A Weekend in Huaraz, Peru, day 2

Read the post about day 1 in Huaraz first!

Shawna rapelling down a waterfall in Huaraz

Our second day in Huaraz was mostly free for tourism. It started off as a promising day, with a bright blue sky and a great temperature. Six of us contracted with a tourist company to do 'canyoning', which I took to be repelling down cliffs. Much to my surprise, it was actually repelling down waterfalls! (They did say to bring an extra pair of clothes, as we 'may get a little wet'- we were actually all completely soaked by the end!). We descended one waterfall, and then made a descent just beside the second part of the same waterfall. It began to rain just after we finished the first descent, and since we were all getting cold at that point, we wanted to avoid more icy mountain water! It was fun though, with some definite adrenal moments, and the area was beautiful.

Emily and Steve pose with alpacas in downtown Huaraz

That afternoon we went to the home of our medical student friend, Jose, to have dinner with his parents, the anthropologist and award-winning author (his father writes in Quechua, the native Peruvian language). We had a lot of stimulating conversation with Jose's family, about literature, medicinal plants, and a pre-Incan culture called Chavin, which has ruins nearby which they say are 2nd only to Machu Picchu. Sadly, we didn't have the time to visit the ruins, but we saw many pictures which looked amazing. The Chavin temple which is nearby has many intricately carved statues with snakes, jaguars and their diety which combines features of the two. The temple is 5 stories tall, and natural tunnels funnel light down onto the main carving of the god, which is in the depths of the temple.


That night we travelled back to Trujillo on the sleeper bus, and arrived back home in time to have breakfast and go right back to the hospital!

A Weekend in Huaraz, Peru, Day 1

This last weekend FIMRC organized an optional trip to the city of Huaraz, so that we could learn about traditional Peruvian medicine. We all decided to go, and were glad we did because it was an amazing experience. Huaraz is a smaller city than Trujillo, about 8 hours away and located in the Andes mountains. It's situated in a valley between two distinct mountain ranges, one snow covered and the other not.

Rural village in Huaraz where we saw traditional medicine.

On Friday night we took a sleeper bus from Trujilllo to Huaraz. These double decker VIP buses are a common sight in Peru, and are incredible. The have reclining seats, food and drinks are served, and there are movies (that may be less incredible, as the movies often play when you want to sleep). We 'slept' on the bus overnight and arrived in Huaraz in time for breakfast. We were met there by a Peruvian medical student, Jose, whose parents live in Huaraz and who had arranged our educational experience. Jose's mother is an anthropologist and his father is an author. His mother joined us and we took a rented minivan far into the valley, and then up a mountain. Our destination was a small village at the top of a mountain- it was a fairly remote Peruvian village, off the beaten path. The landscape was amazing- it was a scenic village of mud brick houses, flowers, birds and great mountain vistas.

Jose's mother talks to a local woman about medicinal plants.

We were introduced to the local healer, who explained Peruvian medical plants to us, and who was going to show us two traditional Peruvian medical ceremonies. The first was healing by Cuy (Guinea Pig), which involves rubbing the patients entire body with a live guinea pig, then killing the animal and disecting it. Any health problems found in the disected guinea pig are thought to reflect those of the patient (ie, if the guinea pig is pregnant, so is the patient- so they always use gender specific animals). The second process is healing by flowers, which is both diagnostic and curative. They take a large number of flowers, which are bought especially for the purpose, heat them up in a clay pot, and then rub the patients body in them. The pattern in which the flowers fall is also important, and the patient can't wash the flowers from their body for at least a day. The ritual also involves throwing the flowers at full force against the patient, much to our surprise. Emily volunteered for the guinea pig diagnosis and Steve underwent the flower healing- it was a fairly surprising experience for all involved, but very authentic and we are told still an important part of P eruvian culture. Many people, they say, will undergo one of these two processes before they will go to a hospital.

Undergoing the guinea pig healing ceremony.

After visiting the local healer, we continued through the valley to visit the ruins of a city which had been covered by an earthquake 30 years ago. The area was built like a memorial, with giant flower and rose gardens and monuments to the dead. It was eerie, but a beautiful place. It rained on us there, but we were interested enough to walk around and see most of the area.

Next, we went to a small mountain town with a nice central plaza and an ice cream shop. We watched them make the ice cream (more like gelatto), and then bought cones for 30 cents each. A few of us then walked over to a coffee shop. It was a really nice way to spend the day.

The Peruvian Hospital Experience

A significant amount of our time in Peru has been spent in the Belen Hospital of Trujillo. A typical day in Peru has us shadowing Peruvian physicians in either pediatrics, surgery, internal medicine, or OB/GYN. We arrive at 8am and leave the hospital usually just before 12:30. So far, we've been doing two days in each service, and in groups of two students with a FIMRC staff member or Peruvian medical student to help translate.

So far we've done 7 days in the hospital, and everyone has had at least one day in each service. From my own experience, surgery and OB/GYN have been the most interesting- a sample of what I saw in each: in GYN I had a Peruvian physician who was interested in teaching and took the time to explain important information about each patient. We saw many women with pre-eclampsia, and many who had had C-sections due to high blood pressure, although the doctor said they probably were not really in pre-eclampsia at all. We saw a number of premature rupture of membranes also. In OB, I saw two natural births. An episiotomy was performed on one mother because it was her first child- it seems to be standard practice to do an episiotomy for a first time natural birth.

In surgery, I saw two C-sections, which seemed to me to be done quickly and professionally. Although I haven't seen much surgery in the US, I imagine it would be hard to tell the difference between a Peruvian and American surgeon unless you know where to look- for example, to save money on buying booties for the OR, most doctors have plastic bags wrapped around their shoes; they use every last bit of their sutures; and one doctor told me he doesn't change his gloves as often as he would like to in order to save money. The doctor told me that 50% of all births in Peru are by C-section, and the national health insurance covers the cost.

I also saw a prostetectomy, and the doctor invited us to get as close as possible to see the surgery. They made an abdominal incision and when it was time to remove the prostate, the physician had his entire hand up to his wrist inside the abdomen, he would occasionally pull out chunks of prostate. The blind feeling for the prostate was fairly surprising, but the surgery was very professional and quickly done.

Pediatrics and Internal Medicine were interesting at times- both services had patients with interesting diseases that you don't see often in the US, such as congenital CMV infection, Stevens-Johnson skin rash, spider bites with necrosis, and lots of cancer. However, these services are busy, and the floors are loud. Although I can have a conversation in Spanish on most topics without too much of a problem, I was completely lost in IM and Peds because of the background noise, the fast cadence of speech, and the fact that the doctors were often speaking to a group and not directly to me. Those services were not as educational as the surgical ones, where you get more personal attention from the physicians and there is less distraction from noise and bustle of the hospital.

Overall the hospital experience has been educational- we've seen how things are done differently, and in many cases, how similar medicine is - in Peru. The Peruvian medical students have been great about volunteering their free time to come and shadow with us, to make sure that the Peruvian medical staff knows who we are and to help translate and to keep us company.

Health Care in Peru (H.I.P.)

Hola!
Well we have definitely been busy and have so much to tell you. For now we decided to give you an update on one of the things we care about most- health care! Aside from all the wonderful food- more to come from Shawna on that- we have been feasting on some food for thought. You see what I did there? Here are some morsels for you digest.

H.I.P.
1) Public H.I.P. - similar to say... Oh Canada! Peru has a public health care system that provides care to the:
A) Extremely poor and Poor via "Seguro Integrad de Salud" (SIS) which is free.
B) Employees/Companies via "Es Salud" which has some minimal cost covered by employers or those that can afford.
C) Policia y Armed forces

2) Private H.I.P. - similar to say... America the beautiful!
A) For Profit
B) Non-profit

Disclaimer: I have provided some well known reference health care systems but in no way is H.I.P., Canada or the US summed up in the above quick and dirty contrasts and comparisons.

Well enough theory let's see it in practice:

Hospital Belen: We will be working here over the coming 6 weeks focusing in pediatrics, internal medicine, surgery, ob-gyn, family med and psych.

Bella Vista Health Center in Nuevo Jerusalen: The doctors, dentists and nurses are really excited to work with us and us with them. Especially as part of their TB program.

Jerusalen Health Center: We have already started working along side the doctor(a)s and nurses (enfermero(a)s) doing well child checks, psicoprophylaxis (preparation for joys and wonders of pregnancy, birth and the bliss thereafter), vaccinations and HIV screening of new mothers.

It's been three short days here in Trujillo and while the above is just a snapshot of what we have experienced we look forward to learning more about H.I.P. and bringing you more news from the proverbial front lines. Be well. Salud!

¡Hola de Perú!

The Peru folks (Shawna, Rachel Brim, Julie Celebi, Alisan Fathalizadeh, Erik Hemingway, Paul Johnson, Emily Jackson, and Steve Moyo) have arrived safe and sound and jumped right into the culture and excitement. A little bit on our time in Lima--

We arrived in Lima late on Saturday night and stayed in a hostel. We were fortunate to have the day to explore the city, and had an amazing full day together. We walked more than any of us have walked in a really long time- we got a great view of the coastline...
tried some Indian-Peruvian fusion cuisine at an all-vegetarian restaurant, including, much to our surpise, tofu ceviche..

visited the Huaca Pucllana ruins...

joined in some traditional folkloric dance at a major festival in the downtown square and Steve & Alisan made it on the big screen! [vid to be posted soon]

Celebrated Shawna's birthday and she was spontaneously serenaded by a local musician...


This was a fantastic nosedive into Peruvian culture, and we are so energized to begin our work here. More to come on our initial introduction to the FIMRC program --
¡Hasta pronto!

Up in the Mountains- Peru

Judith and the crew of Peruvian medical students sift through stacks of medical charts. We are doing a retrospective study on malnutrition, looking at the age, height, and weight of children less than 5 years old.

As Dr. Schnuth commented to me, the clouds are low! Or, depending on your perspective, you could say that we´re just really high up! Many days we could see the clouds hanging in the valleys much lower than where we are now at the top!!! There´s no experience similar to walking through a cloud, as it spits rain in your face ;)

Here is another family we interviewed from La Florida. You can see the adobe house in the background. And the layers of clothing are necessary, as it´s equally cold inside as outside.... especially when in the clouds and at night! Brrrrrrr.......

On a beautifully sunny day this is a normal scene.... impresionante!

Sometimes we had to hide from the rain. Even with umbrellas the wind could easily soak you from the side, especially as you ascend the mountains up serious inclines! We would just camp out and chat until the floodgates again closed :)

Greetings from Peru!

Greetings from Peru!

From left to right: Stefi (our peruvian medical student volunteer), Sarah (MSU medical student), Rosa (the clinic´s obstetrician), Judy (FIMRC Peru coordinator), Cristian (the clinic´s doctor) and Tyler (MSU medical student. This was taken in Paraiso, a very rural village at about 9,000 feet altitude.

Sarah, Tyler and Rosa in front of the Pregnant Woman Radar. Some women have to walk two hours while in labor to recieve medical care at this clinic. One of the priorities of the Peruvian Ministry of Health is to improve maternal morbidity, so this is how they track who is pregnant in the different villages.

This was a very sweet mother and her five children that we met while doing a survey in La Florida. This town is about a 20 minute walk from where we are stationed in Agallpampa. The survey is being done to assess the different medical and educational needs of the population so that we can create a mobile medical clinic.

Some of our friends in Agallpampa. These children meet us at our door each morning to see if we will be teaching english classes. They are vicious tag players, too.

This is a view outside of the place we are staying in Agallpampa. This building is the Posta de Salud, a clinic that acts as a referral point for many of the surrounding, smaller clinics.

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.

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.