Monday, April 21, 2014

Churches, camping trip, conservatories

Friday morning started off very cool, as Anne and I went around to local churches to find which were open for the public to enter and pray.  Catedral only had the side room open, but that was still quite cool.  We then moved on to San Francisco, which was stellar.  Not so much gold, but I was ok with that.  The 2 churches near San Pedro were open, but I could only get a picture in one.  One small church whose name I don’t know was available too.  San Cristobal, which I visited for the first time earlier this week, was open as well.  It was interesting to me, since the Catholic tradition is so different for this holiday.  There are many statues of saints and virgins available to be seen, and many people wait to touch these statues or others of Jesus.  Some churches prohibited photos, but in others I was able to get some good pictures. 
Iglesia San Francisco
Iglesia San Pedro
For the afternoon I hung out at home and checked a few more things off my long to-do list.  I have a lot to get done before being ready to travel.  In the afternoon, I headed to the camping trip with the little church.  There was a younger American who I already knew, then 1 more American girl, a Dutch girl, and a guy from New Zealand.  It was comical, since the guy from New Zealand uses words I would never use and has a different accent, so I struggled to understand his English more than I have struggled with Spanish in a long time.  Good to remember these misunderstandings happen in my first language too J  We delayed enough that we didn’t get the tents up before the dark.  I think it took close to 2 hours to get the campsite all ready, which I thought was a bit much but does match up well with Peruvian time.  In the evening we had dinner of 2 pieces of bread with cheese, which wasn’t quite enough to satisfy my beastly appetite, and a teaching from the pastor.  He basically discussed that our lives should be focused on bringing glory to God, and that the start of that begins with ourselves in forgiveness.  The girl from the Netherlands was an atheist, and the teachings made her very uncomfortable.  I wanted to try to reach out to her to make her feel welcomed, but her 2 other friends were already there and I didn’t have much more that I could do.  Everyone played soccer or other games until late, but I was tired so I went to bed. 
 Our fire :)
Night shot of the lake; I moved just enough to make all the lights look like candy canes.
I initially slept fairly well considering the hard ground below my sleeping bag, but at about 3 AM I was woke up by an obnoxious dog barking.  It went on for an absurdly long time, perhaps 1 hour.  The thought “I’m going to kill that dog,” went through my head many times, but I didn’t get up because I would have had to climb over the people in my tent.  Eventually it shut up, but wow was it annoying.  Early in the morning a soccer game started by another group near our campsite, which also made it hard to sleep.  At one point the tent by my head was hit by a soccer ball; I can think of more pleasant ways to be woken up. 
Camp site during the day
The next day we first had breakfast, which looked shockingly similar to the dinner we’d had the night before.  It is meals like those that make me happy that I have multivitamins here.  The rest of the morning was an alternation between games and lessons.  It still didn’t have the level of discussion that I was hoping for, but I’m learning that such teaching styles don’t really exist here in Peru.  I was going to give one of the lessons, but I realized that what I had planned was a bit too strong compared to what the other people were saying.  So I was in the process of changing it on the fly when the rain started, ruining all plans.  We quickly did what we could to keep our stuff dry, then stayed in dry places.  By the time the rain stopped it was almost lunch time, and we were all hungry after the small meals we were having.  Not a good time to attempt to talk.  So I will be giving my testimony next week instead. 
Fun cultural difference: Peruvians do not believe in rubbing in sun block :)
Quechua Speaker in the town of Urcos
Today was really fun.  I took Anne and her friend to the little church.  Music was excellent, such a great Easter celebration.  This community is one of my favorite places to worship the Lord.  So much passion, so much sincerity.  Following worship, we discovered that there was more white people than Peruvians!  Crazy, I don’t think that’s ever happened before.  So instead of having people try to translate wherever they were, they wanted a translator up front.  Because I attempted that this weekend, they called me up front.  I probably understand ~95% of words now, unless it’s in a bible passage because those words are super challenging.  So, I ran into some troubles with the translation.  Fortunately, one of the Americans who was visiting was fluent in both languages and had done translating for her church back home, so she took over.  I was so happy to not have to do it, but I think the very fact that I can make an ok attempt at it speaks to the incredible advancement of my Spanish during my time here.  The teaching was good, it was also about how we need to start with cleaning up ourselves before we can attempt to clean up the world.  I personally thought a little too much time was spent on the negative effects of cell phones on our culture, but I did agree with the majority of his points. 
My church family :)  Left to right:  Crouched = Carlos, Standing = Jesus (pastor), Amy (pastor's daughter), Taylor (friend from Grand Rapids), I totally forgot her name...  waiting for her to find me on facebook haha, Emparatriz (my professor and pastor's wife), Chelsie, me, upper right hand corner is Antony (pastor's son)

After the talk, I hung out with the other foreigners who were around, then eventually went to some nature conservatories with Emparatriz, 2 Americans who live with her, another guy from the church, and my new friend from Michigan.  It was great to see people saving animals who were rescued from bad situations.  Illegal trading, poaching, etc.  The condor was by far the most impressive.  Their wingspan gets up to about 10 feet, which looks incredibly impressive during flight, as I hope my picture captured J  We also went to what was basically a llama petting zoo, where I attempted to play Lady and the Tramp with the beasts.  Good times.  

Andean Condor in flight
This is probably the most adorable llama I've ever seen.

Thursday, April 17, 2014

Museums, Feast of 12 Plates

In the last 2 days, I’ve had some great experiences with Emparatriz for our “classes.”  Yesterday we went to the Inca Museum, which had some of the coolest artifacts I’ve seen.  Jewelry, the cotton strings they used to communicate across the kingdom, paintings, pottery..  The more I learn about them, the more impressed I am. 

Today, we went to the Yale museum that has exclusively artifacts of Machu Picchu.  It was full of all of Hiram Bingham’s pictures.  With how overgrown Machu Picchu was after 400 years of abandonment, it is really astonishing that the city was still intact.  It is cool to see it in that form.  This may be my favorite museum thus far, it talks about the royalty and the servants, the history surrounding the scientific discovery, etc. 

For lunch, I went to Sandro’s aunt’s house.  So good!  The feast of 12 plates represents the last supper, since there were 12 disciples.  I fared well, but didn’t get through 12.  They gave us too much for each course, so there was no way.  Here was the lineup:

1.      1 pear
2.      soup (I’ll just show you one variety)

3.      another soup
4.      another soup
5.      Main dish of breaded fish and chicken plus a potato

6.      Salad

7.      Sweet fruit dish

8   Empenada

.       Rice pudding

9.      Piece of bread

1.   Cookie thing

I considered 11 rounds pretty decent J 

The rest of the day I’ve been editing photos and writing various applications and such.  

Tuesday, April 15, 2014

Procession, San Cristobal

In the afternoon yesterday, after writing the post I put up yesterday, I first celebrated the completion of my thesis with my Spanish professor, Emparatriz.  The Oreo Sundae isn’t as good as what I would find in Vibrant Grains, but it was still a great way to celebrate.  Emparatriz told me that I’ll be able to share my testimony at the little church camping trip this weekend.  That will be awesome, I certainly have a lot to say.  The language barrier may be an interesting hurdle, but I’m sure everything will work out J

Then I went to the Plaza de Armas for the procession.  The main thing I was told before going was to watch my pockets at all times so that I didn’t get robbed.  Isn’t this a religious event?  I believe some people have missed the point.  Anyway, there’s basically a big statue of Christ that is paraded around the main plazas of the city, and it ends at Catedral.  I have never seen that many people in the plaza at one time.  I arrived at 7, which is when the procession was supposed to enter the Plaza de Armas.  The streets were absolutely absurd, there were so many people that the roads were almost impassible.  Once the plaza was in sight, everything got worse.  There were so many people that I couldn’t enter the plaza, but had to stay on one of the side-streets.  We were packed tighter than sardines.  Many people ran away early because they couldn’t handle the volume of people.  Some mentally or emotionally, others because they physically couldn’t breathe.  There was an adolescent boy near me who basically fainted and was being held up by his friends and/or family.  They kept him there for a while hoping he’d wake up, and eventually they brought him somewhere he could breathe.  I’m glad I have become accustomed to Peru or such an experience would be very shocking to me.  I did manage to get a few good pictures throughout the night; it is helpful to be tall.

Today I went to the clinic and worked with Dr. Marco in his office.  He is by far the best doctor I’ve worked with.  The cases weren’t nearly as interesting as much of what I saw at Belenpampa, but being involved makes it 100% better.  He explained to me how to calculate the risk factors for diabetes, and also explained the process of pre-natal care here.  One patient whose baby was sick due to a lack nutrients didn’t speak Spanish well, so we had to bring in a Quechua translator. 

In the afternoon I went to San Cristobal with Emparatriz.  I’m so thankful for her, she’s been making these last few weeks much more enjoyable J

The rest of the day I did random things I should have completed long ago, like the most recent Gilman Blog post.  It feels so great to do other things now after spending so much time with my thesis.  I also got an email back from Dr. Graves, my PI from Stanford so long ago, and he is excited to write me a glowing letter.  He’s such a great guy, I’m happy that we’ve maintained such a good relationship over the last 3.5 years that asking for a letter was just part of the conversation.  We are both taking on some challenging athletic feats, so it was fun to chat about that too.

Monday, April 14, 2014

Thesis, Saylla, Gabriela

When I arrived in Peru, my Spanish was so basic that it took me a week and a half to figure out my supervisor’s name in the clinic.  Since, my language skills have improved so much that I was able to facilitate, transcribe, and translate interviews with Peruvian physicians and do literature searches in Spanish for my project.  After countless more hours of work, I have submitted my 35 page thesis to Grand Valley State University.  That, friends, is the sweet taste of victory. 

I do apologize that my temporary marriage to my project prevented me from providing updates about my life, but I doubt you would have found very much entertainment in my various attempts to make desks out of pillows and books anyway.

Monday I had a very interesting experience with Santa Rosa.  It was some kind of exercise promotion day, so they closed the clinic and went on a long walk to the nearby town of Saylla.  I was unprepared for the sun, so they gave me a Ministry of Health hat, which I will now treasure forever.  Really.  We stapled signs with phrases about healthy living on our backs and ran or walked the ~5 kilometers on the main roads.  See the picture below for my sign J  I sincerely doubt that had any positive impact on people who saw us, but it was good for the healthcare professionals to get their exercise.  Many people started running and stopped.  Because I didn’t want to be first, I walked most of the time and only ran when the people in the far back caught up with me.  It was a great view, there were a few pictures I saw in my head that I’d like to go back and make a reality. 

This sign reads "Sports are a mirror; they smile at you if you look at them smiling.  I didn't write it, but I think it's precious :)

Translation:  Together Against TB.  Breathe Life.

In Saylla, we stopped by the health center before eating lunch together.  It was so nice!  It all looked nice and clean.  Everything was organized so people weren’t congregated outside or in the hallways.  This looked like a place I could see myself receiving healthcare treatment.  Shocking, after my experiences in Belenpampa and Santa Rosa. 

For lunch, we are Chicharron, which is a super fatty, fried, finger food of Peru.  Somehow I avoided it for 3 and a half months.  It was great, but I am certain that it more than removed any health benefits from out walk that morning.  Dr. Marco was kind enough to buy my lunch, which I really appreciated even if it was only 12 soles.  I got to talk to him and a dentist for a while over lunch.  I’m still figuring out exactly when to use formal and informal tenses of “you” in Spanish…  There came a point when I just couldn’t stand speaking in the formal way while ripping apart meat with my bare hands. 

Also, Gabby has improved!  She is out of urgent care and finally has started urinating, meaning that her kidneys are starting to kick in.  I don't think I have ever been so happy to hear about someone's urination, and I doubt I ever will be again.  

Legitimately, not much else exciting happened last week.  Yesterday at the little church I met a girl from Grand Rapids!  She even went to GVSU for a year before transferring to Northern Michigan!  She was the first person I have met here who actually knew my city…  3 and a half months is a long time to go without anyone understanding my cultural context.  

Wednesday, April 9, 2014

Gabriela's Transport

As far as events in my own life, this weekend was very tame.  Yesterday I made sure to get my run and weight lifting in, then went to church in the evening.  I do really like the little church, I do feel welcomed there.  In the evening I talked with Jason, which seemed to be exactly what we both needed.  It was nice to have a relief from all the stress and tension surrounding the Gabriela situation.  Today, I have literally been working on my project since I woke up except for breaks for meals and talking to Stephan over Skype.  Great progress, I have a tremendous amount of data that I now just have to organize.  I’m not yet entirely sure how I’ll do that, but I will probably end up having a 25-30 page paper when I’m done with this.

I wanted to include everything about Gabriela in one fluent post, so I’ll now go to that.  Saturday morning was very tense.  As I previously posted, it was determined that Gabriela had to get to Lima ASAP to see a specialist and to use a machine that wasn’t present in Cuzco.  However, because they ended up deciding to go to a public hospital instead of a private one, they had to wait for a bed.  No beds were available in the ICU.  We waited all morning, and around noon we found out that a bed was opening up and she could get on a plane and go.  It was mad chaos in the house to get everything packed before the trip, and tension was high because of the gravity of the situation.  Eventually we had everything ready to go and we got to the airport.  We had to wait for a long time for Sandro, Tania, and Gabriela to arrive.  A doctor went with them to Lima to ensure that no medical complications occurred on the plane.  Transferring an ICU patient to another city is no easy task.  She was on oxygen and had a drip that had to be held at all times.  She looked very tired and uncomfortable.  Tania and Sandro were beyond themselves by this point.  If their family hadn’t been helping them with packing and everything I don’t think it would have worked well because of their exhaustion and desperation.  The whole extended family was there to support them for the transport, although Tania hardly seemed aware of everything going on around her.  She was only concerned with the little girl in her arms. 

When they finally left and got on the plane, we all hung around for a little while.  I think no one knew what to do, so we just did nothing.  There was so much sadness and heaviness in the group, it was hard to bear.  She might not be my real family like she is for all of them, but I do certainly have a connection with her and the family so I’m not immune to the sadness. 

The rest of the day went on as normal, and eventually we heard that they were in Lima without complications.  The parents couldn’t stay in the ICU room, which I think will be good for them because they will finally have a mandatory time to relax.  Sleep will help their desperation and return their sanity. 

There wasn’t much news today (Sunday), which is fantastic because it means nothing went wrong.  I learned tonight that she has improved slightly.  She is a little more stable, which is all we can ask at this point.  We will continue to hope for a steady progression towards health.

Friday, April 4, 2014

Measuring Conflicts, Gabriela Goes to Lima

The clinic today was interesting, the lady in charge of CRED and I had some more differences on our height measurements.  On some of them I may have done wrong, but I’m more confident of my measurements now and know I am not that incompetent.  For example, there was one baby I measured to be ~66.5 cm, I don’t remember exactly.  She didn’t like it, so she did it again.  We always do it with both legs in case one is longer.  I had consistent measurements for the 2.  She had 65 for one and 67.7 for the other.  So she decided that 67.7 was correct and put that in the chart.  First, kid had only gained 150 g, and it would be surprising for him to gain 3 cm height [compared to the previous month] without significant weight gain.  Possible, sure, but unlikely.  Second, the baby was probably crooked on her test which is why she had such a tremendous difference between legs.  She also told me today that a measurement couldn’t end in .0, because we don’t know that precisely.  It would have to be .1, .2, .3, etc.  That of course makes absolutely no sense.  Precision is defined by the device, and if that child looks like it is exactly 66.0 cm tall, I am not going to manufacture it and put 65.9 or 66.1.  Ok maybe now I will just to avoid conflict, but it’s just annoying.  Sometimes I think that my training as a scientist actually makes life here more difficult…  We left on perfectly good terms, but I was frustrated because I thought I was measuring just fine and I wasn’t trusted.

Next, Gabriella.  I didn’t hear any updates until I was at ProWorld, when Nico and Mila went to support the family in the hospital.  Nico came back and told me they weren’t able to see Gabby because she had been moved to the ICU.  Something went wrong today, and she got worse.  I went home shortly after that to find out that she is now going to Lima tomorrow in the morning.  The family only told me that things became more complicated, so I have no more details on what is actually going on.  I only know that this is a very tense time in the house and we all need to be praying for Gabriella’s health.  We can only hope that she makes it through this, and that my family doesn’t have to go catastrophically far in debt to pay for the last minute plane tickets and an unknown amount of time in the expensive, private hospital in Lima. 

Even as all this transpires, Joaquin is staying in the house with Tania's mom and Benji.  Therefore, life goes on in a relatively normal fashion.  The only major changes have been the stress-level and the people who are here helping Joaquin with homework and making meals for us.  I think they want it to be as smooth as possible for Joaquin.  

Thursday, April 3, 2014

Gabriela's Health

Before I get into Gabriella’s health, I want to quickly summarize my week.  I have made great strides on the project, and the clinic is going very well.  I was able to interview the director, which proved insightful and helpful.  I’m getting better at weighing and taking height and cephalic measurements of the babies.  I also made a new friend from the Netherlands!  She doesn’t speak Spanish, but her English is good and my Dutch is improving as well.  Just kidding, I’m not taking up another language just yet… 

Now to the important stuff.  Gabriella moved from Hospital Regional to the Hospital of EsSalud.  This one is much better, because it is funded by the government AND specific taxes from the workers who attend it.  The Regional Hospital is only general government funds, so this leaves it without the ability to remain clean and keep patients well-attended to.  Here she has remained hooked up to the dialysis machine all the time, and is continuing to receive treatments.  The acute kidney failure continues.  Her disease is called Hemolytic Uremic Syndrome; more information can be found here:  It was caused by an E. Coli infection.  The bacterial infection spread and was activated by an antibiotic that she was given in response to the diarrhea that she was experiencing early last week.  It’s the most common cause of acute kidney failure in kids.  It has about a 5-10% mortality rate, though the survivors rarely have serious problems following the disease.  I hope and pray (and encourage you to pray) that she is part of the healthy 90-95%. 

Her current situation is not very good.  She has a very high blood pressure, with systolic around 157.  I wasn’t told diastolic.  The pressure rose yesterday morning, and they have been unable to control it.  The absence of kidney function is making everything difficult.  Such a high blood pressure can’t be sustained for too long, especially in a child of 3 years.  If it remains unchanging, it’s likely that she will have to be brought to Lima.  This would be incredibly expensive, and they would have to go to a private hospital because the public ones have all the problems of Cuzco’s Regional, but magnified because of the sheer number of patients in the metropolis.  I don’t know how they would afford this, and I don’t know what would happen with the family if her condition were to worsen.  I am only hoping and praying that she returns to normal health.

I was able to go to the EsSalud Hospital today to see her.  She’s still herself, but she is tired and in pain.  Sandro and Tania haven’t slept much in the last week; the tiredness and exasperation is really showing through in their faces and body language.  I was happy to help even for a very short while today by reading Gabriella “Cat in the Hat” in Spanish.  She fell asleep, which I know is a blessing to her parents. 

I’m glad she is in the hospital of EsSalud, it may be the first time in Peru that I’ve felt like I was in a really legitimate health center.  It’s still not exactly an American hospital, but it’s close.  Here are some pictures of the hospital room and the hospital from the outside.  I covered Gabriella’s face for privacy reasons.

Monday, March 31, 2014

Gabriella's Health Crisis, New Church

What a weekend it was.  Friday I went to the clinic to do the interviews, and no doctors were there.  Shocking, I know.  I continue to see a trend here.  The strangest part to me is not that they fault on their word to me about when they can meet, but rather the fact that nothing happens if they don’t show up to the clinic one day.  In the US, or, I believe, in the private sector here, not showing up to work when you are scheduled would result in your termination.  Here, it doesn’t seem to be so.  People often don’t show up on days they are supposed to, or they show up late, and nothing happens.  I don’t understand how that’s possible. 

I came home when I was sure no one was coming.  I did some work on my project, then went and ran over 9 miles.  It was a decent pace, I’d guess around 8:30.  Not bad for an altitude of 11,000 feet.  The first 4.5 miles were on a slight downhill.  What do you think the remaining 4.5 were?  Yea.  So I was tired when I got home.  I am happy that I was able to do that without excessive difficulty.  To add to the quantity of my energy, while I was walking my cool down a taxi-driver asked for me help to push his broken car up the hill by my house to get to a car shop.  What am I going to say, no?  So after running for 9 straight miles, I pushed a car up a hill.  All in a day’s work. 

The afternoon was project stuff, then I had to eat out because Tania was taking care of Gabriella, who was still quite sick at this point.  Her sickness started on Tuesday.  My restaurant of choice was the little pizza joint I’d been to before.  Mmmm, pizza. 

The célula was hard this evening, because wheels fell off my Spanish.  My exhaustion from my run took its toll, and it felt like I had just arrived in Peru again.  I couldn’t understand what was going on and struggled to put together intelligible sentences.  I still got something out of it, but with great difficulty.  We sat around afterwards and talked, but I honestly just wanted to go home and sleep.  I ended up leaving my bible there because I wasn’t thinking at all. 

After this struggle, I was met by another difficult circumstance.  My mom’s cat, Toby, had to be put down on Friday night.  He was in very bad physical shape, and the vet advised that he didn’t have much hope of living longer.  So it had to be done.  I lost my dog just a few months before I left, so my mom is now down to a fish and a rabbit.  Not the same as a cat and a dog.  I have so many good memories with both of them, it is very sad to see them go.  Especially when I’m in a foreign country so I can’t say goodbye. 

As if enough hadn’t happened this night, at around 11 PM Tania informed me that they were rushing Gabriella to the hospital.  She had just begun to vomit blood, which is obviously a serious condition.  It is hard to mourn the loss of my cat, as precious and wonderful as he was, when my family here is having a grave health problem with their 3 year-old daughter.

The next morning we heard a little more info on Gabby.  She was diagnosed with acute kidney failure, with the cause being some viral infection.  At 9 AM she was brought to the regional hospital for an operation.  I don’t know exactly what the surgery was because I didn’t want to probe the family too hard, but it had something to do with the kidneys.

To combat the many stressors, I went for a run and lifted in the gym.  I am always surprised by the successfulness of this practice in reducing stress. 

All afternoon was spent in transcription and translation of interviews, while I continued to receive updates on Gabriella.  The operation didn’t happen until 1 PM because that’s just how things are in the public healthcare system.  They were lucky to have it that soon.  Following the operation, she had to be hooked up to a dialysis machine because of her lacking kidney function.  Three year old children shouldn’t have to go through things like this…  Meghan sent me an article about the condition that Gabby probably has, and it says that the majority of children who get this disease recover fully without further problems.  We can only hope and pray that Gabriella has this experience.  Any prayers you can send her way are greatly appreciated.

As I’m learning from my project, my family is lucky to live within the city of Cuzco.  While the rural populations do technically have access to similar public resources that Gabriella went through, travel is very difficult.  No cars, no cash, no nothing.  If they had to first find a car, then drive 3 to 5 to 10 hours to get into the city, the surgery would have been even later, and Gabby would probably be in even worse shape than she is right now.  I don’t want to think about it, but if she lived far enough from a main healthcare center, there is a good possibility that she would no longer be with us.  Such is the disparity between rural and urban care.

In the evening I went to a different church with my Spanish teacher from this week.  It is smaller than I’m accustomed to, with under 20 young people and 40-50 members total.  But I enjoyed the cute, small-town feel.  Everyone greets everyone else when they arrive.  And there are Americans here!  There were 3 other Americans at the small gathering of youths.  I’m fairly certain that the La Vid has less foreigners than that during their Saturday gatherings, despite the fact that they have well over 1000 people there.  It was a fun night with games, food, and a great teaching.  I also told my teacher about my role as a leader of leaders in the US, and she would like me to help a little with the spiritual development of the youth leaders in this church.  It is good to feel like I actually have something to contribute.  Sunday morning I also went to the church for the main service, which was also inviting and enjoyable. 

In the late afternoon I decided to intentionally run up the mountain I discovered on accident last time.  I, by some crazed desire for pain, did stair repeats.  This set of stairs took about 2 minutes to run up once.  I was not able to do it all at once, because I could barely breathe after the first minute.  Despite the breaks I took halfway up, I know that I’ll benefit from that self-inflicted torture. 

Gabriella was awake today, but that was probably a bad thing.  For her behavior at least.  She’s very accustomed to getting whatever she wants at home, and she is not adjusting well to the patient role at the hospital.  She is always crying and yelling about what she wants, and it gets worse when her parents are in the room with her.  This tactic works well at home, but she’s not going to win in the hospital.  So now Tania and Sandro must wait outside in the waiting room.  Harsh, but consistent with what I’ve heard about the level of compassion possessed by many nurses here.  They are both spending almost the entire day there, but they can’t even see their daughter most of the time.  I feel for them, this is an incredibly tough situation.  I do hope that Gabriella is able to get off the dialysis soon.  She would still have to be in the hospital for ~2 weeks more, but at least everyone could rest a little easier.  Again, prayers for her situation would be appreciated.  

Sunday, March 30, 2014

CRED, Interview with a Private Doc

This morning I started in CRED, which is basically just what they call Niño Sano.  Mothers have to bring their kids in to the clinic every month to ensure that everything is good developmentally.  Weight, height, circumference of the head.  I was instructed (“instructed”) on how to do these things, then was set loose.  The ladies at the desk talked to patients and filled out the mounds of necessary paperwork while I did the measuring.  I’m so glad my Spanish is better now, I feel like I would be struggling a lot more without that.  When people ask me a question, I actually know what they’re asking me.  Sometimes I don’t know the answer, but other times I do.  That feels good.  Anyway, I wasn’t good at doing height measurements at the start.  I thought I was doing it fine, but the lady in charge of this service instructed me a few times before I did it right.  Yet another lesson in humbleness.  I also had to call patients for this service, which was interesting as always.  At one point 2 people thought I called them at the same time, so we had to resolve who was the right one once we were inside the room.  It really wasn’t a bad day, I’d never get this much hands-on experience in Belenpampa because there are too many people there.  When I had to leave I was actually sad that I couldn’t come in tomorrow because of my interview with Jesus in Belenpampa. 

I wasn’t so positive all morning.  After the last time of being instructed on how to measure height, I was severely red-lining.  I was thinking of how I can do such complex tasks in the US, but something so basic and simple is hard here because of the language barrier and overall a shortage of time for me to be taught things.  After that my measurements did improve, but it was still a struggle.  When I was leaving the lady in charge of CRED told me I learned a lot today and was sad to hear I couldn’t come in tomorrow.  That did feel good, because I think I came out from the struggle better than I entered. 

In the afternoon I worked on the project, and totally found a jackpot article.  It outlines all these trends comparing the rural and urban aspects of healthcare.  I’ll also check out the references in it too, with all those and my interviews I think I will be well-armed to conquer this project. 

This was followed by another great interview with a doctor from the private sector.  ProWorld set this one up, and I was very grateful for that.  He went for 20 minutes about my questions, but he talked so fast I bet I got twice as much information out of him compared to all the other interviews.  He was full of stories to clarify all of this points, I can scarcely wait to translate it.  I may be using a significant amount of quotes from him.  It was also to hear from his unique perspective.  Stellar.  Although it will probably take me 12 hours to transcribe and translate…  I hope to get to shadow him at some point as well.  

Striking Continues, Interview with a Nurse

I made sure to arrive early to the clinic today before 8 so that I could meet with the doctor in charge before she got busy.  When I got to the clinic, I noticed that all the benches outside were gone and no one was waiting.  What now?  Another strike.  It was a one day strike, so not as serious as what was going on before, but I was still becoming moderately annoyed by the prevalence of striking here.  In case you haven’t noticed, I’ve seen a lot of it.  I waited around a few minutes for the doctor, but one of the ladies from admission told me she wouldn’t be coming in today because there was a protest going on elsewhere.  So I left. 

The following bus ride was the most interesting of any I’ve experienced.  Leaving a bus stop we were pulling out into the main lane when another bus didn’t stop so they actually hit us.  Not hard, but enough to cause some scratches and discomfort among the passengers.  That bus was incredibly aggressive.  It refused to back up, so it scraped forward another foot or 2 on our bus until it was free.  We then were driving side-by-side for a little too long, and the guy at the door of the other bus decided to start kicking our bus instead of doing what normal people do; slow down and move over.  I don’t know if that driver and door guy were drunk or what, but that was ridiculous. 

Initially, I thought I would go home to work on my project.  I then realized that I could go to Belenpampa and see if any doctors were there for me to interview.  This proved to be a great decision.  When I got there the outside door was shut and everything was peaceful.  I looked around for doctors, and I did manage to find Jesus.  I caught him just as he was leaving for another function, but we scheduled an interview for Friday morning around 8.  I’m looking forward to that, I think it’ll be great.  I wandered through several laps of the clinic and was about ready to leave when I found Julia hanging out on the wheelchair in emergency.  Apparently she didn’t even know about the strike today, so she was just sitting in the room without anything to do.  We discussed some topics like Meghan and my current rotations, then I realized that I could totally do an interview with her.  She is very fluent is Quechua so I guessed she would know a good deal about the differences between rural and urban care.  Perfect for my project.  I gave her the paper, and she began some external processing to formulate her answers.  During this process I found Dr. Yermoli, the man I was looking for earlier because I really wanted an interview from him.  We set up an interview at 11.  After a little while Julia did the interview with me, which was great.  It was cool to hear from a nurse’s perspective, because it provided unique insights into the challenges and strengths of Peruvian healthcare that I hadn’t thought of and hadn’t been mentioned in previous interviews.  She had more of a personal feel in her responses.  After the interview we talked for some time about other challenges for rural people in Peru, especially education.  They have to walk an hour (one way) in order to arrive at the school, then often have insufficient nourishment throughout the day so it is hard for them to stay awake and focus in class.  To add to the problem, there are not governmental education checks in these places.  Therefore, if a teacher doesn’t care about the benefit of the students and only wants a paycheck, they can show up to work every day and do nothing without consequence. 

During the interview and the conversation, I heard a megaphone outside.  Eventually I wanted to check that out, so Julia and I went outside.  This strike was a national one, involving all clinics from the coast, the mountains, and the jungle.  In Belenpampa, there were people from many postas throughout the Northern Cuzco Network.  They had formal lists of requests from the government and had every intention of making their will known.  When I heard them talk about going to block a street, I got excited.  I hadn’t seen this before.  After some talking to clarify the goals, they exited to take a major street nearby.  They walked slowly even for the already painfully slow Peruvian speed, which I found hilarious.  There were a few people yelling and trying to get the crowd riled up, but the rest slowly meandered their way to the main road.  Once there, the oval eventually expanded to take the whole intersection.  The poor cars that were trying to pass in this moment had to use creativity to get out or get through.  Everyone started yelling phrases like, “This is the response of health!!” and, “Health is in the streets because of the government!”  I assure you the phrases sound better in Spanish.  I can now say I helped block a street and chanted [quietly] with Peruvians during a healthcare strike.  Oh the stories I’ll be able to tell back in the states J

I went back at 11 to find Yermoli, but he was nowhere to be found.  I’ll get him eventually.

The rest of the day was my Spanish class, talking to people over skype, and my project.  It was a good way to spend my day, but I’m now up at 1 AM and have to be up early to make it to the clinic.

Wednesday, March 26, 2014

First Day in Santa Rosa

I woke up early today to go to Santa Rosa, where there is another posta for me to work in.  Lalo (ProWorld employee) and I had a great talk about my experience on the way to the clinic.  When we arrived, I was surprised by how small it was.  Belenpampa is a more elaborate healthcare establishment.  The waiting area for Santa Rosa is outside under a roof that looked ok at best.  I would not volunteer to sit under it during a rain storm.  After a few minutes he passed me off to the managing doctor.  She is very nice and very bubbly.  Her Spanish is fast, but I still get most of it.  I think I’ll enjoy working with her.  She passed me off to admission for the day, which is a service I’ve actually never done in Belenpampa.  There was a reason for that, being that too many people were already there and it’s not actually any kind of medical experience.  If this were my first time in Peru I would have been shocked by the amount of paper in the room, but I instead was pleasantly surprised by the color-coding.  They have a folder enclosing the patient histories, which seems to me like a great way to help keep things straight.  Belenpampa doesn’t have the same system, but they would probably have to dig deep into the rainbow to get enough colors.  My height was very advantageous in this context.  I did actually feel quite useful today, which is not a feeling I had in Belenpampa until after I’d been there a long time.  I’m sure my Spanish is a part of that.  When most of the patient histories had been taken out, I was summoned to triage, the staging area for patients where they are weighed and have their blood pressure taken.  More tasks and direct patient interactions!  Being a technical type of person, I analyzed the scale as a scientific instrument.  It looked about like the typical scales seen in doctors’ offices.  The large counterweight was held in position by a loose washer on a nail instead of the secure grooves I’m accustomed to seeing.  This meant that it could move a little bit while still being counted as 40 or 60 Kg or whatever it was set to.  One lady I was working with wanted to calibrate it to 0 before every patient, but that was completely irrelevant because we’d have to move the big weight anyway and it would end up in a different position.  Also, we rounded to the nearest Kg then always rounded down ~1 due to clothing.  I would have to guess the uncertainty of such an scale is probably 2-3 Kg.  Despite my fun thinking about the scale, it was wonderful to feel useful.  I also sometimes would call patient names to have them come get weighed and to have their blood pressure taken.  While it was necessary, I think they also enjoyed watching me attempt to pronounce the names.  To me, I feel like I’m pronouncing them right.  But occasionally people didn’t understand me and other patients would call the name again for me so it would be clear.  Very kind of them J 

See, the beauty about this clinic is that there aren’t very many students there.  A few who would be willing to help me out (although they’re all Peruvian), but not so many that things get congested like in Belenpampa.  There, it’s becoming hard to do things (except in Sala de Partos) because more and more students have been arriving as I spend more time there.  This really may be a better hands-on experience than many services than Belenpampa were.  I’m excited about my time here J

For lunch, Tania’s cousin who lives in Italy came over to visit.  She isn’t here long, so they had to take advantage of her time in Peru.  What a great lunch, as seen below J  I continue to be surprised by how similar many conversations here are to conversations back home.  Sandro started it by talking about how even though they didn’t have all the technology that kids have today, he thought they were made better people from it.  They went on to discuss all the problems technology is creating in the younger generation.  Very true, and this is totally a theme that would come up in a common conversation at one of my family functions.

Trout appetizer with the typical Inca Kola

Tania's Lomo Saltado :)

I did some project stuff in the afternoon, then had Spanish class in the early evening.  I have a different professor this week because Rodolfo had to travel with his other work.  She’s very kind, and used to own a pharmacy so she knows a good amount about the medical system in Peru.  Yesterday she started off telling me stories about her trip to the jungle about 10 years ago.  It’s absolutely crazy.  We started off talking about a beautiful set of birds she saw one morning.  I guess they always fly to some specific mountain in the morning, and they were able to witness that.  She couldn’t complement the incredible nature of the jungle enough.  However, it is important to not go during the most rainy season (February, start of March).  She almost got stuck in the lodge because the river was so high from heavy rains.  The guide decided to try crossing the river when it was clearly unsafe because she wanted to get home.  That’s crazy.  They tried 7-8 times until they were finally able to cross the river.  There was legitimate concern that they would be sucked into a small canyon that water was pouring into because it had gone beyond its banks.  They would not have survived if that had happened.  It sounded like a terrifying experience, so I’m glad I can go later in the year.  She has been a tremendous help with the interviews, clarifying words I transcribed incorrectly.  I think she gets a lot of enjoyment hearing what the doctors say because of her interest in the healthcare system.  She also clarified Essalud for me, which is the system where employees are covered by a premium paid by their employer, so healthcare is free to them.  I’m trying to get all the securities straight here, because that will help me a lot in unrolling the final paper of my project.  She also told me a lot of stories that will help me remember the different aspects of the healthcare systems and the doctor’s responses.  

Tuesday, March 25, 2014

More Strikes in Cuzco

I knew this transportation strike wouldn’t be very strong when I woke up to cars driving by at about 8 in the morning.  This one was more specific, and it only involved the public transport.  They were requesting for the government to lift some of the taxes on gasoline or to allow them to raise bus prices.  I didn’t even realize the government was in control of that.  After breakfast and all, I went out with Sandro to explore what was going on.  The police were out in force, especially near the airport.  There was one time several years ago when strikers pushed down the outside wall and were able to overtake the airport.  That is basically the one thing that the government fears during these things.  Here’s a picture of the police guarding the airport:

Other than that, there wasn’t much to see.  Most roads were not blocked at all, they were just empty.  By the afternoon taxis were out in force, fully prepared to take advantage of the economic opportunity opened by the lack of buses.  I did take this chance to get pictures of flowers in the median which are usually not available for viewing. 

The rest of the day I spent with my project, which was not especially exciting to describe to you.  

Monday, March 24, 2014

Hospital, Princeton Volunteers, Joaquin's Adventure

First of all, I apologize that my posts are becoming slightly more spread out.  I don’t want to list facts that you won’t find interesting, and honestly after sitting at my computer for hours working on my project it becomes harder to motivate myself to write more about my day.

We’ll start with Friday.  I first went to Belenpampa to interview doctor Yermoli, but he unfortunately never came.  I really want to hear his thoughts and at least one more doctor from Belenpampa.  Probably Dr. Jesus.  So I’ll be back, and I’ll get it eventually J  I can understand why it is difficult to obtain information in this type of research field, the human component adds a lot of variability.  The radioactive mice I am accustomed to playing with always show up on time for their appointments. 

Next was the regional hospital.  I went with Mila (ProPeru director) to see if I could be a volunteer there, because I knew it would be the most traumatic and excellent healthcare experience of my time in Peru.  We got quite the run around attempting to find the correct person to talk to.  I had nothing to do so I was in no hurry, and it was great talking to her.  She is quite knowledgeable about Cuzco, and also knows many doctors who I can do interviews with.  My project will advance far next week as she introduces me to people she knows.  Private doctors, more public doctors, etc.  I think Rodolfo is going to try introducing me to his friend who does (or did) work in the administration of the Ministerio de la Salud.  Apparently he was involved in acquiring and organizing facts from all the networks of the Cuzco region. That would be some great input.  Unfortunately our chase ended with us finding out that internationals aren’t allowed to work in the hospital.  This is too bad, but I’m feeling better after finding out a little more about Mila’s connections.

When I got back to ProWorld I was planning to just go home, but about 10 people I’d never seen before showed up all of a sudden.  This group from Princeton had spent their week in Urubamba, so they only had a few hours to explore the city of Cuzco.  I didn’t have a set schedule, so I decided to help show them around the city instead of sitting around working on my project.  Five of us got into a taxi designed for no more than 4, and almost immediately a police officer pulled us over.  At first I was surprised that they would be pulling us over because I have seen people do far worse on the roads (recall the picture of the people in the pickup bed from a few months ago), but then it became obvious that this was a routine check and nothing more.  How strange that the officer didn’t even care about all the people crammed in the back.  We arrived in the plaza, then went to Mercado San Pedro.  Good times.  The group split for lunch, with almost everyone coming with me to a Peruvian restaurant while the other 2 went to Paddy’s Pub.  It was a great hanging out with this group, I haven’t been around that many Americans at one time in….  I don’t know.  A while.  One guy named Mark and I especially hit it off.  He started college as a physics major then changed to computer science, so we had a lot in common.  I got to describe my previous research to him, which probably made me happier than it should have.  It had been so long since my last technical physics conversation that I forgot some words, but it was still wonderful to get a taste of the technicality I’m accustomed to.  The meal was a bit rushed because it took so long to get of the kitchen, but everything ended up being just great.  This place was another nice find for 12 soles.

When I got home, I realized my translator wasn’t in my pocket anymore.  I looked all around ProWorld, my house, and even went back to the restaurant but with no luck.  The translator is gone L  It’s a good thing Meghan brought one for Joaquin!  It is necessary for my project and I would have felt horrible if I didn’t have one to sell them; they asked me very early during my trip for that. 

The rest of Friday was spent transcribing Dr. Jorge’s interview.  I get excited working with that data because I can see how useful it will be to my project and to my understanding of healthcare in this country.  That said, I think it took me at least 6 hours to transcribe a 17 minute interview.  Some kind of language barrier is still present. 

Saturday was a good day.  More project stuff, then I went for my longest run of my time in Peru, approximately 8 miles.  It was a hot day, and I struggled to make it home without stopping.  But I made it, and I was proud of that achievement.  The rest of the day was heavily influenced by my lack of energy…  I did still make it to La Vid in the evening, but that was it. 

Today I woke up early to, as you guessed, work on my project.  I finalized the transcription, then looked for translation software.  Free software doesn’t tend to do a great job translating passages because they tend to only translate individual words, which doesn’t end up working well at all.  So I decided I would just translate everything myself, which will be another significant task.  Oh boy J

Lunch was notable today.  We had Ceviche, the traditional Peruvian fish dish.  It is very easy to prepare.  Basically, cut up a fish, put a ton of lime and a moderate amount of cilantro on it, then make the fancy looking sides; sweet potatoes, lettuce, and corn.  The bones of the fish are used to make a soup that is served before the main dish.  Here are a few pictures of the dishes I got to experience today J 

Soup made with Fish bones!  The fried corn is basically our equivalent of crackers in soup.

Ceviche :)  Left to right, corn, sweet potato, fish mixed with onion, and another form of potato.  I usually don't like fish, but I do like this dish.

The only other events of the day were talking to Jason, which was fantastic except for the internet, and going for a run.  I decided to do more interval training because I need to work on my speed.  Because I was staying close to home, I let Joaquin come.  Not sure that was a great idea.  For my warm-up, he took off way ahead and eventually realized that he was going excessively fast.  It was dark out by this point, and I didn’t want him to be off alone.  I had told him my plans as we were starting, but he didn’t listen.  You will see that is a common theme in this story.  Once I stopped him so I could stretch, I explained our route to him.  I gave him a head-start so that I would be able to see him.  He did not listen to a single word I’d said and headed the wrong direction down the next street.  I didn’t see him do it, so I had to stop running and find him.  Eventually he realized his error and came down the right direction.  One lap later, as I was starting my fast interval, he seemed tired and I told him to go home if he didn’t have another one in him.  He proceeded to get on his bike to follow me.  I told him several times to follow me since he still seemed unsure of where to go.  He was right behind me.  Then I looked back and he wasn’t behind me at all.  Moderately frustrated at this point, I backtracked to find him.  No Joaquin.  I figured he must have gone home after all, but I wanted to check before I continued on with my run.  I arrived at home to see Sandro and Tania sitting in front of the tv.  No Joaquin.  I asked them if he was here, and immediately they shot up and Sandro came with me to look for him.  We looked all over the place I last saw him, but he was nowhere to be found.  Tracked further down the street, still no Joaquin.  If I had become the volunteer who lost Tania and Sandro’s son, I don’t know what I would have done with myself.  Fortunately, Tania called a few minutes later and said he was safe at home.  Fears relieved, I was upset that Joaquin had done such a poor job of following directions.  Upon arrival back home Sandro explained to him the dangers of being a little kid out in town, abduction being the main one.  Apparently Joaquin decided to take a shortcut without telling me, and he was confused why I hadn’t come out the other side of the route.  8 year old logic, I’ll tell ya.  This isn’t an event that we’ll forget easily because of the sheer horror of having a kid out at night alone even for 10 minutes.  I don’t know if his parents will let him run with me again, but he certainly has some trust to build with me before I let him come again.  I will probably only allow him to come with me on days when I’m really hurting, so I go a short distance at a slow pace.  That way I can always keep a close eye on him to make sure he doesn’t do anything irrational.

The night finished out on a lighter note with Gabriella being adorable, singing a song from one of her favorite TV shows J