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 :)

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
-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?