Call In, Observe, Diagnosis…Repeat

As mentioned in a previous post, I go on home visits in the mornings. I return to La Maternidad de Maria in the afternoon at approximately 2:30 after my lunch break. For the past two weeks, I have worked in the Posta Medica (the Outpatient Clinic) in the afternoons. The Posta Medica serves many, many people every day so it is necessary for them to have a functioning, organized system in order to have everyone seen. Patients start by checking in for either an analysis or medical consultation.

From what I have observed, they receive a slip of paper confirming they have checked in, along with a number. They then wait in the waiting area for their number to be called. Once it is called, they are weighed, their height is measured, and their blood pressure is taken in the below pictured area and recorded on a form.
These forms are then brought to the different doctors’ offices–this is where I come in! My main job in the Posta Medica is to call in the patients of the doctor that I am working with and observing that day.

Now, as I am sure you can imagine, the names here in Peru are very different than the names in the United States. Even if the names are the same, the pronunciations are always, always different. To save myself as much embarrassment as I can and to make sure I call in the right person, I always ask the doctor how to pronounce the names before I yell them down a hallway for the entire Posta Medica to hear. While I have started to recognize common names and remember their pronunciations, I still constantly struggle with any last names that have double r’s in them. I CANNOT, no matter how hard I try, pronounce the double r’s–this brings much amusement to the nurses and doctors (but hey they cannot pronounce the double t’s in my last name so this should be a judgment free zone!). On top of this, the people not only have one last name, but have two (the father’s last name and the mother’s maiden name) so I have to pronounce three names when calling people in to their appointment (because two names wasn’t hard enough!).

From this point on, I observe the doctor’s appointment and do my best to understand why the patient is at the clinic. I try and diagnose the patient before the doctor does, but this is not always possible when some of the cases are more complex than sore throat, cough, fever, or pain in a certain part of the body. Although a lot of the small talk and detailed medical talk goes over my head, I typically understand the general reason why someone is there. It is quite helpful that many names for diseases and illnesses in Spanish are very similar to the English names. The most beneficial experience for me was when I observed a doctor who also speaks English so after the patient had been seen I could re-cap with her in English what I thought had transpired and see if I was right. She could also explain to me details I had missed. My observations are very advantageous to my learning and understanding of healthcare in Peru because it gives me a view of the typical ailments in the country. When I observed a pediatrician, I saw a lot of flu, colds, and asthma in the kids. When working with three other doctors, I observed many cases of diabetes, cold symptoms (sore throat, cough, fever, etc.), and pain in the back/arms/legs. Beyond this I saw a couple cases of cysts in women, a woman with a urinary tract infection, people with anemia, children with rashes, a man concerned about osteoporosis, a child with bronchial pneumonia, a young girl with tuberculosis, a man with an enlarged prostate, and a handful of other illnesses and health problems. Although I do not study medicine (and so cannot practice it on patients), the doctors sometimes let me help examine a patient. I have listened with a stethoscope to the lungs of a child with asthma and to the lungs of the child with bronchial pneumonia, looked in the ears of a boy with a cold, and observed x-rays of peoples’ lungs, knees, and heels.

Beyond observing the doctor’s visits, I have also used my time working in the Posta Medica to learn how everything is conducted. One of my main observations is that besides one computer in the room where peoples’ height, weight, and blood pressure is taken, there are not any computers in the doctors’ offices. This is shockingly different than in the United States where there is at least three computers at the check in and a computer in every doctor’s office. A shift to Electronic Health/Medical Records is a big thing in the healthcare world in the U.S. right now. Having a computer allows all of the information to be stored in one place and easily accessible by the doctors. However, due to the cost of computers (I assume), having a computer in every doctors’ office is not realistic here in Peru at La Maternidad. The clinic uses slips of paper (as shown above) that are customized for La Maternidad and once one slip gets filled with a patient’s visits a new slip is stapled to it. Once there are enough slips to warrant a small folder, one is used to hold all of the patient’s slips together. This system appears to work quite well and efficiently for the Posta Medica although there are a few slips forgotten here and there since it is easy to misplace a piece of paper and information that is not stored and saved in a computer. La Maternidad makes great use of the resources they have and is a great model for clinics in developing countries that have limited access to technological resources!

Pictures of la Posta Medica:

                                 

No Entiendo…

I took Spanish for three years in high school; I chose to not take it my senior year thinking that I would not be taking Spanish in college or use it in my future profession (kicking myself for this decision now). I proceeded to not take Spanish my freshman year of college (still in my senior year mindset). I had gone into college wanting to work in a lab and quickly found out I am much more of a people person and want to work directly with patients in global health. With this change in career path came a new view on Spanish–being able to speak Spanish would open up many more countries that I could work in/with. So there I was on my first day of sophomore year sitting in Spanish 101…realizing how much Spanish I had forgot in 2 years. I took Spanish 102 my second semester and did well, but doing well in Spanish in a classroom setting is much different than being good at Spanish in an everyday life setting–as I have found out while here in Peru. I have memorized vocabulary and different tenses for tests, but using this knowledge in a conversation is an entirely different story.

I won’t lie to all of you–speaking Spanish has been what I have struggled most with so far during my stay in Peru. Yes, observing some of the health conditions on home visits is hard, but nothing I cannot handle with a few deep breaths. Yes, being almost 5,000 miles away from home is hard, but nothing I am not used to given that I go to school about 3,000 miles away from home. Yes, being by myself a lot of the time is hard, but working, reading, blogging, and skyping helps pass the time. Out of these challenges, the language barrier easily lands itself in first place for the hardest challenge to deal with. I can read all of the signs and understand what they are saying, but over half my battle is understanding what people are asking or saying to me. Most Peruvians speak very, very, very fast, have accents, and occasionally do not fully finish their words–I can barely understand the normal words and there they go throwing me off by abbreviating things! So as my title indicates, I often have to reply with “No entiendo” meaning “I do not understand.” I constantly have to ask people to repeat themselves or to speak slower, but sometimes it is to no avail. Typically, I can catch on to what is being said by recognizing words here and there, but I have yet to fully and completely understand a whole conversation. On top of struggling with conversational Spanish, I have difficulty with fully comprehending all of the doctors appointments I observe. So much of the dialogue is based on medical terms I simply just do not know.

I want so badly to be able to understand and communicate with everyone here. I worry that people think I am being rude by not having conversations with them–it is not because I don’t want to, but instead because I am not able to. Or I worry that people think I am stupid for not being able to understand them–which I like to tell myself is not the case. Many of the people who I live with in the Diocesan Center are very patient and understanding with my Spanish helping me a lot in improving both my understanding and speaking skills–but let me tell you, the phrase “slow and steady” has never been more applicable in my life till now with my Spanish. The most uncomfortable time to not understand is when someone makes a joke (that I obviously didn’t catch) and everyone starts laughing. I often join in on the laughter even though I have absolutely no idea what I am laughing at–honestly, I could be laughing at something they said about me and I wouldn’t know. But hey better to make light of the situation and laugh at myself, right? So please feel free to join in, make light of the situation, and laugh at my confusion and “gringaness”.

Fingers crossed that my Spanish improves over these next few weeks!

Soy Una Gringa…

In being from Seattle, WA (a relatively diverse city) I am used to seeing all different races and ethnicities throughout the area. If I were to see a Peruvian in Seattle, it would not be a site that caught my eye. However, the situation is not the same here in Chimbote, Peru. To my knowledge, besides volunteers living in Chimbote, there is not a white population living here. The stares and comments made towards me seem to support this.

I often get asked the question, “Eres de Alemanía?” which in English translates to “Are you German?” or “Are you from Germany?”. I reply saying “No. Soy de los Estados Unidos” (No. I am from the United States). The very same reasons that people think I am from Germany (white skin, light colored eyes, and blonde hair) are why I stick out much like a sore thumb. One of the doctors who I have worked with in the past week would constantly remind me of how white I am in comparison to the Peruvians. These comments were never made offensively and actually seemed much more like compliments. For example, he told me my skin was as white as milk (which I really hope is not true since it is summer and I would like to be working on my tan…). I also often get told that my eyes are the color of the sky, which last time I checked the sky was not hazel, but I’ll take the compliment. One patient even told me that I look like a Barbie doll due to my “gringa” (blonde) colored hair. After all of these statements, all I can do is thank them and chuckle because I have no idea what else to say (any suggestions?).

While being a gringa in Peru has brought a lot of laughter and wonder to those around me, it has also been an eye-opening experience for myself. In the United States, I am so used to blending in and being part of the majority. Being the minority and different from everyone around you really helps to change your perspective of the world and your place in it.

And in saving the best for last, a picture of two kids from the orphanage who loved my “gringa” Providence College hat!

Reality Check: This Is Not Grey’s Anatomy–Home Visits (Week 1)

Every morning, I go on home visits. These involve traveling by foot or automobile to various houses throughout Chimbote and its outskirts bringing medical care, food, and/or clothes to people. I will do my best to stay on top of blogging about the highlights of these each week!

Now, I have seen all 10 seasons of Grey’s Anatomy and can watch most of the medical and surgical scenes, only turning away from particularly gruesome ones. However, on home visits, I quickly learned that this was nothing like what I saw on T.V. One, you cannot turn away or make a face when a condition is hard to look at. Two, putting faces, names, and actual families to cases adds a whole new level to healthcare, something you cannot experience just by watching a hospital based T.V. show. Three, the conditions and access to healthcare are much poorer here with a reliance on the basics and not on advanced surgeries.

After my first day of home visits (talked about in my last post), I thought I was ready for what I would be experiencing over the next six weeks, but boy was I wrong. On Tuesday, the first house that Serida and Elizabeth took me to was home to a family who has a son who is schizophrenic. We were there to administer an injection of his medicine…this is a lot easier than it sounds. He was a very large man and due to his schizophrenia, was wary of us and why we were there. Three of his family members had to hold him down so Elizabeth could give him a dose of his medicine in his rear. This was a relatively quick home visit. The next house we walked to is one we had been to the previous day, the house of Juan who has prostate cancer. Juan is 82 years old and his wife is only 42; they have two young sons. While our home visit the day before consisted of helping to clean up the place, this home visit was focused on his condition. I observed as Elizabeth removed his catheter and then proceeded to put a new one in–something I never imagined I would see in my life. During this process, I helped open and prepare the needed supplies. I also helped to tape the catheter to his leg once it was inserted. This visit was difficult to observe because 1) I felt as if I was invading his privacy and 2) his condition is quite bad and he was in quite a bit of pain the whole time.

After this we took a car to a different part of Chimbote. We arrived at a house that was home to a man who has very limited use in his legs due to being shot in the back. He is in the process of gaining use in his them again. However, he spends a lot of time in a wheelchair, which has caused him to have very serious bed sores. I watched as Elizabeth cleaned his wounds, which are probably at least an inch deep. This was my first experience of getting very lightheaded (I will spare all of you the picture of his sores) to the point where I needed to sit down. Social workers were there with us discussing his need for a better wheelchair and a new bed and mattress.

The social workers gave me a tour of his house, including a tour of the backyard. He had chickens, but that was not all. He also had these little guys:

While guinea pigs are known as pets in the United States and many other countries around the world, they are a common source of protein in Peru. I have yet to decide if I will try “cuí” (guinea pig in Spanish) while here in Peru; I will keep all of you updated on that!

On Wednesday, we started by visiting a woman who had a hernia in her stomach. I watched as Elizabeth cleaned it out and then used sugar on the wound that the hernia had caused to help absorb and pull out the infection. The following visit was one of the more difficult situations to witness. We brought masks to an older woman. These masks were not just to cover her mouth, but were intended for the use of covering her whole face. She had (or still has) cancer and it has led to the loss of both of her eyes and her entire nose, which is now just open flesh. Observing this and knowing that there was nothing more we could do to help besides providing her with masks was something I struggled with.

On Thursday, I traveled to Miramar with a new lady from La Maternidad. This was about a 45 minute journey by bus just to visit two patients. We delivered a bag of clothes to a pregnant woman and talked with a man who needs physical therapy for his legs. Our trip there and back took more time than we were there in total, which showed me the dedication La Maternidad has to its patients and those who need their help. The rest of Thursday and Friday consisted of checking in on patients and seeing how they were doing, but no healthcare was administered. After this week, I am excited and anxious for what I will be exposed to in the weeks to come!

Toto, I’ve a Feeling We’re Not in Kansas Anymore

I left Lima early Sunday morning to catch a 7-8 hour bus ride to Chimbote. I boarded a double decker Cruz del Sur bus at 8:00 am and began my journey. I somehow passed 7 hours with a little reading, a little eating, a little napping, and a lot of listening to music and watching the “scenery” pass by outside of the bus. When I say scenery I mean sand, sand, and more sand. I always thought that Peru was a very green country, but, as I would learn later from Sr. Lillian, Lima is the second largest metropolis with a desert (with Cairo, Egypt taking the cake for the largest).

Finally, seven long hours later, the bus pulled into the Chimbote bus station. I retrieved my bag and went to go meet Sr. Lillian and Sr. Margaret. To my surprise, they were nowhere to be seen.–Let panic mode set in (and trust me it did)–I circled both inside and outside of the bus station, praying and hoping they were somewhere, anywhere on the premises…but no luck. I had no service, no wifi, and no knowledge of where I was. Of course my brain immediately went to the worse case scenario: they forgot about me! I decided to wait and hope that they were just running a bit late. After 20 minutes had passed and there was still no sign of the sisters, I decided I had to do something, anything. Thankfully, there was a small store in the bus station that I found that had computers for use for a mere .80 soles (0.29 cents in the U.S.). I quickly e-mailed Sr. Lillian and Facebook messaged my parents because there was clearly so much they could do from the U.S., but it was comforting for them to know the situation. I glance outside to see if the sisters were there, at this point nothing left for me to do but wait. My prayers had been answered, the sisters were there!!! I had dinner with them that night and got settled, nervous and anxious for my first day at La Maternidad de Maria.

Monday morning I am up and ready, clad in scrubs and my own name tag, feeling very official.

After breakfast at 8, I walk to La Maternidad de Maria, which is only a block or so away from where I live (La Casa de la Iglesia). At La Maternidad I am introduced to everyone who works there (so many people, so many names, so little time) and given a grand tour of the compound, which includes an outpatient clinic, a laboratory, a maternal and infants unit, a pharmacy, an orphanage, and many other small practices. After the tour, I spend the rest of the morning in the orphanage, playing with the kids there who are a handful, but absolutely adorable and a ton of fun!

My afternoon is spent going on my first home visits with Sr. Lillian and two of the Peruvian women who work at La Maternidad. First, we help clean up and improve the house of a family whose father has prostate cancer. Next we go to what I would assume are the slums of Chimbote and bring food to a family whose father is diabetic. Their house is comprised of straw and cardboard walls with ceilings made out of tarps and plastic bags. There are hundreds of houses like this surrounding it. It was eye-opening, to say the least.

We ended the day with a visit to one of the orphans who was in the Chimbote Regional Hospital because she is hydrocephalic, has a heart problem, and a problem with her rectum; she is only two months old. Observing the facilities of the “nicest” hospital in the area and the care that is provided there is disheartening and in need of much improvement. It was a long, but very rewarding first day!

One Major Setback and Thirteen Hours of Travel Later…

My parents and I were running a million and one errands yesterday trying to get everything ready for my trip. Everything finally seemed to be coming together: my suitcase and carry-on were packed, and my important documents were all laid out on the counter ready to be taken to the airport. However, in the midst of all the craziness my parents decided to scan my passport (unbeknownst to me) to have an electronic copy of it just in case I loose it while here in Peru–good intentions, bad outcome. My passport had been in the same clear baggy as my yellow health card and my checkbook–a rectangular, navy blue book very similar in look to a U.S. passport. I run through my checklist one last time and see that everything is there…or so I think. We rush off to the airport and as I go to check in, I pull out what I believe to be my passport (my checkbook) and realize my passport is nowhere to be found. My parents realize it must have been left on the scanner. I instantly became a living, breathing, and walking (or should I say pacing) worst case scenario, the one person you do NOT want to be in the airport. My mom rushes home to get my passport, racing against the clock. In the 40 minutes it took for her to make it home and back, my bad habit of biting my nails increased ten-fold. Somehow my mom made it back in time and with a quick goodbye to my parents, I was off. To my surprise, I made it to my gate before the plane had even started boarding!

Now, after a two and a half hour flight to Los Angeles, a two hour layover there, a horrendously long security line, and an 8 hour flight to Peru, I have successfully arrived in Lima! My day has mostly consisted of resting and making one outing to the supermarket to buy food for lunch and dinner, as well as for breakfast for tomorrow morning. Finding the supermarket was tricky. The man at the front desk told me it was just on the corner of the same block as the hotel. However, I walked down the block and ran into a lot of construction and saw signs for the supermarket, but no entrance. After circling the area a few times, a kind man finally pointed out a clear glass elevator to me that took me to the supermarket, which was underground…who knew this was a thing?

I will be waking up bright and early tomorrow to catch an 8 hour bus ride to Chimbote, Peru where I will be staying for 6 weeks. Fingers crossed this leg of my journey goes smoother than the airport–wish me luck!

Pictures from today:

On my taxi ride from the airport to the hotel, we drove past the ocean. If you look carefully you can see many, many Peruvian surfers!

My humble abode for the night:

Three, Two, One…Takeoff!!

Since fall of this past school year I have been anxiously awaiting today, the day that I will be flying to Peru. Although I am so excited to get on the plane tonight, I’d be lying to you if I said I wasn’t nervous. The idea of being in a foreign country that speaks a different language all by myself is nerve-racking. I have a reoccurring dream of stepping off my plane in Lima and forgetting every bit of Spanish I know. Although this won’t happen, I’m sure I will encounter other speed bumps along my way in this two month-long journey. I have finally gotten over the first speed bump of packing. I am used to having to pack and move all of my stuff 3,000 miles across the country (Seattle, WA to Providence, RI), but that is when I am working with 3 suitcases or more. The concept of packing two months worth of clothes into one medium-sized suitcase was new to me. But here I am suitcase in hand ready to go to the airport after many tries at the right amount of clothes to bring. 

You may be asking yourself, why is Julia going to Peru? I was fortunate enough to receive the Fr. Smith Fellowship, a grant that my school, Providence College, awards to 10 students each summer to study or do service abroad with a Dominican mission. I have been blessed with the opportunity to travel to Chimbote, Peru and work at a maternity and social works clinic there through the mission of the Dominican Sisters of the Grand Rapids. When I traveled to Muhuru Bay, Kenya three years ago with my family and observed a health care clinic there, my passion for global health was lit. Ever since then I have wanted to work in the global health field and help with the delivery of health care in developing countries. Through this amazing opportunity in Peru I will get to work towards my career aspirations and discover my passion even more. 

In less than 24 hours I will be stepping off my plan and arriving in Peru. Until then!