OVERVIEW

Thank you so much for taking time to look at our blog! We are a group of edical students who are passionate about training and in underserved areas. This January and February, we are in Peru, the Dominican Republic and Costa Rica internationally as well as locally in Flint and Lansing completing volunteer service, rotating in hospitals and clinics, and learning about international medicine and local underserved health care. We appreciate any time you take to read our reflections and any donations you might offer.

Please click the “Donate” link on the side for more details on how to give directly to these communities.


Wednesday, January 29

Peru Update- Clapham

Day 13 (1/23/14- Thurs):

Today and the past two mornings from 7-12 am, I've went to a private clinic called Clinica Cayetano Herideria. It is called a clinic but it also has multiple ORs and also two inpatient floors (one for OB patients and one general floor). It also has multiple floors of sub specialty ambulatory clinics, as well as a 4 bed Emergency Room. Although it is in situated in a very dusty area of town, the building is distinctly taller than the surrounding structures and has an exterior of marble and emerald tinted glass. Inside is also pretty swanky. Mostly private rooms with private bathrooms on the general floor, I think there's 12 rooms on the general floor and 10 are private and 2 have two beds. OB floors is all private rooms, maybe 6. All the rooms have leather couches and flat screens on the wall. In the basement is every form of imaging apparatus that I know about, including a Siemens brand CT machine that from what I can tell by appearance only is the same model that Hurley has.

I've been following attendings who manage both inpatient floors as well as the ER visits. Most of the general medicine inpatients are not critically ill, most have either pneumonia or are surgery patients (a post-appy patient, a transurethral bladder tumor removal patient,and multiple ortho patients). The first two days I was there I followed an attending named Dr. Poma, who is in his 2nd year out of medical school. He doesn't speak English so it's been difficult to understand everything that's going on about of the time, but also no doubt is good practice to have medical themed convos in Spanish. It has been similar to my experience following a resident in the states, he gave me lots of mini lectures that were complete with drawings and tables and he pimps me about differential diagnoses from time to time, so I've actually feel like I'm expending a lot of mental energy to follow him around all morning. He was great to be with and, like I'm discovering is typical of Peruvians, is very generous. By the second morning he was inviting me and the rest of my group to dinners with him and excursions to the jungle with him. These kind of invitations at first were awkward because obviously we barely know these ppl but I am realizing that 1) everybody down here invites everybody they meet to things all the time and 2) that about 50% of the time ppl don't actually follow through with their invitations.

Then today I was sent with another doctor, named Dr. Vacilio, who was a bit older. Like in the states, different attendings have different personalities, so it was a different experience. He was less interested in teaching me, but also we had a lot more patients than the last few days so were pretty busy. He was pretty friendly and explained things in good detail to patients, but definitely was more "machisto" than Dr. Poma and other younger docs. I think this stereotype of Latin men is fortunately fading with my generation.  He would flirt hard and pinch and poke EVERY nurse as we went to the different floors, and then in front of a big group told me that when he was in medical school he would always date two women at one once. By American standards it was entirely over-the-top unprofessional, but nobody here really did anything more than roll their eyes and most just laughed at his jokes.

Another difference that I thought I'd mention is how medical care and medicine is paid for here.  Cayetano is a private clinic and it was very often that the issue of payment came up from a patient. Multiple times I observed a patient in the ER only complete a part of the work-up and take their prescriptions, lab orders, radiograph orders or results and leave to take these to another site to get care. An interesting example is a patient came to the ER with a head wound that he got the day before at his job in the mine a few hours from Huancayo (between Lima and huancayo is a large mining industry). The patient had a bandage over about a 4 inch wound in the middle of his forehead. In the ER, Dr. Vacilio looked at the wound and wrote him a prescription for lidocaine, a syringe, suture, a needle, and antibiotics. Then his sister that was with him ran across the campus to the pharmacy and bought all the things that were needed for Dr. Vacilio to suture the wound. Then he sutured the wound. Also, none of the ortho tools and implants for elective surgery are kept in house, but are ordered when a patient comes in that needs those things. For example, a man with a work injury that broke 3 metacarpals and one of his wrist bones was admitted and given a soft cast and pain meds for two days while the pins that were needed to surgically reduce the fractures were ordered. Another patient who was a seamstress was injured on the job by a needle breaking and lodging in her thumb was admitted in the afternoon even though her surgery couldn't be done til the next day. I tried to talk to Dr. Poma and Vacilio about why these patients were admitted when they couldn't have surgery that day, but unfortunately I never really understood a firm answer they gave.

Despite several differences, I am constantly struck by similarities. A twenty-something came in with back pain and was accompanied by his mom, who asked a TON of questions...which is exactly what my mom would do if I went to the ER.

More things have happened but I will have to write tmr.

Day 19 (1-29-14):

We've done a few things since my last update. Mostly my hospital experience has been at the same Clinica Cayetano that I've been at for these past two weeks. I've been going in from 7am - 1 pm and then going home for lunch. Then in the afternoon we have been doing different campaigns or going to an orphanage. The Cayetano clinic folks continue to be very welcoming. A woman who I believe to be some sort of HR director invited me to go with them the past two mornings on an excursion to the Judicial Office of Huancayo. This office, which I was told has 200ish employees, made a contract with Cayetano to come and do a bunch of health screening stuff on site, including physical exams, vital signs talking, EKGs for persons older than 50 years, a blood draw, and a vision exam station. I felt really priveledged to be invited since this wasn't really arranged by FIMRC. When we first got to the building and went to the basement area where the stations were set up there was a lot of court employees crowding the area and Initially the flow of people through the stations was really disorganized with people not getting the right paper work for that station and people skipping around the stations and not following the flow, which made for confusion and people having to wait around because others went out of turn. I jumped in with the doc who was doing physical exams, but I only stayed with him for about 30 mins because he was ignoring me and not involving me in the interview or exam. So I left that station and found a nurse I recognized from the Clinica and asked if I could help her with EKGs. And I'm pretty happy I did because she taught me how to place all the EKG leads and work the printer, and after a few patients I was running the EKG station. This was a good experience because I was able to talk to each patient that came in and enjoyed the conversations we had. I did that from 9-1 probably. Then today I went back for day 2 of Cayetano clinic at the court, but there were fewer patients and I spent most of the morning talking to one nurse about Peru in general, the Peruvian medical education system, public health issues in Peru, and the Peruvian health care system. It was a really great convo because I learned a lot. For example, she told me that there are not very many heart disease patients or diabetes or kidney failure patients in Peru and also that very few Peruvians smoke tobacco. From what I've observed in the hospital and in the streets, I believe her. She also told me about the people in huancayo having a high incidence of volvulus because the low atmospheric pressure causing lots of gas expansion in the gut. No idea if that's right, but I enjoyed the convo. Then she explained To me how the public hospitals Carmen and Carrion were for people who didn't work, or worked for small shops or manual labor jobs. And that Peruvian who worked for a bigger company Were automatically enrolled in the government insurance available in Peru, called EsSalud (in English, This is Health). These individuals had auto-payroll deductions and were able to go to any of the EsSalud hospitals in the country, hospitals which exclusively treated EsSalud patients. However, while EsSalud is better than no insurance (ie the public hospitals), but still isn't great (long waits, etc). Therefore, chains of private clinics and inpatient and even operative services have developed (like Clinica Cayetano), for which people pay out of pocket for quicker attention and more luxurious environments. I'm not sure if you can buy extra insurances that cover expenses of those clinics.

In the afternoon we have done a few different things. Twice we have given first aid presentations to the Huancayo Serenazgo, which seem to be like a neighborhood watch type group because they clarified that they aren't police, but they wear camo uniforms and drive around the city in labeled tanks. At first hearing that were supposed to do this, I wasn't excited because I recognize that we aren't really knowledgeable in first aid topics. But we spent a long evening making talks and posters about different first aid topics and it seemed like it would be okay. Then when we arrived at the site for the first session, the 40 some Serenazgo that were present stood in a ine and at attention. This made me feel even more inadequate, because how could we possibly teach these professionals anything? But, and I think to all of our surprise, they were all super engaged, asking questions, discussing their own experiences with rescuing people, and even taking notes during all our lessons. Then after about 2 hours of lessons, we took about 30 minutes of photos at their request and that was it. We did this session 4 times as a group so all the serenazgo were Able to participate.

Finally, we have spent two afternoons at orphanages.  One that was pretty big and had a big play ground. The other that was smaller, with only an indoor play area, and had fewer children and was specifically for children with HIV and a few of their siblings that didn't have HIV. Both experiences were simply running around for 2 hours without a break and entertaining small children that were hanging all over us begging to be spun around or lifted up or pushed on the play equipment.

P.S. Our family is simply amazing. The experience would definitely be worse without them. The señora is a cute grandma that dotes on everyone and we try our best to make her laugh with our jokes. She micromanages us like little kids, but it is with such affection that we don't mind. Like she tells us to tell David that he should sit in the front of the cab after he has climbed in the back, or to tell Danielle to go put socks on because the floor is cold, etc etc. They are a really tight family with all four apartments on their complex being occupied by their brothers and sisters and their spouses and kids.


Sunday, January 26

Health Campaigns and Saturday Fun

We have been fortunate to host campaigns on Hypertension, Dental, and First Aid. We also had a great Saturday visiting historic sites with our wonderful host family.

We held a blood pressure screening at the oldest elementary school in the city. We screened around 150 adults and encouraged participants to visit their regular doctor.


MPH Student Beth working hard on Hypertension Posters
Our 5 booths for the Hypertension clinic

Another event this past week was a fluoridation project for the children in school. Along with a local dental students, we visited classrooms and drizzled fluoride liquid in children's mouths.


Chris applying fluoride to a child
These teeth were some of the better ones seen during the campaign
All in all, the kids were happy!

Our most recent project was teaching first aid skills to city security guards, the "Serenazgo." 


Preparing for First Aid Campaign
We taught the "Serenazgo" which are city's security guards. They are called for minor emergencies or if neighbors are being too loud. After brainstorming with our local coordinator, Natalia, we decided to cover the following topics for these potential first responders:

  • CPR (John and Beth)
  • Heimlich maneuver on adults and children (Chris and Emily)
  • Trauma (Laurie and Danielle)
  • Intoxication and Electrocution (Chris)
  • Emergency labor and delivery (Phil)
Phil teaching the most important things for emergency labor
We were interested to hear of some emergency deliveries that some of the Serenazgo had encountered. Phil's lecture was helpful to cover the most important things to do and not do during an emergency labor.


Chris giving Phil a life-saving hug demonstration


John and Beth with Peruvian medical student, Freddy, teaching CPR on home-made dummy

Danielle teaching cervical-spine support while simulating car extrication
While some of the Serenazgo had some experience with these topics, many very grateful for the lessons. We were invited to complete further trainings for the police force. The feedback was so positive that local TV footage was taken of Laurie for the Monday news. FIMRC was also featured live on the radio. It was a fun and productive day.

Laurie speaking to TV interviewer
Group photo with the Serenazgo!


This past Saturday, our host family was gracious enough to show us ancient ruins and beautiful areas around Huancayo. 

Margot (left) and Julia (right) are a dynamic daughter/mother hosting pair, featuring their garden
Beautiful Catholic church
Wari Willka ruins - most recent excavation by Danielle Kurin at UC Santa Barbara
(http://www.fertur-travel.com/blog/2013/the-practiced-craft-of-ancient-peruvian-skull-surgery/8156/)
Chris, Laurie, and Phil on top of ridge overlooking Huancayo and nearby mountains
Hasta luego!


Sipi Falls Update

Hi all!

We traveled to Sipi Falls in Mt. Elgon National Park this weekend, and it was beautiful, so I wanted to share some pictures! 

In other news, we will be rounding with a doc at Bududa District hospital next Tuesday and Wednesday. This should be an interesting experience because he covers the entire hospital. I guess we start the morning in the ER, move on to Labor and Delivery, then on to each of the wards, including Male, Female, and Pediatrics. Oh and of course there are a few surgeries thrown into there in the Operating Theatre between everything. I'm not sure how all of this is even possible for one physician, but we will see.

Happy traveling to the other groups!










Saturday, January 25

Nicaragua- Project Limon



A recap of some highlights from last week in Tola, Nicaragua at Project Limon:
 
Caitie, Jenny and Nicole outside the hospital in Rivas
We have had a lot of fun different opportunities so far between working in the clinic and hospital to many community outreach programs. Some of our outreach experiences have included: 


Community tours

Our community is in the Department (like a state) of Rivas, Nicaragua. The community, Tola, is very rural and is comprised of 5 smaller neighborhoods. We spent an afternoon walking through the communities to get acquainted with where we are and learn more about our surroundings. We visited some of the Tiendas and restaurants but there isn’t much for sale here and the nearest grocery store is about an hour away.  We visited the local cemetery and noticed all of their caskets were cement and above ground. We saw the salt fields where they harvest salt from the ocean. 

Cemetery in Las Salinas, Rivas

There is a bakery, Paradise Bakery, but they don’t have baked goods on hand, its all made to order days in advance. Similarly, many of the “restaurants” are found in the homes of women who are known to be particularly good cooks in the community and open their living rooms for dining at lunchtime. A typical meal always includes beans and rice or gallo pinto (bean and rice mixed) and some sort of meat, especially sea food.

Typical Nicaraguan meal


The Natural Healer

We spent an afternoon visiting a local natural healer. She was in her eighties and grew up with other natural healers in her family. Despite many non-western methods she also prescribes things such as anti-parasite medications when she thinks they are indicated. While we were there she diagnosed us individually with ailments from parasites to slipped vertebral discs.


The natural healer working on Jenny


Diabetic and Prenatal home visits

We divided up and spent a few afternoons visiting patients in their homes for diabetes and prenatal checks. For the diabetic visits we checked every patient’s glucose and blood pressure and spent some time counseling. For the prenatal visits, FIMRC has a program where they visit the home of every pregnant person in the community once a month and go over an educational curriculum about pregnancy and motherhood. We all really enjoyed the opportunity to get out in to the community, meeting different members of the community in their homes. 

Physical therapy and clean-up

Tomeny helping us with the clean-up
Every Friday morning, FIMRC runs a therapy clinic for children with various special needs such as children with developmental delays, learning disabilities, cerebral palsy and more. We work with the children every Friday doing physical therapy and learning games. They always finish with a good game of musical chairs. This week we also helped cleaning up the center inside and out, including weeding with machetes and burning the yard waste (the method of trash removal around here). 

Jenny tending to the fires of our yard clippings
FunLimon Carnival

A local community foundation, FunLimon, put on a carnival Friday evening were we participated by creating a health Jeopardy game for kids to play and gave out prizes from the donations we brought. The game was a big hit (or more so the prizes) and we had a never-ending line of kids. A few other local organizations set up informational booths and there was a bouncehouse, a clown running games and cotton candy. Also, 3 major league baseball players came down to run a baseball camp over the weekend and were signing autographs at the carnival. 

Showing off our handy work - Jeopardy game behind us
Us with most of the FIMRC Nicaragua group
We could go on about all we are experiencing and learning and all the great people in the community we have been getting to know, but that's it for now!

"jumping" picture as we head off for a hike

Thursday, January 23

Week 2 in Uganda!

MONDAY
What a day! We all hopped on Boda bodas in the morning with Michael from the clinic. We drove all around the Bududa loop, the road that connects the trading centers within our Bududa district. We visited two other clinics in the district, as well as the Bududa Regional Hospital. 

I was pleasantly surprised with the clinics, as I have been so far with our own clinic. Things seem well organized and it seems like there is decent access to care. There are pharmacies, maternal care, and immunizations available. Everyone was very friendly and welcoming. I think there has been national and international emphasis on increasing the quality of and access to community clinics, and you can really see the positive outcomes from this in these clinics.

Unfortunately, I did not have the same reaction to the regional hospital. The hospital is large. There are many wards: male, female, maternity, pediatric, operating theatre and an ER. For the entire hospital there are three doctors, but usually only one doctor in a given day. The wards are very simple; there are no private rooms, but instead one large room. There are not enough mattresses or IV poles, but they do seem to make sure they have the medications necessary for the patients. I was impressed with the staff I met there, but they just don't have the resources they really need to provide the care they want to. 

This was a powerful day for me, and eye-opening to the medical system in Uganda. I hope to keep having such powerful experiences!

Putting sunscreen on for the day:


TUESDAY
Today was another day in the clinic for me in the morning, and then I traveled back to the hospital with another volunteer, another Michael, to arrange shadowing for us. It was another Boda Boda ride through this gorgeous country, and I loved it!  We came back to the clinic, and the afternoon was spent teaching community health workers how to take vital signs, so they could do that on their outreach trips to different villages. It felt like a really productive day.

Two other med students, Androuw and Carolina, made their way to the hospital in the afternoon as well, and attended a surgery, an inguinal hernia repair. They said it was a good experience to see the similarities and differences between surgery in the US and here in Uganda.

WEDNESDAY
Another adventurous day! We took bodas to the village with the school for orphans I visited last week, Bushika. The building is constructed out of mud, and they are building another room for the fourth grade class. We spent the morning digging out the land for dirt for mud. We worked with one of the teachers, Hosaya, who explained that things like learning how to dig are an "informal education," which, especially in Bududa, can be as important as any "formal education" you would get at school. Within a couple hours we were all pretty good with our hoes!






The afternoon we spent in the clinic, and observed a group called Marie Stopes, who  travel around clinic to clinic to provide women's health services. They did many IUD and
 Implanon placements, but the most amazing was the tree tubal libations we observed. This is a surgery that in the US is done under general anesthesia in an operating room in a hospital. We watched them do these surgeries in an open air pavilion under local anesthesia... This means patients are awake for the whole procedure, and get up off the table and walk away immediately after it was done. It was completely amazing! 

THURSDAY
Today I spent the whole day working with Kristen, a PA that has been here for three months. We saw kids all day, and it was a great day. Some of the other medical students traveled to the other clinic where Marie Stopes traveled for the day to observe more procedures, while others worked taking vitals, in the lab, and seeing adults. Overall a great day!

FRIDAY
Today we will be touring the hospitals in Mbale, the biggest city close to us. I am curious to see how this hospital will compare to the regional one. 

This weekend we are traveling to the Sipi Waterfalls in Mt Elgon National Park, and we are looking forward to the arrival of a professor and OB/Gyn from MSU who will be working with us for the next two weeks!

Packing into the van: 

Monika and the LMU Uganda team


Tuesday, January 21

Welcome to Restauración


Restauracion is a small town of approximately 7,000. It is located in the Northwestern region of Dajabon, a border province of the Dominican Republic with Haiti. Our 1st day involved traveling back towards Santiago to the town of Mao to see the director of public health for the region. We had been told that we needed his blessing for me to be able to work clinically. Luckily, within a few minutes of seeing the director and speaking to him, he gave his permission, and I was officially set to go. We drove back to Restauracion, for me to get an introduction to the hospital, and the FIMRC organization. 

Starting Tuesday, 1/14, I began my work at the clinic. Although it was labeled as a municipal hospital, and did have 3 small wards for inpatients, the Hospital in Restauracion mostly functioned as a primary care center. There was capacity for IV rehydration and antibiotics, as well as an OB/GYN room for births and exams. However, any complications or procedures requiring specialists needed to be sent up to Dajabon, the Regional Seat. The hospital was staffed 24/7 with 1 physician (there was a rotation of 3 that worked 24 hour shifts every 3rd day. One attending physician and 2 medical interns doing their required year of service. 

As this is dry season, my patients presented with mostly run-of-the-mill complaints, colds, flu, UTIs, the occasional Hypertensive urgency, but consistent with a family practice in the US. I was told of episodes of Dengue, occasional malaria, and the epidemic of Cholera that they had faced here months back.

I spent the rest of the 1st week getting used to the town and meeting the generous and welcoming inhabitants.

Monday, January 20

More Peru Update- Clapham

Day 10: 1/20/14

Last Thursday morning, we did a dental outreach at two local public elementary schools (primarias as called in Peru). We were led by three advanced dental students. Dental students here are charged with operating a dental program for 10-12,000 kids in Huancayo. The schools were pretty nice and the classrooms seemed very happy places, reminding me a lot of happy elementary schools in the US, with educational posters and motivational phrases posted all over. The kids were what you'd expect, super happy to have visitors and eager to have the attention of an adult putting fluoride in their mouth and cleaning their teeth. I felt like I was having déjàvu of being in a classroom in the States, but with just enough of a distinct Peruvian flavor (and a lot more dental cavities) that you knew this wasn't the case. Some interesting moments to give you an idea: I observed two boys playing "Papel, piedra, tijeras", the exact Spanish version of "paper, rocks, scissors." Later, we passed by a class of maybe 40 little boys having their gym class in the courtyard outside, all perfectly in a line to do stretches or exercises while over the loud speaker Whitney Houston's "I will always love you" blasted full volume over the courtyard. Also for a little while a particularly ambitious little girl was trying to be my assistant by prying open her classmates' mouths so I could better access their back teeth. Unfortunately I had to relieve her of her self-assigned post because she was hurting her classmates as well as blocking my view of their teeth! The vast majority of the kids were so loving and even the shy ones enjoyed the attention. I more than once observed that after I showed a kid's rotten or dead tooth to one of the dental students, later that same child would become the center of positive attention from classmates as kids gathered around him/her to see what exactly warranted the gringo calling over another adult to discuss.  It was a SUPER busy morning but I'm pretty sure we all loved it and all wore smiles for those three hours.  It was so fun to explain to the kids in Spanish that they had to wait three minutes before they could spit out the fluoride and 30 minutes before they could eat or drink and that they couldn't have milk or cheese or yogurt the rest of the day to preserve the effect of the fluoride, and then to observe their faces and realize how seriously they took these instructions.  During an opening presentation to us MSU students, the lead dental student told us that 95% of kids in their program have cavities... And after having my hands in about 20 of their mouths, I'd say I'm a believer in that statistic. I'm happy that Peru on the system level has taken dental work to the classroom, and Although I have no idea obviously if this is possible, I hope this program continues to grow as it was obvious to me in three hours this is a great need here. 

Then today in the morning, I went with Laurie to Carrion hospital, the general public hospital that I went to a few times last week. Again I was impressed by just the crush of people in the hallway, waiting to visit a patient they knew or be seen by a doctor or technical person or wait in line to receive their prescriptions or talk to someone about their bill. I got to choose what service we would round with today so I chose general medicine! Similarly to how I described my experience above, it was like going to a general medical floor in the States...but with a Peruvian twist. Unfortunately, this time the twist wasn't funny. There was an elderly patient with a history of heart failure admitted for aspiration pneumonia. There was a young man admitted for a small bowel obstruction and possible perforation....but the tragic twists were these acute admissions were secondary to decreased level of consciousness from neurocysticercosis and intestinal tuberculosis, respectively. I had the opportunity to view the radiographic images of these patients as well as of another patient with miliary tuberculosis. And also discuss the cases with a Peruvian attending, residents, and a student. And perhaps by being a little obnoxiously persistent with asking questions and my willingness to be laughed at for my terrible pronunciation I was able to learn more of the language of anatomy, physical exam, and medicine in Spanish. 

We are all so grateful to LMU, MSU, and FIMRC for these amazing opportunities. 

P.s. This weekend I tried grilled octopus (pulpo a la Parilla), more beef heart (anticuchos), and a ceviche with raw salmon and tuna and yams! All were tasty enough to try again.

Sent from my iPad

Saturday, January 18

Uganda!

Mulembe from Uganda!

Carolina, Max, Karthik, Androuw, John and I all arrived safely in Entebbe just outside Kampala last Sunday. We spent a brief night in Entebbe, then spent all day traveling on Monday to our village, a little place called Kiholo (chee-holo) in the Bududa district in Southeastern Uganda. We have no internet access there, so this weekend we rode in a Mutatu, which is a white van packed full with people, two hours to the closest city so that we could have a little email and blog time!

A brief overview of our week so far:

MONDAY
We arrived at our guesthouse, complete with pit latrines, bucket and cup showers, and spotty electricity. It's charming and we like it!  As
 we walk through town, we meet and greet everyone. The local language is Lugisu, which we are slowly picking up. 




TUESDAY
Clinic today; the clinic is a gorgeous 15-20 minute walk from our guesthouse, definitely the most beautiful commute I have ever had. The clinic is very well organized, I was so impressed. There are five stations, and they see about 50-60 patients a day, which is a lot. I spent the day first in the lab, and saw malaria on a blood smear! Then I moved over to triage, which required a lot of Lugisu. I had a blast learning different words from the patients who were waiting, who thought I was hilarious every time I made a mistake, which I sometimes did on purpose just to get a laugh.

The Clinic: 


WEDNESDAY
I spent the day with Michael, another volunteer, doing teacher training for a new school for orphans. The school is really run down, in huts made out of mud and smeared with cow dung for support (sounds disgusting but this is actually a common practice). They pack the kids in these tiny little rooms, and the teachers are all volunteers and have no actual experience. It was a fun day, I enjoy doing that kind of teaching, I just wish I had more to contribute! 

Everyone else spent the day at the clinic again, rotating between stations. Carolina helped stitch up a little girls' hand, which was apparently a lot more challenging than in the ERs we are used to, with a very blunt needle and 2-0 stitch.

THURSDAY
Clinic once more today, I think everyone is starting to get the hang of things!

We also watched the Zimbabwe-Uganda game. It was really strange... We were packed in a mud hut with 30ish people on benches, but they had this awesome TV. It was a crazy juxtaposition.

FRIDAY
Woke eaaaaarly in the morning, and hiked with everyone up the local mountain, Mt. Nusu. It was a little rough with my cold, but it made it! It took about 5 hours total, starting and ending at our guesthouse. It was so beautiful. At the very end we had to hike along the ridges of two other peaks to ours, it was amazing.




That's all for now! We will update more when we have internet access!

~ Monika and the Uganda LMU Team



Wednesday, January 15

First week in Peru
 
Day 2 (1/12/13):
Now we are on a bus to huancayo that has spotty wifi. It took about 10 mins to load my email. We should arrive in huancayo at 8 to 9. Lima reminds me of Quito. It just goes on and on forever and very dusty  with lots of poor housing complexes just lining the highways and sprawling up the mountainsides. I have had weird food so far. I had beef heart on a stick. I actually thought it was just steak and then later discovered it was heart. It was my fault bc I communicated with the guy in Spanish so missed that somehow. This morning had French fries with weird sauces and a cut up hot dog over it, it is called salchapapas. Anyway, gonna nap now bc I hear that's the best way to avoid motion sickness and the bus ride already has me a little queasy. I'm excited to meet my host fam.

Day3 (1/13/14):
Hey! Peru is good so far. Lima was nice but I saw very little of it. It is huge though. I am excited to see more of it after I leave huancayo. Huancayo is a medium size city of about 400 k ppl. It is super industrial and pretty dirty. Today we just went to the hospital and buddied up with Peruvian students.  it was a public hospital and super crowded and run down (by U.S. Standards). I Saw a patient that has tuberculosis of the vertebra that weakened the vertebra and also seeded the Spinal cord and he broke a few vertebra and now he is paraplegic, and tuberculosis really only spreads beyond the lungs when tb goes untreated or inadequately. treated for years, so that was interesting but very sad obviously. Hopefully I can get some pictures of the wards before I leave. Tmr I am spending the day with an obstetrician bc I told the group leader I like that. Also tmr I start Spanish lessons with a tutor that is coming to the house I'm staying at.  Things are insanely cheap here. For example lunch costs 7-8 soles and includes soup, a choice of one or two entrees and dessert. And the exchange rate is $1 equals approx 2.75 soles so that lunch is about 2.50- 3 bucks. Also bc we are in a town in the mountains that's like 8 hrs from Lima there is actually no diversity here so when we walked Down the street ppl are obviously saying "look gringos" and pointing us out. It's kinda funny. Also tons of stray dogs and cats here. That's sad too. Ok more later. 

Day 4 (1/14/14)
Today we went to the same public hospital as yesterday. I didn't end up going with the obstetrician like I was told yesterday. Instead I paired up with a Peruvian med student and went on rounds with her on the women's surgery ward. It was actually a lot of the same type of surgery cases that are seen in the US (at least the same as my two months in surgery). Lots of gall bladder surgeries, appendicitis, pancreatitis, and a few trauma cases from car accidents. One lady had a hydatid cyst in her liver that was 14 cm though, which apparently is common here. Another lady who was in a car accident had worsening cellulitis surrounding the knee. Another lady was thought to have a small bowel obstruction but the Peruvian surgery attending thought that the obstruction had lasted longer than it should have and so it was possibly intestinal tuberculosis or some other rare tropical diseases that I forget now. Then after rounds on the surgery wards I went with another American student in my group and the same Peruvian med student to the pediatric ward and the Peruvian student basically just reviewed a medical chart with us and taught us medical vocab for about two hours , which was helpful. I am trying to learn a lot of medical vocab these past few days. But the chart we reviewed was of an 8 year old boy who spoke Quechua and had an orbital fracture because he tumbled down mountain during a mudslide. His left eye was actually hanging out of his socket and it was in a bandage. All that was in the morning. After lunch we had our first Spanish lesson. It went well. I hope to really recuperate some of the complex grammar that I have lost over the last 7 years since I studied in Sevilla. I am really enjoying my host family. They are all very affectionate like a typical Latin family and seem to love us a lot already. Anyways, I'll try to update again tmr. 


Day 5 (1/15/2014)

This morning I went to the women's and children's hospital. First we rounded in the obstetrics ward. 
It was similar to the other wards, where against both of the longest walls are rows of beds, with maybe 8-10 beds in each row. So there's no actual patient privacy and no curtains between the beds. And there are classic type pictures of Jesus and the virgin hanging everywhere. And when we round there's a huge group of us, including the Peruvian attending, 2-4 Peruvian residents, 2-4 Peruvian medical students, and 2-4 American volunteers. So all of us go bed to each bed and discuss in detail the patient's case, even in the case of them having miscarriages or pelvic inflammatory disease, both of which are the cases of patients in those wards. The ob/gyn was very nice to us and explained a lot of things, and spoke more clearly Than the attendings I've rounded with in the past few days at the general hospital. However he didn't wash his hands between patients, just moved bed to bed and examined every patient. The Peruvian medical students were super helpful with helping me learn anatomy and medical words, like cervix, dilation, Fallopian tubes, steroids, bowel sounds present, etc etc. the patients were pretty standard I thought for that ward, some miscarriages, uterine fibroid, dysfunctional vaginal bleeding.

After that I went to the pediatric ward, which was smaller. This attending spoke very loudly and clearly but didn't seem to be very sensitive to the patients, for example he talked about diabetes causing blindness in front of a young girl admitted for diabetic ketoacidosis and was generally brash with parents. But on the other hand he seemed very smart and ran the ward and his resident team very similar to the American wards.

Then I was prompted to go to a vaginal delivery but when I arrived the baby was born already but then the mom had post partum hemorrhage, and a TONNNN of blood was being lost, but I had to leave because our ride arrived just as the obstetrician that we rounded with arrived to handle it.

During lunch I had a long convo with my Spanish teacher where she tried to make me use verb tenses that are more complex. I have the feeling she is a very good teacher. She charges 20 soles per hour, which is about $8. So I feel like I'm getting a lot for my money and bc I'm paying for lessons I hope 
that keeps me motivated to study.

Welcome to Huancayo!

The Peru team arrived in Huancayo on Sunday night and was happy to meet our wonderful host family, the Thomas's. They are a wonderful family - so gracious, generous, and friendly! We have had some great bonding times over lunches and dinners already. 

David and Phil in our living room. Pics of our family to come!

Each morning this week, we load into a bus to go to one of the hospitals in Huancayo.

Here we are on the first day with our white coats and smiles!

Each morning, we split into two groups. One group goes to Carrion hospital, a public hospital that accepts all patents regardless of ability to pay.  The other group goes to Carmen, a hospital part of the Essalud health insurance plan which requires payment to join. This insurance program is typically for government officials and professional workers.

A very bright morning at Hospital Carrion
This week has been a great taste of being a resident with the responsibility to teach students! There were approximately 15 pre-med students from Brown University and University of Illinois in Huancayo this week. We have been rounding with these students. It is very interesting attempting to understand the medical Spanish from the doctors and Peruvian medical students while also teaching the pre-med students. John and I were able to provide basics on chest x-ray reading, APGAR scores, the newborn exam, hyperbilirubinemia, stages of labor, and AIDS related diseases during rounds and observation in the past few days. We also observed some deliveries together and visited babies in the nursery and step-down NICU.

John teaches CXR reading to Brown University and University of Illinois pre-med students

We also have had the great opportunity to interact with Peruvian medical students. They are currently on summer break (southern hemisphere!), but volunteering their time to guide us around the hospital, teach us medical Spanish, and have fun!
Our group with our wonderful Peruvian medical students
Yesterday, we taught the students how to take blood pressures for our upcoming blood pressure clinic. This afternoon, Laurie led a suturing clinic for all the pre-med students, MPH students, and Peruvian medical students. It was a good refresher while we helped teach students basic suturing skills on pig's feet. Laurie did a fantastic job! 

"... and this is how you do it ..."

Laurie did a fantastic job and will make the best of surgical residents!

It has been a great week and we are looking forward to the next couple days, and next week as well! See you next time!