Huaytapallana Wipe-out

Pura Vida (I can almost hear your response to this Auntie P)!

Like I mentioned in my previous blog, life in Carrión is getting difficult. La gripe porciana (swine flu) is showing more profound effects than I could´ve ever expected. The Fiestas Patrias (the Peruvian Independence Day Celebrations) have been completely cancelled due to the possibility of a mass outbreak with so many people in such close contact, and Doctors and Interns at the hospital have been striking on and off because of unruly work hours and conditions in a potentially contaminated hospital where one Intern was recently diagnosed after working a 36 hour shift without access to a bed to rest or a clean bathroom. Even in the market it is not rare to have vendors ask the Americans if they are infected.

It could be a lot worse, though--I actually could be infected, right?

Let´s begin with early week.

Monday I found the doctor that was to be doing rounds in surgery for my first day in the rotation. The two members of my team and I stood behind the interns as I began interpreting the first case--a man that was recovering from a burst apendix that was taken out the previous day. Suddenly, the director of surgery stormed to the bedside and looked the three of us over. He proceeded to shout over the entire room that anyone that was not a Doctor, Intern, Nurse, or patient must leave the room immediately in order to protect his patients from the swine flu. Only three people left, us. I was so confused and dissappointed with the authority at the hospital. I knew that I couldn´t take the situation personally, but I couldn´t help but feel taken advantage of when I had worked so hard over the past 3 weeks to help out in any way that I could, not to mention the money and donations that I raised in order to earn the opportunity to stand in his room.

We moped around outside for a while, waiting for our coordinator to return and talk to the hospital directors in order to figure out exactly where we can and cannot be when our friend and local medical student, Juan Carlos came and chatted with us. He has got major pull at the hospital because he is an all-around great guy. He took us to the surgery rooms and introduced me to the doctor that was heading surgeries for the day. We talked for a little while about my goals in the medical field and how my studies are going, and then he invited me to join him in a surgery--YES!

I got all scrubbed up and headed in to Sala 3 while the anaesthesiologist was finishing up. It took the doctors and interns quite some time to figure out the technology for the camera that they would be using during the laproscopic gall-bladder removal, but once they did, everything was off and running. They made 4 small incisions in the torso of this particular patient and used each of them to access the gall-bladder and attached canals throughout the procedure. The doctor used clamps to close off the connecting canals leading from the gall-bladder to the stomach, blocking any potential for more signals that would activate the gall-bladder. The most time-consuming aspect of the procedure was detaching the organ from the surrounding connective tissue and from the liver by cauterizing the tissue (approx 1.5 hrs.).

Later that day we were able to visit another orphanage where we played games with the kids to help them remember specific words in English by targeting many different types of learning. It was quite difficult as they were absolutely horribly behaved--we could not keep their attention for more than a few seconds before one was biting/kicking/hitting/yelling at someone else. Their tías did nothing to control them. It is really tough to see how these children are so destructive and violent when they have never been exposed to the things that I took for granted, like constant positive reinforcement, rules, structure, and love.

On Tuesday we conducted our rounds with our favorite doctor, Dr. Soazo--the same surgeon that took us to the mansion in Concepción to attend the party of a lifetime. He was funny and a very good teacher. The most interesting cases were a pair of paratenitis patients, some intestinal fistulas that were leaking waste from the intestines into the abdomen of the victims, and finally, we felt the stomach of a man that had stuck a pen up his anus and which found its new residence in his colon. We left the hospital early due to another transportation paro so that we could make it to lunch on time. Next, we had some medical students come to our house to help us refine our suchering technique from the comfort of our roof, followed by an awesome yoga session as we watched the sun melt into the mountains.

Wednesday we had our first free weekday of the trip. The hospital and the transportation union announced a double paro--there was absolutely no way that we could drive anywhere or see anything in the hospital. We napped and went to ´la casa del artesano,´ a collection of artisans that sell authentic Peruvian goods. At this point the majority of the members of FIMRC here were growing quite weary of the many strikes and the draining afternoon activities. Six of the girls decided to hop a bus to Lima and then fly to Trujillo for the rest of the week/weekend. The remaining 4 thought it better to stay to perform our tasks at the hospital and orphanages.

The dicision by the other girls turned out to work out terrifically for me, on Thursday I introduced myself (I was now doing rounds alone) to a doctora outside of the surgery room who shuttled me from surgery to surgery all morning! I was able to see 4 different surgeries in a matter of 4 hours--Whoa! The first procedure was an osteosintesis, where the patient was a 2 y/o girl that had a broken arm. The doctor used a power drill to place 2 large rods connecting her humerus to her ulna (?), followed by a casting. Then I saw a hernia treatment, where the doctor opened up the groin of the patient and suchured in a metal screen in order to prevent the hernia from protruding. He proceeded to suchure the woman´s abdomen, followed by her skin wound. The third surgery was a ´legrado´. This was performed on a young woman who had had a miscairrage at 30 weeks. She had already passed the fetus, but needed to have her uterus thoroughly cleaned in order to prevent a horrid infection or possible death. It was incredibly violent and looked extremely painful as the doctor literally scraped her uterus, but it is still far better than the alternative. Finally, I was able to watch one of the procedures that I had wanted to see most--a caesarean section. The procedure went very smoothly, and the epideral that the patient had had enough soles to pay for really helped her out. The woman required a c-section because she was having her second child in less than a two-year span--potentially putting the health of her and the baby at risk. The doctors thought it best to perform this immediate procedure to avoid such risks. It seemed pretty sad and anticlimatic when the baby actually emerged from the womb, though. The mother was not even conscious to great the new infant into the world--it was painfully impersonal, but I cannot be objective about child birth in any way due to my obvious lack of the ability to squeeze one out myself.

I came out of la sala de cirugia absolutely exhausted, and my teammates had already gone back home. I walked back to the house and grabbed a delicious juice sack (jugo surtido--piña, papaya, fresa, naranja, lúcuma, and chirimolla) and took a power nap. That afternoon we had a break--we walked into town and bought some bargain CDs/DVDs. I bought a Picasso documentary done by the history channel, Planeta Tierra (Planet Earth!!!), and a collection of Michael Jackson videos for 6 soles! They are so in love with MJ here, I haven´t gone a single day without hearing ´Beat it,´or ´Billie Jean,´ blaring from a passing taxi. So cool--the King lives on.

Friday was our friend Anna´s last day at the hospital. We were all very sad to see her go as she was a HUGE asset to our team in providing motivation and moral support when we were weary. Fittingly, there was a pig roast at the hospital for the employees that same day, and Dr. Soazo took me to feast on this plato típico (traditional plate) after our rounds had commenced.

That afternoon we traveled to the teenage girls orphanage in town to teach lessons and perform skits pertaining to respect and techniques to proactively manage emotions. We then went to the teenaged boy orphan home to continue with our English lessons--body parts were the theme.

Finally the weekend, and the trip that I had been looking forward to for weeks--our hike up the snowy mountain peak of Huaytapallana! We woke up early on Saturday morning, piled on the layers of clothing for our trip up the only snow-covered peak in the Mantaro Valley, packed a pile of sandwhiches and fruit, and headed off to pick up a few of the boys from the teenaged boys orphan house. The base was about 2.5 hrs away, but the trip was full of incredible scenery: llamas, alpacas, mountains, rivers, bridges, etc. We stopped at a small tienda before arriving at our main stop to grab supplies for the traditional ritual: chocolates, a pack of cigarettes, a bag of dried coca leaves, a water bottle of sugarcane whiskey, and some lemon candies. The last stretch was only a few kilometers long, but it took about an hour to drive as the path was littered with treacherous potholes and questionable (to say the least) bridges. Luckily our driver had pinpoint accuracy, because some of the bridges were literally 2 boards, each about 6 inches wide--whoa.

We reached our starting point and set out on the trail with our guide, Henry, who has accompanied us on every journey thus far. The trail was not a trail, rather a steep and slippery mountain covered with ice and snow that we side-stepped our way up until we reached a path of stepping-stones that took us to more of a trail. Each step was exhausting as we were starting from a height of 15,000 ft. and traveling higher--not much oxygen up there. I was sucking air pretty well for the entire trip while the boys from the orphanage were sprinting through the path and hopping from rock to rock with ease. Stupid sea-level hemoglobin count.

After about 45 min. of climbing, we reached the point where we would perform our ritual to pay homage to ´La Virgen de la Nieve,´(the virgin of the snow). We began by each grabbing a handful of coca leaves and sorting through them to find the absolutely perfect leaves with no rips or imperfections. Each perfect leaf represents a future child--smaller leaves represent chiquitos (little boys), while the larger leaves represent girls. I am apparently going to be cursed with poor luck and little prosperity as I accumulated 2 very questionable leaves--a boy and a girl. We found a hole in the Earth where we started our ceremony by piling all of our leaves together after wishing happiness, health, and prosperity on our children. We then each added a small lemon-flavored candy , followed by the lighting of our cigarettes. We each took a single puff from our cancer-sticks and made a wish for our future before lining them in the hole above our children. We added a single piece of fruit (granadilla) and a chocolate bar (sublime) to the pile before breaking out the sugar-cane whiskey. Henry poured each of us a single shot, and poured another over our ritualistic pile. He then filled up and entire Dixie cup for me and asked that I make a wish on behalf of the group before downing the searing juice with a gulp. It was really quite a spiritual experience. The boys covered our hole with a large boulder and then built the traditional tiered rock building on top of the boulder before I sizzurped on the whiskey. Immediately after I downed the stuff, an enormously stiff and steady wind blew down from Huaytapallana and over our group as we marvelled at the site. I felt like I was on another world--completely calm in mind, body, and spirit, and surrounded on all sides by pure wilderness. Whoa.

We continued on our journey for the snow cap with fresh minds and rested (and significantly looser) bodies. After about an hour we reached our summit--an enormous boulder feet away from the snowy cap where we sat and nibbled on sandwhiches and chocolate bars. Doña Elena was nice enough to prepare enough for each of the boys to share in our feast. After eating, we scaled up the slippery ice face of the mountain to play in the snow for a bit=snowball fight. We met some really chill folks up there from Melbourne, Halifax, and Barcelona that were trying to volunteer in the local orphanages in Huancayo but were being rejected religiously (they need a coordinator like Elena).

We headed back down the mountain and toward the turquoise lagunas that we passed on the way. There is a chain of about 6 different natural spring lakes (not hot springs, might I add) that are each a different color on the Blue-Green chromatic spectrum. We approached the most vibrant of the 6 lakes--the most incredible site that I have yet witnessed. As we came upon it the sun was shining brilliantly on the snowy peak and on the emerald water, but as we passed along the edge a thick cloud of fog billowed across the surface. We came to the edge of the water to rest and feel it to make sure we weren´t delirious. I must´ve been feeling the effects of the fire-water at this point--déjame explicar. I perched myself on a rock sitting in the lake and began to inch closer and closer to get a few handfulls to refresh my hot face. All of the sudden, my hiking shoes caught a slimey spot on the rock and I slid feet first into the water! I stood up to my thighs thoroughly confused and surprised for a moment before hopping back onto the rock and dropping my head in shame. Really? Yeah, really. It wasn´t so bad though, kind of refreshing for my steamy feet, and I definitely wasn´t about to let it ruin my trip. Naturally, I decided that since I was already half-wet, I might as well enjoy the water all of the way! As if a sign from the Virgin of the Snow, the sun popped its face from behind a cloud that couldn´t have been 50 meters above us and burned up every ounce of fog that covered the water. I stripped down to my skivies and hopped back into the water, took a dive, and proceeded to backstroke through la laguna (who knew that pools water got colder than Allegan High School´s pool?). It actually turned out to be one of my better ideas, contrary to what my conscience was telling me--my buddy Chris even joined in the fun. Everybody that passed must´ve thought we were two of the craziest gringos they´d ever encountered, but two Limeans thought we were pretty cool, and wanted photographic evidence to prove it. I then dried off with the extra sweatshirt from my backpack and we headed back on our way with some new found energy (thank you adrenaline).

The end of the hike (1.5 hrs remaining) was to be taken at double pace as the sun had set and the cold was setting in quickly. The shadow cast by the mountain was absolutely frigid and the race to the car began. We were literally counting down the kilometers until we could rest our aching legs in the van. We knew we´d arrived when we spotted the baby vicuña resting outside the restaurant where we´d began our journey. We all slumped into the car and endured the rocky ride back to Huancayo.

I hope that you all enjoyed this weeks edition of my blog--stay tuned for updates from my last week in Perú!

Paz y salud,

Nate

Otra vez salgo del valle Montaro

Howdy friends! I`m sitting in the internet café in the mid-afternoon for the first time since my journey began, and it seems that this may be a new trend for me. The transportation `paros` are now being matched by strikes at the hospital (of all things) as the doctors fight for pensions and increased wages--they only make the equivalent of about $10,000 a year.

Our battle to be accepted in Carrión is becoming more difficult as well, as various specialty directrors frequent morning rounds and demand that we leave the bedsides of the patients so that we don´t infect them with the swine flu. Besides being turned away at orphanages, we even feel the effects in the streets as the people of Montaro Valley cover their mouths and noses with scarves and sweaters as we pass by them. My stay here may be coming to a very anti-climatic end.

It hasn´t been all bad though, and I am still learning so much. There is just as much to learn in times of trial as well as triumph--and I am lucky enough to be experiencing both.

I spent all of last week in Internal Medicine, learning about tons of tropical diseases that are seen solely in Huancayo from patients escaping the rainforest in search of aid. We visited patients with Lushmania (again, me falta spell check)--a rare parasite that burrows under the skin of the victim and eats away the flesh as it spreads all over the body, Lymphoma, Typhoid, Tuberculosis, Sepsis, Pneumonia, Malaria, Intestinal Fistulas, Cancer, and many failed suicide attempts. The method of choice in the valley is rat-poison, which destroys the esophogas and stomach, leading to ulcers, internal bleeding, and a probability of cancer in the future for those that survive. The second favorite method is sleeping pills--which tends to be a very poor choice as it almost never kills. Two different women were send to the hospital after downing 80 and 60 pills, respectively--a binge that did nothing but result in an extended nap and a horrible case of constipation.

Rounds are much slower in Internal, but there is so much neat stuff to learn about different treatments for certain ailments. Por ejemplo, if you give a very burnt piece of toast to a patient that has consumed poison, the charcoal acts to attract the toxins so that it can be excreted from the body. Doctors in Perú need to be very creative with their techniques due to a huge lack of technology and medicine--I like it though. Problem-solving is clutch.

Throughout the week it became increasingly more difficult to access the orphanages, teenaged moms center, the older boys orphanage, etc. If it weren´t for our smooth talking FIMRC guide, Elena, we would have had much more free time this past week.

We did manage to get into the orphanages in time to provide fluoride treatments to over 100 kids (they have no fluoride in their city water, and it shows. I saw one kid with a full set of teeth, and even then, she had 3 that were completely black and looked as though I could flick them out of her head). We also visited a local campo (less than 60 person town) where I unloaded a large chunk of my medical supplies and we gave a demonstration to the children about how to avoid spreading virus´such as swine flu, and also consulted local adults about how to deal with problems such as depression, arthritis, asthma, and back pain. For lack of medicine, the best that we could do was offer advice about how to maintain a healthy body and mind through stretching, physical exercise, deep-breathing exercises, healthy communication with friends and family, and avoiding alcohol. We even provided English lessons to the orphanages and teenaged moms home--they are dieing to learn as they see it as their only way out of poverty. There is a lot of truth to it, too. The Peruvians that speak English are awarded the higher paying jobs and more prestigious positions--it is such an asset here.

One of the highlights of my week was going to el cine with the teenaged boy orphan house and watching the new Harry Potter movie--all in Spanish. It was a very different experience hearing Harry speak in a latin accent instead of English, and listening to the attempted translations for words like `bloak´ and `wanker.´ It was incredible, nonetheless, and I think the boys really appreciated the treat.

Oh, and we also learned how to take vitals and to suchure a wound, although I am not sure how comparable a sliced sponge is to real laceration--ni modo.

One of the most informative visits that my small team (Heather, Jessica and I) made last week was to the little known family planning center of the hospital. After seeing so many women in the low teens giving birth for the first, second, and even third time, we wanted to know what sort of services they provide for birth control in such a Catholic country. We were extremely surprised to discover that the center offers a variety of birth control devices, and all for FREE! Birth control pills and patches, condoms, a birth control shot, dental dams, etc. are all part of the program along with family consultation that provides advice for how many children to have, when, and methods for getting pregnant. We asked the woman running the facility how it was possible to provide so many methods of birth control in a nation whose prominant religion outlines the use of such devices as strictly against God´s will, and we received a very concientious and thoughtful response. She explained that it is very simple: the government can either intervene early on in the process and protect the health of these young females before their health issues become too cumbersome to deal with, or the government will be forced to pay loads of money to support these families and health bills while the family with six or seven children struggles to survive. It seems to be a simple matter of prevention--preventing young mothers from becoming unhealthy and preventing huge government support for low socioeconomic households. It is interesting though--the office has been empty each and every day that I have been at the hospital. I wonder if the Católico aspect of the culture has created a certain amount of stigma against using such contraceptives, and thus, the resources are going untapped. Que lástima, tiene la opcíon de prevenir tantos asuntos. I think my next mission will be to promote such services in order to let young women know how important and normal it is to utilize such resources, especially when so many teenage pregnancies are a result of familial rape that demoralizes a family and the lives of everyone involved.

As a side note: the previous President that ruled Perú through the 90`s and is now serving a jail sentence for embezlement and aiding in the killing of thousands of Peruvians (particularly through the Shining Light, a Maoist group that decimated the Montaro Valley), Alberto Fugimori conducted an involuntary vasectomy program in rural Perú. He hoped to prevent government support by rural families that were frequently spawning too many offspring by sending doctors to various homes and performing vasectomies on men aged 20-40 years old. These men had so much life to live and so much potential to make families--the effects are still seen in the rural communities in the Montaro Valley where few to no children are being born in these campos.

Finally came the weekend, and the team made their way to the Amazon Rainforest at 6 am on Saturday morning with our trusty guide Henry and his co-pilota and daughter, Myli. We set out across the Montaro Valley and up the mountains that encircle it. After reaching its highest point and stopping for a photo opp. and a short vicuña search (part of the llama and alpaca clan that make their home in the highest of mountain forests) we descended from the 13,500 ft. summit to a warmer and wetter climate. On our way down we passed through some of the most beautiful and quaint villages built into the sides of the mountain with farms that layer down for hundreds of feet and resemble multicolor steps leading down to the commerce centers. As the sun became more intense we shedded our layers and rolled down our windows bit by bit until we could smell pure green--if green ever had a scent. It was incredible--it simply smelled like pure wilderness--wet leaves and rivers so crowded together that not a single leaf could be added to the dog-pile of vegetation. We were finally here--La Merced.

La Merced is one of 3 Peruvian towns that border the selva, and has a rich agricultural economy that is based on coffee, tons of tropical fruits such as oranges (naranjas), pineapples (piñas), bananas (platanos), coco (coconut), Guanábana (no equivalent in the states), grapefruits (toronjas), papayas (lo mismo), as well as meat from the various indigenous animals to the area; cuy (guinea pig), giant cuy, Zamanya (wild forest boar), Doncella (river fish), Trucha (trout), and Capypara (another big looking guinea pig), and many other species of fish that I have forgotten as well.

We passed through La Merced where we would be staying the night and plunged into the forest. After driving down a single-laned dirt road (it would be a stretch to call it a road--more of a trail with rocks) we stopped at an orange orchard where we changed into our bathing-suits, lathered ourselves with deet, and set out for our first hike. We were sweating buckets and gasping for breath when we reached our catárata (waterfall) destination that was virtually untouched by anyone that doesn´t speak the native Quechua. All along the hike I was in awe of the giant trees and countless plant flora species--simply mind-boggling. The waterfall was about 100 meters high--the measurement felt more than accurate when standing at the collision point at the base of the fall, where the water pounded like a sand-blaster on your skin. I found a wonderful little reprieve from the pressure behind the waterfall where I could hide out and enjoy the sounds and smells of the natrual reservoire. I had to be extra careful not to pee in the water, however, as there are species of fish in the pool that are attracted to a stream of urine and follow it up the culprits urethra where it establishes a home. I don´t know if this tale is accurate or if it was Henry´s way of keeping us from polluting such a natural and pure water source. Whichever, it was enough to scare me enough to hold on until I got out!

We took tons of pictures and played in the water for a while before heading back to the orchard where we had left the van. When we arrived we were so exhausted that we layed under the orange trees and nibbled on naranjas that had fallen to the ground--describing the flavor and the amount of juice would be a disgrace to the true perfection and freshness of the fruit. I almost put myself into a fruit overdose with 3 oranges back to back to back before we headed off for lunch. We stopped at a nice outdoor restaurant that overlooked an Amazon feeder river and binged on tropical juices, fried plantains, yucca, and fresh river fish until we couldn´t eat another thing. I had a feast of chachamanka de doncella (fried Doncella fish) that was fit for a king for the grand old price of 20 soles (about $6.50). En serio?

Next we visited an indigenous Amazon tribe that works to preserve their native culture and traditions. I forget the name and the language, but it was truly unique--a self-sufficient community that earns money by developing seeds and stones from the river into beautiful jewelry, wears tribal clothing and face paints, and even keeps domesticated lemurs, dogs, jaguars, and anteaters for pets! Am I still on planet Earth? After buying some gifts for my family we visited the local coffee manufacturer that specializes in alcoholic coffee drinks, chocolate covered coffee beans, and tropical marmelades. Everything was delicious.

Finally, we returned to La Merced where I bartered with the owner of a hotel for a clean (I am using very loose terminology) and cheap (except here) domicilio to stay for the night. 8 of us settled snugly into 3 rooms for about 20 soles per night (again, about $6.50). We scrubbed off some deet, got dressed, and headed out to explore the city. We traveled through some incredible open-air markets with the freshest fruits, vegetables, and meats before settling into a nice restaurant. We snagged another bulbous meal (I ate a plate of pigs heart, chicken, and cow stomach with rice and papaya juice--while in La Merced...) before grabbing some motos to take us to the local discoteca. The ride to the club was interesting, to say the least. The cars are about 3 feet by 4 feet with a bicycle tire in the front and 2 car tires in the back, and are covered by a loose tarp. I had half of a cheek sitting on the seat and my arm clutching the support bar so that I would make it the entire way--sooooo cool.

The club was so neat--fashioned with all Amazon decore, it was 2 stories of wood and tree decoration with a huge dancefloor and an upper balcony that looked over the river. Being the only club in the city, age range varied from 13 to about 60 years of age. We stayed for a few hours and then caught a moto home (unsurprisingly scarier on the way back) where we passed out hard in our beds until morning.

We woke up early that next morning (6 a.m.) and grabbed some breakfast at a café overlooking las montañas cubiertas en neblina (fog covered mountains), as you can see to the left. We left our desayuno and headed for the jungle.

Our first stop was to the canyon and waterfall, Vela de la Novia (it is a rough translation, but it is the area of a woman that runs from the base of her head and down her back--where her hair falls), which was simply breathtaking. We took pictures and hiked for a few hours before going back to the van for our main attraction.

We reached our new hiking post after traveling through some freshly rock-sliden trails and set out for the catáratas. Traveling along the river was unreal--giant trees, tons of vegetation, and the occational jungle rat spotting. We sipped on coco (coconut) milk and then broke it on some rocks to eat the meat inside--so tastey. When we finally stumbled upon our spot my mouth dropped and I almost lost my coconut--an enormous waterfall with a luxurious and all natural grotto that put Heffner´s to shame. We climbed boulders, jumped off of the falls, and frolicked around in the water for a hours--puro paraíso. I felt like I had found the Garden of Eden and I couldn´t open my eyes wide enough to take in all of the incredible details and sights that surrounded me.

We headed back to the bus feeling absolutely tranquilo (you can guess what this cognate means) and at peace with everything that surrounded us. We arrived back at the van and ate some piña filets before heading back to La Merced for lunch. We ate at another beautiful open-air restaurant overlooking the river. I drank about 5 glasses of the best guanábana juice and ate another fantastic fish filet with fried plantains for about 5 bucks.

Then we traveled to some local animal reserves that take in different species of animals from the forest that are hurt or damaged by human contact until they are healthy enough to be released into the wild. It is a really neat place with an extraordinary array of animals. We also went to la casa de las mariposas (butterfly house), where we learned about the different stages of the butterfly life-cycle and the native species to the jungle, and finally to a bird sanctuary where we viewed some exotic and stylish looking pájaros.

It was time to head back home, and we set sail for Huancayo--a bus full of sleepy gringos that oscillated between sharing frat party stories and snoring.

That´s all folks! I hope you enjoyed this weeks edition, and I will be updating you on next weeks happenings in surgery!

As a sneak peak, things start to look up at the hospital as some of my friends decide to travel outside of the city.

Besos y brazos, paz sobre todo el mundo

Nate

El fin de la primera semana

I´m sitting in the internet café at the end of my street on Saturday morning after a nice yoga session atop my roof, which has an ineffible view of the city and is surrounded on all sides by mountains. It´s tough being me.

A lot has happened since my last post, I hope that you are all in for another lengthy read.

Wednesday morning we all woke up extra early for work, 6.45, due to the ´para´ of transportation throughout the city--fighting for an increase in wages and benefits. Strikes like this happen a few times a week, and when they do, the volunteers must make the 50 minute walk to the hospital in order to get to work. We must´ve been quite a site. Picture this, a group of Americans in white lab coats and scrubs walking almost single file through the narrow sidewalks as the sun rises over the mountains. There was a lot of staring.

When my group arrived in the obstetrics sect of the hospital, we introduced ourselves to the doctor that would be doing rotations that morning. He was a tall Peruvian man, about 35, who was enamored by US culture, history, and medical practices. His first statement to the nurses and interns that were following him that day was that the US is a wonderful land of immigrants, where people from all over the world flocked in search of a new life and a new opportunity to make a better life for their family. A very refreshing view to witness from someone outside of the states.

He was so helpful, and it was really nice to be able to ask questions so freely, and to also be asked so many questions. The most surprising part of the shadow was his technique in assessing infection in the women. He is what we refer to at the hospital as a ´sniffer,´ and he liked to share this technique with me especially. I will not be elaborating on this because I don´t know how to further choose my words while keeping you all interested enough to continue.

I was then able to barter my way into the delivery room ( a 12 x 12 room with 2 delivery tables and a radio) to witness my first birth! I am still shocked at how hands-on they allow volunteers to be, especially after just a few days at the hospital. The mother, an 18 year old from the jungle, had an absolutely gigantic stomach--the doctora delivering the birth ordered me to press firmly on the top of her baby-bump in a downward direction to force out a ton of extra water that was present. About a liter of liquid splashed out as I kept applying force. The delivery actually took longer than I, and even the doctor, expected. There was so much confusion during the entire encounter--it was so hectic. The new mom grabbed my hand and squeezed me so hard during the entire thing--it was so hard for me to think of things to say to her as I am sure she was absolutely livid with man at that point, and having some young boy chirping encouragement at her was not at all what she was looking for. This is where things get a little graphic, skip to the next paragraph if you have a weak stomach. She finally started to crown, and, knowing that the infant was over 4.7 kg from the ecography, the nurse used a sharp pair of scissors to make an easier (about 3´´ easier) passage for the baby´s shoulders to pass through. At this point I seriously feared for the health of my hand and ears. I cannot even imagine how much pain she must´ve been going through with NO medication or numbing cream to soothe her. All that I could think about was how badly I wanted that baby to come out crying and healthy. It came out and was accomplanied by an explosion of about 4 L of water that shot all over the doctora, completely covering her with liquid and leaving a 2 inch layer over the entire floor. A lot of blood followed and the infant was silent for minutes. The nurses worked rapidly to clear the mucous out of the nasal and oral passages of the baby, and it eventually started to cry. The cry was very strange--it sounded like it was drowning in its own mucus. The baby was eventually sent to Lima for reconstructive surgery--it was lacking an anus and a fully developed esophogas, blocking the drainage of liquids from its throat and lungs. After finally delivering the post-birth, the doctora searched the placenta for completion, and eventually had to go back inside to pull of parts of the membrane that were not released before suchering her back up. Pieces of the membrane that remain inside of the woman can cause dangerous infections and even death.

After the hospital, the crew went to Aldeo Rosario to teach some English to the orphans. We started out by helping them with their left-over homework--my job was to help my little buddy (7 y.o Luís) conduct a science experiment with materials around the orphanage. Needless to say, options were very limited. I called upon some creative genes that I am still not sure that I have and we put together a test that examined the requirements for a fire to remain burning. We found a candle, placed it on a plate and ignited it. We surrounded the candle with water to show that even in close proximity to water, fire can burn. We then placed a glass that covered the entire candle. Within moments the flame was extinguished. My pal concluded that fire cannot exist without the presence of oxygen to fuel it. We also put together the old, seed in a moist towel in a bag trick, and placed it in a sunny spot in the home so that he could see it grow a little bit each day. He loved science.

All of the kids in the home are so eager to learn. Their ´tías´ do a very good job of teaching them as much as they can, but they really value our time with the kids. Apart from providing a much needed positive male influence, English provides them an enormous opportunity within Perú to advance economically and socially, and even provide the chance to leave the country to seek higher wages elsewhere. After the lessons, a the monthly birthday party was held for the kids that had theirs in June. We ate cake, drank Inca Cola, and danced the Cumbia and the Santiago. I thought that I was going to lose my shirt when I told the girls that I had to leave, ´´una canción más, por favor, por favor, por favor!´´

From there, we traveled to another orphanage--this one was more of a half-way house for boys to live in a house with 10 other boys and an older male father figure that acts to teach them respect and how to act proactively in society before they get jobs and leave the home. We had a meet and greet with the boys (aged 14-18) and played a few English language games before heading back for dinner.

July 9, 2009

Today we returned to the birthing room to an even more hectic, but more positive environment. Two mothers were delivering simultaneously--each yielding healthy infants, un varoncito y un mujer.

We then traveled to a new hospital, EsSalud--a hospital for patients with health insurance (i.e. government jobs). We visited the Psychiatric ward where we met with a wide array of patients, most of which were extremely positive and happy to see us. We directed a yoga session to teach the patients how to positively deal with their negative emotions in a conductive manner--everybody was very relaxed and happy, not to mention well-stretched. We then practiced our new dance moves with the help of a very special patient, we´ll call her Yoli. She loved to dance and sing, and led us in rounds of salsa, cumbia, and santiago until we could hardly stand.

That night, we went to the centro comercial (mall) to check out some shops and grab a bite to eat. Everything was quite inexpensive and extremely clean.

July 10, 2009

My 2 teammates and I followed our favorite new doctor around Obstetrics again today--visiting with patients and checking on the progress of women recovering from their birth. His approach to medicine is so admirable--although he is obviously very limited in the types of diagnosis that he can assign due to a lack of technology and medicine, he brings an extremely up-beat and relaxed personality to each hospital bed that he visits. He makes every person in the room light up and laugh, which can prove to be the next best solution to many physical ailments, in my opinion. One cannot underestimate the value of optimism when things get difficult. Perserverance and fight is, in my opinion, more dire to the survival of the patient than even the newest pharmaceutical. This type of motivation could be all that a patient needs to shine some sunlight on a very dark situation.

We finished our rounds in the regular care room and had just moved into the high risk area when one of the nurses rushed into the room screaming for the doctor. We scurried back to see the woman with whom we were just talking convulsing violently in the bed. The nurse grabbed the crying baby before it was hurled from the bed while the doctor gently held the woman´s head to the side. This was the second post-clampsia for the new mother. The doctor pointed out that these sort of seizures are quite common among the lower class women in Perú, for lack of a well-balanced diet (especially potassium), which leads to issues like this.

The girls and I then traveled to the HIV center, a separate building about one hundred yards from the hospital. Heather, the post-back that is in the process of applying to medical school (her top choices are Duke, Yale, and John´s Hopkins) works in an HIV advising clinic, and so, had a lot of questions to pose to the director of the department. Heather pointed out that in the US, the newest demographic targeted by HIV is that of college females. This is due to the exclusive use of birth control during sex, which does nothing to prevent against STI´s such as HIV. The director indicated that, in Perú, young males are the predominant target, and that alcoholism, of all things, was the main culprit. The over-use of alcohol among kids in their early 20´s results in lowered inhibitions and decision-making abilities, which in turn can lead to unprotected sex with multiple partners. Which brings us to the meet of this problem--education. We (the world) need to make a valiant effort to increase sex education to stop this rapid killer. Through my scholastic career, the threat of AIDs has been carefully avoided because it is too taboo and uncomfortable for people to talk about. The truth is that knowledge is power, and there is no way that these statistics can be reversed if the issue is not brought to light. Even in an extremely traditional and catholic country like Perú, programs are being initiated in religious schools in order to promote sexual health education at all levels--more than can be said in the US.

After lunch, the team went to visit a center for teenaged moms where we taught them games and songs that they can utilize to bond with their children. The mothers and their children were so happy to learn the games, and were especially attached to the positive male figures in the group. The kids have no male--father, grandfather, mentor, in their life, and are ecstatic to encounter some that show any interest in them. It is really hard to see this group with such a negative image of what a man is. It is impossible to blame them, of course, but you just hope that men in this situation would start to step up and be real men--it´s time to grow up and take care of yourselves and your responsibilities, not to mention to deal with the consequences of your actions instead of forgetting them as if they never happened at all.

Finally, we returned to one of the orphanages that we visited earlier on in the week. We were surprised to learn that no one was allowed to enter the facitities due to the H1N1 scare--the hospitals simply do not have the resources or staff to accomodate the potential for a massive break-out that could occur in a school or orphanage. For this reason, many schools in the area are being shut down within the next week in order to avoid this circumstance. Our guide, Elena, luckily was very close with some of the workers of the ´aldeo,´ and we were allowed to play sports with the kids outside as long as we did not enter into any of the buildings. Desafortunado para pensar que la educación es la primera cosa que se sacrifican por falta de ayuda.

June 11, 2009

It´s finally the weekend! We were all so exhausted after non-stop visits and patient care that we indulged and slept in--´til breakfast at 8.30. We had the usual, rolls with white cheese or jam, a granadilla, and maté--a type of tea brewed from the leaves of the coca plant. They drink it with almost every meal.

I relaxed for most of the day; yoga, internet café, lunch, and then our group was invited by the head of surgery to visit his friend, the head of obstetrics. We were in the center when he called us, and we met him promptly before grabbing some taxis to Concepción (named for the Immaculate conception of Christ). We pulled up to an enormous Spanish colonial style house where a speaker (the owner of the house and the head of obstetrics) was giving a speech about the recognition of his home as a national monument for its use during the Peruvian-Chilean war in 1882. The speech was given in an open-air veranda that was surrounded by decadent wood railings and stairwells (I want to say cherry)that led to one of the three stories of the house. The Who´s Who of Perú were all present--sipping bubbly and nibbling on sugared rolls (a Concepción signature) in the finest dresses and suits that I have seen during my stay. We were SO underdressed after being dragged out of the center. After the speech, the doctor that we came with led us to meet some of the other doctors present before taking us through the house and into an exotic garden where we were fed a 4-course meal and champagne while being serenaded with an authentic Peruvian band that played the classis Santiago and Cumbia style of music. After finishing our pork medallions in huancayino potato and carrot sauce with rice towers, we went into the dance hall where we learned some moves from the guests. What an experience. I am still awestruck by the entire night.

When we returned, we went to the discoteca Taj Mahal with our group and some interns from the hospital. They played the most eclectic combination of music--everything from Samba, to Cumbia, to Salsa, to Santiago, to Mikey Jackson, to Britney Spears. I love latin dancing, it is so much more fun than the grind-fest that dominates the clubs in the states. It is actually a fantastic expression of personality and rhythm--I dig.

Sunday July 12, 2009

We woke up early again to meet our driver, Henry, who took us on a tour to the cities surrounding Huancayo. First we visited San Gerónimo, a town famous for its silver artisans. The girls were all ecstatic to barter their way to 6 pairs of earrings for only 65 soles (about 21 bucks). We then went to see Henry´s campo where he works to raise crops to sell in the market. He grows trigo (wheat), maize, and patatas, the crops that predominate Perú (minus arroz-rice).

After visiting our campesinos livlihood we traveled to Ingenio, aka Trout Town. The town is nicknamed ´ingenious´ because they spawn the most delicious Trucha (trout) in the world. The fish is also said to have a profound effect on mental development. We each shared a few plates of ceviche, a Peruvian specialty which is basicly raw, pink river trout dowsed in a tangy lime juice. It doesn´t sound fantastic but it may honestly be the most delicious thing that I have tasted. We also had another distinctly Peruvian plato, pachamanca. It is actually a technique more than a plate, but it is one where the meat, potatoes and onions are all cooked slowly in an underground hearth. This particular combination was oveja y cerdo (sheep and pork) and was very tough, but wonderfully spiced. Finally, we all decided to taste cuy (guinnea pig) which is a Peruvian delicacy. It was covered in a strange red peanut butter sauce, but actually was quite tastey. Check out the pictures below.

Finally, we stopped in the famous textile town called Huancana where they specialize in creating renowned clothing, blankets, tapestries, etc. out of llama and alpaca fur. It was really neat to watch their technique and to learn about the all natural dyes that they use--anything from dead insects that turn maroon upon squishing to a sunny yellow that is a result of a local flower.

Finally, upon request by my mom and auntie P, here are the pictures of my humble abode for the next month. We have 4 bedrooms and 2 bathrooms between 10 people. We live in a collection of homes, as our bldg. is separate from our Doña and her extended family (sons, daughters and grandchildren).

Colorín, Colorado...

Al llegar--Días uno, dos, y tres

What a first day.

I arrived safely in Perú after a pleasant 8 hour flight and met up with my new co-workers/roommates/friends: a group of ten kids from all over the U.S. Along with my compañera from U of M, there is a duo from Rutgers, a post-back from Berkley, a girl from Boulder, a girl from Cornell, a boy ( my new roomie) from Kansas City, MO, a girl from a small school in Texas, and one from LA.

We hopped a bus for our Hostel in Lima, and by 2 am we were all sitting in Cafe Haiti muchin´ on some South American goodies--chicken stuffed avocados that were the size of my head, shish kabobs, chicken and potatos, and for the less adventurous, papas fritas (your dependable french fry--always a classic). We all went home to our hostel in Miraflores (a city within Lima) and melted into our squishy bunked beds.

The next morning we woke up early, ate a delicious breakfast provided by the hostel--espresso con crema, naranjos, and bread with cheese. I even caught a glimpse of the epic Wimbledon final where Federer eaked out his 16th and record-breaking Grand Slam win over Roddick 16-14 in the 5th. I repeat, epic. I unglued my eyes and went on to explore some of the rich culture in Lima with my compadres. We visited a catedral that was simply exquisite and packed (it was Sunday morning--imagine that), and then walked through the center and talked to local artists about their works. They all really preferred to use olio (like acrylic paint) to give exceptionally vibrant colors of women with their faces burried working in the fields, the sun rising over the Andes Mountain peaks, or city scenes: each was stunning.

We returned to the hostel in time to check out and hop our bus to Huancayo--a topsy-turvy ride through the narrow mountain passes on our 8 hour ascent. My scepolomine patches did me well. We arrived at our new home around 10 pm to a freshly cooked chicken, vegetable, and rice stir-fry prepared by Doña Elena. I unpacked all of my things and headed to bed--ready to wake up in a few hours for breakfast at 7.30 and our first day at Hospital Carrion at 8.00.

I slept great during the chilly night (it is winter in Huancayo with no internal heating, but it is not nearly as cold as I had planned, probably about 50 grados at night and 75 in the sun during the day.) We ate some delicious fried eggs, rolls with cheese, and pineapple juice and headed to work equipped with some scrubs, lab coat, and hand-sanitizer. (here is a photo from my rooftop at 7.30 in the morning. Dad, I thought that you would dig the golden light).

We arrived at the hospital, which turned out to be an actual hospital instead of the Pediatric clinic that I had expected--all the better as there are so many different sects in the hospital that we are able to rotate to a new specialization each week. This week I am scheduled to direct 2 other girls in my group through OB-GYN (I am one of two people that speaks any spanish). In the coming weeks I will be aiding in pediatrics, internal medicine, and surgery. The girls and I (one from Michigan and the other from Berkley) met the doctor that heads the Gynecology department who was doing his rounds while teaching and quizing the medical students and nurses about each individual case. He spoke very clearly and with spectacular grammar so that it was very easy to follow, interpret for the two girls, as well as ask plenty of questions to him directly. Before I knew it he was only quizing me about different symptoms, causes, and also techniques and beliefs about medicine in the states. It was nerve-racking with so many students but I felt very lucky.

After rounds were over the three of us met with him personally to ask further questions about his job, techniques, and common conditions/illnesses that he sees in the hospital. The biggest issue was obviously sanitation and lack of potable water for woment to drink in order to filter out their system and keep everything clean. He even showed us a fetus from an illegal abortion (as are all abortions in Perú) that was at 13 weeks and in a cut off 3 L bottle. The mother, a 15 year old girl from the rainforest, had eaten some special ´hierbas´ to stop the pregnancy. Privacy does not exist here--doctors will often talk about very personal issues right in front of the patients, such as their probability of dying, their sexual promiscuity, and reasons for infection. It gets pretty graphic to say the least.

After following some doctors in the womens surgery area of the hospital while they cleaned the surgery sites (mostly from exploded pancreas that had infected the entire cavity), we returned home to another incredible meal.

We took a small siesta after lunch and then headed to the local ´aldeo´ to play with the orphans in the south of Huancayo. The campo resembled a jail with huge walls and gates keeping the boys in--this image was immediatly dissolved when the boys (ages ranging from 4-17) came running towards us with smiles gleaming from ear to ear. They were so affectionate and loving--they only wanted to hug us and hold our hands. Our group split up: some took care of the infants by feeding, singing, and changing diapers, some to the adolescent boys to teach english and respect for others, while I worked with the kids from 4-8. We colored in our coloring books and played catch before I led a group of boys out to play a game of soccer--it was around this time that I realized how unadapted to the altitude I really was! We moved from soccer to catch and then to tag before the boys were called in for dinner and we parted to do the same at our home.

We feasted on a delicious platano-stuffed chicken dish with rice before going on a walk around the city. It didn´t take long before I was completely exhausted and melted into my bed for the night. I am the luckiest boy in the world.

Tuesday: Woke up a little late--7.30, snagged a few granadías and some rolls with cheese and rushed out the door to catch the bus to the hospital. Heather, Jess and I mosseyed over to obsterics where we met Dr. Ramirez and a pile of note-taking-nurses doing rounds. The women in the OB were all in critical condition--recovering from difficult c-sections and required regular visits to observe the progress of their infections, pain, and bleeding. In Perú, their are 3 primary reasons that a women do not survive child birth: delivering more than 4 babies, which can be very draining for the body, not waiting for a full 2 years pass between births, and infection, which is the most common due to non-potable water and a lack of completely sterile technique. We learned that abortion in Perú is absolutely illegal in all cases, but that it is very common for mothers to chew tropical herbs that stop the development of the baby. We also learned that the majority of births occur in females of 18 years or less, and of these, only about 30% result in a healthy infant. How incredible. The doctors at the hospital will openly admit that their biggest issue in Perú is the lack of education in the forms of sexual and reproductive education for potential parents, prenatal care for mothers, and education on sterile techniques for workers in the hospital.

After rounds, we made our way over to the pediatric unit where we visited and colored with the kids. A large chunk of them were quechua and from regions deep in the jungle with issues ranging from yellow fever to tuberculosis to meningitis. Medicine and specific tests are so expensive that each doctor examines and analyzes each patient in an almost identical manner. Feeling their stomach and head with the hands, possible checking their eyes, tongue, and hands for discoloration, and then perscribing a wide-range antibiotic that they hope will kill any issue that they may be having. If the solution is ineffective within the first few days, the patients are discharged and told to return if symptoms worsen. It is not necessarily that the doctors do not have tremendous knowledge about health and medicine, but rather that they have zero access to more sophisticated techniques, procedures, and treatments to deal with many of the issues that arise in the region. Una lástima grave.

We caught the bus back to our home and walked to the most amazingly intricate parks that I have every seen! Erin, check out the castle--Gaudí much??? Each and every detail was so meticulously carved to weave a beautiful fairytale inspired by the raw wilderness. Check it out:

To Erin & Dr. Gest: check out this 5 ft. tall Aloe plant...Whoa!
Group photo: Roohie, me, Kelsey, and Chris

Finally, we made our way to the only medical school in Huancayo where we performed a cadaver lab with the local med students and their professors. The students taught us so much about every vein, artery, muscle, ligament, and tendon in the body--they were very helpful, and it was interesting trying to learn the vocabulary, which is already pretty complex, in spanish. I peaked into the thorax of my cadaver to see a small turtle resting where the heart should have been--their form of a practical joke. It didn´t take long before 2 of the professors made their way over to Heather and my table and began asking questions and comparing my experience working in the Anatomical Donations Lab of the hospital with that of a lab in Perú. Surprisingly, each of the bodies in their lab were extremely young, all between 20 and 30 years of age. These cadavers are not donated, rather, unclaimed by their family members because of either an accident that rendered them unrecognizable, or the fact that they family did not have enough money to pay for a funeral service.

Our conversation shifted all over the board, from the economic crisis in the US, to our new Pres., to the go-go and sometimes greedy American ideal, to traveling. They all had very strong and well educated opinions on world affairs and I felt very lucky to hear them.

We caught a bus home in the rain and passed out hard. Just another day, eh?

All for now, more to follow.

amor y paz

Nate