Building Health Equity in Peru's Sacred Valley

Peru’s Sacred Valley, a region cutting through the Andes mountains near Cuzco in southeastern Peru, is known worldwide for its historical and cultural treasures. Once the heart of the Incan empire, it is home to many archaeological sites that draw visitors from around the world, including the famous Incan citadel, Machu Picchu.,

But for the nearly 100,000 people who live in the Sacred Valley, the region can be lacking in essential services such as healthcare. There are few health facilities among its remote, rural villages, leaving most residents to seek care in the larger city of Cuzco, an hour or more away. And that’s only if you have access to a car, which many in the region do not.

This summer, Duke student Akhilesh Shivaramakrishnan traveled throughout the Sacred Valley to better understand the region's needs for health services. He focused on a glaring gap in mental health care for the region's 21,000 children and adolescents, completing surveys with students in secondary schools and leading workshops with parents. 

“In low- and middle-income countries, mental health is something that’s secondary because there’s a focus on providing physical health services,” says Shivaramakrishnan, a senior majoring in public policy and global health.

Shivaramakrishnan’s project is part of a growing partnership between the Duke Global Health Institute and Vidawasi, a nonprofit organization working to improve access to free, high-quality pediatric care in Peru. Launched in 2021 by Jesus Dongo, a Peruvian lawayer and real estate entrepreneur, Vidawasi offers free general medicine, dentistry and rehabilitation care from a medical campus in the heart of the Sacred Valley, the first of its kind in Latin America.

“I learned about Vidawasi through a local Peruvian newspaper,” says Ernesto Ortiz, M.D.,a senior program manager with DGHI who is sprearheading the partnership. “I was really impressed with what they do. When I met Jesús, I told him we needed to work together.”

Ortiz, who grew up in Lima and attended medical school in Peru, has worked on several DGHI-led research projects in the country, including studies focused on the health impacts of contamination from illegal gold mining and interventions to improve maternal and child health. He says Vidawasi’s mission to decentralize healthcare services in Peru addresses a critical need for the mostly poor, remote communities in the Andean region.

“I was able to see firsthand the pockets of poverty and health inequities when I went to underserved areas,” Ortiz says, reflecting on his time in medical school. “I didn’t choose [to pursue] medicine because of the money, I chose it because I want to serve people and save lives. I’m very passionate about my country.”

Shivaramakrishnan’s research project, which was funded by the B.N. Duke Scholarship Program, will help Vidawasi determine the scope of mental health services it may offer in the region.  During his interviews with students, he learned some haven’t seen a medical provider in more than a year, and many knew little about the steps they could take to prevent mental and physical health problems.

“That’s what makes the ongoing development of services at Vidawasi so important, to do capacity building and train those to address mental health,” he says. “Physical health can’t be adequate without mental health support.”

Shivaramakrishnan’s work in Peru builds off his experience in 2023 as part of a DGHI Student Research Training Program (SRT) team in New Delhi, India. The team conducted life skills workshops for youth transitioning out of residential care and interviews to assess mental health outcomes for Udayan Care, an organization that houses and serves orphaned and separated children.

“After my time in India, I wanted to do something with global mental health with a community partner, lean on their expertise about their community and design an intervention,” Shivaramakrishnan says. “They’re wanting to provide as many services as they can for the people they serve.”

Ortiz is hoping many more Duke students will follow Shivaramakrishnan’s path to the Sacred Valley. He is working to expand opportunities for students to do research through the partnership, including a six-week Duke in Peru program for undergraduate students planned to launch in summer 2025. He is also exploring the possibility of Vidawasi serving as a home base for a future SRT tteam.

Ortiz, who recently was named an ambassador by Vidawasi in recognition of his efforts to build the partnership with Duke, also hopes to see Duke faculty and clinicians engage with the nonprofit to enhance specialized services such as cancer care and pediatric surgery.

“Health is a right, and it’s one of the duties of a government to provide those services to their people,” he says. “If you don’t have healthy people, there is no well-being.”