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