Friday, January 31, 2014

Wound Cleaning, Peruvian Tai Chi

The clinic was very tame today, but I did have a chance to talk to the med student for a while.  There was a patient who came in with little incisions in several places over her abdomen.  This was clearly the result of a surgery, and Nadin figured out the procedure and later told me about it.  The patient had an ulcer under her belly button, which was caused by excessive pressure in the abdomen.  Some of the incisions were to fix the other organs, and the one in the belly button was for the ulcer itself.  Later she explained a patient she was seeing for her medical training who had tumors in her gallbladder and bile duct.  It is much harder to understand in Spanish, but she was able to draw pictures so that helped.  I also think these little exercises are very useful for improving my medical Spanish.

Between this patient and the next, I rushed out into the hallway because of some screaming that was going on.  There was a man and woman almost ready to start a physical brawl.  Spittle was flying everywhere, and a doctor ended up separating them and shutting a door between them so that they had to leave.  Gotta love drama. 

I was able to perform a wound cleaning today!  The man had been in several times, so his injuries were fairly clean and shrinking.  He had one on his inner thigh and one on his finger.  Quechua was his primary language so I didn’t talk to him much.  He was from the jungle, and had malaria in his medical history.  The cleaning went fine with the guidance of the people who’d done it before.  It’s really quite simple, it’s just doing it for the first time that’s intimidating.  I can have more confidence now.  My only errors were not pressing hard enough at first to get dirt out of a wound, and I didn’t tape the bandage on the finger quite right.  I’ll take that for a first attempt. 

While I was in the ER, someone in the hallway was attempting to hang up a sign.  It is standard protocol to involve me in anything a tall person would be good at, so I was called in.  The big wooden frame (approx. 3ft by 8 ft) that held some kind of information was too big for that spot, so we moved down the hallway to a waiting room.  We began hanging it on the wall, but there wasn’t any nails in the wall that could hold it.  When we saw this they started talking about a stone.  I was hoping this was some kind of code word for someone with a drill, but I should have known better.  A few minutes later everyone returned with another nail and a stone.  We moved the huge board into place and the security guard began pounding the nail into the wall using the stone.  The first one broke, but the second one got the job done.  Just another day in a Peruvian clinic.  I’m not sure anyone will ever read this, since the text is 12 pt. font and the board is above eye-level.  Oh well. 

Just about every day since I’ve arrived to Peru, I have had some moment where I’m surprised or I realize the absurdity of a situation when I view it with a US perspective.  Today, this experience was very easy to identify.  At 11:45, a middle aged woman who I think works in the hospital came in to the ER to tell us about a Tai Chi class she was hosting at noon.  I was non-committal and just asked to see if anyone else from the ER was going.  She returned in about 10 minutes, and I followed about the same protocol.  I don’t know why she was so insistent that I come, but just before noon she came back again.  I was chatting with Katherine (the other American) and she decided to go.  At this point I didn’t think that lady would allow me to say no.  So, here we are.  We entered the room, which is apparently typically used for maternity, to some Chinese music playing in the background.  The walls are painted blue and have cute Peruvians painted all over the walls.  My assumption that I would be the only guy in the class was correct.  Aside from Katherine, the rest of the people there were middle-aged to older women.  In its very nature, I think Tai Chi is designed to be awkward, and to me this was accented well by the instruction in Spanish.  The entire time I was combating my inner desire to laugh uncontrollably.  I can’t describe all the movements to you, but I’ll give you highlights.  In one, we got in a shallow lunge and were alternating hands hitting our butts and thighs.  The lady who got me to attend came over to show me the correct form, and eventually took my wrists to help me do the motions correctly.  I was the only person of the 15 in the room to get this special treatment.  I doubt I will ever again receive such detailed instruction about how to spank myself.  My second favorite was when we had to relax and move our bodies however we wanted.  Julia from the ER decided to attend, and she just tends to be a fairly intense and hilarious person.  One glance at her and I lost my composure.  After a few minutes I was able to wipe the foolish smile from my face and stop my hushed laughter.  Wow, what an experience.  The problem is that it’s every week, so I’m going to have to hide if I don’t want to get roped into this again.  I also enjoyed telling my family why I was late from work when I returned home.

There wasn’t much else out of the norm to report.  My Spanish lesson was fun today.  Rodolfo asked me to look up a bibliography of some person and we’d go through it as practice.  Of course I picked a physicist; Max Planck.  And as you know, when I start talking about physics I don’t stop.  So almost the entire lesson was me attempting to describe quantum mechanics in Spanish.  I’ve been longing for a physics conversation, so I was in a state of pure bliss.  I do find that I miss physics right now, even though the classes they cause me so much pain.  I guess this is why I am willing to go through all that; I do love it.

I am also making leaps and bounds toward planning a trip to Puno for the “Fiesta de la Virgin de la Candelaria.”  This party is the third biggest party in South America.  First is Carvaval in Brazil, second is a similar festival in Bolivia, and this is third.  I wouldn’t want to miss it while I’m so close.  Hopefully I can go earlier and see some of the sights of Puno before the party really gets rolling.

Thursday, January 30, 2014

More Injections, Missing the Gathering

Today wasn’t very exciting and I’m tired, so I’ll keep this short.  Tania gave me the duty of going to the oven to get bread alone.  I wasn’t sure what door it was, since there is no sign indicating its presence.  I pushed on it a little bit and saw someone standing on a table while doing some kind of construction work.  I did think the oven looked like a construction site, but I still found it odd.  I looked for another door but didn’t find one.  The guy cracked the door I’d pushed and looked at me.  I asked if there was bread here and he told me to help myself.  Then he let the door shut in front of me.  Confusion was my primary feeling at this point.  So I went to another store that sells the bread and that was good enough for me.  I do need to figure this out though.  Bread straight from the oven is warmer and better.

At work today, the first event was that a new desk arrived for Julia.  I could probably get a nicer desk for $8 at Love Inc. in Hudsonville.  But it was a big deal.  Everyone had to come look at it.  The drawers were dirty and a little rusty (it’s a metal desk), so those were sent back to the guy who brought the desk over and he washed them.  We also rearranged the office so that the desk faces the doorway.  That made sense to me.

We had many patients today, but not many were serious injuries.  Nothing to compare with the last 2 days.  I did, however, get to do 2 more injections today.  That’s exciting.  One patient who needs these injections is an awkward teenage boy, and it’s always funny watching him cringe at lowering his pants enough for the injector to see his butt cheek. 

The afternoon and Spanish class were good, then I tried meeting up with Carlos and the other church people.  I was told the group started at 7, so when I got out of class at 6:45 I rushed to leave ProWorld ASAP.  I glanced at the emails Carlos had sent me.  The map was helpful, but I still wasn’t sure I could find the plaza it refers too.  Not the main plaza, a different one.  Still I excitedly strolled out the door and caught a bus to Belenpampa, which is the nearest place to my final destination that I’m familiar with.  I walked down the road for a little while, then realized I wasn’t where I hoped to be.  So I turned around, found the road and started up.  I didn’t like the looks of the street.  Not many people, not much going on.  This could be a good place to wait for someone, especially a gringo, and rob them.  It was almost 8 at this point, and I figured I’d missed most of it anyway.  Carlos eventually responded to texts again to convince me to come, but I had made up my mind.  I didn’t have enough minutes to make calls from my cell, only a few texts.  If I got lost I didn’t want to have to rely on text to get me out.  I didn’t have any 5 soles, I only had a 50, which is far too big for a taxi.  So that option was out.  So many things piled up today, there was no way I could go.  I’m sad I didn’t get to go, I was immensely looking forward to making new Peruvian friends.  They ended up starting well over an hour late so I’d have been ok, but that worries me because it could go late and I always have to wake up early the next morning.  Hopefully everything eventually works out!

Wednesday, January 29, 2014

Crazy Clinic Week

I’m going to stop including my training in the blog posts, but you can trust that it’s happening.  I officially signed up for the 25k river bank run today.  I think my goal will tentatively be to enter the 2 hour club.  This is approximately 7:45 miles throughout the whole race.  That’s pretty quick, but I do have altitude training on my side and that will help tremendously.  I plan to run very seriously for my entire time here.  Once I print off a training schedule I’ll be all set.

I went to the local oven where all the bread is baked.  When we arrived they’d already sold their bread, so we’d have had to wait for more to come out.  I wasn’t able to get far into the building to see what this place all about.  I could not differentiate what I saw from an unfinished construction site.  Random piles of things, not super clean looking, etc.

The clinic was not tame today.  Around 9 a man came in with a huge gash in his head.  It must have been at least ¼ in. deep, which is very intense for a wound on the top of the head.  The hole probably had a diameter of ¾ of an inch.  Julia was off today, so they had to call in a pinch hitter; Neilida, my supervisor from my time in radiografia.  I guess she can do anything.  I doubt suturing is a regular procedure for her, but it was certainly necessary for this patient.  Doctors seem like they would be more qualified to do this kind of task, but I have yet to see them do work in emergency.  They seem to direct what procedures occur, but they don’t tend to get their hands involved in those procedures.  Neilida injected him with anesthetic, put a covering on the bed under his head to catch the blood, and went to work.  No amount of anesthetic could entirely block the pain, so this patient’s wailing filled the room for most of the procedure, which took about an hour.  A relative of the patient filmed most of the procedure with his phone.  I’m not sure why, and I don’t think that would be ok in the US, but it was interesting to be sure.  Neilida cleaned and sutured the wound, though the skin was pulled very tight to make that suture work.  Every time the suturing needle went in, his moans increased.  The chaos in the room increased as time went on, since more and more people were waiting for procedures.  There were some typical injections going on at the same time as this man’s surgery.  Try to imagine a small room with a groaning man on the only bed and other people rushing about to prepare and administer injections or check the work schedule.  Maybe you can imagine why I was thrown off balance a bit.  By 10:30 I was tired and about ready to go home.

The second interesting case today was a young boy, who came in with a bandage wrapped around his left thumb.  I wasn’t asked if I wanted to help with this one, but I would have said no.  The bandage was wrapped very large and blood was still obvious all over it, showing the significance of the injury below.  The bandage took a very long time to get off, since the whole tip of his finger was gone.  He was using some type of machine and the tip of his thumb got caught in it, ripping off the nail, skin, and even the tip of the bone.  It looked like an astoundingly painful wound.  He started crying when the bandage was still being removed, so I tried to comfort him by rubbing his back and keeping him from looking at everything going on with his finger.  When his cries grew loud enough his dad came in and took my place.  Eventually the wound was cleaned and gauze was put back on; no suturing here, since there’s no skin left to work with.  Very sad.  The kid has to keep coming back every 2 days to get it cleaned and the bandages changed.  I’m sure this will continue to be a source of agony to the kid and everyone near him during the procedures. 

The other highlight of my day was meeting another med student, Nadin.  She seems more interested in actually helping me get involved in a hospital than Maribel was.  Unfortunately I don’t understand her Spanish quite as well, but it still functions.  And when we struggle to communicate she writes things down on a little notepad she carries around.  We didn’t get to talk too much since it was a busy morning, but I did learn that she either wants to do endocrinology or oncology, and her goal is to do her specialization in Spain.  I also got her phone number so if I have questions I don’t have to hunt for her like I did Maribel.  She also likes to go to the hospital to practice suturing and whatnot.  As makes sense, many of the accidents requiring attention are the result of drunkenness in the evenings.  I know it would be nuts, but I do want to see what it’s like.  Nadin said this evening that she has already started asking around about where I could be a volunteer and will have more information for me tomorrow.  Having connections with med students is great.  I do think I can count on ProWorld to help me find a good hospital to work in too.  I like Belenpampa, but it is small and I’d love to become familiar with a more wide variety of Peruvian medicine.

Because I am finally becoming accustomed to everything, I am starting to think about my honors senior project.  Rodolfo and I discussed the Peruvian health system today during class.  Public sector is cheap, but the doctors don’t tend to be as good because they are paid less.  Also, the general system tends to be too simple and therefore less effective.  For example, our ER is one bed and we don’t have the sterilizing capabilities that we should have.  Also, rural towns typically have one tiny clinic (maybe one room total) that is run by a nurse with no other supervision.  For simple sicknesses or injuries that works fine, but if anything serious happens the patient often dies on the way to a city for better treatment.  The private sector is better, but you have to be very careful that they don’t do extra tests just to make more money.  That can be common, especially among foreigners.  In terms of preventative medicine, the government has tried to host programs in that area but they typically fail because the general population is uninterested.  That’s a decent summary of what I learned during my Spanish lesson.  There is a lot more there, and I’m excited to dive into it and learn more.  My Spanish teacher agreed to help translate my survey that I’ll give to people involved in my study.  I hope to get input from people in many different areas; public doctors, private doctors, administrators, nurses, etc.  We’ll see how successful I am in that endeavor, but I am excited thinking about planning that study.  

Tuesday, January 28, 2014

Many injuries in Belenpampa, Centro Qosqo del Arte Nativo

I ran my furthest yet during my time in Cuzco.  20 minutes one way, over 4 miles.  Using times to gauge my training is easier than distance, although I can use google maps to calculate distances.  I felt good, but I was tired afterward.  I’m trying to figure out my goal time for the 25k River Bank Run; I know I need that to motivate myself in my training.  It isn’t always easy to wake up before 6 for a run. 

Belenpampa was pretty wild today.  There were 3 major, interesting injuries in addition to the typical injections and removal of stitches.  First was a lady who looked like a nun, but her husband was with her so that was clearly a temporary misunderstanding on my part.  She was walking in a street, when a dog walked by her.  Once past, it turned around and bit her in the ankle.  That’s scary, since that could happen to anyone and it’s a major injury.  She had 4 puncture wounds and major bruising, which made it difficult for her to walk.  All we did was clean the wounds.  The husband was very adamant about wanting a vaccination for rabies, but that required a physician’s approval.  They left the room without getting an injection, and I assume they went to one of the doctor consultation offices to get that taken care of.  I don’t want to imagine that they left with nothing but a wound cleaning, because that would be unsafe.  Julia also told them that if the dog is still alive in 10 days, it almost certainly doesn’t have rabies and she should be fine.  I suppose that makes sense, although I’m not sure that anyone wants to just let the dog run wild in the city for a few more days to check diagnosis.  Second was a man with 2 large wounds; one on the inside of his thigh, one on his foot.  The vocab describing this one eluded me, but I know that the same cause resulted in both injuries.  Of course, I was again asked by the students if I wanted to handle this one.  I was foolish enough to say yes, although the nursing student was there helping me.  We had much difficulty removing the bandage on his foot because of all the seepage from the abrasion; it required a lot of water to allow it to move.  Once it came off and I saw what was underneath, I was 100% aware that this was beyond my training.  I let the other student handle this one.  It was still an open wound, roughly circular with a diameter of about 2 inches.  Even if all the techniques don’t translate, the ability to tolerate gory wounds will certainly help me in my further medical training.  Lastly, a woman shut her finger in a car door.  Just the tip was crushed, so instead of fracturing a bone it gave her a nasty, deep cut that required suturing.  I am shocked at the power of circulation in the hands, that ¾ in. long cut bled everywhere.  Julia used anesthesia to silence the pain, then went to town.  Five stitches later all was well, but that would be a horrific wound to have because of the hypersensitivity of the fingers.  I felt bad for the poor woman.  Toward the end of my shift Luis came in and asked me if we could meet this weekend so he could practice his English!  I’ll spend some time to spend with Carlos as well, but I’m very happy with the friendships I’m developing in and outside the clinic. 

For the afternoon I went to ProWorld, where the internet decided to work today.  It seems to be safe when other people are there to reset it when it misbehaves, but without that it can be hopeless.  I encourage you to look at the pictures I put on facebook of Quiquijana; the scenery is incredible, and the town is far removed from anything we’d experience in the US.  It is one of my favorite experiences thus far, and hopefully the pictures communicate that to you.

Instead of the class tonight, I went to the Centro Qosqo del Arte Nativo, where dance performances occur every night.  These dances capture the essence of Cuzco, as one of the most authentic dance groups of the region.  The performance was interesting, involving a large, live band and the dancers.  The outfits were excellent, embodying the colorful textiles of the Cuzco region.  Dresses usually had at least 3 layers, and were always an integral part of the dance.  I must admit it seemed a bit chaotic to me, but I suppose that is very much consistent with my experience in this city, especially with public transportation.

I then returned home, where I was asked to buy pan chuta, which is a particular type of bread that originated in a pueblo we passed through on the way to Quiquijana.  It looks like an artisan bread, with the circular shape.  This is smaller than the artisan breads in the US, but it only costs 1 sol; under 40 cents.  That’s crazy.  The family immensely enjoyed my reaction.  I sometimes feel like a burden to them because our schedules don’t always line up, but it’s times like that when I know that they are enjoying having me here and I need not worry about impressing them or being overcautious about the work that I require with food and whatnot.  

Monday, January 27, 2014

Mercado San Pedro, La Iglesia (The Church) La Vid

I feel like I shouldn’t be learning a ton every day anymore since I’ve been here 3 weeks, but that’s not the case.  I woke up today after a nice full night of sleep, and decided I’d run later in the day to give myself a bit of a break.  We hung out for a while, then we had breakfast.  This was pretty spectacular.  They made orange juice by squeezing oranges as is commonly done in the US, then they added papaya and a little sugar and blended it.  MMmmm.  I’d advise trying it.

In the late morning I went with Joaquin to the park.  This usually has an admission cost of 50 centimos to enter, but Sandro was friends with the lady at the gate so we got in free.  In the US, we usually at least pretend that we are giving friends special treatment for some other reason other than just our relationship.  Peru doesn’t have the same cover-up.  Of course 1 sol is a little over 30 US cents which is nothing, but it does speak to the cultural difference between the 2 countries.  We’ve been trying to do this basically since I arrived, so I was glad we finally found a time that worked out.  For most of the time he played soccer with some neighbor kids while I watched.  It seemed to be the blob version of soccer where all the kids run after the ball instead of having well-defined positions.  They seemed to have fun, and I find that I do enjoy myself when I watch soccer.  Coming here makes me wish even more that I’d have played as a kid, since it would be a great way to connect with people.  Soccer is basically another universal language like music and mathematics.  We did end up playing some Frisbee as well, which made me miss the States a little bit.  I have a deep longing to show up to an Ultimate Frisbee Saturday again. 

Eventually the family came to pick us up, and we were off for the afternoon.  First we visited the grave of Sandro’s dad, who passed some time ago.  The graves are much different here than those I’ve seen in the US.  Instead of grave stones spread throughout the ground, they have a whole complex of what I can best describe as cabinets for each person.  I assume the body (or at least ashes) is behind the visible cabinet part.  I again didn’t have my camera so I can’t show you.  Each section is about 5 tall and 10 wide.  In these ‘cabinets,’ the families can put cherished objects to remember their loved one.  This typically consists of a picture, flowers, religious figures, and other objects that the person would have held dear.  For example, the person next to Sandro’s dad had a small Fanta soda bottle.  I think it’s neat that they are able to have a little lockable enclosed area for each person, it allows the family to do a better job of putting significant artifacts near the deceased than we have in the US. 

Next the family introduced me to a market that’s only open on the weekends, but has great deals on many US apparel and shoes.  I need to buy some grub shoes for my workplaces, so I’ll probably do that here.  I may also get some nice shoes to just wear around since I can’t just have my running shoes on all the time.  I can get a pretty nice pair of casual shoes for around 150 soles, which is below $60.  That’s spectacular compared to the US.  I also saw that they had some guitars and other instruements!  I will probably check those out for the sake of curiosity.  I didn’t have any money today, but I will return when I have the cash. 

The final stop was the Mercado San Pedro.  To me, this place is crazy.  Imagine a huge farmers market.  Make sure it’s on the streets of a major city.  Now imagine the street packed with 3 vendors across in a 2-lane street, along with stores along the sides.  The food is just set on tarps to keep it off the streets, and most of the vendors have some of the traditional brightly colored Peruvian garb.  Everything is very cheap, so that’s why Tania wanted to come here to get food for the week.  There is also an indoor part that’s the actual Mercado San Pedro, and that isn’t quite as wild to me.  But it’s hard to believe that there are that many farmers in Cuzco who make such a variety of crops.  They also had much of the traditional Peruvian clothes, and I’m sure it’s much less expensive than near the plaza.  I plan to check this out later this week, especially since I found out they have great lunches for only 5 soles.  Less than $1.50.  That’s legit.

When we got home I scarfed down lunch and peaced out to the ProWorld office since I offered to meet Matt and Stephan at 4:00PM this Sunday on Skype.  Matt couldn’t make it, which was fine because my internet completely misbehaved at ProWorld.  I spent 2 hours wrestling it to no avail except seeing Matt’s comment about not making it.  That’s it.  Next time I need to just go to the mall and get into a cheap place with wifi.  But it kept tempting me with almost working so that’s why I didn’t leave earlier.  I did leave quite frustrated though, there was a lot I wanted to do. 

As soon as I got back from ProWorld I bounced over to the church that Nick Balcombe and his wife (my family in Lima) told me about.  It’s called La Vid, and it’s not too far from where I live.  It took me about 20 minutes to walk, but it would be much faster if I took a Combi.  I was entirely at the mercy of the people of the church, since the guy who I knew was arriving late so I couldn’t meet him.  I should’ve known the church would follow Peruvian time (start after the official 6:30PM listed time) so I didn’t have to rush, but I hurried to get there anyhow.   I must confess that I was a little nervous because this church is large, with about 7000 members.  They have 2 services so each is similar to the size of Mars Hill.  I think this place is smaller than my church, but it is very large.  I shouldn’t have been nervous because in MI I have experience a massive churches.  Within a few minutes a guy came up to me and started talking to me.  His name is Carlos, and he leads 2 groups for people my age!  One on Wednesdays and one on Fridays.  I chose Wednesdays since Fridays would be less consistent if I travel.  But this is an answer to so many prayers, I’ve been searching for a solid Christian community here my whole time.  I can’t wait to meet the whole group of people, having community again will be wonderful.  Having Carlos to help me understand what was going on was also great.  I would have been very confused when everyone ran to the right during a song if I hadn’t been forewarned.  He does speak English well too, but I learned that after we parted ways this evening.  He also prayed over me a few times over the service, and even if it wasn’t in my native language it was still encouraging to me.  I enjoyed the teaching as well, it was about discerning what God is calling us into, following several passages in Luke.  It went about 3 hours, but that sounds typical here.  As long as they're preaching the Word of God I don’t honestly care how much they talk.  It was certainly different than an American church, but it wasn’t as different as I’d have thought.  I felt at home, and I’m very happy to finally have a male friend J  

More Incan Ruins

I woke up well-rested for a day of adventure.  At 9 I met the ProWorld girls in the Plaza to catch a cab to Tambomachay, the furthest of the ruins we were planning to visit today.  We were going to go just get off here and walk back, but the cab driver said if we paid a little extra then he would stay around and save us a 2 hour walk to one of the ruins.  That seemed reasonable, and ­­­­­­­­Cecily’s knee wasn’t behaving well today, so we took him up on it.  Tambomachay was the smallest of the ruins, but it was still quite cool.  It had several ancient Incan duct systems that still functioned.  That’s so impressive.  Over 600 years old and still running.

The best part about this site was the surrounding trails.  We got many different views of the ruins, and were introduced to some donkeys as well.  In the end we got to walk on the hill behind the ruins, where we were met by a stampede of farm animals being herded toward some unknown destination.  Here’s a picture to illustrate what we all of a sudden noticed coming around the corner:

After managing to evade the herd, we went down and skipped over to Pukapukara, which is right next door.  Also cool, but not nearly as impressive as most of the sites we saw last weekend.  The first highlight was finding a little cave!  I wonder what its use was; it seemed to only have one entrance, with a depth of about 20 feet.  Second, the Incas were masters of utilizing natural features in their architecture.  We saw that last week in the terrace system at Pisac.  Today, it was first evident in this fortress.  The natural rock formations and the Incan wall mesh shockingly well, as seen in the picture below.

This style of development was even more obvious at Q’enqo, which was our next stop.  The 2 hour walk was greatly shortened by the presence of our cab driver.  Initially, it almost appears like the tiny fortress is nothing more than a natural rock formation.  Eventually you realize that there are some unnaturally smooth walls in the rocks and what appears to be seats present as well.  The coolest part was basically a cave between 2 rocks, complete with seats and storage compartments.

Our final intended destination was Saqsayhuaman.  Think of saying Sexy Woman and you will be near the correct pronunciation.  That’s a trick I learned from the tour guide last weekend.  This was a very impressive site; it was once the fortress with which the Incans held off the Spaniards, as it is the closest of the ruins to the city of Cuzco.  After the defeat in the Incas in Cuzco, the rocks from this fortress were used to build the most impressive churches within the city, so almost exclusively the foundations remain.  I thought the size of the fortress was incredible, but my family told me that it’s only 1/10 or 1/15 the size of Machu Picchu.  That blows my mind.  These were still impressive.  Many doorways remained; perhaps the Spaniards didn’t like the idea of attempting to lower the massive rocks.  In the foundations of the fortress are some of the largest stones I’ve ever seen used in a man-made structure.  Absolutely incredible, they must have been over 15 feet tall and sometimes equally wide.  I can’t comprehend how an ancient people was able to use these stones in a structure.  They’d have to cut it, move it, and set it up appropriately with the other surrounding rocks.  The last highlight of Saqsayhuaman was a tunnel.  I’m not sure what it’s purpose was, but there was a 20 meter tunnel in one part of the fortress.  It’s not perfectly smooth or anything, but it was certainly a man-made tunnel.  Walking through it was a fantastic experience.  Here are a few pictures of the site:

Instead of being done here, our driver offered to take us to Tipon for a reasonable price.  It was over an hour drive away from Saqsayhuaman, on the same road my family took to get to Quiquijana.  As most Incan structures, it was high up in the mountains along the road.  The ancient town was better preserved than Pukapukara; you could still see where all the rooms were within it.  In the lower town most of the tops of the buildings had been removed to build the Spanish town of Tipon at the bottom of the mountain.  However, the most shocking aspect of this place were the terraces, and the corresponding water system.  They were built in a rectangular fashion, in contrast to the rounded terraces of Pisac.  However, here there was also a complex system through which water flowed from higher into the mountain to below.  As in Tambomachay, this still functions today.  But it is far more elaborate and impressive than the one or 2 channels in Tambomachay.  There is a spectacular quadruple channel at the top of the terraces, and it flows down through many other channels to reach its final destination.  To get from one terrace to another, there were also stairs built in.  Several rocks of the terrace protruded beyond the wall, which looks ancient but has held up very well until today.  Not a single stair was out of place in the whole complex.  I was very glad we made the trip out there today. 

Volunteering at a Rural School

Instead of going to the clinic today, I went to the volunteer project that the girls are doing every Friday.  Fridays are typically slow at the clinic, so I figured missing one to check it out couldn’t hurt.  I can choose when I want to go and when I don’t, so today was basically tryouts.  I loved it.  Manual labor, extremely rural town, beautiful mountains everywhere in the backdrop.  Incredible.  The president of the town met us as we got out of the cab after a 45 minute drive.  He speaks Spanish, but he and the whole town much prefer Quechua.  It’s interesting that we can communicate in our second language even though our first languages are so different.  There is some limited electricity, but there are only a few places with running water in the town and all the homes are made of adobe.  I couldn’t help but thinking we’d regressed if the Incans were building extravagant stone structures 800 years ago, yet now many rural people live in mud huts.  The economics of the town is solely based on agriculture.  Many animals are roaming the streets, finding the next patch of grass to gnaw on.  The town is surrounded by more fields for grazing, as well as an impressive amount of corn.  We aren’t looking at solely sustenance farming; they produce enough to bring to the market to sell and trade.  Overall the town seems like a peaceful and happy place.  Just because I grew up in a different environment to this doesn’t inherently mean that their life is any less happy than mine.  In fact, I found myself identifying with these people in many ways.  Many parallels can be drawn between my experience in rural USA and the lives of rural Peruvian farmers.  Granted, I have a comparably large, heated house in which I get internet so I can reach the whole world.  My floors are not made out of dirt.  But, I live on a dirt road like they do.  I am accustomed to being surrounded by animals like they are.  Corn surrounds my house just like it does theirs.  Open fields look as much like home to me as they do to these people.  I know these similarities may seem minor compared to the differences.  And maybe they are, but I am very thankful for my rural upbringing because I think it will help me to identify with rural populations throughout the world.  Here are some pictures to give you an indication of what the town is like:

The project we worked on was a school, which ProWorld has been contributing to for about 3 years  (picture below). 

The school is fully built of adobe, and is painted green.  There is another shell of a building next to the school, which is one of the only concrete structures in the town.  Part of this will be a kitchen for the school, and the other section aspires to be a dining room.  The floor of this add-on is unfinished, and we’ll be hauling gravel and cement to finish it off next week.  Today our task was to even out the ground of the playing area for the kids.  There were a few particular areas that could use a lot of work.  The space between the house and the next building was filled with a high heap of dirt for us to move.  I was almost giddy to start, I love manual labor on volunteer projects.  It brought back many fond memories of Mississippi mission trips in high school and the Detroit Urban Plunge from Sophomore year of college.  Each of those trips transformed me in some way.  Throughout the span of those trips, I clearly saw that I had a role to play in God’s plan for restoration.  I was spurred on by the hearts of my brothers and sisters who all wanted to do everything in their power to make a tangible impact on these people’s lives.  The Detroit Urban Plunge especially stands out in my mind, and not only because of its recentness.  That was the most committed team of volunteers I’ve ever been a part of.  We had to be told to take breaks.  When anyone finished a job, they would immediately look for something else to do.  There was even a time when everyone wanted to work but there wasn’t enough work, and I realized the best way I could serve the community would actually be to sit out and allow others to work.  That was a hard decision because I love working so much, but seeing the united heart and strength of our group was truly moving to me.

One nice thing about working with 3 girls is that I don’t need to worry about fighting over the fun, power jobs with other guys; it always just falls to me.  I shoveled with my best speed and efficiency for a long time today.  It was tiring, particularly with the whole elevation factor, but I remained strong.  The others took a break at one point, and I stopped for a little while but I couldn’t stand around talking with that mound of dirt glaring me in the face.  I also moved many very full wheelbarrows, which was a feat.  There are a few little steep areas right before the dropping point, and those gave me a great workout.  I absolutely love working hard with my hands.  I’d never want a career out of it, but one day a week for the next 4 months sounds like heaven.    

We finished the dirt stuff early on, so I was given a tour of the town.  It’s a cool place.  Amid the adobe homes, there are immaculate gardens with fruits and veggies to diversify their diets from the traditional rice, potatoes, and occasional meat.  Among the many farm animals, they had several farms of an animal that we are less accustomed to; cuy, AKA guinea pig.  I got to look at one of them, so if you ever wondered what a guinea pig farm looks like, here it is!

After eating some lunch together, we helped with concrete laying for the foundation of a gate that will be used for the school.  This just means shoveling rocks into a wheelbarrow along with some water, mixing, and pouring it into the hole.  We made good progress on this too.  It’s the first time since I came that I really felt like I was doing something useful for people.  Even if I know that it’s still small, and perhaps the lessons I learn will exceed the little benefit that I can offer this town, I feel good that there is at least some tangible impact.  In the clinic I don’t get to see this very often, so the volunteer project was refreshing.

Upon arriving back home, I had some paperwork to do for the Gilman.  I kept forgetting to put in my new address and whatnot.  I also have to write a recommendation for why the honors college at GVSU is so wonderful.  That is of course something I am passionate about and want to be a part of, but I simply didn’t have the time this week.  I’ll write it during the weekend for sure, since the deadline is coming soon.  My time at ProWorld was tripled by the dysfunctional internet. 

Back home, I hung out with the kids after my much needed shower.  Joaquin and I went to get ice cream at one point, which was delicious.  I had the unfortunate luck of seeing a dog get it’s foot run over by a taxi during this trip.  I think he’ll be ok, since he was able to put a little weight on it after a few minutes.  This wasn’t even a street dog, it actually belongs to someone.  I do feel bad for the poor dogs, so many people just don’t care about them in the way we do in the US.  Maybe we care too much sometimes or spend too much money on that industry, but having dogs roaming the street because of owner negligence is certainly worse in my eyes. 

In the evening I went to the plaza with the ProWorld girls, of their friends from class who’s from Cali, and Katherine (the girl from the clinic).  Again, there just aren’t many males to befriend that are easy to find.  We wanted to check out this Israeli place that Amanda told us about.  Salad, entree, dessert, and a drink for 12 soles, or a little over $4.  That’s what I call a deal.  Food was delicious, and I got to try strawberry juice.  I expect that we’ll be back.  After this we hung out in the plaza for a while.  One little boy commented that I was hanging out with 5 girls, another ploy to get me to buy things.  Eventually they headed to a bar, but I was too tired to continue.  I want good sleep if I’m going to be hiking tomorrow, and I deserve it after the hard work I put in today. 

Friday, January 24, 2014

First Injections!

Routine run, then off to the clinic this morning.  I nothing super exciting, but there were a few interesting wound treatments.  One of them had initial stitching and treatment at another aposta, which is actually the word for free clinic.  I missed the a last time I talked to someone about this.  It sounds like there are many throughout Cuzco, but Belenpampa is the largest.  This patient came here because the wound was not treated properly at the other site.  That seems like a big issue to me, and it was to Julia as well.  She told the patient to return to the other place and make it clear to them that they were in error.  We had several little boy patients today too.  One had a fever, but it didn’t take too long for that to subside with the warm rags and some medication.  Another had a fairly large laceration on his face.  The wound was dry and sealed with scab, so they decided to take out the stitches.  The kid didn’t like this very much and seemed to be in pain from it.  Might by psychological since there was a little blade near his face to do the cutting with, who knows.  Another boy had a small infection on his face, presumably from a dog scratch.  He was very upset that his mom had to leave the room because she was carrying a little dog with her.  I was shocked she was allowed to stay as long as she did.  To me, it’s definitely not ok to have a dog in a room where medical procedures are going on.  At all.  But here we are.  This was actually the second dog to enter the ER today.  Another one seemed to be staying close to a blind man.  I guess it could have been an assistance dog, but it was very hyper and wasn’t on a leash.  This animal wasn’t nearly as clean as many dogs in the US, further making it hard to believe that it actually had a legitimate place here.  I’m still saddened and surprised by the number of dogs in the streets, but the dogs within the aposta really throw me for a loop. 

The best part of the day was giving my first intra-muscular injections!  We give all of them in a nalga, which is a butt-cheek.  I’ve learned how to feel for the correct spot, as well as the procedure to do the injection itself.  My first 2 injections did have supervisor oversight, but I am learning a lot and could probably do it myself unassisted soon if they allow me.  It was cool to have this experience though.  I so so so want to stay involved and learn the ins and outs of Peruvian healthcare, and that’s exactly what’s happening as I make it clear to supervisors that I’m interested!
One more interesting thing happened in the clinic today.  Company representative are frequent visitors to the Peruvian central health system.  Not as many as we have in the US, but many.  So a lady from a baby food company brought in many crowns to give to all the child patients.  It was a huge hit; I don’t think there was any young patient who wasn’t wearing a crown by the end of the day. 
In the afternoon I hung out with Joaquin and headed to ProWorld to talk to Meghan.  After my Spanish class I went out to eat with my ProWorld friends, which was nice.  We are developing some community within the group!  The plan is to hang out with a kid from the other ProWorld office in Urubamba this weekend because apparently he needs friends, but we’ve heard he’s quite the character.  I almost wish I didn’t know as much about him as I do.  A girl in the program is very opposed to spending very much time with him, to the point where it’s hilarious because she’s already predicting all the things he’s going to do that she won’t like.  We got a lot of laughs out of her allegations this evening.

As another side note, I often get tired while I’m writing these and so I write incoherent things toward the end.  This was the case in the last post, where the last paragraph made no sense until I edited it.  For this post I also had some nonsense written, which won't be included online.  I find that I mix Spanish and English in these writings along with having thoughts that drift without reason.  I haven’t yet dreamed in Spanish, but maybe I’m close!

Thursday, January 23, 2014

Museums and a Drunk Guy

Today was a very eventful day.  When I awoke at 5:50 to run, I realized I didn’t have the energy to run.  I need to listen to my body if I’m going to optimize the efficiency of my training, so I slept a little longer. 

When I arrived at the clinic, the lady with the leg injury was back and Julia was cleaning the wound again.  At the same time there was a little girl in the office who had a fever.  There is a second room that does have a bed, but it’s almost never used.  The room also contains many necessary medical supplies and a desk for doctors and nurses to use.  For the girl we put warm rags on her head and armpits.  The fever broke soon enough so we could send her home.  Most cases were quite typical today.  We had to clean out some cuts to make sure they heal properly and give some intra-muscular injections.  I didn’t actually touch any patients today, but I think I will be able to tomorrow.  I’m very excited about that. 

There were 2 events in the clinic today that stand out.  First, at noon, a guy came in slurring his words and walking a little funny.  Clearly drunk, but he’d just wandered into the clinic and ER is the nearest to one of the entrances.  Everyone else ignored him, which was smart.  We went into the other little room by the doctors for a little while, but they paid him no attention.  Eventually everyone left, and I was left standing in the corner.  I should have avoided eye-contact, but I was too curious.  He walked over to me and we had a basic conversation; where I’m from, names, etc.   I was first of all impressed that I could still understand him despite his slurring.  Then he asked me for 5 soles, which of course I refused.  He then asked for a hug.  That’s weird, I didn’t like that.   But unfortunately I was trapped with no doors to leave through.  So whether I wanted it or not, that hug was on its way.  I was mostly concerned with him trying to take something from my pockets during the awkward few seconds, since I could see that being a common diversion.  He didn’t go for my pockets, but he did attempt to go for a kiss on my cheek.  As soon as I felt his chin moving in that direction, I pushed him away and said “NO” multiple times.  He then decided he’d try to sit on me.  This of course wasn’t any better, so I pushed him away again.  This time he got the hint that he wasn’t going get any money from me, so he gave up and went elsewhere.  I hope to never duplicate this experience, in a clinic or elsewhere.

The second interesting part of the clinic was a patient with a long laceration.  I didn’t know how long he’d had the wound or how it was healing, but when he took his shirt off the bandage was massive.  It stretched from the tip of his sternum at least 6 inches to the lower right.  There were 2 other students today.  Micaela was there along with a pharmacy student whose name is hard to understand.  They both were unsure of doing the cleaning themselves, so they offered it to me.  I hadn’t done wound cleaning yet, and while it looks easy, I wasn’t about to start with a wound like that.  Tomorrow I should be able to practice this technique that I’ve learned through watching the last 2 days. 

Also, I figured out the egg thing.  I asked Julia because I was so interested in it.  Basically, it’s a good way to keep a wound sealed shut without suturing.  It’s especially ideal for kids who don’t sit still well.  Additionally, it doesn’t leave a scar.  If I ever get a cut in a location lacking medical supplies, I can just use this trick.  Julia talked about some creams that did the same from the US, but she doesn’t have access to them.  She wants to find them because she likes them a lot, they help heal the wounds of many patients without scarring. 

For the afternoon, I walked the city with the ProWorld girls.  We visited 5 historical spots, and it was also no easy journey.  There are so many places to go in the city.  Four museums plus a historical site today.  They were all quite interesting, but I especially liked the mix of Spanish and Incan relics.    

Eventually I went home and traveled to Spanish classes, which weren't too eventful.  I talked to my teacher about the Incan ruins near Cuzco, and I think we're going to be able to do 4 of them this weekend!  I unfortunately got drenched in the rain on my way home.  Overall, it was a day to remember :)

Wednesday, January 22, 2014

New Friends in the Clinic!

Interval training started my day.  It’s hard, but I know I can feel results.  My lung capacity must be expanding a lot because I breathe very hard during the sprint portion of the intervals.  I’ll definitely be ready for the Inca trail!!

Work today was not quite as intriguing as yesterday in terms of patients.  Several patients from yesterday came in for another shot of anti-inflammatory medication.  I was still struck by how awkward it must be for them to have their pants down for an intramuscular injection while other patients and staff are running in and out of the same room.  Maybe this is just my American lens looking at the situation and it doesn’t actually bother them, but it still strikes me as odd. 
Even if there weren’t any super cool patient cases, today was a great day in terms of making new friends.  A pharmacy student, Luis, was the first person I met today.  He will be rotating through various services fairly quickly during his time here so I may not spend too much time with him in the clinic.  However, his interest in the United States, desire to learn English, etc. should mean I’ll get to hang out with him outside of work.  He will be spending an excessive amount of time there over the next month, but we can probably find time somewhere.  My dictionary was a huge hit with him.  At one point 4 people were huddling around it to learn a little medical Spanish.  I left the book with him to study since he was staying in the clinic until 7 tonight.  I also met another nursing student named Micaela today.  She was quieter than Luis so I mostly talked to her when he was off doing other things.  I think we’ll get along well, she is very interested in running and hiking the mountains near Cuzco, so I may have another friend to do adventures with!  These 2 made the otherwise dull day enjoyable.  I do hope that we have more patients tomorrow though.  I learned from Maribel (the med student) today that my department isn’t only emergency, but also tópicoThis is basically routine cases of the region, basic injections, etc.  That makes sense; all the cases we have are definitely not emergencies. 

In the afternoon I went to Proworld after lunch and chatted with Matt Barylski over Skype, but the internet was giving us many problems.  Some on both ends, since my internet faded in and out and his phone didn’t seem to be working properly.  It was frustrating, but at least we tried.  Hopefully we’ll figure out a better system for next time.  ProWorld internet then went out for almost an hour and a half, which I wasn’t a huge fan of.  ProWorld is all I’ve got, and that little time is precious.  I still entertained myself and got important things typed up, but I hope that doesn’t become a common occurrence.

My Spanish teacher suggested that I go to all the nearby Inca ruins this weekend while I have that tourist ticket.  It will be a very full day, including walking in the mountains J  I think I’m up for it, I just hope I can convince one or 2 of my new friends to go too.  The girls from ProWorld might come too, but I know they weren’t wanting to do anything too intense physically, especially in their first few weeks.

Tuesday, January 21, 2014

Transferring to Emergency Department

Today I went for my longest run of the trip, probably about 3.5 miles.  I’m still going slow, following the schedule that I remember from cross country in high school.  By the end of the 4 months I’m going to have to get up really early if I want to do the kinds of runs I hope to be doing.  I’m finding that it’s really not very easy to do everything I want here.  I get up before 6 to run every day.  Work (including transportation) takes about 6 hours of the day.  I then eat lunch and typically spend a little time with the family.  In order to do everything I need to with the precious proworld internet, I typically arrive to the office by 3 or 3:30.  Spanish class from 5-6:30 or 5:30-7 depending on the night.  Then I go home, tired from a long day of speaking a foreign language.  I eat dinner, hang out with the kids a little bit, then go to my room to write this.  Usually I go to bed after writing this since I like getting at least 7 hours here to make sure that my body is able to recover from adjusting to altitude and running.  I don’t have nearly the time I thought I was going to before I arrived.  Typical Michael Dykstra.

Today I transferred from X-ray to emergency.  When I arrived I told Neilida my plans, and she helped me look for Dr. Jorge, but he wasn't there.  So she put me with her friend Julia in emergency.  This lady seems very nice, although I get very confused when she switches to Quechua.  Now, allow me to describe this emergency room.  There is one bed.  It has no sheets or covering to change, and there aren’t an abundance of sanitary wipes between patients.  A rag is used to wipe it down after each patient, and that’s about it.  Don’t worry though; they have a little metal bowl they put under the area being worked on, so most of the chemicals (water, alcohol, iodine) and blood fall in there.  Most.  That’s wiped out between patients in a little sink.  The extent of the privacy is a curtain that covers part of the space between the doorway and the patient bed.  Patients are always walking in trying to get care, so it is common for them to see procedures being performed on other patients.  I am almost glad I have very little formal medical training, because I think this place would cause me more discomfort if I fully understood all the differences.  I was also happy to meet another US volunteer; she’s also here for 4 months!  And she likes hiking, so I’ll have someone to do that with!  I’m still going to look for more Peruvian friends, but I was very happy to meet another friend who I won’t have to go dancing with to get to know. 

The first case wasn't a big deal, a lady had some kind of object in a small hole in her leg (puncture wound) and Julia was cleaning it and trying to remove the object.  She cleaned it well, but it looked quite painful.  They started with the next patient, a little boy with a wound on his head, when all of a sudden a girl no more than 3 was rushed in with blood all over her face, and she was of course bawling her eyes out.  The wound didn’t end up being very bad, and didn’t even require stitches, but that was a dramatic start to the morning.  I did help some settling the girl down when she got upset again partway through the treatment.  It all happened so fast, I was watching then all of a sudden I was commanded to help out with the toddler.  This is good training for med school even if all techniques aren’t the same.  I was extremely surprised at the method of treatment for this little patient.  Julia broke open an egg, put the part we’d eat in a cup and set it on the windowsill.  With the remaining egg shell, she peeled off the pliable inner layer and placed it over the cut.  The gauze was put above the thin shell and taped to the skin.  I never got a chance to ask why this is done, but I hope to do that.  We had many other patients throughout the day.  Several head wounds that were cleaned and stitched or had stitches removed.  Syringe preparation was part of my task today, and I’m pretty sure that I’ll be allowed to do some intramuscular injections as well.  It’s really not all that spectacular, but I’m excited to get a bit of hands on clinical experience.  There weren’t any other super shocking events today, but I can tell that I’m going to learn a lot during my time on this rotation.

Another side note is that I’m learning that this clinic is largely run by students.  Especially nursing students, but med students as well.  Many of them just started in a rotation the same day I did, so they seemed to feel just as out of place as I did.  It was comforting to me that I could identify with my peers in that way. 

The evening was quite normal, although another systemic difference between the US and Peru became very clear in my mind.  Today I went to the bank to take out some soles, the currency of Peru.  As you can only take out $20 bills in US ATM’s, you can only take out soles by the 50 here.  In the US, it’s usually fine because I use my card for almost everything.  And if I did need cash, every place would take $20 bills anyway.  But in Peru, I have a problem.  This is a cash based society instead of a card based one.  Everything I want to buy requires cash.  Not any cash, but typically small cash.  I only know of 2 places nearby that willingly give large amounts of change when paying with a large bill; the mall and La Canasta (a grocery store).  For everything else, I need to have small bills or coins.  I love that the buses are so cheap, but every single day I need to plan how I’m going to get the coins to pay for the bus out of the large bills that I have.  Maybe I’ll put more minutes on my phone and get cash back for that.  Maybe I’ll buy an ice cream bar.  But it is on my mind all the time.  In the US, I never would think about acquiring the right cash for something except for a large purchase off of Craig’s List or something.  Cash based societies are really quite different than the credit card based one of the US.  Maybe everyone else has figured it out and I’m the only one who hasn’t, but it is proving to be an interesting difference. 

Monday, January 20, 2014

Urubamba Valley Tour

I woke up early today to go to the Urubamba Valley tour that ProWorld paid for as part of the program.  The morning started in an interesting way, since it always seems like there’s a little bit lacking in communication.  Nico brought us to a bus, and the girls and I assumed that he was going to come with us, or at least explain what was going on.  We all got on and he said goodbye.  It makes sense that ProWorld wouldn’t pay for their employees to go sightseeing, but it was still confusing.  No one on the bus talked to us for some time, but it ended up being alright.  They went around the city to pick up various tourists, then we were off to the valley. 

We drove by several historical sights, but I hope to return to them while I still have a tourist ticket to visit without additional charge.  I only have 10 days to use it, but it came included with this trip from ProWorld.  Sacsayhuaman and Pukapukara are the 2 that are close to Cuzco that it would be reasonable to visit.  Our first stop was basically a market for tourists up in the mountains, near 3800 Meters.  I found a fedora there that looked very Peruvian, but it was 50 soles and I only had 40 with me.  That’s still not too expensive, but I figured I could wait.  I also saw some sweaters that I liked.  They cost 40 and 50 soles respectively, but she lowered the price when I was about to walk away.  I still didn’t get one because I didn’t want to use all my money before the trip barely got started, but I learned that I can do a better job of bargaining and save money here.  During this portion I also met a few more people, including a couple from Canada (eh) and a lady from Switzerland.  These Canadians said “eh” more than anyone I’ve ever met, confirming stereotypes.  And apparently the Swiss like Peru a lot.  This was super tourist-y so it’s not like these people will be here for a long time, but it was fun to meet them. 

The mountains are absolutely stunning here.  I could take pictures of them all day and never get tired of it.  At one point we stopped at an overlook over the Urubamba Valley.  Absolutely breathtaking.  Some savvy townspeople set up little shops on the pull off by the side of the road, and some of them approached me.  I’m really bad at saying no.  That’s not just because I give into their pressure, it’s that the things they have are so cool!  They had little rock sculptures of animals and other figures for 15 soles, which is under 6 dollars.  The lady said it takes them a day to make.  Onyx was the only rock I recognized, but I ended up getting an owl made of something else.  A brown stone with some variance in hue.  It’s incredibly cool, and would probably cost 30 bucks in the US. 
Our first archeological stop was Pisac, which was a city high in the mountains that the Incans used as customs for people coming from the Amazon.  It was also a treasured food supply for the rest of the people, meaning it had a very sophisticated terraced agricultural system.  When the Spaniards destroyed Incan establishments, they typically left the terraces alone because they were harder to deconstruct.  So these terraces are still completely intact today, and the aqueduct system still works perfectly.  It has probably been working for near 800 years, with no upkeep necessary.  No erosion, nothing.  So impressive.  They are also constructed to conform to the shape of the mountain, so each level is a different width.  The engineering behind this construction was very complicated and well done.  The picture below shows the terrace system.  Also, the ruins of the town are interesting.  Next door is the only visible graveyard of the incas.  It consists of holes in the mountainside, and there are over 300 holes visible.  There may not be much left inside because of grave robbers, I’m not sure.  This was also a shockingly beautiful place for flowers too.
After this, we went down to the modern town of Pisac, which was founded by the Spanish.  This was basically a tourist trap with things to buy.  I didn’t fall into any traps there.
The town of Urubamba was our lunch destination, and wow it was great.  Buffet with so many options.  I can proudly say I made this a 5 course meal.  Throughout lunch a guy was playing a very exotic, Peruvian looking instrument that added to the atmosphere.  The setting was absolutely gorgeous, with many llamas walking around and beautiful flowers everywhere.  It was included in our tour, but I’m pretty sure I would have been ok with paying the 35 soles ($13) to eat there. 
A short drive away was Ollantaytamba, which is an incredible place.  It’s probably my favorite thing I’ve done here since I arrived.  This city was an Incan city which monitored the river and served as food storage.  It is always windy here; all day, all night.  The Incans utilized this wind by setting up storehouses in the mountains that were open to the air.  This is how they dried out food for preservation purposes.  They also grew crops on another elegant terrace system.  At the top of this was the Sun Temple, which was actually never finished.  It was under construction when the Spanish invasion began.  Upon hearing that the Spanish were coming, the construction ceased.  This provided archeologists a unique opportunity to observe the Incan process of stone-cutting and transportation that were required for building their extravagant temples.  The quarry is still fully intact because the Spanish were unwilling to move rocks as far as the Incas.  The temple itself was still largely destroyed by the Spanish for their own uses, but what remains is very impressive.  There is a set of massive stones that still remain, and it’s hard for me to imagine what these must have been like to drag those to the top of a mountain.  The city itself at the base of the mountain is still a “living Inca city,” in the words of our tour guide.  There aren’t too many fully intact Inca buildings, but just about every building still has 1 to 2 meters of Incan wall base.  The roads are still Incan roads.  The outer wall still remains.  Terraces are all around the city for agriculture, not just at the main historical site.  So the layout of the city is still exactly the same as when it was initially built many hundreds of years ago, even if colonial-style houses have taken over the pure Incan buildings of the past.  It is also here that I found a fedora for 20 soles, which is incredibly cheap.  I wanted to take more time to decide, but the bus was leaving so I grabbed one and left.  Number 11!  Here are a few of my favorite pictures from Ollantaytamba:
The last archeological site we visited was Chinchero, which is a small but historically significant place.  It was first destroyed by the Incas; when Manco Inca (the primary rebel against the Spanish in Cuzco) fled Cuzco after his defeat, he took the resources from this place then burned the rest so the Spaniards couldn’t use them.  The Spanish finished the job of destroying everything.  It’s hard to compare to Ollantaytamba, but still worth checking out. 
Our last stop was seeing some traditional making of Peruvian textiles.  Absolutely beautiful.  It’s incredible the colors they are able to make with little more than llama wool and some plants.  And time.  It takes many days to make some of the most intricate textiles, but they are some of the most impressive I’ve ever seen.  At this point I was down to 5 soles so I couldn’t get anything, but I loved spending time here and learning about how they do everything.
Eventually I got home, and I was too tired to do anything but write this post.  Tomorrow I have a lot to get done (including completing my first Gilman blog post), so I need my sleep!