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 :)

Tuesday, July 26, 2011

The Cock Fight

Coliseo de Gallos - Huanchaco
For the last 10 months I’ve been really curious about the Peruvian Pelea de Gallos (cock fight). My host dad raises and fight roosters, and apparently is well known in the community for his success – in fact, they call him, translated, “The one who kills all the others.” The first time I met my host dad, he was standing outside the front door holding a rooster. Apparently he breeds them and gives away baby roosters to good friends for special occasions – which is considered a highly prized gift. 

my host dad is a cock-fighter!
One day I got the tour of his set-up: up on the roof of the house down the street, he raises about 30 roosters for cock fights. This is no easy task - the fighting roosters have a special (expensive!) steroid-like food mix to boost their explosive strength, a special training regimen including spurs in a large sand pit on the roof, and a rest schedule in the days leading up to fights. They even get special “vitamin” injections!

one of my host dad's roosters
The truth is, I didn’t really want to see a rooster die on some bloody battlefield, surrounded by cigar smoke and drunk men shaking fistfuls of soles in the air, in a dust pit in someone’s backyard. But the whole idea of it intrigued me – plus, I thought, it can’t be as gruesome as the bull fight, right?! (Which I have yet to experience).

So, finally, with 2 other gringos and my host sister in tow, I went to the cock fight. My host dad wasn’t on the rooster roster this weekend, but he came along to watch. I was glad we showed up with a few locals- we certainly stood out among the almost 100% male crowd. 

the battlefield
Before the fight, roosters are prepared for battle by taping these 5cm-long needle-looking bones to the back of their legs – which makes is easier to damage opponents. By the time they’re carried to the dirt pit, they look pretty pumped up and ready to fight! They arrange the fights by the weight of each bird. The birds have 6 minutes of fight time before a tie is declared. A rooster wins if his opponent 1) dies, 2) almost dies, or 3) runs away in the other direction when a door is opened at the end. The bounty for winning a cock fight can be several hundred soles – which is about 60-100 bucks – but here, that is a LOT of money for one day’s work! And for big tournaments, one sign boasted a prize of ~1500 dollars - and a free bull!

roosters in action!
making bets
I have to admit, the experience pretty much lived up to my stereotyped expectations. Yes, it was smoky, and yes, the men all had beer. Feathers went flying and the men shouted and shook their fists in the air to make bets. As a whole, I was intrigued by the cultural experience, though I’m not sure my gringo friends (one of whom is a vegetarian) were quite as enthused to be there. Fortunately we only witnessed one rooster die, though many had eyes gouged out and at times it was a bit gory. I certainly won’t be eating any chicken for dinner – at least until tomorrow. ;)

Saturday, July 23, 2011

Lessons Across Cultures

Holy Cross Rumson (soon-to-be) 8th graders, I know you’re on summer break right now, but I really hope you’ll read this!

Yesterday we had a big party with the kids from Colegio Sagrada Familia – the highlight being a ceremony to give the kids their new uniforms! In prior posts I’ve talked about all of the amazing fundraising my pen-pals in New Jersey did this year to support CMMB’s work in Perú. Holy Cross School in Rumson, New Jersey put on a concert to support about 100 kids with disabilities in the community of La Esperanza. (They raised $2,700! Way to go Holy Cross!)

When I assessed the best use of the funds with the Hermanas Del Buen Soccorro, the nuns who run the school, they thought that the kids could really use uniforms. My first impression was – Um, uniforms? The physical therapist in me was already 2 steps ahead, planning dimensions for all of the needed rehab. equipment for each patient – new wheelchairs and walkers, orthoses?! Pediatric therapy equipment?! But, uniforms?

However, when I took a few steps back, looking at culture-specific factors I realized how much of an impact something simple like clothing can have on a community. The Peruvian culture highly values personal appearance. Kids who attend the other “normal” schools ALL have uniforms – it’s all about pride. Colegio Sagrada Familia functions on the bare minimum of funds and cannot provide the kids with uniforms. Most of the kids, who live in a very poor neighborhood, show up wearing the same clothes – often dirty and unsuited for the climate - each day. Furthermore, if we use the funds to serve ten kids vs. 100, how is that bringing the community – complete with physical and mental disabilities - together?

In the end it all worked out; an anonymous donor from Alaska sent down wheelchair components, so we were able to outfit the kids receiving therapy in better-fitting assistive devices, while also being able to give a uniform to every child. A small local sewing factory that employs women seeking refuge from situations of abuse or violence hand-made the uniforms. Going through a smaller company caused a delay in the production, but was a great way to put the money directly into the community on the grassroot level.

Yesterday, I was able to soak in the school and community impact of the donations. Hundreds of people - students and family members – came to the auditorium for the party. I gave a speech on the mission of CMMB and some information about the students at Holy Cross Rumson and their fundraising efforts. Games followed – dancing, relay races, the mummy contest, partner games, and of course (true to Peruvian style) – more dancing. No Peruvian event is complete without food – so we served tamales and juice, handing out the uniforms at the end.

Throughout the entire event, I felt overwhelmed with emotion. It was obvious that the party was a great way to bring the families together – an important rare form of peer support in this culture for parents and siblings of kids who have disabilities. Students and their parents alike were coming up to me, sharing their stories, their gratitude and giving lots of hugs. And the kids had a blast!

I simply cannot say it enough - THANK YOU Holy Cross Rumson for your incredible commitment to supporting CMMB and children with disabilities. On a personal level, you also taught me lessons about community and culture – and the importance of attending to a community’s desires vs. my own outside assessment of what I think they need. I hope that in the future, we’ll witness a sustainable relationship based on cross-cultural awareness and support between New Jersey and La Esperanza. The kids, families and teachers from Colegio Sagrada Familia want me to pass on their “Saludos” and a big “Muchas Gracias por todo!”

Friday, July 15, 2011

Parasite Care Package!

Blastocystis Hominis
Blogger disclaimer: If you get grossed out easily, you may not want to read this. Sorry if this is “TMI!”

As medical practitioners, we spend a lot of time focused on the health of others and often not as much attention to our own bodies. I know I am a terrible patient and I hate going to the doctor (not to mention, the Peruvian doctor, who usually just tells me I am a gringa and therefore I have a weak stomach and just need to ride it out). We all know that I can be a big hypochondriac, so when I started getting some strange symptoms several months ago, I ignored them and just attributed them to my diet/ laundry detergent.

It all started back in March or so. Stomach problems have been a common part of my life in Peru with the changes in diet, water etc. But I began having more severe problems – diarrhea for days, then severe constipation for days, then nausea and absolutely no appetite for days. It seemed to be cyclical but also a constant- I never felt completely normal. I started having strange skin sensations. Whenever my skin was wet, I’d feel like things were crawling underneath it. (Yeah, I know. Gross.) I tried changes in water sources, water temp (Peruvians insist it’s because I was using the wrong water temp), lotion, shampoo, laundry detergent. Nothing changed it. I’ve been super fatigued, too, no matter how much sleep I get. Finally a friend mentioned parasite testing. Looking at websites I realized I had many of the symptoms:

Diarrhea – check
Nausea – check
Abdominal cramps – check
Bloating – check
Anal itching, worse at night – check, check (disgusting)
Fatigue – check
Itchy ears and nose – check
Pain in back, thighs, shoulder – check
Crawling feeling under skin – check
Forgetfulness – hmm, not sure if it’s any worse than normal
Arthritic pains – it’s strange, I’ve had these weird arthritic-like bouts of knee pain starting 4 months ago - check
Etc etc etc.

Even seeing these websites, I was in denial. But, once work slowed down, I decided to do the tests. One test involves sticking scotch tape to your anus and then putting it (the tape) on a slide. The other is a series of three stool samples. (It’s funny how you can poop all day long, yet when the week comes to give stool samples – nothing! Yep, in constipation phase.) Once my host family got wind of my stool samples, the jokes would not stop. (They are still waiting for me to leave one in the fridge for them! I’m sure that they probably all have some type of parasite themselves – they always have stomach symptoms.)

Anywho, I finally got one sample out and sure enough – positive for parasites. Lovely. Fortunately my wonderful parents have already mailed me a “parasite care package” full of herbal treatments for parasites, because it seems that the antibiotics are not extremely effective. Until then, I’ll try to avoid thinking about what’s crawling around inside me. (Internet pictures DO NOT HELP.)

Never a dull moment… getting another taste of the daily life in a developing country- the good, the bad and the ugly! According to a study done in 2008 entitled “Prevalence of enteroparasites and genotyping of giardia lamblia in Peruvian children,” (Cordón et al.) enteroparasites are extremely common here. In fact, this study was done in my very own neighborhood – La Esperanza, Trujillo! Researchers found that out of 845 children tested, 66.3% had enteroparasites, and nearly half the population – 45.6% - had multiple parasites! Wow. These parasites are strongly tied to poverty – poor hygiene and sanitation in particular. Another –quite personal- reminder of the vast health disparities in this world tied to socioeconomic status.

Saturday, July 9, 2011

The Survey (Por Fin!)

If you haven’t already gathered… Peruvian culture has an interesting juxtaposition of a slow, laid-back lifestyle combined with a unique amount of regulations, red tape and official processes, stamps, logos, fingerprints, certificates… for EVERYTHING. The other day I was at a meeting where we had to stay an hour afterward to submit an official letter to approve the official note taking during the meeting. (What?!) The visa process itself is a whole other story (right, Cathleen?!) And I won’t go into the headache of preparing for an international continuing education conference. Yes, being dropped down into the Latin American culture inevitably will strengthen the patience of any individual who spends much time here. With the combination of a slower daily pace and the necessity of a mountain of official documents, everything just takes that much longer. But it’s good for my character, right?

I’m happy to say that patience with work projects is finally paying off. In November I began a project to create and apply a survey for persons with disabilities. In December the survey was complete. In February we did the pilot study. Last month we presented the survey to a disability committee at the Peru Ministry of Health to gain feedback. And, finally, over the last few weeks, we had the training and then applied the survey, with the help of a group of nursing student volunteers, in Sector Bellavista (pop. ~16,000). Not quite the timeline we had hoped for, but all things considered that’s not too bad for Peru!
resident of Sector Bellavista
The whole process has been an incredible learning experience. We had a lot of preparations – creating a manual for volunteers who will apply the tool, taking photos and making official identification for each volunteer, mapping out each section of the sector, figuring out who will go where and the codes they will use, informed consent. Copies of everything, supplies and snacks, monetary compensation for transportation, etc etc. Not to mention the two-day training of our volunteers. I am so lucky to be working with CMMB’s program coordinator for Peru, who was the driving force behind so much of this project - it definitely would not have happened without her.

We had a number of challenges come up. For one, because the neighborhood is known to be dangerous, our volunteers wanted to go out in pairs, which extended our timeline. Second, last week the sector had an outbreak of Hemorrhagic Dengue, so some of our volunteers were recruited to go out to homes and educate/treat water instead of helping with our survey (and rightfully so!) And third, we had no screening process for volunteers and the students happened to have exams the same week, so thus we encountered some challenges with the motivation of volunteers, their aptitude in administration of the tool and the quality of data received. We had to meticulously check and double-check through each page of each survey for missing information.

Training of our volunteers
Though it was an exhausting process, especially on top of my other clinical work commitments, it was also a nice change of routine. My favorite part was the “field work” – going door to door to identify people with disabilities and administer the survey. The part of the neighborhood that sits at the base of the mountain is an area of significant poverty. It was very humbling to walk around an area where the road is sand, the homes are barely standing with roofs made of flimsy thatched straw, there are no bathrooms nor electricity and the only source of water is a bucket from a vehicle that comes by every morning. The residents of the sector did not hide their shocked surprised to have a gringa wandering around their neighborhood! (Fortunately, my only negative encounter was an angry guard dog – but I fended him off!)

It was absolutely heart-breaking to hear the responses of people surveyed- many who are illiterate, don’t have any idea how old they are, never leave the home, and have little to no access to food, caregivers or healthcare. I encountered many children who looked neglected, and a kid with Down Syndrome who neighbors said had no caregiver the majority of time – I found him standing alone in a pile of sand. Many people interviewed say that they live in fear that either they will be robbed, harmed by gang members, or that the roof will literally collapse on top of them. One report described a 100-year old woman who is blind, unable to walk, hasn’t left the home in years and only receives food twice a week from her daughter who stops by for a few minutes to drop it off. Reading through completed surveys literally brought me to tears. I can’t help but compare cases to patients I’ve had in the US who - with the same exact disability - have a much higher quality of life, simply for socioeconomic reasons. On a more positive note, the residents were really friendly and I enjoyed a new glimpse into the daily life of Peruvians.

resident of Sector Bellavista
We are not through with data entry and will have to wait awhile for all of the results, but it’s clear that we are under the estimates for the national prevalence of disability. We are missing identification of people with disabilities – though it’s not yet clear if our volunteers were mistaken in their definition of disability, have missed houses, or if the residents simply weren’t home when they came by (twice).

While our study itself may have several confounding variables from a statistical standpoint, I still know that the information we receive will be incredibly valuable from a community based rehabilitation perspective. I will soon have answers to questions like - What resources are currently available? What does the community need the most? And what types of resources would they actually use if available? I’ll be using the data to create an intervention plan and now that I’ve gotten to know more people in the sector, I’m even more excited to get to work! From this process, we will also be able to fine-tune certain areas for (hopeful) future application of the survey on a grander scale in Peru.

Someone recently pointed out that I’m receiving a glimpse into so many different levels of the system – the poorest of the poor in their homes, middle class patients coming to the clinic, all the way up to the political level though the Ministry of Health. I’m counting my many blessings here and feel so lucky to be able to be part of these types of sustainable projects!

Wednesday, July 6, 2011

Feliz Cumpleaños!

One of the hardest aspects of living abroad lies in what I’m missing out on back home. For me, I was pretty homesick around Christmas and New Years (though I thoroughly enjoyed experiencing the Peruvian version), and I definitely missed our American Thanksgiving too. I heard an exceptionally loud explosion the other day, which reminded me of fireworks (oh yeah, it’s July 4th)! But generally I don’t feel like I’m missing out on too much – pretty sure the Peruvian calendar has more holidays than ours anyways. However, what I miss the most are family and friends’ birthdays. This week I’m missing two… HAPPY BIRTHDAY GRANDMA (today) and DAD (tomorrow)! I wish I were there to celebrate with you and hope you know I am thinking about you from afar!

My dad and my grandma are two influential people in my life that I admire greatly. My dad was very supportive of my decision to take up this opportunity with CMMB, though I’m sure that inside he must have been worried about having his (not so street-smart) daughter being off across the world by herself! He’s always been extremely supportive of my dreams and is also very talented and intelligent, patient, giving, humble, and organized yet laid back – characteristics that inspire me on a daily basis. Thanks Dad for your constant support and I hope that you have a wonderful birthday!

My grandma is an incredible woman- she is thoughtful, giving and also very active – and you would definitely under-estimate her age. (Hope I got those genes!) She is very driven and has an amazing strength in any obstacle that comes her way. Like my dad, she’s always been a very supportive figure in my life. Happy Birthday Grandma, I miss you, hope you have a fun day!

I really do like birthdays. Not just for the excuse to party – it’s a nice chance to send a person some sort of message or gift reminding them of how much you care about them. In a perfect world, I’d be able to pick up the phone and call everyone I’m close to on his or her birthday – or have time to write a little blog post – but for today, I’ll just say “Salud!” to 2 very important people in my life - and a big belated (or early) FELIZ CUMPLEANOS to the ones I’ve missed (or will miss) out on this year!