Meetings

I've spent a lot of time lately at meetings. It's good because I'm meeting people that are tackling health care issues from many different sides, but it's frustrating because I'd rather be out there doing work.

So this week I met with a Dr. Alex at the offices of Es Salud. Es Salud is the health care system for those that are formally employed. It's pretty decent coverage and well much more comprehensive than the MINSA system. Access to most technology, medicines, specialists, etc. The doctor I met with has been working on their special projects. They basically go out and do "campanas" (they love those here) in provincias, where they bring specialists, medicines, xrays and they treat anyone. Anyway, he wanted to here about the work we are trying to do here and gave me some ideas of areas that he thought would be good fits. He suggested Ica/Pisco because of it's proximity to Lima and also because it was devastated by an earthquake in 2007.

Then yesterday, I met with a lady from the NGO Yanapana Peru. Yanapana was started by this group that owns these luxury lodges on this super fancy Inca Trail. They are trying to be eco-friendly and trying to give back to the communities they work in by supporting them in different areas: education, agriculture, business development, and health. Last year they also did a "campana", but they brought doctors in from Lima and Cusco and took them through the trail visiting all these people, many who had never seen a doctor. Apparently, it went pretty well, but it was expensive and not sustainable. So, she thought we might be able to help. We're not so interested in the campana model, but if they decide to invest in a more long-term, sustainable model of health care, I'd love to explore this, especially since it would be serving a population that has very little access to care.

Then today, I went to an Es Salud hospital, El Hospital Almenara, apparently one of the biggest referral centers for Es Salud in Lima. There I met an ENT doc, Dr. Luis, who does some volunteer work en el cono sur de Lima. He works with a Catholic parish there that provides care to the poor and he thought we could be a good fit. So hopefully I'll get out there to see it.

Then I went off to Universidad Peruana de Ciencias Aplicada (UPC) to meet with a doctor and professor who teach a class to medical students about evaluating community health needs. The university is relatively new, 15 years old, but the med school is really new, just 3 years old, but it's really well financed. It is definitely one of the nicest and most modern campuses I've seen. During their second year of med school the students learn how to do an assessment and then go out to one of the poorer communities of Lima and do the assessment. Since the med school is only 3 years old, they haven't been doing it long enough to develop programs around the health problems identified. Anyway, I'm going to try and go out with them when they go to do their evals and see what they do. The professors love the idea of an interchange between universities and are open to US med students coming to Peru.

So, like I said, really neat meeting this people, just wish I was more hands on...just part of the process. Just thinking that this Peru thing is going to take longer to get in place than the six months i'm here, but at least I've got lots of options.

Living with Terrorism

Last night I went out with my cousins for dinner and while there the topic of Peru's years of terrorism came up.  The Shining Path caused some major chaos here from in the 80's the worst of it being from 1895 - 1990.  Thousands of people died, mostly in the rural parts of Peru caught between the Shining Path and the military, but Lima had it's fair share of attacks.  They talked about all the places that had been blown up, having curfews, always wondering if it was safe to go out or not.  And although I had come to visit during that time and remember once going to see the ruins of a building that had been bombed, I can't imagine having to live your life with constant threats.  They said you just have to keep living, nothing else you can do.  

Around Lima

I spent most of the first week back from Julcan helping my mom move from her apartment to a new house.  Moving is just as painful here as it is in the states, but we're settled now and feeling more like I really live here.

This last week the goal of universal health insurance got a little tiny bit closer when the Peruvian congress made the it a law.  Still far away from a reality, but it's a first step. 

This week, I spent some time with some family practice doctors.  It was really good to start seeing what they are doing down here.  There are scattered family practice programs around the country, but there doesn't appear to be any association that sets guidelines, so they can vary pretty widely.  The family practice program that I'll be spending some time with is based out of la Universidad Peruana Cayetano Heredia.  It is arguably one of the best medical schools in Lima.  

The family medicine residency has been in existence for about 6 years, but they haven't always had residents.  There is a national residents committee that determines how many spots to grant a residency program each year and it varies widely.  3 years ago Cayetano got ZERO residents, the next year they got 6 residents, and this last year they got 18.  They haven't heard how many they'll get for the next year.  It's partly determined by the hospitals where the residents spend their first year and half.  My understanding is that they assume the cost of these residents and their budgets fluctuate (although I'm still trying to figure this out).  

So the family practice residency is 3 years, but they spend their first 18 months rotating in different, mostly hospital based specialties, with one day in family practice clinic each week.  The last year and a half is spent in the community.  They spend a 6 month block at one of two health posts seeing patients, but also doing some serious community work.  The rest of their time is spent rotating in other community settings.  During this whole time they continue to have family practice clinic at Cayetano.  I don't think there is really a concept of continuity care here for patients, but I haven't spent enough time with them to know for sure.  

I went to visit one of the health posts where the residents spend an extended period of time.  It's in one of the poorer parts of Lima.  It's a small, but nice facility.  The resident just started there about 2 weeks ago so she's just starting with her community assessment.  She has the help of a volunteer preceptor doctor who is employed by MINSA (the ministry of health) and an intern (med student in their last year of school).  She is expected to see patients in the clinic for 4 - 1/2 sessions - each week and the rest of her time is working out in the community addressing the problems they've identified.  The amount of stuff they have to cover is pretty daunting...but she starts and the next resident will continue.  Anyway, hopefully I'll get to see some more of how this works.

The last week in Julcan

So my last week in Julcan was pretty good. I had 3 medical students from Loyola come up for their spring break. They received funding through the global health program at Loyola. They came to get a first hand view of my experience and learn what they could about health care in rural Peru.

Overall, it was a really good week. They came in on Sunday and we did a quick little tour around Trujillo. We saw the beach, ate ceviche, and went to the Huaca del Sol y Luna. Monday we headed to Julcan and basically just got settled and took them on a tour of the health center. Plus they got introduced to the super room in the "hotel".

Tuesday morning we did home visits on pregnant women. We reviewed warning signs and started explaining how to make suero casero. The students were excellent...Beau and Dina took turns explaining the warning signs and Mark entertained many of the children with his camera. In the afternoon we took an hour walk to the caserio of Oromalqui with Rebecca, Christopher, Marianela, and Juner to see their talk on Microbios and do home visits of families identified as at risk by their community.

Wednesday we sat through a semi-painful sesion demostrativa. It was so long and complicated and the women really didn't participate. The practice session was so much better. We got to present our suero casero...so that was pretty good and it's so simple: water, salt and sugar.

Thursday morning the students rotated through the different services in the health center so they could get a sense of what a day in the health center was like - so this included medicine, family planning/OB, nursing/well child checks. Oh and that afternoon we took a walk to El Rosal to go check out an Incan mummy that is just hanging out in a lawn chair in this guys house. Crazy, but cool. Then we had a very wet walk all the way home.

Friday we went to another caserio, Santa Rosa, where Christopher checked out the water system which is completely non-functional. Beau and I presented the suero casero again and did home visits. These home visits gave you a better sense of people how in the communities further away, actually live. They definitely aren't eating the portions of milk, veggies, and meats they're being told to eat. Friday night was capped off with a pretty rocking party.

Our weekend began with a tour of the state medical school in Trujillo and one of the big public hospitals...El Belen. It was good to see the hospital where patients get referred. While there we learned that the patients who get pap smears in Julcan, not only have to wait three months to get there results, but SIS doesn't cover a colposcopy...so not sure how you actually do a diagnostic test if you have an abnormal pap? Ah, got to love SIS.

The rest of the weekend was spent in Huanchaco enjoying the sun, beach, food, and hot showers!