Drinking Cultures: A Surprising Tale of Unhealthy Choices (Part III)

A final comment on alcohol: Alcoholism among Paraguayans is a widespread health & social problem (that was not covered in our training as Rural Health and Sanitation volunteers). 

Spanning across ages and genders, alcohol consumption is widespread and culturally normal among Paraguayans. The most obvious demographic with a high level of alcoholism is men between the ages of 15-30, obvious because there is little cultural pressure to hide their drinking (which is to say that this demographic is culturally allowed to do as they please, openly, without serious repercussions). The majority of my young Paraguayan male friends drink daily, with weekly binge episodes. Alcohol is less-accessible to women because they are literally less-able to leave the house to go out and purchase it. My host-mom Laura (28) for example, always has her cousin Evard (21) go out and buy her a beer if she wants to drink while her husband isn’t home. At the same time, there is an older woman in my site, maybe 60 years old, who is a known alcoholic and always reeks of booze. So, there are various gendered components to drinking.

Perhaps I am too quick to suggest that alcoholism is unaddressed by our Pre-Service Training (PST). I will revise that to say that it was not directly addressed as a training topic. However, one of our main teaching tools is a program for youth called “How to Plan Out My Life,” (Como Planear Mi Vida), designed to address issues related to self-esteem, reproductive health/family planning, and short- & long-term life goals. In this sense I will be working to prevent alcoholism among the jóvenes in my high school, by helping the students to feel hope, to believe that they are valuable individuals, to believe that they can control their futures, and to help them feel motivated to improve their own lives, rather than to deal with their problems by self-medicating with alcohol or engaging in other self-destructive behaviors.

It is probably unreasonable to think that PCVs can realistically attempt to treat current alcoholic behaviors in their communities (especially given the lack of treatment facilities in the campo), but as health workers, we can at least teach young people the risks, symptoms, and prevention of alcoholism to help them avoid getting to the point of needing treatment later in life. I think future RHS-PST should include an alcoholism-prevention component.

Drinking Cultures: A Surprising Tale of Unhealthy Choices (Part II)

The second aspect of “drinking cultures” that I refer to has to do with alcohol consumption on the part of PCVs. 

I started to notice during training that every time PCTs (Peace Corps Trainees) got together to hang out during our free time, the activity always centered around alcohol, and there was no alternative group to hang out with because everybody wanted to go to the alcohol-centered get-together. (Our PCT group never wanted to split up into cliques, we always wanted to do everything all-together.) On weekends in Guazu Cora, we would sometimes do 3 evenings in a row (Friday, Saturday, Sunday) of get-togethers that centered around drinking games. A beer or two was certainly welcome after a loooong week of training, but between the Brahma beer, local Vino, and Paraguay’s main liquor caña, many of these nights did not end well for some volunteers (including me once or twice). As somebody who went through my “drinking phase” in college and was quite over it, I often found myself wanting to do other things with my compañeros. But the group was clearly set on drinking, even to the point of being determined to drink. Not attending group get-togethers was also not an inviting option, since we were all very dependent upon each other for moral and emotional support during this extremely difficult time. We needed to be with each other as much as possible. I remember feeling stuck between a rock and a hard place, needing to be with my training companions but at the same time feeling unenthusiastic about the drinking aspect of our get-togethers. 

The alcohol was a crutch for PCTs, to help us deal with the stress of training, and to help us all get along and bond. Peace Corps Training is an extremely difficult and trying time for a trainee; you are undergoing major life-changes and dealing with major physical, emotional, and psychological stressors. You do not have the liberty of choosing what kind of friends you want to spend time with, it is simply imperative for your emotional and professional health that you get along with the PCT group with whom you’ve been plopped down. Somehow, all of these factors combined to make drinking a prominent activity among PCTs.

I also suspect that there is a relatively high incidence of alcoholism among PCVs in Paraguay and world-wide. Alcohol is readily available and cheap in most places in Paraguay, and I suspect in most places where volunteers serve throughout the world. When I visited a current volunteer for a few days, she drank alcohol every day, by herself, sometimes starting early in the day, and drinking into the night. I was a little bit shocked, but when I thought about it, it all made pretty good sense. Peace Corps Service is an extremely stressful experience. A person is removed from their familiar surroundings, many struggling with the loss of their significant others, removed from their family and friends, and put in a place where everything is new, language barriers make communication difficult, and there may or may not be a good friend to turn to when you most need emotional support. We all develop various healthy and unhealthy ways of dealing with these challenges. (Everybody knows that my best friend is Nyquil...) Especially for those with a genetic predisposition to alcoholism, Peace Corps service presents the perfect stressful situation to trigger it. 

But these explanations do not make binge drinking or chronic alcoholism any less dangerous for a PCV. The health implications are numerous. The extreme stress of Peace Corps Service already renders the majority of volunteers somewhat immuno-compromised, and PCVs also often face nutritional changes and/or deficiencies that can weaken our defenses. Alcohol usage, both binge and chronic, further compromises our bodies’ ability to protect itself from illness. And for most PCVs, service is one of the worst times to be immuno-compromised; we are faced daily with foreign bacteria, viruses, parasites, and other infectious and non-infectious diseases that our bodies are already ill-equipped to handle. For example, alcohol consumption (especially binge drinking) often gives intestinal parasites (Giardia, roundworm, hookworm, etc.) an opportunity to grow and strengthen while the body’s immune system is compromised by the alcohol- most people with Giardia will tell you that the symptoms worsen during the week after a night of binge drinking.

And of course, chronic alcoholism leads to liver cirrhosis, vitamin deficiencies, and a whole host of other physical and psychological health problems. 

But in addition to compromising our health, alcohol usage in the Peace Corps also compromises the safety and security of volunteers. Alcohol consumption is involved in nearly all incidences of rape and physical assault in PC world-wide, indicating that alcohol may be a significant risk factor for this kind of crime. In general, alcohol impairs our judgment and makes us less-able to identify and deal with unsafe or risky situations. (Probably also plays a role in spread of STIs/HIV & unwanted pregnancies among volunteers, things which DO occur in the Peace Corps.)  

Furthermore, excessive alcohol usage can make us less-effective volunteers. It can impede our ability to do good work and perform at the level of excellence of which we are all capable. It can impede our community’s ability to see us as professionals and respect the work that we do. Personally, I make a conscious decision not to consume alcohol in my community, and to consume minimally or not at all when spending time with other volunteers. Although it may not be popular or typical, I believe that it makes me a healthier, safer, and more effective volunteer.

Drinking Cultures: A Surprising Tale of Unhealthy Choices (Part I)

Paraguayans, for reasons I have yet to understand, do not believe in the idea of individual drinking glasses. All drinks, with few exceptions, are shared. A dinner table of 5 people will be set with no more than 3 glasses to drink from. (If there is a drink and glasses at all…)  Además, the traditions of tereré and mate (practiced by ALL Paraguayans, EVERY day) involve passing around a shared glass where everybody drinks from the same straw. Basically, in this culture, there is almost no individual or private drinking of liquids. Almost all instances of drinking take place in a context of sharing. I cannot stress enough how deeply ingrained and prevalent this cultural custom is.

A couple interesting things logically follow from this custom. First and most obviously, there is an excessive sharing of germs. Paraguayans get sick together because they are constantly sharing germs with each other via drinking glasses and bombillas. During training, me and my entire host family got a horrible tonsillitis infection when my 5-year-old host sister came home from school with it. She was very sick, missed school, and couldn’t get rid of it for over a month. Within a week, me, my host-mom Laura, and my host-dad Carlos had the same infection. We all had to take antibiotics for it, which, by the way, can be bought over-the-counter in this country with no prescription and no instructions for proper use. AND, there was absolutely NO effort to avoid spreading it to friends or other family members. Tereré glasses were still passed around when outsiders came over to say hello, and the outsiders didn’t miss a beat when they found out we were all sick. “Oh that stinks,” they would say, as they took a hefty swig of shared tereré. “I hope you guys feel better soon!”  It’s as if there is absolutely no concept of “contagion,”and absolutely no sense of what germs are or how illnesses are transmitted. You can already see the extent and variety of larger problems presented from this whole germ-transmission standpoint. (Antibiotic-resistant bacteria, children missing school, parents missing work, and just being sick/miserable, for starters.)

Secondly, there follows an unexpected cultural rule of thumb from this custom. Drinking can never take place during eating. No drinks are ever poured until after the meal. I assume that this is because it is considered disgusting to share drinks containing backwash that might include pieces of food. Small children who complain of thirst while eating their dry, salty, fatty meals are reprimanded for being so “uneducated” as to desire liquids while eating. “Finish your food and wipe your mouth off, and THEN we’ll talk about getting some juice,” says Dad. “You need to learn some manners, cochina,” adds Mom. As a privileged guest, I am often extended the courtesy of my own glass at a meal. But it took me a couple weeks to realize exactly what was going on with the drink situation at the dinner table. For a long time I didn’t understand why my family stared at me with incredulity when I, thirsty during my meals and confused by the lack of drinks, started bringing my personal water bottle to the dinner table to drink from as we ate. I don’t know that there are any immediate health risks posed from this cultural difference, or whether it is necessarily better or worse than alternative ways of doing things, but it is an interestingly stark contrast to how we conceive of drinking liquids in our country.