Just another day at "work"...

Monday I went to Huilloc to do a formal door-to-door community needs assessment. Unfortunately I had decided not to bring my camera, which is a shame because there were so many surreal and beautiful moments as I wandered through this rural community.

Amy, a Sacred Valley Health volunteer, and I were tasked by Leticia, the SVH nurse, to climb up the hill (mountain rather) that this community sits on to find the promotora named Teresa to help us do the questionaire and serve as our Quechua interpreter. As we started our journey up the steep hilside, we asked whoever we could find where Teresa Echami lived. They would just chuckle a little at the out of breath Gringas and point up the mountain and say "Arrrrrriba arriba" - waaaaay up there. So we kept on trucking. We would be stopped occassionally by the few other people traveling along the foot path who wanted to figure out what we were doing up in the mountains. One man was clearly drunk or high on cocoa leaves and was making no sense at all. Amy and I chuckled to ourselves as we tried to make sense of his incomplete Spanish/Quechua questions.

We got to the top of one hill to discover a makeshift soccerfield in the middle of the mountain, set just in front of another dauntly steep slope with even more houses nestled on top.  Asking again, people pointed to a house at the top of this peak to indicate where we should go. So we trecked on. Finally, huffing and puffing, we made it to the top. As we paused to catch our breath, we turned around and were in awe at the way Huilloc layed out below us. Our magical and literally breathtakingly difficult 1.5 hour climb allowed us an incredible view of the slowly climbing valley and distant glaciers. If only I had remembered my camera....

We turned around to find two darling little girls gawking at us. We asked if they knew where Teresa lived, and the just looked at us saying the two Quechua works I know "ari" - yes, and "mana" - no.  We wandered a little further only to stumble upon a group of women sitting amidst piles of "Paja" - hay, and "papas" - potatoes - layed out on blankets. A beautiful image of how these women spend their days.  They confirmed that the two little girls belonged to Teresa, but that she was infact off with her "burro" - donkey - for the day.

So we tried to take advantage of what time we had left to talk to these people so high up in the Huilloc community. We interviewed some of these women in broken Spanish on both ends.  Then continued around the slope to find a few more hidden houses. We walked up to each yelling "Compañera?" until someone would emerge to talk to us.  A cute 17 year old girl helped us ask her mom questions, then accompanied us to two of her neighbor's houses to interpret for us.  At one house, we were invited into the field outside their house. The woman of the house layed down a blanket for us to sit on while we chatted, which I was grateful for since the "yard" was essentially a field filled with pellets of goat poop. Her husband was clearly drunk (confirmed by his wife), and was super funny and very adamantly told us that he was very healthy and has no health problems when we asked about what health concerns affect men in the community.

We bid our young friend/interpreter goodbye and started down the mountain taking in the sites and pickin up an interview or two on the way. As we went down, it realized how incredibly high we were. When we headed the slope below the soccer field, we had to stop for a pack of llamas and alpacas heading up the hill at us. Gorgeous.  We made it down and met up with leticia and headed back to town, to compile the data we collected, but the incredible day and intimate look into the lives of the people in Huilloc stuck with me.

Medical Campaign

Last Thursday through Saturday I was able to tag along on a medical brigade with the NGO I'm working with, which took me into the super isolated communities in this mountains. It took 3 hours by Combi (van turned into a little bus) to get to some of these places that are towns of no more than 70 to 100 people. They mostly speak Quechua - very few people speak Spanish.  They have no way to get anywhere besides walking (which they will, for endless hours to get to town), live off of what they grow themselves (which is primarily potatoes), and have virtually no access to health care of any kind. They are beautiful people and live in the gorgeous puna (dry high hills).  These communities are at 13,000 feet or higher. We would set up our make shift clinic in the school and my job was mostly to take social histories and chief complaint information. It was incredible to hear these people’s stories. Most of the ailments were backaches from hard labor either working in the fields or as porters on the inca trail (the trail tourists can hike fro three days to get up to Macchu Picchu), dental pain, headaches, and “la gripe” – which is anything from a head cold to the flu. In one community we saw quite a bit of alcohol use on the part of the men, and unfortunately that seemed to coinced with a lot of domestic violence.  One woman was even suffering from epilepsy, which may have been related to many things – being beaten by her drunk husband, syphilis, cycsticercosis, something related to her drastically low blood pressure – but she had no money to go into town to get a full work up, so there wasn’t really much we could do for her.

But it wasn’t all sad. I took a break when we were in a community called Kelccanka to play soccer with some little boys, but I tried for all of 5 minutes and thought my lungs were going to explode. Damn altitude. Another time, we pulled our two combis over on the side of the road to serve some people working in the fields that couldn’t make it down to the school. The people generously offered us Watia – potatoes cooked in the ground with hot stones – which is their only source of income. It was incredibly generous of them to offer the only thing they had as a thank you for our services. Not to mention how awesome it was to set up a clinic out of two Combis on the side of a mountain.  

The campaign was a great introduction to the way the way of life in the Sacred Valley, but also a bit heart breaking. We just kept uncovering more and more problems that need solutions much bigger than I could ever solve and need a lot more buy in from the government, whose support is virtually absent in these communities. Coincidentally I’m reading “Healing of America” which is an exploration of different health systems around the world and how they came to be. It makes me think not only about what would be required to get health care coverage and services to the people out in small communities like Yanamayo compared to what it would take for the United States to finally change to a health care system that also cared for those who don't have access to health care. 

Yanamayo

Yanamayo

Little girls in Yanamayo

The Puna on our way to Kelccanka

Watia in Kelccanka

Kelccanka 

Sitting on Chicken Crates in Open Top Cargo Trucks

I've spent the last four days exploring the smaller communities high in the Andes.

Wednesday I me the spanish/quechua speaking nurse that works with Sacred Valley Health (the non-profit I'm partnering with here in Ollanta) named Leticia. We were supposed to go up to a village called Huilloc about 45 minutes up the mountain by car to talk with the president of the community and the two elected promotas to get an interview and ask about their take on the health status of their community. We tried to find a Combi - essentially a mini van converted into a little bus - but they usually leave around 7:30 am and we didn't get our butts in gear until 9:30.

 Because we had missed all the Combis, we decided to wait and see who was driving up the mountain that day. After about an hour, we were at the point of giving up and walked back down the road, but Leticia flagged down a big open back truck to ask where they were headed. Before I knew it I was climbing a ladder into the back of this HUGE cargo truck full of produce, crates, and people headed up the hill to sell what they had harvested that day.  After a few minutes I realized that the crate I had perched myself on was chirping and the one next to me was oinking. The folks in the back of the truck just kept smiling at the two Gringa's who'd just joined their party (me and Amy, another SVH volunteer)  and telling Amy - who has golden blond hair - that they wanted their son to marry her. Men were sitting on the top of the wooden walls keeping us all contained and had to duck occasionally for tree branches, and two babies just laid sprawled on the sacks of produce. We arrived at Huilloc only to find that the two promoters were working in the Chakra (fields), but were able to talk to the nurse at the seldom used Posta (government clinic), and we tracked down the community president. With no phones and only the radio to commentate, it's pretty difficult to connect with people. I think this is the community I'll be doing my project in so I'm excited to go back. Just hopefully with a real seat and a roof over my head...

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oh.my.goodness.so.beautiful

I've arrived safely in Ollantaytumbo, and this might possibly be the most beautiful place I've ever been. It's nestled in the valley between the jagged hills of the Andes looking out at distant snow capped peaks. These are not like our northwest mountains.  They are much more steep and threatening. I'm living at about 9,000 feet which feels better compared to how winded I was getting off the plane in Cuzco at about 12,000.   The hour and a half drive to Ollanta was one of the most breathtaking car rides I've taken. But also the scariest - winding down narrow switchbacks and passing cars at 80 miles an hour...

The town itself is darling with narrow cobblestone streets, and plenty of quaint restaurants for the tourists surrounding a darling little central plaza. School must have just gotten out when I arrived because there were tons of kids running around in uniforms and backpacks. There are two different Incan ruins on the west side of town up in the steep hills that I can hike to once I walk past the edge of town. 

My homestay is going to be interesting. Thankfully I have a nice room all to myself with a little desk complete with Justin Beiber poster among the Incan/Peruvian/Religious paraphernalia.  It's a cute little family. Ana Maria and Margarita (mom and adult daughter) picked me up from the Awamaki office (the non-profit I'm partnering with). The three of us and all my stuff smashed in a little moto-taxi to get home then Ana Maria and made a late lunch as her son and Margarita's husband came home. Ana Maria made Lomo a la Plancha (kind of like carne asada) from the meat that was sitting in a plastic bag on the table, rice that had been in a rice cooker for who knows how long, and "ensalada rusa" - russian salad which is carrots, onions and beats, hopefully cooked but at least pealed - as the flies whirled around us. The kitchen itself is super rustic. They heat the water over an open fire in the corner and there's a hole in the roof for the smoke. Dirt floors. Cats, dogs and rooster running in and out. The Goat bleating outside. Most things are covered with plates or plastic to keep clean and no refrigeration. The food and cocoa leaf tea were really quite good, but I'm crossing my fingers that I don't have diarrhea tomorrow.  I also tried a new fruit that is SUPER tasty... you just pull it apart and it has really sweet white flesh and big black seeds in each of the little fleshy sections.  But I can't remember what they called it...

So I'm truly living in the Campo for the next 7 weeks. Not quite what I expected, but it's pretty awesome.  I meet with the health non-profit people tomorrow to talk more about how my project is going to take shape. Here I go!!

Lima Mini-Vacation

I know it's only been 5 days, but I'm heading to Cuzco/Ollantaytumbo tomorrow and thought I'd post a little update since I'm not sure what internet will be like once I get there. Lima is super dirty and gross. Some of it's neighborhoods are alright, but I'm glad I was only here for four days. Every day has been gray and gloomy. I'm excited to get out to the Campo  and breath some fresh air and see some blue sky again. 

Lima Highlights

Quincha House:

I've been staying at this super strange hostel in town. No one is ever here. The guy who showed me my room at 6:30 am on Thursday morning looks very much like a SoCal surfer beach bum:  Tan, bleach blond hair, only wears board shorts, probably late 20's early 30's. I expected him to speak to me in English, but nope, he's definitely Peruvian. I think his mom might live in the basement? It's been nice and very relaxed and safe, but just a little strange.

Random Old People:

Friday I had to spend on my own while my friends from school who are in Lima finished up work, so I walked to some pre-Incan ruins in town. While there I met this super friendly old Peruvian man who mistook me for a Brazilian woman - I have no idea how or why, but I'll take the compliment. He was there with some french friends and they invited me to lunch for authentic Peruvian food and beer after the tour. I had nothing better to do so I went. The french people were super into natural medicine and it came up that I was a medical student, so they talked my ear off about Shakras, and Auras, and Reincarnation and the Curandero (natural healer) that the French man worked with in Ecuador - all in broken french/spanish and some translation through our peruvian friend. I just sat there laughing to myself most of the time because it was so random.

Teenage Cover bands:

In an attempt to like Lima more, my two friends from WWAMI land (the Pullman first year site) wandered all over the city exploring the cooler neighborhoods of Lima. There's not a lot to do here in Miraflores where I've been staying. We ended up in the Barranco neighborhood which we discovered has all the bars and discos. We wandered into a sketchy looking bar that had live music, grabbed some Cuzqueño beers a took a seat in the dark and creepy looking balcony. It must have been some kind of open mic or local band night because we were the only white people there and the band was REALLY bad. Some kind of peruvian grunge. I'm pretty sure everyone in the audience was friends and family of the band members. But THEN these teenagers who couldn't be older than 14 came on and were doing covers of the Red Hot Chili Peppers, Elvis, Cold Play, Green Day and some Spanish pop. It was AWESOME! 

But now my mini vacation is over. Time to head to the Valley and start thinking about my project.  Hopefully I'll find some fun locals or expats to have some adventures with!

Reflections of a Rising MS2

Reflections of a Rising MS2

Erin Cooley, MS1 (MS2 now I suppose), WAFP Student Trustee

My first year of medical school year is over! For all you physicians for whom med school is a distant memory, this is indeed big deal. It marks the consummation of years of arduous academic work, rigorous health volunteer experiences, and serious introspection on my part.  It signals the achievement of a goal I had pursued long and hard.  Of course, I thought the hard part was over when I received the phone call letting me know I’d been accepted to the University of Washington School of Medicine. Ha! This year made it clear I was taking only the first step of a whole new phase of achieving and striving. But with MS 1 behind me, I feel I'm on my way.

For those of you may not remember your first medical school year, let me remind you a little of the whirlwind MS 1 journey. Our year was jumpstarted with gross anatomy “boot camp” that bonded our class unlike any other experience. I struggled with seeing my first dead body in the form of my cadaver and being confronted with the reality of life and death while simultaneously in awe of the intricacies of the biological mechanisms that allow us to exist.  The macroscopic gross anatomy was juxtaposed with the microscopic in histology and biochemistry.   Winter quarter we returned to our cadavers for musculoskeletal anatomy and cell physiology. I was enthralled by all the minuscule innervations and origins and insertion that work together and allow me to walk to my self-assigned seat in the lecture hall. In the spring, neuroscience and microbiology were woven together to give us an understanding of the command center of the body and it’s tenuous relationship with microbes housed both within and outside of ourselves.  Ever time I studied for a final exam I was astounded by the sheer quantity of facts I had mastered, or fit in my brain long enough to pass the exam. I cross my fingers that it’s true when they say all the important things will be repeated over and over and over. Because as fascinating as I found most of the material, I’ll be honest, I barely remember what ventral tegmental area does, or what the tendons that make up the “snuff box” in the wrist are. 

I found the MS1 year difficult for many reasons.  The transition back to the classroom was more challenging than expected after two years of working side by side with patients and providers in clinics.  Not only that, I had to learn to balance my new friends and future colleagues—the people who will truly understand the what the transformation into becoming a doctor entails—with my community and family within Seattle who knew my pre-medical school self to the core.  Then there was the challenge of trying to maintain the “person” parts of me—my interests and passions outside of medicine—while managing to pass my classes and feel confident that I am learning the facts and skills that will make me a good doctor. Thankfully mentors abound in my new environment and they consistently remind me of what I am working towards as well as modeling well-rounded and healthy lives outside of clinic. They remind me of The Big Picture and that keeps me going. 

The Big Picture for me continues to come back to my passion for the underserved and for rectifying the unfortunate realities of our difficult medical system. This passion continued to grow with the stories and experiences my fellow classmates shared with me as well as the patient’s stories I listened to in the hospitals and at my preceptorship. I am grateful for the physicians in the community who have modeled for me the kind of clinical and advocacy and work that I hope to continue in my career as a physician.

The other picture that keeps me motivated is a global one that I hope to recapture as I now head off to South America for my “last summer of freedom.”  Based on a community needs assessment, I will develop a project specifically designed to serve rural communities outside of Cuzco, Peru. The time I spent in this area five years ago is what first inspired me to become active for health and social justice as a physician.  I hope to reconnect to my inspiration as well as gain a better understanding of what health care means in a worldwide context. The program that I'll work under is called the Global Health Immersion Program. Interestingly, it underwent an intentional name change from International Health Opportunity Program. The reason for this is that health issues are not international in the sense that we can draw a line between heath concerns in our country and health concerns in other countries. The health concerns plaguing those in Africa or Asia or Latin America all find their way to our back yard.  We cannot separate ourselves from our neighbors.

This fall, as I enter what they say will be the hardest quarter of my undergraduate medical education, I hope that my experiences this summer, and the awe that I felt this first year of classes, will continue to forge me into a truly compassionate and competent physician. I want to be able to hold on to the faces of the people I meet in the rural Andean villages in my head as I memorize the intricate workings of the cardiovascular or reproductive systems.  They will keep me grounded on those late nights of studying.