tag:blogger.com,1999:blog-72012561897277996522024-03-05T01:19:57.558-08:00Leadership in Medicine for the UnderservedMichigan State University College of Human MedicineLeadership in Medicine for the Underservedhttp://www.blogger.com/profile/07013306657304268476noreply@blogger.comBlogger80125tag:blogger.com,1999:blog-7201256189727799652.post-23856929482412554882017-02-20T10:02:00.002-08:002017-02-20T10:12:50.000-08:00Anconcito, Ecuador<div class="MsoNormal">
<i>Bienvenidos a Ecudaor!</i> The time has flown by, and my wife Lauren and
I have had our share of hard work, new experiences, and excitement!<o:p></o:p><br />
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<i>Anconcito, Ecuador<o:p></o:p></i></div>
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We are working with the Foundation for International Medical
Relief of Children (FIMRC) on a project to assess childhood malnutrition and
anemia in the rural fishing town of Anconcito.
There is a great deal of need in the community, with widespread poverty,
overcrowding, and limited access to healthcare being among its chief
problems. Some statistics: the majority
of families in Anconcito survive on $200 or less per month, and while the cost
of living is substantially less here than in the U.S., it is still hard to make
ends meet. For reference, the minimum wage here in Ecuador is $366 per month,
but since so much of Anconcito depends on the fishing industry, and some
times/seasons are profitable while others are not, families here are often
making far less than minimum wage.
Indeed, less than 6% of families make more than $400 per month!<o:p></o:p></div>
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Additionally, while diseases such as parasites and diarrhea
are common, often owing to contaminated tap water, there is little in the way
of medical care for the community. The
Ecuadorian Ministry of Health (MoH) runs a small clinic here in town where
people can receive free health care, but there are only three doctors for a
town of nearly 20,000 people, and, while private clinics do exist, the poverty
of the residents here makes cost a daunting obstacle to using these
services. The MoH clinic is
understandably overwhelmed with its impossible task of trying to provide care
to the town, so patients often must wait weeks or months to be seen. And even when they do get in for a visit, the
MoH clinic has so few resources at their disposal that the level of care
provided often falls well below what we would expect in the U.S. Cases of even low complexity must be referred
to a hospital in the nearby town of Salinas (I once saw a child with an earache
referred to a pediatrician in Salinas because the MoH clinic didn’t have an
otoscope to perform a proper ear exam).
I do not blame the doctors at the MoH clinic; they are good people doing
the very best that they can. The task before
them is simply far, far greater than the manpower and resources they have
available to them.<o:p></o:p></div>
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that my wife and I are conducting our research.
To our knowledge, there is very little data about malnutrition in this
community, so we are hoping to help fill that void of knowledge. Our study involves collecting height and
weight measurements of children aged 0-59 months, as well as collecting
hemoglobin samples from kids aged 6-59 months.
From these data, we will estimate the prevalence of manifestations of
malnutrition such as underweight or stunting, as well as estimate the
prevalence of anemia in the community.<br />
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We are nearly done with data collection at this point, and
while we have yet to sit down and analyze the data, we can already see that
malnutrition and anemia are both very significant problems in children
here. Stunting is very common, and even
the children that check out as “normal” on the growth charts are nearly all below
average for height-for-age.
Additionally, mild-to-moderate anemia seems to be almost the rule rather
than the exception, and our screening has even detected a handful of cases of
severe anemia that required urgent medical attention. <o:p></o:p></div>
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</v:shape><![endif]--><!--[if !vml]--><!--[endif]-->We hope that our work
here will be much more than an academic exercise. We are collaborating with the MoH clinic to
conduct the study (they are very kindly lending us their hemoglobin analyzer to
perform our tests), and we will share the information we collect with the
doctors there so that they can hopefully follow up with the children most in
need of medical intervention. We also
hope that our results will be useful to FIMRC as they continue to work to
develop interventions to promote health and nutrition here in Anconcito.<o:p></o:p></div>
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But it hasn’t been all work and no play for Lauren and
me. We have taken advantage of our
weekends to do a little sight-seeing in this beautiful country. One of our trips took us hiking and
snorkeling at <i>Isla de la Plata</i>
(Sliver Island), also known as the “Poor Man’s Galapagos,” where we saw blue-footed
boobies, a whale, a shark, sea turtles, and a huge variety of fish. This past weekend, we visited the city of
Cuenca, a sprawling historical city surrounded by beautiful mountains. And this weekend, we hope to journey to
Riobamba and see the famous volcano, Chimborazo. Ecuador truly is a land of immense natural
beauty, and I wish we had more time to see it all!<o:p></o:p></div>
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<i>Chris and Lauren in Cuenca, Ecuador<o:p></o:p></i></div>
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Chris Diroffhttp://www.blogger.com/profile/17307280646199267392noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-24114272818686424312017-02-17T10:48:00.000-08:002017-02-17T10:48:23.700-08:00Private Practice in Flint <div class="MsoNormal" style="text-indent: .5in;">
As Ji-sun mentioned below we both
have been working at a private clinic in Flint that provides care specialized
in internal medicine and pediatrics. The clinic functions as a safety net
health center serving some of the most vulnerable individuals of the Flint
community. Most patients fortunately have been able to obtain health insurance
following the Affordable Care Act, however the clinic still offers care to
those uninsured/ underinsured struggling to find care. Being able to work
alongside a variety of providers in both the primary care and urgent care
setting has allowed for immense learning opportunities. I have become more
familiar with the management of chronic conditions such as hypertension and
diabetes as well as learned how to manage acute presentations ranging from
upper respiratory infections to ankle sprains. <o:p></o:p></div>
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In addition to our clinical
responsibilities Ji-sun and I chose to focus our community project on health
education. In many outpatient clinics, like this one, providers have large
patient loads leaving very limited time for educating patients about their
health. Understanding the impact that education can have in helping patients
manage their health we chose to provide diabetes health education at the
clinic. With the high patient loads of the clinic many patients find themselves
waiting 1-2 hours to be seen, which for us was a perfect time to focus on
providing health education. This thought to serve 2 things: opportunities to
provide health education and patients would not be so focused on their waiting
time. The waiting room provided a perfect avenue to implement education on a
diversity of health related topics. We provided patients with simple yet
important handouts covering topics such as what diabetes is, common symptoms,
medication use, nutrition and physical activity information. We also spent time
working individually with patients that desired more information about managing
their chronic condition. Patients shared how being better informed about their
diabetes made them feel more confident in being able to work with their
provider to better manage their health. </div>
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Empowering patients to take on a more
active role in their health is essential and the health outcomes are by far
better, thus we hope that our efforts in promoting health education are
continued!<o:p></o:p></div>
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Yvonnehttp://www.blogger.com/profile/17284910174619276117noreply@blogger.com3tag:blogger.com,1999:blog-7201256189727799652.post-16617065757866113052017-02-15T15:13:00.001-08:002017-02-15T15:13:37.199-08:00Hurley Children's Center and Nutrition for Flint Children
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Hurley Children’s Center is a one-of-a-kind clinic in a
one-of-a-kind city. After all that Flint has faced, this clinic truly does the
best it can to provide its patients with the many resources they can use to
improve their lives. This clinic is home to many wonderful residents,
attendings, PAs, health psychologists, WIC staff, dietitians, nurses, and many more members. </div>
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One of the biggest changes the clinic has undergone in the
past two years is its move to the current location. In September of 2015, the
clinic moved from its old location next to Hurley to the new location next to
the Farmers’ Market. The thought was that maybe families would be more likely
to purchase healthy food options if they had to travel next door for their
clinic appointments anyway. Since the move, other programs with a similar goal
have been implemented. The Double Up Food Bucks program has been expanded to
Flint, which allows people who buy fruit, veggies or milk with a Bridge Card at
a participating site to get a matched amount of Double Up Food Bucks to spend
on fresh fruits or vegetables. The Hurley Children’s Clinic also participates
in the Fruit and Vegetable Prescription program, which gives “prescriptions”
for produce at the Farmers’ Market. These are $10 vouchers given on days when
the market is open, and bags of fresh produce on days that the market is
closed.</div>
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After being in the clinic as a medical student for a few
weeks, I have seen firsthand how much this population could benefit from these
programs. Many staple diets include chicken nuggets, hot dogs, chips and pop.
It is difficult to advocate for healthier choices when produce is more
expensive and less convenient, so hopefully these programs can have some
positive impact.</div>
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The project I am involved with is a qualitative study which
aims to address how these programs, as well as the move of the clinic, have
impacted the patient population at Hurley Children’s Center. We are
interviewing parents and caregivers of patients who are willing to discuss their experiences
with the programs. We hope to find out how the programs have been beneficial,
as well as what barriers patients still face in accessing healthy food. Hopefully, we
will receive answers to these questions that we are not able to predict. For
instance, many people viewed the move of the clinic’s location as an obvious
positive, but many parents do not like traveling to the new location because
parking is more difficult. If we are able to find out more information like
this, hopefully these programs can be improved to provide a greater benefit to
the Flint population!</div>
Anonymoushttp://www.blogger.com/profile/08105898849692146769noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-8651622167856269782017-02-07T17:19:00.000-08:002017-03-19T19:05:14.204-07:00Hamilton North Pointe Clinic and Breast Cancer and the EnvironmentI've been working at the North Pointe Hamilton Clinic on the North side of Flint since early January. I see patients with the Med/Peds residents and then present the cases to the attending physicians. The clinic has been very busy lately! I've been able to interact with a multitude of patients from different backgrounds. The clinic serves a population that is mostly Medicare, Medicaid, or uninsured. Most of the patients have multiple chronic medical conditions that have not been addressed in many years. I get to work with the residents in creating a plan of attack on which issues to address first, and which ones can wait until later. I am getting more comfortable with management of diabetes, hypertension, obesity, and COPD. I also get to help with a lot of well child visits, which are my favorite! I love seeing kids and counseling parents on nutrition, anticipatory guidance, safety, and behavior. <br />
<br />
I've also been working with the MSU Extension office here in Flint on a research project showing a connection between the consumption of high amounts of animal fat, exposure to phthalates, and BPA exposure during adolescence and the later development of breast cancer. I will be going around to various schools in Flint this month presenting the research results after nutrition classes. My goal is to make the public aware of the importance of a healthy diet and the dangers of certain chemicals (phthalates and BPA) and what kinds of products contain those chemicals. Hopefully I can make an impact. <br />
<br />
These two months of LMU are flying by! I've learned a lot and have enjoyed the exposure to underserved populations. I plan to take this knowledge and incorporate it in my future patient encounters no matter where I end up practicing. Anonymoushttp://www.blogger.com/profile/03990475125207964249noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-86982981694640341302017-02-06T16:44:00.001-08:002017-02-06T16:46:50.538-08:00Private Practice in FlintYvonne and I are working mainly at a private clinic in Flint, providing internal medicine and pediatric expertise to its patient population. The practice has 3 clinic sites, two on Flushing road and one on Saginaw road. One of these sites is an urgent care. This variety has been very exciting for Yvonne and I as we embark on the adventure of working with physicians and nurse practitioners - seeing different of practicing styles amongst all the health care providers.<br />
In the urgent care setting, I am seeing patients with acute presentations, while at the other 2 clinic sites, I am seeing patients with chronic illnesses. At all the sites I also get to see pediatric patients. It has been a practice with a broad spectrum of patients, which has been great for educational and academic learning. I have also seeing a trend, of a lot of URI symptoms, given the current weather and its changes. Another aspect I've enjoyed, is that Dr. Arif and Dr. Ahmed take any opportunity they can get to add a teaching moment to every patient visit. Because of this, I have also learned about new medications that are either on trial or already in the market, and it's impact on patients' quality of lives.<br />
Aside from clinical time, we have also been working on our community projects, which entail providing educational sessions on Diabetes and Hypertension with the patients waiting to be seen at the clinic, as well as providing Spanish classes at a local high school. It has been a slow start on these projects, but we are excited to share our results and impact with our other LMU students, as these programs further develop.Anonymoushttp://www.blogger.com/profile/06736123825456737641noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-13636104836421936822017-01-30T06:41:00.001-08:002017-01-30T06:42:34.432-08:00Genesee Free Clinic<div class="MsoNormal" style="line-height: 200%;">
Latinos United came into existence during the Flint water crisis because all the materials regarding the crisis were in English, so the six major Latino organizations in Flint came together to distribute information to the Latino population. Myself, residents, and other medical students have been working with Latinos United for Flint since last September. <span style="font-size: 12pt;">Our original plan was the start health
talks and health fairs for this population to raise awareness about diseases
that Latinos are more susceptible to. We began this way but soon found out that
there was a large subset of undocumented immigrants within this Latino
population, meaning they had no access to health care. Through a team of highly
committed and motivated individuals the Genesee Free Clinic wrote for and received
a grant for a number free visits specifically for undocumented immigrants living within Genesee County. We have
been going to events hosted by Latinos United and explaining that these undocumented
individuals can receive care without fear of being exposed.</span><span style="font-size: 12pt;"> </span><span style="font-size: 12pt;">We started scheduling visits, but to our disappointment
every single one ended up no showing.</span></div>
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<span style="mso-tab-count: 1;"> </span>Now
that I have been working at the free clinic we have actually had some of these
visits used! I hope that the individuals that have been seen at the clinic will tell others
that it is a safe program, simply there for their health care not for any ulterior
motive. However, it is understandable this fear of being found out given the
current environment in our country. Decisions for this group are often made out of fear of being exposed, which means that healthcare is often sacrificed. The programs in place to aid this
population need to continue to reach out more than ever and assure them that there
are resources, safe havens, and remind this group that they are not lesser than
anyone else. <o:p></o:p></div>
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<span style="mso-tab-count: 1;"> </span>I’m
very proud of the work that Latinos United is doing, and I am honored to be a
part of this group. While these office visits won’t solve the larger issue this
country is currently experiencing, I do believe if utilized they could make an
impact on the Flint population of undocumented immigrants. I hope that with a
continued presence in Latinos United and repeated reminders of the grant that
we can get more visits, which will hopefully equate to improved health outcomes
for this group. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
Joann Samalikhttp://www.blogger.com/profile/13480841032698151918noreply@blogger.com1tag:blogger.com,1999:blog-7201256189727799652.post-30091113431723462882017-01-27T13:11:00.000-08:002017-01-27T13:11:11.342-08:00Fighting Alcohol and Drug Addiction Together<div class="MsoNormal">
The use and addiction of heroin, alcohol, opioids and other
drugs are on a rise in the United States.<span style="mso-spacerun: yes;">
</span>Specifically in Flint, Michigan there have been a large amount of addiction
reported, as well as mortality from overdose.<span style="mso-spacerun: yes;">
</span>Stopping any kind of addiction is no easy feat because the brain
literally adjusts to the euphoria and makes your body crave the reward over and
over again.<span style="mso-spacerun: yes;"> </span>There are programs set in
place for people who are ready to quit the majority of addictions that are
known.<span style="mso-spacerun: yes;"> </span>Programs such as Alcohol
Anonymous for Alcoholics, long-term residential treatment, individualized drug
counseling, 12 step programs and other self help groups.<span style="mso-spacerun: yes;"> </span>These programs have all shown to be helpful
with the aid of medical management for withdrawal symptoms, spiritual guidance
and strong will from the individual.<o:p></o:p></div>
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<br /></div>
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In Flint, Michigan there is a unique approach to helping
former and current addicts start and complete a road of recovery at the Genesee
Community Health Center.<span style="mso-spacerun: yes;"> </span>The Genesee
Community Health Center is one of only two Federally Qualified Health Centers
in Flint.<span style="mso-spacerun: yes;"> </span>Their mission is to provide
high quality healthcare services and programs in an integrated,
patient-centered environment with a priority focus on homeless and public
housing residents.<span style="mso-spacerun: yes;"> </span>They offer a
multitude of services from preventive health screenings, well-child visits and
physicals to chronic disease management and mental health and substance abuse
services.<span style="mso-spacerun: yes;"> </span>They always leave room for
walk-ins everyday and are right down the street from Hurley Hospital in case of
emergencies.<span style="mso-spacerun: yes;"> </span>They have a mobile clinic
and do community outreach at a local mission every week.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
I have the pleasure of working with the Genesee Community
Health Center and my mission is to learn as much as possible about the clinic,
how it functions and of course see patients.<span style="mso-spacerun: yes;">
</span>The GCHC has medical management such as suboxone and vivitrol and
comfort medications as part of their substance abuse services.<span style="mso-spacerun: yes;"> </span>Their approach to the counseling and
psychosocial support that is necessary for a successful recovery program is
what I have found to be one of the most unique I have encountered.<span style="mso-spacerun: yes;"> </span>They have staff who are “Recovery Leaders”
who have all at some time in their lives had an addiction to a drug or
substance and have chosen to give back by helping others on their road to
quitting their addiction. As a recovery leader you not only show support, but
you offer a ride to a recovery meeting, give advice, take clients for coffee,
support the family members of the person going through the addiction, whatever
is necessary to really reach out and help that person get through this hard
time and successfully start or continue recovery.<span style="mso-spacerun: yes;"> </span>During an open conversation with some of the
recovery leaders, I had the honor of hearing their background stories and I
learned that they love what they do. They come to work everyday with a full
heart, ready to help and also feel that this helps them continue their road to
recovery because they can lean on each other when they’re having a bad
day.<span style="mso-spacerun: yes;"> </span>One recovery leader mentioned that
she actively seeks patients and goes into “drug homes” and “sketchy
neighborhoods” because she is so passionate about stopping the cycle of
addiction and showing that help is there if you need it.<o:p></o:p></div>
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There are possibly other substance abuse programs with a
similar approach or maybe the same approach that I have not encountered. I have
encountered this approach and I feel I would be doing a disservice if I didn’t
share what they are doing in Flint to make a difference in fighting addiction. <o:p></o:p></div>
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Anonymoushttp://www.blogger.com/profile/14520621297523169722noreply@blogger.com18tag:blogger.com,1999:blog-7201256189727799652.post-13993200932391638352017-01-26T05:04:00.003-08:002017-01-26T05:04:40.154-08:00The Free Clinics<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
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<span style="mso-tab-count: 1;"> </span>If
you look at the Detroit Metro area you will find a plethora of free health
clinics. At first glance this seems incredible. In a place where the residents
have lost so much, and lived in poverty for so long, it is inspiring to see so
many clinics set up to provide at least basic healthcare for the residents of
metro Detroit. However, the closer I looked the more I began to understand that
an overabundance of free clinics might illustrate larger issues. </div>
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Firstly, if there are a large
number of free clinics that means that we aren’t providing, or able to provide
adequate healthcare (in the current system) to a large number of people that need
it. There are a significant amount of social justice issues that explain this prevailing
problem, which I will not delve into in this particular space. Secondly, I
found another quite significant issue. <span style="mso-spacerun: yes;"> </span>While it is beneficial if you have strategically placed free
clinics to serve a population and thus eliminate the problem of a lack of
transportation limiting access to healthcare, it can be counterproductive to
have a random distribution of free clinics. I don’t doubt that the people who
build free clinics do so with the best intentions, but I think that sometimes there
is a lack of collaboration with already existing clinics. Those who start new
clinics often do so, because of a perceived need that they hope to uniquely
address. I argue that rather than continuously starting anew, we should invest
in the already existing infrastructure. We should pool our resources and create
phenomenal care in strategically placed locations. </div>
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The Gary Burnstein Clinic in
Pontiac, MI exemplifies this idea. I was working there last week. It was 6 pm
and we were beginning to see patients for the night. There was an excited buzz
around the clinic that evening, because for the first time in a long time we
were going to have a cardiologist seeing patients in the clinic. Not only that,
but we also had a pulmonologist there, and we were beginning to do sleep
studies on patients. It was especially thrilling because Gary Burnstein who
started the clinic, in what was basically a closet, was a cardiologist himself.
It is part of what led to this particular cardiologist to seek out the clinic
and donate his time and expertise to care for those who needed it, but had no
means to pay for it. This clinic is an example of how we should be using our
resources. If we can create very strategically placed clinics where patients
have access to every specialty then I believe we can improve patient care.</div>
<div class="MsoNormal" style="text-indent: .5in;">
The clinic is an inspiring place,
filled with altruistic volunteers that are trying to do a little extra good in
this world. Yet, it must run to the best of its ability. This particular clinic
fires on all cylinders in large part thanks to the executive director and his
dedicated staff. They are constantly trying to pool resources so that people
have the opportunity to come to the clinic for all of their healthcare needs.
As the resources expand at Gary Burnstein I feel that the care the patients
receive will continue to improve and hopefully their health will do so as well.
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In closing, I think that the people
who need care would better be served if free clinics spoke and collaborated a
little bit more. It is similar to the problem that exists with electronic
medical records in this country, where we as healthcare consumers would be
better served if EMRs communicated with one another. We know the value of
communication, but sometimes we falter, whether it is because we physically don’t
have the means, we can’t find the time, or we are simply don’t know how to do
it effectively.</div>
Anonymoushttp://www.blogger.com/profile/06716970475170829705noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-81907366150646611902016-02-28T07:15:00.001-08:002016-02-28T07:18:59.654-08:00Alcoholism & Cloud Forests<div style="text-align: center;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;">Alcoholism...</span></div>
<div style="text-align: center;">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div style="text-align: center;">
<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">Part of our project here in Costa Rica, which was mentioned in a previous post was to develop a curriculum for the "charlas" and talks that the clinic will discuss with the community as a part of their health education outreach. We dedicated the month of February to Addictions and Vices. This past Wednesday, we went to the local soup kitchen to talk to the women about Alcoholism and the effects of binge drinking. The group is SUPER interactive so we try to come up with fun ways to teach them important information. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">This week we played "Spin the Bottle" in Spanish known as "Gire la Botella" with questions and facts related to alcohol use and abuse. This brings me to one major learning point that I realized this week: it is hard and almost impossible to teach or explain to a person or group of people that they cannot or must not do a certain behavior. We were reminded by many of the people we work with that these women come from families where drinking alcohol or smoking is just what they do. What is important is that we remember to focus our efforts on moderation and reminders of the affects instead of preaching "Do Not Do ___" or "You must completely quit___". </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">The rules were simple: Each person had a chance to spin the bottle and the color they landed on would correspond to a pre-written question or true-or-false statement written on that color of colored paper. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">As many of our charlas go, questions sparked discussion and the ladies delved into stories of their past, questions about family members, or would share statements to just relay that they understand alcoholism and the effects of binge drinking. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;">One of the ladies sharing a personal story about a family member who struggles with alcoholism and how she dealt and continues to deal with it. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;">More of the ladies conversing. Often times children of the women are around for the discussion and enjoy participating and learning about the important topics, no matter the sometimes sensitive nature of the conversations surrounding such topics. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;">Andrea reading off one of the "Cierto o falso?" True/False questions during the game.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;">We ended our session doing some yoga with one of the volunteers Claire! </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">We measure the level of success of our charlas by the level of participation. We had almost every woman involved in discussion by sharing stories or even attempting to answer the trivia questions. We like to think that the interactive nature of the activities we bring fosters this kind of environment. The ladies exhibited more understanding of the effects of alcohol use on your mind and body and their level of excitement to participate makes us feel that this was a successful charla! </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;">... & Cloud Forests</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">That weekend, the #treschicasinrica went to explore The Monteverde Cloud Forest located in the Cordillera de Tilarán<span style="background-color: white; line-height: 22.4px;"> (mountain range) within the </span>Puntarenas<span style="background-color: white; line-height: 22.4px;"> and </span>Alajuela <span style="background-color: white; line-height: 22.4px;">provinces. </span>The reserve consists of more than 26,000 acres of cloud forest. This natural attraction has very high biodiversity with the most orchid species in one place as well as hundreds of different types of mammals, birds, reptiles, amphibians, and insects. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEEXaFZKVc2kHDmQh_61EAL9J2pt-zFowmRdv4tKcDJ0u2LxGHq4fDDUWfyEoADPrFzxQSqI-Lnhb4sP_-6lvzjkmJWMvikQmGdOafrqjSf6rRqiU4vbsNxlIAWQE0plhX8tcmIio9AL0/s1600/IMG_3270.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEEXaFZKVc2kHDmQh_61EAL9J2pt-zFowmRdv4tKcDJ0u2LxGHq4fDDUWfyEoADPrFzxQSqI-Lnhb4sP_-6lvzjkmJWMvikQmGdOafrqjSf6rRqiU4vbsNxlIAWQE0plhX8tcmIio9AL0/s320/IMG_3270.JPG" width="240" /></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7TMUfu8RbhYK07aCRns6ts7KZOlMKS4IHHu__-Ie1TU-uzBbsjHhfMxOdCrmIRoDdBo2PxdHq98PnYMVOX6zGakZFUmrxGE63lauaCEiQfP8DR2DYH2YICyRdhc978VBPQ_tgHYLqR-g/s1600/IMG_3266.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7TMUfu8RbhYK07aCRns6ts7KZOlMKS4IHHu__-Ie1TU-uzBbsjHhfMxOdCrmIRoDdBo2PxdHq98PnYMVOX6zGakZFUmrxGE63lauaCEiQfP8DR2DYH2YICyRdhc978VBPQ_tgHYLqR-g/s320/IMG_3266.JPG" width="240" /></span></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">The reserve has several trails and the trails connect in certain points. Some trails are longer or more difficult than others and may feature bridges, waterfalls, a different type of path that involves more intense hiking. The weather was constantly changing- there would be drizzle or rain one moment and the next moment we would see the sun breaking through an opening in the trees. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj57pWsE7p0ir_FnXY78LXPniNwXnTUfeLtKZzTl26YqO92TgAP2_pZ4WJKNHfFfOuTtBzG3dShH7eFKFHVKhopC6JTdMMsuvGwNarkl2hMtl31kYbLoLOq18jDB-zGjyGLy5kuLLANz8/s1600/monteverde-reserve-trails-map.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "trebuchet ms" , sans-serif;"><img border="0" height="371" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj57pWsE7p0ir_FnXY78LXPniNwXnTUfeLtKZzTl26YqO92TgAP2_pZ4WJKNHfFfOuTtBzG3dShH7eFKFHVKhopC6JTdMMsuvGwNarkl2hMtl31kYbLoLOq18jDB-zGjyGLy5kuLLANz8/s640/monteverde-reserve-trails-map.jpg" width="640" /></span></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;">Map of the Reserve</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">The location of the forest being at such a high altitude (4,662 ft above sea level to be exact) allows it to be high enough to have clouds and moisture-filled fog permeating throughout the forest at all times. We learned that this helps nourish the ecosystem that live within the forest and sustain all life in it. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">Costa Ricans pride themselves on living in a country that puts so much money, energy, and time into preserving aspects of the country's natural beautiful. The Monteverde Cloud Forest Reserve is looked at largely as a tourist attraction, but little is done to alter the reserve and there are many native Costa Ricans who come to visit the forest, in addition to the medley of Europeans, Americans, and South Americans of course. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">Working at the clinic during the week and doing talks with the ladies at the soup kitchen gives us the chance to learn directly from the people of here on a close and personal basis. We get snippets of the way that so many people's lives work on a day-to-day basis and how they handle things that are thrown at them and can add confusion and complexity to their daily routine and especially their health. The weekends are nice for us to explore the country when we can, and reflect on the stories and situations we have been involved in that week. We get to learn more about Costa Rica and the history people that reside in this country but we also get to see the dynamics of Costa Rican life and culture in a non-acute setting. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">We hope you enjoyed this blog post!</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">Pura Vida,</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: xx-small;">#TresChicasInRica</span></div>
Amandahttp://www.blogger.com/profile/12341202298652046913noreply@blogger.com1tag:blogger.com,1999:blog-7201256189727799652.post-27345817061225262882016-02-14T18:27:00.000-08:002016-02-17T16:59:57.589-08:00A brief(ish) comment on the ethics of the medical trainee at home and abroad<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="line-height: 22.08px;"> There’s a natural conflict inherent to medical training that often goes unspoken. On the one hand, patients typically receive the best care (and least harm) when treated by the most experienced and seasoned clinicians. On the other hand, it’s impossible to create seasoned clinicians without having novices gain experience treating real patients. Medical education has created certain ways in which novices can gain experience without putting patients at risk: case-based book learning, a well-regimented hierarchy of supervision for trainees, and high-fidelity simulations, to name a few. Nevertheless, we have yet to figure how to completely protect patients from the learning curve of trainees and other less-experienced doctors. It’s a puzzling and tremendously challenging Catch-22 in medical education.</span><br />
<span style="line-height: 22.08px;"> I’ve reflected on this much during my training at home, and have continued to do so now in a Global Health context. In the U.S., I work hard to maintain a subtle balance in my training: on the one hand proactively challenging myself to take on new responsibilities while on the other hand knowing when something is so far beyond my level of expertise that it would ultimately compromise patient care. Of course, much of the decisions about what is or is not appropriate for a medical student of a certain level of training to do comes from medical educators. Some of these boundaries are designed directly into medical school curriculums, but in my experience much of the decision behind “do I feel comfortable with medical student X doing patient care task Y” falls on the individual level of trust built between a student and a preceptor. If the student shows they are well-read, comfortable, professional, and capable, then they get to take on patient care responsibilities possibly above the level of some peers. If they exhibit a critical lack of knowledge, poor clinical skills, unprofessional behavior, immaturity, or significant discomfort with basic patient care tasks, then they stay working on the basic patient care tasks and possibly get closer supervision to boot. For me, I’ve consistently felt that I learn the most when I’m challenged with the most amount of patient care responsibility, within reason.</span><br />
<span style="line-height: 22.08px;"> <br /> Abroad in the Global Health context, however, things are a bit different. Not since my first clerkship a year and a half ago have I so often been a simple observer rather than an active participant in patient care and medical decision making. However this is the spot I often find myself now in the emergency departments here in Peru. I am still learning a lot, but not in the same hands-on taking care of my own patients sort of way I’ve become accustomed to. I’ve thought about it a lot and I’m not certain that pushing for more than this would be appropriate, for a couple of reasons. First, the patient care resources here are both vastly different and generally less abundant than in the U.S. For this reason, applying my knowledge and experience of American medicine to medical decision making in Peruvian patients will, while for the most part be OK, create at times an unacceptably high risk of making serious errors due to a lack of understanding of Peru’s medical resources. Secondly, while I speak Spanish well enough to get by in the majority of both conversational and medical interactions, I am still far from the level of a native speaker. As such, taking histories without supervision and presenting patients to non-English speakers does have a risk that subtle but critical details will be lost in translation. </span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="line-height: 22.08px; text-align: start;"><span style="font-size: x-small;">Props to Joe: taking a BP on somebody running on a treadmill is tough. Oh, and yeah my stress test was normal.</span></span></td></tr>
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<span style="line-height: 22.08px;"> So what has this meant for my learning here in Peru? For the time here to be a valuable addition to my clinical training, I needed to be challenged in a way similar to domestic clerkships that test my clinical skills and clinical knowledge. Despite taking a far more conservative than normal approach to clinical training here in Peru, I still think these learning goals have satisfactorily been met. On the one hand, a large part of my interest in doing a Global Health experience was the possibility to greatly improve my clinical communication abilities with Spanish-speaking patients. This certainly has been the case, as working directly alongside doctors and patients who don’t speak a word of English has forced me to get better very quickly. Additionally, I’ve learned a lot from analysing both the direct medical decision making as well as the greater healthcare system as a whole in Peru and comparing it to what I know at home. Both the similarities and differences are illuminating, and I think I’m gaining some great perspective with every comparison of what seems to work and what doesn’t. And finally, it’s been interesting to see many presentations of diseases that are rare but important in the U.S., like TB or stomach cancer. So, though I might not be putting in central lines or evaluating multiple critical patients on my own before staffing them with a preceptor, I feel that the clinical experience has been well worth it and a strong addition to my final year before residency.</span><br />
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Anonymoushttp://www.blogger.com/profile/11951463869151697553noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-90356715482575523682016-02-13T18:03:00.002-08:002016-02-13T18:03:57.274-08:00Health Issues in PeruAfter volunteering with different projects in Peru for 5 weeks and having the chance to work with doctors and nurses from La Merced and Huancayo, we have learned much about the challenges facing the Peruvian health system. While our focus is more on teaching children about healthy habits and addressing nutrition issues, it has been very eye-opening to sit down with local doctors and discuss the issues they are facing and the different and similar issues that we face in the US. <br />
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<b>Health Insurance</b> - Most people in Peru are covered by public health insurance called SIS (Seguro Integral de Salud) that is available to all citizens. It covers most of the basic things that health insurances cover, but there are some failings. One major charge to patients is payment for supplies. This may include basic things, like nutritional drinks (e.g., Ensure) for patients who can't eat solid foods and water to mix medications. Families must go out and buy these supplies with their own money and give them to the hospital so they can be used to treat patients. In rural areas, there is also the issue of transportation to larger hospitals. One boy came into the health post after his hand was crushed by a machine in an iron-works facility. One finger clearly had a fractured bone but the adult who brought him in insisted he be treated at the health post since the hospital was 30 minutes away and would cost about S/. 5 (quite a lot when weekly wages can be as low as S/. 30). So the doctor did her best in a situation where there were no capabilities of getting an x-ray nor an available surgeon to treat the wound. All she could do was suture the wound, place a splint, and ask him again to go to a hospital to get properly treated.<br />
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<b>Health Posts </b>- Most communities have a small health post which is similar to a community clinic in the US. People come for routine well-child checks and urgent care type visits. These health posts, however, are extremely under-resourced. At one that I worked at, gloves were rationed to the point that they were only allowed for births and suturing and left over sutures were sterilized and re-used. These health posts are also typically run by a recent medical school graduate. All medical students are required to do a rural medicine year after graduating medical school and prior to starting residency. These doctors are fresh out of medical school and are not overseen by a senior physician and are expected to handle the vast majority of cases that come through the door on their own.<br />
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<b>Pharmacies</b> - While most people in the US tend to head for an urgent care center or an emergency room when a cold or a pain comes up, the people of Peru often head first to a pharmacy. Pharmacies are on ever corner and some offer medical consults for S/. 10 (or about $3 USD). Often times, patients will come away with some pill which they take once and hope it works. Patients rarely know what it is that they have taken and even when it is the right medication, they can only receive one days worth without a doctor's prescription, a dangerous thing when it comes to antibiotics and even more so when it is happening in a country where TB is prevalent and there are many cases of MDR and XDR-TB.<br />
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<b>Traditional Healers</b> - Traditional medicine is a very important aspect of Peruvian culture. Traditional medicine practitioners are called curanderos. One of their ways of detecting disease in people is by passing a guinea pig over the person's body and then performing a necropsy on the guinea pig to identify the disease. There are also hueseros who are similar to chiropractors who focus on fixing pain through manipulating the bones. Matronas are untrained midwives who help women deliver their babies at home, a very common practice. Sometimes, these matronas provide women with an herbal drink to induce contractions, but these can sometimes induce placental rupture due to the strong contractions which tends to result in the death of the baby. <br />
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<b>Obstetrics</b> - Obstetricians face many challenges in Peru. For one, pre-eclampsia and eclampsia are very common problems and deaths of pregnant women is a major public health concern. For the obstetrician, however, there is added pressure as the death of the mother under their care can result in criminal prosecution. Unsurprisingly, there are now very few obstetricians and women are having difficulty finding one when they need it. Many women prefer to have their children at home, particularly in rural communities. When they do, they often cut the umbilical cord using a rock or a roof shingle. Abortions are illegal under Peruvian law and many women are at risk due to going to illegal abortion centers. While contraceptive usage is fairly high nationally, the machismo culture sometimes forces women to say no to contraceptives since men feel that if their partner is using contraceptives, they would be more likely to cheat.<br />
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<b>Pediatrics</b> - Most of our focus has been with working with kids and being an aspiring Pediatrician, I had many opportunities to work with the Pediatric wards. Many kids that we saw in the hospital were there due to accidents involving horses. Broken legs, broken arms, and severe head injuries in several of our patients could be traced back to falling from a horse. During our home assessments for our nutrition project, we also learned that safe sleep is not something that is done. Parents almost always have their baby in their bed and none so far that we have met even own a crib, and very few babies sleep on their backs.<br />
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<b>Other Diseases </b>- Cancers, particularly stomach and cervical cancers, exist at relatively high rates in Peru. Stomach cancers are likely linked to food preparations which often include very highly salted meats for preservation and fire-grilled foods. Cervical cancer screening is increasing and more and more campaigns are being held to try and catch early cases. Skin cancers are also common, particularly in Huancayo, where people live at high altitudes and there exists an ozone hole right over Peru. People are also not very inclined to use sun protection. Another disease that seemed more common in the rural areas was adermatografia, or the loss of fingerprints. Some people who work in the farms or factories end up having their fingerprints erased due to constant manual labor. These people must then get a medical certificate since fingerprints are used as an additional layer of identification on health forms and are required for a DNI, the national identification card that all citizens must have.<br />
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As you can probably tell, medical resources are severely limited in this country so I would like to thank all of you who have graciously donated supplies and/or finances to help us bring much needed items for the health care workers here in Peru. Simple things like soap and toothpaste go a long way in helping kids stay healthy and a box of gloves can mean a greater sense of security for doctors when examining and treating patients. We have seen these supplies go a long way in helping the people here have greater access to health. Thank you for your generous support!Johnathan Kaohttp://www.blogger.com/profile/16934914851949547867noreply@blogger.com14tag:blogger.com,1999:blog-7201256189727799652.post-89592202235270749222016-02-10T15:54:00.002-08:002016-02-10T15:58:03.560-08:00A Visit to Quitirissi<div style="text-align: center;">
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<span style="font-family: "georgia" , "times new roman" , serif; font-size: large;"><b>The Huetar People</b></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><span style="font-family: Georgia, Times New Roman, serif;">Last Wednesday, we had the AMAZING opportunity to visit an area of Costa Rica called Quitirissi, where descendents of the tribe of the Huetar people live and maintain certain aspects of their historical and influential culture. </span><span style="font-family: georgia, times new roman, serif;">Alth</span></span><span style="font-family: "georgia";">ough their language is largely lost due to the influence of European colonization and influence, many customs, crafts, and some of their medical beliefs live on. This area is one of the few indigenous reserves in the country and it is protected and recognized by Costa Rican government. </span><br />
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<span style="font-family: "georgia" , "times new roman" , serif;">This is Juan Sanchez, whose name is Poto in the indigenous Huetar language. He served as our leader/guide for the day and is a shaman in his community. He spent about an hour and a half telling us wonderful stories of the history of his people. While he told many stories of the Spanish conquests to Costa Rica and the difficulties his people endured in keeping their people and customs alive a few things stood out to me that I would like to share with you all. </span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><b><u>Death: </u></b>The Huetar people view death differently than many of us do. As we are accustomed to mourning the death of loved ones, the Huetar people view this as the happiest moment for that person. Death is celebrated with the favorite food of the deceased, dancing, and music. The person is buried with many of their possessions that they loved or items deemed necessary for their journey to the afterlife. Crying is not at all a part of the celebration. The deceased is initially buried in one location and after 5 years have passed, the body is removed from the ground and the remains, which are bones at this point, are cleaned with herbs and mixtures and reburied in a different location. During our visit, we learned that Poto's brother had recently died and his body was taking up the spot of one of the burial sites. It had not been 5 years yet, so his remains had not yet been cleansed and reburied.</span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><b><u>Life:</u></b> While we are used to the birth of a child being a momentous and happy occasion, the Huetar people view it a little bit differently. Knowing that a new life is a new responsibility and that this new person will face hardships in life is something they pray and meditate over. Deep contemplation about the life that this new person will face is the way that births are "celebrated". </span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">We were given a tour of the grounds, here are a few pictures:</span></div>
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This tee-pee is their version of a doctor's office for the shaman. People come here for spiritual cleansing and healing. </div>
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Inside the Tee-Pee</div>
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<span style="font-family: "georgia" , "times new roman" , serif;">The Huetar people believe in balance of the spirit and body and all efforts made in a persons life are to maintain that balance. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhobj1hyz4npsjakrqzMlnXA2au3Gk6V3GkWSnEFALFt83uluhbtxzYd13ExVtcUyHCLmAcZMgFXWKHU9Jblm_0Gc5cdfSwCj2oXy0_4x9DSoWlDfgukdApL3rP2xyYLZUZULwdY9NH5EU/s1600/IMG_2607.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "georgia" , "times new roman" , serif;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhobj1hyz4npsjakrqzMlnXA2au3Gk6V3GkWSnEFALFt83uluhbtxzYd13ExVtcUyHCLmAcZMgFXWKHU9Jblm_0Gc5cdfSwCj2oXy0_4x9DSoWlDfgukdApL3rP2xyYLZUZULwdY9NH5EU/s320/IMG_2607.JPG" width="240" /></span></a></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Doctora Karen using berries as a beautiful lip color. The Huetar people are known for their crafts especially baskets-making and using clay from the earth to make pots and other items. These berries are used to dye and paint their crafts. </span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Bamboo trees grow all over Costa Rica! It's different for us to see but they are beautiful and make a cool sound when the wind blows past them. </span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">A spectacular view as we left the tribal grounds and were hiking up a hill on our way out of Quitirrisi. </span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Thanks and we will update you soon again on the rest of this week's adventures--</span></div>
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Amandahttp://www.blogger.com/profile/12341202298652046913noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-33213649512275193162016-02-08T15:09:00.001-08:002016-02-08T15:10:30.906-08:00Mobile Clinic<div style="text-align: left;">
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvXeRLbOhxEEFpngmWsvRSV2CVv4mg9FlEw4AvAyFxgtOpYzGhjf300I1HN5uNI2cjOWvVv9353rg8Zd5Jnf1AQrLcgEOn3sBX9drlxbhQSKa_0Jp3BbLs7HfiLOyxIjLdzpJD-uewWuYL/s1600/IMG_3677.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img alt="" border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvXeRLbOhxEEFpngmWsvRSV2CVv4mg9FlEw4AvAyFxgtOpYzGhjf300I1HN5uNI2cjOWvVv9353rg8Zd5Jnf1AQrLcgEOn3sBX9drlxbhQSKa_0Jp3BbLs7HfiLOyxIjLdzpJD-uewWuYL/s320/IMG_3677.JPG" title="" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">14 Adults in one pickup truck!</td></tr>
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<span style="text-indent: 0.5in;">What do you get
when you combine 14 volunteers, medical supplies, and a pickup truck? You get a
mobile medical clinic, that’s what. </span></div>
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<span style="text-indent: 0.5in;">We took our show
on the road this past week and we went to a small village called El Rincón,
which is about 2 ½ hours away by truck. We literally put 14 people, and medical
supplies (which includes a pharmacy) into one truck and hit the road.</span><span style="text-indent: 0.5in;"> </span><span style="text-indent: 0.5in;">This is the first time that FIMRC has gone to
this particular location so we weren’t exactly sure what to expect. We left
Restauración at 5:30 AM, got to El Rincón around 8:00 AM and set up the clinic.
Patients started to arrive shortly after we arrived and they kept coming all
day long.</span><span style="text-indent: 0.5in;"> </span><span style="text-indent: 0.5in;">They heard that a doctor would
be there today and they came from literally miles away in what I will describe
as rather unforgiving terrain.</span></div>
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<tr><td class="tr-caption" style="text-align: center;">Samara doing intake</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">The drive to El Rincón</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicvxCOw7C0mW-NRep89Cic5xLBSrwaVB_3TspIXGZqSCdOfUr1pXcvjAzk3XLkkafM8ZcuLzNVlSuLCRGl5HhP9uObvyyp-fI7_g2s9KYNYRYedaRmyK4GCTCVyMlq_MRm2WI969eb3SN7/s1600/IMG_7486.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicvxCOw7C0mW-NRep89Cic5xLBSrwaVB_3TspIXGZqSCdOfUr1pXcvjAzk3XLkkafM8ZcuLzNVlSuLCRGl5HhP9uObvyyp-fI7_g2s9KYNYRYedaRmyK4GCTCVyMlq_MRm2WI969eb3SN7/s320/IMG_7486.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Mina finds coffee!!<br />
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We had volunteers setup outside doing
intakes and getting vital signs. We had a few volunteers inside running the
pharmacy and some directing traffic. We
would see patients with the aid of a translator and the supervision of a
doctor. We saw many familiar conditions
like high blood pressure, dehydration, URI’s and UTI’s. We also saw many other
conditions that are not common in the US like parasitic infections, many
different types of skin fungal infections, and even a case of the mumps for
good measure. Diagnostics wasn’t an option, nor was follow-up with your PCP in
a few days. Watching the practice of
medicine under these conditions was quite interesting. Everything was based on experience and
clinical judgment. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN91p_m9EqWJwKGhXZfrsoplwka_YfVQt3MmzrvW34F_7L22EpLvxatUdYNf8y4M7xNe6Ea4C6bRHFxE2hCXdOaBGWBR2g54bxfFTJLtW5VmiBNJJCjBcydyr1NRr47ZS_u9zhYNplBSLZ/s1600/IMG_7545.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgN91p_m9EqWJwKGhXZfrsoplwka_YfVQt3MmzrvW34F_7L22EpLvxatUdYNf8y4M7xNe6Ea4C6bRHFxE2hCXdOaBGWBR2g54bxfFTJLtW5VmiBNJJCjBcydyr1NRr47ZS_u9zhYNplBSLZ/s320/IMG_7545.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rick sees a few kids</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNUqOm3PB-tFFH27iG8goQql_Jrg1wL-pwUkSQfl-WSUapTeWCITcrYUr_6lSV9LyDNxBCu3dLp2WdIT9FhjOi20qSthGn2vMJChTo9jCJuTcfg7oJGAPrdLyEU4nm744croMpw2Ms-6EU/s1600/IMG_7495.JPG" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNUqOm3PB-tFFH27iG8goQql_Jrg1wL-pwUkSQfl-WSUapTeWCITcrYUr_6lSV9LyDNxBCu3dLp2WdIT9FhjOi20qSthGn2vMJChTo9jCJuTcfg7oJGAPrdLyEU4nm744croMpw2Ms-6EU/s1600/IMG_7495.JPG" style="cursor: move;" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">People patiently waiting to be seen</td></tr>
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The
patients just kept coming and coming, no matter what we did the line outside
never seemed to budge.<span style="mso-spacerun: yes;"> </span>Before the day
was over we saw close to 150 people. Men, women, and children from all over the
surrounding area. Many traveled far distances and waited all day just to have
the chance to be seen by a doctor, and as far as I know, there weren’t any
complaints about waiting.<span style="mso-spacerun: yes;"> </span>We were able
to finish with the last few patients just as we were running out of daylight.
An important point because electricity is not available in El Rincón.<span style="mso-spacerun: yes;"> </span>We packed up our supplies, crammed everything
back into the truck and headed for home.<span style="mso-spacerun: yes;">
</span>It was a long, long day, but it was the most rewarding one so far.<o:p></o:p></div>
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UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
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Rick Mhttp://www.blogger.com/profile/02598095842334576897noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-17935455906890263022016-02-08T11:02:00.003-08:002016-02-08T11:04:48.012-08:00A late week 3 in DR <div style="margin-bottom: 0in;">
This week we did sexually transmitted
infection “charlas” (talks) at the surrounding schools within a
30 minute radius of Restauracion. Rick and I helped edit the
Powerpoint presentation, so it was nice to see them being presented.
The first charla was at Carrizal, a town about 30 minutes away. This
was a pretty small town and the school had under 50 students. One of
the residents there told us that they haven't had running water there
for two months. The second charla happened Mariano Sostero, a
slightly larger neighboring town 20 minutes away.
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<div style="margin-bottom: 0in;">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheYMI5gPDrX2k58-6knCMCCbPwIEvvT8IfJxbisuojfKA-DaUySwWKLzlu326XYtKGio4VlRcjM7FB6ILyomXn0n_tro1jr8r8hgav29HRrZoYicW6_srQFySAtuoK96OAvePIcphzNvJ6/s1600/IMG_7431.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEheYMI5gPDrX2k58-6knCMCCbPwIEvvT8IfJxbisuojfKA-DaUySwWKLzlu326XYtKGio4VlRcjM7FB6ILyomXn0n_tro1jr8r8hgav29HRrZoYicW6_srQFySAtuoK96OAvePIcphzNvJ6/s320/IMG_7431.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">STI charla in Carrizal</td></tr>
</tbody></table>
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Dr. Ricardo gave the presentations in
Spanish. He did a great job at getting the kids involved with the
presentation and used terms that the kids would use. Of course, some
of the kids found it difficult to get through the class without
giggling.
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijkzdGBtexdzkLRJsKByqAsh0tnFJd8LpR_QZX-nctchyuIXkEF5q8bWEmCaIQ2XE7MWv0xaeWV9MP5vSrhF-58e2yDAUMEmJRRbh21K7SWTf0qZ4u1aG4Rj1oq-VyvhIoHMDqG7-noTxm/s1600/IMG_1065%255B1%255D.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEijkzdGBtexdzkLRJsKByqAsh0tnFJd8LpR_QZX-nctchyuIXkEF5q8bWEmCaIQ2XE7MWv0xaeWV9MP5vSrhF-58e2yDAUMEmJRRbh21K7SWTf0qZ4u1aG4Rj1oq-VyvhIoHMDqG7-noTxm/s320/IMG_1065%255B1%255D.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Ricardo giving the STI charla at Mariano Sostero</td></tr>
</tbody></table>
The second half of the week we worked
with the adults who have diabetes and hypertension. FIMRC works
with a chronic disease doctor from Santiago who drives over to
Restauracion once a month to check on and counsel the locals in and
around here. FIMRC encourages the local to come get weekly blood
pressure and glucose checks and provides them with medication
refills. At the end of the month Dr. Lesly reviews their charts and
counsels them in case they need to change their treatment. The
locals get really excited when he visit, so we had great turnouts. <br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6F9bPft2dajWg22IMAS__mf6aF66Ose0IuwrmFmwD220_WkF_mGhXu-5ql9z3d6MgQyo0ReTwuBOCnmQTKXXfrf0tgf5sAnn7qoMaqBQR0dWwdhoH9R5P6izLutLvNQC5cZdnhx4VHa99/s1600/IMG_3556%255B1%255D.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh6F9bPft2dajWg22IMAS__mf6aF66Ose0IuwrmFmwD220_WkF_mGhXu-5ql9z3d6MgQyo0ReTwuBOCnmQTKXXfrf0tgf5sAnn7qoMaqBQR0dWwdhoH9R5P6izLutLvNQC5cZdnhx4VHa99/s320/IMG_3556%255B1%255D.JPG" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">BP and glucose checks at a local community.</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiU0fJEh4ZJHg2DvDufw95FoMCmgyFVWceGTxqSXFtGuaAOmnU69ejW4y2HR2GkE8FAFRjLp99P7ylQfJJPmsLdXx8-kmiKhrMKvJevKRNSQ3DFIFIt8HxxoRZG0Cg7k92A3KrwiPYzGQok/s1600/IMG_3561%255B1%255D.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiU0fJEh4ZJHg2DvDufw95FoMCmgyFVWceGTxqSXFtGuaAOmnU69ejW4y2HR2GkE8FAFRjLp99P7ylQfJJPmsLdXx8-kmiKhrMKvJevKRNSQ3DFIFIt8HxxoRZG0Cg7k92A3KrwiPYzGQok/s320/IMG_3561%255B1%255D.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Lesly with us before he headed back to Santiago.</td></tr>
</tbody></table>
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Anonymoushttp://www.blogger.com/profile/13278138942492829854noreply@blogger.com2tag:blogger.com,1999:blog-7201256189727799652.post-25406133886743910022016-02-04T20:31:00.002-08:002016-02-09T16:35:12.283-08:00#treschicasenrica<div style="text-align: center;">
<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">Hello Again Family, Friends, and Supporters!</span></div>
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<span style="background-color: transparent"><span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">This post has been long overdue, but we have been keeping so busy and things haven't quite slowed down enough for a post! So let me update you on what we have been up to!</span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><b style="font-family: 'trebuchet ms', sans-serif;">Penny Papanicolaou: </b><span style="font-family: "trebuchet ms" , sans-serif;"> Last Wednesday we had another 'charla' or health education session with the women at the soup kitchen. We took this opportunity to talk to the women about women's health and more specifically, Papanicolaou…or as we say the The States…a Pap smear. For starters, in Spanish the test is called "Papanicolaou" because that is actually it's full name…in The States we just use abbreviations. Georgios Nikolaou Papanikolaou was a Greek cytopathologists who studied early cancer detection and invented the test which later was called a Pap Smear in the English language. I was so happy to prepare this lecture with my two colleagues (Amanda and Huda) who are budding OBGYNS…they were awesome! The women were SO interested in this topic. I know we gave them lots of great information and knowledge that will help empower them to take ownership of their health and enable them to take better care of themselves. For those of you who don't know, Papanicolaou (which I still cannot spell) is an ESSENTIAL screening in the prevention of cervical cancer. In today's day, having Papanicolaou is arguably even more important because of the prevalence of Human Papilloma Virus (HPV) and its innate ability to predispose women to cell dysplasia dn ultimately cervical cancer. The group of women we provide health education to are among the highest risk populations. These women are at higher risk because they are a part of a medically underserved group of individuals who do not have insurance. During this talk we provided them with information for receiving Papanicolaou at a reduced cost of 11,000 colones (about 20 American dollars). This week, we gave a great charla about two topics: 1) Smoking and its Effects and 2) the Zika Virus. These topics were also very well received by the attendees. Unfortuatnely, we do have any pictures from this week's charla, but below you can see pictures from last week.</span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhReLTigp-57LyEch7LP1Iz00SHERHiX0jNRJEyHIapcny-5rvEvDKo5sO3o3pTHJO65-qp2hJ6S-XZqFX4s0KRjhmTmeCyJjXq4VCLgbeMcfVeaKjYXo4O0Phx9Iu-YK8OOj7uw-21rek/s1600/pap5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhReLTigp-57LyEch7LP1Iz00SHERHiX0jNRJEyHIapcny-5rvEvDKo5sO3o3pTHJO65-qp2hJ6S-XZqFX4s0KRjhmTmeCyJjXq4VCLgbeMcfVeaKjYXo4O0Phx9Iu-YK8OOj7uw-21rek/s320/pap5.jpg" width="240" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1aIC6iPFVP8iW_MITmTJXEbG-7Blx8SRFyLVGBdPRCBPeWpbWqwQaD_xzozj9dHHTyi_wb0EqBd4j2jsTqx9MBLwT9YfYOOqBR99PUNYm_xg1sm1PUmKTFOTVKkeqV74_QmNXTSYukzE/s1600/pap6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1aIC6iPFVP8iW_MITmTJXEbG-7Blx8SRFyLVGBdPRCBPeWpbWqwQaD_xzozj9dHHTyi_wb0EqBd4j2jsTqx9MBLwT9YfYOOqBR99PUNYm_xg1sm1PUmKTFOTVKkeqV74_QmNXTSYukzE/s320/pap6.jpg" width="240" /></a></span></div>
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<span style="background-color: transparent"><span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">Pictured: (upper left) Amanda, Andrea, Penny Papanicolau (diagram) Huda (upper right) Amanda, Andrea, play-dough uterus, and Doctora Karen (lower left) attendees of the charla (lower right) Amanda, Andrea, cervical brush.</span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeneaQoHLYIVkSHJyZqtMRm_ximRG9gvoxCGdjRk4Rd_A5Ia-Yow2FEdi7IKPb-nLHok0wJmeFR43l-8Tid36p84horiT0TTzLp57QfB1cpkZRsSgKlrfVPrsJ_YCKmGQK_RsJCIszOow/s1600/pap2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeneaQoHLYIVkSHJyZqtMRm_ximRG9gvoxCGdjRk4Rd_A5Ia-Yow2FEdi7IKPb-nLHok0wJmeFR43l-8Tid36p84horiT0TTzLp57QfB1cpkZRsSgKlrfVPrsJ_YCKmGQK_RsJCIszOow/s320/pap2.jpg" width="240" /></a></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><b style="font-family: 'trebuchet ms', sans-serif;">Below: </b><span style="font-family: "trebuchet ms" , sans-serif;">Pictures from random days in the clinic; (left) Dr. Schnuth with two patients that fell in love with her and did not want to leave the clinic until we bribed them with stickers ;) (center) Huda, Dayan (clinic coordinator), Andrea, Doctora Karen, Amanda enjoying an afternoon popsicle in the exam room (right) #treschicasenrica taking a mid-workday selfie</span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>Birthdays: </b>We also have celebrated a few Birthdays in the clinic recently. Below are some pictures from Danielito's 8th Birthday! Daniel is the son of our FIMRC Clinic's beloved housekeeper Socoru. He wanted nothing more than to have his birthday party at the clinic with us. Although the children look unhappy in the bottom photo-- I assure you they were very happy-- and may have been in a sugar induced coma at that point! Attendees were encouraged to have cake (the most amazing carmel/carrot? cake ever), purple bubble gum ice cream with chocolate straws (to slurp up the melted ice cream of course), and a large glass (or two!) of Coca Cola (made from pure Sugar Cane). Holy moly-- that was a culture shocking thing for me to see! We had a wonderful time celebrating Daniel's birthday</span>!</span></div>
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<span style="text-align: start;"><span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><b>Weekend Excursion:</b> Over the weekend we were able to take an amazing trip to Montezuma! I will post more about our weekend trip at a later date (too many details to post). However, pictured below is a panoramic view of Montezuma Beach (courtesy of Huda's photography skills). It was a gorgeous weekend and an amazing experience. </span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><b>Projects: </b>Since we last blogged we also have been presented with a slew of projects that we have been very excited to get started on! We decided to take a divide and conquer approach among the three of us girls…so I'll break down the projects accordingly. </span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">1. Clinic Handbook and Volunteer Informational Guide [Huda]-- For this project Huda is developing a resource for FIMRC volunteers to preview before they make their trip to Alajuelita, Costa Rica. Huda is including extremely important information such as how the clinic runs, what the different jobs are for volunteers in the clinic, how to conduct those jobs, and different tips and tricks at how to be successful during their stay. This guide will be and awesome tool to give the clinic when we leave. Right now, all information and instruction falls on the clinic's coordinators who are very busy coordinating patient care (amongst their many other roles). This guide will help volunteers be self-instructed and prepared upon their arrival to jump right in and become a member of the existing team.</span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">2. Clinic Calendar and Charla Schedule Development [Andrea]: As of right now, the clinic organizes about 1 charla a week for women at the soup kitchen. Upon until this time, we have been brainstorming weekly to decide what we should teach the women about each week. While this is nice to stay abreast of current events in health, it is also time consuming and not the most efficient use of our clinic time. Thus, I am creating a year long calendar for the clinic that is full with daily activities and is accessible by all clinic members-- employees, volunteers, and community members alike. Part of this calendar development includes developing an health education theme for each month and coordinating the weekly charlas and activity with that theme. For instance, February is "Addiction and Vices" month-- this month our charkas will include a Smoking Campaign (today), Alcohol and its Health Risks, Drugs and Gambling, and General Health and Hygiene (the Importance of Sleep, Diet, Exercise Etc.)</span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">3. Intake and Screening Questionnaire Development and Translations [Amanda]: The clinic has very recently transitioned to an electronic medical record system, which we are still working the kinks out of. Amanda has taken over the job of developing intake and screening questionnaires for common diseases that we see in the clinic. She is using templates to develop questionnaires that are personalized to FIMRC and our patient population. This large task requires some translating back and for from English-Spanish and some designing of common measurement tools and graphs used in the medical field. Streamlining this system will help the clinic tremendously with organization and keeping track of patients with chronic diseases and needs. </span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">4. Pharmacy [All]: Lastly, we are in preliminary discussions of how we can reorganize our pharmacy! Below are some pictures of our humble pharmacy which is filled so wonderfully with your generous donations. We have been working since our arrival on organizing and reorganizing the layout of the pharmacy so that it is easily accessible for workers to fill prescriptions and also organized in the most logical way. This is a work in progress that we hope to update you more on in the next few weeks to come. </span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;">We cannot believe we are already half way through with this amazing experience! We don't like to think about that too much, for now we are trying to soak it all in…one experience at a time! </span><span style="font-family: "trebuchet ms" , sans-serif;">For now, Ciao from myself and my partners!</span></span></div>
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<span style="background-color: transparent; color: #cccccc; font-family: "arial" , "helvetica" , sans-serif;">Andrea </span></div>
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<span style="color: #eeeeee;"><br /></span></div>Anonymoushttp://www.blogger.com/profile/14911363977826187955noreply@blogger.com84tag:blogger.com,1999:blog-7201256189727799652.post-46462383959661483452016-02-02T17:54:00.002-08:002016-02-02T18:18:45.863-08:00Incan Trail Hike & Machu Picchu<div class="MsoNormal">
<b><u>Day 1:</u></b> “<i>Acclimatizing</i>,”
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8fYZSjsyb_e_cSFHjEZIyqylaRl0qqRSj258_05RZgBwHV_Qd64_FhZ5oo_d3EXm1Z5ghsozNtZEIcdwCVy4Df3uLhonvSZioW1qAiXpuIR2_Z6yrDlUov3xxQDw2u9snYaAlrzTRKVc/s1600/12644732_10208679125921691_3112251871905237558_n-2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8fYZSjsyb_e_cSFHjEZIyqylaRl0qqRSj258_05RZgBwHV_Qd64_FhZ5oo_d3EXm1Z5ghsozNtZEIcdwCVy4Df3uLhonvSZioW1qAiXpuIR2_Z6yrDlUov3xxQDw2u9snYaAlrzTRKVc/s400/12644732_10208679125921691_3112251871905237558_n-2.jpg" width="400" /></a>Day 1 of our hike on the Incan Trail with SAS Tours started
with a 3 hour bus ride, with a breakfast break in between. On the bus, we donned our sleeping bags and
mats which weighed an additional 5 kg (11 lbs) on top of our own packed
supplies. Elias was our guide through this journey to Machu Picchu and there
were three other hikers that we met and started to get to know. Our hike started at the train station at km 82
which sat at 2,680 meters.<o:p></o:p></div>
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Mey was not feeling well on this first day which made it
difficult for her to carry on especially with her backpack. Luckily, we did not ascend many meters on Day
1. It was mostly for us to acclimate to
the altitude. We did not see many sites
or points of interest, except for the beautiful mountain ranges and glacial
peaks.<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOHsqzbALYluH7Ckcip7E1QCR6a0CmZ6XdApIuswtjSak_11VbOJ76DK29nryintWsFwdZSCKMivSpZW9IrMH0aEnkwfxIAUl3nVw-48mtOKjhAkwqhaZJhogVf-dWfJDVxwLGKbfgfQc/s1600/southfacts_pricklypeara.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOHsqzbALYluH7Ckcip7E1QCR6a0CmZ6XdApIuswtjSak_11VbOJ76DK29nryintWsFwdZSCKMivSpZW9IrMH0aEnkwfxIAUl3nVw-48mtOKjhAkwqhaZJhogVf-dWfJDVxwLGKbfgfQc/s400/southfacts_pricklypeara.jpg" width="400" /></a>We did see a plant called a Tuna Cactus. It has small blebs of fruit that grew off the
main stalk. We had a chance to try these
at one of our rest stops. It tasted a
lot like watermelon but with less “fruit” part and a lot more “seed” part. Nonetheless, it was refreshing. The plant also produces small seeds that can
be used to make rich paint colors. The
natural color is dark red, but when added to things like lime juice or salt,
the colors change. There apparently are
around 25 colors that can be produced.
Joe wants to steal one of the leaves to be used for painting in his
retirement. <o:p></o:p></div>
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As for other plants, we learned about the “Angel’s Trumpet” which had hallucinogenic properties, the red more than the white. There were apparently many other hallucinogenic plants that were used along with the Coca leaf to create a more direct spiritual connection with the Incan gods. We also had a long history lesson by Elias explaining how
many routes there were to Machu Picchu and how much of an interconnected web of
trails the Incans constructed.</div>
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<o:p></o:p></div>
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There were 10 porters for the 7 of us who each carried
approximately 35 kg of supplies on their backs.
They hiked ahead of us at an alarming pace compared to us. By the time we got to our lunch site, they
had already set up tents and began preparing the meal. We were all very impressed and surprised with
how gourmet the food was. For example,
this day we had ceviche for an appetizer and many dishes for the main
course. They always served tea, coffee,
water or hot chocolate.<o:p></o:p></div>
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After lunch, the porters would pack everything up and hike
to the campsite for the night. By the
time we arrived, five tents for sleeping and one tent for dining were already
erected. Bathrooms were scattered
throughout the trail but were usually a dirty hole in the ground where one
would have to squat. Toilet paper was
usually not provided. Public restrooms
usually cost one sol.<o:p></o:p></div>
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<b><u>Day 2:</u></b> “<i>The
Challenge</i>,” 5:30 AM wake up time<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8GX56NsFXkVkQsArsxOzzh8KAp4Wlm3cOo6Xksh6U5PfA0qu1FLawWMf-gWIdTYLXgMXmaDjw3zW_ATcvobbJF4knm1wNvGP91K4oAHjXH9mGYpoTnYEIXxbp2BfxtKEQfshyphenhyphentb1qVPA/s1600/10668988_10204842156487706_4669742521428971749_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8GX56NsFXkVkQsArsxOzzh8KAp4Wlm3cOo6Xksh6U5PfA0qu1FLawWMf-gWIdTYLXgMXmaDjw3zW_ATcvobbJF4knm1wNvGP91K4oAHjXH9mGYpoTnYEIXxbp2BfxtKEQfshyphenhyphentb1qVPA/s320/10668988_10204842156487706_4669742521428971749_o.jpg" width="240" /></a></div>
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Mey was still not feeling well on Day 2, and unfortunately
this was the toughest day of our trek.
Mey decided to hire a porter to carry 9 kg of her materials. According to her, “best investment EVER!” We stumbled upon a scale which gave us a
chance to weigh our bags. Johnathan had
11.1 kg, Joe 11.6 kg, Nick, 13.0 kg, and Mey did not weigh hers. However, just lifting her bag made it clear
that it was one of the heaviest.
Thankfully, she was able to subtract the 9 kg for the rest of the trip.<o:p></o:p></div>
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We met an older man on the earlier part of the trail who
spent his time picking up trash left by disrespectful hikers. John, one of the other hikers, and Joe
offered him some Coca chocolate which he graciously accepted. We made it a point to keep our trash in our
bags for disposal at the campsites, and even John and Joe picked up trash along
the way as they came across it.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAyRglz8RgWiljy0lgdqlksMxg2dwnWfmFbK9Oz-DvRxl299McC2MsrKIKiV5O9TkSVl3UUY6Tteg97qjsBUgMOCHS6Ih30O8-VG20u7765gOIlE_hG1KCVUMRflhZb-SbA3ipukH4wKI/s1600/12565448_10208679289925791_4660843597094779713_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAyRglz8RgWiljy0lgdqlksMxg2dwnWfmFbK9Oz-DvRxl299McC2MsrKIKiV5O9TkSVl3UUY6Tteg97qjsBUgMOCHS6Ih30O8-VG20u7765gOIlE_hG1KCVUMRflhZb-SbA3ipukH4wKI/s400/12565448_10208679289925791_4660843597094779713_n.jpg" width="400" /></a></div>
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The weather was sunny and dry, perfect conditions for a
light hike. However, fog began rolling
in just when the hike started to become more intense. We reached a part of the trek called “Dead
Woman’s Pass” because they found mummies there and the mountain range looks
like a woman lying on her side with her arms crossed. This was a steep climb to the summit of the
mountain. Beginning the day around 2,600
meters, we reached the summit out of breath at nearly 4,200 meters. Unfortunately, the fog was so dense that it
was difficult to make out any views at the peak. It even rained a little. We rested for a while to wait out the fog and
were able to see a bit more of the distant views. We took a number of photos here and also had
a celebration with canned, first-catch, smoked salmon brought by our new hiking
companion, Bobby. He is a fisherman back
in Alaska.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzOe9N_m3HSMkY1aAKfpasUfzZGTRDQdIj9O7K9tikcXxUTRFS8L_j3cELWRpn22Y140FKv3UYlvlOny3DZ9AkyHJr5OJW5lJb_BF6xq5Le89pkdUQj8gkXN4fZYQDigaRqN_bdBoTDwU/s1600/12657236_10204842145327427_4159191750814566817_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzOe9N_m3HSMkY1aAKfpasUfzZGTRDQdIj9O7K9tikcXxUTRFS8L_j3cELWRpn22Y140FKv3UYlvlOny3DZ9AkyHJr5OJW5lJb_BF6xq5Le89pkdUQj8gkXN4fZYQDigaRqN_bdBoTDwU/s400/12657236_10204842145327427_4159191750814566817_o.jpg" width="400" /></a>Shortly thereafter, we began the sharp, steep descent to our
campsite. The steps were nearly 1.5 feet
deep and seemed endless. We really
worked our eccentric exercises and tore up our quads. Eventually we arrived to our campsite after
about 1.5 hours, located at the bottom of a large waterfall.</div>
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Over dinner, Nick began feeling feverish and nauseous. He decided to retire early to bed and hopefully
rest it off. Mey did also as she was
still not feeling 100%. The rest of us
shared a bottle of liquor provided by Elias after dinner. We toasted to finishing the hardest day of
our trek. Johnathan toasted with a cup
of water. After leaving the tent, we
were struck by a vividly clear night sky full of twinkling stars. We stared in awe at the clarity of all the constellations. What an enchanting feelings to sleep under
such beauty.<o:p></o:p></div>
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<b><u>Day 3:</u></b> “<i>Cultural
and Unforgettable</i>,” 5:00 AM wake up time<o:p></o:p></div>
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With Mey and Nick already feeling under-the-weather, it was
only a matter of time for another member of our group to fall ill. Joe woke up at around 4:00 AM with intense
nausea, vomiting and diarrhea. He tried
to take Azithromycin antibiotic but was unable to keep it down. We soon after, began our hike with a steep
ascent. Joe was lagging far behind
feeling as if he were going to get sick after every few steps. Eventually he did and felt somewhat better,
but for the rest of the day, felt borderline nauseous and weak. He slept at every resting point.<o:p></o:p></div>
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<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQbj_0-LBerJW23nPne7LFLHT0-FpiI1LZgaslr8IG4iPu5Nkb8P-7PwBwicnhtKBtHsvy1anK1baZWToKwirFiN1VmNI2evN4ZCM3DKTEdgH3QM8no3KD_kWFX1hBN_YVW1E3GNH6Bdk/s1600/12642958_10103678086616764_4685750177057721703_n.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span style="color: black;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQbj_0-LBerJW23nPne7LFLHT0-FpiI1LZgaslr8IG4iPu5Nkb8P-7PwBwicnhtKBtHsvy1anK1baZWToKwirFiN1VmNI2evN4ZCM3DKTEdgH3QM8no3KD_kWFX1hBN_YVW1E3GNH6Bdk/s320/12642958_10103678086616764_4685750177057721703_n.jpg" width="320" /></span></a>Throughout the day, we came across four separate ruin
sites. The first was named Runquracay at
3,800 meters. Here, we talked about the “quipu,”
a knot system used to communicate by runners (chasquis) traveling between
cities.<br />
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On this day's trek, we passed through a number of high jungles. We noted that as we ascended/descended to various altitudes, the foliage changed.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_ruG1yyLzXjlZe0vej09b-ReVFRBcj5vgpI7iH8ercfr5jCwx7znjsWyceHQMGknMO-oc-5De7-4rS_fpTnJuaTOfAxSqfPyQf6ipdmkBl0Ov3mbEJ5WvcMIdGma3oWG6uNDHyulCZ0o/s1600/12644903_10208679549412278_7190608255373363372_n.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_ruG1yyLzXjlZe0vej09b-ReVFRBcj5vgpI7iH8ercfr5jCwx7znjsWyceHQMGknMO-oc-5De7-4rS_fpTnJuaTOfAxSqfPyQf6ipdmkBl0Ov3mbEJ5WvcMIdGma3oWG6uNDHyulCZ0o/s400/12644903_10208679549412278_7190608255373363372_n.jpg" width="400" /></a></div>
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The next ruin, Sayacmarka, was atop a set of high stairs off
the path. Here we learned about the Incan
fountains and rain drainage systems which kept the cities from sinking. The ruin was a temple used for animal
sacrifices, specifically llamas.</div>
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<o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzsWKANYIvdijNUayLfMJIygwLdSU3TL3nFLjnaa399NWPxz3UFupyfY0bd8N68K5hfO8Vps0uzRCxC9oT5CXMkvlYZlRlOcRO2xwcXctWn7VL5qzP2X7HxsHbltNbd6AfJn53mCoc4b8/s1600/12605291_10204842146887466_1705633155093996407_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzsWKANYIvdijNUayLfMJIygwLdSU3TL3nFLjnaa399NWPxz3UFupyfY0bd8N68K5hfO8Vps0uzRCxC9oT5CXMkvlYZlRlOcRO2xwcXctWn7VL5qzP2X7HxsHbltNbd6AfJn53mCoc4b8/s320/12605291_10204842146887466_1705633155093996407_o.jpg" width="320" /></a></div>
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The third ruin, Phuyupatamarka, was an angled terrace
structure. Here we discussed the
importance of the three “Pachas” (Worlds): (1) Hanaq Pacha (“World Above” aka “Heaven”),
(2) Kay Pacha (“This World”), and (3) Ukhu Pachu (“World Below”), symbolized by
the condor, puma and the snake, respectively.
Incans believed that there was a continuum between these “worlds.”</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzFjKqFuFpWpt-3o7Q62wxbBIRVcOOjy0TYWpivirt79NcnkW6B_mAM-wMOSOvY8BXMQvt_ltmMeO2q8bf9hqbaWIQ8bgSt5IcKoMnJ2riFG-j8KmmT3y0ZPTj73iakq4miqzSnc45FQ8/s1600/12622280_10204842150927567_418980733434422450_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzFjKqFuFpWpt-3o7Q62wxbBIRVcOOjy0TYWpivirt79NcnkW6B_mAM-wMOSOvY8BXMQvt_ltmMeO2q8bf9hqbaWIQ8bgSt5IcKoMnJ2riFG-j8KmmT3y0ZPTj73iakq4miqzSnc45FQ8/s400/12622280_10204842150927567_418980733434422450_o.jpg" width="400" /></a></div>
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The last ruin, Wi<span style="font-family: "times new roman" , serif;">ñ</span>aywayna,
was a beautiful terrace structure on the side of a mountain face at 2,700
meters. Here, we marveled at the view,
traced the course of the journey by looking across the valley at the trail, and
observed llamas grazing. After a long
three days or rigorous cardio, we enjoyed this final ruin before making our way
to the final campsite thirty minutes away.</div>
<o:p></o:p><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzFjKqFuFpWpt-3o7Q62wxbBIRVcOOjy0TYWpivirt79NcnkW6B_mAM-wMOSOvY8BXMQvt_ltmMeO2q8bf9hqbaWIQ8bgSt5IcKoMnJ2riFG-j8KmmT3y0ZPTj73iakq4miqzSnc45FQ8/s1600/12622280_10204842150927567_418980733434422450_o.jpg" imageanchor="1"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8SYLfXkGOmVijponblbSmmFAjUoMtaOCVWnzcISMA9AzC25tQRKKic5QFQvWvXC7ENHNHM2wp5dGxg9OFrpYUKCK5_vTFJ08vf2kc5g1YTyngFSk8jZAICJHXwvjYSLIrMhur0Rt81vk/s1600/12565521_10208679653054869_5460971441920536280_n.jpg" imageanchor="1"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg8SYLfXkGOmVijponblbSmmFAjUoMtaOCVWnzcISMA9AzC25tQRKKic5QFQvWvXC7ENHNHM2wp5dGxg9OFrpYUKCK5_vTFJ08vf2kc5g1YTyngFSk8jZAICJHXwvjYSLIrMhur0Rt81vk/s400/12565521_10208679653054869_5460971441920536280_n.jpg" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3ahhz-HYuRKGjb4hMSewlK5836v_GYaXjXz7U5Ku0KygwwZQ5PN4rxwWyvCvgWUccqUQd1lZZrI0yzCRkJ8A-iggcAsy58MaTlITgl8m7zMt-7LmdEcPyKGrYAU0f15hDMUXlBA0mAww/s1600/12593995_10204842157847740_661517637614414481_o.jpg" imageanchor="1"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3ahhz-HYuRKGjb4hMSewlK5836v_GYaXjXz7U5Ku0KygwwZQ5PN4rxwWyvCvgWUccqUQd1lZZrI0yzCRkJ8A-iggcAsy58MaTlITgl8m7zMt-7LmdEcPyKGrYAU0f15hDMUXlBA0mAww/s400/12593995_10204842157847740_661517637614414481_o.jpg" width="400" /></a></div>
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<b><u>Day 4:</u></b> “<i>Magical
and Mystical</i>,” 3:30 AM wake up time<o:p></o:p></div>
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We woke up very early in order to get in line for the Inti
Punku, “The Sun Gate,” which is the entryway to Machu Picchu. Even though, we joined the line at around
4:30 AM after packing up and finishing breakfast, we were still the last group
in line. Fortunately, we were able to
rid of our sleeping bags and mats since it was our last day. Surprisingly, 5 kg off our backs made it much
easier to hike. With this lighter load,
we were able to pass by a number of groups on the trail to Machu Picchu. It began raining approximately 1.5 hours in,
and most of us were so determined to get there as soon as possible that we were
pretty wet before putting on our ponchos.<o:p></o:p></div>
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Just before reaching Inti Punku, we came across a steep “staircase”
that was coincidentally coined “Gringo Killer.”
The steps were nearly two feet tall and slippery due to the concurrent
rain. We saw a number of fellow hikers
literally crawling up the stairs, but we made it up unscathed (mostly).<o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNUtxW6IitdKxI2MTFP0g6DcDNa26mSyqbxBUYeoxUZ5Kms3sTKCRfL1C5kGdKIA6RVo2hMQD_eO9zKTlIW1Ao0WcrfFyTG5nWG5iFjlm987TetT_KhZ2pTulwbhzdAtGvugPDthOq2bs/s1600/12657415_10204842277010719_2839867097339093915_o.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNUtxW6IitdKxI2MTFP0g6DcDNa26mSyqbxBUYeoxUZ5Kms3sTKCRfL1C5kGdKIA6RVo2hMQD_eO9zKTlIW1Ao0WcrfFyTG5nWG5iFjlm987TetT_KhZ2pTulwbhzdAtGvugPDthOq2bs/s400/12657415_10204842277010719_2839867097339093915_o.jpg" width="400" /></a>As we reached the Sun Gate at 2,750 meters, the clouds had
completely engulfed our view of Machu Picchu and the surrounding mountains. We continued to hike on while we waited for the rain to pass. Upon reaching Machu Picchu at 2,400 meters,
it was still raining heavily and the view was obscured. We found the entrance to Machu Picchu where hiking averse enthusiasts would enter via the train. Here we deposited our backpacks in lockers
and attempted to dry off. The rain still
did not let up, and thus we began our tour of the site. We were freezing and tried our best to
listen to Elias describe this ancient architectural exhibit.<o:p></o:p></div>
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<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKvsxK0GsigEpedq_2jpNa3WZDxs3bM_puT5xLAWF9D6C-VqOqcAi0jZQtZkFIhaQU9-uvTtfAIKoT8w2qlmUY2Sk1zftJdWSN9VGuzTrRrr-n-OcSRF0KkBewIAjQou0c5p7rsawKZN8/s1600/12633534_10204842229049520_1338577667594337415_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKvsxK0GsigEpedq_2jpNa3WZDxs3bM_puT5xLAWF9D6C-VqOqcAi0jZQtZkFIhaQU9-uvTtfAIKoT8w2qlmUY2Sk1zftJdWSN9VGuzTrRrr-n-OcSRF0KkBewIAjQou0c5p7rsawKZN8/s400/12633534_10204842229049520_1338577667594337415_o.jpg" width="400" /></a></div>
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Five of us bought an extra ticket to climb a nearby
mountain, Huanyapicchu, which overlooked Machu Picchu. Of note, Machu Picchu literally means “Old
Mountain” in the Incan language Quechua whereas Huanyapicchu means “Young
Mountain.” Fortunately the rain had
begun to slow as we entered the Huanyapicchu trail. It turned out that this trek was more
rigorous than any of the other trails we had faced thus far, unbeknownst to us. There were wire ropes that helped us climb at
certain points, but otherwise, it was a straight drop down to the valley, hundreds
of meters below. The clouds began to
dissipate before we had to descend the mountain, giving us picture-perfect
views and photo opportunities to capture Machu Picchu. We thought the ascent was bad, but the return
trip was even more terrifying.</div>
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<br /></div>
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Around 1:30 PM, we grabbed our bags from the lockers and
hopped a bus to Aguas Calientes, a nearby town that flourished due to local
tourism. Here, we enjoyed our last lunch
together and boarded the PeruRail toward Ollantaytambo. From there we took a SAS Travel bus back to
Cuzco where we arrived around 8:30 PM.<o:p></o:p></div>
<br />
<div class="MsoNormal">
In all, we walked over 50 km in four days with around 25 lbs on our back and up and down between 2,400 to 4,200 meters. What a trek, eh!? A great sense of accomplishment!</div>
Anonymoushttp://www.blogger.com/profile/01421723556771465668noreply@blogger.com1tag:blogger.com,1999:blog-7201256189727799652.post-28198318570712697612016-01-28T14:53:00.000-08:002016-01-28T14:57:23.988-08:00Week two in the DR...<br />
<br />
<br />
<br />
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our day trip across the border to Haiti there were three patients with
cholera.<span style="mso-spacerun: yes;"> </span>They have their own small
building known as the cholera ward. We were told that cholera is not that
uncommon in the more remote areas, many of which lack latrines. A few days
later we were surprised when a patient showed up at the hospital in
Restauracioń with cholera.<span style="mso-spacerun: yes;"> </span>The doctor
has treated cholera patients before and made a clinical diagnosis, that was
later confirmed by a laboratory a few days later. Fortunately, this patient was
the only one we saw.<span style="mso-spacerun: yes;"> </span>This presented an
opportunity to go out to the community and educate about cholera.<span style="mso-spacerun: yes;"> </span>We prepared scripts and we literally went
door to door in selected neighborhoods. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSx901_rT9uRiAwsm1d6BWOWo6Q4T5JzdRBQFPQEYM5gnlEFJige9Nw0IG95MTrJ17fvuvmVdj_8zwoE7V1udUj1LbNpWfOF2qZ7smdQ_oibgFGf7cHBH1i3FbnUZLtcCefgVBZAxkmQAz/s1600/Picture2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSx901_rT9uRiAwsm1d6BWOWo6Q4T5JzdRBQFPQEYM5gnlEFJige9Nw0IG95MTrJ17fvuvmVdj_8zwoE7V1udUj1LbNpWfOF2qZ7smdQ_oibgFGf7cHBH1i3FbnUZLtcCefgVBZAxkmQAz/s320/Picture2.png" width="240" /></a><span style="mso-tab-count: 1;"> </span>Dr. Ricardo also anticipated the
need to educate and raise awareness about Zika virus, so a few days after the
cholera education, we hit the streets again and spread the word about mosquito
borne illnesses (dengue, chikyngunea, malaria, and zika). Much of the education
was geared at eliminating mosquito breeding grounds, ie.) standing water. <span style="mso-spacerun: yes;"> </span>I am happy to report that we finished this
project before the CDC travel warning. All credit goes to Dr. Ricardo, he is
amazing!<o:p></o:p></div>
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<br /></div>
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have a little fun too.<span style="mso-spacerun: yes;"> </span>More on that
later.<o:p></o:p></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="line number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="page number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote reference"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="endnote text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="table of authorities"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="macro"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="toa heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
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Rick Mhttp://www.blogger.com/profile/02598095842334576897noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-40446283588225457312016-01-24T11:20:00.002-08:002016-01-30T09:13:43.815-08:00Tragedies on buses and Training for bomberosAs we depart La Merced for the next phase of our journey, I wanted to post about a particular experience that meant a lot to me. For my primary outreach project I have been working with FIMRC Peru to develop a series of "Emergency Preparedness" didactics for their partner communities, with the goal being for me to train one of their staff to head up the project for sustainability into the future. <a href="http://msuchmlmu.blogspot.pe/2016/01/early-week-2-update.html">Like I mentioned previously</a>, the first lesson FIMRC requested was to teach CPR to laypeople in rural native communities, which I had some ethical dilemmas in doing. The compromise I made was to teach the CPR lesson I designed to first responders in the city, which for La Merced is basically just the volunteer firefighters ("Los Bomberos"). <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGWIY3aHZioDCL_pupruczh8i3Ff3oMCwl1F1XeS5vO55vZMlBBkuJyyeT0kxBLEtgPh8Tl6DYrcLOXBmELcXxfPpyuFfjI54O_2JwHNajdZBzG52bNbvXcvzEt5w35K6PD7GAF2nosJWz/s1600/DSCN0444.JPG" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjGWIY3aHZioDCL_pupruczh8i3Ff3oMCwl1F1XeS5vO55vZMlBBkuJyyeT0kxBLEtgPh8Tl6DYrcLOXBmELcXxfPpyuFfjI54O_2JwHNajdZBzG52bNbvXcvzEt5w35K6PD7GAF2nosJWz/s320/DSCN0444.JPG" width="320" /></a></div>
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And then, something tragic happened - a couple days before the lesson a bus crashed just outside the city. The driver reportedly passed a car on a two-lane road only to be confronted with a potential head-on collision as he turned onto a bridge. Rather than swerve back into his own lane, the driver did the unthinkable - he jumped out of the door onto the road, leaving the bus to drift sharply to the left, through the bridge's guardrail, and into the river below. 14 people died, and many more were critically injured. The bomberos responded to the scene but many would later relate to us that they felt unprepared.</div>
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And so, two nights later we came to their firehouse to teach CPR. I was worried it would be too basic for them. Quickly, though, we found that many basic skills were unpolished or unlearned. I had them demonstrate taking a pulse, and many reached for the ulnar side of the wrist, or lateral to the SCM in the neck, or somewhere else that wasn't likely to elicit a pulse even in a healthy person. I was happy that we could identify such a basic deficiency and provide an effective learning intervention. So it was too with the CPR - many did not perform fast enough compressions, or deep enough compressions, or even more importantly, did not know the indications for CPR.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXlwXWX1axTKne6-DDKR1hGi4TyfSeS8HCxvH4lPYpNM9s4vsc6g6l4tlHC6_afPtYM2t0ZQnQMJ9OAwas-sjhsqU4hS_tLaaoyj4qK9SRJRqWC7dvd4de5MihzSe5viyZ5CP0UJbrc78r/s1600/DSCN0467.JPG" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXlwXWX1axTKne6-DDKR1hGi4TyfSeS8HCxvH4lPYpNM9s4vsc6g6l4tlHC6_afPtYM2t0ZQnQMJ9OAwas-sjhsqU4hS_tLaaoyj4qK9SRJRqWC7dvd4de5MihzSe5viyZ5CP0UJbrc78r/s320/DSCN0467.JPG" width="320" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh5pYzjdVlBQ2YT43TTTV02z_FWZnxjFIaBMVT45rbDTccY96_G-OtAVUqyi2aVaSQy8kmhD6yr0PdXkYczHlS_-rNGDe7gmBwvNqo1Jws6g5MnUZkfgF2sLXIU47FeLQfYvaywwRJhh6A/s1600/DSCN0453.JPG" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh5pYzjdVlBQ2YT43TTTV02z_FWZnxjFIaBMVT45rbDTccY96_G-OtAVUqyi2aVaSQy8kmhD6yr0PdXkYczHlS_-rNGDe7gmBwvNqo1Jws6g5MnUZkfgF2sLXIU47FeLQfYvaywwRJhh6A/s320/DSCN0453.JPG" width="320" /></a></div>
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It was gratifying to be able to teach this lesson. More importantly, the FIMRC staff member I've been mentoring for my project took well to the lesson and really seems primed to continue teaching this and other lessons we design going forward. The biggest goal for me in global health projects like this is to achieve self-sustainability of any intervention I design, and I think this was a great start toward that end.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjEDNDNktPR42ZKKym9HcpSnKMUCzVugFdSCq3ldFxh4VbjWEeGLH4CEc5l0pI0NJaOh6Z5iAxoYjcb6WC2QiQq0gYj3EDGB8SVO4te7s8XzNxFbSTDs5dBPoKPrEII9NdAF-Xqg-c5yi9/s1600/DSCN0473.JPG" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjEDNDNktPR42ZKKym9HcpSnKMUCzVugFdSCq3ldFxh4VbjWEeGLH4CEc5l0pI0NJaOh6Z5iAxoYjcb6WC2QiQq0gYj3EDGB8SVO4te7s8XzNxFbSTDs5dBPoKPrEII9NdAF-Xqg-c5yi9/s320/DSCN0473.JPG" width="320" /></a></div>
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At the end, the fire-chief thanked us and related that she wished we had only been able to come a few days earlier, before the tragic bus accident. Hopefully implementing this program will be a small step towards making sure that the next time tragedy strikes, they'll be that much better prepared in their response.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwwwxzQVmyJ1PPIgObSGCRywWREKq9PeDdFo6-J5Rw9QLiN81ZI64se7c8PXXrJpmF3E1bmexYxnjyiOn__KPyWN8ubxiwX19K3Q_2HY8ctbqtnxpLtJdidG3-qQf9X2YrYlvXRD-RRSOx/s1600/DSCN0475.JPG" imageanchor="1"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwwwxzQVmyJ1PPIgObSGCRywWREKq9PeDdFo6-J5Rw9QLiN81ZI64se7c8PXXrJpmF3E1bmexYxnjyiOn__KPyWN8ubxiwX19K3Q_2HY8ctbqtnxpLtJdidG3-qQf9X2YrYlvXRD-RRSOx/s320/DSCN0475.JPG" width="320" /></a></div>
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UPDATE 1/30/16: Dinah (FIMRC Field Operations Manager, in navy blue t-shirt above) has informed me that in the past week Alvaro (the FIMRC-Peru staff member I'm training for their "Emergency Preparedness"project, in red above) has independently taught the CPR lesson in addition to a Wound Care lesson I prepared and taught with him last Friday. It's only one repetition and just a start towards sustainability, but this made me so happy :)<br />
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-Nick</div>
Anonymoushttp://www.blogger.com/profile/11951463869151697553noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-56800549409324846672016-01-22T11:36:00.000-08:002016-02-08T11:04:33.879-08:00Week 1 in DR and HaitiGreetings from the Dominican Republic, where the coffee is strong and the music is always playing!<br />
We're happy to say we arrived to Restauracion without any security issues or lost luggage. Each of us were placed with a family within walking distance. It was a little bit of an adjustment not having internet or hot water, but overall we've felt very welcomed and almost at home here. Here in Restauracion, FIMRC coordinates many activities here and in Haiti every week. The mornings are usually divided between the hospital and the local clinic, except for the one day per week we go to Haiti. The afternoon usually focuses on educational activities at a local school, library, or by going door to door to educate the locals. In January we are focusing on HIV/AIDS education.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNnxEudxlQ_duuafuCHPQnBTI3nyS5DR4KW21xgtJ1S13X_XqRFstr3XzE71GYAV3wYdC04XAEBBXdXVKDQUoWW7hWDfQ6clZrAIPRUTkhQjct2EPb8Q8ns37TXgQ72ge3JG5njzDFuxFJ/s1600/P1100112.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgNnxEudxlQ_duuafuCHPQnBTI3nyS5DR4KW21xgtJ1S13X_XqRFstr3XzE71GYAV3wYdC04XAEBBXdXVKDQUoWW7hWDfQ6clZrAIPRUTkhQjct2EPb8Q8ns37TXgQ72ge3JG5njzDFuxFJ/s320/P1100112.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The view from the FIMRC office.</td></tr>
</tbody></table>
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Living in Restauracion: Life here is very different from what we are used to in the US. We have scheduled power outages every other day. Running water tends to alternate with the electricity. Oh, and we don't flush toilet paper! Every night there's music playing at various bars throughout the town. It is a bit humid here but none of us can complain when the temperature hovers around 80F. <br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjJC3gYEg1ODS6YZM0u3JqJzQSPoe1CmojGLJejRPK7HC5yPAYISwd9GliGUL-KLNiUIn63qQ7USz3hyphenhyphenHjsqzQApiv6EECsPMafOaMW-AZcb6-JEez3umEQRodlPFkMVk1ptYIHPFrSt4o/s1600/P1110128.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjJC3gYEg1ODS6YZM0u3JqJzQSPoe1CmojGLJejRPK7HC5yPAYISwd9GliGUL-KLNiUIn63qQ7USz3hyphenhyphenHjsqzQApiv6EECsPMafOaMW-AZcb6-JEez3umEQRodlPFkMVk1ptYIHPFrSt4o/s320/P1110128.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Group discussion.</td></tr>
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Visiting Haiti was a very touching experience- the living conditions there are extremely bad. They still have cholera outbreaks. Their access to water and electricity is much more limited. Most houses resemble shacks and have dirt floors. Many Haitians try to escape poverty by crossing through the porous border into Dominican Republic only to face low wages, racism, extortion, and possible violence. <br />
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<tr><td class="tr-caption" style="text-align: center;">The group in Haiti.</td></tr>
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Anonymoushttp://www.blogger.com/profile/13278138942492829854noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-53053872113273484452016-01-21T20:19:00.001-08:002016-01-21T20:19:26.791-08:00A Very Delayed Week 1! <br />
¡Hola de Costa Rica! Amanda and Andrea did a wonderful job sharing some of our most meaningful activities during our first week. Im going to try to give a close-up look at our clinic that we travel to in the city of Alajuelita. During our first week we were able to get acquainted with our host families and the routine of the clinic. <br />
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The main reception area where we check in patients.<br />
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Patient waiting area<br />
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Our main volunteer area <br />
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<br />Our roles for the day, where we get to alternate each day. WR= waiting room, EX R= Exam room, Pharm= Pharmacy, SK= Soup Kitchen<br />
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The clinic is integrated into the community of the small town of Alajuelita due to its high concentration of Nicaraguan immigrants. The immigrant situation of Nicaraguans is interesting because they are considered "illegal" yet they are accepted to contribute to society through construction jobs, waste management and other jobs less likely to be in demand among Costa Ricans. Despite their contribution to society, they are not able to purchase Costa Riccan social health insurance and therefore cannot obtain routine healthcare from various E.B.A.I.S. centers or Equipos Básicos de Atención Integral en Salud which serve as first-line health centers. <br />
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We see many women and children as well as teenage and adult males. The doctor provides acute care for non-emergent cases as well as chronic disease management. The clinic helps with managing chronic conditions by giving them a starter regimen for their needed medications as well as plenty of patient education. <br />
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I really enjoyed being a part of a few child psychology sessions with the clinic Psychologist, Tatiana. The conditions that are endured by families can cause young children to find unhealthy and dangerous coping strategies, and it gives me hope that starting regular sessions would improve their coping skills now as well as later during their adult years. <br />
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Looking forward to meeting more people of Alajuelita and being a part of FIMRC's Proyecto Alajuelita!<br />
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-Huda<br />
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<br />Anonymousnoreply@blogger.com0Costa Rica9.7489169999999987 -83.7534279999999851.7311404999999986 -94.080576499999978 17.7666935 -73.426279499999993tag:blogger.com,1999:blog-7201256189727799652.post-27291882468729655382016-01-19T14:05:00.002-08:002016-01-19T14:17:15.529-08:00Early week 2 updateWhat a great weekend. Waterfalls, hiking, swimming in rivers.....it was some good R&R before starting a very busy week 2.<br />
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<tr><td class="tr-caption" style="text-align: center;">Velo de Novia, one of the waterfalls we visited</td></tr>
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But now....back to work. Yesterday was a longer day, working at the hospital in the morning before spending the afternoon and evening at the Chanchamayo prison for a health campaign. We identified some sicker people there then at the health campaigns last week. Some examples included: out-of-control diabetes and hypertension, bloody cough and fevers concerning for tuberculosis, an unidentified neck mass concerning for a thyroid nodule, and a woman with stage III uterine cancer who recently developed rectal bleeding. Interestingly, the accounts given by the prisoners sometimes did not match up with those of the prison's medical staff, who tended to downplay the concerns of the prisoners. I'll leave that open to interpretation. </div>
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This morning more work in the hospital, this time in cardiology. Tonight, we're going to the fire-station where I'll be leading some CPR teaching. The firefighters are, from what I have been able to gather, the only medically equipped first-responders here in La Merced. Unfortunately, they're all volunteers and many don't know how to use their equipment or perform basic life support procedures like CPR. </div>
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There's some interesting and controversial ethics behind teaching CPR in developing countries, as highlighted in <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9548241&fileId=S1049023X14001265">this paper by Friesen, Patterson, and Munjal from the past year.</a> I have some misgivings about designing CPR lessons for lay-people in rural native communities, which I had been asked to do originally by the FIMRC-Peru administration. Without getting into it too much here, though, I see less of an ethical dilemma in teaching CPR to designated first-responders who are going to be taking ambulances to medical emergencies with or without me. So I'm excited for tonight.</div>
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Hasta luego,</div>
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Nick</div>
Anonymoushttp://www.blogger.com/profile/11951463869151697553noreply@blogger.com1tag:blogger.com,1999:blog-7201256189727799652.post-6223641006380613692016-01-17T11:59:00.001-08:002016-01-17T11:59:38.989-08:00Costa Rica - Weekend Update<div style="text-align: center;">
After a wonderful first week in Clinic, the #treschicasinrica were able to have some fun-- we headed to the Arenal Volcano as a part of a tour package that included travel, two meals, and some time in the relaxing natural hot springs that are warmed by the heat from the volcano. Along the way, on the three hour journey to La Fortuna, the district where the volcano is, our wonderful tour guide Edgardo pointed out beautiful landmarks and educated us on the rich history of Costa Rica. </div>
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One of the most interesting things about Costa Rica is that it is such melting pot of culture. About 9% of the population consists of people born in Nicaragua, escaping the circumstances of their country. They are the largest ethnic group that our clinic serves outside of Costa Rican locals. Because many of them are undocumented citizens, they are not eligible for the social insurance, and must pay out of pocket for healthcare costs, or come to clinics like ours. However, their children are still eligible to go to schools here; not only are they eligible, but it is mandatory; parents who do not send their students to school (Nicaraguans and Costa Ricans alike), may face a fine or worse consequences. </div>
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<span style="font-size: xx-small;">Huda & I with two of our fellow FIMRC volunteers, Courtney & Sabrina at Volcan Arenal</span></div>
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In addition to citizens from other countries in Latin America, the Caribbean (east) coast of the country is home to a large percentage of citizens of Jamaican descent that migrated decades ago for better work opportunities. As our tour guide put it, Costa Ricans welcome other cultures as their influence as far as food, and music only serves to enhance Costa Rican culture!</div>
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<span style="font-size: xx-small;">Volcan Arenal, which is active but has not erupted since December 2010. </span></div>
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<span style="font-size: xx-small;">Some of the hot springs we bathed in at The Springs resort near Arenal</span></div>
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We will update with more of our service projects in the coming week! </div>
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Pura Vida!</div>
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Amanda</div>
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Amandahttp://www.blogger.com/profile/12341202298652046913noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-65451102931247351002016-01-15T20:51:00.002-08:002016-01-17T11:59:44.035-08:00<div class="separator" style="clear: both; text-align: center;">
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Hola from Santa Ana, Costa Rica from the #treschicasenrica !<br />
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I think I can safely say that all three of us girls feel extremely happy to be here and lucky to have this opportunity. A week has already passed and so much has happened that it's hard know where to start. I'll give you a quick overview of the week from my perspective! <br />
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Saturday: Our arrival was a little complicated. Between the 3 of us we brought 6 bags full of medical supplies (each weighing 30-50 lbs), our own personal suitcases and backpacks. This made for an interesting trip through Customs when landing in Costa Rica.<br />
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<tr><td class="tr-caption" style="text-align: center;">2 of the 6 bags of medical supplies we packed and traveled with, they were up to 50 lbs! Thank you Donors!</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Amanda, wondering how we managed to carry all 6 bags through both airports, customs, and have them arrive safely at the clinic.</td></tr>
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Sunday: Our FIMRC coordinator, Rita, helped organize a trip for us to visit a National Park in Costa Rica called Manuel Antonio. This was a wonderful way to get acquainted to Costa Rica. Our driver picked us up at 6:00 am and we headed to the national park where we did a small hike and saw monkeys, sloths, and raccoons (up close and personal) and ended up at the most beautiful beach!!<br />
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<tr><td class="tr-caption" style="text-align: center;">The beach at Antonio Manuel National Park.</td></tr>
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<tr><td class="tr-caption" style="text-align: center;">One of the many monkeys we saw along our hike to the beach.</td></tr>
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Monday: The first at the clinic was very exciting. The mothers at our home stays made us breakfast and packed our lunch before the van picked us up and took us to the clinic in Alajuelita with the other volunteers! Most other volunteers are undergraduate and pre-medical students volunteering for 1-2 weeks. The employees of the FIMRC clinic were excited for our arrival, because they know we will be staying for 6 weeks and they have a wonderful existing relationship with MSU College of Human Medicine. They are also excited that we speak Spanish and have a good amount of medical knowledge! Lastly, I think they were most excited by all of the WONDERFUL medical supplies we brought with the help of our donors--- Thank you!<br />
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<tr><td class="tr-caption" style="text-align: center;">My breakfast: egg scramble with ham and cheese, tortillas with white cheese, grapes, orange juice, and coffee. This was a lot of food, but breakfast is the biggest meal of the day here! </td></tr>
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<tr><td class="tr-caption" style="text-align: center;">Volunteers at the clinic on Monday, with Diyon (in costume), the Alajuelita Clinic coordinator. The clinic employees are AWESOME and were so welcoming.<br /><br /><div style="text-align: left;">
<span style="font-size: small;">Tuesday: From 8:30am -12:00pm each morning we rotate working through different areas of the clinic (we'll speak more to this later). Afternoons are usually reserved for education and some play. Tuesday, we prepared a "charla" or mini educational talk for a group of boys from Alajuelita (the city where the clinic is located). After, we played dodgeball and kickball with the kids-- they are very athletic and very competitive!!</span></div>
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<tr><td class="tr-caption" style="font-size: 13px;">La charla: the educational talk prepared about healthy eating.</td></tr>
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<tr><td class="tr-caption" style="font-size: 13px;">Volunteers and players after the games!</td></tr>
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<br /><span style="font-size: small;">Wednesday: Sick day for me :( but my wonderful group members gave another charla about the importance of breastfeeding and its benefits! </span></div>
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<tr><td class="tr-caption" style="font-size: 13px;">One of the women attending "la charla" holding the poster with information about breastfeeding.</td></tr>
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<span style="font-size: small;">Thursday: Some mornings we rotate at the soup kitchen in Alajuelita which is partially funded and supported by FIMRC. On Thursday, Amanda, Nicole, and I went to the soup kitchen to help prepare and serve lunch to many families in the area that also visit the clinic for free medical care. At night, we went to a well known restaurant in Costa Rica called "Mirador Tiquicia" where we were able to enjoy a show put on by Costa Ricans who performed dances very traditional to the country. </span></div>
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<tr><td class="tr-caption">Amanda and Nicole preparing lemonade at the soup kitchen.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9FajXQIq_QzYcGp9Zwh1wUXAJcck_B_YURazEXALpa3l9o8jIUCBqlN4FzQWLFLyQPBhcImyII-T-su5XY_aVM5xLfu9OAE-RY4rkAyi6gIOHQ0-FkQs9YuIvFs-S8_50QXD9zsp-D8Y/s1600/IMG_1451.JPG" imageanchor="1" style="font-size: 13px; margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9FajXQIq_QzYcGp9Zwh1wUXAJcck_B_YURazEXALpa3l9o8jIUCBqlN4FzQWLFLyQPBhcImyII-T-su5XY_aVM5xLfu9OAE-RY4rkAyi6gIOHQ0-FkQs9YuIvFs-S8_50QXD9zsp-D8Y/s320/IMG_1451.JPG" width="320" /></a><br />The show at Mirador Tiquicia.<br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivPFTsmbMYuV3PKWmT_s_yIqovvfpUNMnPVPyj2yIGZ99TuvVb0OqBdePXthonLC9UA54DA42ZdyMaMfOmx4nO68JPRYOKrzjIe2nyTlWmI5ggjjpeZ7vCzPhGi85UDcIg8sZhiwvQWbI/s1600/IMG_1458.JPG" imageanchor="1" style="font-size: 13px; margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivPFTsmbMYuV3PKWmT_s_yIqovvfpUNMnPVPyj2yIGZ99TuvVb0OqBdePXthonLC9UA54DA42ZdyMaMfOmx4nO68JPRYOKrzjIe2nyTlWmI5ggjjpeZ7vCzPhGi85UDcIg8sZhiwvQWbI/s320/IMG_1458.JPG" width="320" /></a><br />Mirador Tiquicia is on the top mountains overlooking the cities below. The view is spectacular! <br /><br /><div style="text-align: left;">
<span style="font-size: small;">These were just a few highlights from our stay so far. It's been a wonderful week in every respect. There is still so much more to say about the families we stay with, our work in the clinic, and the people we have met. For now, we are looking forward to exploring the country more this weekend-- hasta luego! --- </span><span style="font-size: small;">Andrea (Huda and Amanda) #treschicasenrica </span></div>
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Anonymoushttp://www.blogger.com/profile/14911363977826187955noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-10644772171555844202016-01-14T18:52:00.001-08:002016-01-14T19:06:31.547-08:00Catching up with the last few daysFirst off, internet here in La Merced is extremely spotty so this is the first time I've been able to get online since Monday. We've been busy, though, so there's a lot to catch up on. The highlights:<br />
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Tuesday - We worked with a local women's organization in a couple different communities. Part of the visits were general health campaigns, with the pre-med volunteers taking vitals, Accuchecks, BMI, etc., followed by the three of us looking over the results and offering what basic health counseling we could. The other part focused on domestic violence, which is a big problem in Peru. This included a segment where me and one of the other volunteers acted out a domestic violence skit, which Mey took a video of and is now holding me hostage with (Just kidding Mey! But seriously delete that video). <br />
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Wednesday - Trauma service. Wound care is a bit different here, though perhaps in predictable ways. All wounds get copious amounts of iodine and alcohol, regardless of perceived contamination. The reasoning is that they consider all wounds to be contaminated, at least at this hospital. Related: there is not a lot of hand-washing. Interesting case of the day: tense, swollen, dusky tissue surrounding a snake bite on a child's ankle. DDx: Local necrosis primary to the snake bite versus evolving compartment syndrome. <br />
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Thursday - We went to a small native community called Belen, where we are helping them build a small school building for their kids. This is one of two communities where FIMRC will be implementing the Emergency Preparedness program they asked me to help develop, so I was very excited to meet everyone today. Anyway, our day today consisted of climbing an hour up a mountain into the jungle, chopping down 5 trees, dragging them back down, and putting up the frame of the building:<br />
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We'll be back to finish the building next week, and we'll likely do our first Emergency Preparedness session as well. Tomorrow it's off to another native community (the other one my project is going to hopefully be deployed in), where we'll be doing hand-washing teaching among other things. <br />
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Also excited for this weekend, when we'll take a little time for ourselves to go hike a waterfall in the nearby jungle. <br />
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Hasta Luego,<br />
<br />
Nick<br />
<br />Anonymoushttp://www.blogger.com/profile/11951463869151697553noreply@blogger.com0tag:blogger.com,1999:blog-7201256189727799652.post-78946876298578608202016-01-11T16:05:00.001-08:002016-01-16T14:42:50.776-08:00LMU Peru 2016: Primeras Impresiones<div class="separator" style="clear: both; text-align: center;">
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Nick: It was great to back in the emergency department for the first time in a few months, but this time it was in Peru! The department wasn't all that different from what we see in the united states, but certain things did stand out. It's mostly staffed by non-emergency trained physicians, similar to the original U.S. ED's or some contemporary rural ED's that haven't been able to hire emergency physicians. The doctor I worked with today had excellent clinical acumen, and it was clear they rely a bit less on testing and radiology than we do. It was a good shift, and I learned a lot. I'm excited to go back, keep practicing my medical Spanish, and build relationships with the doctors in the ED. <br />
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In the afternoon we planned out our outreach activities for the rest of the week, some of which we'll be working on tomorrow. It's shaping up to be a good week!<br />
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Johnathan: Our trip started off a little rough, with my donation baggage getting lost somewhere between Miami and Lima. But I knew it would be a fun trip when in the first hour of our arrival, I was able to use my English, Spanish, and Chinese. We spent our first day on travel and getting to know some of our teammates from Massachusetts and New York and then began our clinical experiences today. Along the way, I got to try my first Peruvian street dish, choclo con queso (corn with the largest kernels ever and a side of cheese). Today was our first clinical day and I got a taste of their internal medicine outpatient work with one of the most popular and hilarious doctors in the hospital. Our hosts here in Peru have been amazing as well. The host family made a great dinner of Peruvian tortillas (a kind of chicken omelette) and the staff, Dinah and Allison, have been incredibly helpful. All in all, not a bad start.<br />
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Mey: I have been looking forward to this trip and it has not disappointed. On the plane, I sat next to a Peruvian lady who had married a Chinese man and was excited to meet a Chinese girl going to Peru. Even though my Spanish was limited, we had a great conversation and she offered to take us around Chinatown in Lima. So far the people have been amazing in Peru. The driver's wife knew Cantonese and I was so happy to chat with her. We spent the next day traveling from Lima to La Merced. The back drop of the Andes was breath taking. The massive rolling hills, waterfalls and winding roads was worth the long ride. Today was our first clinical experience here. I got to go to San Ramon, the next town over, and volunteered in the maternal/child department. What could be better than working with moms and their babies? Oh, and the coffee here is YUMMY.<br />
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Joe: The residency interview season caused me to arrive a little later than the rest of the group to Peru. Unfortunately, this caused me to miss a few days of activities and to travel alone on the two day journey to La Merced. It was definitely an experience traveling all the way from Michigan at 7:00 AM to Lima by 10:00 PM, making it all the way through customs and to the Hostel by 12:00 midnight, and riding on the 10 hour bus trip from Lima at 8:30 AM to La Merced where we arrived at 6:30 PM. Que una viaje larga! I was on the second level of the bus and had a FANTASTIC view of the rolling, serpent-like roads that clung close to the mountainsides. Often the road followed the natural tributaries of the Amazon river that carved out valleys in the mountains. On first impression, the people of Peru are very kind, helpful and interested. The city of Lima was a bit rough, but just outside it the Peruvian countryside is breathtaking. I cannot believe how crazy the drivers are here. Although I have experienced the insane driving of Haiti and other countries, in Peru it is a completely different ballgame because one poor move and you might find yourself rolling down the slope or crashing into the mountain side. I look forward to investigating and learning more about this beautiful country. Stay tuned!<br />
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<br />Johnathan Kaohttp://www.blogger.com/profile/16934914851949547867noreply@blogger.com1