An International Event is Born!

This story begins some time ago… about ten months ago, to be exact. In my first few weeks here in Peru, one of the doctors at the clinic I work at invited me out to see a hospital in Chocope, a small town about an hour from Trujillo. In a few hours, despite my broken Spanish, I got to know a great group of PT’s in Hospital Chocope – I was able to observe how they practiced, share ideas and patient treatments, and teach some basic manual therapy principles and techniques. As I was leaving, the PT’s asked me if I’d be willing to teach a course on scoliosis in a few weeks for a small group of 5 people. Next thing I knew, the day of the course arrived – and there was standing room only! I stared out like a deer in the headlights at the 40+ crowd of PT’s who had shown up for the lecture!

I was amazed at the interest in continuing education. I was getting requests from all angles to teach, despite the language barrier. I soon discovered that PT’s in the north of Peru have very few continuing education opportunities, and employers don’t have any sort of requirements. Furthermore, work in a variety of settings was showing me that the foundational education received by PT’s/aids here was very basic and focused on modalities and passive treatment. I decided to teach a course of varying themes once-twice a month in different local hospitals.

Since the first lecture back in October, it’s been much of a snowball effect. I’ve taught 13 different classes in a variety of themes and locations– some of which had labs. I’ll never forget a lecture I did on postural analysis where 125 people showed up! It was intimidating at first but I found it was a lot less nerve-wracking to speak in front of people in Spanish – I was so busy trying to say everything correctly that I “forgot” to be nervous! I also found that by March I could teach the classes without reading off any notes, which was encouraging.

Practicing techniques in one of the physical therapy courses

The prep time was often overwhelming, as on top of work in the clinic, hospital and school each day, in my free time I was constantly creating, translating or practicing a different powerpoint. But the rewards were abundant – over time I was able to network with several hundred physical therapists/students and I’ve learned so much about culture in the process, and made some great friends. After a few months (maybe even less time!) I felt that I was being called to plan a bigger event. Fresh out of PT school, I’m certainly no expert in my field.  I connected with some faculty at Regis University and some PT’s I know and the next thing I knew – We’ve had an international event in the works!

Before Peru, the biggest event I’ve ever planned was my friend Loren’s bachelorette party held all over town in my parents motor-home in Anchorage, Alaska. (Which was a hit, by the way!) Needless to say, event planning for 200 participants was a first for me. Event planning in South America is a whole additional dimension. I’ve spent the last 8 months or so in a sort of “conference haze.” It’s been challenging to communicate mainly via email. The to-do lists are endless. In Peru, forget the double-check – you seriously need to quadruple-check everything. The other day I had a phone conversation with a colleague confirming – for the third time in a month- that my group of volunteers could tour her facility when they are here. At the end of the call, she said, “okay, we’ll be in touch, I’ll confirm the visit later.” There’s also been a lot of “red tape” to get through – official approval from so and so, official letters and stamps, etc.

Luckily, I’ve had the help of Claudia Llanten who is CMMB’s program director for Peru – without her this all would not be possible. I also started meeting regularly with “focus groups” of PT’s in Trujillo and Lima back in January to get a good feel for exactly what Peruvians are looking for in an event like this. I did a survey to gather which conditions are most commonly seen by PT’s in Trujillo, and determined that neck pain and knee arthritis are most frequent on the list – thus our themes for the 2-day conference.

I’m really excited for the event. The 200 spots are nearly paid and full, which I think it pretty great considering we’re in Peru and everything here is last-minute. We’ve rented out three auditoriums in a nice event center in town. We are covering everything from exam (non-existent here) to evidence-based treatment and will also include “labs” in the afternoons to practice skills with actual patients. In efforts to mesh CMMB’s public health work within the event, we’ll also have some guest lectures in the theme of disability, visitors from the Ministry of Health, and a dynamic lunch in small groups. We’re planning another lunch with the academic institutions here to talk about sustainability between Peru and the US/Regis University. We’ll have a reception Saturday night with music and cocktails –something social to bring the PT’s together. We’ll have catering for breaks and a patio of vendors/businesses for participants to explore. We’re giving each participant an embroidered bag complete with conference info. and a DVD of material, plus small rehab equipment that is not normally available here – goniometers, theraband, reflex hammers, tape measure, etc!

I’d like to recognize our extremely generous donors of equipment and/or money:

Dr. Michael Mulligan Memorial Fund
Ola Grimsby Institute
Aureus Medical Group
JOBST
Beth Calder

David Paz & family

Providence PT (Denver, CO): Michele Wesley, Cynthia Molloy, Jessica Winkel, Angie Mueller, Laura Krum

Dennis O’Connell

Chuck Riddle and Rehab Authority (Boise, ID)

Rehab Care

Physiotherapy Associates – Colorado

(Apologies if I missed anyone – some of the packages were un-marked so let me know if you are missing from the list!)

And, of course, everyone at Catholic Medical Mission Board (www.cmmb.org) who have been
an incredible source of moral and financial support from the start.

Also, my physical therapist volunteers who have donated their time and savings to make the event happen:

Alec Kay – Anchorage, Alaska

Ommar Ortuvia – Houston, Texas

Michelle Madron – Houston, Texas

Kristin Carpenter – Boulder, Colorado

Ana Herrera – Lima, Peru

Pedro Rojas – Trujillo, Peru

Pedro Romero – Lima, Peru

And I’m extremely grateful for the bright group of Regis students who are coming down for an “alternative experience” trip to support us:

John Zapanta, Megan Kelly, Jenna Neff, Megan Daly, Erin Carpenter, Laurel Proulx

In addition, a HUGE thanks to Nancy Mulligan at Regis for all of her countless hours in helping organize the group and event.

Laslty, our official event sponsors - Regis University, Perú Ministry of Health, Colegio Tecnólogo Médico Consejo Regional V, Universidad ALAS Peruanas, CMMB and Las Hermanas Del Buen Soccorro who are offering the students lodging and meals.

As I write this, I’m about to get on a bus to head to Lima where I’ll soon meet the Regis group. Our next week will be a whirlwind of visits to hospitals, schools, clinics, rural areas, the Peru Ministry of Health, etc. In addition to tours, we’re planning a screening fair for older adults, an exercise class, home health visits, and of course some down time to explore the great tourist sites around Trujillo. At the end of the week, we all unite together to begin the conference. I've learned so much from this entire process and though it's been a mountain of work it's also pushed me out of my comfort zone in so many good ways. Thanks again to all who have supported this goal from near and far. I can hardly believe the event is finally here!

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. ;)

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!”

 

 

 

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.

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!

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!

Stop and Smell the AJI

“I didn’t really grow until I learned how others live.” –Ben Sollee

I'm sure I've commented before about how the slowness of the Peruvian culture is simultaneously frustrating yet fantastic. I’ve had to adapt in a number of ways from my prior fast-paced western-culture ways – Here, several hours late is on time, and many aspects of life are not as efficient as could be – tasks that used to take ten minutes in the US can take hours or even days here, between transportation, procedures, communication mix-ups, detours, lines, etc.

But, there’s a glorious two-hour lunch here – generally everyone comes home in the middle of the day to eat with family, and lunch is the biggest meal of the day. And, at night, we sit around with a lighter fare- usually coffee and something small – and often stay around the dinner table talking for hours.

It’s a nice change from life as I knew it in the US. We get so caught up in rushing from point A to B to C to D throughout our daily lives – and how much of it really matters? Why are we okay with spending hours each day in our cars alone, yet unable to set aside more than 20 minutes for a rushed meal (often not even together)?

I’m still super busy as far as work goes here, but my spare time feels different – full of aimless but very enjoyable moments “doing nothing” with the people I am close to. In the book “Eat, Love, Pray” Gilbert talks about the joy of doing nothing. It’s something I’ve come to really savor about this culture. In fact, I feel like Perú is my own personal secluded island - it transforms me into a place where stress is all relative and I mostly just feel calm contentedness. (Okay, maybe the opposite of secluded, but you know what I mean).

I would even go as far as to say that my Peruvian island is slowly sucking the type A personality out of me. Really, you don’t believe me?! Exhibit A: walking speed. Just ask my sister- it drove her nuts that I was walking so slowly when she came down to visit... I now generally amble about, true to Peruvian style. Another example, I don’t stress out when I don’t have time to exercise as normally as I’d like – I’ve long ago accepted that with long work hours and few places to safely exercise, this one I’ll take for the team for a year. (Exhibit B: rice baby.)

Speaking of eating, I’m starting to panic as I realize that in 3 months I will have to do without my top ten Peruvian foods (to be announced- stay posted). At the top of my list - anyone who’s ever tried Peruvian cooking knows that aji (a concentrated liquid of hot pepper) is a staple to the diet – and it’s delicious. Peruvians take a great deal of (justifiable) pride in their Aji. I’m proud to say that I can now tolerate a moderate to strong blend of aji without batting an eye! (Another step closer in operation: become Peruvian).

Beyond the incredible culinary impact, I hope that this taste of how others live that’s led to so much personal growth will stick with me long after my time in Peru is gone. I think we could all use a little time to “stop and smell the aji”… What do you think?

(PS: visitors still encouraged!)