. I thought about how I could provide the best care for the people that meant the most to me in the world. I also thought about what kind of care they would want as they neared the end of their lives.

When I arrived in Peru it became apparent to me that nursing home care is not viewed in the same way as it is in Canada, nor is it as easily accessible. Since I knew a little bit about our system of care in Canada I thought it would be interesting to research how the elderly are cared for in Peru.

Peru is a country situated on the West Coast of South America with its most northern tip being just a few hundred kilometers below the equator. It is a country rich in culture and history, but economically poor. The average monthly wage is roughly $112 US dollars a month, while the cost of living for a family of four can run as high as $540 US dollars a month (Lonely Planet, 35).

Trujillo and Huanchaco are the two main places I was able to conduct my research. Trujillo is a city of 650,000 inhabitants and is located on the North coast of Peru. Huanchaco is a small vacation town that is located 12 kilometers from Trujillo and is renowned for its ancient fishing practices still used today. The population of Huanchaco is approximately 35 to 55 thousand people. During the summer season the town is a popular tourist and vacationing area however during the winter season the town is much more quiet and peaceful. It was during the winter season that I conducted my research, more specifically the month of June.

When I first got to Peru, I asked my Professor if she knew of any nursing homes in Trujillo or Huanchaco and she said she didn’t think there were any. However, after discussing this with some of her friends she informed me that there was in fact one nursing home run by nuns in Trujillo. After doing some further research I found out that there is an additional nursing home in Trujillo – bringing the total number of nursing homes to two. This was a pretty clear indicator to me that most care for the elderly was provided in the home.

As my initial research progressed it occurred to me just how much the family unit is valued, if not necessary here in Peru. As my own culture has increasingly devalued the importance of the family in favor of the importance of the individual, I was naturally curious to discover the popular practices of a culture that placed the family unit above all else. I decided that for my topic I would focus not only on how and why care is provided in the home, but also how the quality of the care provided in the home would compare with care provided in the nursing home run by the nuns. By doing this comparison I would bring in my own experiences in dealing with caring for elderly people.

Methods:

My methods for conducting my research were varied depending on the social setting I found myself in. I first began my research at the nursing home in Trujillo, (Asilo de Los Ancianos), run by Hermanitas De Los Ancianos Desamparados. This particular order of nuns (Patron of the Ancient) is in charge of caring for elderly and destitute people all around the world. After meeting with the director of the nursing home I offered to come and volunteer in the home three times a week for two hours at a time. The hours that I worked were between 3 0’clock and 5 O’clock pm. This allowed me to spend approximately ten hours in total focusing on the daily lives of the patients living there. This form of participant observation also permitted me to give something of myself to the nursing home since I worked while I observed. Basically, my time at the nursing home was spent in participant observation since I could not speak Spanish. I was able to ask the odd question to the workers at the nursing home but all in all I was treated as a ‘gringa’ worker who was just there to help out. This form of participant observation lasted two and a half weeks. While at the nursing home I would normally make mental notes of various events and then record them in a journal once I had a few spare minutes. There was a small vacant room where I could write in privacy without being disturbed. Usually when I returned to Huanchaco I would fill in missing information in my fieldnotes.

The second method I chose for my research was one-on-one interviews conducted with a married middle-aged woman, Eva who cares for her mother at home and who lives here in Huanchaco. I met with her on five occasions to discuss her life experiences and her thoughts on being a caretaker. My visits with Eva lasted approximately an hour each time and we discussed many aspects of her life, including her experiences with providing care for her mother. I also had the chance to see Eva interact with her mother as well as her daughter who is fifteen years old. Eva and I were able to communicate well because we both speak French; Eva was particularly happy to speak French with me because she rarely got a chance to practice this language. The opportunity to speak and interact with Eva was particularly useful for me since she had lived in Canada only six years before and so she had a very good grasp of not only Peruvian culture but also Canadian culture as well. Usually I would take jot notes when Eva spoke and then expand my notes in private. On one occasion I taped an interview with Eva and later transcribed the tape. Eva was never hesitant to talk with me and she seemed to enjoy reliving her past experiences.

There were several limitations to my research methods. The first and most prominent limitation was a lack of time. I conducted my research in a time span of only three weeks, and so I do not claim to give the reader a ‘general’ or ‘complete’ view of my topic as it pertains to the country of Peru (my research was only conducted in Huanchaco and in Trujillo). My paper is basically a comparison between one woman’s experience in caring for her mother, and my observations of the nursing home.

In addition I have only a limited understanding of Spanish, therefore my interpretations of the events at the nursing home are based mostly on visual observations. While I had some understanding of the Spanish that was spoken at the nursing home I did not feel that I was accurately able to translate conversations. For these reasons it is more difficult for me to ‘claim’ an understanding of all the events that occurred at the nursing home. However, I feel that in some ways my lack of the language allowed me to remain rather unobtrusive at the nursing home, since I was often given a task and then little attention was given to me.

Since Eva was my main informant I feel it is necessary to provide a brief life history of her. Eva has lived in Huanchaco for the last six years. She was born and raised in Trujillo but has also lived in Quebec, Canada. At one point she applied for Canadian citizenship but has never returned to the country because she feels it is more important to build a house in Huanchaco which she will eventually leave to her daughter. Eva stated that if she were to return to Canada she would have nothing and that it would be too difficult since she is the sole caretaker for her mother.

Eva’s husband earns a living by buying used trucks, fixing them up and then selling them again. I did not feel comfortable asking Eva the exact state of her finances but I got the impression that her and her husband are simply ‘getting by’. For example, they have been in the process of building a house for the last six years. This house is approximately three-quarters completed and Eva hopes to be moved in by the end of this year. Currently Eva and her family live in a five-room house that is located in central Huanchaco. Eva has four living siblings, and one brother who died while he was living in Quebec. As was mentioned before, Eva has a fifteen-year-old daughter named Louisa .

Fourteen years ago, Eva’s mother, Rosa , was diagnosed with Alzheimer’s disease. The diagnosis was made while Eva was in Canada and Rosa was living with Eva’s brother in Trujillo. Eventually it got too difficult for Eva’s brother to look after Rosa because she began to wander out of the home. Eva returned home to Peru to look after her mother because she believed this was her mission from God. At first Eva shared the responsibility of caring for her mother with her sister, however, after an argument Eva decided that she alone would look after Rosa. According to Eva it is mostly the daughters of the family who tend to care for the elderly parents in Peru, however she was not clear on how the decision was made in her family. Currently, Eva’s sister comes to stay with her two days a month to care for their mother and during this time Eva has a break from caring for her mother.

Currently Eva’s mother is in the final stages of Alzheimer’s disease. The doctors have estimated that she has the mentality of a 5-month-old baby.

Rosa is not able to feed herself or walk and is bedridden most of the time, however Eva does lift Rosa into a chair on the days she is feeling well. Rosa is incontinent and requires constant supervision and care. She no longer speaks coherent sentences and seems to be non-responsive for long periods at a time.

Obviously, if a family member is providing care in the home for their parent they must forfeit certain freedoms; this sacrifice may take its toll emotionally, financially, or socially. I discussed with Eva several times, how her role as a caretaker affected her life.

Emotional and Physical Strain:

The first time I met Eva she discussed the emotional and physical strain she suffered because she was the sole caretaker of her mother. She told me she had sickness of the colon and stomach and that her nerves were bad. On a separate occasion she told me that she suffered from chest pains because of the stress of her mother’s illness. On two occasions Eva described to me why her nerves were so bad. She said at first when Rosa was still mobile and able to get around by herself it was very hard for Eva because she would disappear out of the house . Eva told me she was especially nervous at this point in her mother’s illness.

At one point in our conversation I asked Eva how her life would change once Rosa passed away. She responded with the following:

yes, for example, my doctor, he told me, yes it’s difficult, but it’s my life, my health, my well-being, will be a lot better because I was nervous with her, but I think it will be totally different, totally, totally, totally…

Financial Strain:

Eva not only feels the strain of caring for her mother emotionally, but financially as well. Eva does not receive money from the government to help with the costs of caring for her mother. She does receive money as child support for her daughter but she does not receive any additional benefits for providing care for her mother. More specifically, I asked Eva if she received any supplies (diapers, creams, and medications) from the government, she said ‘no’. I asked Eva if she could estimate how much it costs her per month to look after her mother in the home. She said that it was over 130 soles a month on average. She then added that when Rosa is sick it is more money (because she has to pay for medication by herself).

Eva does not have access to a Geriantologist to come and see Rosa when she is sick so she calls a family physician into their home. I asked her how much it costs to bring a doctor into the home and she said that this doctor is a friend of hers so he does not charge her (Eva told me that he is aware of her financial situation).

Since Eva does not receive any support from the government I asked her if she received financial support from her family. She responded to this question by telling me a story about her brother who lives in Houston. What follows is an excerpt from my fieldnotes:

Eva also described another incident with her brother…Rosa was very close to dying and Eva had told her brother that she didn’t have the money to bury their mother. The brother told Eva that she should pay the costs of the funeral etc…and that he would send the money when he could. She told him that she didn’t know where she would get the money – it was impossible. She told me that she doesn’t understand how he doesn’t have any money because he is single and lives alone and works…how can he not have money? Eva said that the diapers and clothes and even alcohol she uses to clean her hands after she changes her mother’s diapers are expensive. And so is the cream that she puts on her mother’s groins when she has sores from diapers. In Eva’s particular case she does not receive financial support from members of her family, nor does she receive money from the government. As a non-working mother she is reliant upon the income of her husband to support her and her family. As I grew to understand Eva’s situation it became obvious to me that making enough money to get by was a struggle.

Social Strain:

Eva also felt the strain of caring for her mother socially. In one of our more formal interviews I asked Eva if she felt she had a social life. She commented that she feels she does not have a normal life like everyone else:

… if I don’t have Louisa (at home), she is at school for example, et I have to leave for Trujillo, I don’t go..I have to find a person to stay here each time, this is why, for me it’s not like everyone else, ‘okay bye’..no. For me it starts, okay, I call, okay, I have to ask George if he will stay , if not I can’t go, or only if Louisa comes home or Antoine, then, yes I can go out

Eva lacks the freedom of movement that most adults have. She can not come and go as she pleases, at least not for extended periods of time. She must always find someone to stay with Rosa while she is out of the house.

Eva is also limited in choosing her social environment. On one occasion she expressed to me that she would like to go back to Canada with Louisa (she would like Louisa to receive her university education in Quebec), however, she cannot go with Louisa until her mother dies. In the following passage Eva talks about her reality – that she has chosen this path in her life and that right now she has to concentrate on caring for Rosa:

For example, I have to go to Canada with Louisa, it’s my decision that she studies, but I can’t leave until Rosa goes to God, this is the decision of my life, I cannot worry about my family, about Louisa and Antoine, because there are things I must leave in order to attend to Rosa, to stay here with Rosa

In addition, there were many occasions in which I asked Eva if she would be home on certain days. She usually responded by telling me that she is home everyday, so I should just come over because she will always be there. Nonetheless, I should take this opportunity to mention that Eva always had a good attitude. She was always cheerful with me and she seems to view her life in a positive manner. My impression of Eva was that she had accepted all that life had given her and was making the best out of her situation.

I believe that Eva is a product of her culture, just as I am a product of mine. She felt it was her duty to care for her mother even though there were times she struggled financially, emotionally and socially. Once I asked Eva if she would ever consider placing her mother in a nursing home. Her response was as follows:

It’s my obligation, because I am sure that if the situation was reversed, and I was sick, that Mary..I am sure she would look after me, more than I look after her. Because the love a mother has for her daughter is large, yes.

It was clear to me that Eva felt a very strong moral obligation to care for her mother in the home; there was no other choice. When I really got to thinking about Eva and her mother it ‘hit me’ that there really was no other choice. In Peru, there are expectations and roles that need to be fulfilled correctly and to not do so would be greatly frowned upon. Family members are expected to care for one another until death, just as they are to remain loyal unto each other until death. The reality of life in Peru is that family members are expected to support each other emotionally, financially and socially; this was the reality of Eva’s situation.

Peruvian Attitudes toward Nursing Homes:

Because of this reality nursing homes have not become the ‘norm’ in Peru. Peruvian society does not require an external geriatric support system outside of the family.

In order to test this hypothesis I questioned Eva on attitudes toward nursing homes. I was curious to know what values and beliefs are associated with Nursing Homes in Peru. Eva commented that it is looked down upon in Peru to have people placed in nursing homes, which may explain why there are only two nursing homes in all of Trujillo. She also described a situation in which her sister attempted to convince her to place Rosa in a nursing home:

Ah yes, they will think it’s a mean person, I am sure but I could never put, never… but my sister asked me one day, four years or five years ago, she started, yes five years ago, into a nursing home, never, never, if I put Rosa into a nursing home in one week she will die, and she said ‘Eva it’s a lot better’ and no, no .In the same interview Eva commented on families who put their loved ones in nursing homes.

Yes, my aunt, my godmother, it’s terrible, terrible, terrible, I said ‘why, why’ If you have a job where you can afford to pay someone to look after and care for a loved one…then it’s not a problem…but to put them in a nursing home, ah it’s easier for the other person, okay, we put them in a nursing home and we continue with life, yes it’s difficult, right? I think that it’s very sad, I hope never, I prefer to die than to be in a nursing home, that my daughter leaves me and forgets about me, oh yes.. I prefer to die, and so I will write it in my will…okay I want to die before

It is quite apparent from these comments that Eva does not have a very good impression of nursing homes. She told me that she had visited the nursing home in Trujillo before and that she thought it was very sad. Obviously for Eva, placing Rosa in a nursing home was not an option, but what options existed for other families in Peru?

If a family member wishes to place an elderly parent in the nursing home they are faced with the reality that very few facilities exist and that it is in fact frowned upon in this society. I believed that institutionalizing elderly people would be looked down upon since it is the family’s duty to provide care however, I also wondered if it had anything to do with the quality of care that is associated with nursing homes here in Peru. This is where my observations from the nursing home in Trujillo became significant.

Peruvian Nursing Homes:

While working at the nursing home I was expected to help in the daily activities I witnessed, for example washing dishes and cleaning commodes. This allowed me to have some interaction with the patients living there. Most of the patients living there were elderly persons who did not have anywhere else to go or their families were either unable to care for them or too poor to care for them. My specific assignment in the nursing home was to work in the men’s section . Each day I would serve the men food, help those who needed to be fed, wash the dishes and generally clean up. On average, the ages of the men I worked with were between sixty and eighty years old. Most of the men could walk, however two were blind and one used a walker. Three men were in wheelchairs.

My first impression of the nursing home was that it was a relatively clean and pleasant place. The following passage is taken from my fieldnotes:

It really didn’t look like a nursing home to me at all. The entire center of the nursing home was an open garden with beautiful flowers and the halls were all open to air. The rooms were very clean and well-kept. There were about 6 beds in each room we looked at…. The director took us on a tour of the home. It really was a surprise to me at how beautiful it was. The building was in really good shape (nothing looked old or rundown) and was surprisingly clean. There were about 4 gardeners and I noticed a worker repainting some outdoor planters. There was a plaza in the center of the nursing home, and there was also a social area used for dancing (a dance floor and a billiards table - they sometimes put music on). The nursing home had a very nice big kitchen that was immaculately clean!

However, in the days that followed I realized that my first impressions were inaccurate. I had wondered why people had thought of the nursing home as such a terrible place to send their loved ones. It soon became clear to me why people viewed the nursing home so negatively. The next passage is taken from a few days later:

All of the old men were dressed in mismatched and worn clothes with holes in them and buttons missing (my impression is that the men who come in here basically have nothing and so they end up wearing donations). When I leaned down to give one of the men his cup of warm milk I noticed that he smelt strongly of urine and feces. One of the men had a wound to his head that was bandaged and soaked in iodine. Two of the men were in wheelchairs upholstered in red plastic. All of the men looked like they hadn’t been shaved in a couple days.

In addition to the nursing home not being as ‘well-kept’ as I had initially thought, there were also several other problematic situations going on in the nursing home. However, I am aware that I am comparing this nursing home to my experiences at home in Canada. For example, in the area in which I worked there was one nun, and one male worker looking after approximately twenty men. There was one nurse, a twenty-five year old female, who was in charge of administering medications and treating all one-hundred and thirty patients. By the condition of the clothing worn by the men, and by the appearances of some of their injuries (two of the men had extreme head wounds), it seemed to me that the home was understaffed and that the patients were not receiving the attention needed. One of the men, Carlos was bedridden and was totally dependent on having care. The following passage is a description of the first time I fed him:

It was hurting my back leaning over him so I went to sit down beside him but I could feel a lump under my bum. I pulled back Carlos’ covers to find that his hands were tied to the sides of the bed with the ties from an old housecoat. His hands were covered with socks and I think there were bandages underneath the socks. Carlos’ did not seem to be in pain or uncomfortable. However, I did suffer some initial shock at discovering the ties. After I had fed Carlos about half of his meal, he refused to eat anymore and abruptly fell asleep. That’s when Madre L. came back in the room and I asked her why his hands were tied to the bed. What I understood was that Carlos has bedsores and is scratching at them and so to prevent infection he needs to be constrained.

After working a couple more days at the nursing home I noticed that Carlos also had a base-ball-sized bedsore on his left hip that was bandaged. However, I never saw the dressing changed nor did I see the wound checked in the time that I worked there. Also, I noticed that many of the men helped themselves. For example, there were two men in wheel chairs that sat beside each other; one of the men had suffered from a stroke and could not eat so his companion mashed up his food and fed him. I also noticed that constraints were used very frequently to keep the men in bed and to keep them from scratching bedsores.

Medications were left out in the open and could have been easily taken by the patients. None of the drugs administered to the patients were charted or recorded in any manner. I noticed that quite often men wore the same dirty clothes everyday and that they smelt very strongly of feces.

The men were not provided with any form of entertainment and seemed to spend a lot of the time sitting in the courtyard. There were not a lot of visitors to the nursing home; in total I saw three men being visited by outsiders.

Discussion:

My experience at the nursing home helped me to understand why people associate nursing homes with being ‘dirty’ and providing sub-standard care. There were many times that I felt angry and helpless while observing daily life at the nursing home. I also realize that the home was run completely off donations and was severely understaffed; all in all I believe the nuns were doing the best they could. However, I found it disheartening that I witnessed young nuns in training spending considerable amounts of time cleaning and polishing the floors when patients were sitting in their own feces or suffering from bed wounds. It seemed that in the nursing home a strong emphasis was put on appearances rather than quality care; for example on our first visit to the nursing home the director kept reiterating how clean the home was.

I do realize that the judgments passed on the nursing home in Trujillo are directly related to my own experiences as a nurse’s aide. For example, at the nursing home in which I worked patients were dressed in clean clothes daily, medications were clearly charted and kept locked away and never in the three years that I worked there did I see a bedsore. We could provide this level of care because we had funding from the government and therefore an adequate amount of staff not to mention subsidized medications. On the complete opposite end of the spectrum was the nursing home in Trujillo, where on my first visit the director told us that they lacked the specialized medications needed for diseases like Parkinson’s.

On looking back at my experiences at the nursing home in Canada and then here in Trujillo I realize that the focus of the two homes were completely different. In Canada, the focus of the nursing home was primarily to make patients comfortable and happy for the remainder of their lives. This meant that all necessary measures were taken to make sure that patients were physically and emotionally comfortable. Medications, psychiatric treatments, counseling and activities were all provided and utilized for the well being of the patients.

In Trujillo, the nursing home was concerned with appearances, with making sure the home looked neat, with giving outsiders such as myself the right impression. Minimal work was done to ensure the comfort of the patients. I got the distinct impression that the nursing home in Trujillo was a place for the destitute to come and die, not to live.

Through my interviews with Eva and my participant observation at the nursing home it became clear to me why nursing home care is not considered an option here in Peru. Because the family is so highly valued it is seen as insensitive and even cruel to place elderly parents into a setting outside of the home. After witnessing life at the nursing home I can understand why they are given a ‘bad name’. However, I do not think it is fair to say that one form of care is ‘better’ than the other. Both types of care, either provided in the home by family, or by a public institute have their advantages and disadvantages. These advantages and disadvantages in turn make either option more successful in a particular cultural context.

In Canada we can provide patients with a more comfortable setting in the nursing home thanks to funding from the government. This is turn makes the family more comfortable since they do not have to deal with a sick elderly person ‘cramping’ their lifestyle. However, this situation is problematic. While a family may have freedom from the burdens of caring for a loved one they may also feel guilt and sadness at abandoning their loved one. In my time spent at the nursing home I have witnessed many patients die without the family being there; I have known many patients who have never received a visitor in all the time I worked there. The elderly person suffers, as they do not receive company or love from their immediate family. In my opinion, the nursing home staff fill the role of the person’s family in many cases. Since the staff work and care for individuals every day they acquire a certain closeness which is similar to the love and care a family provides, however, I am in no way saying that nursing home staff are a more favorable substitute for the love of a family.

In Canada if a family member would want to care for a loved one in the home they would receive aide from the government. They elderly person themselves would receive a pension, and a monthly benefit from the government. Since health care is a provided for every Canadian citizen a nurse would be able to visit the home and to treat the patient free of charge. Medications are often reimbursable and are widely available to the public. There are many external relief systems for the caretaker, including cancer, Parkinson’s disease and Alzheimer’s associations, support groups for caretakers, private volunteer groups that work with elderly and public run activities designed especially to stimulate and entertain the elderly person. In other words the caretaker does not have to face the challenge alone. It is for these reasons that I most likely will care for my parents in my home should the time ever come. After working in a nursing home for three years I saw too many lonely patients who ached for the love of a friend or family member. While being a caretaker is not for everyone, our system of health care allows for open and unlimited visiting hours and complete interaction with loved ones while they are institutionalized.

While it may seem that we have perfected the ‘nursing home’ system we have in fact cut out a very important faction of life that is still present here in Peru. The family bond and responsibility exists in Peru while in Canada the individualist mentality is dominant. In Peru, the majority of elderly people are reassured that when the time comes their family will do the ‘right thing’ and care for them until their time on earth is finished. The support system continues to be the family rather than the government. Families do not have the option of placing their parents in nursing homes because of the social connotations and consequences that go along with this action. Also, quality facilities are not accessible for the average Peruvian since the family has traditionally filled the role of the caretaker. However I would offer some suggestions based on my experiences with Eva.

Eva was obviously lacking the financial and emotional support she needed to care for her mother. While she did the best with what she had, she was obviously bothered somewhat by her situation. In Peru, better support systems need to exist to meet the needs of the caretaker. The cost of being a full-time caretaker is felt financially and emotionally since they do not have subsidized medications, can rarely afford to have a doctor come to the house, and do not have the external support from being part of organizations that are specifically designed to meet their needs. What I would suggest is that each community develop a support group for caretakers. I could tell that Eva felt good about talking to me about her problems, if she had the opportunity to do this on a weekly or monthly basis with other full-time caretakers I believe she would benefit from it. While it is unrealistic of me to suggest that the Peruvian government needs to give financial support and necessary medications to caretakers (this will not likely happen any time soon), a support group is an obtainable goal that can be organized by member of a community to meet the needs of a special group within the community. If I could offer a primary suggestion to any given Peruvian community, a support group would be most beneficial addition.

Conclusions/Recommendations:

When comparing two completely diverse cultures it is unfair to say that one form of health care is more successful than another. In each particular context, either Peruvian or Canadian, health care systems have been designed to meet the needs of the population and to function in a specific cultural context. Nonetheless, this does not mean that either system has been perfected. Obviously more work in needed in order to meet the needs of the elderly and the family in more fulfilling manner.

In addition, I feel that as North Americans we have a lot to learn from people who so willingly give of themselves in order to make the last years of their loved ones lives easier and the transition into death less cumbersome. In North America the care of an elderly parent is associated with confusion as well as guilt since families naturally want to choose the best possible option for their loved one; more often than not the only feasible option becomes a nursing home. In Peru the opposite situation exists. As an anthropology student I believe that through exploring the ways other cultures treat their elderly populations we can learn valuable lessons about how to care for our aging population more efficiently. My experiences here in Peru have made me appreciated the care and love that are given to elderly persons in the home – needless to say I will take these lessons home with me.