Tuesday, January 7, 2014

La Clínica Belenpampa

Today was my first day at the clinic.  I woke up early, showered, etc. in preparation.  At 7:30, the ProWorld director for Peru came to the house to bring me to the clinic.  Her name is Milagro (Mila for short), and she’s very nice.  We took a taxi to the clinic.  Dr. Jorge (they all go by their first names) greeted us, and with him were the people I’d met on the plane from New England.  The first thing he said after the introduction was that my hair was quite long, and it wouldn’t hurt to get it cut.  Looks like my ponytail dreams are gone.  He told Mila and I that I needed a uniform to work, so we left to go find one.  Apparently most of the stores don’t open until 9 or 10, so we had to scour the city at 8:30 to find a place.  We finally found one and I got some scrubs.  I thought of bringing my VAI scrubs because I love them, but I wouldn’t want to hurt them by using them too much.  I’m glad I didn’t. 

During the trek around Cuzco, it was cool to talk to Mila.  Apparently they have many volunteers who come that don’t speak any Spanish.  I know that most of the ProWorld employees aren’t very comfortable in English (or don’t speak the language at all), so I can’t imagine how hard that would be for both parties.  I’ve been speaking Spanish to everyone there, since it is functional and I enjoy the practice.  Heck, I thought it was fairly bold of me to come here all by myself with very little formal training in the language.  But I can speak well enough.  That’s really gutsy to come to a Spanish-speaking country without speaking Spanish.  There are 3 other volunteers coming for the semester (all girls), and none of them have very much background in the language.  That means that if we hang out somewhere, my Spanish will have to sustain us.  Oh boy.  I also learned that Dr. Jorge studied in Russia for his medical training.  It takes a total of 9 years (including specialization) to become a doctor in Peru.  I can’t speak to what that training is like, but it certainly seems like they have a good amount of training. 

Clinica Belenpampa is set up as a clinic to serve the poor of the Cuzco region (city and surrounding areas).  Basically, it’s exactly like a clinic in the US with a few subtle differences.  For example, the entrance is more of a door-shaped hole in an outer wall than the fancy valet service of most US hospitals.  After passing through the outer wall, which I can only assume is for protection, you arrive at the hospital itself.  A long line winds around outside.  Peruvians are much more comfortable waiting to get what they need, probably because they know they have no choice.  It is common for them to arrive in the morning and wait much of the day to be seen.  Stray dogs can be seen on the grounds next to the hospital, as is common in the rest of the city.  Inside, there are also many people lining the halls waiting to get into a room to see a doctor.  The complex has a total of 13 doctors, which are distributed throughout the specializations that the clinic provides.  The rooms seem clean, but they are certainly far from the sparkling white that coats the hospitals I’m more familiar with.  Ok fine, I guess there are more than subtle differences ;) 

After we returned to the clinic, I found Dr. Jorge and told him I needed a bathroom to change.  He looked at me funny when I said bathroom, though I didn’t yet understand why, then told me I could change in his office.  After I was suited up, we discussed what I could be doing during my time here.  Most specializations sound similar in English and Spanish, so I was able to have the whole conversation in Spanish.  We decided to start with radiografia, or X-ray, since that’s what I have a good background in from the US.  I may be able to use my training in suturing and phlebotomy later during my stay, but they would teach me more specifics and such before I’d be on the floor.  I hope.  The plan is that I’ll be in X-ray for about 2 weeks, then I’ll move to another area.  By the end of this I should have a basic understanding of each discipline, at least the Peruvian version. 

The X-ray department basically only has 2 functions.  The most common is to look for Tuberculosis in the thoracic cavity.  The second is to look for broken bones.  The office for this discipline seems to serve many purposes; a consultation office, patient records and basic pharmacy.  The only entrance to the office comes from the outside, not from within the main hospital.  It was fine during the dry morning today, but I don’t like the thought of it during a hard rain.  The X-ray machine was a short walk away across the dirt outside the building and through a crowded hallway.  I was excited to see the X-ray machine, since kilovolts and milliamps are familiar terms to me.  Of course I’m most familiar with machines like CT and PET, which I doubt the infrastructure could uphold even if I could manage to drag one there.  I tried explaining my work with CT to my supervisor, which I think worked, but I didn’t even try to explain PET or Cerenkov…  That’s hard enough in English.  The process of performing an X-ray is different than what I’m accustomed to.  They don’t have much in the way of computers, so they have the patient take their shirt off, put a film on a holder by the wall, and align the X-ray using the light coming through the collimators.  Of course we leave the room because of the radioactivity, but there isn’t a switch outside the room or a wireless hookup to the machine.  My supervisor closed the door most of the way, pulling the wired connection to the machine with her.  Push the button, shoot the X-rays, then we have to process the film.  They have a dark room for this, in which I can barely see my own hand in the dim light.  I’m astonished at the efficiency of my supervisor at navigating in the lighting, but I imagine she’s done it more times than she can count.  The ‘processing’ is just dipping the film in various fluids to prepare it for viewing in the light.  We then walked the film back to the office and hung it up outside to dry.  Again, I’m unsure of the protocol on a rainy day.  The way to store the film in patient records is to take one of those typical, large, orange envelopes, cut one end open so the film will fit, and set it on a shelf.  A little different than the digital uploading I’ve become so accustomed to at VAI.  We only had 2 X-rays today, and the rest of the time they were talking to patients and such in the office.  This part was hard for me, since I struggle to understand them at full speed.  And they were using words outside my vocabulary.  I did strike up a few conversations with patients who were waiting, and we were able to understand each other which was exciting.  But toward the end I was feeling tired from speaking and listening to Spanish for 5 straight hours.  I tried to stay engaged, but it was a struggle.  I did pick up on the fact that my supervisor was complaining about patients who didn’t like cooperating.  Looks like that happens a little everywhere J  I hope that I’m able to progress in my understanding and involvement as time goes on, after all today was only my first day.  The doctor from this department was also very kind, and made sure I felt at home.  At first I was intimidated since he addressed me in the formal tense, which I have not used to any extent.  It’s very similar to the 3rd person, but it’s awkward when I’ve never used it in this context.  I was able to carry on the conversation a little bit, and he was at least able to understand.  He liked my Spanish-English medical dictionary and joked about me teaching him English.  At least I think that’s what he said J

One more interesting part about today.  In the afternoon I asked my supervisor where the bathroom was.  She looked at one of her coworkers, they talked a little while, then one of them grabs a key and tells me to follow.  We arrived at a tiny, almost hidden door with a padlock.  She opens the door, tells me to lock it when I leave, and returns to the office.  If I need to harass them every time I need to use the bathroom, that will discourage me from using it..  I need to figure out a way to eat enough and drink enough at breakfast to be full and hydrated, but not have to use the bathroom.  I would have thought a clinic would have sanitary, readily available bathrooms, but I should have expected surprises.

Nico, another ProWorld employee, picked me up and the clinic and showed me the way home by bus.  Not quite as crazy as the combi, but still pretty crazy.  It wasn’t very busy when we got on, but people just kept coming.  Before I knew it I was rubbing legs with the people crammed into the isle, since the guy in the seat next to me seemed to like his space.  The most hilarious part about the buses is getting off.  In the US, we typically will move out of the way to make it easier for the person.  In Peru?  No.  If they’re sitting, they don’t want to lose their seat so they will make you climb over them.  I don’t know why the people standing don’t move, but they don’t either.  So I basically had to plow my way out of the bus when we finally got off.  Because I have a fairly small personal bubble, I’m ok with this.  But again, I’m glad that closeness with other people doesn’t weird me out. 

My family was worried that I wasn’t home yet, so they called Nico then Joaquin waited for me outside the door to make sure I knew where to go.  I appreciated that a lot, I know they really care about my well-being.  Lunch was fantastic, more soup and fries with chicken and veggies mixed in.  Benji and I are going to run together for a little while tomorrow morning.  Slow, not far, but we will go.  I really haven’t felt a strong effect from the altitude yet, but I’m sure that running will provide that experience.  I’m not going to go hard, this is more to test what it’s like to run at an altitude of 2 miles.

In the afternoon I went to ProWorld to use their internet, but I didn’t have my computer cord so my time was limited.  Responded to some emails and posted the blogs from before.  Before I left home I put on sun-screen because I realized my face was a little red from the few minutes I was outside at the clinic.  It’s crazy how fast I can burn in this intense sun.  Sandro took me to the place, then within 15-20 minutes a torrential downpour ensued.  I’ve always been impressed at the weather changes in Michigan, and this was also impressive to me.  The storm even had some hail in it.  I know it’s not as extreme as what’s going on in MI right now, but it counts for something.  My teacher wasn’t able to come today, so I will start the Spanish classes tomorrow. 

I walked home by myself home from ProWorld.  Safe area, enough people, and broad daylight.  It felt like I was becoming part of the culture since I was self-sufficient for the first time.  It’s probably a mile walk, and I didn’t seen a single white person.  Lots of Peruvians.  I enjoy submersion.  

Back home, I played some more soccer with Joaquin.  In reality, I actually do have to try so that he doesn’t crush me…  I am not surprised that an 8 year old from south America could beat me in soccer.  Also, his victory dance is evidence enough for me to believe that Latin Americans are innately blessed with hip-gyrating abilities. 

The night wound down with a movie, conversations, and reading Mere Christianity by CS Lewis so that I’ll be able to be a part of a book discussion with some friends at GVSU in the near future.  What a day!  I’m excited to see what happens tomorrow.

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