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 :)

Sunday, March 27, 2011

Sembrando Infancia

This weekend I took a “field trip” out to work with one of CMMB’s more rural projects. Sembrando Infancia works to provide resources for mothers and children within about 300 families in an area called Cambio Puente, just outside of Chimbote (about 2 hours from Trujillo). An impoverished area, Cambio Puente has dirt/sand roads, no running water, and no electricity in many cases. Here, an outhouse is considered a luxury. Geographical distance and financial constraints are large barriers to receiving healthcare in this community. Thus, Sembrando Infancia goes to them. Every few months they conduct a “campaña” within the community, offering free visits with doctors, nurses and other health professionals. They move the location of the campaña each time in order to reach out to more residents.

They also offer regular health education – this time, they had a talk on how to prevent the tropical disease Dengue. Symptoms of Dengue include a fever, head/body aches, and a rash – and the disease can be life-threatening. Dengue is a disease transmitted through mosquitos – with no vaccine available, prevention measures are crucial.

Sembrando Infancia also attacks issues such as hygiene and sanitation – teaching important skills such as hand-washing and safe drinking water practices. For example, they taught residents of Cambio Puente the SODIS system, a method of water purification via ultraviolet rays, which involves hanging clear plastic bottles in the sun. They weigh the children and address issues related to malnutrition. In the last few months they’ve also performed large-scale screenings and treatment for problems such as intestinal parasites and anemia. My friend and fellow CMMB volunteer Cathleen Daly is spending a year working hard with this project and you can read about her work in her blog: (Cathleen, I hope I did you all justice with this short description!)

I had a great experience working with the team for the campaña. We set up a bed and some reed mats on the dirt entry-way of a residents’ home, where I conducted physical therapy assessments for the day. Most of my patients were children, and I saw everything from mild to severe hypotonia, cerebral palsy, hydrocephaly, torticollis, and clubfoot. All of the children were underweight and most had a history of labor complications. My observations continued to note the trend that here in Perú, developmental delays in motor milestones, particularly walking and crawling, are very common.

It was difficult to perform my assessments knowing that these families would not receive much follow-up, and of course a big part of the day revolved around education and practicing home exercises. A big challenge I’ve noticed here is that the families are very hesitant to do home exercises with their children – sometimes it’s the fact that there’s simply little time with job demands and trying to find the next meal. Other times, the cultural attitude seems to be very much a contentedness with dependence on receiving outside care. These parents/caregivers simply think that they don’t have what it takes to do it on their own, even when they are fully capable and we start with very basic exercises. Illiteracy is another complicating factor, but next time I plan on bringing some home exercise handouts that have pictures.

The campaña ended with a child-mom dance party, and each kid went home with bags of a nutrient-rich milk-and-oat beverage. All in all, this physical therapy experience was a great one, and the kids were adorable and a lot of fun to work with. I really enjoyed learning about the strategies and inner workings of a successful public health program.

I head back to Cambio Puente in May for their next campaña – where I hope to also do some home visits of the families I worked with this past weekend. I would say that the health disparities here certainly mirror what I’ve seen closer to “the city” in my own neighborhood of La Esperanza, but I had a great time getting out to “el campo” to learn about a new community and the incredible efforts of its’ leaders to empower the residents with health resources.

Friday, March 25, 2011

N-O: Universal?

I love the Spanish words that don’t need to be translated to English. Unfortunately, there are few that fall into this category, but hey, at least we have “NO!” A big challenge I’ve faced in my work down here is in knowing how and when to say NO to requests. (It’s a lot easier said than done.)

Anyone in healthcare will attest that they are constantly getting bombarded with health questions from people when they’re not working, no matter what continent they’re on. However, I have to say, I’ve never had it quite so intensely as I do here.

The other day I was in the bathroom at a hospital after a meeting, and as I left the stall, a patient cornered me and shoved a bunch of x-ray and MRI reports into my hands. She overhead me talking with the PT’s and wanted me to do an eval right then and there! As I pondered this strangers’ diagnostic imaging amidst this dirty, crowded bathroom, I realized that I am still pretty terrible at saying no to requests.

Peruvians are definitely not shy when it comes to asking for favors. Host family, friends, friends of friends, co-workers (even fellow PT’s), random people on the street… Sometimes it puts me in really awkward positions, such as when clinic staff insist they or their family members be treated for free, or when the surgeon insists that I accommodate some of his patients outside of my schedule, or when one of the nuns show up at my door and my schedule is already jam-packed full of patients for the day. (Is it a sin to say no in this case?) When people show up after hours when I’m about to head home… when people literally show up on my doorstep when I’m not working… when it happens during my weekends… when I have a “meeting” with someone and I arrive to find out he really just wants me to treat a room full of his waiting patients on my lunch break.

Or, once a patient gets a foot in the door, “Hey, my __________ (insert friend or family member here) has these symptoms – what do you think it is?” Or, “Now that you’ve evaluated my back, neck, and knee, can you look at this pain in my finger?” Or, my latest favorite, “I know you’re not supposed to, but can you inject this medicine (holds up vials of liquid steroid) into my spinal canal? Because I just can’t afford to have the doctor do it.” (Well, yeah, I said no to that one….)

I think what makes it so overwhelming is that it’s at a constant high level – it never seems to let up. I open the door to call a patient into the therapy room and have people literally running up to bombard me with requests. Being my own “secretary,” there’s also a constant knock on the door in the middle of my treatment sessions.

What it boils down too is that I’m a sucker and usually end up coming in an hour early and staying a few hours late, and the notion of a 40-hour work week is far from reality. I’ve gotten better about using NO, and trying to stick to the schedule more, but it’s so hard here. Especially when I get the “Senorita, porrrr favorrrr” from the family members of the woman recovering from a stroke - who sit outside my door for hours until I say yes – and even though my schedule is over-booked, I just know that she desperately needs the care to better her quality of life.

It bothers me that I get special attention, treatment or respect, just based on the fact that I’m a foreigner. It frustrates me that there’s the ulterior motive with many people, but at the same time it frustrates me even more that there’s a shortage of access to rehabilitation services here!

Asi es la vida…

Sunday, March 20, 2011

Sandboarding and Surfing!

Sandboarding at Duna Pur Pur
Longboard Championship - Huanchaco Beach

My time here in Perú is definitely not all work... I try to reserve my Sundays for a little R+R. I’ve explored 2 of Perú’s popular tourist adventure sports, and I have to say that I’m pretty hooked on both! Huanchaco is about 30 minutes away from Trujillo and is a popular surf town. Rocky, small beach space and many little local surfer kids who make fun of my (lack of) surfing abilities in Spanish – but still a pleasant surfing experience. I’ve heard the surf is great up north around Mancora but haven’t made it there yet.

Stick around Huanchaco to catch a gorgeous sunset
I highly recommend sand-boarding, although if you are not with a bunch of locals you may want to go with an official company – there have been lots of reports of tourists getting robbed at gunpoint on the sand dunes if they go alone. There are tourist operations for sand-boarding all over Perú (the most popular being down south of Lima in Ica), but of course it’s a lot cheaper to do it on your own.

We rented sand-boards for 15 soles (5 dollars) for the day in El Centro (Trujillo). Hopped on a bus (Santa Cruz station) toward Viru for 3.50 soles one-way ($1.25) and 40 minutes later were dropped off on a dirt road in the country-side, right after the road that turns to Puerto Morin. We walked down the road until we ran into a man with a giant gun, who told us he thought the area we were heading was “forbidden.” That did not deter my host sisters and cousins, so we continued on until we came to a big gate. After 5 minutes of bribing the guy at the door, he let us in (for the price of 5 soles for all of us).

We walked through the farm until we arrived at a giant sand dune surrounded by green farms and with a view of the ocean. It was pretty incredible. I learned a few things very quickly, 1) sand-boarding is pretty slow, you need to find a very steep spot to get any sort of momentum and 2) if you try to turn the board like a snowboard, you will inevitably eat it – just plan to go straight. We had a wonderful time and cooled off with ice cream at Playa Puerto Morin afterward- which is a nice, local-vibes non-touristy beach spot. I’m still digging sand out of my ears, but it was definitely worth it!

Friday, March 11, 2011

Carnaval en Cajamarca!

Last weekend I headed about 6 hours inland for a new taste of Peruvian culture in Cajamarca. Cajamarca is a beautiful town surrounded by mountains, filled with picturesque avenues and known for it’s delicious dairy products – cheese, yogurt, manjar blanco – as well as the ever popular “cuy”(guinea pig).

We arrived at 4:30am and headed straight to a place called “Los Baños del Inca”- a tourist spot that boasts steamy natural hot springs (previously visited by Inca King Atahualpa), private hot tubs, a pool, beautiful gardens, spa services, and ruins. Great (and cheap!) way to warm up for a few hours!

That afternoon we explored a culinary fair and climbed up to the top of Cerro Santa Apolonia for a great (though rainy) view of the city. I finally gave in and tried the cuy for dinner – and let’s just say that I am still not too impressed. May have been the fact that most of my portion was the head of the animal (see picture).

We also got soaked at one point as we explored town- one of Carnaval’s traditions is to dump water (via buckets, hoses, water balloons) on complete strangers! That night we hit the streets around the Plaza de Armas for the start of the festivities – which involved a whole lot of music, dancing, singing and chanting.

The following days’ festivities continued with much of the same, plus extra dosings of water and lots and lots of brightly colored paint! Massive crowds paraded around the streets, grouped in smaller bands, singing songs about carnaval and engaging in rowdy paint and water attacks. Being a bit competitive myself (ahem…) I joined in by dumping cups of red paint on anyone not in our group.

Residents of the homes dumped water and launched balloons from doorways and rooftops. Toward the end, it started to downpour, which did not seem to deter anyone at all (we were already completely drenched anyways). Miraculously my camera made it out alive!

We managed to catch a big parade on the last day before we headed back to reality. It was definitely the rowdiest weekend I’ve had yet, and a bit of unique, glorious Perú culture I will surely never forget.

Tuesday, March 1, 2011

Pilot Study!

Last week we had our pilot study for the survey of persons with disabilities. I created the survey back in December based on a combination of questions similar to those from the US-based National Health Interview Survey for Persons with Disabilities (1995) and from cultural observations/interviews. Fortunately I had a lot of help with translating and getting the correct wording down in Spanish, and we added and subtracted items according to cultural relevance. (For example, “Do you drive?” or questions about scooters/motorized wheelchairs and artificial limbs don’t quite apply here.)

The last several weeks were busy with recruiting participants and training our “Encuestadores” – a group of medical students – to apply the survey. Because the tool is brand new, the purpose of this “practice round” was to make sure the questions were ordered and worded properly – to assess participant understanding and content feedback, and also to assess the ease of use for the volunteers asking the questions. The adult survey is about 40 minutes long and the one for children (caregivers) is about 30 minutes long. I was worried that those interviewed would feel that the survey was too long, but from commentaries afterward it seemed to be fine.

The best part of the afternoon was getting to know the participants – many of whom graciously waited for hours in the heat to participate. We were looking for 15-20 participants and about 50 showed up! Needless to say, we had a large outpouring of support from the community. This is the first survey encountered in Perú that delves beyond simply identifying diagnoses to include in-depth questions about access, functional mobility and quality of life for persons with disabilities. The questions cover areas of the home environment, transportation, social activities, work history, education, social assistance, adaptive equipment, medications, functional mobility, health opinions/actions, etc. It was fun to finally see the tool in action and once we fine-tune it a bit more, we will apply it to Sector Bellavista of La Esperanza (about 17,000 potential homes) in April.