We´ve been charged with the insane task of planning and effecting a community health fair for about 300 kids in a suburb near the clinic.
Tomorrow morning.
While we´ve all participated in health fairs before, this time we have one day, zero resources, and a giant gaping culture gap and towering language barrier.
I´ve been scouring the internet and there are hundreds of sites about planning a health fair with helpful tidbits like:
-Call your local chiropracter, have them set up a booth about back care
-Have the american heart association donate stickers, prizes, and posters
-Establish a planning committee of 6-10 members, 6 to 10 months in advance of the fair
-Get the fire department involved in teaching fire safety
-Set up a video screen showing advertisements and tips from local health care organizations
The minimum proposed budget I´ve seen is over $1,000.
Clearly not so relevent to 5 medical student gringas in Requena, Peru.
So I´m going to fill the gap. Tomorrow I´ll post our triumphant guide to "Planning a health fair for kids with no money, resources, and no time."
Unless the whole thing is a stunning failure, in which case it will be "How not to plan a health fair for kids with no money, resources, or time."
Either way we´ll all learn something.
I´m off to buy a basin and soap for our handwashing station. Wish us luck!
Saturday, February 28, 2009
Friday, February 27, 2009
Baby name of the day
Dino Milker.
Anyone who can find an appropriately awesome google image gets double gold stars.
Anyone who can find an appropriately awesome google image gets double gold stars.
Preventable tragedy of the day
Young woman with no prenatal care delivered a six week premature baby with multiple congenital abnormalities as a result of a simple sexually transmitted infection that could have easily been caught and treated with penicillin. Not unique to developing countries, but sad anywhere.
It´s the thought that counts
The family that owns the local restaurant we eat at most days have been promising for a week that they´re going to get us a special present before we leave. Well, yesterday it finally arrived. . .
On the floor behind the table (watching us eat) is. . .
Tomorrow´s lunch. Lucky us!
On the floor behind the table (watching us eat) is. . .
Tomorrow´s lunch. Lucky us!
Carnivale!
The entire month leading up to Ash Wednesday, culminating the Sunday before, is Carnivale. Every Sunday for a little over a month, the country essentially turns into a giant water balloon fight on the streets. In the big city we seemed to be a preferred target, but here we´ve attained a bit of celebrity status, and people are too busy staring and pointing and yelling "Hello! My name is!" (apparently the only English taught in school here) to aim for us.
Anyway, on the very last Sunday, giant posts are decorated with t-shirts, mixing bowls, assorted kitchen utensils, and various other "gifts." These posts are planted in various mud puddles around the city, and the entire day is spent rolling around in the mud, throwing water balloons, painting faces with plant sap, and dancing around the "gift trees." Towards the end of the afternoon, the dancing is interrupted by whacking the tree with a tiny axe five times each until it finally falls over and all the gifts can be collected.
I guess in previous years, the groups from my school have opted not to participate. But we figured we´ve already reached our maximum parasitic capacity anyway, why not roll around in the mud a little? It was a total blast. The kids went crazy smearing mud on us, crushing berries onto our faces. The teenage boys were knocking each other over to be our dance partners. The men kept insisting that we be the ones to chop the tree down at the end.
It took about 7 minutes for someone at the radio station to get word that the gringas were in fact participating in Carnivale and maybe 20 minutes later nearly the entire city was gathered around our tree to throw water on us, dance with us, take pictures, or stand off to the side and giggle.
We already felt pretty well accepted into the community, as much of a spectacle as we are, but since Carnivale it´s like the ice has been completely broken. The kids all know our names now and run after us shouting them. All the nurses in the clinic like to do impressions of us dancing for the 5 people who somehow didn´t see us that day. And of course, we now get special meals prepared for us. . (see next post)
Descriptive Peruvian medical term of the day
Explosiva
A multiparous woman who delivers within minutes of going into labor and/or arriving at the clinic.
Usage: "Hey you! Senorita! Do you have gloves? Get in here, this one´s going to be an explosiva!"
And the end result:
A multiparous woman who delivers within minutes of going into labor and/or arriving at the clinic.
Usage: "Hey you! Senorita! Do you have gloves? Get in here, this one´s going to be an explosiva!"
And the end result:
Thursday, February 26, 2009
Where the world takes you
I was extremely excited for running in Peru, imagining long sunrises by the river and sunsets in the forest. (Although after Israel, any run that doesn´t involve carrying two large rocks in preparation for encountering wild dogs and packs of stone-wielding Bedouin children sounds dreamy at this point. Really any run that doesn´t involove desert would be super).
Unfortunately, we´re such a novelty here that even a casual walk down the street attracts a small army of children and a radio announcement. My friend doesn´t let it stop her, but I just feel too self conscious and obvious to enjoy the run.
As a substitute I´ve started leading yoga classes in the prenatal education room at the clinic. It started out with just the five of us, but has now expanded to include several nurses, secretaries, and technicians (who often come straight in from work in their white lab coats, lacy bras, 15 bracelets, and painted-on jeans and do a remarkable job of keeping up despite my Spanish and despite the fact that they´ve never even heard of yoga.)
The room is dusty, is tucked in between two hospital rooms, hovers around 90 degrees, and is filled with dying cockroaches as well as a giant poster of a uterus. Somehow it´s perfect.
Unfortunately, we´re such a novelty here that even a casual walk down the street attracts a small army of children and a radio announcement. My friend doesn´t let it stop her, but I just feel too self conscious and obvious to enjoy the run.
As a substitute I´ve started leading yoga classes in the prenatal education room at the clinic. It started out with just the five of us, but has now expanded to include several nurses, secretaries, and technicians (who often come straight in from work in their white lab coats, lacy bras, 15 bracelets, and painted-on jeans and do a remarkable job of keeping up despite my Spanish and despite the fact that they´ve never even heard of yoga.)
The room is dusty, is tucked in between two hospital rooms, hovers around 90 degrees, and is filled with dying cockroaches as well as a giant poster of a uterus. Somehow it´s perfect.
Tuesday, February 24, 2009
umm . . .
The nurse I vaccinate with (72 babies yestereday!) has been buzzing all week about her son´s 1 year birthday coming up this Saturday. She checks every day to make sure I´m coming, and has given me not one, but two Strawberry Shortcake invitations as well as a map to the bar (yes, a one year birthday is being held at a bar) hand drawn in sparkly pen.
At the end of the afternoon today, she casually asked if I was going to dance at the birthday party. "Yeah, sure." I said, knowing that 99.9% of social events here (and many regular afternoons) involve a requisite minimum of booty wiggling before the night is through.
"Oh, good!" She jumped up and down. "You can dance and all the kids wíll laugh at you and now I don´t have to get a clown."
And she exited the room.
At the end of the afternoon today, she casually asked if I was going to dance at the birthday party. "Yeah, sure." I said, knowing that 99.9% of social events here (and many regular afternoons) involve a requisite minimum of booty wiggling before the night is through.
"Oh, good!" She jumped up and down. "You can dance and all the kids wíll laugh at you and now I don´t have to get a clown."
And she exited the room.
Sunday, February 22, 2009
Epic cross-cultural misunderstanding
So my friend B frequents a bakery a few doors down from our hostel. She´s there multiple times a day, and the owner has started chatting with her and teaching her about the traditional Peruvian cookies and cakes.
Yesterday was B´s birthday. She mentioned this to the bakery owner, who was very excited and offered to get her a gift. She asked B if she had every heard of some spanish word she had never heard of. B said no. The owner tried to explain, saying that it was little and green and had something to do with the market down by the river. B figured it must be some kind of cookie or food item and was excited when the woman told her to come back this afternoon and she would have one of whatever it was for her.
Afternoon comes, and B heads back to the bakery, hungry. Only to have the woman present her with:
Yes, a baby turtle in a two-liter soda bottle.
"Por una mascota (for a pet)," she explained.
It turned out the bakery owner had actually spent the entire afternoon down by the river in order to catch B a baby turtle. For a pet. B was, well, speechless, and couldn´t quite figure out a polite way to decline.
And that´s the story of our pet baby turtle, Keke. And why it´s probably a good idea to carry a dictionary.
(We initially named her "torta" which means cake in Spanish, appropriate on many levels. But eventually this morphed into Keke, the local Peruvian slang for cake.)
We´d like to release her into the wild, but the scene of 5 gringas carrying a soda bottle full of turtle down to the river is not something that would go unnoticed in this town, and we don´t want to offend the bakery owner.
Yesterday was B´s birthday. She mentioned this to the bakery owner, who was very excited and offered to get her a gift. She asked B if she had every heard of some spanish word she had never heard of. B said no. The owner tried to explain, saying that it was little and green and had something to do with the market down by the river. B figured it must be some kind of cookie or food item and was excited when the woman told her to come back this afternoon and she would have one of whatever it was for her.
Afternoon comes, and B heads back to the bakery, hungry. Only to have the woman present her with:
Yes, a baby turtle in a two-liter soda bottle.
"Por una mascota (for a pet)," she explained.
It turned out the bakery owner had actually spent the entire afternoon down by the river in order to catch B a baby turtle. For a pet. B was, well, speechless, and couldn´t quite figure out a polite way to decline.
And that´s the story of our pet baby turtle, Keke. And why it´s probably a good idea to carry a dictionary.
(We initially named her "torta" which means cake in Spanish, appropriate on many levels. But eventually this morphed into Keke, the local Peruvian slang for cake.)
We´d like to release her into the wild, but the scene of 5 gringas carrying a soda bottle full of turtle down to the river is not something that would go unnoticed in this town, and we don´t want to offend the bakery owner.
Overheard conversation
Roommate 1: What percentage of women here do you think are lactating at this current moment?
Roommate 2 (without pausing to think about it): At least 93.5% At least.
It´s extraordinary. The women here breastfeed while walking down the street, while riding sidesaddle on a motorcycle. While shopping for chickens. While waiting for aerobics class to begin. While in labor with their next child.
I think it´s fantastic, one, that women are breastfeeding only (rates of diarrhea and malnutrition here in the under-two set are close to zero!) and two, that this society allows women to be women and doesn´t shame them into closets and under blankets and into public restroom stalls. Well, American issues are another subject for another time.
But the one that does get to me here is the insistence on latching the babies on right before I vaccinate them. It just seems like an invitation for disaster. No nipple amputations have been witnessed yet, but it makes me cringe a little every time.
Roommate 2 (without pausing to think about it): At least 93.5% At least.
It´s extraordinary. The women here breastfeed while walking down the street, while riding sidesaddle on a motorcycle. While shopping for chickens. While waiting for aerobics class to begin. While in labor with their next child.
I think it´s fantastic, one, that women are breastfeeding only (rates of diarrhea and malnutrition here in the under-two set are close to zero!) and two, that this society allows women to be women and doesn´t shame them into closets and under blankets and into public restroom stalls. Well, American issues are another subject for another time.
But the one that does get to me here is the insistence on latching the babies on right before I vaccinate them. It just seems like an invitation for disaster. No nipple amputations have been witnessed yet, but it makes me cringe a little every time.
Thursday, February 19, 2009
4 years. . .
and $200,000+ of training in international health. . .
and I spent my entire afternoon hand-rolling cotton balls for tommorrow´s vaccination clinic.
The saddest part is that it took us nearly 10 minutes and over 15 attempts before we were able to produce one that didn´t make the nurse nearly fall out of her chair laughing at us.
success!
Wednesday, February 18, 2009
small town
So there is very very little to do in this town. On the radio this morning, we heard the words "cinca gringas de los estados unidos . . ." and perked our ears up. Apparently, the five of us coming to volunteer at the clinic for three weeks is indeed newsworthy. We´ve even been asked to come by the radio station for an interview this weekend. Given the state of our Spanish, we´re not 100% convinced our charm will translate over the radio waves but since there´s nothing else to do on a Saturday afternoon, we just may chance it.
The desk clerk at the hostel is equally enthralled with the novelty of our whiteness. For the first few days she would wander into my room at random intervals and go through my stuff.
"This is a book! In English! You read it? In English? What happens in it? You like to read books? This is a book in English."
"This is your white shirt! For the hospital? You wear it when you work at the clinic? Are you a doctor? Why aren´t you a doctor? Doctors wear white shirts. This shirt is white. For doctors."
This has gotten old so now she sits on the couch and carefully monitors our comings and goings with extraordinary diligence.
"You´re leaving now."
"Oh! You´re back."
"You´re leaving again?"
"Now you´re back!"
She offered to do our laundry for free yesterday. I imagine she´s just curious about our clothes. Or it´s something to do.
Saturday, February 14, 2009
We´ve arrived in Requena
After an epic comedy of errors involving missing the boat to Requena, hiring a cargo boat to take us and try to catch up, frantically waving down the driver, and then boarding the boat with all our boxes of medical supplies and bags of food and backpacks while both boats were still moving, a 12 hour journey that mostly involved every single child on the boat standing in our doorway and staring at us, and just in general making a giant scene, we finally arrived in Requena.
A new friend from the boat invited us over for lunch with his family, who own a "nightclub" (their living room with a stereo, one purple light on the ceiling, and two posters of naked girls on motorcycles). They killed both a chicken and an armadillo for us. Without even knowing it was my anniversary!
There are no ATMs here and cash is limited so I´ll be updating once a week or less. . . happy valentine´s day!
A new friend from the boat invited us over for lunch with his family, who own a "nightclub" (their living room with a stereo, one purple light on the ceiling, and two posters of naked girls on motorcycles). They killed both a chicken and an armadillo for us. Without even knowing it was my anniversary!
There are no ATMs here and cash is limited so I´ll be updating once a week or less. . . happy valentine´s day!
Friday, February 13, 2009
Chief complaint of the day
"My pee tastes sweet."
::no, we didn´t ask why she knows that
::::yes, she did turn out to have a new presentation of diabetes.
::no, we didn´t ask why she knows that
::::yes, she did turn out to have a new presentation of diabetes.
baby name of the day
14 day old two months premature baby girl with a pink bow on her wrist.
Name?
Killer.
Really.
Name?
Killer.
Really.
Wednesday, February 11, 2009
On our way into the floating side of Belen to do home vaccination visits.
Highlight of the day was this conversation:
me: Why are we only giving the women tetanus boosters?
nurse: There are lots of rusty nails here, so there is a high risk of tetanus.
me: Right, but why only the women.
nurse: Because they are weak.
Belen
Today marked day 1 of clinic work in the "floating village" of Belen, the poor suburb of Iquitos. The neighborhood spills into the Amazon, about half consists of floating houses reached by canoe, and the other half are built into the riverbed on stilts.
Reaching the clinic involves walking through about 1/3 of the miles long Belen market which is filled with just about any animal, vegetable, organic or inorganic object you could hope to purchase. Today's special appeared to be turtles.
In the herbal medicine aisle we were offered a free love potion perfume whose smell was astonishingly reminiscent of used diaper. We declined. Although I did try to pursuade my unmarried compatriots to give it a try and let me know how it worked out.
The village is in the midst of a Dengue fever outbreak, not a shocker given the amount of trash, human waste, and puddles of highly questionable water literring the alleys. The government has arranged for trash pickup twice a day but the citizens protested explaining that it's much more convenient to keep throwing trash into the street or river.
This was demonstrated for us when a patient reached past us with an empty juice bag. we stepped aside, assuming he was going for the trash can. Nope, he was reaching past us to throw the bag out the window. It landed on a rooster.
I spent most of the day vaccinating and doing well-baby checks; a fun job assignment no matter what country you're in. They take their vaccinating seriously here. I was instructed to insert the needle all the way up to the hilt every time, even though I had easily penetrated to muscle a good 3-4 cm earlier. Poor bebes.
My friends administered tourniquet tests for hemorrhagic dengue. Basically you take the patient's blood pressure and then reinflate the cuff to 1 1/2 times that amount. The cuff stays inflated for 2 minutes, then you take it off and count the number of petechiae (little red rash spots) that appear. If there are more than 2, the person has a tendency to bleed and is admitted to the hospital. Neat.
Tomorrow we take a canoe trip to some of the water bound villages a bit further away.
Reaching the clinic involves walking through about 1/3 of the miles long Belen market which is filled with just about any animal, vegetable, organic or inorganic object you could hope to purchase. Today's special appeared to be turtles.
In the herbal medicine aisle we were offered a free love potion perfume whose smell was astonishingly reminiscent of used diaper. We declined. Although I did try to pursuade my unmarried compatriots to give it a try and let me know how it worked out.
The village is in the midst of a Dengue fever outbreak, not a shocker given the amount of trash, human waste, and puddles of highly questionable water literring the alleys. The government has arranged for trash pickup twice a day but the citizens protested explaining that it's much more convenient to keep throwing trash into the street or river.
This was demonstrated for us when a patient reached past us with an empty juice bag. we stepped aside, assuming he was going for the trash can. Nope, he was reaching past us to throw the bag out the window. It landed on a rooster.
I spent most of the day vaccinating and doing well-baby checks; a fun job assignment no matter what country you're in. They take their vaccinating seriously here. I was instructed to insert the needle all the way up to the hilt every time, even though I had easily penetrated to muscle a good 3-4 cm earlier. Poor bebes.
My friends administered tourniquet tests for hemorrhagic dengue. Basically you take the patient's blood pressure and then reinflate the cuff to 1 1/2 times that amount. The cuff stays inflated for 2 minutes, then you take it off and count the number of petechiae (little red rash spots) that appear. If there are more than 2, the person has a tendency to bleed and is admitted to the hospital. Neat.
Tomorrow we take a canoe trip to some of the water bound villages a bit further away.
Sunday, February 8, 2009
Luckily I´m trained for this
(courtesy www.toothpastefordinner.com)There´s a cultural norm here that one must be introduced to new people by someone they know who is of equal or higher status than themselves. So I can´t go up to a doctor in the hospital, explain who I am, and start working with them. Instead, the director of the hospital or chief of the department has to officially present me to the doctor, after which all is well and good.
This usually goes fine after the preliminary awkwardness of the formality. Unfortunately on Saturday the peds floor team had just rotated, and none of the doctors I was familiar with were working. I knew the interns and the nurses at least recognized me so I thought it would be no big deal. Wow, so wrong. Since the interns are of "lower" status than the doctors they were powerless to effect a magical introduction for me. And the nurses, having never formally met me, were not open to helping either.
So I show up in the ward and literally everyone ignored me, actively, for over an hour. I made optimistic eye contact with the nurses, they looked right past me. The interns said hi but pretended not to know me as soon as the doctor came around. The doctors absolutely looked right through me, despite the fact that the patients were running up to me for hugs and I clearly knew all of them as well as the interns.
Apparently it´s a tremendous faux pas to introduce yourself to someone and from my friends's experiences it just results in being ignored in a more hostile fashion. So after an hour or so I went home.
Cross-cultural understanding in action!
Saturday, February 7, 2009
Coolness
Apologies times a million for my shameful lack of paintbrush skills. I do have an actual photo but can´t seem to get it to upload, I´ll edit it in later.
A 9 year old on the ward came in with a fractured femur. Lacking any equipment whatsoever, and the family lacking the money to buy splinting materials (in Peru patients are responsible for buying their own supplies if uninsured) the doctors quickly improvised a kick-butt traction splint using a two liter water bottle and some rope. Rendered (poorly) aqui:
So simple, just a loop around the ankle and the other end of the rope tied around the neck of the full water bottle. The water bottle was then hung over the footboard of the bed. Pretty awesome.
A 9 year old on the ward came in with a fractured femur. Lacking any equipment whatsoever, and the family lacking the money to buy splinting materials (in Peru patients are responsible for buying their own supplies if uninsured) the doctors quickly improvised a kick-butt traction splint using a two liter water bottle and some rope. Rendered (poorly) aqui:
So simple, just a loop around the ankle and the other end of the rope tied around the neck of the full water bottle. The water bottle was then hung over the footboard of the bed. Pretty awesome.
Signs in the ward: before and after
Yesterday: Please do not remove the sheets from the hospital.
Today:Please please return the sheets to the hospital.
Today:Please please return the sheets to the hospital.
Friday, February 6, 2009
another winning combination
One of my patients hospitalized for suspected hepatitis got his lab reports back this morning. He now has a new diagnosis of "multiparasitosis" (which should really just be imprinted in the charts, it´s that much of a given.)
His lucky draw?
-Ascaris
-Giardiasis
-Whipworm
-Amoebiasis
-Hookworm
I´m amazed the worms haven´t staged a massive death battle yet; instead they seem to be peacefully coexisting if not actually plotting together to take over this poor kid´s every organ system.
On a personal note, my own roundworm infection is going awesome. I´ve decided to imagine the worms as silent squiggly protecters of my digestive system. This has freed me to eat absolutely whatever I feel like. Street-corner ceviche? Sounds great!
Unwise? Perhaps. But it keeps things interesting.
His lucky draw?
-Ascaris
-Giardiasis
-Whipworm
-Amoebiasis
-Hookworm
I´m amazed the worms haven´t staged a massive death battle yet; instead they seem to be peacefully coexisting if not actually plotting together to take over this poor kid´s every organ system.
On a personal note, my own roundworm infection is going awesome. I´ve decided to imagine the worms as silent squiggly protecters of my digestive system. This has freed me to eat absolutely whatever I feel like. Street-corner ceviche? Sounds great!
Unwise? Perhaps. But it keeps things interesting.
Thursday, February 5, 2009
uh oh?
This morning our hostess came into the kitchen wearing only a towel and filled a mug with sterilized water before heading in to shower. Catching our puzzled looks she explained that it is very very important to wash our lady parts (with a brief mime of how lady-part-washing should occur) with filtered or boiled water, and absolutely not, under any circumstances, with the shower water.
She offered no further explanation and cheerfully skipped off to the bathroom, vagina mug in tow.
So now we´re all wondering exactly what noony-invading parasites lurk in the shower water. And also, if this was so so important, why why why would she wait four weeks to share this it us? And does she use the yellow coffee mug every time?
It all just gets stranger and stranger. Well, I suppose I´m off to wikipedia water-borne loo-loo destroying parasites. . .
babel
Working on a survey of biosafety practices among Peruvian health care workers, I decided to ask google translate for some help. The first question: "have you ever had blood or bodily fluids splashed into your eye?"
Google of course translated this to "Do you always have the blood or body fluids splashing into your eyes?"
I'll be translating the rest by hand.
Google of course translated this to "Do you always have the blood or body fluids splashing into your eyes?"
I'll be translating the rest by hand.
Typical breakfast conversation
Me: How´s your capuccino?
Roommate: (considering her questionably pasteurized beverage) Pretty good, you can hardly taste the brucellosis.
Roommate: (considering her questionably pasteurized beverage) Pretty good, you can hardly taste the brucellosis.
Tuesday, February 3, 2009
Not often seen in America
Now I get it/overseen in the ED x70
So I began my rotation down in the ED mid-last-week. Chatting with the physician one afternoon, I mentioned my interest in tropical medicine and infectious diseases. "Is there anything you're hoping to see while you're here?" he asked.
"Well, I've been here three weeks and I still haven't seen a case of Dengue yet."
The doctor laughed for what felt like 47 minutes, nearly fell out of his chair. Catching his breath, he glanced out the window at the non-stop drizzle (so apparently it rains a fair amount in the rainforest), glanced at his watch and said: "wait 40 seconds."
Sure enough in the next five days I would see literally over 200+ cases of Dengue. Luckily, few are hemorrhagic, and even those are much less dramatic than the textbooks and Discovery Health specials had led me to believe.
It's absolutely endless. I can spot them from a mile off now. The shuffle, the index finger and thumb squeezing the bridge of the nose, eyes covered with a towel or bandana. We do a brief workup: check the urine for blood, check hematocrit, listen the lungs, and take a blood smear for malaria. But most leave with just a painkiller and reassurance.
Many of the patients refuse a workup, simply marching into the triage area and announcing "I have Dengue again." We thank them for letting us know, tell them to take some tylenol, and off they go.
"Well, I've been here three weeks and I still haven't seen a case of Dengue yet."
The doctor laughed for what felt like 47 minutes, nearly fell out of his chair. Catching his breath, he glanced out the window at the non-stop drizzle (so apparently it rains a fair amount in the rainforest), glanced at his watch and said: "wait 40 seconds."
Sure enough in the next five days I would see literally over 200+ cases of Dengue. Luckily, few are hemorrhagic, and even those are much less dramatic than the textbooks and Discovery Health specials had led me to believe.
It's absolutely endless. I can spot them from a mile off now. The shuffle, the index finger and thumb squeezing the bridge of the nose, eyes covered with a towel or bandana. We do a brief workup: check the urine for blood, check hematocrit, listen the lungs, and take a blood smear for malaria. But most leave with just a painkiller and reassurance.
Many of the patients refuse a workup, simply marching into the triage area and announcing "I have Dengue again." We thank them for letting us know, tell them to take some tylenol, and off they go.
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