Oh the awkward

As I mentioned before there is a very strick sort of code of formality here, when it comes to introductions and departures and the like.

One of the tenets is that once you have been introduced to someone you must greet them with a kiss on the cheek at every future chance encounter. This happens when a nurse comes into the room to join rounds in the morning, when the waitress comes over to take your order, when a patient that you´ve met before comes in holding their morning sputum sample, etc.

The unfortunate side effect to having lived in Iquitos for over one month is that there are now a gigantic number of human beings whom we have been formally introduced to and are now prone to run into without warning. Thus while sitting here at "cyber coffee" (which, alas, serves no coffee whatsoever) or while eating lunch with my friends or while attempting to cross the street, out of nowhere I´ll feel a tap on my shoulder and turn just in time to intercept an incoming pair of lips, which often make contact before I´ve even registered who this person is.

The double difficult part is that I´m a softypoof and have no ability to ignore the street kids in the plaza selling gum and begging for food. I usually make polite conversation, occasionally buy them an ice cream in exchange for a pack of gum. This apparently counts for a formal introduction as, in the 35 minutes I´ve been sitting here typing, 4 separate children have run in, kissed me, sloppily, and run out.

Charming. I´m starting to be ready to come home.

Headline of a lifetime

My friends and I were enjoying a gander at the lovely Amazon from a bench in our front yard when a homeless man wandered over, sat down uncomfortably close to us (any closer would have been inside my soul, really), opened a newspaper, and started reading.

So engrossed was he, he was utterly oblivious to our stares of discomfort and casual scooting of our bottoms out from underneath him.

Finally, my friend caught a glimpse of the headline of the article he was reading and very nearly fell off the bench laughing.

It was?

Las vaginas imposibles

Really.

/Also an excellent band name, in my opinion.
//Aren´t they all impossible, when it comes down to it?

But you know

For all my eye-rolling and medical student attitude(previous post) you know the next time I´m anxious I will be sticking a 100% cotton ball in my ear and avoiding computer screens.

Neato!

While searching google for an image of a cotton ball in an ear (re: yesterday´s post). I came across this.

The gist of it:

Of all the health benefits that placing a piece of a cotton ball in the ear does
(by recreating the same pressure that the fetus does when it explores its ear
with its finger) the one which occurs the quickest (in minutes) and in all human
beings who have tried this is the relief of anxiety.

I have multiple favorite parts.

-First is the part about the cotton ball increasing the level of medicines in the bloodstream.

-Second is the reply stating that rayon won´t work, only 100% cotton (sort of makes you question the initial statement that the effect is derived by stimulating pressure receptors in the ear).

-Third is that the radiation from computers negates the cotton´s effects. (Clearly).

- My fourth favorite is the line that it works on "all human beings who have tried." First of all, amazing. I mean, amazing. Second, sad for anxious puppies and bunnies.

Okay, my true favorite part is imagining a fetus exploring its ear with its finger. Which naturally leads me to trying to envision an anxious fetus. (Google image got nothing for me there).

I mean I hate to be a cynic but, really.

//But maybe the all time best part is that three google results down from that result is the link: "How do I remove a piece of a cotton ball stuck in my ear?"

Despite the paucity of resources and the lack of a bright shiny exterior, the little health clinic here really strives to do the best, and most modern, medicine they can.

I therefore find the following ritual absolutely charming.

I noticed on newborn vaccination day that all the brand new mommies come in with cotton balls in their ears. Doubting there was an ongoing epidemic of postpartum otitis, I asked the nurse about it. She answered, as though it was the most obvious thing in the world, "The doctors do it so a cold wind doesn´t come in. Then they get cramps and fever and their body hurts."

Of course.

This is now, that was then

Two nights ago we were woken up and rushed out to the hospital to assist an emergency c-section.

The story was arrest of labor, bordering on 8 hours with no progression.

Now there´s no anesthesiologist in Requena (there aren´t even surgeons, the general practicioners do six months of training to be able to perform emergency appendectomies and c-sections) so all surgeries take place with only an epidural.

After about 4 hours of frantically trying to round up the necessary surgical equipment and an IV catheter (which took close to three hours to find on its own) we were ready to go, only to discover. . .
No lidocaine.

Without lidocaine the insertion of the epidural needle is too painful to be realistic, so there was no way to procceed with the surgery.

We were now approaching 12 hours of stalled labor. The only option was to put the woman on a "fast boat" to Iquitos, the nearest large city. This involves a 4 1/2 hour boat ride, a two hour ambulance ride, and then the inevitable delays in the hospital itself to gather the surgical equipment (which the family has to buy for themselves) and round up a surgical team.

Luckily at this point the baby was like "screw this" and decided to poke his head out and be born the normal way.

All ended well, but for the want of one vial of a medicine that abounds in emergency departments throughout America (the laceration cart at both ERs I spent time at has at minimum 4-5 half used vials in it all the time, we routinely throw away 2-3 vials per shift if they´ve been opened too long), this woman and child were nearly lost.

Last day in Requena

My classmates asked me at lunch how my morning went. My reply: "Completely uneventful."

What actually happened this morning was the following (I continued happily vaccinating, 81 children, all the while):

-A four year old boy wandered into the vaccine room, peed into the trash can, walked out. (With approving mother watching). ((With an actual bathroom literally one door away)).

-A stray dog wandered into the vaccine room and knocked over the now-full-of-pee trash can. Wandered out.

-A woman with a plate of hand made cheese balanced on her head stopped and swatted at the stray pee-covered dog (making contact) then entered the vaccine room and attempted to sell me cheese.

-The nurse tech encouraged me, with syringe in hand, to pause for a second and buy an unwrapped, warm piece of cheese. I considered it, considered Brucellosis, continued vaccinating.

-A three year old girl, eyes wide, grabbed her mother and pulled her into the room. Pointing at me, she asked, "Mom! Is that a gringa?"
"Yes," the mom replied, "You can touch her if you want to."
(No, no. You may not touch me. Vaccine clinic. Not a gringa petting zoo.)


Overall an uneventful morning. And a beautiful Requenalicious last day. I´ll miss you little town.

Kid´s Health Fair!

So we actually pulled it off. . . a boom box, several gallons of "yellow cola" flavored kool-aid, a sphygmomanometer, an entire neighborhood of assorted children, and a budget of $35.

What we learned:

1. Be prepared

We advertised not at all, figuring that we were a big enough scene in our whiteness to draw a crowd without help. We bought enough cake and bread for about 300 kids, imagining that there were about 150 or so in the immediate neighborhood and a few more would wander over.

This is the sight that greeted us in the morning. (That would be the sight of a room full of 350+ kids, silently waiting to be entertained).

We quickly scrapped our initial ambitious plan with lots of individual activities and healthcare topics for a looser plan of large group games and simply keeping the kids entertained for a few hours and throwing in some education where we could.

2. Use what you got

Our activities included "fishing" little plastic toys out of bowls of water, bowling with a ball of socks and empty water bottles, throwing a soccer ball into a laundry hamper, and a ring toss with large water bottles and rolls of masking tape.

Elizabeth demonstrating the ring toss

All cheap, available pretty much anywhere, and kept the kids entertained for more than two hours.

3. Have something for the parents

We made a poster about high blood pressure and did free blood pressure checks. Simple, useful, gives us some health care worker cred, and helps get the adults in the community involved.

4. Choose one theme

We went in way too optimistic. We wanted to cover crossing the street, dental care, person hygiene, good nutrition, parts of the body. . . we had a page long list of topics to cover. With just five of us, the age range, the language issue, and that many kids, it would have been insanity.

Instead we settled on hand-washing as the theme of the day. We made a poster, talked about it in the morning when they were all sitting and then we asked them questions about hygiene for prizes in between games. Later, they all had to show us good handwashing skills before the snack.

5. Embrace chaos

Baby in the "bowling" lane

Kids are kids.

6. Give out stickers

I can´t emphasize this one enough.

Kids go nuts for stickers.

Sound advice

A large "health and safety" poster hangs above the doctor´s desk. It includes loads of helpful tips (with delightful illustrations).

Some are great:
-Wash your hands before you eat.
-Look both ways when crossing the street.
-Don´t go to the bathroom inside your home and then eat there.
-Don´t drink water that is contaminated with poop.

Some are on the obvious side:
-Don´t look directly at the sun
-Don´t pet dogs that often bite people

And my all time favorite:
-Don´t squeeze lemon juice into your eyes.

Excellent, excellent advice poster.

A little disturbing

We spent the afternoon at a one-year birthday party. Among the clown-filled and generally creepy festivities was a dance contest. All contestants were female and 6 or 7 years old. The videos are sideways, but I think you get the general idea. All the moms clapped and smiled. My friend and I did our best to keep our faces neutral. I imagined that Peruvians were born with world-class booty shaking ability, apparently it´s the result of years of training.