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.

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Wednesday, February 5

Peru Update-Clapham

Day 24:

Last Friday our group did a hypertension education and screening campaign in a smaller pueblo in the hills outside of Huancayo. It took us about 30 mins in bus to arrive, through dusty roads that wound enough that one of our girls got car sick. When we arrived I realized we had been there the previous Saturday on one of our tourist excursions with our family. In the center of town is a cathedral loaded with religious icons. And outside the church is a huge stone cross that my seƱora told me is 500 years old. It has four sides, of the two large sizes, one depicts the crucifixion (very defaced making it the most difficult image to appreciate) and the other side has the Virgin with baby Jesus. The two smaller sizes have images of two monks, I don't know if they are particular ones or not. Around this cross on all sides people come and burn candles to ask God for something. And they wait until the candles burn entirely down. Different colors and arrangements signify different types of requests I was told. The aura of devotion of the faithful that are gathered is impressive. Chris took good pictures when we were there the first time. This time, our work was across the street from the cathedral in a convent. On arrival there were maybe 20 mostly old people that were seated in a big open room that had a few tables and chairs where we would do our visits. Laurie introduced us and gave an overview of blood pressure, hypertension, and preventative measures. Then we split up into teams. The really old people gravitated to one corner of the room where Danielle checked their BP and talked to them about various health concerns. Like in the States, the old folks took longer than the other patients. I laughed when I was done checking my patients' pressures and I saw that Danielle had a lot of old folks seated around her table waiting their turn for a SECOND consult to discuss more issues.

Peruvian medical student Freddy was working with Danielle

After the intro, I went to one corner of the room and started "seeing patients." I asked their name, age, medical history, social history and wrote this all down on a paper and then took their BP twice and and then their pulse and respiratory rate. Then I listened to their lungs and heart with my stethoscope (mostly just to oblige them bc they saw the other students in our group auscultating patients at their stations). This town and this population was distinctly different than Huancayo, I could tell as soon as I started to be near the people. This was truly the Andean pueblo. The women I thought were 50 were in their mid 30's. Most women wore the dress of the campo (five layers of skirts of worn fabric and straw hats). When I inquired about occupation, 90% told me they worked in the "chacra," which means intense manual labor farming. And their worn leathered hands proved their response. Their speech was markedly more difficult for me to distinguish than my Huancayo host family members and physician friends. More than one was illiterate. More than these pieces of evidence though, is just the palpablility of poverty that was present, I've seen it in patients I've met in the Hurley ED, and it was the same here. Part of it is a smell, but a bigger part of it is a deeper feeling from your soul that tells you that this fellow human lives at a lower standard of living than you do.

Most of my "patients" had systolic blood pressure below 100. Probably because they physically exerted themselves for long hours each day and nobody smoked and nobody drank alcohol and nobody had diabetes and nobody had a family history of heart disease or hypertension and nobody was overweight. But everybody wanted to talk about a health issue. And like I've experienced already once or twice in Peru, they all gave my medical opinion great deference, and showed me that they cared deeply about their health, and said "thank you doctor" and "bless you doctor" about 1000 times.

Photo by Danielle Chang
I talked to an elderly man with BPH, another elderly man with the most knee crepitus that I've ever appreciated, a lady from Lima that was visiting the cathedral to make supplication to God who carried a tomagraphy film of her face that showed a maxillary sinus mass and who wanted my opinion (I didn't ask, but I wonder if she made the journey to ask God to heal her), multiple patients with gastritis, an 18 year old girl who had recently graduated high school and had aspirations to be a lawyer. I gave lots of advice about healthy diets and exercise. To the patients with medical concerns, I offered an opinion about the source of their symptoms and directed them to see a doctor if possible to receive treatment. And to the young girl I beseeched her to follow her dream and make wise choices in regards to her lifestyle and her relationships. I felt that within this environment that I've been describing, that a young person would have thoughts of pursuing an education and a life beyond manual labor in the campo, was a special thing that needed nurturing and even though it was just free advice, I hope it motivated and stoked her ambition to follow her dream.

Among these events though, stands out a particular encounter. After a few hours of sitting at the same table and having conversations, I was feeling ready for a break. Then she came and sat down after another patient vacated the chair at my table. I'd be lying if I didn't admit I wanted just to be done with talking to her before we even started. She smelled liked poverty. She had only a few teeth. I couldn't understand her hardly at all. She had food crumbs all over her lap and her dress was tattered. I knew it was going to be hard for me, practically and emotionally and I didn't want it at that moment. Finally after a few minutes I decided that I would seek a translator, which I hadn't needed to do yet. I decided this because I thought she was telling me that her son was punching her. And also I thought she was telling me that she was having bloody nipple discharge. Then Natalia, our Peruvian FIMRC director, came over and translated. The patient told that her husband had beat her for years and now her sons were following suit. She told that her husband forced her to work by begging on buses.  She told that she had no family in the area, except her husband's extended family, who all hated her. I had to get this story later because I could understand neither her nor Natalia's Spanish through their sobs. Also because I had to maneuver her husband to another area of the room when he approached the table and accused her of lying and dementia.

I didn't talk to her after I guided her husband away. The sisters and someone Natalia talked to them for about 1-2 more hours. Now I don't know what will happen to her. The experience was another lesson for me about the assumptions I make without realizing or intending to and how easy it is for me to misjudge a person and a situation. Easily she was the patient that had the most at stake that morning.

All in all, it was a demanding morning, both mentally and emotionally. It really covered a lot of of the primary care roles: health screening, education, patient reassurance, and unplanned psychosocial troubleshooting (of the utmost importance).

Lunch with Nuns and Community Volunteers after the campaign - Delicious!

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