My professor walked into class on Wednesday morning wearing a full suit and Jordans. This, he said, was his walking outfit.

At the end of class, he took us on a tour of downtown New Brunswick. More specifically, a section of town called Unity Square.

To give you some context, New Brunswick is both a college town and a city. Near my university there are three or four well-known streets where restaurants and shops cater to a young demographic. You’ll see things like vegan places, Instagram-worthy date spots, and a Rite-Aid for everything your dorm room would ever need. A business has to be very successful in order to survive on these streets because the rent is so high. As a result, there’s a high turnover in restaurants — we get one or two new restaurants almost every year.

Most students never leave this college bubble. The academic buildings are all clumped together, with only a handful of medical school and hospital buildings going deeper into the city. On our Wednesday morning walk, my class saw a completely different world: Unity Square.

Unity Square is home to about 5,000 low-income residents who are mostly Spanish-speaking immigrants from Oaxaca, Mexico. As you pass the three to four college town streets, you start to see more bodegas, houses with toy cars in the front, and stores with Spanish signage.

The small family restaurants and cantinas in Unity Square, my professor said, couldn’t compete with the youthful restaurants in the college town despite having better food.

As we walked through the residential areas of Unity Square, we saw duplex houses that had up to eight satellite dishes set up. I didn’t realize it until my professor pointed it out, but that means that there are at least eight families in a house built for two.

There’s an academic theory called the “broken window theory” which basically says that visible signs of disorder in a community (things like broken windows or shuttered buildings) increases disorder and crime in that community. I like this theory because it verbalizes ideas and generalizations that usually sit in the back of our head when we avoid walking through a so-called “bad part of town.”

So what do those satellites really mean?

In healthcare, we have social determinants or qualities of a location or population that indirectly affect quality of life and health in that area. For example, areas with more green space are typically healthier. More jobs, access to good school systems, and little pollution are some other examples. Those are pretty obvious connections.

When you look at the data, the satellites bring up a couple of interesting ideas. Typically, Latino immigrants like the ones in Unity Square have lower mortality rates than your usual non-Hispanic white person. It’s a concept well-known as the Latino Paradox: despite having less access to higher-education and higher income, these populations are healthier in a number of ways.

Many of the immigrants that live in Unity Square and other similar places come to the United States because they already have an existing network of family and friends that will support them. That’s how we get these pockets of ethnicities and communities of similar cultures. That’s how we get eight satellite dishes on one house.

A social support network like that provides stress-reducing advantages that could contribute to the Latino Paradox.

When I see the eight satellite dishes my first thought is that multiple families are living in that house to save money. There’s a high population density because of the poverty in the area. My second thought is that, the number of moms in that house must keep all the kids in line and the fathers must let off steam together all the time. Studies show that smoking and substance abuse are all lower in this immigrant population and again, with that kind of family presence, I’m not even surprised.

It’s one thing to read these statistics in a journal study and another to see it with your own eyes. Actually, you can see things and still not know what they represent. For example, we were walking around Unity Square during the middle of a school day and the streets were so quiet.

None of us noticed, except our professor.

“That means the kids are at school and the adults are working,” he said. This was different from a few years ago, when the streets would be more active during the middle of a weekday.

Last Saturday, I volunteered nearby Unity Square at a health clinic that was doing breast cancer screenings and prostate exams for free. With a little over 20 patients showing up in a three-hour window, the nurses said it went better than their previous clinic events. Why? It was on a Saturday.

On weekdays, the kids are at school and the adults are working.

Understanding these social factors and symbols are important for knowing how to engage a population in healthy practices and how to treat individuals in that community. Take a walk doc, maybe your patients’ streets will teach you more than what their symptoms will tell you.

My university is closing all of our on-campus pharmacies. Until I started reporting on it, I didn’t really care.

Honestly, this happens with a lot of healthcare-related news. We hear about or read about industry changes, recalls, and research but unless it directly relates to us, we scroll past all of it. Frankly, we do that with all news.

Last semester, I started writing for my campus newspaper. That means that every week, I pick two issues or stories that I care about or find interesting, the kind of things that would make me do a double-take on my Twitter feed, and I delve deep enough that I can write a 700-900 word article about each.

This week, I chose to report on my university’s decision to close our pharmacies: a story that broke two weeks ago on Reddit and has been gracing the front page of our campus paper ever since.

When I first heard about the pharmacies closing as a student, I recognized that it was important news and I figured it would be a problem for several students. But that concern or interest, whatever it was that made me do a double-take when I saw the headline, wasn’t enough to make me read the article in the paper.

Even though the story was unfolding literally outside my dorm, I didn’t feel like it applied to me. Fortunately, I’ve never been to an on-campus health center, which also means that I never even realized we had on-campus pharmacies.

This, of course, is a direct result of my privilege. I’m lucky enough to be on my family’s health insurance plan, so I don’t need to worry about university health insurance. I live close enough to home that if I needed to fill a prescription, it would just be easier to have my mom pick it up at our local pharmacy and drop it off at my dorm. I’ve never had to look for discounted contraceptives or cheaper cold medication: if I need something, I’ll buy the cheapest one on the shelf, but I won’t go to a different store for a better deal.

After taking the story in my school paper, I started talking to students who aren’t in the same boat as me and actually need these pharmacies. That’s when I really started to care. Why?

In global health, current events, or really anything that requires empathy, the way to make people understand is by humanizing the issue. I think that’s where news and science can sometimes fall short and fail to retain our attention. It’s hard to relate to statistics and facts that don’t have a face or story attached to them. Those issues, whether its surgical inequity around the world or climate change, often get shoved to the back of our heads as abstract things that we don’t need to worry about because A. they’re outside our sphere of experience or B. they aren’t imminent threats to our immediate, individual, well-being.

I also think that’s completely fair — there are too many bad things happening for us to worry about all of them. But, I do think that in order to make the general public care about issues that are niche or hard to understand, the extremely intelligent people that want us to listen to them need to realize that we need a reason to care. More than fear or facts, we resonate with the experiences of other people. I mean, I like to think that, for a lot of people, empathy is inherent.

We’re starting to get at it, but this opens up a much bigger conversation on medical communication and announcements in general. One of the reasons there’s so much uproar and confusion related to the pharmacies closing is the poor communication on the issue.

With an announcement like this, nothing should be left in the dark. All students hear is that the pharmacies are closing, with specific information on procedures and alternatives being released weeks after the announcement. The danger in waiting a few weeks between making the announcement and clearing things up, is that there’s now room for doubt and frustration to build up. That makes understanding less likely and, honestly, creates resentment. Clarity and, more importantly, transparency is what bring down the walls between students and administration and make tough pills a lot easier to swallow.

The other issue is that while we’re in this college bubble, we often forget that the problems we’re facing within our institution are sometimes symptoms of the outside world.

This past August, Walgreens said they were going to close 200 stores in the US. In fact, the retail pharmacy industry itself is starting to lose business to things like mail-order prescriptions. Knowing that, it feels like we should have seen this coming.

If anything, I think that makes the case for staying updated on news — you never know when the rest of the world will start impacting your own world.

This past summer, over 215 patients were hospitalized with mysterious respiratory problems. The majority were young and healthy despite having difficulty breathing, severe nausea, and fevers. A handful of these patients ended up in the ICU, in comas, or on ventilators. In Illinois, a young woman died after experiencing similar problems.

All of these cases are tied to vaping.

The term “vaping,” comes from the misconception that the vapor produced from the e-cigarettes, vape pens, or JUULs, is water vapor or steam. In reality, each device heats an e-liquid that produces an aerosol that the user inhales and exhales.

The e-liquid often contains some kind of solvent like vegetable glycerin, nicotine, flavoring (which gives JUULs their trademark sweetness), and other chemicals. So the aerosol produced, that sweet-smelling mist, still contains toxic chemicals that could be linked to cancer and other respiratory diseases. THC, the active component in marijuana, can also be found in vaping products.

Notice how I slipped “nicotine” in there? If we’re talking about JUULs, which take up 72% of the market share of e-cigarette-like products, one pod or flavor cartridge has the same amount of nicotine as one pack of cigarettes. Nicotine, of course, is found in cigarettes and while it doesn’t necessarily cause cancer nor is excessively dangerous on its own, it’s highly addictive.

In fact, it’s as hard to give up as heroin. That’s why people who start vaping eventually need to vape.

What’s crazy is that JUULing, or vaping, was originally invented to help cigarette-smokers quench their nicotine addiction without using cancer-causing cigarettes. Unfortunately, the market didn’t realize that while JUULs could help people come down from their cigarette addiction, they would introduce a younger generation to a new kind of beast.

Yes, vaping is safer than smoking cigarettes. But, what makes vaping dangerous is the heating process. Sometimes, when the e-liquid is heated, there are oil (remember the vegetable glycerin I mentioned?) droplets left in the device that can get into the lungs. The body then treats the oil as a foreign object and launches an immune attack that creates inflammation and fluid build-up. That can lead to pneumonia and the other symptoms the patients have been seeing. At least, that’s what we think we’ve figured out.

Seizures, heart attacks, high blood pressure, and cardiovascular problems are all also linked to vaping. These could be caused by the metal particles present in e-liquid, nicotine, really anything. The fact is, because vaping has been getting so popular so fast, science can’t keep up.

If vaping has been on the rise since 2012, why are we only seeing problems now? The FDA thinks that illegal manufacturers may have introduced something new into the e-liquid that’s causing these reactions. Makes sense, right?

The CDC even issued a warning to young people to not use illegal vaping products — problem solved, crisis averted.

But the problem is that even people who are legally purchasing reputable, well as reputable as it gets, vaping products are experiencing problems. This challenges the idea that the problems are being caused by illicit products that have been tampered with or DIYed.

According to Wisconsin public health officials, 89% of the individuals they spoke to experienced problems used vaping devices to inhale THC. This may be a lead, but again, some exceptions complicate the situation.

Because the industry is so unregulated, we know next to nothing about what’s actually in the devices and e-liquid. The ingredient labels, of course, leave out a lot. With so little knowledge, it’s very difficult to understand and treat the root cause of these respiratory problems caused by vaping. Right now, steroids and other treatments have been working in patients by reducing inflammation. But that’s treating the symptom, not the source of the illness.

In response to the growing number of vaping related hospitalizations, the FDA is now analyzing various e-liquid samples in an attempt to find the culprit chemical. Until we know more, it’s probably best to lay off the vape.

CUSCO, PERU — An elderly woman wearing five sweaters shuffled through her purse to find the pills she had been taking. She pulled out a small sheet of four pills and another sheet of two pills.

This woman, like many patients at the clinic, had used antibiotics to cure her common cold, taking two pills here and three pills there as soon as her throat started to hurt. After one or two days, she’d be cured and would stop taking the pills.

In the United States, federal law states that the purchase of all antibiotics requires a doctor’s prescription. Why? Antibiotics specifically treat illnesses caused by bacteria and only health professionals can truly tell whether symptoms are caused by bacteria or not.

If you take the wrong antibiotic, your symptoms won’t get better. If you take an antibiotic when you don’t need to or don’t finish the complete treatment course (typically 7-14 days of pills), you risk developing antibiotic resistance.

As the antibiotic tries to kill the bacteria in your system, the bacteria turn on their survival instincts. After spending time with the antibiotic, they adapt and learn how to get around it, becoming immune to it. This is the same reason we’re supposed to change up our skincare products every now and then — our bodies adapt and get used to the chemicals we introduce to them. Once the bacteria has adjusted, it becomes a strain or version that can’t be treated with that particular antibiotic. If this resistant version affects you or anyone else again, doctors will have a hard time prescribing something that will actually work.

Something as simple as strep throat would become deadly. So deadly that we’d call it a superbug.

So, imagine my shock when this woman, among other patients, pulls out her antibiotics and explains that she’s only taken a handful of the pills to kill her sore throat.

In Peru, and many other Latin American countries, antibiotics can easily be purchased over-the-counter or without a prescription. In almost every corner store or botica (pharmacy), you’ll see ampicillin, penicillin, and many other antibiotics. All you have to do is walk up to the store clerk and say you have a headache for them to rip off a section of three or four antibiotic pills for you to buy. Even if it’s the wrong antibiotic or a fraction of the complete treatment course, your common cold will slow down over the next few days and you’ll decide that the pills worked. Plus, they were cheap and you avoided a trip to the doctor’s office.

For that reason, this short-term solution of self-medication appeals to the majority of underserved patients who lack insurance or can’t miss a single day of work.

I’d say the solution is stricter regulation, but because the populations have already gotten used to the ease of buying and selling antibiotics, it would be difficult to enforce new rules. For the patients of course, but even for the botica owners and employees who see selling antibiotics as another way to make quick money. In places like Peru, corruption affects almost all aspects of life, including healthcare. When you have black market hubs of adulterated and expired medicine, keeping the teenager at the corner store from selling three pills to an elderly woman is both low on the priority list and hard to expect actual change from.

In all honesty, there are more similarities between the US and Peru than we think. A recent study in the Annals of Internal Medicine states that self-medication of antibiotics is causing a drug resistance problem, much like the one in Peru, in the United States.

For the same reasons too. The study blamed poor access to health-care, the hassle and cost of the doctor’s office, the cost of a full treatment course of antibiotics, and even embarrassment of getting treated for bacterial STIs.

What’s more interesting is where the antibiotics came from: places like flea markets, friends and family, and community swap meets. Again, something very hard to address through rules and regulations.

So, it’s near impossible to address this problem top-down or systematically. In Cusco, what I’ve seen work is education.

Every time a patient came into the consultation with antibiotics they shouldn’t have taken, the doctor took the time to explain to them how the antibiotics worked and the dangers of their misuse. By the time the doctor was done, the patient would be terrified of the concept of superbugs. The goal of instilling this understanding and fear was to prevent them from unnecessarily buying antibiotics again.

I say this works because whenever I would bring up the ease of obtaining antibiotics in conversation with my host family or local friends, they would explain antibiotic resistance to me and tell me how big of a problem it was.

While my host family and friends weren’t in the socioeconomic bracket that would lean towards self-medicating in the first place, this meant that something a doctor once told them actually stuck. That’s some kind of progress, right? Rather than blindly and hopelessly enforcing rules that don’t appeal to struggling demographics, it’s better to educate communities, be it in a classroom or a consultation, so that individuals will choose not to self-medicate with antibiotics and understand why.

If you want to learn more about the existential crisis I have almost every day, you’re in luck. The New York Times just wrote about it.

“How Medicine Became the Stealth Family-Friendly Profession” was recently published and talks about what medicine can teach other career fields about being family-friendly. Family-friendly, meaning it’s more common for female doctors to continue working after having children than female lawyers, female engineers, etc.

The article shares the story of Britni Herbert, a chief oncology resident who switched her specialty to internal medicine and geriatrics after having twins. With more flexible hours, she’s now able to balance a career and a family. Other fields, of course, don’t offer women this luxury of choice.

“But medicine has changed in ways that offer doctors and other health care workers the option of more control over their hours, depending on the specialty and job they choose, while still practicing at the top of their training and being paid proportionately.”

Claire Cain Miller, Author of “How Medicine Became the Stealth Family-Friendly Profession.”

To a third-person reader, it seems fantastic that Dr. Herbert still gets to play the role of a doctor while having a family, but the fact is, she felt pressure to switch to a less demanding field within medicine. Her husband, she says, was balancing an intensive radiology residency at the same time and by switching, she’s now able to continue practicing medicine while being able to pick her kids up from school.

For Dr. Herbert, this was the best decision for herself and her family. In other fields, according to the article, you don’t really have this option. In that regard, medicine is family-friendly.

However, as a woman who’s pursuing medicine, there’s something that’s always been nagging at the back of my head. If I want to pursue a specialty that’s more demanding, say surgery, will I have to give up the idea of having a family?

On #MedTwitter, a community of healthcare professionals on Twitter, there’s been some backlash towards the article’s claim that medicine is “family-friendly.”

For example, Dr. Kimi Chernoby, an Emergency Medicine doctor at Indiana University’s School of Medicine, said the following:

This is something that female pre-med students and medical students think about and hear about regularly. We all know female doctors who made career sacrifices to maintain their families and we’ve all been told that being a nurse is easier than being a doctor.

But, the article says that there are other options too. Dr. Sara Gonzalez is a mother and pediatrician who works as a hospitalist: a position that offers predictable hours. Dr. Julia Knarreborg is a mother and radiologist that takes advantage of electronic medical records and telemedicine to work from home.

According to an analysis in the article done by Harvard economist Claudia Goldin, more women have entered medicine because of the rise in flexible and predictable hours in certain specialties.

Again, that’s awesome. But women shouldn’t be entering medicine because it’s the only job that will let them maintain a family, but because there aren’t enough women in medicine. This lack of female representation contributes to misdiagnoses of female conditions, maternal mortality, and discrimination in the medical workforce. This goes for women and all minority groups: medical treatment of those groups is lacking because the representation is lacking.

There are other reasons that the article mentions that make medicine family-friendly. For example, as a doctor, you usually make enough to afford a nanny. But even that opens up a can of worms when it comes to how much female doctors make.

“Female doctors are paid 67% of what men are, but much of the gap is because they work less,” says the article. Taking hours, specialty, and years of experience in account, this number becomes 82%,” says Goldin. The remaining gap, she explains, is because reduced hours earlier in their careers result in losing grants or leadership positions later on.

Sheryl Sandberg, the COO of Facebook talks about this in her book Lean In. She says that women, in any field, are perceived to be handicapped because of their potential desire to have a family. So, by putting a woman in a leadership role or trusting them with grant money and research commitments, you’re taking a gamble. All of that time, money, and effort could go to waste the minute she decides to have a family. You lose her time when she’s pregnant, you lose her effort when she’s on maternity leave, and from then on she will never be 100% committed to her job because she’s thinking about what to make for dinner.

Again, this is a problem that applies to all fields, not just medicine and not excluding medicine.

In the article, Aisha Haynie Smart, a hospital medical director, says “There are so many sacrifices that women physicians make in order to remain in their careers, remain working, things that aren’t taken into consideration when looking at how wonderful and flexible it can be.”

The article brings up a valid point that there are family friendly options within medicine. However, it also neglects to include perspectives from famously demanding specialties of medicine. One such perspective is that of Dr. Nikki Stamp in her recent opinion article in the Washington Post.

“When girls or women ask me if they can be a surgeon, I’ll still say yes, they can. I’ll still encourage them because despite the obstacles, I love my job and I want to see the ranks swell with more women…But I will then tell them that it may not be an easy or fair road,” says Stamp.

A statistic mentioned in the article adds a different perspective: The Association of American Medical Colleges’ annual survey of medical school graduates says that 80% of male graduates value work-life balance: this is 70% more than a decade ago. This, in turn, affected what specialty they chose within medicine.

Nowadays, it’s not just women who seek a work-life balance, but millennials in general. I mentioned earlier that the idea of maintaining a family and a demanding specialty is one that plagues female pre-med students. That’s not to say guys don’t worry about it — I’ve had that late-night conversation about family vs. career with both female and male students.

The fact of the matter is that there are structural differences that make some specialties more family-friendly than others. But I like to think that when everyone gets to a point in their medical education and career where they have to decide between family and career, they make the right decision for their unique situation.

The article says that medicine is a family-friendly field and, honestly, I think that discredits how hard it is to pursue specialties like neurosurgery or to own a private practice. I agree with the fact that there are family-friendly paths within medicine. That’s the beauty of medicine; there are so many options and you can pick what works best for you and the lifestyle you want.

I can understand the backlash on social media and in the comment section of the article because when I first read it, I was frustrated too. When you read “In general, when a field becomes female-dominated, its pay and prestige drops,” it’s hard not to feel frustrated.

At least for my sanity, I have to understand that medicine is recognizing its room for improvement in areas like equal pay and physician burnout. Both of these issues are systemic and because of that, they’re hard to address.

The best solutions right now, and the article says this, come with community.

Working near extended family who can watch the kids or with other doctors who also have children and struggle with a work-life balance makes the situation easier for female doctors. Being in a relationship where both spouses share the responsibility of raising a family also makes it possible for women to pursue those grants and leadership roles. Sheryl Sandberg mentions this in Lean In, so again, these ideas apply to every field.

My point is that the article feels like a one-sided argument, but so does the response on social media. If we really want to understand the situation, we have to consider all of the arguments and variables. Not doing that and jumping to conclusions, is risky.

Check out the article and let me know what you think:

Tucked in a corner of Cusco’s bohemian district of San Blas is the quaint Laggart Cafe. There, they serve a delicious passionfruit cake and support local artists by displaying and selling their work.

You can pass hours here working and listening to smooth jazz, but you can also order one of a number of their medicinal infusions or teas.

As I flipped through the cafe’s menu, I was surprised to see a page that had more medicine than food. There were teas labeled for everyday medicinal needs: an anti-fever tea and an anti-gastritis tea, just to name a few. Each one had a unique mix of herbs that the owner had carefully selected to achieve a specific medicinal goal.

“I speak to my grandmother and grandfather to create the recipes for the infusions and afterward, I corroborate their recipes with a book on herbs and plants that my friend, who’s an anthropologist, put together. So the recipes come from family tradition, but are also backed up by science,” said the owner of the cafe.

Laggart Cafe isn’t the only restaurant in Peru that prides itself on medicinal foods. At Jardin Organiko, the waitresses will encourage you to eat the decorative flowers on your plate of spaghetti to improve your digestion and boost your immune system. This practice of eating flowers for health reasons even has a name: florifagia.

These restaurants, while applauded on TripAdvisor, don’t use medicinal foods and drinks to appeal to tourists. Their health consciousness comes from a culture deeply engrained in many Peruvian families.

“For me, my sister, and my family, we never directly bought medicine. Not because they were expensive or hard to access,” said the owner of Laggart Cafe, “but because we didn’t need them in the first place.”

For her, using muña to improve symptoms of gastritis and ayrampu to kill fevers is much better than overusing antibiotics, something that’s also very common in Peru’s healthcare scene.

Perhaps this culture is a product of its environment. Some of these recipes are generations old and come from the fact that Peru is home to a wealth of different fruits, herbs, and spices. As a result, it’s not surprising that super foods like quinoa, maca, and kiwicha or medicinal teas make their way into diets.

While staying in Peru, my host family would serve a different tea every night with dinner. Some were meant to improve digestion, which is slower in high-altitude places like Cusco. Others were meant to calm down fevers or migraines so that we could go to sleep and wake up feeling ready for work.

One night, while cooking dinner, my host mom and I talked about this unique side of Cusco’s dining culture. She said that her daughter had only been to the doctor a handful of times in the past decade because she treats their food as their medicine.

From what I saw in supermarkets in Cusco, it’s much easier to maintain a healthy diet there than in the US. Here, fruits cost more than chips and we wonder why we have problems with obesity, cholesterol, and diabetes. Granted, some of the most beneficial ingredients in Peru are also expensive.

My host mom’s philosophy? If you’d spend the amount of money you do on pills or medication, then you should spend the same amount on the food you eat.

But, something tells me that this culture of eating healthy is starting to fade away. While working at a local clinic, the majority of patients coming in had issues with cholesterol or diabetes caused by their poor diets. While superfoods and infusions are common in Peru, so are potatoes, bread, and red meat. For the average worker, it’s a lot easier to eat the latter as street-food or a quick meal at home than it is to regularly cook medicinal meals.

One of the doctors I worked with also saw food as the first line of defense in medicine. Having lived in Ecuador, where natural medicine often makes its way into mainstream medicine, she often encourages her patients to try natural remedies like adding kefir grains to milk to promote good digestion and gut health.

She also spends a good portion of her consultations not only explaining what patients can’t eat, but what they can eat: fruits, vegetables, fish, and chicken. And, of course, llama, alpaca, and cuy.

For those of you who don’t know, cuy is guinea pig.

These meats are considered traditional dishes in Peru and while they’re not eaten on a daily basis, they are nutritionally superior to their red-meat cousins like beef and pork. In fact, they are higher in protein and lower in calories, cholesterol, and fat.

For the younger generations in Peru, it might be a good idea to lean into the recipes of older generations, making medicinal infusions and traditional, healthy, dishes more common. For the US, maybe we should just start with something, I don’t know, green?

Being Indian, I’m no stranger to the idea of seeing recipes as home-made prescriptions. If you know what Ayurveda is, none of this would be new. For me, the most interesting part of Peru’s organic, natural food culture is that it’s recognized in Peruvian healthcare. Another doctor I worked with would explain his prescriptions to patients and follow them up with an herbal tea he thought would target their symptoms.

In the US, while eating healthy is also supported by the medical community, I’ve yet to see out-of-the-box herbal remedies hit mainstream medicine. Understandably, things like homeopathy are treated like snake oil in the medical and scientific communities but why don’t we talk about beneficial herbs, spices, or foods in our consultations? And I don’t mean in the GI’s office, I mean in primary care.

That’s not to say that nutritional diets and healthy eating aren’t popular in the United States. With all of the supplements and powders available, it’s starting to feel like nutrition is becoming an industry just like medicine. But with the amount of pseudo-science and noise in the dieting industry, it’s up to doctors to help patients navigate their options.

While our version of medicinal foods and healthy eating may not come from generations of family recipes, I think it’s time we take a page out of Cusco’s cookbook and remember that not all medicine comes in pills.

*All quotes are paraphrased from their original Spanish

In almost every bodega on every corner in Cusco, there is a rack full of small bags of green candy. In La Plaza de Armas, the center of the city, men and women dressed in cultural garb will approach tourists and try to sell the same bags of green candy.

This candy is made of coca leaves, which are considered an herbal remedy for what locals call “sorroche,” or altitude sickness. Coca leaves are the raw material for cocaine and when unrefined and unprocessed, provide vitamins and minerals that boost metabolism and help “gringos,” or foreigners, adjust to the altitude of Cusco. While many chew the leaves, coca is often more palatable as a tea or candy. Hotels and restaurants will often offer coca tea, or “mate de coca,” and vendors will sell the small bags of coca candy.

At first, I was very surprised by how popular coca products were in Cusco. In the US, we don’t see racks of a single type of candy or cough drop and our hotels mostly just offer coffee or water. Herbal remedies especially, can often only be found in specialty stores or online. Or at least, that’s what I thought.

Before coming to Peru, I spent a few days with a friend by the Jersey Shore. In one of the boardwalk stores, there was a rack filled with small bottles and packets of one type of herbal remedy: CBD.

Apparently I missed the memo because CBD products, or cannabidiol products, have been gracing stores in the US for almost a year. Often sold as a powder or oil, CBD is an active ingredient in marijuana and is thought to improve symptoms of childhood epilepsy, chronic pain, insomnia, anxiety, etc.

Both coca and CBD are one of hundreds of ingredients of cocaine and marijuana respectively, but they themselves don’t cause anything remotely similar to a high. While coca has been valued as a medicine for almost 8,000 years by South American civilizations, CBD has recently been introduced as a mainstream herbal supplement. CBD, which can be found in bath bombs and ice cream, is also much more commercialized in the US compared to coca in South America, which comes as no surprise considering our commodity-obsessed corner of the world.

The popularity of both of these herbal products come from the fact that they address niche medical issues that are specific to a particular region.

Coca addresses the symptoms of altitude sickness in a city that is 4,000 meters above sea level.

CBD addresses anxiety in a region plagued by the rat race and all of its symptoms: imposter syndrome, FOMO, and stress.

The regulation of coca in Peru, however, is unique compared to the regulation of CBD in the United States. Possession of more than a certain amount of cocaine is punishable by law in Peru, and police officers often treat all who possess processed cocaine as possible traffickers. Unrefined coca, however, is legal and openly sold in the market. Cocaine is also illegal in the US, but so are coca leaves and all coca products.

In the US, the federal government considers marijuana as a Class 1 controlled substance: illegal. Despite that, almost half of the states in the US have approved using marijuana for medical purposes, as it can reduce symptoms associated with Parkinson’s, anxiety, cancer, and multiple sclerosis. Other Class 1 drugs include heroin and LSD, while Class 2 drugs are highly addictive but have medicinal purpose (think morphine). According to a study published by the Shafer Commission during the Nixon era, marijuana should be a Class 2 drug because of its medicinal value.

Being in Class 1, medical marijuana can’t be formally prescribed by physicians, even in states where it’s considered legal. It also can’t be held by doctors, who can really only suggest that patients seek it out on their own. Needless to say, that comes with its own risks.

Doctors in Peru, however, can provide patients coca leaves and coca tea.

Of course, coca is a lot farther from cocaine than medical marijuana is from marijuana: cocaine is refined coca but medical marijuana is just marijuana dispensed from a MMTC (medical marijuana treatment center) and used for medical purposes.

But weren’t we talking about CBD?

According to the federal government, CBD products, with the exception of a seizure medication called Epidiolex, are also considered Class 1 drugs: illegal. The fact that the FDA approved Epidiolex makes the situation even more complicated: the drug exclusion rule states that you can’t add any active ingredient in a pharmaceutical to a food. Yes, that includes CBD muffins and lollipops.

Frankly, the law has a point.

In Cusco, the uses of coca are well-known and trusted by the general public. I mean, it makes sense because people have been using it for thousands of years with no long term damage.

CBD products, on the other hand, are far from trustworthy. While there are some accredited studies to support some of its uses, there isn’t enough science to back up its safety. A number of institutions are doing more research on CBD, but until then, the FDA is turning a blind eye on stores and companies that sell CBD products.

Because no one’s really paying attention to the products on store shelves, CBD is being advertised as a panacea for almost anything and it’s getting harder and harder to determine fact from fiction. It’s also hitting the market in an era of social media that perpetuates misinformation and, well, hype. If it’s uses, as seen by the general public, aren’t scientifically backed, it’s hard to see the supplement as anything but snake oil. The danger of this is that potentially useful CBD products and medicines, like Epidiolex, could disappear under a cloud of misunderstanding and high expectations that CBD can’t live up to.

CBD is quickly becoming the American version of Peru’s coca, but it’s all happening a little too fast. In order for CBD’s medical potential to be realized, the media and market have to take it seriously: it could be much more than an opportunity to capitalize on millennials, vegans, and creatives who seem to be the target demographic for CBD products.

With less noise, science can make a valid case for the use of CBD products. Then, maybe we’ll have laws that actually make sense.

Sources:

https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476

https://www.nytimes.com/2018/10/27/style/cbd-benefits.html

https://www.inquirer.com/business/weed/cbd-legal-cannabis-weavers-way-fda-lietzan-health-food-fuel-kombucha-ice-cream-20190326.html

https://www.doctoroz.com/article/what-s-next-cbd-what-dr-sanjay-gupta-predicts-about-its-future

I am currently sitting in a hotel room with a very colorful shawl wrapped around me and an amazing view of the mountains. My study-abroad group is meeting in a few hours for dinner, paid for by our university, and we have the next two days to rest and get settled. And so begins my five-week study abroad in Cuzco, Peru.

Friends, it took a lot to get to this point.

During the week leading up to our flight, I was panicking trying to figure out what to bring and what not to bring. While this is reminiscent of me packing for any trip, packing for Cuzco a little more difficult. Why? The city, which is at an elevation of 3,400 meters above sea level, presents a mixed bag of situations.

Temperatures in this mountainous city can reach up to 60-70°F during the day because of the sun’s harsh rays and drop to 30-40°F in the mornings and at night. Needless to say, you have to dress in layers.

Travelers often use Cuzco as a base for exploring nearby areas like Machu Pichu, Lake Titicaca, etc. Those day/weekend trips require their own set of preparation: Lake Titicaca and its man-made floating islands are at a higher elevation than Cuzco and are, as a result, freezing. On the other hand, Machu Pichu and other sites like the Sacred Valley of the Incas are lower in elevation and warmer, but involve some serious hiking. During our trip, we’ll be lucky enough to visit each of these sites and others to learn more about the Incas and Peruvian culture.

But, the most nerve-wracking part of traveling to Cuzco is preparing to deal with altitude sickness. Because Cuzco is located in the mountains at a very high elevation, the air is much thinner and this can cause fatigue, nausea, vomiting, headaches, and other symptoms. It affects everyone differently and your physical fitness doesn’t even determine how you’ll be affected. You could be in the best shape of your life and still be huffing and puffing after climbing two flights of stairs in Cuzco. There are a number of different medications and remedies for altitude sickness. There are herbal remedies like ginkgo biloba supplements or chlorophyll drops as well as prescription drugs like Diamox. When you first arrive in Cuzco, you have to move a lot slower and stay hydrated to help your body acclimate.

Of course, you can also drink coca tea or chew coca leaves. Coca leaves are very common in Peru for treating altitude sickness as they contain vitamins and minerals that increase energy and improve your metabolism, allowing your body to adjust faster to the lack of oxygen in the air. Almost every restaurant will serve coca tea and coca leaves or candies can be found in most stores. But listen to this: coca leaves are the raw material for cocaine.

In fact, if you consistently drink coca tea or eat coca leaves during your stay in Peru, your body will contain traces of cocaine for a few weeks after returning to your home country. But, the coca leaves cause none of the effects that cocaine causes. The difference between the two is that cocaine is an extremely processed version of coca leaves that are refined and mixed with a number of chemicals. So yes, coca leaves are completely safe and often times the most effective remedy for altitude sickness. However, they are illegal in most countries and it is suggested that government officials avoid them in case of blood tests upon returning to the workplace.

All of this was explained to us by our tour guides who insisted on only speaking to us in Spanish. While I expected the language barrier to be difficult at first, you quickly realize that most residents speak a decent amount of English. In fact, about 70% of cuzqueños speak English. It makes sense, considering the fact that tourism is Cuzco’s biggest industry. Knowing that, if we want to improve our Spanish, it’s up to us to take the initiative to speak in Spanish. That combined with getting used to the city is a little overwhelming: Cuzco’s transportation systems, neighborhoods, and cultural norms are all very different from those in the United States. But, our tour guides told us to dive right in and make a few mistakes so that before we know it, we’ll feel like locals.

For me, and this goes for anywhere I travel, I always worry about seeming like a tourist. In my head, I feel like locals are either annoyed by tourists or immediately target tourists with high prices and whispered jokes. “Gringa” or foreigner isn’t meant as an insult, but it still feels like one. While in transit to Cuzco, I realized that you will always start as a tourist any time you go to a new place. It’s normal and, frankly, exciting to have that child-like sense of wonder when you see new things. The awkward interactions with staff at airports or in restaurants are all part of the growing pains of getting used to a new area. It’s hard, but I think all we can do is take them in stride and learn as much as we can as we go. This may be a very American way of thinking about it, but I feel like every local, at some point in their lives or in the generations before them, was a tourist. Right now, that’s what’s helping me get through my faulty Spanish grammar and purchasing nerves.

It also helps to realize that as much as we want to experience other cultures, others want to share their culture with us. As a group of us sat in the waiting area of the Lima airport during an 8-hour layover, we ended up speaking to a woman who was flying to Arequipa to visit family. After explaining our study abroad program, she was gushing with excitement about Cusco. She shared tips and tricks she had learned over the years and some of her favorite parts of the city.

She had grown up in Peru but moved to Denver, Colorado when she was a young adult. “Welcome to my home, girls. You’re going to love it, enjoy every moment,” she said.

I also wanted to mention that Pride Month is also wrapping up in the city and symbols of LGBTQ+ support are all over city walls. Rainbow flags were flying in the center of the city and while you may think they’re for Pride Month, they’re actually Cuzco’s city flags celebrating various traditional festivals in June. From what I’ve seen so far, Cuzco is a diverse city with all types of cuisine and culture, where people from all walks of life are welcomed.

With that, I’m going to start unpacking! Stay tuned to hear more about my host-family stay, volunteer experiences, university stories, and all the adventures Cuzco has to offer!

P.S. When you unpack in Peru, be careful when opening water bottles, containers of lotion, shampoo, etc. The pressure difference makes things explode, completely casually. Excuse me while I go clean the Jergens off my jeans.

For the past two to three weeks, my Instagram stories have been one thing: blue.

People have been changing their profile pictures to a particular shade of blue and reposting the same text-image that promises one meal for Sudanese children per every follow and share.

This phenomenon is called the Sudan Meal Project. It’s an example of what I think is a new kind of grassroots movement that is taking the world of social-good by storm.

Whether it’s providing clean water to communities, planting trees, or making donations, a number of groups have made 2019 the year of Instagram charity posts by promising action in exchange for spreading awareness. For the average Instagram user, this type of impact model is almost too good to be true. You’re able to scroll through Instagram, repost one of these action/awareness posts and without any real effort, feel as though you’re making a difference in the world. At the same time, you get to publicly demonstrate to your followers that you are an aware citizen who isn’t afraid to do good. Ideal, right?

This kind of post goes viral for a number of reasons. First, awareness of social issues spread like wildfire on social media. The crisis in Sudan is a perfect example: with a situation that at first didn’t get enough media coverage, Instagram took charge and after a week of people sharing stories and information about the humanitarian crisis in Sudan and reposting about the lack of awareness, everyone knew what was happening. This spread of awareness comes with the realization that learning and talking about an issue isn’t the same as taking action. Reconciling that is something that everyone who gets involved in global health or social movements goes through. Of course, sharing that knowledge is a way to take action. But, sometimes it doesn’t feel like enough.

So, impact models like the Sudan Meal Project do well because they appeal to a now educated public that has a desire to physically impact change. It’s almost instant gratification: while all we do is repost an image, we’re picturing a packaged meal being handed to a starving child.

Typically, charities struggle to get commitment or donations from individuals because there is little incentive other than abstract emotional fulfillment and the idea of improving self/public image. Impact models like that of the Sudan Meal Project, however, are so low-commitment that it requires little to no incentive. That’s why it’s so easy for this kind of post to go viral.

There’s also a peer pressure aspect of the process. The nature of social media is competitive: who went on the better vacation, who takes the betters pictures, and who has the more fulfilling life? When a handful of your friends or the people you follow post an image for social-good, you’re more likely to join in because it feels like you’re expected to do so in order to keep up. More and more people post the image, and at a certain point, you even start to notice the people who don’t participate as much as the people who do.

This impact model is effective because, in an ideal world, it takes advantage of social media to create positive change in the world. Unfortunately, we don’t live in an ideal world.

After the Sudan Meal Project post went viral, people started to question the process and feasibility of providing the now-thousands of meals. The group commented a response on their post stating that they didn’t expect this kind of reaction and that they were working on other ways of keeping their promise. Originally, they were going to use their own money to buy and provide meals.

Ironically, it’s how easy it is to create change on social media that causes problems. Real-life, physical grassroots movements take time and a considerable amount of effort to gain traction and be impactful. When we apply that idea to social media, we are ignoring the fact that initiatives can very easily spiral out of our control. So, while it’s commendable that individuals and small groups are taking action, we have to be cognizant of how quickly an idea or a mission can go viral and realistic about what kind of change is actually sustainable.

While I think grassroots social media movements are perfect for raising awareness, it’s not responsible for them to promise tangible change that requires more time, money, and effort than they can actually provide. At that point, the post that went viral distracted from the mission of well-established organizations that can actually keep up with the volume of responses.

A better version of social media action is the Twitter post that went on Bell Let’s Talk day that promised a donation towards mental health for every retweet. While very similar to the Sudan Meal Project, the difference is that the Bell Let’s Talk Day tweet had a large corporate backing from Bell, a company that could sustain the social media commitment it was asking for.

I think this comes back to the idea of doing what’s best for a community rather than doing what we think is the most obvious way of helping. Yes, it’s noble for small groups and individuals to use the power of social media for good and try to impact change. But, maybe it’s more conscientious to realize our limitations and redirect that energy towards existing groups and initiatives. Why reinvent the wheel?

In March, I went to Panama for a week as part of a medical Global Brigade and helped run free clinics for various communities. During that week, about 20 other students from my university and I stayed at a compound, prepared posters and presentations to give to patients and children, packed medication for our makeshift pharmacy, and practiced taking vitals. Each day, we’d spend seven-ish hours at the clinic, taking vitals, recording patient history, helping out with dental procedures and eye exams, observing medical consultations, and reminding kids to brush their teeth. The communities were so welcoming and it was extremely gratifying to feel like we actually made an impact. I learned so much.

The entire time, and especially when I came back, I had this guilt gnawing at me. I would tell people exactly what I told you but would have these complicated thoughts eating away at my conscience. Seeing as it’s June, you can tell that I put off dissecting these thoughts for months. But I’m sitting in a Barnes and Noble now and can’t watch Netflix without being judged so I figured it was time to face the music.

First, my motivations for getting involved in the brigade. I think I applied to be a part of the brigade in the fall because I was gung-ho about global health and thought that there was no better way to practice global health than to go abroad and help people. Noble, right? It also came from the fact that I was seeing my peers do amazing things in their respective fields and I felt that I should catch-up and do something cool with my time. I justified it to myself because I was an EMT and planned on minoring in Spanish — I felt like I could really be useful providing patient-care in a Spanish-speaking country. Yes, some of my motivations were altruistic. But like most, dare I say all, good deeds, it was selfish as well.

I applied, got in, and was super excited. That’s when I found out about the price-tag of the experience. The group was supposed to fundraise to lower the costs, and while that helped a little, it was still a hefty price to pay out of pocket when most local volunteering opportunities come at no cost. This is a characteristic of voluntourism: think traveling abroad to volunteer.

According to a 2016 New York Times article, it’s a booming industry. In fact, a 2008 study that surveyed 300 voluntourism organizations stated that about 1.6 million people collectively spend over $2 billion annually to “volunteer on vacation.” But maybe instead of paying for a flight ticket, the money could have been better spent as a donation to organizations actively and consistently impacting change.

What I’ve realized is that voluntourism comes from a ghastly amount of privilege. It has to mean something that rather than donating the money, volunteers are packing up and setting up temporary shop in remote villages to do things that maybe locals could have done better with the right support and infrastructure. It’s almost like a new-age version of white man’s burden — suddenly upper-class individuals from developed countries are going abroad to third-world countries and impoverished communities to act as saviors for a week. Considering how well off we are, we can.

Before going to Panama, I had this naive mentality that I was going to help people who desperately needed help. When I got there and actually started speaking to mothers and brothers and grandparents, I realized that I could not have been more wrong. The people living in Punaloso and Arimae, the communities we were working in, were so happy and full of life. They had beautiful families, jobs they were proud of, and dignified elders. Yes, the medication and glasses we gave them were useful, but we were by no means saving their lives.

When it comes to all kinds of volunteering and service, I think there’s a difference between serving out of pity and serving with respect. If we recognize and let go of the savior complex and focus on understanding the communities we serve, we can serve in a way that maintains the dignity and pride of everyone involved. We’ll learn more as volunteers and the people we’re working with will also be more receptive to whatever services we can offer.

I just can’t believe I had to go abroad to realize that.

I don’t regret spending my money or spring break being a “voluntourist.” Within one week, my Spanish improved exponentially and I learned so much about what it means to practice medicine. I bonded with members of the communities and made little kids laugh while their parents got their blood pressures checked. I got to teach kids sayings about hygiene that they proudly repeated back to me and I saw a woman’s face absolutely light up when I said her new prescription sunglasses made her look like a movie star. I’ll remember the people I met and the things I learned for a lifetime.

I think voluntourism should be presented as more of an educational opportunity for the volunteers than a gift to the communities being helped. It’s a privilege and that shouldn’t be taken lightly.

When it comes to global health, there is so much value in going abroad to learn more about healthcare systems. You can’t compare first-hand experience to reading or learning in a classroom, and the perspectives gained can be applied to our own communities at home and the ways we address health equity all over the world.

At the same time, we have to be honest with ourselves and realistic about our motivations and the quality of help we’re providing. Rather than diving head-first into building latrines and setting up free clinics or whatever seems like the most obvious way of impacting change, we should first respect and listen to the communities we want to help. Once we genuinely understand their needs and their systems, we can use our privilege to lift them up in ways that are long-term and effective.