Super Hilo getting down and dirty with Mr. Cariaton:

The Clinic at La Promesa while Dr. Stedem explained the government program that brought the families to the area:

Angela giving the demonstration at the conclusion of the STD program and Mike showing enthusiastic support:

Children with their toothbrushes:

At the start of brushing the human mouth:

Doing physical exam for a child with strep throat:

It’s been quite the two weeks since we last checked in. We continued the week at the mobile clinic in La Promesa. The clinic was held in a soon to be soup kitchen for the city. They are still in the process of getting funding for electricity and running water. The clinic is situated at the side of a canyon with a breathtaking view. There are always birds that sore trough the canyon throughout the day. The mother of the house next door was always kind enough to bring us homemade goodies each morning. She made, what I believed was called “pan de pan” which is all the left over bread mixed together with milk, cinnamon and sugar and then baked. One day she brought over the Costa Rican version of Horchata, which is a sweet creamy thick rice drink.
Similar to the week before, we rotated through visiting patients with the doctor, working in the pharmacy and checking patients in. Once patients were checked in we would spend time with the children. We would color with them, read aloud or help them read, or simply spend time talking to them. Dr. Stedem spent time explaining to us that simply talking to the children makes them feel important, as they rarely get attention from anyone besides their friends or siblings. They have few, if any, role models in their lives. I’m hoping they will remember us as fondly as we remember them.
The children showed immense interest in stethoscopes. During one of my days in the front office I spent some time with a group of girls. I would help them listen to their hearts. As soon as their heard the “lub-dub” their eyes would light up like it was Christmas. It was very touching. I also got to have story time with the children, though sadly I think Donde Viven Los Monsturos (Where the Wild Things Are) is a bit out of my Spanish league. I’m at more of a Ve, Perro. Ve! (Go Dog Go) level. Though the kids, after laughing at my attempt at reading in Spanish, were more then happy to jump in and have group read aloud. Joe, our undergrad friend from Princeton, also had a read aloud session with the kids.
Working with the Doctor was always a great experience. He is a wonderful teacher and more then willing to answer any and all questions. He is also very interested in having students as actively involved as possible. He lets us ask questions during the history, do physical exams and help develop the treatment plan. He is great with the patients and they really do seem to respect him. He is also wonderful with the children. He calls them all “campeon” and “princesa”. They light up when he is around. During time with him a few of the things I saw were scabies, allergies, UTIs, URIs, gastroenteritis, colitis, IBS, psoriasis, HTN, Diabetes, strep throat, congenital heart murmur in a young child with chronic fatigue, a variety of neurologic/developmental disabilities, carpal tunnel, malnourishment and a few cases of suspected child abuse.
The doctor also made house calls during the week. One day during the clinic we went to a house of a boy who had gotten an ingrown hair that had become infected and had formed an abscess. The other was a patient who was post-op from a heart catheter.
Tuesday after the clinic we had a little taste of San Jose, the big city. Mike, Angela, Joe and I went into downtown San Jose and visited the Costa Rican Contemporary Art museum. The exhibit had a sacrificial theme featuring alters, lights, bread, blood and oil. The piece that struck me were a collection of oil barrels draped with a sea of dead roses to represent the people that had died for liquid gold. We then visited the National Library and spent some time getting to know our new friend Joe in a quaint coffee shop at the side of a lovely Parque Morazon. Dinner was at Café Mundo, which is a popular restaurant in down town San Jose. We concluded our evening at Café Morezon.
Our health presentation on Wednesday was on STDs and contraception. We began the presentation with a small skit where Angela pretended to have some STD symptoms and she went to the doctor. We hoped the women would grasp that it was ok to ask your doctor about these symptoms as they are not normal and also some exposure to questions the doctor may ask during the visit. We also added information about getting both partners treated and abstaining from sex until after the symptoms were gone. The presentation involved additional information on what STDs are, the most common, how they are transmitted, signs and symptoms and what to do if you think you have one. Then Joe and I got to perform a memorable skit on the importance of using a condom. The opening line was “Mi Amor, Hagamosolo” aka “my love, lets do it”. I’m sure I turned bright red. But the women laughed and hopefully it will give some of them some boost in confidence when it comes to condom usage. Then we concluded with a demonstration of how to use a condom correctly, handing out condoms and a small sheet of patient information on ETS’s (aka STDs) that summarized the information we had delivered. Once the presentation was over, Camilo (the right hand man of the clinic) did a phenomenal job of answering any and all questions the women had. Thank goodness Doctor Schnuth was there to contribute her professional knowledge. It was wonderful to watch the women so engaged in asking questions and I feel that a lot of misconceptions (such as whether or not you can use Vaseline as lubrication) were straightened out and hopefully the women will feel somewhat empowered after the presentation.
The following day we did a dental campaign at the mobile clinic. We went door to door getting the children of the village to come to the clinic. Then we had a presentation on the parts of the tooth, why to brush, why to floss and how to brush. Luckily Camilo’s sister is a dentist and we were able to utilize her as a great resource. She let us borrow a model of a mouth for the presentation and was able to double check our presentation for accuracy and appropriateness. We started the presentation with a skit about Angela the tooth, and Joe as Mr. Cariaton (Mr Cavity). But luckly Super Cepillarse del dientes (toothbrush) and Super Hilo (floss, aka Mike and myself) saved the day by scaring away Joe. We ended by forming a mouth with all the kids as teeth and proceeded to brush and floss them. Then Dr. Stedem showed them a cartoon and we handed out tooth brushes and toothpaste to the kids. We repeated the presentation again at the soup kitchen in Alajuelita that afternoon and ended, as usual, with playing with the kids. I’m pretty sure their favorite phrase is “corre caballo corre” (run horsey run).
On Friday, Angela’s Tica Mom (her house mother), sent enough lunch to feed a small army. We all got to partake in the traditional Costa Rican Taco which consists of corn tortillas, beans, pico de gallo, eggs, and sausage and of course a little topping of Salsa Lizano (the most amazing condiment known to man). After lunch we concluded the week with inventory and organization of the pharmacy. Our Spanish class followed. To end the week we met up with Camilo in San Jose for our last night with Joe.
Saturday we woke up early for our trip to Manuel Antonio. We spent the day relaxing on the beach and playing in the waves. It was filled with people from all walks of life and is known as the Costa Rican Mecca for alternative lifestyles. While we were on the beach we unfortunately saw a near drowning. The lifeguards of the beach ran down to pull him out of the water and laid him on the sand. They proceeded to draw a crowd of people, fan him with a towel and at some point rolled him onto a surf board for a backboard (talk about resourcefulness). The ambulance eventually followed. However, soft sand and mini-vans seem to not mix as the ambulance got stuck in the sand. Sunset soon followed and our evening was concluded with a nice game of foosball with the restaurant at the hostel.
The next day we ventured into the National Park. After walking through the jungle we came upon a nice quite beach. As we were out enjoying the waves a monkey proceeded to open our bags and steal our food. As soon as we realized we ran up to save it only to find the monkey sitting in the tree skillfully opening the package and eating it in front of us. I could have sworn he was laughing at us the whole time.
We walked back into town to enjoy the local fair and then proceeded to a different part of the national park. While there, we got to watch a family of monkeys and a family of iguanas. The waves were big, the sand was white and it was like a little tropical paradise. It was the perfect way to recharge for a busy week at the clinic.

Part 2 to come soon…Cheers, peace and love!

Photos from Uganda!

Here we are with Richard, the health outreach coordinator at the FIMRC clinic in Uganda. We are outside the Bududa District Hospital, awaiting the arrival of staff from TASO (The AIDS Support Network). We were able to observe an outreach visit for AIDS patients in the area. Patients talk with a counselor, meet with a physician, and are provided with medications. The organization has been used as a model for treating AIDS throughout Uganda and other places in Africa.

Getting to know the Community

Hola!

 Hello again,

Today was day 2 of volunteer work in El Salvador, and what a day it has been.  We started the day with Spanish lessons, and soon after that, we went with Morena to perform prenatal visits with locals.

Karyn performs a prenatal visit

 Afterwards we had lunch, and we helped out around the clinic whenever it was needed.

Angela and Madonna apply a new dressing

Homemade jewelry for sale at the clinic

Reading?  We can help with that too.

A child enjoying a book.

After lunch, with met with a number of community leaders.  We also began work decorating for a large community event coming up in about 3 weeks.  We are very excited to be working with the local community to ensure this will be a successful event!

Our neck of the woods

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.

First Volunteer Day in El Salvador

Hola, we made it safely to San Salvador, El Salvador on Saturday night.  Sunday we unpacked and explored the local area.  Our clinic is located in Las Delicias, which is approximately 40 minutes away by bus.

This morning, we met the staff.  In addition, a local nurse, Morena works with the FIMRC clinic.  She is also part of the ministry of health for that area of San Salvador.  She does home visits throughout the community and focuses especially on pregnant women and ensuring children are up to date with their vaccinations. Today, she took us to several homes in the community and let us practice our interviewing skills as well as vaccination administration.

We had a lecture from the local physician, Eduardo, about common diagnoses and treatment.  We are excited to work with him and seeing patients.  Over the course of the next 4 weeks, we will be seeing lots of children, dispensing medication, and offering basic health education.  This will be an amazing 4 weeks!

Greased Lightbox

→←+-↻

Loading image

Click anywhere to cancel

Image unavailable

¡Comida de Peru!

WARNING: The pictures to follow may cause your mouth to water, please keep una servilleta (napkin) in hand...

One of the wonderful parts of Peruvian culture is the delicious cuisine! We have been lucky enough to have the majority of our meals prepared by our host mom, Margarita, who we are trying to convince to write a cookbook! Her food is muy, muy rico!! She makes us everything from sopas con pollo (soups with chicken) to cabrito con arroz (goat with rice). Every meal is followed with a melt-in-your-mouth fruit which has included mangos and a cactus fruit called "Tuna." Outside of our casa we have tried three different ceviches so far, but there will be more to come! Our favorite thus far was at a restaurant on the beach in Huanchaca that was sprinkled with onions and perfectly flavored with lime juice. We all fell in love!

Another delicacy in Peru is Cuy (Guinea pig). A mildly fatty meat reminiscent of duck was enjoyed by our group in Lima.
Don't worry we didn't eat the ones to the left, we saw those at the Huaca Pucllana ruins.

Additionally, Causas are a popular potato dish stuffed with chicken, seafood, and chicken. We experienced a lovely Causa prepared by our very own Margarita. ¡Deliciosa!

Last but not least, many of us have tried the national cocktail, Pisco Sour, which is created with local grape brandy, fresh lime juice, sugar, and topped with frothy egg whites.

Looking forward to experiencing more culinary wonders of Peru! ¡Buen Provecho!

Happy Monday from Costa Rica

Hola from Costa Rica!

After an eventful weekend of tourism, we were back to work bright and early this morning. This week we are running a mobile clinic in an underserved area of Santa Ana (a suburb of San Jose), which also happens to be the place where we live. Apparently, there was a movement a few years ago to help a group of unfortunate families in San Jose to obtain better housing. These families were given new homes in Santa Ana, which is a safer and nicer neighborhood to live in. However, this move didn’t solve all of the problems of this population, and so many of the people who live in this particular area are still very poor, unemployed, and/or sick. And, interestingly, the move makes them farther away from work opportunities in downtown San Jose and leaves their children in a district where the school is quite far away (and still not very good). We are set-up in a building which is in the process of becoming the equivalent of a soup kitchen, which is called a “comedor” here in Costa Rica. We forgot to pack a few key things, but were able to make it work for the day and we’ll bring more supplies tomorrow. I worked in the waiting room and pharmacy today, but it sounded like the patients had different health concerns than the population in Alajelita, so I’m excited to see some more variety of the medical kind. Dr. Stedem also explained that there is a large population of handicapped persons here, so I am interested to learn about the difficulties that such minority groups face in Costa Rica and the ways the health system, government, and foundations like FIMRC can help.

We parted with the Harvard students on Saturday during our weekend of adventures and were greeted by a new volunteer, Joe, a junior from Princeton, this morning. The additional volunteers were very helpful in coming up with ideas for evening and weekend adventures, and they definitely provided some great ideas and lots of energy and extra bodies for the health education programs and day-to-day activities in the clinic. I hope we were able to teach them a few things about some simple medical terms, conditions, and medicines, and that perhaps we opened their eyes to medical school programs like LMUV. I didn’t speak much with Joe today since he was in the doctor’s room with Claire, but I’m sure he’ll get the hang of things. And after Joe, I hear that we’ll be getting two more students during our last week here.

We had Spanish session #4 today and I think I am picking up on a lot more—certainly much more than last Monday! But I can tell that my brain has its limits—while I feel like I can understand WAAAYY more than a week ago, it seems that my vocabulary hasn’t improved much, or that I am now stuttering and speaking more slowly than ever. But it reminds me of learning the new “language” of anatomy in my first year of medical school. There is a time-period where you are taking everything in, then it needs to simmer in your brain, and then, finally, your mind puts everything together and you can understand and speak the language. So, hopefully all of that happens within the next week ;)

And finally, I’m sure you’re dying to hear all about our weekend adventures. On Friday we (all 7 MSU and Harvard students) drove to a resort near Jaco on the Pacific coast (about 2 hours away) and got to swim at two beaches and several pools. We went back home on Friday evening and went out dancing at a local salsa club. On Saturday morning we made the three-hour trek to La Fortuna, where we got to see a waterfall up-close, gazed at the volcano from afar, and went canopying (a.k.a. ziplining) through the jungle. The Harvard students went back to San Jose that evening, and left for Boston early on Sunday morning. We stayed the night in La Fortuna and took a public bus back to San Jose onb Sunday afternoon. It was an exhausting weekend, but the experience was well worth it.

Harvard kids—good luck with starting your new semester!
Families—we’re still alive and kicking!
Classmates in Peru—hope you’re having as much fun as we are!
Everyone else—Pura Vida!!!

From Angela.

The FIMRC Clinic at Alajualita: The doctors office:

Playing soccer at the soup kitchen after giving the nutrition presentation:

Mike tending to a minor injury during the game:

Hard at work preparing the presentations with the students from Harvard (next to Angela, in the upper left corner, is Jessica, then Rosmary, Denni and then Marie is next to Mike)

Hola from Costa Rica! It's been almost a week in Costa Rica already. We spent our first day here visiting the local Sunday market and then went out to celebrate Angelas birthday. There are 4 undergraduate students from Harvard that joined us this week and have been a great addition to the group. Once we were oriented to the clinic on Monday we began working with the doctor and the psychologist. We have also been able to spend time in the pharmacy and in the front office doing patient intake. We had two days of lecture on the health system of Costa Rica and the use of psychology in the clinic. We also planned and executed two health programs for a local soup kitchen. The first was a presentation to a group of women about hypertension and stroke, and the second was a presentation to the children at the soup kitchen about nutrition and exercise. Both were well recieved by the community.

We have also had three spanish lessons from a Costa Rican medical student. He created a complete book geared towards medical spanish complete with grammer lessons, patient-doctor dialogues and a medical dictionary.

Our three different homestays have been a great immersion experience since none of the families speak english. They have been very gracious in their introduction into the local fare of Costa Rica including Gallo Pinto, a taste of the fresh local produce and plently of coffee. The coffee has definitely lived up to its reputation.

We spent one afternoon in downtown San Jose visitng the various stores and the souvenir market. We also took a tour of the Museo de Oro while downtown.

Dr. Schnuth has been very welcoming and enthusiastic. She seems to know everyone here.

This weekend we plan on spending some time on the beach, visiting a live volcano and relaxing in the Costa Rican sun.

Pura vida!

Greased Lightbox

→←+-↻

Loading image

Click anywhere to cancel

Image unavailable