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Lima, Peru (Violence)
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Villa El Salvador

Can impoverished cities provide adequate sanitation systems to cope with growing populations? The answer is, they can.

One of Lima's largest shantytowns, Villa El Salvador was an urban invasion of the desert; a village without electricity or water. Today Villa El Salvador is a thriving community. Praised by the United Nations, it's an example of what can happen when the poor organize to develop their own infrastructure.

Villa El Salvador has paved streets and electricity. It established a small manufacturing sector that provides employment opportunities and a chance to escape the chains of grinding poverty. Communal health centers and kitchens cater to those in need. And above all else Villa El Salvador has a sewage system and clean running water. Its success has also shown the way to other, younger shantytowns like Ventanilla, which is just beginning to improve its infrastructure.

Violence | Disease | Water

Through dense vegetation of high valleys and jungles of Peru — perennially shrouded in mist — water slowly courses down the eastern slopes of the Andes. These are some of the greatest stands of tropical rainforests in the world. It all eventually flows into the vast basin of the Amazon River.

In the depths of the jungle, people are suddenly dying of malaria. This crisis has brought to Peru a team of international scientists. Their mission takes them downstream on a remote tributary of the Amazon. Their goal is to enter the hot zone of infection and discover the cause of the epidemic.

Field researcher Amy Vittor visits village

Field researcher Amy Vittor visits village

Field researcher Amy Vittor from the Johns Hopkins Bloomberg School of Public Health and her assistant begin by visiting villages that are suffering the most fatalities. They are looking for the slightest clues that could explain the mystery. She also asks questions and patiently listens to their stories, but learns nothing that would suggest the cause of the epidemic. She keeps searching for answers, knowing only one thing for sure; in 1965 there were only fifteen hundred cases of malaria in all of Peru. Today, it's over one hundred and sixty-five thousand.

In 1965 there were only fifteen hundred cases of malaria in all of Peru. Today, it's over one hundred and sixty-five thousand.

In a Bora village, the tribal leader explains how malaria affects his people. Before they used to sleep without mosquito nets. Now it's impossible, he says. He also reports that the Bora children are being repeatedly infected and the situation is getting worse. Three have died in just the last week. Amy's research takes her deeper into the jungle, closer to the center of the hot zone. She is aware that one cause of the epidemic may be the abandonment of mosquito eradication programs, a result of Peru's recent economic crisis.

Bora children are being repeatedly infected

Bora children are being repeatedly infected

But she thinks there may be something else behind the epidemic. For months Amy collects water samples from streams and rivers surrounded by dense forest. She is looking for the larva of the malaria carrying Anopheles mosquito. In nearly every location, none are found. Then Amy confirms her suspicions.

When she samples water from deforested areas there is clear evidence of a widespread infestation of the Anopheles mosquito. Everything points toward a link between malaria and the clear-cutting of the rainforest. But today huge expanses of the rainforest are being clear-cut for cattle ranching. Here there is no rotation; the forest is not allowed to grow back. Amy and her team have found that recently cleared open pastures are perfect breeding grounds for the anopheles mosquito.

Each day, as Amy records her findings she knows the importance of her research. Globally, malaria kills over two million people every year, mostly the poor who can't afford medication. This makes the anopheles mosquito the greatest killer of man in the animal kingdom.

Recently cleared of rain forest are perfect breeding grounds for the anopheles mosquito.

Amy test water for mosquito larva

Amy tests water for mosquito larva

The spread of malaria is not the only consequence of clearing the rainforest, but it may turn out to be one of the most devastating. Cut down at the rate of a thousand acres a day, the Amazon is being cleared to make way not just for farmland, but for towns too. One of the great concerns for the future is that insect born diseases are adapting to cities. Malaria is one, but there are others.

The port city of Iquitos, built in the heyday of the rubber boom, still remains the center of commerce on the upper Amazon River. But those living in its sprawling shantytowns not only suffer from an upsurge of malaria, but they have also become victims of another mosquito borne disease; Dengue fever. Ten years ago it posed no threat. Today, Dengue has reached epidemic proportions — 5% of its victims will die. Once again, research shows that cities can create their own ecology of disease, making them ripe for colonization by mosquitoes.

The port at Iquitos

The port at Iquitos

In Iquitos, collectors search for the mosquito aedes aegypti in anything that holds water is a potential breeding ground. In the hundreds of old tires, basins and wells of the shantytowns, aedes aegypti has found its ideal environment. Its larvae thrive in these stagnant waters. Epidemics in Iquitos would have once seemed remote from the developed world. But this city has become a favorite destination of eco-tourists. And with daily flights to the U.S. and Europe, no disease outbreak stays local for long.

Once a small Spanish colonial port on the Pacific, Lima, Peru's capital, has become a bustling, overcrowded metropolis of nearly nine million people. In the wealthier parts of town water is piped in from the mountains. It's abundance makes it hard to believe that the city is located in one of the driest deserts in the world.

But in the slums sprawling across the arid landscape that surrounds Lima, the lack of water is a brutal reality. Their hardships are almost unimaginable. Most live with no electricity. Their huts are made of sticks, straw matting and salvaged bits of corrugated steel. Sanitation is non-existent and disease is rampant. The life expectancy of a child born in these slums is ten years less than those living in the developed world.

The cholera epidemic began in a small coastal fishing village about 250 miles north of the nations capital. Within days Lima became a hot zone.

It's hardly surprising that intestinal infections are common to these slums. What is surprising is that the most serious water borne infection of all — cholera — was, until recently, non-existent.

Many of the gravesites of Lima's cemeteries are grim reminders of a national disaster. They mark the beginning of the largest cholera epidemic to strike the western hemisphere. The year was 1991. This was a time when funeral processions became common throughout Peru, a time when an entire country went into mourning.

In 1991 there was a major El Niño event in the Pacific. This resulted in the warming of the ocean along the 2000-mile coastline of Peru, creating the perfect conditions for a massive growth of algae that also nourish the toxic cholera bacterium. Scientists have now discovered why the periodic warming of ocean waters triggers Cholera outbreaks.

The cholera epidemic began in a small coastal fishing village about 250 miles north of the nations capital. Within days Lima became a hot zone. Victims started arriving at local hospitals every few minutes. Cholera causes severe diarrhea and vomiting which quickly dehydrates the patient. Death can come within hours. The treatment is to quickly rehydrate the patient by mouth or more often intravenously. Within weeks the disease overwhelmed Peru's medical facilities. Hospital personnel desperately tried to cope with the growing epidemic.

Peru’s cholera epidemic spread as far as Mexico

Peruís cholera epidemic spread as far as Mexico

Because the epidemic began in a fishing village, many thought seafood might be responsible. This nearly destroyed the export markets for Peruvian fish. Fisherman and their relatives staged angry demonstrations. The reality is, raw fish was never the problem provided it was washed in clean water. Cholera is transmitted when infected human waste contaminates the water supply — it is a disease of the poor. In Lima's wealthy neighborhoods cholera claimed very few victims where people can afford to drink bottled water.

Within a month the epidemic crossed the Andes and struck the Amazonian port city of Iquitos. In its slums, people bathe in and drink the same river water they use as a toilet. It didn't take long for cholera to spread north until it reached Mexico. Ultimately a disease that was thought to have disappeared from the Americas left a harsh legacy: more than a million people infected, 11,000 dead.

For now, the cholera epidemic is long gone. Daily life has returned to normal. Yet Lima's semi-treated sewage still pours into the Pacific, just a few hundred yards off these popular beaches. Coping with the conditions that foster epidemics is a difficult task, but, motivated by suffering, the people of Peru are beginning to make positive changes.



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