slathering on the sunscreen here in balmy Michigan

Hi all! Emily here. I am the only LMUVer who stayed here in Michigan, and let me tell you about all the tanning and sightseeing I am doing in this lovely weather. Um, none. But I am having a wonderful hodge-podge of a time working outpatient family medicine Mondays and Wednesdays at the Imlay City migrant clinic and Tuesdays and Fridays at the Shiawassee clinic in Owosso. Thursdays I work with a psychiatrist, Dr. Lenhart, at the Bay City county jail, the Cathedral House free clinic, and Bay Arenac Behavioral health. Dr. Lenhart seems to have the patience of Job, and I have seen so much just after one day. Almost all of his patients' mental health issues--depression, anxiety, bipolar disorder, and schizophrenia--are complicated by substance abuse, domestic abuse, emotional abuse, violent crime, or any combination of the aforementioned. On Sunday evening Dr. Lenhart invited me to the Mustard Seed, a homeless shelter run through Catholic Worker House that takes in women and children. The Catholic Worker House runs charitable offices across the country, and coincidentally my mother and sister have been volunteering as ESL tutors for years with a CWH charity out in California. Last Saturday I worked in the ER at Covenant with Dr. Wagner, and I saw a patient with toxic shock syndrome and a patient with pseudotumor cerebri. Since my patient population of interest is Latino immigrants, my favorite site so far is the Imlay Migrant clinic. And though I am not eating mangoes and touring rain forests, I bet I am learning almost as much new medical vocabulary in Spanish as my classmates abroad. For example, "comezon" means "itchy" in Mexican Spanish, and "flujo vaginal" means vaginal discharge (sorry to all the non-medical people reading this but it's handy to know how to say that). Anyway I am off to bed so I can be ready to head up to Imlay tomorrow. Les deseo muy buenas noches a todos!

First Aid Training

Short and sweet post.  3 videos + bonus footage.










Thursday, we have first aid session #2: CPR.

The Peruvian Schedule

I just realized that I´ve posted many pictures, but without explaining what it is that I do here in Peru. Honestly, it´s a question we´ve been asking ourselves down here for a the past week or so & it´s always a work in progress. But for the moment, it has taken the following form:

Mornings: Hospital Belén

Monday- Pediatrics
Tuesday- Internal Medicine
Wednesday- Surgery
Thursday- Pediatrics
Friday- Obstetrics

Afternoons: Hospital Regional

Every day- Emergency


Life will be extremely different in the mountains, once I arrive with Tyler in Agallpampa. We will be working on a research study, which will be published in a medical science journal here. And I would imagine it will all shift again when we come back from Agallpampa, as there will be 2 of us! Peru will keep you posted! At least this gives an idea :)

Sending hugs from the South!!!!

Peruvian Hospitals

My emergency room suturing! This 18 year old guy was assaulted in order to rob his motorcycle, and in the process he found himself stabbede 5 times in the back and once over the liver. As they need hands in the ER, I do a lot of suturing! Sunday night was a war zone!!!


This señor had a traffic accident (I´m not sure exactly what, as no one seemed to understand well). He entered the ER with gray matter hanging out, a shatter cranium, a broken patella, shattered right lower leg, and internal hemorrhage (undetermined at the time with the bare essentials of diagnostic apparatus at their alcance). He kept desatting down into the low 70s and I´m not sure he will survive. Honestly, I´m not sure how anyone survives the traffic down here... it´s chaotic and whatever rules there are, they aren´t followed to my knowledge!!


Dr. Juan is a family doc of 10 years who is just now going back for his residency in pediatrics. I spend as much time by his side as I can, as he has the most love for these children out of everyone I´ve met thus far! Plus, he loves to teach ;)


Half of my host family... they´re amazing!!!!!! I´m just missing my host mom, Diana (the FIMRC director here in Trujillo) & her baby, Mònica (the other sister), and their husbands.... we have quite the houseful!


Random chicken head in the road... I thought someone might appreciate that!! ;)



Here´s Janina, a 21 year old girl about to have her first baby! She´d been 1cm dilated for the past week, was having 2 contractions every 10 minutes, but wasn´t progressing. We spent 2 hours talking while we started the induction with oxytocin and when I went by later that night she still hadn´t dilated!! My guess is they did a cesarian, but unfortunately no one seems to know & I may never find out! She was amazing!!


Here`s the neurosurgery team after just having put in 2 CSF drains (including 2 peruvian medical students)! There`s nothing like watching someone drill through another`s head.....


Here`s a little girl with hydrocephalus. She`s been in inpatient peds for over 3 months as her mom put together money to return for her. In the parents` absence, the hospital put out requests on the radio for help taking care of her, so the community is currently providing her with diapers and food. Hospitals down here have to stock of supplies. People that need treatment must first get a family member to go buy their supplies. In the ER that can waste previous time.


CT of the girl with hydrocephalus. I´ve seen many of these images in my week here. It would be interesting to find out why the incidence is so high here.


Finally, another mom caring for her child with hydrocephalus.

Estamos feliz como un lombriz. We are as happy as clams!

Every morning we wake up to the bright Costa Rican sun shining in. After a filling Costa Rican desayuno (breakfast) of usually pinto gallo (rice and beans), an egg, toast, some sort of fruit (usually pineapple/mangos/papayas), Alvaro (FIMRC chauffer) picks us up at our respective houses and drives us to the clinic in Alajuelita.

The waiting room is already filled with women and their children by the time we arrive. Time only allows for about 15 patients to be seen. Dr. Stedhem, who is finishing up his training in palliative care here in Costa Rica, sees the patients from about 9-1. He writes out a plan of care and prescriptions. Usually there is 1 or 2 students in the room working with him, and he translates for us when necessary, and lets us perform a selective physical.

The prescriptions he writes out are then passed out to the student in the back who is working pharmacy. Whoever is working pharmacy writes out directions for taking the meds, and measures out medications/counts out the pills for the patient. The pharmacy student then takes the meds out the waiting room and speaks to the patient, and makes sure they have no further questions.

The other 2 or 3 students are either busy with the psychotherapist, Tatiana, or are in the waiting room, triaging patients and taking their vitals. All in all, the day goes by in the blink of an eye. Afterwards, we eat lunch together, sharing what our Mama Ticas (Costa Rican moms) have packed for us. All is well in Costa Rica...Estamos feliz como un lombriz....

The Weekend

This weekend we took the time to relax and tour around the city of Granada.

At the outskirts of the city, the volcano Mumbacho can be seen looming in the background.  In the city itself, there is a heavy Spanish influence.  Granada is a land of colorful buildings,

cathedrals,

and of course so much more that simply can't be translated into pictures.

We also took a boat tour around the small islands in the area, which were created from chunks of rock thrown from Mumbacho.  The islands are mostly occupied by vacation homes, but there was one island in particular that was inhabited by monkeys.

We spent today at Laguna de Apoyo, a volcanic lake that offers a sharp contrast to the hustle and bustle of nearby Granada. 

Week 1 has been amazing, and after a weekend like this, we are recharged and ready for more.

Week 1 Costa Rica

Melissa and Colleen dispensing donated medications and educating patients on their proper use.

Ingenuity in the face of Scarcity...Creativity Counts

I believe it was Einstein who said that imagination is more important than knowledge. Never before have I ever felt this to be truer. Dajan is an artistic genius. We met him our first day at the FIMRC clinic, and he greeted us with open arms and great enthusiasm. He is the clinic assistant, and with his charming gregariousness, I can definitely understand the reason why the patients love him so. And we learned to love him too. Without him, we could not have constructed the skit that we did on Wednesday. The theme we decided on was "Personal Goals." We cut out paper stars out of the construction paper that we brought, as well as costumes. The gist was that the children at the soup kitchen in Alajuelita were to write down their dreams for the future on these stars. We also did the same, and acted out the part of different professions, including a ballerina, veterinarian, marine biologist, and carpenter, and more.

We were prepared to do the skit in front of 60 kids, however, when we arrived, we discovered it was free ice cream day, and so over 100 kids were eagerly awaiting. However, with the help of Dajan and Dr. Stedem, we pulled it off without a hitch. We did an enormous amount with very little supplies. And the kids seemed very happy with their stars.

Week 1 in Costa Rica

We arrived with our luggage and medical supplies and had no problems settling into our home stays. Monday was our first day at the FIMRC clinic. We worked with the Psychologist, Tatiana, Dr.Stedem in his patient office, in the front waiting room with Clinic Assistant Dayan, and running the pharmacy for the clinic. The staff are amazing and are an integral part of the local community.

Yesterday's Health Fair

It's been a busy past couple of days for all of us.

Yesterday, we presented another water filtration charla, at a 3rd clinic. 

After the presentation,  we headed back to the Roberto Clemente clinic for the health fair.  By this time, the new baseball field adjacent to the clinic had been clinc, and many of the children were already playing a game.

The Baltimore Orioles donated jerseys and caps.

There was also a pinata that was put up for later in the day.

 Then there was a cultural dance performance.

 Now, time for our health fair charlas.  There was a very packed house.  Josh and I started with a smoker's lung demonstration.

Boramee talked about healthy food choices.

Sara and Sukhi discussed healthy tooth brushing habits.

Josh and I also brought out the beer goggles we made and let the children participate in a game of catch.  Will they catch the balloon?

No.  They're beer goggles.  No matter how good you are a baseball, alcohol will always mess you up.

Later, the pinata was put to good use.

 We all celebrated by going to the beach, jumping for joy, and having a great meal.

(Tanya, one of the FIMRC workers, is a both physician and a ballerina)

Images of Peru

The reality of Peru is so different and yet so similar to our own in many ways. This little girl above has an astrocytoma. I watched them put in 2 cranial drains to relieve the intracranial pressure. Now we wait and see if she wakes up.
This 8 year old has been in the hospital for over a month waiting for her burns to heal....
Here´s the new coordinator, Judith! She´s from Oregon and one of the most dynamic people I´ve ever met! Everything is changing and we´re taking it one step at a time, rolling with the changes and doing a lot of laughing in the process :)
(A little boy took this picture for us in the hospital Belén)
Street music in Trujillo.... it´s all in the family!
AND.... you can´t forget the typical dishes of the region!!!! On my first full day in the hospital, the pediatrician invited me to a birthday party for one of his friends, who was turning 79. Not only did it turn out to be a fancy feast with all of the traditional dishes (from papas a la hauncaina to pato and cabrito), but there was 5 hours of talking, laughing, singing, and dancing! I haven´t felt so accepted so quickly in a long time.

Preparing for Tomorrow's Fair

Today we delivered the water filter presentation to another clinic. In addition, we prepared for tomorrow's health fair for the local community.

We created educational materials including fruits,

beer goggles, and more.

We even stuffed a pinata.

We searched hard for the hole for the candy, but in the end we created one ourselves in the backs of their heads.

After some preparation, it was time for Spanish classes again.  The instructors gave us some carambola...

...and we gave them instructions on how to play blackjack.  Sound like a good tradeoff to me.

Tonight we continue preparation for the health fair.  This is going to be an amazing event.

Este es bidon. Este es filtro de barro...

Today was our first visit to a public clinic, and there was a marked difference compared to the private clinic we were in yesterday.  It's free to the public, but there are less resources to go around.

At the back of the clinic was a small garden used to grow herbal remedies.

We are happy to report that the incinerator built last year was in full use.

Today we also put the finishing touches on our charla, a short lecture we made about using a water filtration system.  Contaminated water is a problem to many people here, and the implementation of water filtration systems can lead to a large impact.    We spent much of the time creating a script and memorizing it.

Some of us had less to read. Some of us had more.

So, how did it go?

The nurse putting in the first liters of agua into her new filter:

Now let's celebrate with some awesome mood lighting:

The first day of clinic

Yesterday we went to our first day of clinic.

We were able to participate in their care...

We prepared for a talk tomorrow about water filtration.  Afterwards, we had a great lunch...

We came back to the clinic for Spanish lessons.  Sara even taught the instructor a few things about Michigan.

Some Pictures from Nicaragua

Pictures from our first full day in Nicaragua.