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

Thursday, March 20, 2014

Aji de Gallina, More info on Wuqu Kawoq

The clinic was about the same today, although I was done before 11 so I got to come home very early.  I did appreciate that because I downloaded several more articles for my project during my extra time with the internet.  Lunch was Aji de Gallina, as seen below.  Definitely one of my favorite Peruvian dishes, but don’t even think about it if you have a peanut allergy.  I'll be learning to make it in the near future, and you may be lucky enough to have me share the secret recipe with you too :)  

In the afternoon I talked to Mila about changing to the regional hospital.  She had gone in the morning and learned that for students here it costs $$ to do rotations there.  That’s strange to me.  But, I’m not a student, I’m a volunteer.  So she found someone else to talk to and they directed her to another lady who typically coordinates these things.  That person won’t be back until Friday morning, so then Mila and I will go to her office and see what we can do.  I so hope this works out, I can’t imagine a better place to be.  Wild, but a great experience. 

After a nice run I met once more (online) with the people from Wuqu’ Kawoq.  Everyone who I’ll be working with is from the social sciences, and I’m from the rock-hard science of physics.  I know it will be uncomfortable and difficult for me at times this summer, but I’m extremely excited to learn from an in-depth experience in another discipline.  Just how I like itJ

Location: Paquip
This town speaks almost exclusively Kaqchikel.  It’s clearly not a big tourist attraction.  In this town of 2000 residents, there are 2 schools and a health center.  The clinic is technically government run and does have a general practice doctor, but Wuqu’ Kawoq still plays a significant role there.  They both have a longer history of them and understand the language more extensively.  Now that the town is growing there are a few places open for food and American clothing of all things.  That’ll be interesting to see…  America has influence everywhere it would seem.  Maybe Nike will start making ads in ancient Mayan languages, who knows.  The gender roles in the town are well-defined, with women working at home to clean and prepare meals while men spend most of their days doing agriculture.  The medical problem that we will be exploring in depth is malnutrition, particularly in children.  In the malnutrition of very young children, there are 2 primary warnings signs: underweight and underheight.  I usually think of underweight when I think of this theme, but underheight is actually a bigger deal in relationship to overall developmental effects.  This problem is especially potent because it regularly goes unnoticed, especially when the entire population tends to be short anyway.  I learned yesterday that genetics plays a relatively minor role in height until age 5, which is why the investigations of very young children clearly demonstrated the presence of malnutrition. 

Background of the project:
As mentioned above, children were used to find the presence of malnutrition in the community.  Mothers breast feed their kids for about 6 months, and it was at 6 months of age that the researchers noticed kids falling off the growth curve.  Why?  Several reasons.  One, the transmission of bacteria is more common in solid foods than in breast milk.   They noticed an increase in diarrheal infections in this age group.  Additionally, this town is impoverished.  That prevents many families from buying a healthy, well balanced diet for their children.

The project I will be a part of:
I don’t want to describe this in detail in the blog for fear of overstepping my bounds with this research group.  I hope that I have enticed your interest enough with the introduction that you will email me to ask about it; I can give some details in that context J

Broad outline:
·         1-2 weeks of Kaqchikel class to prepare me for basic interactions in that language.  Timing depends on what my finances allow.  The class goes from June 2-13, so it is likely that I will have to leave the country again before my birthday.
·         Start surveys after the class.  My role will likely be interviewing the men, as it is more socially acceptable for men and women to interact with people of their own gender.  This was estimated to take about 6 weeks, so I’m not sure what tasks I would be assigned after that.

Daily schedule:
·         I will be living in Tecpan, a nearby city about 45 minutes from Paquip.  This is mostly for sanitation safety reasons, as our immune systems would struggle in a smaller, less developed town. 
·         Every morning I will take the bus at 6:20 to Paquip.
·         Average arrival time will be 7:30-45, depending on the roads, traffic, driver, etc. 
·         Complete 5-6 surveys per day (they are long to prevent ambiguity while sticking to yes/no questions)
·         At 1PM I will take a bus back home.  I will not ever miss this bus because it’s usually the only one out each day.  I will probably also bring snacks, because that would be too long for me to be without food.
·         In summary, I’ll have about a 5 hour work day with long commutes on both ends.
·         Hopefully, I will have a good deal of time to run there since I want to continue altitude training. 
·         Afternoons will also consist of entering the data into Excel sheets and completing my med school secondary applications.

 It’s going to be quite the summer J

First Interview

I got up early this morning to register for classes.  As always, I looked up some harder, non-blow off classes just for fun.  Pathophysiology only worked with my schedule on Fridays, which isn’t going to happen, so I will be taking Human nutrition instead.  It sounds like it has more of a focus on the hard science than on clinical usefulness, but it will still be a good basis for forming my own habits and clinical knowledge.  Fall classes will probably be Nutrition, Astronomy, Intro to Stats, Spanish for health professions.  I’m done for the week at 10:00AM on Thursday’s this semester.  I am probably not going to get my chem minor because I don’t think it is useful enough compared to what I could learn in other classes.  Winters are a little less pretty with the 2 hard physics classes (electromagnetism and statistical thermodynamics) plus the physics senior project, but I should manage ok because my schedule is open other than those and a few fun gym classes.  After what I’ve already put myself through, I’m not too worried that I’ll be able to push through a few more classes to graduate. 

The clinic was the same.  The pains in my legs from yesterday’s torture made it hard to want to stand for 3 hours.  The day did end with the interview with Dr. Reynaldo, which will be a good start for my senior project.  I’m realizing how much work I have to do on it and I really probably won’t have very much time for other things in my last month and a half here.  Sad but true.  

Tuesday, March 18, 2014

Desire to Change to the Regional Hospital

I arrived to the clinic today before 8:15 to talk to Jorge about the dictionary and my project.  I then waited over an hour for Reynaldo to come.  I almost wish I had just left, but I did meet a nursing student who recognized me from La Vid which was cool.  I really have nothing exciting to report about these visits, there wasn’t much interesting today.  Which lead me to long for something more stimulating like the regional hospital.  I asked my program coordinator and she will get back to me.  Hopefully I can find a good department to work with and get another great clinical experience out of this trip J

The rest of the day I have nothing to report but soreness…  I accidentally ran all the way up one of the mountains surrounding Cuzco on a recovery day.  Then I went and lifted weights, all legs.  I’m brilliant, I know.

Monday, March 17, 2014

Weekend summary- Pollada, Pisac

I didn’t do very much this weekend, hence why I decided to sum it up in one post.  Saturday I utilized my gym membership then went to a pollada with Carlos.  These are basically an excuse to eat food, drink beer, and raise money for some cause.  In this case, one of his co-workers was driving drunk on a motorcycle (yea….  I don’t think that ever ends well), got in a crash, and is now in a coma.  There were a tremendous number of people who came out, although if many had lunch paid for by the company like Carlos it makes perfect sense.  Getting the food was quite the extravaganza.  There were 3 lines; one to pay or have the ticket verified, one for chicken, and one for meat.  It would have been easy to believe that there were no lines.  I’m perfectly accustomed to this type of chaos now, so I waited patiently as Carlos and friends figured out the system.  Eventually we got food.  It was good and flavorful, but when I’m lifting and running I can generally eat the equivalent of 2 lunches.  So I did; Tania had left food for me at the house because they went to Calca this weekend. 

Next was Spanish class, followed by La Vid.  Because the family was gone the rest of the night, I checked out a new pizza place.  It’s really not a bad deal, I got 2 mini pizzas for 13 soles.  And wow they were worth it.  I think pizza is becoming my guilty American pleasure.  As it was St. Patrick’s day, I was up until 2 AM…  researching everything I need to compile to apply to medical school.  Wild, I know.

Sunday I went to the markets in Pisac to check them out.  I didn’t have any money to buy things, but I did find a lot of great stuff there.  Much of it is hand-made and better than what I’ve found in Cuzco.  I’ll probably go back for some final presents at some point.

In the evening I hung out with Luis.  It had been far too long since we did that, I hope to make it more regular. 

While I was running in the evening my family returned from Calca.  They were concerned about me because I wasn’t in the house or answering my phone.  I returned quickly and will now leave a note to them if I go running without my phone while they are gone J

Saturday, March 15, 2014

Work Project at a Different School

Instead of going to Occoruro, the ProWorld people and myself went to Huacarpay.  It’s a beautiful little town with a lake in the middle of mountains.  The school is off by itself overlooking the lake.  Apparently the students of the school have to walk 45 minutes to an hour every day to attend: that’s dedication.  It makes sense that they would be willing to do that though, for the school has won many awards for its innovation.  The kids designed the outdoor play areas and a garden.  They all have specific upkeep tasks to further develop ownership of the place.  There is a small store where they can learn math in a real life setting.  When they misbehave, access to the fun places is withdrawn instead of any type of negative punishment.  Next time I will take pictures so I can better explain everything J

The rest of the day was fairly uneventful, although I did get to talk with Peter which was great.  My contact with friends back home has been extremely limited, so I was in need of a conversation like that. 

Later I went on an hour run, which should be over 6 miles.  There were too many people on the street so that did slow me down.  But I am happy with how my body is holding up on some longer altitude runs, I’m confident that I can pick up my training a lot without shocking my body too bad J

Friday, March 14, 2014

Reynaldo in Topico, Internet Complications

I continued working with Reynaldo today in Emergency/Topico.  I have no idea what the difference is between that and a regular consultation office.  Slightly elevated blood sugar isn’t an emergency.  A fall 6 months ago that is hurting your leg isn’t an emergency.  None of the cases he say would have been classified as an emergency in my book.  I’ve been noticing that he’s one of the most consistent docs, meaning that he doesn’t arrive late or leave at random times of the day.  The consequence of this is that he tends to see more patients.  If someone shows up and needs a doc, Reynaldo will be around.  I didn’t stay in the consultation office all day, but also spent some time in the normal part of Topico.  I didn’t get to do anything because it was a very slow day, but it was fun to talk to students again.  Lady, the nursing student from Tuberculosis, is in Topico now.  Sometimes I don’t realize how much my Spanish has improved since I arrived.  My first few weeks you probably remember that I could barely communicate at all with her or other people in the department.  But today I could talk to her fluently with minimal repeated words or uses of my translator.  That felt good J

The main other event of the day was Benji talking to me about the internet.  I guess Sandro isn’t a huge fan because he thinks it’s distracting Joaquin from doing hw, etc.  That’s probably true, but having the TV turned on for hours a day on mindless shows isn’t a great benefit either.  So I will have to be creative with my internet use, making sure to not get online when Joaquin is supposed to be doing something.  The problem is that the router has such a weak signal that it doesn’t reach my room, so I have to be out in the common area.  In some ways I feel like it may be discouraged for me to use my computer there for fear of distracting Joaquin even without the internet.  I will probably still be frequenting ProWorld, and I have spent an unfortunate amount of time in my room with the computer this week.  My long list of tasks on the computer are still far from completion… 

Thursday, March 13, 2014

Working with Reynaldo

When I showed up to work today I knew I was looking for either Reynaldo or Jorge, because you couldn’t pay me to work with Adriano again.  I conveniently saw Reynaldo as I was walking into the building.  He paid me for the dictionary then agreed to let me work with him in his office today.  For some reason, doctors don’t seem to start working until about 9AM.  I guess that’s typically when people start arriving to have medical consultations.  Tomorrow I might arrive to Belenpampa closer to this start time to avoid awkwardly hanging out for 45 minutes.

My time with Reynaldo was better than yesterday.  He had 14 patients to meet with in the morning, which usually only goes from 9 until 12.  The doctor-patient time seems comparable to what a family doctor would have to do in the US.  As interesting as many patients were today, I’m becoming convinced that I couldn’t be a family doctor.  It’s hard for me to imagine myself sitting in an office all day like that.  I think I would go crazy.  It’s certainly valuable and necessary, but I do have to report that I will become part of the problem with the shortage of family practice docs. 

The first patient of today was not in very long, but he had a skin abnormality that Reynaldo told me looked like Leprosy.  That was terrifying, I didn’t realize that was still a significant problem here.  The test came back positive, then they filled out an epidemiology sheet outlining where he had been after the symptoms had started.  I don’t know what is done with epidemiology records here.  Interesting patient number 2 was a man who had painted cars for over 30 years.  The problem was that he was working with lead-based paints and didn’t wear any kind of protection for 17 of those years.  Yes, you read correctly.  17.  The effects of lead poisoning were now setting in, with the most significant factors being shortness of breath and an overworked heart.  Lead can’t just be removed from the blood, so the best things to do are prevent further exposure and rest to let the body heal.  It’s astonishing to me that no one told him to wear protective gear for 17 years of working with lead paint.  That’s absurd.  I’m honestly surprised he’s doing as well as he is.  Another interesting case was a little girl who had hives.  This is an allergic reaction on the skin that typically arises from food.  There were several women who came in for complications after pregnancy, although the doctor said that what they were experiencing was not abnormal.  Another woman was probably starting menopause.  I saw another little girl who had to wear leg braces at all times and still couldn’t walk even though she was of age.  Anything I didn’t understand I could ask Reynaldo or the pharmacy student who was working with him.  That’s a much better feeling.  In terms of patients it was really an exciting day.

In the afternoon all was normal until I decided to go check out the gym.  Tania and Sandro told me about 2 more that are nearby, so I checked those out too.  They were less expensive, but not as nice.  The machines were old and they seemed dirty.  So I returned to the first gym that I mentioned yesterday, which is very clean and almost all the machines are new.  It is definitely comparable to a good but small gym in the US.  Another nice thing is that because of the newness, there are very few members and I get the gym to myself!  Sweet gig.

In the evening I was supposed to go to a dinner with ProWorld (though they weren’t paying this time), but I for some reason mixed up the time.  I thought it was 7:15, but when I rechecked the text at 6:50 it said 7.  Oops.  There was no way I could get to the plaza on time.  So, I spent the rest of the night preparing my class schedule and beginning some application brainstorming and writing.  Don’t hate me, but in the fall I think I’ve figured out a Fall schedule where I only have classes Monday through Wednesday.  That would be very convenient for any potential interviews, and it will give me the freedom to work and volunteer for much of Thursday and Friday.  The Winter semester isn’t so pretty because upper level physics classes are never scheduled in a convenient way, but I should be able to tolerate it.  That semester will be difficult because I will not have taken an intensive physics class in over a year.  I still have 2 credits to fill that I’m unsure about; if you have any brilliant ideas, please send them my way J

Wednesday, March 12, 2014

Rough First Day in Medicina

After a nice run I excitedly ran off to work to start my time in medicina, where I work with a doctor in a consultation office.  I was to work with Dr. Adriano.  I didn’t recall who that was, but I was sure I’d done rounds with him at some point.  I recognized him immediately when I stepped into his office.  He’s the doctor who was unhelpful and cold to the med students and I throughout rounds when he led them.  I tried to hide my disappointment and confusion about why I had to be paired with him of all the doctors.  Needless to say, the morning started awkwardly.  He asked me some questions about myself, but they weren’t comfortable questions.  I’m fine with “where are you from” or “what are you studying,” but I don’t like answering questions about my finances in the US or here.  I didn’t think I had a choice because of the already thin ice I was walking on with this doc. 

Around 9:00, the patients began arriving.  I will tell you the interesting points about these patients, but I want you to keep in mind that Dr. Adriano didn’t say a single word to me during my entire time in the room with patients.  Zero words to me for three hours.  Yea.  The first patient had fallen at her work and had a big bruise above her ankle.  The doc wasn’t very gentle with it even though she was almost crying when he touched it.  To me, it seemed completely pointless for him to cause her that pain.  He ordered an X-ray, which came back negative, and gave her some pain meds.  The second was a lady who had been using too many cleaning agents without gloves so her hands were misbehaving; they had poor circulation, poor movement, and pain.  The prescription was pain killers and gloves.  Third was a guy with very severe diabetes and joint troubles.  I won’t describe everything to you, but there were a few highlights I’d like to include.  While he was talking with a 2 meter tall Peruvian girl (WOW that’s tall for this country), there was a knock on the door.  It was a woman looking for another doctor because her kid had a cold and she wanted to get him checked on.  I looked for a little while with her, then she asked to see Adriano.  I didn’t have any better ideas so I let her in.  He was very cold to her, basically saying that he was busy with another patient and she should see someone else.  It would have been so easy for him to see her, but I think he’s only there to do exactly what he’s paid to do and nothing more.  Money is clearly important to him based on the way he questioned me.  There were several patients who didn’t know the drugs they were taking and forgot the receipts at home.  He would hit the table just hard enough to communicate how upset he was, then would explain to them in a frustrated voice all the reasons they needed to bring them.  I think they understood long before the end of his explanation.  I think the most abrasive of all was his response to an old man who came in even though his name wasn’t called.  This guy was in his 80’s and could barely here, he just wanted to be seen.  Yelling at him for going out of order did no one any good.  As you can tell, I did not enjoy my time with Adriano today.  Tomorrow I’ll change to someone else where I can actually learn something.  Once I start my project I might not have a regular schedule in the clinic anyway. 

On the way home I discovered that the gym near my house opened its doors!  I’ve been looking for a place to work out but there was nothing close enough.  I will probably get a membership there.  I will change my running schedule to afternoons so that I can do both while only showering once.  I will be in great cardio shape after this, but if I’m going to keep up climbing I’ll need good muscle tone as well. 

The rest of the day was relaxing, with the only exciting event being that I can now connect to internet in the house!  It’s so nice to not have to cram everything into ProWorld.  I need to be more careful that I don’t waste time though…  Far too easy of a temptation now.

Finally Back in Belenpampa

This morning was normal except that I was assigned the task of bringing Joaquin to school.  It’s very close and on the way, but the entry door is quite the ordeal.  There are a few Combi-sized vans that seem to serve as buses, but the majority of students arrive with their parents.  This could be via taxi, personal car, or on foot.  It’s certainly a different system than the US, but it seems to work well for them.

It almost felt weird to be in the clinic because I had such a long break.  It has been about 2 and a half weeks since I actually put in a full day there.  I found Jorge in the morning to change services, but he was busy preparing for a yearly evaluation to present to the regional directors so he told me to return later this week.  So I went back to the Sala de Partos for one more day.  Andy and Wilson had left, as had some of the obstetrics students, so I was the most “experienced” during rounds.  With new people doing everything I felt like I knew a lot less than I had before.  I tried talking to the new med students, but they weren’t very friendly.  They would answer my question and nothing more, so no conversations could ever start.  Sad, but I’m glad I had such great med students during my time there.  I felt very out of place today, so I knew it was time to move on.

After work I went to pick up Joaquin, which was also an interesting experience.  The parents gather around the outside gate, then are called in by the grades of their kids.  It was quite easy to navigate, but I was happy Tania had told me that Joaquin is in the 3rd grade.


I slept for 11 hours last night, and my body is thankful for it.  My knees are rested but sore, and my back and shoulders are slightly tense, but I can feel that my body is returning to normal.  I don’t have very many exciting things to tell you about today.  I wrote all the blogs from previous days and edited some pictures, although the task still seems almost futile with all that lies ahead.  I could see that it was beautiful today, probably one of the most sunny days I’ve experienced.  But that wasn’t enough to entice me outside.  I did eventually go to ProWorld to see if Meghan had arrived (she hadn’t), then went to La Vid.  The only real news to report was that internet was installed in my house!  I still can’t access it because I need Benji to tell me the password, but I know that in the next day or 2 I will not need ProWorld for internet anymore.  What a relief.  For now, I checked my email on Joaquin’s iPad to see that Meghan did indeed arrive home safely J

Shopping, Meghan Departs

I woke up this morning to see Joaquin staring at me, since I was sleeping on the couch in the living room.  I honestly just wanted to sleep, but I could tell that wasn’t going to happen at this point.  He suggested that I bring Meghan breakfast in bed, which I thought was a great idea.  So I made eggs and warmed up fries for our breakfast.  Tania showed me a different way to make eggs without flipping them.  Putting the top of a pot over the pan helps cook both sides worry-free.  You probably already knew that, but I'm an amateur.

Meghan and I first checked out how much we already had to put in her suitcase to bring home as gifts, then went to the markets to fill it the rest of the way.  I don’t want to ruin the surprise in case one of the gifts is for you, but I’ll tell you that we made some good finds.  My bargaining is getting better now that I know the prices to expect.  For example, we got some items for 6.5 soles each instead of her initial offer of 10 when we walked out to look for a different place.  Another purchase of 3 items came down from 30 to 22 soles.  I will be honest with you, I was proud of myself.  Meghan also found a good gift for herself, a beautiful purse with many Peruvian-style colors and designs.  I’m so glad that she didn’t purchase things for everyone back home without finding something for herself.  My main purchase of the day was the pair of hand-made boots I ordered on Monday.  They are durable while looking incredible.  They made 2 variations for me to choose from.  Both were beautiful, but I ended up picking one that had a more bright and extravagant pattern. When in Peru, right?  I’m sure that Meghan was tired of hearing about how much I liked them by the end of the morning.  Meghan is so giving, she wanted to buy flowers for my family here to thank them for the hospitality.  We went to Mercado San Pedro to find these, and found a jackpot of flowers.  We found some beautiful, massive flowers for the family at a good price. 

When we got home, Tania was very excited to see them.  Such a simple but thoughtful gift can really make a big impact.  But Meghan didn’t stop there; she had a Spanish and English Cat in the Hat book for them as well.  It’s so cool, they loved it.  Even though they only spent a few hours together and they could only communicate through me, my family was wishing that Meghan could stay more time with them.  They offered her their house if she ever returns to this city, though they suggested that she learn Spanish J 

Meghan, the fam, and the beautiful orange flowers she bought them from Mercado San Pedro :)
Sandro took us to the airport, then we hung out until her flight was about to take off.  We were going to buy pan chuta for our families, but we didn’t know where to find it in the airport.  So we got creative and she went to the airport bookstore and got a Peruvian cookbook for her family.  A good gift for both selfish and unselfish reasons.  On my way out of the airport after saying the difficult goodbye, I found the breads we were looking for.  Oops.  I guess that the cookbook was meant to be.