Portfolio of Work Completed in Huamachuco, Peru

Michigan State University

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Internship Portfolio A summary of work in Peru

Zachary R. Tomczyk

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Contents

PROPOSED PROJECTS WITH COLEGIO “CENTRO DE APLICACIÓN” 3

LOS MUERTOS EN VIVO 4

PROPUESTA: 6

COLEGIO TALK 1 7

COMMUNITY ENGAGEMENT PROJECTS WITH HOSPITAL LEONCIO PRADO 9

DESCRIPCIÓN 10

MATERIALES 10

PROYECTO SIEMPREVIVA 11

HIERBAS: 12

SAMPLE HERB CARD: 15

MURAL PROJECT 16

CALENDAR 18

Section 2

REFLECTION ESSAY 1

RESEARCH ESSAY 6

AN INTRODUCTORY SURVEY OF DISEASE CONTRACTED BY INFORMAL MINERS IN HUAMACHUCO,

PERU 8

ABSTRACT 8

ACKNOWLEDGEMENT 8

INTRODUCTION 9

BACKGROUND 10

FIGURE 1. 15

MATERIALS/METHODS 16

2

RESULTS 17

FIGURE 2 2

FIGURE 3: 9

FIGURE 5 10

FIGURE 6: 11

DISCUSSION 11

RECOMMENDATIONS FOR HEALTH PROFESSIONS 14

RECOMMENDATION FOR FURTHER STUDIES 16

CONCLUSION 17

APPENDIX: 18

A.1 18

A.2 19

REFERENCE 35

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Proposed Projects with Colegio “Centro de Aplicación”

Working the local school mentioned above, we proposed the following

projects: Living Dead, Every 15 minutes, and we lead a discussion on

the topic of violence and drug abuse. The first two projects were not

realized but there are plans to complete them in October with students

from Centro de Aplicación and San Nicolas.

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La propuesta para el programa “Cada 15 Minutos”

Resumen del programa:

Los Muertos en vivo Uno estúdiate sale la clase cada 15 minutos y se hace parte de los muertos en vivo. Una

policía y un psicólogo entran la clase y leen el obituario a los que quedan en clase. El obituario

es puesto en la clase para el resto del año académico. Aunque la noticia de muerto es simulado

y todos saben eso, las noticias terminan en una exposición de emoción y preocupación. Durante

el día, miembros de los muertos en vivo ponen sus lapidas en un cementerio temporal

(normalmente una hoja de papel en una forma de un lápida es puesto en una pared) en una

área publica en el colegio para que los amigos de los muertos puedan llorar la muerte de ellos.

El día empieza con un anuncio por micrófono para explicar todo que pasará. Es muy

importante decir que esta actividad es una dramatización y que los estudiantes no están

muertos. Después de explicar la actividad, la voz explica la motivación por esta actividad y da

hechos de adicción. Luego el primer nombre es llamado. El estudiante sale la clase como

descrito. Miembros de equipo acompañan al estudiante a otra sala de preparación. El

estudiante es dado una camiseta negra para llevar sobre su camiseta. La camiseta negra tiene

un hecho de alcoholismo y cada camiseta es diferente. También, la cara del estudiante es

pintado blanca con negra arreglador los ojos y labios. Luego el estudiante es instruido que no

pueden hablar por el resto del día. Pueden asistir a la clase pero participan al mínimo. Después

el estudiante regresa a la clase y actúa como un muerto (muerto no es igual a zombi). Esta

Ocurre cada 15 minutos. Depende en el tamaño del escuela, es posible que más que uno

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estudiante es llamado cada 15 minutos. Después del término del día, Psicólogos están listos

para cualquier estudiante que necesite hablar del día.

Antes del evento, aproxmoante 25 están eligidos que representan una muesta

representavia de la poblacion del colegio. Estas personas deben ser considerado lideres dentro

del colegio. Puede incluir meimbros de estudiantes que no exige mucho pero la persona es un

lider en su grupo de amigos. También, un profesor o un entrenador favorito puede ser eligido.

Es imporante que esas personas sean de carácter fuerte porque otros estudiante crearían

situaciones con la intension de romper al carácter del participante. Si piensa que una persona

no puede quedarse en su personaje, no debe participar.

Después del evento los estudiantes puedan regresar a casa para escribir una carta para

decir adios a sus familias, amigos, etc. En la carta los estudiantes expresan sus ideas de estar

muerto. Dicen adios a sus familias y amigos y lo que van a extrañar. Estas cartas deben ser

serio y expresan las emociones que la person siente con la idea de estar muerto. Estas cartas

están leido el dia siguiente durante una ensablaje con el colgio. Durante esto tiempo

información sobre alcoholismo es dado a los estudiantes. Los padres deben estar presente

también. Mientras los estudiantes escriben sus cartas, los padres deben escribir una para decir

adios a sus hijos. Este parte es muy emocional y es sugerido que unos consejeros estén

presente para hablar con personas si necesiten.

Asi mismo al final se realiza una conversacion, en donde toman conciencia de que

tenemos que vivir nuestro presente y no dejar para manana lo que se puede hacer hoy, no

sentirnos tristes por lo que no tenemos sino alegrarnos por lo que tenemos.

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Propuesta:

Este proyecto va a dramatizar la gravedad de las consecuencias de beber en exceso. Los

estudiantes serán capaces de contextualizar las consecuencias de sus acciones, mientras que se

sienten las repercusiones de la muerte simulada de sus compañeros. La participación de los

padres reforzará el alcohol peaje emocional relacionado con la muerte de asumir las familias y

la comunidad. El compromiso de toda la comunidad obligará a que los miembros de la

comunidad frente a este problema acuciante y los cambios de la fuerza en la mentalidad de la

gente. Al ver sus compañeros en un estado estimulado a los estudiantes de muerte se ven

obligados a enfrentarse a emociones reales sobre las consecuencias de la vida real de las malas

decisiones. Esta dramatización se verá reforzada por una sesión informativa. Durante esta

sesión se presentarán los hechos acerca de los efectos sociales y personales de alcohol. Este

mensaje se puede ampliar para incluir a otros fármacos y la voluntad de la fundación de más

educación sobre la prevención de drogas.

Hay pocos materiales necesarios para este proyecto. Camisas negras serán necesarias y

la pintura camiseta será necesaria para que los estudiantes puedan representar datos y

estadísticas sobre el alcoholismo. Por otra parte, la cara pintada será necesaria para

transformar a los estudiantes a los miembros de los muertos vivos. Pedimos que las escuelas

que deseen participar en esta actividad a financiar su participación. Esto no debería ser recibida

con resistencia demasiado, porque los costos son generalmente bajos.

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Colegio Talk 1 Introducciones

- Introducciones del equipo

o Nombres

o De donde somos

o Intereses

o Explanación de temas

- Juego:

o Alumnos se sientan sobre las pupitre y tiran una pelota a si mismos. Cuando una

estudiante recibe el globo, se introduce con su nombre e intereses

Habla del círculo

- Alcoholismo

o Razones por tomar

o ¿Cuando años se necesita para empezar de tomar?

o ¿Prometería a sus hijos tomar? Y ¿cuando?

o ¿Piensan que alcoholismo es un gran problema en Huamachuco?

¿Qué podemos hacer para bajar el número de accidentes relacionado a alcohol?

Por ejemplo, usamos videos para educarles sobre los riesgos de alcohol.

- Bulear

o Problema de bulli en los estados

Coulmnbine High School

o Cadena de violencia

o ¿Por qué algunas personas pelean?

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o ¿Es un problema muy grande en Huamachuco?

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Community Engagement projects with Hospital Leoncio Prado While working with the hospital we were given the

opportunity to engage with the community of Huamachuco

and Cushuto (a rural community outside of Huamachuco). At

one of the local institutes we participated with the

psychologists in a workshop to educate students about

self-esteem and controlling anger. We engaged with the

students by helping to lead discussions, reflections with

the help of music, and active participation where we

asked students questions, invited them to dance in tandem

with us (from their seats) and by asking them to scream

as loud as they could. This project promoted health forms

of expression. In Cushuto, we worked with school age

children as we educated about proper treatment of people

and how to respect everyone. We lead games and group

exercise.

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Descripción En el interés en aumentar el conocimiento de la comunidad de la salud holísticos y crear una atmósfera

de espera más tranquila para pacientes, nos gustaría establecer un jardín de hierbas medicinales en la

sala de espera. El jardín consistiría en 6 cajas rectangulares, hechas de madera, alrededor de la sala de

espera de manera que permite el mismo camino para que personas puedan pasear. Pondríamos un

signo pequeño en frente de cada planta con su nombre, cómo se utiliza, lo que alivia, y una imagen

pequeña de la planta madura. Además, quisiéramos establecer una tienda muy pequeña que operaría

en la cafetería, que vende las semillas en el jardín. Todas las ganancias del hospital volverían al hospital:

una mitad hacia mantenimiento del jardín, y otra mitad hacia la cobertura de los servicios de salud

general del hospital para pacientes.

Materiales - 6 cajas hecho de madera (2m x 1m x 0.5m). Conocimos a un carpintero – se llama Don Bentio,

quien vive en Sucre - que puede construirlas - 0.5 metros cúbicos de suelo - Semillas vendrían de la comunidad inicialmente. Después, las semillas pueden ser cosechadas de

las plantas mismas. - El jardinero actual sería responsable de mantener el jardín, así como vender las semillas

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Proyecto Siempreviva

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Hierbas: Manzanilla:

- uso interno: trastornos digestivos (dolor de estómago, indigestión, digestiones difíciles de tipo

crónico (dispepsia), cólicos, flatulencia, diarreas); afecciones de las vías urinarias (cistitis o

inflamación de la vejiga); dolores menstruales; insomnio

- uso externo: heridas superficiales, contusiones, picaduras de insectos; irritaciones e infecciones

en la boca; ojos irritados; cólicos abdominales; hemorroides

Colen

- Estomago flojo

- uso interno: trastornos renales y de las vías urinarias; estados reumáticos y febriles; control de

la diabetes mellitus insulino-dependiente

- uso externo: lavados de heridas infectadas, piel con comezón; previene la caída del cabello

- Precauciones: evitar su uso en casos de edema por disfunción cardiaca y falla renal. Por su

contenido en salicilatos, no usar demasiado concentrado en pacientes con hemorragias activas o

que estén siguiendo tratamientos con hemostáticos o anticoagulantes

Menta:

- Efectos: antiespasmódico, carminativo

- Usos tradicionales: desórdenes digestivos (gases, náuseas, mal aliento y dolores estomacales);

tonificante

- Precauciones: no se debe administrar a niños menores de 2 años. Cuidado con personas con

cálculos biliares y madres que amamantan (puede reducir el flujo de leche). Almacenar en un

lugar fresco y protegido de la luz.

- Estos productos tienen el carácter de auxiliares sintomáticos y no remplazan lo indicado por el

médico en el tratamiento de una enfermedad. Al consultar al médico, infórmele que está

usando esta hierba medicinal. Evite su preparación en utensilios de aluminio

Hierbaluisa/Cedrón

- Se utiliza como digestivo, carminativo y antiespasmódico para casos de dispepsia o dolores de

estómago

- Se la consumen también cono sedante ligero.

- Posee una importante cantidad de melatonina – relajante natural y que favorece el sueño

nocturno

- Se emplean las hojas tiernas y las sumidades floridas

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Anís de Estrella

- Aparato Digestivo: Limpia los intestinos de fermentaciones y purtrefaccaciones debido a una mala digestión. A los niños y lactantes les resulta muy eficaz la infusión de anís en casos de gases o de diarreas malolientes. Es una Buena costumbre dar infusiones de anís a los lactantes, a modo de refresco.

- Aparato Respiratorio: es expectorante, al facilitar la eliminación de las mucosidades bronquiales, haciéndola más fluidas. Conviene a asmáticos y bronquíticos. Se recomienda especialmente a los que siguen un plan para, pues dejar fumar pues actúa como un verdadero antídoto de la nicotina y de los alquitranes de tabaco: limpia los bronquios de mucosidad irritante y facilita la regeneración de las células de las mucosas.

- Glándula Mamaria: Galactógena, es decir, que aumenta la producción de leche. Por eso los ganaderos dan anís a las vacas ovejas, mezclándolo con el pienso. Curiosamente, el anís se elimina con la leche, por lo que las madres que lactan, al tomarlo benefician también a sus niños.

Diente de León

- Hepático: es un buen estimulante de la función hepática y biliar, siendo útil en aquellos casos en que se presente hepatitis

- Diurética: es una de las plantas que más estimula la producción de orina. Hasta el punto que su nombre vulgar en catalán pixallits (mea Camas) hace referencia a este aspecto. De ahí que su uso es muy adecuado en aquellos casos que resulte interesante eliminar tanto agua-hidropesía y obesidad- como en aquellos en los que resulta fundamental eliminar toxinas de la sangre-colesterol, ácido, diabetes, etc.,- y favorecer la expulsión de las piedras de riñones.

- Aperitiva - Estreñimiento: constituye un laxante suave - Problemas de Visión: por su contenido en helenina y vitamina A, estimula la captación de luz,

siendo interesante en el tratamiento de la carguera nocturna - USOS EXTERNOS

o Piel: aplicada en forma de emplasto, realizadocon las hojas frescas machacadas, ayuda a cicatrizar las afecciones de la piel como heridas o llagas y es muy adecuado para el tratamiento de cardenales o moretones

o Varices y Hemorroides: también su riqueza en taninos la convierte en una buena amiga, con propiedades calmantes y relajantes de problemas circulatorios periféricos

Siempre viva

Alcachofa

- Usos tradicionales: enfermedades hepáticas y biliares; retención de líquidos por mal

funcionamiento hepático; colesterol alto; gota

- Efectos: colagogo, colerético, depurativo, diurético, protector hepático, hipolipemiante

- Precauciones: estos productos tienen el carácter de auxiliares sintomáticos y no remplazan lo

indicado por el médico en el tratamiento de una enfermedad. Al consultar al médico, infórmele

que está usando esta hierba medicinal. Evite su preparación en utensilios de aluminio.

Ortiga

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- Los principales agentes activos son acetilcolina, histamina, serotonina, clorofila, enzimas,

carotenoides, hormonas, sales minerales, ácido fórmico, taninos, y vitamina C

- Purifica la sangre con un efecto diurético y los propiedades desintoxicantes

- Estimula el metabolismo

- Mejora la digestión

- Alivia dolor

- Muy efectivo en el alivio de la artritis y la gota

Matico

- Las hojas se utilizan en el tratamiento de una serie de malestares de aparato digestivos: Dolor

de estómago, úlceras estomacales, diarrea, colitis, afecciones hepáticas y de la vesícula; también

en los casos de golpes y heridas internas.

- En forma externa se emplea para lavar las heridas y úlceras, y en lavados vaginales

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Usos Internos: se utiliza como digestivo,

carminativo y antiespasmódico, para

casos de dispepsia o dolores de

estómago. Se la consume también como

sedante ligero. Posee una importante

cantidad de melatonina, sustancia que se

usa como relajante natural y que

favorece el sueño nocturno. Los

elementos usados en infusión se recogen

dos veces al año, a fines de la primavera

y comienzos del otoño. Se emplean las

hojas tiernas y las sumidades floridas

Su infusión: realizada con entre 5 y 20 g

por litro

Sample Herb card:

Cedrón

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Mural Project

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02.06.12

La propuesta de los Murales en la pared exterior del Hospital Leoncio Prado

Un problema más grande con Huamachuco y el mundo es la violencia entre adolecentes y el

aumento de las tasas de alcoholismo entre los adolescentes. En combinación con programas empezadas

por los psicólogos en Hospital Leoncio Prado, proponemos un concurso de murales en los colegios de

Huamachuco.

Las reglas del colegio serían muy simples. Los estudiantes de un colegio, elegido por los

psicólogos tendrían una semana dibujar una representación del tema en una pieza de tamaño estándar

de papel con color. El tema de los murales es la intimidación y/o adicción a las drogas. Los miembros del

equipo recogerían las entradas después de una semana y presentan a los jefes de cada departamento

del hospital. Los jefes votarían para su dibujo favorito. El dibujo con los más votas ganaría. El artista del

dibujo más popular recibirá una notificación y pueden plasmar sus ideas en la pared exterior del

Hospital.

Por esto proyecto varios tipos de materiales son necesarios. Materiales necesarios incluyen: la

pintura, Las brochas y rodio para pintar para pintar la pared. Además se necesita materiales para lavar la

superficie de la pared. Estas materiales incluyen jabón, un cubo, un cepillo. Los materiales serán

adquiridos a través de una combinación de donaciones hechas por las agencias locales de presupuestos

Y adecuado de los recursos económicos. Estamos pidiendo que el hospital facilite recursos a nuestra

disposición, incluyendo los materiales físicos y / o económicos. Cualquiera y todos los recibos que ser

conservado y dado a un hospital a fin de justificar todos los gastos.

El proyecto aumentará la conciencia mediante la visualización lucha contra las drogas y el

sentimiento la violencia a las personas que pasan por allí. Por otra parte, con la participación de los

estudiantes locales, que estarán obligados a reflexionar críticamente sobre este tema tan importante

que reforzará las ideas de un trato justo y la toma de decisiones responsable.

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Calendar

Lunes Martes Miércoles Jueves Viernes

2) Autoestima Reunión con los profesores de teatro Reunión con Estudiantes 12:30 Observar los entrenadores 3pm Reunión con teatro – Lucho Flores 7:30pm

3) Reunión con la Municipalidad con comité de lequiridad Ciudadano – el programa de actividades 3pm

4) Comunicación Asertiva Reunión en la casa de Tania

5) Proteger nuestros hijos 6) violencia intrafamiliar

9) Reunión con Dorilaz en El colegio Centro de Aplicación

10) Reunión con docentes en el Centro de Aplicación 5pm

11) reunión con alumnos 2pm

12) 13)

16) 17) 18) Taller en el ISTE con Jóvenes: Autoestima y control de la Ira

19) 20)

23) 24) 25) 26) 27)

30) 31)

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Reflection Essay

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Zac Tomczyk

August 15, 2012

Final Reflection paper

This trip to Peru has been and experience that has changed me in deep and profound

ways. During my time in Cusco I learned a lot about Andean culture and history, but in

Huamachuco I learned how it continues to affect daily workings of Peruvian life. I have grown

personally and professionally, but I think that my time working in Huamachuco helped build

myself. However, I have to recognize the time spent in Cusco helped us grow together as a

group and develop better Spanish skills. Without the time in Cusco we would not have

functioned as a group and in the strong manner in which we acted.

The trip began rather rough. When we arrived at the hotel in Lima there was extreme

confusion about transportation to the airport the next day. We were unable to get a hold of any

one and both hungry and tired. We were forced to pray for a miracle and accept that there was

nothing that we could do. We were all extremely relieved when the bus arrived the next

morning but we were worried that miscommunication and lack of information would become a

motif for the rest of our time in Peru. For this we were forced to quickly come together as a

group and become more independent in a foreign country. I think this helped us prepare for

the difficulty of Huamachuco.

While in Cusco we were able to experience many culturally enriching events. We of

course visited many ruin sites including Machu Picchu, Pisac, Ollantaytambo, and the potato

national park. While visiting these sites we were able to indulge the tourist side of our program

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while learning more about Andean culture. While we enjoyed the sites and learning about the

land that we were calling home, we often felt overwhelmed by the amount of time these trips

monopolized, especially during the weekends. We did not have many full days to explore and

experience Cusco. Furthermore, the timing for leaving Cusco was unfortunate as we left as Inti

Raymi, the festival of the Sun, a Quechua holiday. According to chronicler Garcilaso de la Vega,

Sapa Inca Pachacuti created the Inti Raymi to celebrate the New Year in the Andes of the

Southern Hemisphere.

However, we were able to attend Corpus Christi and the entrance of the saints. The

entrance of the saints actually dates back to the Inka Empire when they would parade the

Mallqui around the center of the empire (modern day Plaza de Armas). Mallqui or mummies

were often revered after death and were thought to still have great influence on the living.

People would touch the mallqui for luck and blessing. When the Spanish came, they put an end

to this pagan ritual and replaced it with Corpus Christi and the La Entrada de los Santos. During

the Entrada, the saints are paraded through the plaza de Armas and come from all of the

surrounding communities and people still try to touch the saints for blessing. However, they are

not touching the catholic images but rather the Mallquis. When the Spanish outlawed the

parading of the dead, the Quechua put the images of the Saints over top of the mummies, thus,

creating the illusion that they were honoring the catholic saints.

The nest day was Corpus Christi. We met outside a bar and sat then went to the plaza to

watch the procession after mass. They marched the Eucharist around the plaza in this big silver

thing. After the procession Charlotte (Armando’s housemate from France) and I got separated

from the group and went up to the Plaza de San Francisco to try some Chiri Uchu. They called it

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“El festival Gastronómico de Chiriuchu.”Chiriuchu is a tradition dish comprised of many

different kinds of food. It is served cold and contains pork sausage, turkey, cuy, roasted corn

cornels, seaweed, fish eggs, and a “tortilla.” It was kind of tough and gammy and not a lot of

meat but eatable. I had a midsection which threw me. They prepare the cuy by gutting with a

cut down the abdomen and then fill it with herbs. They then roast the hell out of it and serve it

cold. I got a section with lots of herbs in it and at first I thought it was the guinea pig’s last meal.

Honestly, I tried everything on the place, including the fish eggs. Charlotte and I then wandered

back to the plaza de armas to watch the parade of saints…which was very much like the

entrada. I left after about 2 hours of saints. It’s a very slow parade and takes about 5 hours for

15 saints to march around the plaza. I think what I learned most in Cusco was how to be

assertive and more independent when it came to everyday situations and using my Spanish.

My experience in Huamachuco however, was entirely different from anything I had ever

done before. While here I was required and expected to use my Spanish in a way that had

never been required of me before. I was required to be able to critically address health issues in

this poorer region of Peru and collaborate with locals in order to use social capital to better the

community. Partnering with the hospital, Will and I worked on social problems such as

domestic violence and alcoholism. One statistic read that 1 in every 3 women under the age of

16 is a victim of sexual abuse.

While working at the Hospital we realized many projects. We completed 2 sets of

murals, installed a medicinal garden, talked to a local school about bullying, participated in a

presentation to over 300 high school age students about self-esteem and controlling rage, ran a

rehabilitation program for elderly women, and worked with various patients that wanted an

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outside opinion. The murals were, in my opinion the most successful projects. The first mural

set was called proyecto manitos. In this project we painted the children’s area of the hospital

with the hand prints and traditional Peruvian designs (the lines of Nazca and llamas). This

involved the community members to better the waiting area of a previously cold and stale

ambiance. The second mural required the students of Centro de Aplicacción (a local school) to

critically think of an issue that constantly bombards them, drugs and violence. They were

challenged to design a mural to raise awareness on this matter. The winners were two girls in

their first year of secondary. We completed this over the course of the final weekend in

Huamachuco.

This time in Huamachuco has allowed me to see how the other half lives as well as

allowed me to prove to myself that I can function within a Spanish speaking culture and

contribute positively. Overall I am thankful for this program but it does have some kinks that

need to be worked out like communication, better organization regarding expectations, and

better communication with host organizations in facilitating work for the students.

sources

"ISS 330C." Cusco, Peru. 28 May 2012. Lecture.

Provincial Municipality of Huamachuco

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Research Essay

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AN INTRODUCTORY

SURVEY OF

DISEASES

CONTRACTED BY

INFORMAL MINERS

IN HUAMACHUCO

PERU

In Peru mining is divided into two distinct sectors: formal and informal. Formal

mining, or legal mining, companies are required to follow certain mandates to

protect the environment and the health of the miners. Informal mining is the direct

opposite to formal mining. Informal mines do not follow government regulation and

therefore the health of the miners is often compromised in order to maximize

profits. Furthermore, since the informal mines go unregulated, there is often a lack

of information on the health statuses of the people that work and live in and

around the mines. This study solely looks at informal gold miners of El Toro-Cerro of

Huamachuco, Perú and the health concerns they have. This is an informative cohort

study to identify diseases and health issues that have been previously unaddressed

by the local health cooperatives. Interviews were conducted to identify symptoms

and with the help of local health professionals diagnosis were theorized, but not

confirmed through clinical testing (i.e. radiographs, blood testing, pulmonary

testing, nor sputum testing). However, after the interviews were conducted the

symptoms were reviewed by a licensed practicing doctor and diagnoses were

assigned.

A summary of

work in Peru

Michigan State University

Hospital Leoncio Prado

2012

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An introductory survey of disease contracted by informal miners in

Huamachuco, Peru

Abstract

In Peru mining is divided into two distinct sectors: formal and informal. Formal mining,

or legal mining, companies are required to follow certain mandates to protect the environment

and the health of the miners. Informal mining is the direct opposite to formal mining. Informal

mines do not follow government regulation and therefore the health of the miners is often

compromised in order to maximize profits. Furthermore, since the informal mines go

unregulated, there is often a lack of information on the health statuses of the people that work

and live in and around the mines. This study solely looks at informal gold miners of El Toro-

Cerro of Huamachuco, Perú and the health concerns they have. This is an informative cohort

study to identify diseases and health issues that have been previously unaddressed by the local

health cooperatives. Interviews were conducted to identify symptoms and with the help of

local health professionals diagnosis were theorized, but not confirmed through clinical testing

(i.e. radiographs, blood testing, pulmonary testing, nor sputum testing). However, after the

interviews were conducted the symptoms were reviewed by a licensed practicing doctor and

diagnoses were assigned.

Acknowledgement

Special thanks to the Rotary Club of Huamachuco, Peru and its president Sr. Luis

Carnaval Chavez whose continuing support and willingness to share local resources made my

project in Peru a truly successful endeavor. Also thanks to Rocio Padilla Agreda of the

Huamachuco Chapter of the Rotary Club who facilitated the interviews with the miners and

9

provided pivotal contacts within the community and her mother Justina Agreda Campos

without whom the interviews would not have been possible. I would also like to extend

gratitude to Michigan State University and the many professors who have guided me in my

educational journey and facilitated my personal growth. Finally, I would like to express my

appreciation to the staff at Hospital Leoncio Prado who aided me in every way possible to

further my knowledge on this subject.

Introduction

Based on initial research, gold miners have higher rates of uPPEr respiratory disease

including bronchitis, pulmonary tuberculosis (PTB), asthma, fibrosis, and silicosis. Additionally,

hearing loss, cancer of the trachea, bronchus, lung, stomach, and liver, and illnesses related to

mercury and heavy metal exposure are also common as well as pleural diseases (Eisler, 2003).

Based on initial interviews with the epidemiologists at Hospital Leoncio Prado, there exists a

gap in knowledge. The aforementioned diseases are common in formal mining where safety

regulations are (ideally) enforced but few, if any, studies have been done to look at informal

mining and no epidemiological information exists in the records of the hospital in Huamachuco,

Peru on the current health conditions of those living in and around the informal gold mine of El

Toro-Cerro.

Data was collected through interviews with miners. During these interviews participants

were asked about their employment history in order to learn about their potential exposure to

mining chemicals and if they have had prolonged experience with such chemicals and mining

practices. Men who have worked in mining for a longer time are hypothesized to have more

10

cases of exposure related illnesses. The interviews were conducted at the participant’s

convenience during the afternoon and evening of 14 July 2012. For comprehension purposes all

interviews were recorded. Participants’ identities were protected through omission of last

names and identifying details. They were made aware of this before any interviewing. Fifteen

successful interviews were completed. Participants were compensated for their interviews with

personal protective equipment.

Background

In Peru, the mining sector accounts for 50% of the country’s annual export earnings.

During 1993, the mining industry’s contribution to the Peruvian economy was 21% represented

by $240 million paid in taxes; $400 million spent on local purchases; $280 million in imported

goods and accounted for over 11% of GDP (Acheampong, 2003 cited in Yeboah 2008).

However, this report only takes into account the formal sector of mining and the direct effects

it has on the national economy; the informal sector plays a smaller part and the effects are

more strongly felt on the local scale. While mining practices play an intricate role in the

economic development of a nation (namely Peru), the environmental toll and effects on health

conditions must be weighed. The research presented in this paper explores the health effects

on those with the most uncensored exposure to mining agents, the informal miners.

During the process of extraction and purification of gold ore the miners are exposed to

heavy metals, toxic chemicals, dangerous work conditions, and destructive forces. The mines of

El Toro- Cerro employ a process of drill mining in which the miners penetrate the earth.

Underground mining is done when the rocks, minerals, or in the case of El Toro, gold, are too

11

far underground to get out with surface mining. Shaft mining is one technique that is common

in South America, namely in Chile, where a vertical shaft is drilled for miners to enter the

mountain. A network a tunnels is then drilled inside the mountain. The dirt of El Toro is broken

up by pickaxe and excavated by hand.

In the case of informal mining, the miners often do not have access to or choose not to

use protective equipment and with high decibel levels associated with explosions in closed

areas, hearing damage is inevitable. A 2002 study showed that 23% of surface miners in Ghana

showed classic signs of noise induced hearing loss (NIHS) (n=252). Furthermore, the research

showed a direct correlation between length of employment and hearing loss in an environment

with noise levels of ranging from 82-98 dBA (Amedofu, 2002).

During the mining extraction and refinement process miners are exposed to a plethora

of harmful agents such as cyanide, hydrogen sulfide, mercury, and silica dust. Cyanide is also

found during the mining extraction process and produces a distinct odor. Prolonged exposure

to these agents leads to a multitude of health concerns. For example, extended exposure to

silica can lead to cases of silicosis in which the bronchioles become hard and may lead to

pulmonary tuberculosis (PTB). Additionally, “a recent study reports an estimated LC(50) in

humans of 3,404 ppm for a 1-minute exposure; other sources report that 270 ppm is fatal after

6 to 8 minutes, 181 ppm after 10 minutes and 135 ppm after 30 minutes” (Hathaway et al.

1991 quoted by OSHA). A correlation was found between silicosis and comorbidity with PTB in a

study of black South African miners (Eva Hnizdo, Jill Murray 1998).

12

PTB is one of the largest concerns in surface and underground mining as its contagious

nature can infect large masses of people especially when in confined areas such as a mining

shaft. It can present with a number of symptoms that can be easily confused with other

diseases or respiratory infections. The primary indicators are a cough that has lasted more than

15 days which contains more mucus and/or blood, fatigue, night sweats, fever, and/or

unintentional weight loss. There was also a significant association between TB and the miner’s

roll in the operations. Positions that have more contact with dust particles and are in more

confined areas tend to have higher rates of PTB (Kleinschmidt and Churchyard 1997). These

positions include Capacheros and picadores. Capacheros are responsible for hauling the earth

out of the mine while picadores, or face miners, break apart the earth and advance the mining

shaft.

Other diseases of interest include uPPEr respiratory infections, asthma and COPD,

fibrosis, silicosis, and bronchitis. These diseases present with a range of symptoms including dry

cough, shortness of breath, rapid breathing (tachypnea), loss of aPPEtite, and chest pains. In

the case of silicosis, gradual dark shallow rifts in nails aPPEar that eventually lead to cracks as

protein fibers within nail beds are destroyed and blue skin (cyanosis).

We visited the community of Shiramaca located on the outskirts of Huamachuco proper

with a population of 1081 (Census 2009). Shiramaca provides home to many of the informal

miners and two processing houses. It has small general stores, like the one owned by Justina

Agreda Campos, a kindergarten (Jardin), and adobe houses. There is power and running non-

13

potable water; 9% of the population is without running water (Census 2009). There is a small

river on that runs near this community called El Rio Toro. Fifty-one percent of the population

lives without electricity and 43% of the women are illiterate (Census 2009). Shiracmaca is

located 3.5 kilometers from the city of Huamachuco, region La Libertad, Peru, has an area of

178 hectares, is an agricultural area, and its soil is sandy and a minimum depth of 1.50m,

climate cold and rainy. It is 3,216 feet above sea level approximately. Now it is affected by

environmental pollution as a result of the exploitation of Cerro "El Toro" (Ishikane Jiménez

2006).

El Cerro "El Toro" is located a few meters from Shiracmaca, opposite the city of

Huamachuco, where the informal gold exploitation is realized. This affects all people living in

the area below the hill. The Shiracmaca area has seen a shift which occurred in March of 2006

following the removal of soil from excavation by artisanal miners and began slipping from the

top of the hill "El Toro." The community of Shiracmaca is in constant danger of natural disasters

like landslides. Landslides in this region have been known to destroy developed areas, kill and

maim people without discretion, and trap miners still in the mines. The risk of this has grown

since 1995 with the beginning of informal mining and the constant destruction of natural

vegetation. As the progression of mining operations continues the community is in ever

increasing danger of landslides and flashfloods (Ishikane Jiménez 2006).

A study conducted in 2011 by the provincial municipality of Sanchez Carrion looked at

the high incidence of parasitic diseases and diarrhea in the El Toro population. Initial reports

14

showed an incidence rate of 4.58% in 2007 and 4.53% in 2008 of parasitoids and 3.02% in 2007

and 3.65% in 2008 of gastroenteritis diarrhea (PS de Salud de Huamachuco cited in ESTUDIO A

NIVEL DE PERFIL). These ailments were related to the consumption of non-potable water, air

contamination, and poor hygiene habits of the inhabitants. The study is summarized by figure

1.

15

INDIRECT CAUSE:

Lack of knowledge of

sanitation and of

operation and

maintenance in the

population

Figure 1.

Tree of Cause and Effect

Direct Effect:

The increasing cases of

malnutrition.

INDIRECT EFFECT

The rise in the cost of

attention in health of the

populations

Direct Effect:

Increase of environmental

pollution

Central Problem:

High incidence of parasitic illnesses and diarrhea in the Population of El Toro

DIRECT CAUSE:

Consumption of non-treated water.

DIRECT CAUSE:

Poor hygiene habits

by inhabitance .

DIRECT CAUSE:

Disposal of excretions

into the air

INDIRECT

CAUSE:

Inadequate

disinfection of

water.

INDIRECT

CAUSE:

Existence of

infrastructure of

the system of

contaminated

water

Final Effect:

The deterioration of the quality of life for the population of El Toro

Direct Effect: Increased mortality

rates

INDIRECT CAUSE:

Nonexistence of

adequate

infrastructure for

the evacuation of

excrement

Direct Effect: Increase of student absences

(truancy).

16

Source: Provincial Municipality of Sánchez Carrion

Materials/methods

Interviews were conducted at the El Toro-Cerro mine and community of Shiracmaca.

The interviews were recorded using a handheld voice recorder. The audio files were then

uploaded and played back using Audacity. The interviews were then transcribed and can be

found in APPEndix A.2. A total of 16 interviews were conducted and transcribed, but only 15

interviews were conducted properly attaining viable information.. APPEndix A.1 contains a

blank interview form, but the interviews were conducted orally. The miners that participated

were given soda to break the ice and upon the completion of a successful interview they were

compensated with either a hard hat or a pair of leather work gloves and a dust mask or a set of

3M© ear plugs. Upon a successful interview the participant was given a ticket. With this ticket

they were able to go to the store of Sra. Justina Agreda Campos and claim their compensation.

We interviewed 1 administrator, 4 chancadors who crush rocks, 4 capacheros who

excavate the dirt from inside the mine, 3 cargador who transport the ore rich dirt outside the

mine, 1 picador who works inside the mine advances the mine shaft, 1 maquinista who runs the

machinery used in crushing and sorting dirt, and 1 miner interviewed who worked both as a

chancador and a capachero.

All the miners were males ranging from 15 to 60 years of age with a mean age of 26.

Collectively they have 87.54 years of work experience. The most experienced member has

worked in mining for more than 16 years and the least experienced miner has approximately 2

17

weeks experience as a “formal” informal miner. The average number of years working in the

mine is 5.47 years.

The majority of the informal miners contested issues of difficulty breathing and uPPEr

respiratory problems. In the following section each of the 15 successful interviews are broken

down by job, age, years working in the mines, symptoms, and potential diagnosis. The names

have been omitted to protect the identities of the participants and instead they are assigned

numbers. The miners interviewed came from various communities including Shiracmaca,

Sashacota, Yagón, and Tayabamba. They represent many roles in the mine both inside and

outside of the mining shaft. 5 out of15 worked inside the mine, 9 out of15 worked outside the

mine, and 1 out of the15 worked both inside and out.

Results

Previous work experience was taken into account as this could lead to confounding

variables with relation to exposure to harmful agents. 13% of the miners reported working

previously in other informal mines. 6% reported to working in engineering. The largest cohort ,

40%, previously worked in agriculture, but their roles varied from caring for animals to

cultivating and harvesting crops. On these farms it is possible they were exposed to fertilizers,

pesticides, fungicides, or other harmful chemicals. These were not accounted for in this study.

Thirteen-percent of the participants reported working in construction, 20% were previously

high school students, and 6% chose not to respond. When asked about personal protective

equipment (PPE) 74% of the participants reported having access to PPE and 47% reported using

it. Of the 47% that reported using PPE 33% have access to boots, 20% to respirators, 6% to

18

gloves, 33% to hardhats, and 13% to head lamps. A third (34%) reported not using the PPEand

were miners that worked outside the mine. Twenty-percent reported having access to PPE but

did not specify the type of PPE used or the frequency with which it was utilized.

Forty-six percent of the participants reported strong coughs that lasted longer than two

weeks, with one participant (6%) reporting strong coughing fits that would last 3-4 days. Of the

7 participants that reported strong coughs, 4 (57%) stated their coughs were dry coughs, most

commonly caused by the abundant dust present in the mine, while 43% reported “wet” coughs

with the presence of mucus. Mucus color was also reported; they included green, yellow, and

white.

When asked about nocturnal sweating 26% responded in the affirmative, reporting

occasional night sweats while 66% responded by denying sweating during times of rest while

6% did not respond. Additionally, 74% of participants reported weight loss. The average weight

loss was 2.1 Kg (~4.6lbs) with a maximum of 5Kg (~11lbs) and a minimum of 2Kg (~4.4 lbs).

However, without clinical testing it is difficult to determine if these are consequent of chemical

exposure or a result of difficult manual labor. Fatigue was also examined as participants were

asked if they felt tired after a good night’s sleep (more than 6 hours), 80% reported feeling

tired. When asked about respiratory issues, 46% of participants responded by stating they did

have difficulty breathing or experienced loss of breath during normal activities such as walking

or eating. 40% reported that their difficulty breathing prevented them from working on

19

occasion. This was classified as dyspnea. None of the miners reported smoking, but one did

mention that his father smoked in the house and he was exposed to second hand smoke.

Further medical histories were taken and 7 (46%) reported visiting the hospital in the

last year for the following reasons: respiratory problems (2), flu (1), injury (1), and unspecified

(3). Only 1 participant reported abnormal urine stating it was dark yellow in color. However,

20% reported diarrhea. Cyanide, being present in the mines was also a concern of this

investigation and 40% of workers reported having direct contact with cyanide. Only 2

participants reported having all the classic symptoms of acute cyanide poisoning (headache,

dizziness, nausea, and anxiety). Two participants (14%) reported skin irritations and 8 showed

deep cracks and discoloring of fingernails.

The following is a list of possible diagnosis broken down by participant:

Participant 1

- Respiratory infection - Chronic Cough

Participant 2

- Acute Cyanide toxicity

Participant 3

- Obstructive respiratory/pulmonary disease

- Acute cyanide toxicity

Participant 4

- Pneumonia - Chronic Cough - Early onset of silicosis

Participant 5

- Tracheolaryngitis

Participant 6

- Common cold - Stress headaches - Gastritis

Participant 7

- Pulmonary Tuberculosis - Bronchitis - Acute Diarrhea

Participant 8

- Malnutrition - Dermatitis - Acute Bronchitis

1

- Cyanide toxicity

Participant 9

- Bronchitis - Pulmonary Tuberculosis - Malnutrition

Participant 10

- Pharyngitis - Pneumonia

Participant 11

- Malnutrition

Participant 12

- Cyanide poisoning

Participant 13

- Malnutrition causing anemia

Participant 14

- Pharyngitis - Acute diarrhea

Participant 15

- Bronchitis - Abdominal infection

2

The distribution of potential diagnoses is shown in figure 2. The chart shows that bronchitis is

the most common potential diagnosis for this cohort.

Figure 2

Participant #1

Male, 26 years of age and is an administrator in one of the sites. He has worked for the

mine for 16.5 years and had previously worked in another mine. He presented with a cough

that had lasted more than two weeks with green mucus. He suffers from night sweats and

involuntary loss of weight (approximately 2 kg). He also has fatigue, dyspnea, has had the flu in

the last year, and has visited the hospital previously for respiratory problems. He has recently

had diarrhea and direct contact with cyanide, but does not present with any of the classic

symptoms of acute or chronic cyanide toxicity. His fingernails were cracked. Possible diagnoses

include a respiratory infection and a chronic cough.

0

1

2

3

4

5

6

7

nu

mb

er

of

case

s

Diagnoses

Blue: General Ailments Orange: Respiratory Infections Red: Nutritional/intestinal diseases Green: Throat Problems

3

Participant #2

Male, 33 years of age and works both inside the mine (capachero) and outside the mine

(chancador). He previously worked as an engineer, but has worked in El Toro for 12 years. He

has had a dry cough that persists for 3-4 days, suffers night sweats, lost approximately 5kg in

the last year, suffers from fatigue, and has had chronic sinus infections. In the last year he has

missed work (S/.30 or $15) due to respire tory problems. He does not smoke and has no close

contact with TB. In the last year he visited the hospital for flu-like symptoms and works directly

with cyanide. He shows classic signs of acute cyanide poisoning (headache, dizziness while

working, nauseam, anxiety and skin irritation). Therefore, the most probably diagnoses is acute

cyanide toxicity.

Participant #3

Male, 60 years of age working as a Capachero (inside the mine) with 11 years of work

experience and previous experience in agriculture. He reports using personal protective

equipment, but did not specify what he specifically uses. He is relatively healthy, but reports

fatigue, having missed work due to difficulty breathing, headaches, and cracked fingernails. A

diagnosis for him could include obstructive respiratory or pulmonary disease or acute cyanide

poisoning.

Participant #4

4

Male, 48 years of age, working as a cargador (moving dirt outside the mine) for 10

years. Before becoming a cargador he worked as a capachero inside the mine for many years.

He does not have access to PPE and states that only the people working inside the mine have

access to this type of equipment. He reported a dry cough that has lasted more than 2 weeks

and a weight loss of 4 Kg. He has also had loss of breath, fatigue, the flu, and has missed work

in the last year due to difficulty breathing. However, he did mention that he has had close

contact with someone with a confirmed diagnosis of pulmonary TB. He has visited the hospital

in the last year for respiratory problems. Based on these symptoms his potential diagnoses are

pneumonia, chronic cough, or early onset of silicosis.

Participant #5

Participant 5 is an adult male (23 years of age) and works inside the mine as a

capachero. He has worked in the current site for 5 years and was previously a high school

student. He reports using a hard hat, but nothing else as far as PPE. His symptoms are indicative

of Tracheolaryngitis. These symptoms include a persistent dry cough, night sweats,

unintentional weight loss (5kg), sinus infection or the flu, chest pains, dyspnea, headaches, and

a bloody nose.

Participant #6

The sixth interview conducted was with a 22 male that has worked as a chancador

outside of the mine for 5 years. He previously worked in agriculture and has access to PPE. In

5

the last year he reported flu, chest pain, common headaches, dizziness, nausea, and anxiety

while working. The possible diagnoses include common cold, stress headache, gastritis.

Participant #7

Participant 7 is a 21 year old capachero with 5 years of experience in the mine and

previous experience in construction in Trujillo. He reports using a hardhat and lamp while

working in the mine, but nothing to protect from dust. He reported a wet cough that has lasted

for a month with yellow mucus. Furthermore, he reported night sweats, a loss of 3 Kg, frequent

flus, chest pains, dark yellow urine, and diarrhea, a headache that has lasted 2 days, a bloody

nose, skin irritation, and cracked nails. He has also visited the hospital in the last year for flu-

like symptoms. Based on these symptoms, it is possible that he has pulmonary TB, bronchitis,

or acute diarrhea.

Participant #8

Participant 8 was a 19 year old male who works inside the mine as a Picador (face-

miner) with previous experience in construction. He reports using protective boots, a hardhat,

and a respirator. His weight loss of 2 Kg is within the normal range expected, but shows fatigue,

loss of breath, and chest pains. He presented no signs of cyanide toxicity, but did note a skin

irritation. These symptoms could be indicative of malnutrition, dermatitis and/or acute

bronchitis.

Participant #9

6

Participant 9 was a 32 year old male who works as a chancador outside of the mine. He

has 4 years of experience in the mine and does have access to PPE. He chose not to divulge his

previous work history nor what pieces of PPE he uses. He reported a dry cough that has lasted

more than 2 weeks. He reported weight loss of 3.25 Kg, feeling fatigued, and dyspnea that has

not made him miss work. Possible diagnoses for him include bronchitis, pulmonary TB, and/or

malnutrition.

Participant #10

Participant 10 was a 23 year old capachero with 4 years of experience and previously

worked in agriculture. He reported using a hardhat and boots. He also reported having a mucus

producing cough that lasted more than 2 weeks (green mucus). His weight loss equals 3 Kg and

has dyspnea and chest pains that do not resolve with simple treatments. While he says that he

does not work directly with cyanide it is present in the site and he suffers from headaches,

dizziness, nausea, and anxiety. He also mentioned that he gets frequent nose bleeds and a sore

throat. Possible diagnoses include pharyngitis and pneumonia.

Participant #11

Participant 11 was an 18 year old male with four years of experience working as a

cargador outside the mine shaft. He previously worked in agriculture. He reported having

access to PPE but not using it. He was a relatively healthy person except for reporting weight

loss. This can be attributed to a number of things but based on local demographics it is

probable that he is suffering from malnutrition.

7

Participant #12

Participant 12 is the youngest member of this cohort. He is 15 years old working as a

chancador. He has two official weeks as a formal informal miner, meaning he has only officially

worked in the mine as a paid member for 2 weeks, but he did report that he has worked in an

unofficial capacity with his father (another miner) for a few years. The participant was

previously a student at a local school where he did not complete the standard curriculum. He

reported fatigue, dyspnea, and flu like symptoms. While he does not smoke, he did say that his

father smokes in the house where he is exposed to the harmful chemicals second hand. When

asked about his health while working, he stated that he does not have direct contact with

cyanide, but it is present in the mine. Furthermore, he admitted to having vomited while

working as well as having a bloody nose which he attributes to the dry conditions and dust, sore

throat, and stomach pains. Based on this information the probable conclusion is bronchitis or

an abdominal infection (i.e. digestive track related illnesses).

Participant #13

This participant was an 18 year old male working as a chancador with 1 year experience.

He was previously a student at a local school. During the interview he mentioned having a

strong cough that had lasted more than 15 days, weight loss, diarrhea, and showed cracks and

yellowing of the finger nails and cuticles. It is probable that he is afflicted with pharyngitis

and/or acute diarrhea.

Participant #14

8

This participant was a 23 year old cargador (male) with 3 years’ experience and previous

work history in agriculture. This participant said that he has direct contact with cyanide and

experiences fatigue and loss of breath (to the point it affects his ability to work). For these

symptoms, it is reasonable to say that he could be suffering from acute cyanide toxicity.

Participant #15

Participant 15 was a 21 year old machine operator with 1 year experience. He previously

worked in agriculture. He works outside of the mine shaft and reported using a hard hat, boots,

and a light (for when he works at night). He was a rather thin man who reported losing weight

in the last year, feeling fatigued, and missing work from dyspnea. It is possible that he is

afflicted by anemia caused by malnutrition.

When the distribution of respiratory diseases is looked at we find that respiratory

diseases are more common in participants that have worked in the mine for a few years as

shown in figure 3. The highest rates of respiratory disease are at 5 years of experience with a

negative trend as the participants gain more experience in the mine. Potential explanations for

this are explored in the discussion section.

9

Figure 3:

When distribution is broken down by where the participants work, the data shows that

the group with the highest rates of URI’s are the participants that work outside the mine, as

show in figure 4.

Figure 4:

0

0.5

1

1.5

2

2.5

0 5 10 15 20

Nu

mb

er

of

Cas

es

of

Re

spir

ato

ry

dis

eas

es

Number of Years working in the Mine

3 3

6

4

0

1

2

3

4

5

6

7

Inside with URI Inside without URI Outside with URI Outside withoutURI

Distribution of UPPEr Respiratory Infections (URI)

10

Although it was not the primary focus of this study, participants were also asked about

the preference for seeking health care and what if any personal protection equipment they

have access to. We found that the minority of participants responded that they would go to the

hospital when they were sick, but would first visit a botica. The data is shown in figure 5.

Figure 5

The PPE data suggests that the participants favor boots which protect from some

damages, but the most useful pieces of PPE are being ignored (respirator and gloves). However,

hardhats were frequently mentioned as being readily utilized, but ear plugs were not

mentioned and hearing loss was not noted. The PPE data is shown in figure 6. Three

participants did not report what PPE they used, but did say that they did in fact use some sort

of protective equipment.

5

6

4

2

0

1

2

3

4

5

6

7

Clinic Botica Hospital Pharmacy

Care Preferences

11

Figure 6:

Discussion

There are many aspects that could have affected the data and the results of this study.

When discussing respiratory disease, it is shown that the participants that worked outside the

mine had higher rates of URI. This could be the result of many things. The first and most

prevalent is the use of PPE. It was reported that 6 out of10 of the participants that worked

outside of the mine had some form of URI, but none of them reported using respirators. It is

thought that the excessive amounts of loose dust could be a contributing factor to this. Since

these workers do not enter the mine there is an assumption that they do not need PPE.

However, they are possibly the population that needs masks the most. Dust entering the lungs

can cause irritation and illness, especially with chronic exposure.

The miners that work outside of the mine shaft also have an average age of 24.8 years

while the participants that work inside the mine have an average age of 29.8 years. Age could

3

1

5

2

5

3

0

1

2

3

4

5

6

Respirator Gloves Hardhat Light None N/a

Personal Protective Equipment Used

12

be a contributing factor but the relationship between URI and age was not explored in this

study.

Another problem we faced in data collection was a stranger bias. Since the investigators

collecting the data were not local and unknown to the participants there is a possibility that

there was significant stress or a general mistrust which would have changed results and the

symptoms that were reported. When the investigators entered the mine they were

accompanied by community members in order to combat this source of bias, but it is possible

that stranger bias was still a problem. For example, none of the participants that reported

seeking brujeria (the use of witchcraft) as a form of treatment although we know that there

was a brujo (healer) present in the mining community and that people do seek their help. It is

our opinion that this number was under reported because we were not trusted members of the

community.

Another area that we challenging was that a total of 16 interviews were conducted but

only 15 were used. One interview had to be thrown out because it the investigator took

liberties with the interview that he was not given. The interview form was not followed and the

majority of the information needed was not collected. This investigator did the same with

participant 11 and 14 but the information collected was able to be salvaged, but it should be

noted that the diagnosis for participant 11 and 14 are based on incomplete data.

In some cases severe and rapid weight loss, sometimes called wasting, can be indicative

of chronic cyanide exposure. This study showed that the majority of participants had lost

13

weight in the past year while working at the mine. However, it had to be ruled an unreliable

contributor due to not knowing how quickly they lost weight and the fact that mining is hard

manual labor and weight loss is normal with physical activity.

Another contributing factor is the lack of insurance in the informal sector. Because these

people work in an informal sector health insurance is not offered; the people of Shiracmaca

cannot afford healthcare. This causes simple illnesses to grow into much more serious

problems.

When asked about preference in health care only 4 of the 15 interviewed stated they

would go to the hospital. This could be for many reasons. The first is that the hospital is located

15 minutes away from the mining community and visiting the hospital would mean missing a

day’s pay. This could be exacerbated by mistrust in modern medicine. Based on discussions

with local community members, it is justified to say that the people still have a great

connection to the earth and have more confidence in natural cures and magic.

The final point that is worth discussing is the miners’ ages and work schedules. We

noted that there was a large amount of adolescents working in the mine shafts or in the

surrounding areas. It was mentioned to us by a community member that it is very common for

a person to start working in the mine as early as 13 years of age. This is because the young

people have an easier time fitting into the mines as they tend to be shorter than the adult

males that work in the same mines. This, however, can severely impact development and

14

normal growth. This should be investigated more to discover the long term effects of child

workers in the informal mining sector.

Finally, it is worth noting that 80% of the workers reported feeling fatigued during the

day. This can be caused by many pathogens but can also be caused by lack of sleep. In the

informal mines, there is always a person on site 24 hours a day, 7 days a week. This person is

charged with protecting ore rich carbon and the mining site. They do not sleep during the night

and the next day work a full shift. These long hours can cause fatigue as well as other problems,

especially in a young population of adolescent miners who are still physically developing.

Recommendations for health professions

As of current, the only health services being offered in Shiracmaca are to pregnant

women and early life care for infants with the assumption that the rest of the community is

close enough to be able to travel to Huamachuco for medical attention. However, as the data

shows, the miners, a population at high risk for sickness, is not seeking out medical care at the

hospital. The first recommendation would be to expand medical services offered in the

community of Shiracmaca. If the miners are not going to seek out medical attention, as

healthcare providers we have a moral responsibility to bring the services to them as they do in

the communities of Cashuto and Sanagodón. As members of the community, these people

need to have access to healthcare just as members of the formal working class do. The fact is

that these citizens are at more of a disadvantage working in the informal sector because they

have higher exposure to illness causing agents and lack the health insurance they need to seek

proper medical treatment. Respiratory screening needs to be conducted at least once a year to

15

measure the prevalence of transmissible diseases such as pulmonary TB and acute viral

bronchitis. Urine testing should also be used for measuring levels of cyanide to assess the risk

of cyanide poisoning.

The second recommendation concerns general sanitation conditions on the

hospitalization areas of Leoncio Prado Hospital. After following many nurses and doctors

through rounds it was noted that medical professionals rarely use standard sanitation practice.

One practice that needs to be implemented is very basic, hand washing. It was noted that the

clinical staff only occasionally wash their hands before beginning rounds and never wash their

hands between patients. This is a simple and easy way to prevent the transmission of disease

between patients especially when the majority of patients hospitalized are elderly and

immunocompromised. A patient should not be afraid to go to the hospital because they are

worried about getting sicker. This would also require installing soap in the patient rooms. A

better option would be the instillation of hand sanitizer in every room. This would prevent the

cross transmission of disease from patient to healthcare provider to patient as well as from

family members to the patient. This should be complimented by the use of personal protection

equipment including rubber gloves that get changed between patients. This is especially

important with the patients in isolation. Patients are put in isolation for a reason; they have

transmissible diseases that can readily spread. Extra precautions need to be taken including the

use of protective masks, gloves, and disposable gowns which need to be worn and changed

before working with patients in the general population.

16

Recommendation for further studies

This study solely focused on miners with direct contact to risk factors such as chemical

exposure, silica dust, poor sanitation, and hazardous environments, but does not look at

secondary effects of gold mining in this area. Areas that are still to be researched include

environmental effects. Mining in general has devastating effects on the immediate

environment which include soil erosion, destruction of local environment, and pollution of local

water sheds. While these effects are severe in formal mines it can be hypothesized that they

are more exaggerated in an area less regulated.

Secondary exposure could also be looked at. We know that miners with primary

exposure to disease causing agents have higher rates of many diseases. Efforts are being made

to help the miners, but what about the families? Often the families are at risk levels similar to

the miners for illnesses related to chemical exposure. The men who work in the mines collect

chemicals on their clothes and when they return home the other family members become

exposed to these same chemicals; transferred via clothing. The women who wash the clothes

could be compared to domestic workers in the formal sector; women who do not wash clothes

potentially coated in harmful chemicals. It could be hypothesized that the women who washed

contaminated clothes have higher rates of diseases of exposure.

To address the sanitation issue, a study should be conducted to look at the cross

transmission of disease caused by lack of sanitary conditions in the in patients of Hospital

Leoncio Prado. Patients could be assessed and given an initial diagnosis and followed for the

duration of their stay. New symptoms should be noted and classified as related to the initial

17

diagnosis or indicative of a new illness. The duration of their stay could then be compared to

the average stay of in-patients in the national hospitals in Lima and the leading hospitals in the

United States.

Conclusion

In conclusion, it is shown that the most common types of diseases faced by the informal

miners of El Toro are respiratory diseases and diseases related to malnutrition and the

respiratory system. The respiratory diseases could be caused by any number of agents, but the

most probably include the abundant amount of loose dust outside the mine shafts and also the

lack of proper ventilation within the mine shafts. The high number of chronic disease in

combination with frequent tunnel collapses and natural disasters, the mortality rate in this

mining community are uncommonly high, especially in men aged 18-45. The specific numbers

should be investigated on a larger scale. For these reasons, I have recommended the increase

of health services offered in Shiracmaca with focus on occupational health services to cater to

the mining population.

18

Appendix:

A.1

1. Nombre:

2. Edad:

3. Papel en la mina:

4. ¿Por cuantos años ha trabajado usted para la mina?

a. ¿Qué tipo de trabaja tenia antes de la mina?

5. ¿Tiene acceso a equipos de protección personal?

a. ¿Utiliza a equipos de protección personal?

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas?

a. ¿Cómo fue el tos? (seco, con sangre, mojado)

b. ¿Se tiene una tos con moco?

i. ¿De qué color era el moco?

7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos)

8. ¿Ha perdido peso de manera involuntaria?

a. ¿Cuantos kilos?

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño?

a. ¿con qué frecuencia te sientes cansado después de una buena noche de sueño?

10. ¿pierde su alimento fácilmente mientras está haciendo trabaja normal?

11. ¿Ha tenido una nariz que moquea, en combinación con un dolor de garganta, y / o falta

de aliento?

12. ¿Se trabaja directamente con el polvo de sílice?

13. ¿En el último año ha experimentado dolor en el pecho que no se resuelven con

tratamientos simples?

14. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar?

a. ¿Puede describir cualquier otro síntoma que haya tenido durante este tiempo?

15. ¿Fuma?

a. ¿Cuántos cigarrillos fumas cada día?

b. ¿Cuándo empezaste fumar?

16. ¿Alguien en su casa o familia inmediatamente ha recibido un diagnostico de

tuberculosis?

17. ¿En el último año ha visitado a un hospital para una infección del sistema respiratorio

superior?

a. ¿Qué hospital?

b. ¿Podría darme el permiso tener acceso a su historia medical?

18. ¿Qué son las preocupaciones de salud que tiene usted?

19. ¿Qué color es su orina?

19

20. ¿Cuántos tiempos en la última semana ha realizado diarrea?

21. ¿trabaja con cianuro?

a. Mientras está trabajando con cianuro ¿siente dolor de la cabeza, vértigo, fatiga,

náusea, o ansioso?

b. Mientras trabajando ¿ha vomitado, empezado de sangrar de la nariz, tenido

dolor de la garganta, dolor del estomago,

c. Desde empezar de trabajar acá (en El Toro) ¿ha notado una erupción de la piel,

un cambio en el color de la piel (rojo), una sensibilidad a la toca?

i. Si la respuesta es “Sí” ¿podría ver las áreas afecta

A.2

1. Nombre: Román

2. Edad: 22

3. Papel en la mina: Chancador y adentro sacar capacho

4. ¿Por cuantos años ha trabajado usted para la mina? 5 años

a. ¿Qué tipo de trabaja tenia antes de la mina? Trabajaba en una chacra

b. Es de Sashacota

5. ¿Tiene acceso a equipos de protección personal? Sí

a. ¿Utiliza a equipos de protección personal? Sí

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? No




7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) no

8. ¿Ha perdido peso de manera involuntaria? No

a. ¿Cuantos kilos?

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? No


A veces

10. ¿pierde su alimento fácilmente mientras está haciendo trabaja normal? no


de aliento? Sí


tratamientos simples? sí

13. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? No


14. ¿Fuma? No


20



tuberculosis? No

16. ¿En el último año ha visitado a un hospital para cualquier razón? No

a. ¿Qué hospital?


17. ¿Qué color es su orina? Claro/amarillo

18. ¿Cuántos tiempos en la última semana ha realizado diarrea? No

19. ¿trabaja con cianuro? No directamente


náusea, o ansioso? Sí, todo


dolor de la garganta, dolor del estomago? No


un cambio en el color de la piel (rojo), una sensibilidad a la toca? No.

i. Si la respuesta es “Sí” ¿podría ver las áreas afectadas?

20. Si estuviera enfermo ¿Qué haría?

a. Visita a un Botica

21. En último año ¿ha visitado a un brujo? No.

1. Nombre: Niven

2. Edad: 15

3. Papel en la mina: chancador Trabaja fuera de la mina

4. ¿Por cuantos años ha trabajado usted para la mina? 2 Semanas

a. ¿Qué tipo de trabaja tenia antes de la mina? Estudiante

5. ¿Tiene acceso a equipos de protección personal? No

a. ¿Utiliza a equipos de protección personal? n/a

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? No.




7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) No.


a. ¿Cuantos kilos?

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? Sí, pero

trabaja con su padre en las noches. Su papa cuida.


10. ¿pierde su alimento fácilmente mientras está haciendo trabaja normal? Sí

21


de aliento? Sí.


tratamientos simples? No.

13. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? No. Un

enfermedad antes de trabajar Sí.

14. ¿Fuma? No pero su papá sí




tuberculosis? No.


superior? Sí en Pataz para dolor de la garganta y dolor de la cabeza. él es de Tayabamba

17. ¿Qué color es su orina? Claro

18. ¿Cuántos tiempos en la última semana ha realizado diarrea? no

19. ¿trabaja con cianuro? No directamente, pero está presente


náusea, o ansioso? No.


dolor de la garganta, dolor del estomago? No pero sí antes





a. Visita a un clínica


1. Nombre: Pedro

2. Edad:23

3. Papel en la mina: Cargando la tierra


a. ¿Qué tipo de trabaja tenia antes de la mina? Agricultura

5. ¿Tiene acceso a equipos de protección personal? Los que están afuera no, pero los que

están adentro sí.

a. ¿Utiliza a equipos de protección personal? No

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? no


22




8. ¿Ha perdido peso de manera involuntaria? normal

a. ¿Cuantos kilos?

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? Sí a veces


normal



de aliento? No

12. ¿Se trabaja directamente con el polvo de sílice? No

a. ¿Tienes acceso directamente a los químicos? Cianuro, peróxido, etc.


tratamientos simples? No



15. ¿Fuma? no




tuberculosis? No


superior?

a. ¿Qué hospital?


18. ¿Qué son las preocupaciones de salud que tiene usted? No

19. ¿Qué color es su orina? Normal

20. ¿Cuántos tiempos en la última semana ha realizado diarrea? No, tampoco

21. ¿trabaja con cianuro? Sí


náusea, o ansioso? No




un cambio en el color de la piel (rojo), una sensibilidad a la toca? No


23


a. Botica

23. ¿Has visitado a un brujo? No

1. Nombre: Wilson

2. Edad: 19

3. Papel en la mina: Picador – adentro


a. ¿Qué tipo de trabaja tenia antes de la mina? Construcción en Trujillo


a. ¿Utiliza a equipos de protección personal? Botas, casco, respirador

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? no





8. ¿Ha perdido peso de manera involuntaria? sí

a. ¿Cuantos kilos? 2kg

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? Sí

10. ¿pierde su alimento fácilmente mientras está haciendo trabaja normal? No


de aliento? Aliento un poco


tratamientos simples? Pastillas usa



14. ¿Fuma? No




tuberculosis? No

16. ¿En el último año ha visitado a un hospital para cualquier razón? No

a. ¿Qué hospital?


17. ¿Qué color es su orina? Amarillo

18. ¿Cuántos tiempos en la última semana ha realizado diarrea? Nada


24




dolor de la garganta, dolor del estomago? Garganta


un cambio en el color de la piel (rojo), una sensibilidad a la toca? Piel un poco





1. Nombre: Juan

2. Edad: 48

3. Papel en la mina: Cargador de la tierra afuera de la mina porque


a. ¿Qué tipo de trabaja tenia antes de la mina? Trabajaba adentro pero está

enfermo con una enfermedad de los plumones

5. ¿Tiene acceso a equipos de protección personal? no

a. ¿Utiliza a equipos de protección personal? No

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? Sí

a. ¿Cómo fue el tos? (seco, con sangre, mojado) seca

b. ¿Se tiene una tos con moco? No



8. ¿Ha perdido peso de manera involuntaria? Sí

a. ¿Cuantos kilos? Bastante, 4kg

9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? Sí mucho

trabaja como vigilante




de aliento? Sí muy común



13. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? Sí

25


No

14. ¿Fuma? No




tuberculosis? Sí su familia pero se fue.

16. ¿En el último año ha visitado a un hospital para cualquier razón? sí

a. ¿Qué hospital? Clínica pacifico

17. ¿Qué color es su orina? Normal/claro













1. Nombre: Pablo

2. Edad: 21

3. Papel en la mina: adentro, capachero


a. ¿Qué tipo de trabaja tenia antes de la mina? Construcción

5. ¿Tiene acceso a equipos de protección personal? Si

a. ¿Utiliza a equipos de protección personal? Casco, Lámpara

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? Si

duró un mes

a. ¿Cómo fue el tos? (seco, con sangre, mojado) moco y sangre

b. ¿Se tiene una tos con moco? Sí

i. ¿De qué color era el moco? Amarillo

7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) sí


a. ¿Cuantos kilos? 3kgs

26





de aliento? Sí todo.



tratamientos simples? Sí, no hizo nada para tratar eso.

14. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? No.


15. ¿Fuma? No




tuberculosis? No

17. ¿En el último año ha visitado a un hospital para cualquier razón? Clínica para tos dolor

de cuerpo, gripe

a. ¿Qué hospital?



19. ¿Qué color es su orina? Oscuro

20. ¿Cuántos tiempos en la última semana ha realizado diarrea? 1

21. ¿trabaja con cianuro? no directamente


náusea, o ansioso? Dolor de cabeza, dura 2días-2semanas


dolor de la garganta, dolor del estomago? Sangra de nariz


un cambio en el color de la piel (rojo), una sensibilidad a la toca? El “rostro” de

piel.





1. Nombre: Eduardo

2. Edad: 26

3. Papel en la mina: administrante- dueño de la mina

27

4. ¿Por cuantos años ha trabajado usted para la mina? 15-18

a. ¿Qué tipo de trabaja tenia antes de la mina? Trabajaba en otra mina

b. ¿De qué comunidad eres? Shiracmaca

5. ¿Tiene acceso a equipos de protección personal? sí

a. ¿Utiliza a equipos de protección personal? Botas, respirador, guantes,

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? sí

a. ¿Cómo fue el tos? (seco, con sangre, mojado) mojado

b. ¿Se tiene una tos con moco? Sí

i. ¿De qué color era el moco? Verde/amarillo

7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) un poquito







de aliento? Sí como gripe





a. ¿tienes dificultad de respirar? Sí

b. ¿Puede describir cualquier otro síntoma que haya tenido durante este tiempo?

15. ¿Fuma? No




tuberculosis? No

17. ¿En el último año ha visitado a un hospital para cualquier razón? Sí para un razón de los

plumones

a. ¿Qué hospital?




20. ¿Cuántos tiempos en la última semana ha realizado diarrea? Un vez



náusea, o ansioso? No – para los respiradores

28




un cambio en el color de la piel (rojo), una sensibilidad a la toca? no





1. Nombre: Faucino

2. Edad:23

3. Papel en la mina: adentro capachero


a. ¿Qué tipo de trabaja tenia antes de la mina? Estudiante


a. ¿Utiliza a equipos de protección personal? Casco


a. ¿Cómo fue el tos? (seco, con sangre, mojado) seco

b. ¿Se tiene una tos con moco? no

i. ¿De qué color era el moco? n/a

7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) Sí






de aliento? Sí a veces



tratamientos simples? Sí


15. ¿Fuma? No




tuberculosis? No

17. ¿En el último año ha visitado a un hospital o una clínica para cualquier razón? no

a. ¿Qué hospital?

29







náusea, o ansioso? Dolor de Cabeza – dura horas


dolor de la garganta, dolor del estomago? Sangrar de la nariz





a. Visita a un Botica


1. Nombre: Estégano

2. Edad: 60

3. Papel en la mina: Capachero a dentro de la mina

4. ¿Por cuantos años ha trabajado usted para la mina? Mucho años

a. ¿Qué tipo de trabaja tenia antes de la mina? En La chacra - Sembrando

b. El Es de Shiracmaca







7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) No, tranquilo


a. ¿Cuantos kilos?



A veces



de aliento? No


30



14. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? Sí pero

trabaja todo los días

a. ¿Tienes dificultades de respirar? Sí

15. ¿Fuma? No




tuberculosis? No

17. ¿En el último año ha visitado a un hospital para cualquier razón? En este año no pero en

el pasado sí

18. ¿Qué son las preocupaciones de salud que tiene usted? No, tranquila







dolor de la garganta, dolor del estomago? Dolor de la garganta


un cambio en el color de la piel (rojo), una sensibilidad a la toca? no



a. Visita al Hospital o botica porque está más cerca


1. Nombre: Agustín

2. Edad: 33

3. Papel en la mina: Chancador y Capachero


a. ¿Qué tipo de trabaja tenia antes de la mina? Ingeniera


a. ¿Utiliza a equipos de protección personal? Botas, respirador (adentro)


a. ¿Cómo fue el tos? (seco, con sangre, mojado) sí 3-4 días media seca


31


7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) sí



9. ¿se ha sentido cansado durante el día después de una buena noche de sueño? Sí por el

aire pero toma medicina




de aliento? Sí



tratamientos simples? En la espalda



15. ¿Fuma? No




tuberculosis? No

17. ¿En el último año ha visitado a un hospital para cualquier razón? Clínica por la gripe

a. ¿Qué hospital?



19. ¿Qué color es su orina? Amarilla/claro

20. ¿Cuántos tiempos en la última semana ha realizado diarrea? A veces por días



náusea, o ansioso? Cuando está a fuera sí todo


dolor de la garganta, dolor del estomago? No.


un cambio en el color de la piel (rojo), una sensibilidad a la toca? una erupción

de la piel en el rosto


22. i estuviera enfermo ¿Qué haría?


32


1. Nombre: Clemente

2. Edad: 23

3. Papel en la mina: Trabaja adentro sacar capacho


a. ¿Qué tipo de trabaja tenia antes de la mina? En la selva – agricultura

5. ¿Tiene acceso a equipos de protección personal? Casco y botas

a. ¿Utiliza a equipos de protección personal?

6. ¿En el último año ha experimentado una fuerte tos que duró más de dos semanas? No.

Dos o tres días sí


b. ¿Se tiene una tos con moco? Con Moco blanco


7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) no.

8. ¿Ha perdido peso de manera involuntaria? Sí.

a. ¿Cuantos kilos? 3 kilos



10. ¿pierde su alimento fácilmente mientras está haciendo trabaja normal? Sí, es muy

normal también cuando está comiendo.


de aliento? Sí



tratamientos simples? Sí hace un mes.

14. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar? No. Pero

tiene dificultades de respirar especialmente cuando está cansado


15. ¿Fuma? No.




tuberculosis? No.

17. ¿En el último año ha visitado a un hospital para cualquier razón? Nada.

a. ¿Qué hospital?


c. ¿De qué comunidad eres? Yagón

33

18. ¿Qué son las preocupaciones de salud que tiene usted? Tiene más preocupaciones de

trabajo que salud

19. ¿Qué color es su orina? Amarillo claro

20. ¿Cuántos tiempos en la última semana ha realizado diarrea? No.



náusea, o ansioso? Sí todo.


dolor de la garganta, dolor del estomago? Dolor de garganta y sangrar de nariz





a. Mejor ir a una farmacia por la gripe


1. Nombre: Aselmo

2. Edad: 32

3. Papel en la mina: Chancador

4. ¿Por cuantos años ha trabajado usted para la mina? “mucho años” 4 años

a. ¿Qué tipo de trabaja tenia antes de la mina?




a. ¿Cómo fue el tos? (seco, con sangre, mojado) seco/normal



7. Durante las noches ¿suda mucho? (ha realizado sudores nocturnos) No


a. ¿Cuantos kilos? 3-3.5 kilos





de aliento? No.



tratamientos simples? No.

34

14. En el último año, ¿ha perdido el trabajo debido a la dificultad para respirar?

No/”normal”


15. ¿Fuma? No.




tuberculosis? No.

17. ¿En el último año ha visitado a un hospital para cualquier razón? No.

a. ¿Qué hospital?




20. ¿Cuántos tiempos en la última semana ha realizado diarrea? Nada

21. ¿trabaja con cianuro? No, no directamente


náusea, o ansioso? No.







a. Visita al hospital pero no ha visitado a uno


35

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Huamachuco: n.p., 2009. Print.

36

Rothand, Dr. Sheldon, and Verona Goodwin. "HEALTH EFFECTS OF HYDROGEN SULPHIDE:

Knowledge Gaps." Http://environment.alberta.ca/. Science and Standards Branch

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University of Science and Technology.

Health & Medicine

Portfolio of Work Completed in Huamachuco, Peru