Sunday, July 17, 2011

Sunday, July 10th, 2011 Espinar

The bus finally arrived at 4:30 for the “4-hour” bus ride to a clinic in Espinar. Unfortunately, our huge tour bus had to ford a couple rivers, sketchily pass several oncoming cars on narrow mountain roads, and carefully cross some primarily wooden bridges, among other questionable acts for such a large vehicle, which ended up taking 6 hours. (We did get to see a huge herd of llamas though – a major win for the day.) We were supposed to start at 8, but didn’t arrive till after 10. Luckily there wasn't a long line of women waiting. Sarah, Chelsea, and I set up rather quickly and got started with Dr. Ferris without breakfast. We had a steady flow of women till 3pm, so my hunger pangs were only a slight hindrance. We ended up seeing about 190 patients total - not a bad day, considering some of the campaigns earlier in the summer only had ~70. The drive back seemed just as brutal, but I slept through most of it. We got back at 10pm and grabbed hot showers before passing out. Long day..


Monday, July 11th, 2011


[list of number of patients in each department at the hospital]

Shortly after waking up, I was told that we’d be touring Regional Hospital at 1pm. We started on the 4th/ top floor and worked our way down. Scott was our Santa Claus and carried the big trash bag of toys and stuffed animals for the kids. They absolutely loved him. Oddly, they seemed equally thrilled by the toothpaste and soap we were also giving out. The hospital looked dirty and old, fairly similar to the one in Argentina, although much larger. Not a place I’d want to have any sort of procedure done. I wouldn’t even want to stay there overnight for that matter. Every floor had creepy Jesus shrines in the hallways. You really can’t escape Him here, even if you wanted to. Old Jesus pictures that look like they were made in the 70s are EVERYWHERE: cabs, bus windows, bathrooms, around people’s necks, in the clinics we visit on campaigns. There were sweet murals on a couple of the floors though. They were awesome, minus the fact that some scenes on pediatrics floor mural seemed slightly inappropriate for children under the age of 18. Not to mention this mural was done by a pediatrician. Among others, we saw some cute newborn twins with a poor mother who had no other family and was on the verge of tears, a few kids with burn wounds, and old dudes with unknown issues. Hospitals are gloomy places, but the smiles on the kids’ faces helped alleviate some of the newly-induced depression.



After the tour, we checked out a market that was more for the locals than tourists. First, we went though the meat market, which was absolutely grotesque. Forget the chicken legs and pigs’ feet sticking up in the air; the horse head sitting randomly on a stool with its tongue out; a cow (?) liver laid out nicely in an attempt to look appetizing (seriously, who eats that??) – the most appalling scene of the day was a woman hacking away at a cow’s head with a machete, totally unphased by the identical looks of horror on 10 gringo faces. Sharpened the blade, back at it again. Derrick snapped a pic, and we moved on to the happier land of fruits and vegetables.





There were other shops of random kitchen utensils and appliances, TVs, and kids toys. David and I decided to share a bistek, egg, and fries, which I’m surprised I could even stomach after witnessing such a horrific act on that poor cow head earlier. I debated a fresh glass of juice at another station, but Sarah told me I’d be an idiot to drink that. I think my body has been doing well so far with all the new germs I’ve introduced. I do feel that I’m pushing my luck though, considering Dr. Ferris shudders every time I tell him I tried more ceviche. Whatev, I have cipro to save the day should anything happen…

We went out again, despite clinic opening at 8am the next day. After happy hour at Paddy’s Pub (oddly from 10-11pm or something), Derrick, Carolyn, David, Sarah, and I ended the night at a bar claiming to have a Radiohead cover band, but of course they played one Radiohead song, followed by a lot of Nirvana, Pearl Jam, Blur, and everything but Radiohead. Fairly uneventful, minus the flock of at least 15 elves that came and tore up the dance floor and the bar counter. Kind of hilarious.


Tuesday, July 12th, 2011

Clinic was slow today, as usual. I saw a colposcopy, which basically just involves finding the cervix, dabbing vinegar on it, and looking for white patches that indicate potentially precancerous areas. I also assisted on an endometrial biopsy on a woman with a stenosed os, which required injecting lidocaine to numb the cervix, dilating the os with gradually widening spikes, then sticking a skinny tube up the os to collect a good bit of the lining of the uterus. It looked pretty painful, but some women have cried over a pap, so I’m not really sure how bad it really is.


Wednesday, July 13th, 2011 Urubamba: chutiqui calcon ikita!



Today began a 3-day run of campaigns. The drive to Urubamba was absolutely incredible. Perhaps I'm a little biased because I love South America so much, but Peru is absolutely beautiful. We made a stop at one point along the drive where there were ruins on a hill to the right; to the left, there were huge, snow covered mountains with a valley below buried in a thick blanket of fluffy clouds. The city was nicer than the others we’d been to – lots of restaurants, parks, and paved roads, although skinny - perhaps too skinny for the 2 large vans we were in. Outside of our “clinic,” there were palm trees in the park with more snow on mountaintops in the background. Not often you see that.



Our space was similar to a church gym with a stage. We set up curtains across the stage to separate 5 “rooms,” each less than 6 feet wide. Ours had a delightful vintage-looking poster of Jesus looking down on us.



The main floor was for registration and watching a video on what exactly a “Papanicolaou” was. This video (done by an MCG medical illustrator) turned out to be incredibly helpful. Since our tables didn’t have stirrups, we had to have them put their feet on the backs of chairs, which made things a little more complicated. Many of the women had never had the pap experience before, so the video helped cut out some time explaining the process. Not to mention Dr. George, the doctor Sarah & I worked with, spoke great self-taught Spanish. She’s a 50-something surgeon who has decided to do another residency to get certified in family medicine – interesting change of heart. She was very energetic and taught us a new way to do breast exams, so hopefully that helps. Unfortunately, many of the women spoke Quechua, and in these cases, there’s not much more we can do than use charades-esque motions and brute force to get them to do what we want. I have managed to learn about 3 phrases, one of which is the title of this post: “take off your underwear” – and probably the most crucial!

A few more doctors and nurses have joined CerviCusco for the next week, so we were fortunate to have experienced docs to explain stuff to us (and of course double-check some of our paps and questionable breast exams).



After a delightful lunch of grilled trout (not chicken!!!) and fries, we hung out in the park for awhile till our vans arrived for the ~1.5 hour ride back to Cuzco.


Thursday, July 14th, 2011 – San Salvador



Today’s campaign was at the Centro de Salud in San Salvador. Amanda & I worked with Dr. Bob, the eccentric once-ob/gyn doc who now works for Kaiser Permanente and has a sweet handlebar moustache. We were lucky to have the OB room, complete with stirrups and a big standing light. Nothing too eventful happened, but it did get a little hectic at times and we ended up seeing over 200 patients. After the last patient had been seen and we packed up our stuff, the mayor of the town met us outside with his paparazzi. He expressed his gratitude for this first-ever event in his town, hoping that we would come back again next year.

We had a bistek lunch at a restaurant with a nice view of the Urubamba River before heading back.


Friday, July 15th, 2011 - Pomacanchi

The last campaign was in Pomacanchi. I’m not sure what the building was, but we ended up setting up curtains in a large room to make 4 stations. Sarah, Amanda, and I worked unsupervised for most of the day. Again, fairly uneventful, but Amanda did find a breast lump in a 19 year old that we then referred to the CerviCusco clinic for a biopsy.


Saturday, July 16th, 2011

Today was a big day at the clinic! We watched Dr. Bob do a pelvic ultrasound for an ovarian cyst in a young woman; more colposcopies; Dr. Ferris perform a loop excision (LEEP); and Dr. George perform her 2nd cervical biopsy.

We also had the first patient to ever get a pap using the SurePath liquid-based method in Peru, given to CerviCusco through a $1 million grant. Kind of a big deal, as indicated by the numerous pictures we got of the situation. Hopefully she understood the magnitude of this event and didn’t just think we were creepsters. The fancy new machine came in a few days ago and is supposed to be far superior to the traditional method we’ve been using. Exciting day for CerviCusco, indeed.

Later that night, Sarah, Derrick, and I booked our trip to the jungle, then ate at another Ferris favorite: Cicciolina. I ordered a tender filet of alpaca that came with roasted tomatoes and fried mashed potatoes. Delicioso!

We also ran by the botica/farmacia to find some meds for this bug I’ve had for a couple of days. I hate to be a whiner, but the incredible amount of dust this city has managed to stir up coupled with the unforgiving dry air has been a force my little throat and sinuses just could not take anymore.

It’s hard to believe that all our medical stuff is done now. It’s sad in a way, but I am super pumped about our plans for the upcoming week: Machu Picchu, Punu/ Lake Titicaca, Arequipa to see the Colca Canyon, then to Manu for the JUNGLLLEEEE!! I’m excited that David will be joining Sarah, Derrick, and I since he found the yellow fever and typhoid vaccines (for ~100 soles total, by the way. Ridiculous, considering Sarah and I paid well over 4 times that in the states…)

Time to get some much needed rest...

Sunday, July 10, 2011

abre las piernas!





Friday, July 8, 2011

We were informed that the CerviCusco workers wouldn’t be coming in on the 8th, as it was the 100 year celebration of Machu Picchu. No complaints here; this gave Sarah and I the opportunity to catch up on much needed sleep and slept in till 2 - quite an amazing feat for Sarah Hilton, who can’t sleep in past 9 on a good day. Clearly, we were sleep deprived.

Later, we went to the plaza with Clay and Mack to talk to a travel agency about the rainforest, and magically ran into Derrick and Scott. This city seems so big, but we keep running into each other as well as Peruvians and travelers that the others met earlier this summer. Sarah and I showed the boys the shops and got some souvenirs and gifts. You cannot imagine the disappointment in myself that I feel for haggling with not one, but two children under the age of 10... I did manage to get a hat and mittens set for 15 soles though. Pretty sweet.

Later, Sarah and I cooked a delightful veggie pasta dinner with cucumbers as an accidental, but delicious side (we thought they were zucchinis). Speaking of inadvertent purchases, I managed to be the only one out of 10 of us who got plantains instead of bananas at the grocery store. Lesson learned: do not buy "bananas" that are larger than 5 inches. As such, I've decided to do plantain experiments, so we've had salt/pepper baked plantains, fried plantains in caramelized syrup, and next up will have something to do with peanut butter.

Everyone else was out watching a world cup game, so it was a quiet and romantic lady date. When the others got back, we played cranium then went out again for Andrew's last night. We started at 7 angelitos for a Cuban band, then Inka Team, where we danced the night away. We managed to squish 6 into a cab, although the cabs here won't let you get in the back if it's a hatchback, nor will they let 2 sit in the front seat. This left 4 butts miraculously filling the tiny backseat, and me laying across them for the 15 minute ride home. I was actually quite comfortable & content until I got out of the cab and realized my wallet was nowhere to be found. Luckily, my passport wasn't in there, but I am now cardless. :( Could've been worse, I suppose. Incidentally, I had lost my wallet a day before leaving for Peru, so I didn't even bring my license, 50 credit cards, school ID, etc. I guess I was a little lucky in that sense.. Apparently another boy on the trip was pickpocketed earlier on the trip while in a crowd, but they managed to hunt down the suspect and pat him down, retrieving the wallet. Oh, sketchy South America.

Saturday, July 9th, 2011

The clinic opened at 8 today, but the staff didn't show up till 9 and the patients till 9:30. I slept in till 10 or so, then headed downstairs, where I saw that it was quite dead, as warned previously. Things picked up a little bit after Dr. Ferris and Dr. Bob arrived from the States though.

Dr. Ferris is an ob/gyn/family med doctor at MCG who founded CerviCusco about 3 years ago. It's really amazing what he's done here in 3 small years.. He says he comes about 8 times a year. The 4-story building houses the clinic on the 1st floor; the ladies' rooms, dining room, and big kitchen on the 2nd floor; boys' rooms and a smaller kitchen on the 3rd floor; and the "casita" - 4 bunks & a bathroom - on the 4th floor/roof, where I'm staying. There's even a nice little backyard, complete with a floral garden and croquet set for the green lawn. I hear the campaigns usually bring in 100+ patients, although I'm not sure what the flow is through the CerviCusco clinic. They are able to do procedures at the clinic though, such as colposcopies to detect metaplasia, loop excisions to remove those cells, polyp removals, and probably much more. There's also been a lot of interest from doctors wanting to volunteer and even add some departments to the clinic in the future.

Things were fairly slow at the clinic and there were too many students, so I decided to go with David and Katie to the hospital to get an xray for her leg. She had fallen on a solitary hike up the mountain behind the clinic a week prior and twisted her ankle. It was purple and swollen and painful, so after a quick exam, Dr. Ferris told her to go to the hospital in the city. It was a mere a 70 soles & no wait. Pretty amazing. Although the guy walked out and handed her the radiographs without any explanation. The three of us attempted to read the xrays, but of course we're first year med students and know pretty much nothing about reading xrays, so we saved them for Dr. Ferris. Katie went limping back to catch a cab to the clinic, while David and I went on a hunt for his vaccines/meds for the jungle (yellow fever, typhoid, anti-malarial). We found that the vaccine people don't work on Saturdays or Sundays, but we did get chicken and apple empanadas from a lady on the street, which were AWESOME. Not as awesome as in Argentina, but I don't think empanadas are nearly as big here, unfortunately.

He took me to Chicha, an amazing restaurant named after a Peruvian drink made from purple corn. With a huge menu full of Peruvian dishes as well as pasta, pizza, and meat dishes, it was a tough decision, but I finally settled on pumpkin-filled ravioli with a cheese sauce, and David had pesto-filled gnocchi covered in marinera sauce and cheese. Absolutely delicious, only made moreso by the fact that it only cost me 10 bucks.

Later, Clay escorted Sarah and I to Two Nations, a tiny restaurant run by an Aussie and his wife. I finally tried ceviche - his version was 2 raw purple onion rings housing chunks of trout in a citrus juice, with potatoes and pepper rings on the side. He claims spice is harder to handle at higher elevations if you haven't been here long, so he lets the customer tailor the ceviche to their tastes.. whatever, it was delicious. I had bacon-wrapped chicken, recommended by both the chef and Clay. Sarah had mushroom risotto, and Clay had an alpaca burger, which was juicy and tender!

We got back to the clinic and called it a night due to the 4am departure (thankfully moved from 3am by Dr. Ferris) for our campaign the next day.

Friday, July 8, 2011

Bienvenidos a Peru!

And I'm off again! This time to Peru with Sarah Hilton, my good friend from MCG. The plan is to work in a clinic for 10 days then travel around and see what Peru has to offer.

We left Atlanta around 6am on Tuesday, July 5th after an awesome, but tiring July 4th weekend. Alex dropped us off at the airport, and we embarked on a 24 hour journey of airplanes and layovers (on a record 3 hours of sleep, mind you). Only a 2 hour flight to Miami, 6 hour flight to Lima, then 2 hours to Cuzco, but a whole lot of downtime between. We arrived in Lima around 9pm with plenty of time till our next departure, so we decided to check out Miraflores, according to most, the only part of Lima worth seeing. With my broken Spanish, we got a ~20 min cab ride to the center plaza. There were a surprising number of people out for a Tuesday night, just hanging, eating, drinking, sitting. There was a little market in the center of the park that I had to resist strong urges to buy earrings and cute alpaca stuffed animals. We took a stroll down the main avenue to the bay, where there was even more going on, but much more tourist-based. TGIF, Ruby Tuesday, etc. I'm sure the view from the dock is incredible during the day, but unfortunately, we only had a vast blankness in front of us, with a massive white lit cross on a hill off in the distance. We got a quick bite to eat back in the center from a place that offered us free drinks. Sarah, a vegetarian bless her heart, ate potatoes with a mustard-based sauce. I had a quarter chicken with a huge helping of fries and a salad, which I left most of for fear of getting sick on my first day. Complete with two pisco sours, the national drink, our meal was only 25 soles. Less than ten bucks. Oh, how I love South America. :)

When we made it back to the airport, we found a few fellow MCG kids, Scott, Amanda, and Meggie. We attempted to crash until our 7am flight, but relatively unsuccessfully. We should have been more prepared like the 15+ people we saw curled up in sleeping bags in a random corner. I slept a little on the plane and opened my eyes just as we were approaching Cuzco to see the snow capped mountains on the outskirts of the city. The runway lies in a valley surrounded by the city. Two strings of small mountains line the sides, with densely packed houses rising up the hillsides.

As soon as we got off the plane in Cuzco, about 20 Peruvians dressed in traditional wear busted out in song with their instruments. Quite a welcome greeting! We gathered up the MCG crew plus Derrick, and hopped on a van cab to the clinic, which we had to ask directions for about 5 times. When we arrived, the clinic was dark and appeared empty. We hit some random buttons on the gate outside until finally Lynn came down and rescued us. Dr. Ferris, the founder of CerviCusco and the man in charge, didn't arrive for another couple of days, so we took it easy the first day. Sarah and I are staying with two others in the "casita" on the roof.



Clay and Mack showed the newcomers the Batman, the van that makes a circuitous route around the city for 60 centimos, and dropped us off at the grocery store. We decided to grab a bite to eat first and found a small Peruvian restaurant with a set menu for 5 soles. That included chamomile tea, barley soup, a piece of potato in Huancaina (a cheese/mustard sauce, as far as we can tell), a fried chicken filet (milanesa de pollo), rice, and a salad. In retrospect, I should have perhaps tried a different entree than chicken, because chicken is hard to escape in this country, as I soon found out. We grabbed some groceries and took a cab back. After a short nap, Lynn took all the ladies shopping down near the Plaza de Armas, where hundreds of vendors have little shops that essentially all sell the same stuff, just different colors and shapes and sizes. I just did some scouting for future shopping.

view across the Plaza de Armas:


I am sad to report that my first real dinner in Peru was spicy ramen noodles, but you really can't beat a 30 cent dinner. We played some Cranium back at the clinic and called it a night due to our 5am wake up call.

Thursday, July 7th

CerviCusco takes trips out to other towns, called campaigns, to do paps and breast exams. This campaign was in Huayaccocha about 2 bumpy hours away. The bus was supposed to pick us up at 6am, but of course was at least 30 min late. The towns usually arrange for transportation there and back, as well as feed us breakfast and lunch. (Dr. Ferris later told us that they sometimes work with the mayors, who use the event to get re-elected.) We usually get a few rooms to set up shop in where we do pap smears, prepare the slide, and do breast exams. Anything more complicated requires a referral to the CerviCusco clinic in Cuzco.

15 of us piled into the sketchy bus that amazingly made it there and back without problems:


This clinic served us bread and jam, tea, and hot chocolate for breakfast. There were 15 of us including Lynn, the students, and the few CerviCusco workers and translators. There were three exam rooms with about four students per room, paired with someone who actually knew what they were doing. This clinic didn't have real exam tables, let alone stirrups for their feet to go in. This caused complications with almost every single patient, only made worse by the fact that none of us really spoke Spanish. Lynn and I spoke the most Spanish out of the 5 of us, but that's not saying much. We could basically say the commands that we wanted, but any attempt at understanding the patient was futile. Most of the women out there speak Quechua anyway, so we brought in a translator when we really needed to.

Lynn & our "exam table"


We put a fitted sheet on the table, folded a couple of pillowcases to make some semblance of a "pillow," and used the same table cloth and gown with every woman. Totally would not fly in the States, but here, it almost seems normal, albeit disgusting.

I was in a room with Sarah, Derrick, Scott, and Lynn, who did the first pap, then let us do the rest. The four of us got our system down by the end of the day. One person, the "assistant," prepped the plastic speculum with lubricant and prepared the slide; another strapped on a headlamp and did the "papanicolaou"; a third did the examen de mamas (breast exam); and the fourth filled out the paperwork. Once, I got to be "baby holder," a job that I loved. Unfortunately, the feelings were not reciprocated; that thing literally screamed throughout the entire exam.



The women in the rural areas and many in Cuzco all look the exact same. Anywhere from 1-10 brightly colored, layered skirts down to their knees (depending on the weather), leg warmers, shirts and cardigans, 2 long braids, and a top hat. Some younger ladies wore pants, but not many. They also have colorful blankets that they use to carry babies or loads of things on their backs. Maybe because they live in more rural towns, but maybe not, most of them were covered in dirt; not just their shoes, but also under their clothes and shirts, as I found out when doing breast exams. These women work so hard doing manual labor all the time, I guess it shouldn't be so surprising. Many complained of pains, which Lynn attributed to arthritis and told them to take ibuprofen.



We saw about 150 patients, and the four of us did about 60 of those. We are basically pros at paps now. I still haven't figured out the best way to do the breast exam, but I'm workin on it... We pretty much worked non-stop, but I did take a couple breaks to eat my granola bar and wander around outside, watching kids run around and women sitting on the ground, knitting various clothes.

"Lunch" came around 3pm when the line finally ran out of people. We ate outside on the grass eating our chicken, rice, and beets (!) for a change. We got back around 6pm and later went out to dinner at caller batata (sp) with everyone, then out for a night on the town. It was the night before the 100th anniversary of Machu Picchu, so there was a band set up in the Plaza de Armas. David, Mack, Sarah, and I braved the cold to get a beer and catch a few songs, but the rest headed to a bar that we were supposed to meet them at. Of course they were nowhere to be found when we arrived, so we headed to another bar that had a Doors cover band (although it was actually a classic rock cover band that probably only knew three Doors songs). Lastly, we made it to Inkateam, a ridiculously crowded dance club playing the usual US hits. We ran into Carolyn and Andrew, danced awhile, then caught a cab back.