One Year. One Physical Therapist in Trujillo, Peru.

Combining passions of global public health with travel and cultural immersion... With the help of the Catholic Medical Mission Board, I was afforded the opportunity to live outside of Trujillo, Peru for one year's time (2010-2011). Check out old posts about my experiences as a PT working in hospitals, a school, an outpatient clinic, doing research/community based rehabilitation, and a little teaching too. And my experiences with an entire calendar year of holidays, cultural customs and new culinary experiences!

I make it back about once a year with university students/CMMB projects, so I will periodically provide updates :)

Thursday, December 30, 2010

Yellow Underwear, Grapes and Luggage

Here in Perú, they don’t practice “New Year’s Resolutions.” There’s no New Year’s Eve kiss. However, there are some traditions, most of which are performed at the strike of midnight, that are supposed to bring good fortune in the year to come.

1. Take a hot shower with a bunch of herbs. Cleans out the system- better health and prosperity for the  year to come.
2. Put 12 grapes under the table. At midnight, eat each one separately with an accompanying wish for each grape that you desire to come true in the year to come.
3. If going on a big trip in the coming year, pack your suitcases and run around the block several times (with them) at the strike of midnight – brings safe travels.
4. Tie three knots in a string and put it on like a bracelet. When the knots break, your wish will come true.
5. Wear yellow underwear on New Year’s Eve for happiness in the year to come. (EVERYONE is selling yellow underwear right now!)
6. Run up the stairs and throw money down from the top to guarantee financial success in the year to come.
7. Put glasses in your pocket or wallet for good luck in money in the year to come.
8. Write down bad events of the previous year, construct a doll, put the papers inside, and burn it! – Fresh start in the new year.

My host sisters also told me that you will also have great luck if you pour a bucket of cold water over your head at midnight! And that the beaches in Perú are topless…. HA! Needless to say, I got my facts checked for #1-8, just to make sure! ☺

You usually only do one of the traditions… but I think that to increase my odds, at the strike of midnight, in my yellow underwear, I’ll run around the block 12 times with my luggage, each time stopping to eat a grape from under the table.

HAPPY NEW YEAR!!! AND HAPPY BIRTHDAY MOM and BRITT!!!

Sunday, December 26, 2010

Christmas in Perú

Mi Familia Peruana!
My favorite part of the Peruvian culture – the family values – especially shone this as this holiday season approached. Here, there’s little stress of the commercial side of the American Christmas as we know it- the gift giving is kept to a minimum, and the emphasis is simply on spending time with family. My family draws names every year for an “Amigo secreto” (or secret Santa), and this is the only gift each person is expected to give.

In the holiday season, “Chocolatadas” are popular here – small parties to eat paneton (Peruvian fruit cake –actually really delicious!) and drink hot chocolate. We had one at the colegio before the students had their summer break, which was a lot of fun!

Paneton - Yum!
Christmas decorations seemed a little out of place at first for this Alaskan, as it’s summertime here. Some people use lights or garland, and most have a small fake Christmas tree. The centerpiece of the decorations is the nativity scene, which is large, multi-leveled and usually involves at least 40 farm animals! (plus your random giraffe, lion, etc.)

Nativity Scene at Mi Casa
The work Christmas party for the clinic was quite the event in itself. It began with a large group sitting in a circle singing Christmas songs together. Then we went to a special mass together, which was followed by a cena – turkey, and of course paneton. Entertainment during the dinner included a choreographed dance by the nurses in santa hats, a guitar performance, many photos, and of course the secret Santa gift exchange.

Nurse Dance
As for Christmas Eve, I was told that there are generally two types of celebrations – 1) a low-key dinner and evening in with the family, ending pretty early or 2) a large family party that begins at mid-night and lasts all night long! My family never lets me down- they, of course, are the type to have the latter.

The celebrations began with a 2-hour mass. The mass on Christmas Eve was unlike anything I’ve ever experienced in the Catholic Church. In particular, in place of a homily, the baby Jesus was placed in the large decorated nativity scene. However, before this happened, everyone in the church stood in line to kiss the forehead of a small baby doll. And at the end of the mass, out came a disco ball, flashing lights, balloons, and a giant Santa to sing “Happy Birthday” to Jesus!

Back at the house, all sorts of relatives began filing in. At the strike of midnight, everyone ran around for hugs and “Feliz Navidad,” almost like a new year’s celebration. Then came the dinner… three huge turkeys to feed the family, salads, and a rice dish.

Pavo (turkey!) - a nice change
After the dinner we did the secret Santa gift exchange, which involved a lot of shouting and was pretty hilarious. Then the sound system was set up and the “Peruvian Power Hour(s)” began (see previous post- “Birthdays and Baptisms”). Basically, it involved a lot of consumption of champagne, sangria, and cerveza (via peer pressure), and of course, loads of dancing! Trying to move my hips like Peruvians is already entertaining enough, but when you throw in the fact that I am much taller than almost all of the men here, it’s even funnier.

They let me add one American song to the playlist – I chose country and I taught everyone how to line dance! ☺ (Well, attempted to.) We ate more paneton around 5am, and finally at about 6:30am, as the sun was already up, it was socially acceptable to excuse myself to go to bed. Needless to say, a Christmas experience I will never forget!

Monday, December 20, 2010

Monkey in a Cage

One of my biggest challenges with living in Peru has been in finding ways to exercise. It’s a bad idea to walk around the neighborhood during the day, let alone to go for a run! And yoga videos, Billy’s boot camp, jumping jacks and self-invented circuits loose their appeal pretty quickly in my little bedroom. So, I’ve been going into “town” 1-2 times a week to use a gym. At first I felt kind of guilty about it – after all, it’s not a financial option for the overwhelming majority of people in my area. But, for my own mental health and stress relief I decided it was probably a good idea. Plus, when I found out that they had hot showers, it was a done deal!

I’ve had a lot of interesting moments at the gym so far. The first was doing a double-take as I walked by one of the TV’s - apparently it’s normal here to watch a full-nudity show while getting in some cardio! Other than that, it’s much like your average gym in the US- personal trainers, a big room for group workouts (I’m still working up the nerves to bring my non-Latino moves into the dance class), and even a juice bar! Some of the weights are a bit rusty, and there are areas where the roof has fallen in, but I would still say that it creates a few hours of luxury for me every week. Although, now that summer is here, with no air conditioning it gets pretty muggy (especially when I try to blend in by wearing Spandex).

I’ve tried out a few spinning classes, but I try to limit them as I can’t hear well again for hours afterward! (Peruvians have a thing for loud music). One of the spinning instructors also likes to scream into her headset wildly and hop up and down, but she never gets on the bike. Sometimes she runs around the room and cranks up the resistance on peoples bikes without warning too! My first day she avoided me like the plague and gave me strange looks the whole time but she’s gradually warmed up to me and includes me in the madness now.

The gym has a few treadmills that are located by the front windows, or the area I refer to as “The Zoo.” It looks like a nice area to get some people-watching in as there is a lot of foot traffic on the street outside. However, it’s quite the contrary - it just makes me feel like a monkey in a cage. Old men, young women, old women, young men, children – you name it – are intrigued by the gringa running on the treadmill. People stop dead in their tracks and point, or walk up to the glass and just stand there! Sometimes cars even slow to a stop. I don’t get it. Yes, I am white. Yes, I am actually running on the treadmill (most people here just walk on it).

I am always trying to find ways to blend in, but the truth is I don’t think it will ever happen here. No amount of sunbathing or Spanish practice will do the trick, and I’ve come to accept it. (Although most people I meet here ask if I am from Spain, which is progress!) But, I hoped that after a few months of life in Perú, the constant stares/pointing/whispers would slow down. Not a big fan of unwanted attention, so this is yet another reason that my patience should (hopefully) increase in bounds this year!

Thursday, December 16, 2010

CMMB Around the World

Learn about my organization´s work around the world! Check out the links below to the new TV series with Telecare Television. Some of my colleages from the newest group of volunteers are featured in it!


Episode for ¨MVP¨ - Medical Volunteers Program: http://www.cmmbheals.org/medical-volunteer-program 

Other online episodes:  www.cmmbheals.org

Salud y Feliz Navidad! -Amber 

Wednesday, December 8, 2010

Virgen de la Puerta

Today was another “fediaro”- holiday! While many smaller religious holidays seem to pass in the US without a lot of notice, holidays related to the Catholic religion here are a big deal. Almost nobody works, and there’s usually some form of celebration. Today was no exception- in fact, the celebrations began last night!

First, for the story:
During the 17th century, the port of Huanchaco (which is very close to Trujillo) began to flourish, and attracted a large number of pirates from the north who used to raid South American ports. In 1674, word spread that pirates were attacking parts of Ecuador and were headed south, so the people of Trujillo began to panic. They passed along the news of an inevitable attack to nearby towns, including the mountain town of Otuzco which is 70 kilometers away. The villagers spent three days in prayer and then led a procession to the entrance of town with a figure of the Immaculate Virgin, asking for help and protection. Miraculously, they were not attacked and the pirates retreated permanently.

In current times, the famous image of Mary is now regarded as Virgen de La Puerta, the queen of peace and patron of Otuzco. Otuzco holds a festival the 13th-15th of December every year, but Trujillo celebrations begin December 7th so that devotees can attend processions in both places. There’s also a pilgrimage December 13th that begins in Trujillo – people walk for two days up a mountainous road to reach Otuzco, without stopping! Apparently, if I am praying for something important and seek Mary’s help, in return I must promise to complete the pilgrimage in order to fulfill my prayers.

The festivities began last night with a mass, followed by a celebration in the streets surrounding a shrine area for the blessed mother. Bands played, people danced, and they had light shows, culminating with a big display of fireworks and even a Peruvian-Mexican Mariachi band at midnight!




Today the holiday continued with another mass and a 5-hour-long procession around the streets of La Esperanza. It was a beautiful event and yet another interesting cultural experience I feel blessed to have been a part of.

Some of the devotees smear their faces with black soot, a sign of penance
Procession through my neighborhood


Sunday, December 5, 2010

Numbers

I’ve been taking notes on some statistics since my arrival. 80% of the population in the district of La Esperanza are living under the classification of “extreme poverty.” Recent studies indicate that 45% of children in my district have some sort of stomach parasite, and many cases appear to be resistant to first-line drug treatment. 75% of people in La Esperanza do not have medical insurance.

Interestingly, the rate of anemia is high here for both adults and children. Anecdotally I’ve also had an overwhelming amount of middle-aged patients with the diagnosis of osteoporosis- not surprising, I’ve also seen a large number of fractures. Facial paralysis and lower extremity amputations secondary to diabetes are also emerging as common pathologies in the clinic and hospital.

However, it’s suspected that due to financial and access/transportation barriers, many people with disabilities in my district rarely leave their homes or seek medical care. So, it’s very possible that we have no idea what is truly going on in this area in terms of the numbers. And it’s not just my neighborhood- as a whole, Perú lacks detailed information regarding persons who have disabilities.

While I’ve made several personal observations on the types of conditions I’ve encountered in various blog posts, my district of La Esperanza lacks data about the specifics. Which types of disabilities are most common? How many people are affected? What are the needs and resources desired of the persons who have disabilities? ETC!

The good news is, in about 5 months I will have a whole bunch of concrete answers to these questions! Part of my public health project includes the creation of a door-to-door survey for persons with disabilities (and their families) that will cover all 40,000+ homes in my district! It’s a “pilot” study with the potential to be applied around the country. Based on the data from the survey, I’ll be putting together a plan of action that will likely incorporate a combination of treatment and prevention-based components.

Math is definitely not my favorite subject, and I never thought I’d get this pumped about a bunch of numbers. But I’m really excited that I get to be a part of this and can’t wait until the results are in! So stay tuned for more numbers…

Saturday, November 27, 2010

Chan Chan and Las Huacas

Trujillo has a very interesting history, and I decided that it’s about time I touch on this part of the culture (especially since I visited the pictured sites over a month ago!)

The overall history of Peru is fascinating (even for someone who has a short attention span like me) and you can spend hours upon hours reading about it. I’ll spare you the complete details as I’m sure Wikipedia (and my Lonely Planet book) do a much better job. But, some little signs of history you catch in daily life here include
1) The Spanish influence - Spain occupied Peru for several hundred years, beginning in the 1500’s. A significant amount of the food and certain customs/architecture decorating the city of Trujillo reflect this bit of history.
2) Chifa - Chinese food/restaurants everywhere! This is due to a historical immigration and influx of workers, and the food today is more of a hybrid combination of Chinese with the Peruvian and Spanish substitution for some ingredients.
3) Ruinas – Every day that I work at the school, I walk by two different walled in areas that almost blend in with the homes of the residential area. Turns out they are ancient archaelogical sites from the Chimú era- and well preserved too! It’s common to see historical ruins interspersed within close proximity to the more modern culture around Trujillo.

Last month, I got to be a tourist for a day thanks to Shana, Hailey and Marcelle who were visiting.

Our first stop was at the Huacas del sol/de la luna outside of Trujillo. These structures belonged to the Moche, a coastal society of northern Peru who inhabited the land from AD 100-800. The Moche are noted for exquisite pottery and large temple mounds (‘huacas’ or pyramids), and they are still being excavated. While the climate and El Niño have reportedly done quite a bit of damage to these sites, we were still able to enjoy the mural paintings that remain in Huaca de la luna with an interesting guided tour.



Check out the local wild dog that hangs out around the Huacas. It’s called "biringo" – a native Peruvian hairless dog. Traditionally used as body warmer for people with arthritis, this dog has a higher body temp. than average!


Our second stop was at Chan Chan, which was built around AD 1300, covers 36 km, and is the largest adobe city in world and largest pre-Columbian city in the Americas. The 60,000+ inhabitants were from the Chimú empire and were known for gold, silver, and ceramics prior to looting. The sheer size of Chan Chan is incredible. It once consisted of 9 major compounds or cities (but only part of 1 accessible by tourists). It’s a barren area, but with a little imagination and exploration it grows on you.




We ran out of time at the end and didn’t even make it to the other sites that Trujillo has to offer, so there’s definitely more to see – If planning a trip, may want to allow for a few days in the area just to see the historical attractions.

Monday, November 22, 2010

La Esperanza

The paint on the bridge says, “La Esperanza … Estamos trabajando … Estamos Cambiando.” We are working, we are changing. The name of my community, La Esperanza, translates to HOPE in English.


Every Sunday evening when we walk to church, we’re faced with quite the dilemma- To run across the highway (in the dark) or to take the bridge? Cars don’t slow down for pedestrians here… but, there’s a very high likelihood of getting attacked/robbed by taking the bridge. Asi es la vida… So is the daily life in my neighborhood. (I cross at the highway.)

Last week I caught a glimpse into some additional hardships that are faced in La Esperanza. I attended a day of meetings and presentations with some visitors from Lima representing the Peru Ministry of Health and other organizations. At the end of the day, we toured some local facilities and took a drive to Parte Arriba. Parte Arriba is the area of La Esperanza that’s especially notorious for crime and extreme poverty. As we climbed up in elevation, the roads turned from pavement to sand, houses turned from bricks to a mixture of sheet metal and thatched straw. Amenities like electricity, water and bathrooms vanished.


We got out of the cars to take in the view. I was told that just in the last week, there were two separate murders within a block from where we stood. Women and children especially are said to live in constant fear of leaving their homes, even during the day. This level of poverty seemed even steps beyond what I saw in Ethiopia. Perhaps this is because the dirt/sand landscape here in Peru is so barren- at least in the rural areas of Ethiopia, many homes had some sort of crop growing, and everything was much greener. Or, perhaps this is due to the violence- not many people were outside and the atmosphere was a bit eerie.


I half jokingly comment about “hardships” like “showering” in a bucket, or having to buy purified drinking water. But the truth is, I’m living in a nice part of the not so nice neighborhood, and I haven’t even began to know the half of what the poverty is truly like here. If I really want to, all I have to do is take a 20 minute ride to Trujillo for access to a gymnasium and a warm shower. The extremes between Parte Arriba and the other areas I’ve seen are astounding and the experience left me feeling a bit stunned, overwhelmed, and even guilty.

And this is not an isolated phenomenon- More than half of the world live below the internationally defined poverty line - on less than $2/day. How can we effectively combat extreme poverty in places like Parte Arriba, La Esperanza, Peru? And who is "we"- who is taking responsibility?

Saturday, November 20, 2010

Birthdays and Baptisms


I went to my second birthday party today, this time for 4-year-old Elizabeth, the daughter of Antolino and Marie. It also happened to be her baptism day. The celebrations began in the church with birthday blessings and baptisms of about 20 children all at once, and from what I gathered this happens monthly within the parish. (The baptism ceremonies are shorter here - under two minutes - and it appears they are never performed during masses). Afterward, everyone related to the newly baptized lights a candle and carries it to the picture of a decorated saint.


The party after the church ceremony went something like this:
1)   Congregate in a big circle of chairs around the living room with about 35 other people.
2)   Take a shot of red wine from a Dixie cup (ages 2 and up).
3)   Take another shot of red wine (ages 2 and up).
4)   Consume a LARGE heaping plate of food (usually rice, yuca/potatoes and some kind of meat). Successfully refuse seconds (if you’re lucky).
5)   A custom begins- I’ve affectionately named it the “Peruvian Power Hour.” (One glass per 5-10 people. Fill up the glass with beer, shove it in front of someone, watch them chug, then it’s their turn to fill the glass for the next person. Repeat… for one hour, and pray that no-one has mono).
6)   Dancing – powered by very loud sound system.
7)   Peruvian Power Hour #2.
8)   More dancing.
9)   Simultaneous Dancing + Peruvian Power Hours. (Slippery- watch your step!)
10)   Speaking loudly for the two hours that follow until your hearing returns to normal.

The cake custom of the US is hit and miss here- depends on the family. The gifts custom appears less common. But I must say, they know how to party here! It didn’t matter if you’re 90 or 9- everyone seemed to be having a great time!

Saturday, November 13, 2010

Pediatrics and The Onion

                                                                   Fabio is just beginning to walk on his own
One morning a week, I set off walking due north toward what has grown to be the highlight of my week: working with kids at the “Colegio Especial.” It’s a 25 minute walk with plenty of sights (and smells) along the way. I’m discovering more and more that the layout of urbanization here is sort of like an onion - at first glance, neat and pretty, but delve a few layers deep and you may be moved to tears quickly.

I’ve described the city of Trujillo in earlier posts, and at first glance it does seem glamorous and rich compared to where I live, but there are also many people living in poverty alongside the wealthier in the city. Similarly, my neighborhood in La Esperanza has a modern, nicer area around the highway, boasting pharmacies and internet cafes and banks. Walk a few blocks in any direction, though, and the scenery changes pretty quickly.

The same goes for my walk to the school each week. The homes and road conditions, clothing and hygiene, and access to amenities like regular water/plumbing and electricity diminish almost block by block. Some of the kids that attend the school sleep underneath tarps at night. Some don’t have access to a toilet. So, it’s no surprise that school attendance is poor, the kids are frequently ill, and the access to resources like medications and proper adaptive equipment are low.

                                                                                                   Ana Cristina is all smiles every day!

There are over 100 grade-school aged kids attending the school and the most common diagnoses are Cerebral Palsy and Down Syndrome. I was a little nervous about working there at first, as I had no pediatrics experience when I arrived, but I absolutely love the time I get to spend working with the kids. Right now the most frustrating aspects revolve around a lack of financial resources and appropriate care at home. Many of the kids we treat have severe spasticity and or/seizures, but the families can’t afford the appropriate medications. If a kid uses a wheelchair, it’s on loan from the school and it’s generally a very poor fit (as you can see in the pictures- sadly, this is how the kids arrive every single day). And, education aimed at the teachers and families/caregivers regarding home exercises, positioning, etc. generally seems to be ignored. It’s rather common to observe a caregiver other than a parent because in some cases, due to a general lack of cultural acceptance for disabilities, the kids are abandoned when they are born. Nonetheless, they are incredibly resilient and a joy to work with. I’ll try to post more pictures soon!

Saturday, November 6, 2010

Feet, intestines and heart, oh my!

Since my first posting on the food here, I’ve had a number of different new culinary experiences to share. First of all,
Peruana Cosita Importante #7: When in doubt, always ask. (Especially when it comes to food). 

Every week, Monday-Friday, I have lunch with the nuns who live in the convent next to the clinic, who happen to have their own personal chef, Isabel. The typical menu includes some sort of chicken broth soup, and a rice dish with meat or vegetable atop. My first day in Peru, I lifted the soup ladle to find a large white bumpy mass with several stubs- yep, an entire intact chicken foot (a delicacy here). I’ve been able to dodge the bullet in regards to animal feet by selectively serving myself soup, but haven’t been quite as lucky in other areas. The other day I arrived at lunch late to find a plate with my name on it. I was starving and began eating without a thorough look-over. Mushroom stir-fry, I thought. But wow, I’d never quite had anything quite like it, and not necessarily in a good way. Mid-last-bite, one of the nuns walked in the room and asked me how I liked the chicken heart/intestines. Just another day in the life…

But, chicken internal organs aside, I’m really enjoying the food here. Here’s a small listing of some of the highlights:

-Anticuchos → cow heart, marinated and cooked on skewers- fantastic!
-Lomo saltado → beef marinated and served with onions, peppers and rice on a bed of French fries. (see picture)

-Las Frutas → I never realized how much fruit I was missing in my life! Peru boasts a number of unique, colorful fruits. “Tuna” is one of my favorites- spiny on the outside, red and soft in the inside, a cross between the flavor of a pomegranate and raspberry.
-Arroz con leche → Classic dessert of rice, milk, cinnamon, vanilla.
-Cerveza con gaseosa → beer mixed with Coke, sometimes Inca Cola… interesting combination!
-Pescado → This area of Peru is known for it’s fish, and I’ve tried a number of different types of white fish- all fantastic. Below, the “pescado frito” dish that a friend ordered.


My family’s been teaching me how to make some of the local cuisine/beverages:

-Chicho Morado → a delicious purple drink made from maize morado (purple corn) and flavored with cinnamon, lime and pineapple.

-Croquettes de Atún → mixture of tuna fish, onions, tomatoes, egg, flour and spices, served fried.
-Tortillas → Nothing like the Mexican version! We made them with a mixture of broccoli, spices (the Aji here is amazing), shredded chicken, potatoes, butter, milk, and egg, also served fried.
-Mazamorra Morada → a thick jelly-consistency dessert also made from maize morado and mixed with various fruits.
-Marciano → a cross between ice cream and shaved ice, this simple dessert involves mixing mashed fruit such as the lúcuma with milk and sugar and letting it sit in the freezer.

Of course, I’ve also dazzled them with my cooking skills. (HA. HA.) My family’s requested a random assortment of “American food” dishes. So far I’ve introduced them to…

-Lasagna and garlic bread
-Pancakes
-Banana Bread
-Macaroni and Cheese
-Peanut butter
-Cous cous
-Oatmeal chocolate chip cookies

Whenever La Gringa cooks, it somehow turns into a small family reunion. Word travels fast here, especially when all of the extended family live within a two block radius! I’ve begin to double and triple recipes in anticipation ☺

Food is also a common gift brought to the PT clinic. My favorite surprise was a plastic bag full of choclo, ready to eat, from one patient. Choclo is a large type of white corn here that is absolutely amazing (I’m already plotting ways to get mass amounts past customs when I leave.)

But, I think that my favorite aspect of the food here is more of how it’s a centerpiece of family and culture. Every day families come home for a large two-hour (or so) lunch together. Lunch is the biggest meal of the day quantity-wise, as it’s common to skip dinner or have a light “sena” of bread and tea. And no frantic rushing out the door, or scarfing down a sandwich while doing paperwork at lunch - it’s very relaxing. I think we could all use a little more time mid-day to slow down. Think a siesta lunchtime will ever catch on in the US?

Sunday, October 31, 2010

Señor de los Milagros

Señor de Los Milagros, or Lord of Miracles, is a Peruvian cultural tradition I’ve been very fortunate to experience in my first month here. The name originated from the 17th century, where an earthquake destroyed all of Lima but left a mural of Christ (see picture) standing intact. Celebrations occur during various days in the month of October, and the streets are a flourish of purple and white balloons and processions of people following replicas of the painting with song and prayer.


My first experience of the procession occurred at the Colegio Especial (school for children with mental/physical disabilities) that I work at a few days a week. I have to preface this experience by saying that the small courtyard in the middle of Colegio can be quite chaotic, as over 100 grade school aged children attend this school. During recess I dodge balls and other playground equipment, running children, assistive devices, and the occasional vehicle in this space- and there’s usually only one class out there at a time.

That being said, last Tuesday in between patients, I was drawn out into the courtyard by religious music and prayers over a loudspeaker. There in the courtyard sat all of the children and their teachers, surrounding a moveable platform beautifully decorated in purple. It was quiet and calm and incredibly moving. Some students sang along and many participated by either carrying the platform from spot to spot or by contributing flowers to adorn it. I can’t really explain the feeling except to say that it seemed to be a small miracle in itself that there was such a spiritual calmness in the air of what is otherwise a rather disorganized chaos.


My second procession participation occurred later in the week right outside of my house! Every year this particular procession spans the entire district of La Esperanza. It, too, was beautiful and I am moved by the faith of the people here, which seems to be incredibly strong and prioritized, regardless of age- teenagers, children, and adults alike. Apparently, this procession, which occurs throughout Peru, is considered the largest Catholic procession in the world.

Friday, October 29, 2010

POCO a POCO, SE ANDA LEJOS...

My favorite Castellano expression, which roughly means “One step at a time.” Life is definitely slower here. Patience is key. For those of you who know me well, patience and a slow lifestyle are not exactly my strengths. (I can’t help but wonder if part of the reason I am here is for self-improvement in this area!) Well, I hope it works, because my patience is tested on a daily basis!

I have so many ideas for how I want to influence the healthcare system/physical therapy practice here, but it seems like there’s a mountain of obstacles. To do what I envision would involve some serious shifting of cultural norms and standards. So, I will have to learn how to be more patient and accept small successes/changes. Also, it’s important to go about everything humbly- the last thing I want to do is to come off as condescending about the standards of practice here when compared to the US.

This whole experience reminds me constantly of how lucky I am to have been born in the US and to grow up comfortably in the “land of opportunities.” I feel so fortunate to have the PT educational background that I do (not to mention all of the other luxuries I grew up with). Here, PT’s aren’t really respected- the ones in this area go to a technical school but the courses are very basic and their roles seem to be more like a PT tech than anything else. Today I was informed that they are actually mocked here and my profession is considered a job for idiots. Wow, good to know! Apparently the ones in Lima are more highly regarded.

I’ve also learned that there is an organization in Lima that has a yearly conference for PT’s, but it’s really expensive (we are talking several hundred USD per person) which could be a months pay for some! Another obstacle- this time in the form of lack of continuing education, and lack of specialists in the Trujillo area.

But- on a more positive note- I spent my morning working at Chocope Hospital (about 40 minutes north of La Esperanza). It was great to get a glimpse into a hospital setting. The care revolved almost completely around modalities, but the PT’s were fantastic- all very friendly and with a huge hunger to learn. We practiced various joint mobilizations and shared management ideas and fracture management tips. (Fractures are not generally immobilized or operated on here, so there are a lot of ugly long-term consequences.)

The PT’s requested that I organize a monthly course on outpatient conditions- and in return, they’re going to spread the word to other PT’s in this area. Our first course, in a few weeks, is on postural analysis/scoliosis exam and treatment and will be followed with light refreshments and an excursion to hear mariachi music. ☺ I’m really excited for this new development and can see it opening a lot of doors for El Proyecto this year!

Sunday, October 24, 2010

Outpatient Rehab

The first few weeks of work have been a blur! It’s hard to get started as a PT working by yourself- all initial evaluations in the beginning to build up a caseload! (Not to mention, all initial evals in a foreign language, with limited resources!) I’ve put together some documents translated in Spanish- initial eval forms, patient history, versions of functional outcome tools, home exercise plans, etc. to hopefully increase the quality of care and serve as resources for other PT’s here.


For the most part, I haven’t seen anything too crazy in the outpatient clinic. My typical patient is a 30 or 40-something year old mother with low back pain. I’ve also seen a fair share of shoulders, knees and necks. Last week, however, I made my first referral- I had a patient show up at the door doubled over in severe pain, with bilateral pitting edema and a large, hard, pulsating abdominal mass. YIKES! They would not take her into the emergency room until her family had waited in line to pay the cashier in advance.


Some of the biggest challenges so far in the outpatient clinic have been…


1) “Peruvian time.”
Peruana Cosita Importante #6 – “Peruvian time” dictates that late is on time here, and it’s not uncommon to wait several hours for people to show up for meetings, outings, etc. The slower pace is nice in some ways, but can also be frustrating and can completely alter the course of your day.


I’ve tried to keep a schedule with patients but they tend to show up whenever they can or desire. The trend is that the first hour of work, the room is empty, and then everyone shows up at the exact same time- typically 3 or 4 patients ready for treatment while I’m not only in the middle of an eval, but have two other new patient evals waiting! Add a little chaotic arguing about who was there first and… It can get a little overwhelming, especially with the small physical space in the PT room and the fact that there’s no-one else there to help.

2) Lack of patient adherence - this affects home exercise programs, (lack of) lifestyle changes, patient progress and follow-up visits too. Most often the reasons appear to be economic/financial, and of course cultural. Many of my patients are illiterate which poses additional challenges.


3) Expectations about PT – because of previous experiences, many patients express that they expect a passive treatment filled with heat, ultrasound, ESTIM, infrared, and massage for every session. The concepts of regular physical activity and exercises seem relatively foreign within the population.


4) When to say no - As a new volunteer here, I’m constantly bombarded with- oh, can you take a look at me for free? Or, my _______ (insert friend, relative here) has a really bad _______. For my friends from school, this is something we get all the time, right?! But, it’s harder to say no when it’s someone in my host family or the other healthcare professionals I work with… the person who helped me when I was sick, the person who fed me an incredible meal… With the hospitality level so high here, I feel like people are offended when I don’t jump right in to examine them when I’m off-duty. And when it’s one of the nurses I work with saying, “There’s this little boy who can’t walk and his family is simply too poor to pay the 5 soles for therapy...” Where would YOU decide to draw the line?

Friday, October 22, 2010

Exploring Trujillo and Peru Mission


I’d made a few short trips into the “big city” before this past weekend, but they were usually for a quick meal with someone, so I hadn’t really gotten a good feel for Trujillo yet. Saturday I met my friend Jose in town and he gave me a fantastic walking tour, beginning at the Plaza de Armas (picture below). 



Jose works for an organization called “Peru Mission” (www.perumission.org), a facilitator of Christian community development here in Peru. The programs in Trujillo range from group Bible studies, music and medical mission work in clinics to economic development including a microfinance program and a locally-run woodshop.  He gave me a tour of the woodshop and I was completely enthralled by the whole process. They use wood that’s already been cut down for other reasons to create these absolutely incredible looking modern works of art.

 
We also wandered through the large marketplace and shopping area in downtown Trujillo, and Jose helped me get my bearings as many streets look alike here. Trujillo definitely feels a lot more clean, modern, European and safer than La Esperanza, though only 15 minutes away. The big city ambiance is quite the contrast from the outer-lying poor communities- clean paved streets and brightly colored buildings with a mixture of architectural styles, some areas reminisce of the Spanish historical influence in Peru. Trujillo also boasts a lot of modern amenities- hot showers, fancy apartments and restaurants, 2 malls, and even gyms and lap swimming pools! Though we wandered around the “tourist area,” I haven’t seen a single other American here, aside from my friends in Chimbote and Jose.


The highlight of the afternoon, of course, revolved around food. We stopped in at Jose’s favorite place to get a sandwich de pollo- shredded chicken in a bun with sauce and vegetables piled on- fantastic! And then had some dessert – my first taste of Peruvian helado. It had to be the best ice cream I’ve ever had. I’m trying to pace myself with the food for fear of stomach problems but it’s really hard to hold myself back!

Wednesday, October 20, 2010

A Cultural Tidbit

                                        The neighborhood Catholic Church 
 
Peruana Cosita Importante #5: At a Catholic mass here, you only take communion if you’ve committed a really big sin in the previous week. (Let’s just say I learned this the hard way, and of course my host family got a big kick out of it!!)

Enough said…

Saturday, October 16, 2010

5 THINGS TO KEEP ME HUMBLE

Here are five parts of my daily life here that serve as frequent reminders to always strive to be humble:

1) Drinking water
I retract my previous statement about Steri-pens. (Mine stopped working exactly one week after my arrival.) After that, I began drinking boiled tap water, but it was a bit murky and occasionally contained small black worm-like bugs. After that discovery plus a 5-day bout of fevers, vomiting, etc. I’ve succumbed to drinking bottled water. I’m lucky I can afford it- the locals don’t ever drink it.

2) Showers
In the beginning, I prepared myself for the freezing cold shower by doing squats, push-ups, plyometrics, etc. before bolting in and out. My housemates thought I was crazy. However, it’s not hot here yet and the showers still leave me shivering for the rest of the day. So, I’ve given in and now take a bucket shower twice a week, as do the members of my familia. I mix boiled and cold water and use a little plastic cup to dump it over my head!

3) Toilets
A lot of the toilets here don’t have toilet seats, including mine, which makes life interesting. Also, the plumbing systems are such that you dispose of all toilet paper into a bucket next to the toilet instead. But hey, beats the dark night trek to the outhouse in Mexico! :)

4) Garbage
No trash cans here... Just small plastic bags on the countertops that attract bugs. Every day the trash truck comes by, announcing its arrival with a loud clanging bell. People rush outside with their trash from the day before and leave it in the streets. It seems that a lot of it never actually makes it into the truck, as the streets are covered in litter. with accompanying odors, in my neighborhood (less so in Trujillo). (However, random side note, Peruvians take great pride in their sidewalks, and every day they are out there sweeping the dirt aside.)

5) Hand Sanitation
Hand-washing seems optional, and soap even more optional, expensive, and rarely utilized here. I feel like a complete germ-a-phobe carrying around my little hand sanitizer bottle, but it does come in handy, especially at work. With all of the above issues related to sanitation in general, I can’t help but wonder exactly how many of the minor (and major!) health problems here are preventable.

Friday, October 15, 2010

FISIOTERAPIA

The first thing I noticed when I walked into the PT room at the clinic was a skeleton model that had one arm. This one arm was not only on the wrong side of the body, but the scapula protruded from between the 4th and 5th ribs… coming out of the front of the chest cavity! I hoped it was not a bad omen of things to come.

The entire clinic itself is a lot larger than I had expected- over 70 people work there (30 doctors) and it has a 24 hour emergency room. Health professionals from a number of disciplines including gynecology, pediatrics, odontology, trauma, internal medicine, psychology, nutrition and alternative medicine are represented. They’re also are equipped for diagnostic imaging and blood lab work and have a pharmacy on site. It’s a beautiful, clean, facility full of friendly staff!

I was pleasantly surprised to learn upon my arrival that there is actually one PT currently working in the outpatient clinic. However, she is only there 9 hours a week. And, according to the man who is in charge of the Ministry of Health in this area, no full time PT exists in the public sector- serving the poorer individuals- in all of La Esperanza. Nobody!

I learned a lot during my first week of work at the clinic. I am splitting my time between working there, at a school, and on the public health program – “El Proyecto.” Before I get into the details, I just want to say that future commentary on the healthcare system here is by no means meant to incriminate or belittle the practices and culture. Rather, I hope that my observation on cultural differences and their impact on the quality of care will bring light to the challenges that need to be addressed regarding healthcare worldwide.

That being said, I think it’s fair to say that the level of PT here may be compared to the standards of care in the US from many decades ago. Documentation is sparse- one little box in the patient chart listing the day’s treatment, or nothing in the case of a walk-in patient. No evaluation forms, no doctor notes, no daily notes, no insurance paperwork. Definitely no outcome forms, home exercise programs, or even past medical history forms.

Patients here pay the same price regardless of whether they have a doctor referral or not, which is 8-10 soles normally (about $3/visit) or if they see me, only 5 soles since I am a volunteer. $3 sounds great to us, but when you remember that 8 pieces of bread cost 1 sol - 0.33 cents in USD here, it’s not always that affordable. And, if it’s the father of the house who is in for therapy, you’d better believe he is really stressed out – not only is he paying to see me, but he’s out of work due to his injury, and his entire family is depending on him for food. No such thing as worker’s comp here!

Fisioterapistas here go to a technical type of school for 3 years, right after they’ve finished the high school equivalent. There’s one PT program in this area that has about 20 students per year to serve the 1+ million people inhabiting the Trujillo area. Lima has several schools.

Normally I won’t be working at the same time as the other therapist (we have different schedules) but this week she was showing me the ropes, so to speak. The treatment I’ve observed so far includes Infrared, TENS, moist heat, massage, range of motion exercises and PNF’s in supine, and Ultrasound at an intensity of 0.1 w/cm2 (reason = “any higher and the patient may be uncomfortable”). I haven’t observed any initial evaluations yet but was informed that PT’s do not perform special tests; they generally leave the diagnosis for the doctor and stick to modalities for treatment.

Last week I visited one of the two local hospitals in Trujillo and met with some doctors and interns there. One of the doctors informed me that inpatient PT is pretty much unheard of- patients with hip and knee surgeries, for example, receive no post-op rehab and are told by nurses to stay immobile/bedridden for as long as possible after surgery! Yikes… DVT waiting to happen, among other things.

Similar to experiences I’ve had in other countries, I’ve already had a hard time taking this all in. It’s clear that physical therapy in this part of the world lacks evidence-based practice. To confound matters, there is a significant, complete lack of inter-disciplinary communication in outpatient and inpatient care here. I’m planning to incorporate a section of El Proyecto to (delicately, tactfully) attempting to shift the standards with some of these things- whew, good thing I have one year!
If you have any ideas I’d love to hear them, post them here or email me!

Saturday, October 9, 2010

MI CASA ES TU CASA

I’ve been overwhelmed by the amazing hospitality here. On day five I made a switch to a new casa a few blocks from my old one, for various reasons, the most important being that I did not have access to the kitchen at all. Now I’m living with (rough estimate) about 15 people, but I’m not entirely sure because I haven’t met everyone yet and a lot of people come and go. It’s an outdoor design similar to the previous house, but has a bigger living space, a little more privacy, and a lot more safety. I am very grateful for the switch as now I can have meals and use a table to study more regularly! Also, the family is incredible. The mother, Nelly, and her two daughters Karito and Betsy, plus various aunts live in my section of the house. Upstairs are aunts and cousins, and through a connecting door are aunts, cousins and occasionally the father (he works in a fishing town so is only home a few time a week). People are always here and there is always something going on. All of the girls (ages range from 6 to 22) are studying English, so we have “clases” together and in return they help me with my Castellano! Mi familia has been nothing but generous and incredibly helpful and I feel so very grateful.

Peruana Cosita Importante Numero 4: The greeting here is a kiss on one cheek. If you show up to a party or gathering, everyone in the room stands up and forms a line to greet you in this manner, even if there are 30 people in the room!

The friendliness of people on the streets has also been improving. Apparently I am the first white person to visit this neighborhood, let alone live here. At first, I felt like everyone- even the perritos (dogs)!- stared at me. This is my first experience in another country completely away from a group, so the stares took a little more getting used to than I expected. It’s been hard to crack smiles or hellos from most of the people I see on the street, but I’m making some progess, slowly. Peruvians seem to hold a lot of stress of daily hardships in their faces, but once you get to know them, everyone is so friendly. I am hoping that now that I am with a huge family, will be attending the local church, and starting work on Monday, people will associate me with something good and maybe the street vibes will improve. My biggest struggle so far is with lack of exercise- I was hoping to walk every day but I am constantly warned by everyone I meet that it is extremely unsafe, even during the day. However, my “sisters” Karito and Betsy have already asked me to teach exercise and yoga “clases” in the casa, so surely I’ll adapt to new methods of exercise this year.

Thursday, October 7, 2010

La Comida Peruana

Peruvian food is very rich and interesting, and it also varies according to geographical location. Trujillo is known for it’s seafood and ceviche is very popular here. (Sadly I am allergic so will not get to try it). Also, interestingly, “chifa” – Chinese food – is extremely common here.

My taxi driver in Lima told me that the people of Trujillo and the northern region are “really fat.” My first few days in Peru, Antolino said that “I am too skinny, he needs to get me fat” so he was doing his best to feed me constantly, but all he knows how to cook are eggs, so when we didn’t eat eggs, we had “fast-food” from the street. Street food I’ve tried so far includes fried chicken, french fries and salad. Plus mayonnaise- on EVERYTHING. I mean everything.

Peruana Cosita Importante Numero 3: If you don’t pretend to LOVE mayonnaise and treat it as a special luxury and put it on EVERYTHING you eat, people think you are weird.

In general, Peruvians tend to be a bit overweight, and I have yet to see the stark signs of starvation that I noticed in Africa. But, it’s also not nearly close to the level of obesity in America. The street food is generally unhealthy here but is cheap, so similar to the concept of McDonalds in the US, people seem to make choices based on necessity and financial strains that seem to be affecting their health.

My neighborhood has outdoor mercados everywhere. The mercados are fun to explore- they sell everything from brightly colored fruits and vegetables to bins of rice and spices, freshly squeezed juice, sugar cane and fresh coconut, “quick food” stops – tables set up outside around lunchtime, shoes, toys, and car parts. Many people also have small shops in their homes – bodegas - where you can find soda, crackers, candy, phone cards, etc. I’ve found one place that – to my relief – sells pasta! So, when I need a gastrointestinal break, I know where to go.

I’ve been to one supermarket but it’s about an hours commute one way with the public transit from where I am living. I felt like a little kid in a candy store- amazed at all of the familiarity I found (they have soy milk and cereal.. what?!!) But there were also some of my previous staples missing (yup, no mac ‘n cheese). While I enjoyed the options of the large chain, in general I will stick to supporting my neighborhood options. I definitely want to experience as many local foods as possible, and I’ve already purchased a Peruvian cookbook! Plus I enjoy interacting with my community here in La Esperanza in the markets. People here buy a little at a time and seem to utilize the market daily. One stand for bread, another stop for eggs, another for fruit... it’s so simple!
Some of the Peruvian food I’ve tried with the hermanas (nuns) include ensalata mista (beets/potatoes/carrots), chicken, various soups, maize, salad, and tamales. Rice is a staple of the diet here. Also, chicken legs in soup are a delicacy, as I discovered, much to my dismay on my first day! But I will need to braver, as there’s another delicacy here called cuy – guinea pig!

The postres (desserts) are by far my favorite part so far. I’ve tried picarones, which are donut-like fried dough pieces made of pumpkin and topped with a cinnamon syrup. The pastries sold on the street are also delicious. The most popular gaseosa (soda) here is called Inca Cola – kind of a cross between Mountain Dew and Bubble Gum! Very sickly sweet yet strangely addicting- I finished the bottle despite the instant stomach pains it brought on!

Wednesday, October 6, 2010

Initial Impressions

I’ve likened my first impression of my neighborhood to a cross between Mexico and Ethiopia- I know, sounds strange! Everyone here seems to have a cell phone and TV, no matter what their financial situation. The visible poverty seems less than Ethiopia at first glance- less beggars in the streets. The buildings and markets remind me more of Mexico, and Catholicism is most common here, like Mexico. The little mototaxis remind me of what we saw in Africa everywhere. No donkeys pulling carts in the big city here, but lots and lots of homeless dogs, like both places. My neighborhood is notorious for its crime but so far I have not been harassed or felt threatened, but I am cautious and do not venture out alone at night. The brown dirt that lines the streets somehow finds its way into everything, and the road conditions in La Esperanza are poor- watch your step all the time! The homes are unfinished on top, like the ones I saw in Mexico. (In Mexico it was so that you didn’t have to pay taxes on them- maybe the same reasoning here?) A lot of brick and cement exteriors on the houses, and barred doors/windows. The traffic is loud, always sirens and horns blaring. I am about one block from the main road and 5 blocks from the clinic/church. The driving is probably the scariest part, I still hold my breath when I get into a taxi, as I did in Ethiopia, but I suppose I will adjust to the crazy drivers and lack of seatbelts.

The housing situation took some getting used to, but now it feels more like home. It’s an outdoor design – only the bedrooms and kitchen are completely enclosed. I feel very fortunate to have plumbing and electricity! Frigid showers (no exageration) and no bathroom mirror, which means minimal getting ready time for me in the morning! No heating which is not a problem now but could get pretty cold come winter, especially with the holes in my door. There are cucharachas- my least favorite bug- and the little girl in the room next to mine screams for several minutes every time she sees one (and I almost do the same!) My room consists of a short twin bed and a small bedside table, a see-through curtain, and cold dirty floors- no desk, chair, closet. It’s funny the amenities you are so used to in the US– but really, after a few days, I’ve realized that I don’t need them! There are a few things that I still miss, including toilet paper- a rarity here.

Peruana Cosita Importante Numero 2: Glad I packed… slippers (thanks Cathleen!), long underwear, a small mirror (so I don’t develop a uni-brow), a reading light, my yoga mat, and my Steri-pen.

*If you don’t have a Steri-Pen and are an international traveler I highly recommend it! It saves the environment- No need to buy bottled water as the little UV light supposedly kills all the bad stuff. The water tastes a bit funky but so far, no stomach problems!

They say that similar to mourning, you go through different phases when moving to a new country by yourself. The first is a few days period of excitement and awe, followed by a longer period of depression, possibly several weeks, before you adjust. Maybe because I’ve been fortunate to travel a lot before this, my “depression” phase lasted about 5 hours, and now I feel pretty adjusted. I’m so grateful for the hospitality of my host dad and the friendship of Hermana Sandra (she is hilarious!) and the other nuns and hospital staff, who have helped tremendously. They’ve made my transition very smooth and I already feel pretty comfortable in this new culture!

Monday, October 4, 2010

One Long Journey!

First of all, I stand corrected… I had 5 flights, not 4, in over 40 hours to get here… next time I will look at my ticket more closely! Fortunately I only had to lug around the 240 lbs. of baggage and carry-ons during 2 of the 4 stops. It was an exhausting journey, but during my 12 hour layover in Lima I had a chance to get some sleep so I was pretty pumped and energetic by the time I got to Trujillo. It was interesting to see the vibe of the people change over that time… each flight had less and less familiarities (language and otherwise) in the people around me. I already have a few friends in this new place including a cab driver in Lima who informed me “that I will marry a Peruvian before the year is over.” Ha.

I got to practice my Spanish on my last few flights, and also during my 8 hour layover in Mexico City, which improved my confidence. I had a window seat flying into Trujillo and it was awesome to emerge from the clouds and see this brown, barren-looking but very beautiful landscape of mountains and cliffs on the seaside. I’ve never seen anything distinctly like it. After collecting the bags once more, I was promptly greeted by this adorable, energetic nun and her brother, Luis. Everything moved quickly from there- we were shuttled into a tiny car and I learned my first “Cosita Importante” about my new life:

Peruana Cosita Importante Numero 1: Always hold tightly onto something in a moving vehicle, even if you are buckled, or you will get a giant bump on your head. Ouch.

When we arrived at my new casa, it was already dark and we literally threw all the bags at mach-10 pace through the door before congregating inside for introductions. (Apparently not good to stand outside at night in my neighborhood.) My host family consists of mi padre, Antolino, madre Maria and bebe Isabel. However, mom and baby were on vacation so it was me and Antolino to start. He is a traveling salesman from Trujillo. He is also hilarious and talks really fast. I was amazed at how much Spanish I could understand from the nuns at the beginning. However, with my new padre there was a lot of nodding and “Si’s” to who knows what those first few days! He is very talkative and sweet and I’ve already seen every photo in the casa, his extensive collection of antique Peruvian coins and bills, and his DVD collection of Peruvian music/dancing. He gets up before dawn is on the streets all day selling his goods, and sometimes travels to other regions for sales too. He is a hard worker- says he is barely scraping by, which seems evident from his simple lifestyle and sole pair of shoes which are literally falling apart into pieces. He has a huge heart and I’ve already learned a lot about the culture from him.

Wednesday, September 29, 2010

Adios Alaska!

I'M READY!!!
4 checked bags are going to be a pain but hopefully worth it to get some PT supplies down there. We'll see how it goes at Customs...



I have a long trip ahead, starting tomorrow night...

Anchorage-Seattle
3 hour layover
Seattle-Mexico City
8 hour layover
Mexico City-Lima
12 hour layover
Lima-Trujillo!

All in all, 38 hours...ugh. Prayers for a safe journey / bags making it / not getting robbed are very much appreciated :)

A little nervous, especially for finding my housing, and overcoming the initial Spanish language shock. But otherwise really excited! 

Monday, September 27, 2010

Fundraising Results!

First of all, MUCHAS GRACIAS to all of you who have supported me through the last several weeks- financially, through equipment donations, Spanish tutoring, or in any other way. I cannot begin to express my gratitude to the enormous outpouring from my family, friends and parishioners at St. Pat’s.

There’s been so much enthusiasm that a number of individuals have approached me inquiring about sending down short-term volunteers to where I will be working during my year of service. I am not sure about the feasibility of this idea yet, but will update on this in the future!

The fundraising efforts were a huge success. At one weekend of masses, St. Patrick’s Parish contributed $3188 in cash/checks alone! The online donations surpassed my goal of 8,000 at $8,750, thus bringing the total to $11,938.00!!!

I’d specifically like to thank the incredibly gracious gift of one anonymous donor, who has pledged a very large amount to help make this trip possible → I would not have felt financially able to commit to one year without your initiative, I’m very humbled and touched by your contribution, and promise that I won’t let you down!

The equipment donations have also been extremely successful. I’d specifically like to thank:
Eric and Lisa Reimer
Robert McClune, Robin Wahto and UAA Allied Health
Grace who connected me with Michael Friend / Access Alaska
Tom Bruce
Anonymous donor of pediatric equipment
Sports Authority
Alec Kay / United Physical Therapy
Boyd Esplin and Heather Brown / Chugach Physical Therapy
Linda Rose Weppner, Esther Petrie and Providence Hospital

And, the many anonymous donors who left items in my collection box!

Also, my excellent Spanish tutor:
Cecilia Plascencia

I am still blown away by how supportive my community has been with this endeavor. The monetary donations will help tremendously with the aims of improving the access, education and quality of healthcare in the community. The physical donations will provide a solid foundation for fostering evidence-based PT care in the La Esperanza area.

Thursday, September 23, 2010

Lists.. lists.. and more lists!

I’m a list person (this may be an under-statement…), and the last few weeks have been especially full of lists as I get close to departure date. Unfortunately my to-do-before-Peru list seems to just keep growing larger by the day! It’s definitely a lot more work than I expected to get ready for living abroad for one year.
The vaccinations alone are daunting:

-Yellow Fever
-Hepatitis A series
-Hepatitis B series
-Typhoid
-Meningitis
-Polio
-Rabies

Fortunately a recent trip to Africa made this easy and I only had to get one additional vaccine.

I also discover how expensive one year’s worth of medications, just-in-case prescriptions like antibiotics, anti-malaria pills, and over the counter drugs can be. While I’ll be living in a large city it sounds like over-the-counter meds are particularly hard to find, so I stocked up on those. Add in a year’s supply of daily contacts (argh..) and my carry-on is already full!



A trip to REI and some online shopping helped with some other basic items:
-Steri-pen (makes water safe to drink)
-water tablets
-mosquito net
-motion sickness bands for long bus rides
-bug-repellant sleep sack
-waterproof shoes
-water repellant pants
-long underwear (while hot in the summer, most buildings are un-heated year-round)
-camping towel
-mace
-outlet adaptors, convertor
-clothesline
-hidden passport pouch
-locks
-first aid kit
-slash-proof bags (Magellans.com)

I had fun raiding the dollar store for kid toys/games that can be used in therapy… UNO, cards, foam letter, balls, bubbles, crayons/markers, coloring books, etc.

The most time consuming part of my preparations have been in getting documents ready. All passports, photo IDs, licenses, diplomas, immunization records, etc. are recommended to be carried as notarized copies in case originals are lost/stolen.
I’ve also been working on bringing down electronic copies of physical therapy resources I can use, such as:
-patient education materials (in Spanish)
-home exercise program pictures/instructions (in Spanish)
-commonly used outcome tools (in Spanish)
-research articles
-intake/eval forms (in Spanish)

It’s been very time consuming to try and locate all of these materials in Spanish, but I think it will be worthwhile to have some of these things ready in advance.

Lastly, I’ve been trying to get my hands on as many books as possible. Here’s my reading list:
-Half the Sky by Kristof and WuDunn – great read for anyone! Excellent book*
-Where there is no doctor (Donde no hay doctor)
-501 Spanish Verbs
-Lonely Planet- Peru
-1001 Pitfalls in Spanish
-Culture smart: Peru
-Physical Therapy for Children
-Women’s Health in Physical Therapy
-Essentials of Global Community Health

If you have any recommendations for other resources please let me know!

Saturday, September 18, 2010

Orientation Week!

 The countdown is on – less than two weeks to departure, and I just returned from a 5-day orientation session in New York/New Jersey. It was really fun to meet the other volunteers and create some support networks. About half of the other volunteers were also new graduates in their respective fields, which made me feel a little better! There are a number of nurses, one PA, one other PT, one psychologist, one speech pathologist, and one attorney that will be departing soon. Locations include different parts of Africa, Central America and South America. I met a nurse who will be working in a town about 2 hours away from mine, so I’m excited to have someone to travel with on vacation days! J

The highlight of the week involved spending a day in NYC at the headquarters. It just so happened that the board of directors were meeting that day, so we were able to have lunch with them which was a great experience. I got to meet a number of influential leaders, and we also had a guest lecture by Dr. Cahill who is a specialist in infectious diseases. They were filming a TV-based special on the CMMB while we were there, so we even went to the “make-up” room and then had on-screen interviews.

The most memorable part of the day was the tour of the United Nations building. I don’t normally get that excited about tours, but this one was exceptional if you ever get the chance to go. At the end we were able to sit in the room where the UN meets for part of the year – as shown in the photograph (we missed seeing a live meeting by only about 30 minutes!)





The display portion of the tour discussed the roles of the UN, but also included a large presentation on the Millenium Development Goals (MDG) which I thought was fantastic. If you are not familiar with the MDG’s, definitely check them out- this website is a good resource: http://www.un.org/millenniumgoals/

The MDG’s still have a long way to go, and the UN is sometimes criticized about it’s slow progress. As a volunteer at the grassroots level, it’s important to educate oneself about the big picture, to see some of the ideas for solutions to the identified problems, and to understand how we as volunteers can move from simply working in the field to becoming activists and advocates for the root of the problems.

Wednesday, September 15, 2010

What is the CMMB?

The Catholic Medical Mission Board is a non-profit organization that began its work in 1912 and was officially founded in 1928. The CMMB Mission reads, “Rooted in the healing ministry of Jesus, CMMB works collaboratively to provide quality healthcare programs and services – without discrimination – to people in need around the world.” The organizations’ primary values include social justice, integrity, leadership, accountability, quality collaboration, compassion, courage and risk taking, self-reliance, sustainable development, and building individual and community capacity.

Approximately 98% of the CMMB’s funds go directly to serving those in need, which makes it an excellent non-profit with low administrative costs. The organization has three main focus areas: healthcare programs, medical supply/pharmaceutical donations, and volunteer placement programs such as the one I will be embarking on soon. In 2009, 73 long-term and 475 short-term licensed healthcare professionals served in 27 different countries through the CMMB. In addition, the Healing Help program has distributed over 1 billion dollars worth of pharmaceuticals to over 100 countries since 2005.

I was particularly drawn to this organization because of their non-discriminatory characteristics. The CMMB serves people and communities of all religious backgrounds and beliefs, and likewise accepts volunteers from any type of faith. They accept a number of different types of volunteers, including nurses, MD’s, occupational/speech/physical therapists, psychologists, pharmacists, physician assistants, and people with law, finance or public health backgrounds.

I also like the fact that the organization strives to create self-sustainable programs with long-term impacts. This is such an important piece of improving health needs globally, and it can often be lost on short-term mission trips. A large part of what I will be doing will not simply be working as a PT in a clinic, but as a person striving to solve the root of local health issues in order to create an effective solution program.

I recently attended a lecture by Richard Garfield, who is a professor at Columbia and an expert in public health and the UN data collection. He pointed out that today, we are actually making gains at reducing AIDS, malaria and maternal/infant mortality when it comes to global statistics. However, the latest trend at the forefront of mortality rates in developing nations are turning out to be due to non-communicable diseases… cardiovascular diseases, lung diseases, cancer and diabetes. The number of deaths in children under age 5 are actually decreasing, but the number of deaths in those ages 15-60 are on the rise.

This is not to say that malnutrition, HIV and other issues should not be the aims of humanitarian action. However, we are still not addressing an important piece of the solution. As a PT I’m really excited to be able to try to create a program that will target these preventable non-communicable diseases, but I also know there will be many cultural challenges. In Peru in particular, cigarette smoking is a large contributing factor, and a high amount of disability is caused by motor vehicle crashes and lack of helmet use on motorcycles. Also, interestingly, the body weight of a child is seen as a social indicator of status. A skinny child is viewed as poor, whereas a child who is overweight or obese is considered better off, so the presence of a higher body mass index is actually something that is culturally desired. These are only a handful of the potential factors that may make it difficult to attack these issues from the root of the problem.

I am grateful for the support of the CMMB and for this opportunity to serve through them with the goal of creating sustainable change. I hope that you will continue to support their mission. More information can be found at their website: www.cmmb.org

Tuesday, September 7, 2010

Living SIMPLY!

I think that one of the most challenging yet rewarding aspects of the next year will be in living simply. On a very modest (by American standards) stipend of monthly money for food, I will by no means be “roughing it” but will definitely have to carefully plan what I buy, particularly if I intend to visit some of the other areas including desired trips to Ecuador, Lake Titicaca or Machu Picchu.

Since my return from one month in Africa this spring, I’ve been more and more disgusted with how much waste and excess are present in America. It’s hard to watch reality shows, overhear some people’s ideas of “problems,” or watch people dish out $400 on a Prada bag. Dollar amounts are now translated into miscellaneous quantities… The cost of one month’s rent, one year’s food, etc. in Addis Ababa. The cost of a custom-molded orthotic that changes the ability to walk in a patient who has hemiplegia. The cost of a bus fare to make the trek to the fistula hospital for a woman whose life is threatened during labor/delivery. The trip changed the way I view things, sometimes overwhelmingly, and I found the transition back into American culture significantly harder than the initial culture shock when I first arrived.

I am definitely not trying to say that I am a good model of living simply; I definitely get caught up my own life and drama frequently. As middle to upper class Americans, we are really fortunate to have such an incredibly high quality of life. This should not necessarily constitute guilt every time we do something fun or beyond our basic survival needs, and I’m constantly reminding myself to stop making comparisons to my experiences in Africa and to instead give thanks for my many blessings.

So what would YOU really miss if you were going abroad for a year?

While I consider myself pretty low-maintenance compared to many people I know, I imagine it will nonetheless be a drastic lifestyle change. I don’t watch TV regularly (aside from the occasional LOST or -(guilty pleasure)- Grey’s Anatomy). I don’t particularly enjoy shopping for clothes, and get a rare bi-yearly pedicure if I’m lucky. Not the biggest fan of talking on the phone or text messaging either. I think that the parts of my daily routine that I will miss the most will revolve around using a gym or the outdoors for exercise/running/swimming laps and the possible lack of internet. Of course, I’ll also really miss the food. Specifically, my comfort foods- mac ‘n cheese being one of them. For those of you who know me well, you know to stay away when I’m hungry or haven’t exercised in awhile, so it could get ugly as I’m adjusting! I’ll make a post later on the common cuisine of this area. I know that some forms of gyms exist in Trujillo but I’m not sure if I will have the time, transportation, or money to experience them. (The bigger cities in Peru have a very stark contrast between the facilities available to the upper and lower class.) Plus, I truly want to experience daily life through the eyes of the people I will be serving, which will mean making many sacrifices.

While I will definitely miss these aspects of my current life, I also think I’ll really savor and embrace living more simply in a new culture, which I anticipate to be strongly based on family values and spending time together. This doesn’t mean I won’t occasionally fantasize about giant cheeseburgers, Wifi or elliptical machines!