2/27/09
On Wednesday, I went to do home visits of our pregnant women with one of the midwives, Irlanda. We were able to speak to 11 of them, so felt like a pretty successful day. Plus we got good exercise walking all over the city…even through part of a garbage dump to get to a patient washing her clothes in a stream. We had a goal of speaking to about 40 pregnant women in two weeks and I think we’ve been able to find about 25 total. We haven’t been as successful at speaking to the whole families…it’s just hit or miss whether anyone else is home and wants to talk to us. Anyway, most women seem interested in learning how to make their own suero, so hopefully we’ll get to do some of that next week.
Thursday and Friday this week are the celebration of Carnaval in Julcan. It’s one of the big parties here in the city. The festivities started at 6am with the different barrios in the communities, putting up their palo cilulos – a palo is a stick…so I was expecting some small branches, but these are full grown trees that have all kinds of things hung on them (t-shirts, household appliances, etc). So each tree was lying on the ground in the plaza and it was pretty crazy watching everyone working to get them lifted up and put in the ground. The barrio with the best tree wins a prize.
On my way down to the clinic, I was approached by a family who asked me to come see there sick 3 year old at home. They said he was sent home from the big hospital in Belen and wasn’t doing so well. That’s what I understood but when I got to the clinic the nurse said that she was told that the child was dying and they needed a doctor to see him before he actually died so they wouldn’t have any difficulty getting a death certificate later. So they picked me up on a moto and took me about 15 minutes down hill to the home. I found a tiny very pale boy taking very slow breaths…the mom showed me his CT scan which showed a huge mass in his abdomen and the report stated it was most likely a Wilm’s tumor. The mom said that they had been in Trujillo visiting family and she noticed that his stomach looked big suddenly and when she took him to the hospital they found the mass, but it was too large and advanced for treatment. Kids don’t really get regular physical exams here …so not sure how anyone would’ve picked it up. While I was there examining little Maycol, he died. People here often say that families in the sierra don’t mourn their kids in the same way…I don’t know if that’s true, but this family broke down immediately. It was heartbreaking, I just met the family that morning. After that, I got jolted back to the craziness of Carnaval in Julcan proper.
The clinic was not very busy, b/c most people we’re out celebrating. Most of us went to go see the parade of floats put together by the different barrios. Each barrio has it’s own float and it’s own band…so there were 6 bands playing simulataneously in the plaza. A huge part of carnaval here is people throwing water filled balloons at people. I was for the most part spared any significant hits, but not sure I appreciate this part like Peruvians do. The rest of the day was just one big party in the plaza…people dancing and doing some serious drinking. Later on in the evening, the trees that aren’t in the top three get knocked down and it’s a free for all for the items on the tree (imagine a piñata, but a humongous tree). Our evening ended with a centro de salud outing to one of the discotecas. It was a blast.
The carnaval continued today. Today was pretty much just people dancing and drinking along to a bad that they brought in from Cajamarca and of course, more water throwing. I honestly don’t know how people drink as much as they do here. Surprisingly we only got two Carnaval related injuries and they were both pretty minor. Anyway, I’m glad I saw this side of Julcan.
Saturday, February 28, 2009
How many patients can you see in one day?
2/24/09
Yesterday I went on another campana. This one was significantly further away…we got there on motorcycles, locals say it’s about an hour and half walk, which is probably 2 hours for those of not used to walking those distances. It was beautiful in the morning and we were put in a building adjacent to the school. It started nice and slow, but by lunch time we were swamped. It was just family after family…most families were 4 or 5 people. Most people came with complaints of headache, colds, diarrhea, or heartburn… not very complicated, but with the amount of people that came in, it was hard to be thorough or do much more besides give out a ton of Tylenol. So much for education. I was the only doctor that went, but thankfully to medical technicians also saw patients. I think I’m the only one that actually examined any of the patients and I’m pretty sure I also give out the least amount of antibiotics. We finished around 6:30pm and by that point it was raining, freezing, and our room was dark and I was glad to be done. Feeling pretty strongly that this is no way effective or good medicine. I can’t get an exact number of how many patients we saw…but somewhere around 200…crazy.
Today my home visits were thwarted by the threat of a supervision visit by the ministry of health. I spent the morning seeing patients with one of the fill in docs. He’s pretty cool, so the morning went fast and there was yet again someone for me to stitch up. In the afternoon, we had a capacitacion (training) on how to do a sesion demostrativa (educational demonstration). It was specifically about how to teach pregnant women and mothers how to prepare well-balanced nutritious meals. The idea is to give them a talk, but then to have them actually prepare four different meals – for children age 6 – 8 months, 9 – 11months, 12 months +, and then for a pregnant woman. So after we got our talk we prepared the dishes. It was good hands on learning. We are going to do something like this next week with the nutritionist and pregnant women so we’ll see how it goes with a real group.
Yesterday I went on another campana. This one was significantly further away…we got there on motorcycles, locals say it’s about an hour and half walk, which is probably 2 hours for those of not used to walking those distances. It was beautiful in the morning and we were put in a building adjacent to the school. It started nice and slow, but by lunch time we were swamped. It was just family after family…most families were 4 or 5 people. Most people came with complaints of headache, colds, diarrhea, or heartburn… not very complicated, but with the amount of people that came in, it was hard to be thorough or do much more besides give out a ton of Tylenol. So much for education. I was the only doctor that went, but thankfully to medical technicians also saw patients. I think I’m the only one that actually examined any of the patients and I’m pretty sure I also give out the least amount of antibiotics. We finished around 6:30pm and by that point it was raining, freezing, and our room was dark and I was glad to be done. Feeling pretty strongly that this is no way effective or good medicine. I can’t get an exact number of how many patients we saw…but somewhere around 200…crazy.
Today my home visits were thwarted by the threat of a supervision visit by the ministry of health. I spent the morning seeing patients with one of the fill in docs. He’s pretty cool, so the morning went fast and there was yet again someone for me to stitch up. In the afternoon, we had a capacitacion (training) on how to do a sesion demostrativa (educational demonstration). It was specifically about how to teach pregnant women and mothers how to prepare well-balanced nutritious meals. The idea is to give them a talk, but then to have them actually prepare four different meals – for children age 6 – 8 months, 9 – 11months, 12 months +, and then for a pregnant woman. So after we got our talk we prepared the dishes. It was good hands on learning. We are going to do something like this next week with the nutritionist and pregnant women so we’ll see how it goes with a real group.
Dia de Mercado
2/22/09
Ok, so the rash is not scabies, but most likely 14 flea bites…that’s right, 14! Yuck!
Apparently, Sunday is the day to be in Julcan. It’s market day. People come from all the surrounding towns to buy and sell their goods. It’s the most people I’ve seen in the town. All the stores are open, there are restaurants open I didn’t know existed, and there is a lot of potato and livestock being sold. I went to Rebecca’s house for lunch, but luckily they had run out of the sheep head soup!
Sunday is also one of the busiest days for the health center. Since people come in from far away for the market they take advantage of their trip to come to the health center. The vast majority of patients are for the midwives and nurses. The consultorio de medicina had a steady flow of patients, but nothing like the other services. My bike accident patient came in for a wound dressing. Besides looking pretty bruised, the wounds like ok, although his mouth looks pretty painful. Anyway, I stressed the importance of cleaning his wound everyday and finishing his antibiotics, so hopefully it’ll look ok when he comes in to have stitches removed on Wednesday.
Ok, so the rash is not scabies, but most likely 14 flea bites…that’s right, 14! Yuck!
Apparently, Sunday is the day to be in Julcan. It’s market day. People come from all the surrounding towns to buy and sell their goods. It’s the most people I’ve seen in the town. All the stores are open, there are restaurants open I didn’t know existed, and there is a lot of potato and livestock being sold. I went to Rebecca’s house for lunch, but luckily they had run out of the sheep head soup!
Sunday is also one of the busiest days for the health center. Since people come in from far away for the market they take advantage of their trip to come to the health center. The vast majority of patients are for the midwives and nurses. The consultorio de medicina had a steady flow of patients, but nothing like the other services. My bike accident patient came in for a wound dressing. Besides looking pretty bruised, the wounds like ok, although his mouth looks pretty painful. Anyway, I stressed the importance of cleaning his wound everyday and finishing his antibiotics, so hopefully it’ll look ok when he comes in to have stitches removed on Wednesday.
Going on a Campana
2/21/09
So I spent the rest of this week making a stab at home visits of pregnant women. Our home visit team consists of Vania, Rebecca, and I. We are just finding it hard to actually find the women and their family members at home. The idea is to not only visit the pregnant women, but also her family (husband, mom, mother-in-law) and review the emergency signs of pregnancy and labor and then also address other health concerns they may have, especially about their children’s health. And we wanted to teach them on a second round how to make their own oral rehydration solution. Anyway, we’ve only found 7 of our pregnant women. The one’s we have found have been nice and open to what we are reviewing and all have said they are willing to be transferred to a referral center if needed, so that’s good. So we start again on Monday to see if we can find some more pregnant women.
Today we went on a “campana”. A campana is when the team responsible for a certain sector of the outlying communities goes out to them to see patients. It is, I suppose, their attempt to get out to the communities, so people don’t have to come in to the health center, since most of the communities are anywhere from a 1 – 3 hour walk away. I think it could be a good thing if there was any continuity/consistency in the staff that was responsible for the different sectors. This mostly felt like any band-aid campaign, where people come in with pretty typical complaints of colds, diarrhea, heartburn and mostly just want medicine to get by…there’s not much time for education. The good thing is that they are connected to the health center so if there was something serious they could follow up. I don’t think they can fix this until they fix their staff turn-over problem. It was really beautiful on the way down, the way back was a good 45 minute walk up the mountain to a part of the road where the clinic car could pick us up. And I came home with a seriously itchy rash on my arm, as long as it’s not scabies, I’m ok.
So I spent the rest of this week making a stab at home visits of pregnant women. Our home visit team consists of Vania, Rebecca, and I. We are just finding it hard to actually find the women and their family members at home. The idea is to not only visit the pregnant women, but also her family (husband, mom, mother-in-law) and review the emergency signs of pregnancy and labor and then also address other health concerns they may have, especially about their children’s health. And we wanted to teach them on a second round how to make their own oral rehydration solution. Anyway, we’ve only found 7 of our pregnant women. The one’s we have found have been nice and open to what we are reviewing and all have said they are willing to be transferred to a referral center if needed, so that’s good. So we start again on Monday to see if we can find some more pregnant women.
Today we went on a “campana”. A campana is when the team responsible for a certain sector of the outlying communities goes out to them to see patients. It is, I suppose, their attempt to get out to the communities, so people don’t have to come in to the health center, since most of the communities are anywhere from a 1 – 3 hour walk away. I think it could be a good thing if there was any continuity/consistency in the staff that was responsible for the different sectors. This mostly felt like any band-aid campaign, where people come in with pretty typical complaints of colds, diarrhea, heartburn and mostly just want medicine to get by…there’s not much time for education. The good thing is that they are connected to the health center so if there was something serious they could follow up. I don’t think they can fix this until they fix their staff turn-over problem. It was really beautiful on the way down, the way back was a good 45 minute walk up the mountain to a part of the road where the clinic car could pick us up. And I came home with a seriously itchy rash on my arm, as long as it’s not scabies, I’m ok.
La Reunion
2/18/09
So today was the meeting with all the CODECOs for Julcan. CODECOs is an abbreviation for Comites de Desarollo Communitario (or something very much like that…abbreviations are sometimes hard to figure out here). Anyway, they are these community groups that are made up of the leaders of the community and they are charged with the development and improvement of their communities. No small task. The health center has taken on the job (or be given) to help organize the CODECOS to meet the health needs of the community and the other larger issues they have…they see it as all being interconnected anyway. So the plan for today was for them to come and go over some of the areas they had identified previously as priorities and meet with some of the leaders/authorities in Julcan and start developing a work plan.
Anyway, so it was interesting to be an onlooker…they of course introduced me as the American doctor although I had no role in the meeting except as an outside observer. About 70 CODECO members and health promoters came…so it was a good showing. And there was also a good turn out by heads of other organizations like education and agriculture. The meeting concluded with each CODECO coming up with a specific list of priorities for their particular communities and a list of what their health promoters should focus on. Anyway, it was nice to see some community health in process.
An added bonus to the meeting was that I got to see Rebecca and Christopher the Peace Corps volunteers. Sometimes it’s just nice to meet a fellow US citizen and swap experiences. Which we did plenty of tonight.
The afternoon was good…Vania, Rebecca and I sat down to review the work plan and try to make a schedule. So I think we have a plan for the next week and half at least. I think I’m finally going to get out and see some caserios (small communities). So YAY! And then another emergency came in…a 20 year old who fell off his bike and his face took a serious beating. So I volunteered to stitch him up…which went well, especially with the help of the very skilled tecnica…(Delicita).
The evening ended with some good discussion with Rebecca and Christopher and now I’m going to sleep.
So today was the meeting with all the CODECOs for Julcan. CODECOs is an abbreviation for Comites de Desarollo Communitario (or something very much like that…abbreviations are sometimes hard to figure out here). Anyway, they are these community groups that are made up of the leaders of the community and they are charged with the development and improvement of their communities. No small task. The health center has taken on the job (or be given) to help organize the CODECOS to meet the health needs of the community and the other larger issues they have…they see it as all being interconnected anyway. So the plan for today was for them to come and go over some of the areas they had identified previously as priorities and meet with some of the leaders/authorities in Julcan and start developing a work plan.
Anyway, so it was interesting to be an onlooker…they of course introduced me as the American doctor although I had no role in the meeting except as an outside observer. About 70 CODECO members and health promoters came…so it was a good showing. And there was also a good turn out by heads of other organizations like education and agriculture. The meeting concluded with each CODECO coming up with a specific list of priorities for their particular communities and a list of what their health promoters should focus on. Anyway, it was nice to see some community health in process.
An added bonus to the meeting was that I got to see Rebecca and Christopher the Peace Corps volunteers. Sometimes it’s just nice to meet a fellow US citizen and swap experiences. Which we did plenty of tonight.
The afternoon was good…Vania, Rebecca and I sat down to review the work plan and try to make a schedule. So I think we have a plan for the next week and half at least. I think I’m finally going to get out and see some caserios (small communities). So YAY! And then another emergency came in…a 20 year old who fell off his bike and his face took a serious beating. So I volunteered to stitch him up…which went well, especially with the help of the very skilled tecnica…(Delicita).
The evening ended with some good discussion with Rebecca and Christopher and now I’m going to sleep.
Me Mato
2/17/09
Well the substitute doctor finally made it last night. He brought along with him a patient with pre-eclampsia. When I arrived in the morning I went to see if there were patients to round on and he was trying to convince her to be transferred to the bigger hospital in Otuzco for further care and likely a C-section. The patient was a young girl in her late teens whose bag of water broke yesterday (over 24 hours ago) …they were going to induce her in her village, but when the midwife checked her blood pressure she noted that it was in the 150’s. So she recommended she be transferred and apparently it took them hours to convince them to even come down to Julcan. So then when they got here and she continued to have high blood pressures and protein in her urine…they could not convince her to go to Otuzco. When I got there the patient and her parents said well if she dies that is God’s will…they both felt they knew better and that they would rather take her home than transfer her to Otuzco. So why not just keep her in Julcan? Well, one there is no C-section ability in Julcan and not much emergency equipment and secondly no one really wanted to take responsibility if something went wrong. The family refused to sign any kind of form that said they would release the center of any responsibility since they weren’t following medical advice and b/c they wouldn’t sign the doctors didn’t want to try and doing anything that could potentially help, but has it’s risks. I recommended she be put on continuous magnesium sulfate and be induced with oxytocin, but no one wanted to take the risk…so we prayed and tried to find their pastor. Somehow about 4 hours later after almost everyone in the health center talked to them they decided to go to Otuzco with one of the midwives. But she went w/o any Mag….definitely some stuff to go over here. And definitely an area to target in outreach is churches…ridiculous what we heard today.
The other patient on rounds was a 17 week pregnant patient that was admitted two days ago with pyelonephritis. She was clinically doing well…no pain, no fever, eating well, but as we reviewed her chart we noticed she’d had 4 UTIS during this pregnancy already. Anyway, so we decided to keep her for one more day of IV antibiotics and then she’ll go home one oral antibiotics. Per our guidelines this patient should be on antibiotic prophylaxis for the rest of her pregnancy. The doc says that it’s not covered by the insurance and most patients can’t afford it so she’s essentially out of luck and at risk for more UTIs.
I spent the rest of my morning with the nutritionist trying to bone up on that…I think I’m starting to get a better idea and hopefully by Thursday we can be out seeing patients.
So the rest of the day proved to be an adventure…after lunch I went back and did some reading and had fun talking to a little girl named Ana, who said she’d like to be a Pediatrician one day. Then I was lucky enough to have the pleasure of sowing up a 3 year olds gaping forehead. He was hit lightly by a motorcycle and came in with a pretty big gash on his forehead…so fun to stitch him up while he screamed “me mato” (literally I am killing myself) over and over. Anyway, at least I got to use my doctor skills.
Then I sat in a 3.5 hour staff meeting. I will never complain about another PCC meeting…I mean this was so long and at such an awful time, 5pm – 8:30pm. I’ll have to say that since the head honcho was there they talked about every single thing under the sun and they’ve got a lot of management issues…it was painful, but interesting. I really think they could use a fulltime management person, that is at the center all the time just to deal with all the management issues so the staff can really focus on taking care of patients. Anyway, tomorrow is a big community meeting…so should be interesting.
Well the substitute doctor finally made it last night. He brought along with him a patient with pre-eclampsia. When I arrived in the morning I went to see if there were patients to round on and he was trying to convince her to be transferred to the bigger hospital in Otuzco for further care and likely a C-section. The patient was a young girl in her late teens whose bag of water broke yesterday (over 24 hours ago) …they were going to induce her in her village, but when the midwife checked her blood pressure she noted that it was in the 150’s. So she recommended she be transferred and apparently it took them hours to convince them to even come down to Julcan. So then when they got here and she continued to have high blood pressures and protein in her urine…they could not convince her to go to Otuzco. When I got there the patient and her parents said well if she dies that is God’s will…they both felt they knew better and that they would rather take her home than transfer her to Otuzco. So why not just keep her in Julcan? Well, one there is no C-section ability in Julcan and not much emergency equipment and secondly no one really wanted to take responsibility if something went wrong. The family refused to sign any kind of form that said they would release the center of any responsibility since they weren’t following medical advice and b/c they wouldn’t sign the doctors didn’t want to try and doing anything that could potentially help, but has it’s risks. I recommended she be put on continuous magnesium sulfate and be induced with oxytocin, but no one wanted to take the risk…so we prayed and tried to find their pastor. Somehow about 4 hours later after almost everyone in the health center talked to them they decided to go to Otuzco with one of the midwives. But she went w/o any Mag….definitely some stuff to go over here. And definitely an area to target in outreach is churches…ridiculous what we heard today.
The other patient on rounds was a 17 week pregnant patient that was admitted two days ago with pyelonephritis. She was clinically doing well…no pain, no fever, eating well, but as we reviewed her chart we noticed she’d had 4 UTIS during this pregnancy already. Anyway, so we decided to keep her for one more day of IV antibiotics and then she’ll go home one oral antibiotics. Per our guidelines this patient should be on antibiotic prophylaxis for the rest of her pregnancy. The doc says that it’s not covered by the insurance and most patients can’t afford it so she’s essentially out of luck and at risk for more UTIs.
I spent the rest of my morning with the nutritionist trying to bone up on that…I think I’m starting to get a better idea and hopefully by Thursday we can be out seeing patients.
So the rest of the day proved to be an adventure…after lunch I went back and did some reading and had fun talking to a little girl named Ana, who said she’d like to be a Pediatrician one day. Then I was lucky enough to have the pleasure of sowing up a 3 year olds gaping forehead. He was hit lightly by a motorcycle and came in with a pretty big gash on his forehead…so fun to stitch him up while he screamed “me mato” (literally I am killing myself) over and over. Anyway, at least I got to use my doctor skills.
Then I sat in a 3.5 hour staff meeting. I will never complain about another PCC meeting…I mean this was so long and at such an awful time, 5pm – 8:30pm. I’ll have to say that since the head honcho was there they talked about every single thing under the sun and they’ve got a lot of management issues…it was painful, but interesting. I really think they could use a fulltime management person, that is at the center all the time just to deal with all the management issues so the staff can really focus on taking care of patients. Anyway, tomorrow is a big community meeting…so should be interesting.
Julcan, Attempt #2
2/16/09
So, I came back to Julcan today to give it a second chance. I took the bus back and the road was amazingly smooth…what a difference no rain makes. I got back and for a while could not find Rolando, the midwife who was going to help me make my schedule for the next few weeks. I roamed the center for a while and had a nice talk with the psychologist. She’s been in Julcan for about 4 months now and she says she’s focusing on domestic violence. She says there is a high prevalence of both emotional and physical abuse. I then went and hung out with two of the midwives for a while and they explained to me the whole system of care for a pregnant women.
Decreasing maternal mortality is a priority in the region of La Libertad (La Libertad has the highest maternal mortality in all of Peru), therefore the care of the pregnant woman has been a big focus of the health center. Julcan is divided into sectors and each sector has a team that is responsible for that sector. The team consists of (in theory): a doctor, a midwife, a nurse, and a medical assistant. The sectors don’t affect prenatal care all that much, but at least there is one midwife assigned to each sector, although it seems like they all cover for each other. Pregnant women are supposed to get seen as soon as possible in the center…they don’t want them to have to wait, b/c they say that otherwise they’ll leave. The care is not dissimilar to what we do in the states and at PCC. Each pregnant woman has to see the doctor, the midwife, the nutritionist, the psychologist, and the dentist. She gets a prenatal panel done twice and she gets two ultrasounds (I’d say this is truly different than in most MINSA health centers). They also get home visits on a weekly basis from 36 – 40 weeks. Lastly they also are encouraging family planning in all girls 15 – 49. The methods available are the pill, the IUD, Depo, or condoms.
I did finally get to meet with Rolando and we made a plan. I’m going to try and visit all the pregnant women in Julcan city proper…which is about 40. And we made a very extensive list of things for me to cover…from prenatal care issues, to post partum, newborn care, diarrhea, URIs, and nutrition. It’s a pretty ambitious goal to cover all that stuff, but we’re gonna give it a go and see what happens. Tomorrow I need to really get the nutrition stuff down. It would be nice to see if what we were going to do made some kind of difference. We’ll have to keep really good track and maybe we can come up with something to follow.
Oh, and in other news…we are currently doctorless, well, besides me. Dr. Paola did finally leave, the new doc has a vacation day, and the other doc that was working here just never came back from his vacation. They have called a doc to come in from one of the other health posts, but that leaves that health post all by itself. It’s a no win situation…anyway, so I’m it for any emergencies…although I doubt they’ll call me...I still don’t think they fully trust me in that sense. OK that’s all.
So, I came back to Julcan today to give it a second chance. I took the bus back and the road was amazingly smooth…what a difference no rain makes. I got back and for a while could not find Rolando, the midwife who was going to help me make my schedule for the next few weeks. I roamed the center for a while and had a nice talk with the psychologist. She’s been in Julcan for about 4 months now and she says she’s focusing on domestic violence. She says there is a high prevalence of both emotional and physical abuse. I then went and hung out with two of the midwives for a while and they explained to me the whole system of care for a pregnant women.
Decreasing maternal mortality is a priority in the region of La Libertad (La Libertad has the highest maternal mortality in all of Peru), therefore the care of the pregnant woman has been a big focus of the health center. Julcan is divided into sectors and each sector has a team that is responsible for that sector. The team consists of (in theory): a doctor, a midwife, a nurse, and a medical assistant. The sectors don’t affect prenatal care all that much, but at least there is one midwife assigned to each sector, although it seems like they all cover for each other. Pregnant women are supposed to get seen as soon as possible in the center…they don’t want them to have to wait, b/c they say that otherwise they’ll leave. The care is not dissimilar to what we do in the states and at PCC. Each pregnant woman has to see the doctor, the midwife, the nutritionist, the psychologist, and the dentist. She gets a prenatal panel done twice and she gets two ultrasounds (I’d say this is truly different than in most MINSA health centers). They also get home visits on a weekly basis from 36 – 40 weeks. Lastly they also are encouraging family planning in all girls 15 – 49. The methods available are the pill, the IUD, Depo, or condoms.
I did finally get to meet with Rolando and we made a plan. I’m going to try and visit all the pregnant women in Julcan city proper…which is about 40. And we made a very extensive list of things for me to cover…from prenatal care issues, to post partum, newborn care, diarrhea, URIs, and nutrition. It’s a pretty ambitious goal to cover all that stuff, but we’re gonna give it a go and see what happens. Tomorrow I need to really get the nutrition stuff down. It would be nice to see if what we were going to do made some kind of difference. We’ll have to keep really good track and maybe we can come up with something to follow.
Oh, and in other news…we are currently doctorless, well, besides me. Dr. Paola did finally leave, the new doc has a vacation day, and the other doc that was working here just never came back from his vacation. They have called a doc to come in from one of the other health posts, but that leaves that health post all by itself. It’s a no win situation…anyway, so I’m it for any emergencies…although I doubt they’ll call me...I still don’t think they fully trust me in that sense. OK that’s all.
Sunday, February 15, 2009
The Road to Julcan
It's been a bit of a bumpy ride, both literally and figuratively, to get to my next stop on my Peruvian travels, Julcan. Julcan is a district in the northern highlands of Peru. In order to get to Julcan you have to first get to Trujillo, the capital city of the province of La Libertad. My mom decided to join me for the first part of this trip because she wanted to see one of the places I would be working. We arrived in Trujillo and were supposed to be met by my Peruvian hosts, but weren't. So we jumped in a cab and headed to a hotel in the Plaza de Armas. Trujillos Plaza de Armas is beautiful, it is an old colonial town that has kept it's charm. We did eventually meet up with our hosts and made plans to leave the next day for Julcan. But it was not meant to be...the car broke down and so I had another relaxing day in Trujillo. Finally on Tuesday we were able to leave for Julcan.
Julcan is about 3 hours outside of Trujillo in the mountains. The first hour is a decent paved road. The last two hours are a bumpy and sometimes a bit scary dirt road. The road is particularly rough right now because it is the rainy season and much of the road turns into huge muddy craters. I was thrilled to arrive in Julcan, but it is a drastic contrast to Trujillo.
It is winter right now in Julcan...which means cold weather and rain. There is no heat so it is really pretty cold in all of the buildings. I'll have to admit it took me a day or two to adjust to the complete change in weather and scenery. When the sun comes out, Julcan is beautiful. It's in the mountains and it's incredibly green...but much of the time it's cold and rainy.
Besides the fact that I was adjusting to a whole new climate my first week at work was less than ideal. The doctor with whom I had been coordinating my stay here, left Julcan for meetings in another city and no one in the center was sure what to do with me or what my purpose was in Julcan. I decided to make my own schedule and spent some time doing rounds, seeing patients that came to the clinic, spending some time with the nurses, midwives, and nutritionists....just to start getting a feel for what the work was like. By the end of the week though I decided I needed to meet with the Jefe to see if we could come up with some more constructive experience, because this was not the best use of my time and I wasn't getting a sense of how we would be able to help them in the future. After a frustrating meeting, I decided to come down to Trujillo, talk to a few of the nurses that were down here for a capacitacion (training) and decide how to proceed.
While here, I met with Rolando, a midwife and Flor, the nurse in charge of community education. They were great. I explained why I had come and they explained better the work they do and we came up with a plan for the next three weeks. We also decided that it would be best if Rolando was the main contact as he has more time and is more available that Dr. Henry. So, I head back to Julcan tomorrow and am hoping for a fresh new start. There is NO internet in Julcan, so when I get back I'll have to play catch up on the blog.
Julcan is about 3 hours outside of Trujillo in the mountains. The first hour is a decent paved road. The last two hours are a bumpy and sometimes a bit scary dirt road. The road is particularly rough right now because it is the rainy season and much of the road turns into huge muddy craters. I was thrilled to arrive in Julcan, but it is a drastic contrast to Trujillo.
It is winter right now in Julcan...which means cold weather and rain. There is no heat so it is really pretty cold in all of the buildings. I'll have to admit it took me a day or two to adjust to the complete change in weather and scenery. When the sun comes out, Julcan is beautiful. It's in the mountains and it's incredibly green...but much of the time it's cold and rainy.
Besides the fact that I was adjusting to a whole new climate my first week at work was less than ideal. The doctor with whom I had been coordinating my stay here, left Julcan for meetings in another city and no one in the center was sure what to do with me or what my purpose was in Julcan. I decided to make my own schedule and spent some time doing rounds, seeing patients that came to the clinic, spending some time with the nurses, midwives, and nutritionists....just to start getting a feel for what the work was like. By the end of the week though I decided I needed to meet with the Jefe to see if we could come up with some more constructive experience, because this was not the best use of my time and I wasn't getting a sense of how we would be able to help them in the future. After a frustrating meeting, I decided to come down to Trujillo, talk to a few of the nurses that were down here for a capacitacion (training) and decide how to proceed.
While here, I met with Rolando, a midwife and Flor, the nurse in charge of community education. They were great. I explained why I had come and they explained better the work they do and we came up with a plan for the next three weeks. We also decided that it would be best if Rolando was the main contact as he has more time and is more available that Dr. Henry. So, I head back to Julcan tomorrow and am hoping for a fresh new start. There is NO internet in Julcan, so when I get back I'll have to play catch up on the blog.
Saturday, February 7, 2009
Puno & La Virgen de la Candelaria
I spent this past weekend in Puno for the festival de la Virgen de la Candelaria. Puno is a town of about 200,000 located in the southern highlands of Peru. It is most famous for Lake Titicaca, the highest navigable lake in the world. It's at about 12,000 feet - that's higher than Cusco. It is also known as the folkloric capital of Peru. I've been to Puno before, but this time we went because their festival is supposed to be amazing and it did not disappoint.
The Virgen de la Candelaria is the patron saint of Puno and her festival combines both catholic and Andean traditions. She is associated with the purity, fertility, Pachamama (mother earth) and mining. The festival lasts for 2 full weeks, but we just went for the first weekend. The first weekend there are two main events: the competition of folk dances and the procession of the Virgin.
We went to see the competition and it was great. There were 81 teams competing from towns all over the province of Peru. They wear these bright costumes and play their instruments and dance all in sync. Apparently towns, save all year to be able to come to the festival and compete. After they are done dancing, they dance their way to the Plaza de Armas until they get to the church where the Virgen is hanging out. I think I liked the street dancing even better than the formal competition. The only negative part of the day was when we went to sit down at the competition they didn't want to let us into the tourist section b/c we didn't look like tourists. Basically we didn't have blonde hair. I had to show my drivers license to get in...but what annoyed me more was that ever
yone in the section paid the same price, so even if I got in, it didn't make any sense that other Peruvians couldn't get in when they had paid the same price as I did. Alas, racism is alive & well in Peru.The next day we had an excellent city tour. But the main attraction was the procession of the Virgen. Before the procession different groups decorate the streets surrounding the cathedral with designs that are filled in with flowers. I'm not describing it well, but it's super cool. I went in to the church to get a close up look at the Virgen and she's beautiful. They take really good care of her. The procession was preceded by a small ceremony in front of the church that involved blessing the virgin, offering her gifts, and a dance by men dressed in devil costumes. Then they processed. I've never been to a procession like this before and I thought it was really neat to be part of a towns tradition. That was the extent of our festival experience. This weekend is the end of the festival and it's supposed to be huge party....I'll have to make it down for that next time.
The rest of our time was spent seeing beautiful Lake Titicaca, the floating Uros Islands, the island of Taquile and the Sillustani ruins. It's all just so beautiful.
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