Monday, June 18, 2012

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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Monday, June 11, 2012

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!!

Sunday, June 10, 2012

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!

Wednesday, June 6, 2012

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. 

Thursday, July 28, 2011

June: Changed for the Better

As the year comes to and end, I’m starting to process what I will take away from this experience. One of the most valuable parts of this program is my team. Partly because we support each other as we learn and grow and struggle; trying to understand the role of a community health center, how to provide quality care, and define what “quality care” really means. But also for the amazing experiences and interests we are able to share with each other as our relationships have developed, as well as learning from each other in the more formal setting of member lead trainings and individual service projects.

I thought this year would simply be a continuation of what I had done previously – working in community health serving the Latino population. But this year I have developed a much greater understanding of the bigger issues, how those are manifested on an individual scale, and I have grown in compassion towards populations I had previously harbored prejudice towards or simply did not recognize, and can now validate the struggles different populations endure.

Member lead trainings on LGBT health disparities made me realize how uncomfortable and unwelcoming something as seemingly small as the way bathrooms are set up in clinics can be, and how simple changes can break down this barrier. It also made me think hard about the needs of this community as it ages and finding safe and appropriate facilities to care for their health. The mental health training made me recognize my own misunderstandings around mental health issues , and tendency to see the disease, and not the person. Another member’s discussion of her time with the People’s Harm Reduction Alliance and the challenges and condescension IV drug users encounter in the medical system made me want my practice to be a safe place for people to receive the medical attention they need and be treated with dignity and respect.

This experience has not just been my own. My time in clinic has helped me value one-on-one interactions and the importance of listening, and my outreach work has awoken my passion for teaching, but the stories of my teammates have made this year that much richer and that much deeper than I ever could have anticipated. I have allowed myself to be challenged and to grow with the support of those around me and I am coming out a more aware and compassionate person on the other end. I am immensely grateful for the people who chose to challenge themselves this year, and walk with me through our struggles to not just serve those in need, but to make greater changes so that those services aren't a necessary fabric of society.

May: Early Disadvantage

Among the various and invaluable services Sea Mar offers are yearly physicals for high school students of migrant families. As part of the outreach team, I went and gave presentations during the Proyecto Saber class while students were pulled for exams. This class in and of itself is a pretty upstream model of education. It provides support for minority students especially in a predominantly white high school, and is also a way for these students get credit retrieval for classes they may have failed and receive enough credits to successfully graduate. Additionally, it offers an opportunity for students to learn more about their native culture. It places value on where these students have come from in a way that is lacking in today’s public school curriculum.

Our outreach team gave each class an option of what topic they wanted to learn about – chronic diseases, nutrition, mental health, tobacco, or sexually transmitted diseases. Each class period felt more like a conversation with peers than a presentation and reminded me that I am not as far removed from my own high school experience as I may have thought. It also made me recognize a little of my own ageist tendencies. These kids are smart! And many of them have experienced more in their 16 years than I have in my 23.

I had one conversation in particular with a student who made me realize how difficult being a teen can be, especially in a migrant family. The icebreaker for the mental heath presentation requires that everyone to share something that causes them stress. This droopy eyed student shared that family problems on top of balancing work and school were stressful. After the presentation he came up to me, asking about the consequences of drinking a lot of energy drinks. As we talked about sugar content, and the trouble with using energy drinks as a supplement or actual sleep, he revealed to me that his dad was recently injured and he was taking over his father’s night shift to support his family. He would go to work around 11pm, work all night long, come home at 7 or 7:30 and sleep for an hour or so, wake up and come to school. He was failing classes, having anger management issues, and only had one friend who helped keep him awake during class, but no one knew the whole story. “I’m a private person, I don’t want people to finding out about this and start talking about me” he told me, reminding me of how vicious rumors can spread in high school.

I talked with him about some of his options – make sure his teachers were on the same page and working with him to accommodate a schedule that allowed him to sleep and do school work, and to make sure to be in touch with the school counselor about his anxiety and anger issues. But I couldn’t help but feel slightly helpless. His family relied on him for survival. He was carrying way more responsibility at 17 than I ever have. And there wasn’t really any way around it. Who else could work? Who could take care of his siblings if his parents were to take a different job? How else could they make money? Who was going to pay the medical bills? These burdens were falling on his shoulders impacting his mental and physical health as well as his social health – the quality of his education and future prospects for job development and breaking the cycle of poverty his family is in.

I am grateful for Proyecto Saber that offers support, the free physicals that Sea Mar provides during school hours, and the school psychologist, but this student’s story exemplifies heartbreaking effects of social determinants of health that inhibit people from being truly and wholly healthy.

May: Culture Shock

A Laotian man sat down at my desk yesterday seeking medication assistance. He is a refugee. He has been living in the United States for about a year, and three months ago "moved" to the South Park neighborhood. I say "moved" because he doesn't really have a home. He has no money and no house, just a friend who would let him stay on his couch, but occasionally will change his mind and throw him out.

He has no money and is trying to manage hypertension and cholesterol. Fortunately his medications are available on the $4 list for some generics, but he can't even afford that. He is plugged in with an Asian Resource Center, but he cannot find work until his health is better. He speaks in a hoarse whisper and doesn't know why he can't speak louder.

As we talked about his inconsistent housing situation, and difficult financial circumstances, he started to talk about life in the United States:

"I am a refugee form Laos. I love America. I am proud to be in America, But in America, you are all by yourself. At 18, you move out of your families house, you are expected to pay for things on your own. You are responsible for yourself. Its different here when you have to pay for things, how you have to pay for things, and who has to pay for them. I'm proud to be an American, but it is a hard life here."

This makes me call into question the individualistic nature of our American culture. We strive for independence from our families, from each other, to make our own story and our own lives. There is social support, but it is created by individuals or some families, not necessarily supported by our societal or governmental structure. Social support and a willingness to help people outside of yourself are values that can be easily lost.

Hearing the story of someone who is deeply struggling to get by shows me how painful this isolation and individualism can be. It helps me better understand the value of community - how it can provide not just social support but can be a tangible resource, a source of sanity, and a vehicle for positive change that everyone deserves be a part of.