Una cerveza por favor...

5 May 2011

Happy Cinco de Mayo!  In honor of the occasion, we had Mexican food for lunch.  Of course, every Thursday is Mexican, so that may have just been a coincidence.  They don’t actually celebrate Cinco de Mayo in Peru, you may be surprised to learn.

Yes, that’s right, we are in Peru.  We arrived on Saturday morning and were welcomed by the absolute worst stench I have ever smelled.  We are anchored not at one of the lovely coastal beach towns, but outside the Peruvian Navy Base located in Piata, Peru.  The Navy base, our boat landing zone (BLZ), is home to a large fishing port and squid processing plant.  Fish processing is an odiferous process.  Truly, if the wind is blowing in the wrong direction, it is actually painful to be outside on the ship (which is an 8-10 minute boat ride from the shore).  And the BLZ (where the hospitality boat drops us off to wait for our buses) smells awful 100% of the time.

On Sunday, I was part of the team to set up one of our clinic sites.  The site that was chosen by the ACE team (not sure what it stands for – but it’s the advanced planning team) is a local school in a poor, small town called La Huaca, in the province of Piura, Paita.  La Huaca (pronounced by all of us as La HWAH-CAH! with lots of emphasis on the HWAH) is a desert town with a small river running by it.  Because of that river, they have several rice paddies and can grow sugar cane.  That is their main export. 

The school actually closed for the 12 days that we are here so that we can run the clinic.  So as I mentioned, Sunday was set-up day.  The school is situated in a large, sandy courtyard with several trees in the middle, so there is a good amount of shade.  There is also a nice breeze, so it hasn’t been too hot.  Before we started set-up, we got a quick tour.  The classrooms contained anywhere from 30-40 student desk-chairs (you remember, those, right? from elementary school) and one only slightly larger desk for the teacher.  There were chalkboards on 1-2 walls and basically nothing else in the classrooms – no decorations, pictures, drawings, letters, numbers, or anything.  A couple of the rooms had a crucifix on the teacher’s desk.  Some of the windows had makeshift curtains (usually sheets) to keep some of the glaring sun out. 

I wanted to cry when I saw those classrooms.  I remember when Meghan (my sister) started teaching in San Antonio, and Mom, Dad, and I went to her classroom a few days before school started to decorate.  We plastered the walls and bulletin boards with colorful paper and cutouts to make an inviting, exciting, interesting environment.  We sorted through dozens of boxes of educational toys, games, and books so that the kids would WANT to come to school.  The only decoration in the classrooms here was on the kids’ desk chairs – some of them had their names written on a piece of paper, which the kids had (I assume) decorated, and then the paper was taped to the chair.  Part of our set-up job was to take all the desk-chair sets out of the classrooms to use as seats for the waiting patients in the courtyard.  I must have been really emotional that day, because as we were all hauling desk-chairs out of the classrooms, all I could think about was how heartbroken the kids were going to be when they came back to school in a week and a half to find their beloved decorated chair missing.  There’s no way we’ll get them all back into the correct classroom.  I just really couldn’t get past that.  Still haven’t.

I perked up a little bit when I saw a separate building, next to the principal’s office, with the sign “Biblioteca.”  Sadly, there were very few books, and still no decorations, but a couple of teaching aids, like an aquarium (empty), a human skeleton (missing several bones), some white boards (cracked in several places), and some more desks and chairs.  I thought about all the stuff we have sitting in our attic at home, that could decorate the school and fill the library.  I don’t know why the stark minimalist décor affected me so much.

Anyway, after the Biblioteca, we were shown the restrooms.  There is no running water in the school.  To flush the toilet, you have to take a bucket (already mostly full with filthy water) and pour some of it into the toilet bowl, then pull the lever to empty the bowl.  Turns out, the school (and all the homes in the surrounding villages of La Huaca) gets only 2 hours of running water per week.  This made our Jamaica clinic (at the National Sports Arena) look like the Ritz.  This was real-deal poverty.  This sounds selfish, but I was ecstatic to see that someone had procured port-a-potties to be used during the mission.  (No, I never thought I’d use ecstatic and port-a-potty in the same sentence, either.)

After moving all the desk-chairs out of the classroom and into the waiting area, there wasn’t much setup to do.  We took the teacher’s desks (about 2x2 feet) and covered them with Chux pads, to make them look more doctor-ly.  We set up our privacy screens (that we transported from the ship) so that 2 or 3 providers could work in the same room.  We worked for a long time to get a 1000-lb generator across the sandy courtyard so the dentists could run their equipment (our first attempt at using a forklift ended up in it getting stuck in the sand, and I have a great photo of a bunch of us playing tug-o-war with the forklift/ generator combo).  Partway through the day, we got a visit from a local village band (consisting of about 8 or 9 members).  They paraded around the school and stopped out front.  We all took a break to watch the performance.  There was a trombone, a couple of horns of some kind, a few drums, some cymbals, and a woman with a 2-liter soda bottle with a rock inside.  Several of the women and children from the village right next to the school came outside to dance with us.  All of the kids wanted us to take their pictures with them, and then look at the camera screen to see themselves.  They were too too precious.

After the band, we finished what little setup there was, and boarded our buses to get back to the BLZ (boat landing zone, remember?).  The bus ride from La Huaca to the BLZ is only 17 miles, but takes about 60 minutes.  Most of us sleep the whole way.  At the BLZ, we usually wait 20-60 minutes for a hospitality boat to bring us back to the ship (each hospitality boat holds 35 people, and it’s a 20+ minute ride round-trip, and sometimes they only have one hospitality boat running).  This wouldn’t be so bad, except for the smell.  It’s not the kind of smell that you get used to.  It’s indescribable.    At the end of the first day, I just couldn’t wait to get in the shower.  Thankfully, they have nighttime laundry on the ship for “mission personnel.”  I never used this service in Jamaica, but definitely couldn’t wait to get my uniform into the laundry after my days in Peru.

Monday and Tuesday I saw patients at the clinic in La Huaca.  When we got off the bus on Monday (the first day the clinic was open), there was already a line of probably about 150-200 people.  They all started clapping when we got off the buses and kept clapping as we walked past them and into the clinic.  The kids were giving us high-fives and I’ll admit it, I had tears in my eyes.  What a nice welcome.  In Jamaica, there were riots outside the gates with people fighting each other to get inside.  I immediately decided that I love the Peruvian people.

Ok, more later.  Today’s my day “off” and there’s lots to do.  Specifically take a nap.

We were assigned translators to work with us in clinic.  My translator was a 24-year old Peruvian – he was a mechanical engineer who wanted to improve his English.  He was sweet sweet, but his English needed a lot of work.  We worked together though, and managed to get by.  The second day I worked with him, he came in and told me that he had looked up some terms on the internet that we couldn’t translate the day before.  I was impressed with his initiative and his desire to learn.  And he quickly learned my teaching points and recommendations for the very common problems we encountered.  About 80% of the patients we saw had “kidney pain” – which meant anything from back pain to stomach pain to hip pain to trouble urinating to actual kidney pain.  The other 20% of patients had “gastritis” – which meant heart burn, gallstones, chest pain, or constipation.  There were a couple of patients with other issues, who were much more complicated.  Unfortunately, our lab testing was extremely limited (we could check a UA or an iSTAT) and we had no radiology capabilities at this site.  So I handed out a lot of motrin, tylenol, zantac, and antibiotics.  The patients were all so grateful, because they had been suffering with pain for decades but couldn’t afford to buy pain medication at the pharmacy.  It’s amazing how simple interventions (mostly over-the-counter medications) can make people so happy.