I can’t wait to show this card to my host sister, Milagros. I know exactly what she is going to say; “Wow…son locos! Todos!” (“You’re all crazy!). She will then, likely, erupt into a fit of giggles, much like I did upon seeing this card for the first time (and the second…and the third…). Enjoy!
Here’s wishing everyone a very Merry Christmas filled with too much food, enough candy and cookies to make your tummy ache, lots of board games and a wonderful day spent with loved ones. ¡Feliz Navidad!
Life has a way of getting pretty busy down here in Chimbote which makes it easy for me to forget to take care of myself. I need to remember that if I am to really take care of patients and be a good nurse, I have to take some time for myself. This past week was exactly that, and it was much needed. I was fortunate enough to be able to take a trip up to Montañita,
I would be lying if I said I was excited to come back to Chimbote after my trip. It was weird being at the airport, thinking that I was not going back home to my family and friends or on to a new adventure or vacation. Life can be tough down here and I am still adjusting to Peru (although it is feeling more and more normal every day) so I was not quite sure how I felt about coming back to brown, dusty and dirty Chimbote. Thankfully, I am not here for the beauty of the city (which is hard to see on a daily basis), but I am here for the people. I was reminded of this the instant I walked into my house and was greeted by my host family. We sat down for dinner and everything felt right and that annoying question that has a way of popping up every so often (“What am I doing here, again??”) took its’ appropriate place in the back of my mind.
I am not much of a birthday person (or a party person in general). Most of the time, I would be just as happy to sit at home with my family and friends, eat good food, chat or watch a movie. Unfortunately, that is not considered a very Peruvian birthday. 
This week, I am thankful, firstly, for a host family who treats me like a daughter/sister of their own. Secondly, for the opportunity to travel. It is always humbling to talk to a local and realize that a vast majority of Peruvians will never have the chance to see their own country, let alone a different one. Most locals will go through their lives only seeing Machu Picchu in pictures and on TV. It definitely puts my blessings into perspective. Thank you, everyone for all the birthday wishes and your continued support and encouragement!
If you want to see some more pictures, click here. As a reminder, there is always a link to my pictures on the left under ‘More Info’.
I have this game I like to play a couple times a week at lunch. I call it, “Name that Organ Meat”. So far, I have successfully identified brain, liver, and kidneys. My quality BCC anatomy classes have, however, failed me a few times. I am still quite unsure what organ of duck I ate this past weekend…
The arrival of December has presented some new challenges down here in Chimbote. The one other RN at the clinic went on vacation starting last week which meant that I have been the only licensed nurse on staff for the past week. While intimidating, it has been nice to know that my skills and knowledge are trusted enough to put me in this position. My confidence in both my nursing skills and my Spanish have grown just with the independence I have been given in the past week. One of the highlights from this week was seeing a woman who has elephantiasis which has caused her a lot of pain and a pretty bad infection in one of her feet. After helping her up on the bed, cleaning her feet and chatting with her for a good half hour she was in much better spirits than when she arrived. It is patients like her, who are so grateful for everything, that really make you appreciate what you have been given. Walking her out of the clinic while our security guard ran and hailed a taxi which had to drive through a construction zone to pick her up just brought a smile to my face. Whenever I get frustrated with anything that goes on around me, I have to remember patients like her and know that this is why I am here. I saw another patient this week who was in a mototaxi accident about two months ago. His entire heel is completely torn up and infected. The day before he came to the clinic, he went to the state run hospital to have his stitches removed. When he came to see us, he still had pieces of stitches around the wound as well as some that were just forgotten about. Unfortunately, this is the accepted standard of care in many healthcare institutions.
This past weekend was spent getting our house ready for Christmas. I learned that Peruvians decorate their trees in the exact opposite order of what I am used to, starting with the star on the top and ending with the string of lights. I also learned that Santa, a fairy, a fast food chicken, flamingos and a giraffe were all at the birth of Jesus. Our nativity takes up an entire half of our living room wall and took almost two days to complete. Pictures are forthcoming.
This week, I am thankful that the hole in my ceiling is over my dresser, rather than my bed as it would have been a very unpleasant surprise to wake up with it raining on my face this past week. A dresser full of wet clothes and a flooded room make for a much happier Cathleen in the morning and a much cleaner room than the alternative.
To all you Pacific Northwesterners and Minnesotans dealing with your first tastes of winter, I feel your pain. Seriously. While we may not be dealing with snow and ice down here in Chimbote, everyone is still all bundled up. I actually had a patient come into the clinic last week wearing a pair of fleece pants under his jeans. Today was a chilly 80 degrees Fahrenheit. And while the Peruvians may still be bundled up in their sweaters and scarves, I'm wishing it was culturally acceptable to bare my white legs and wear shorts. I fear I am in for a long summer…
If someone had told me two months ago that I would walk into a house with a dirt floor, cardboard walls and no running water and think nothing of it, I would not have believed them. But that is exactly what has started to happen. It appears that I am adjusting to life and work in Peru. My views on luxury and comfort have changed considerably since I first got here. I feel very fortunate to be living where I do and not a day goes by that I am not thankful for all my blessings. It is humbling to go into a patient’s house to bathe them only to find the family searching for a clean shirt or towel, and here I was worried about being able to live off my few t-shirts for the year. My fear is that these experiences will start to become normal and that the poverty I see will start to become acceptable and standard.
My favorite days of the week continue to be those in which I work out in Cambio Puente. This week, we went to see one of the families and have a quick visit. I should know by now that nothing is ever quick in Peru. Our visit ended up being over an hour where we were invited into their home and got to talk about their hometown and their health. The hospitality here continues to amaze me. This is the same family that could not afford the fare to get to the hospital in Chimbote for suspected appendicitis and here they were, offering us slices of watermelon. I think we could all stand to learn a little from these people. This was by far one of my favorite days in Peru to date.
I hope everyone back hope had a wonderful holiday. Thanksgiving was celebrated in style down here with way too much food, plenty of Peruvian wine and an anxiously awaited viewing of Harry Potter. I am thankful this week for the continued support of all my loved ones back home, for everyone who has pushed me to reach my goals, for clean drinking water, for a real cement floor in my house, for my roots and for the fact that I found a chicken feather in my bed, rather than the whole chicken.
I have learned a lot in the short time I have been in Chimbote, but there is only one thing I have mastered. The judges give it a 10 out of 10 for effectiveness, 5 gold stars for execution, a happy face for creativity and an A+ for originality. I have perfected my blank stare. My deer in the headlights look. My state of shock. It is my pride and joy and apparently the only thing I can do absolutely perfectly in Peru. Admittedly, my Spanish continues to improve, especially with the help of my host family, but there is still much room for improvement. A month ago, I could probably carry on a fairly decent conversation with a three year old. Now, I like to think that I’ve advanced to the speaking abilities of a five year old.
I love Cambio Puente. Every time I start to get frustrated or tired with hospice, I go out to Cambio Puente and get so excited about being here. Hospice is really a needed service, but it has been a distinct challenge for me these past two months. I think it takes a special kind of nurse to really enjoy working in hospice (even in the States). It is hard going into the homes of people who are actively dying every day. I am glad that I have other worksites that are so life-giving.
Last week we went out to Cambio Puente to start some health assessments on a couple of the families in the community. The families we talked to only have running water from 5am to 9am everyday, use pit toilets, drink untreated water, cook over wood or kerosene and many have only attended primary school. With our neighborhood agents in Cambio Puente, we are working on finishing these health assessments on all of our families involved in the project. One family we talked to moved here a couple months ago from the Sierra. They speak Quechua, one of the native languages of the Andes. We went to their house hoping to speak to the 15-year-old daughter who has a baby of her own. After waiting for a long while and being sent on a wild goose chase by her youngest brother, we saw her walking down the street. She had just come back from the clinic where she had seen the doctor for severe right-sided abdominal pain. Diana and I instantly thought appendicitis. She was given a referral to go to the hospital in Chimbote and confirm the diagnosis. ‘Oh good’, I thought, ‘she has insurance, she’ll be fine’ (I am still pretty unclear how the state insurance system works here because most people are not covered). Yes, her hospital bills would be taken care of, but what about her S/. 1.50 (about 55 cents) transportation cost to get to Chimbote? After a couple phone calls, we were able to arrange her transportation through our project and get her to the hospital. The doctors at the hospital decided to do a couple last tests before taking out her appendix and discovered that it was not appendicitis. They are still unsure what has been causing her so much pain, but at least surgery was avoided.
My host family has really been wonderful. I can tell that my Spanish has already improved in just the short amount of time I have lived here. My days are full and I am exhausted when my head finally hits the pillow. If you have never realized it, I generally like pretty stupid, cheesy jokes. So does my host family. We typically eat miel de vieja (as opposed to miel do abeja) with our pancito every night. When someone answers ‘nada’ to a question, the appropriate response is always ‘¿Donde?’. If a joke is just too stupid, family members are often seen tickling themselves to make them laugh. If there is one thing Peruvians have mastered, it is their sense of humor.
A big thanks this week goes out to my Aunt Mary, Uncle Paul and cousin Rebecca who have been on my cheering squad since my days on the St. Thomas swim team.
When I was younger, my best friend
If there is only one thing I will take away from my experiences in Peru (I’m sure there will be many), it will be my voice, especially as a nurse. Challenging situations continue to present themselves and I am getting more and more comfortable speaking up. I rejoice at the minor successes I have and try not to dwell on the things that need to be improved. Just this week, a Peruvian nurse and I were doing a dressing change for a 26 year old man who had been paralyzed in a car accident. He has been left in bed so long that he now has infected stage IV pressure ulcers on both his hips that tunnel 8-10cm. Ideally, people would never get pressure ulcers since they are preventable and pressure ulcers like these are even more mind-boggling. Most of the research I have been able to do down here on pressure ulcers has led me to specific types of dressings for different types of ulcers. We do not have those kinds of resources available so we have to do what we can with what we have. The nurse I was working with on this day was great. He is really interested in how we would do things in the States and wants to learn more about nursing. Unfortunately, nurses like him can be hard to come by here. So, we packed the wound, which was the first time I have seen this done. Inside, I was jumping for joy. Maybe we can make a difference down here.
There is a woman who lives at hospice. She is tiny and is missing all her teeth. No matter how we try, she always ends up clumped down in her bed. Her job, as she calls it, is killing the flies. You can see her at any time of day, slumped down in bed with her ‘matamoscas’ in hand swatting away. I don’t think she’s killed one yet, but that doesn’t stop her from trying.
Things to be thankful for this week: pillows, toilet seats and pre-folded gauze. Not necessarily in that order.
I have uploaded some more pictures which can be found by following the link on the left.
Figuring out public transportation is always a great way to get to know a new city. Chimbote’s public transit is particularly exciting. There are a number of different options for the Chimbotano. The first option, which is also the most expensive, is of course, a taxi. There is nothing altogether thrilling or different about a Peruvian taxi
This week was my first with my new schedule. I am splitting my time between three different worksites and I could not be happier. I feel that after a month of being in Chimbote, I am finally starting to do some real work. While I am continuing to work with hospice, I am now working with their inpatient care as well as working in the community. Even though the inpatient setting in hospice is very similar to long-term care in the US, there are some unique challenges. One of the biggest issues I continue to run up against, is how to provide quality care to these people with such limited resources. It means a lot of creative thinking and sometimes the realization that I can only do so much with what I have been given. On Wednesday, I was given the chance to go out to Cambio Puente for the first time. While the work for the project is still moving slowly at this point, there is so much potential. I cannot express how excited I am about this project. Just today I went to a meeting with the women of Cambio Puente. In such a machismo culture it is so great to see the power the women have in their communities. Their love for their country and city really leads them to want to better their lives and the lives of their children through systemic change rather than the escapism that is so often seen. I could go on and on about all the great things that are happening down here. Thursday was my first day at the Santa Clara clinic in our neighborhood. I walked in Thursday morning, got oriented to the clinic and was told “Ok, well you’re a nurse, right? This is where your patients will be, I’ll be over there if you need anything”. Overwhelming? Yes. Exactly what I needed? Absolutely. It was nice to have my knowledge and skills trusted even if I am still working on the language. Friday morning I was taught how to check people into the clinic. This led to lots of frustration on the part of the patients waiting in line, tons of giggling from the staff by the fact that I could not spell the names correctly and a very frazzled Cathleen by the end of the day. The learning curve is going to be steep, but at this point it is exactly what I need.
This week’s exciting new food choice? Anticuchos. Cow heart is quite possibly the best cut of beef you will ever eat. The fact that it is cooked and sold out of my neighbors house and they invited me inside to sit and chat while waiting made it that much better. Anything served with ají and sweet potatoes is ok in my book.
Another huge thank you this week goes out to the Crum family from St. Louise Parish whose smiles and words of encouragement make me feel like I can do anything. As well as to my wonderful Godparents, Aunt Mickey and Uncle Eric whose love and support I can feel all the way down here!
I have started to settle into life in Chimbote. Things that were initially so new and exciting are starting to become commonplace. I am now able to sleep through the howling dogs next door, the garbage truck in the morning and the never-ending sirens and horns of the motos and taxis. After almost a month in Chimbote, I am starting to feel comfortable here. And while it is still too brown and dusty to ever give me the feeling of home, I am even more excited for the next eleven months of my life in Peru.
The past two weeks have been full of positive changes and exciting adventures. As I started working more in hospice, I realized how easy it would be to get burned out if that was where I would spend all my time and energy. The people I work with have been very receptive to my needs and CMMB is great at recognizing that in order to be effective, I need to be happy in my work. So, I will now be splitting my time between three different work sites. I will still be spending time with hospice, but as my language skills continue to improve, my role is going to start to change to include more education. Program sustainability is something that is very important to me throughout this year. I do not want to simply have the same role as the staff down here, but rather, want to leave a lasting impact in order to help better the future of the organization. Education will help me to achieve that goal. Secondly, I will be working at the Santa Clara clinic in my neighborhood. The clinic tends to be a mix between urgent and primary care. Specialists come in a couple days each week to give the community an opportunity to get the care they require. The project I am most excited about is a joint project with CMMB, the Bon Secours Health System, Caritas del Peru and Christus health. The Chimbote part of this project is working in an area called Cambio Puente, located about 30 minutes outside the city. Aiming to reduce the infant mortality and morbidity rates in our region, this is a pure community health project, which I never expected to enjoy. Still in its’ early phases, one thing being worked on right now is a handwashing campaign. I have never been so excited about clean hands before! As if this wasn’t enough excitement, I have decided to move in with a host family. I think the full immersion will really help me to get the language skills and the cultural experience that I desire. It also doesn’t hurt that the family has hot showers, a cook and chickens on the roof.
I realized my complete lack of cardiovascular fitness (likely, at least partially, the result of too many chicken 
I have experienced a lot of ‘firsts’ in the past two weeks. My first trip by bus up to Trujillo turned out to be a raving success as we correctly navigated our way to and from the bus terminals and were pleasantly surprised by the movie choices, the comfort and the timeliness of the service. My first patient passed away last weekend. I thought it would much harder to hear of a patient’s death. In this gentleman’s case, it was a blessing as you could see the pain he was going through and the stress his condition put on his family. I know that news of a patient’s passing will not always come this easily. I received my first eviction notice this week! After some research (and lots of use of the dictionary) we discovered that our landlord was delinquent on some taxes. Thinking that the missing payment was from September of this year, we were sure that there would be no immediate repercussions. Much to our surprise, we were told that this was a pretty serious matter. Shocked and amazed by the rapidity of action taken by the city of Chimbote, we went downtown to pay our taxes. While there, we found out that the outstanding taxes were from 2006. The world was right again. I was slightly disappointed that this issue was resolved as I figured being evicted would have been a great cultural experience. I tried my first Peruvian beer and was pleasantly surprised. This first was followed by many more opportunities to sample Peru’s finest brews. One of the local drinks is mixing dark beer with Inca Kola. While it almost seems a waste to mix perfectly good beer with bubblegum-flavored pop, I am doing my best to be as fully Peruvian as possible. Just this week, I ate my first combinado and as we so lovingly call them, my first spamburguesa. Not sure what you want for lunch? Choose the combinado. It has the perfect blend of papas huancaina (instantly one of my favorite Peruvian dishes), spaghetti, roasted corn and ceviche. Now as for the spamburguesa…I typically consider myself to be pretty daring on the food front, but there was something about the pepto-bismal pink meat that seemed a little frightening to me. After some deliberation, I decided to live a little. With all the fixings, it is out of this world. My mouth is watering just thinking about it. I think I know what I’ll be having for dinner tonight…
I want to thank all of you who have supported my trip so far. For anyone else, consider sponsoring my work down here for a day by donating $5 or $10 to CMMB! Let me know which day you would want and I will add you to my fundraising calendar. On that day, I’ll send you a note, letting you know what kind of work I was able to do with your contribution!
My initial thoughts upon riding into Chimbote of “What have I gotten myself into?!” have since (mostly) subsided. If you thought that Chimbote looked like the picture I have under my blog heading, you are sorely mistaken. In reality, Chimbote looks exactly like this:
And while I don’t exactly enjoy the moments when the strong smell of fish wafts through our drafty house and I’m sure the nice brown color I have on my feet is from the dust rather than a tan (especially since I’ve been wearing tennis shoes), there is a certain amount of charm to the city. Donkeys with trailers share the roads with motos and taxis and the abuelitos are always sitting in front of their houses to wish you a good morning.
This week has been one of adjustments. I started working at the hospice center Santiago Apόstal. I have spent the week going out into the community with other nurses to do house visits for the patients who still live in their homes. It has been a really great way to start to learn my way around the city and figure out all the different modes of transportation. Hospice in Peru is still a very new concept and is very different than hospice in the States. They are still working on the concept of creating a good death for their patients. Quality of life is notion that has yet to fully take hold, but they are certainly trying. Most of the patients have bed sores that are painful to even look at. For all you nurses out there (or anyone brave enough to Google it), most of the patients I have seen have multiple stage IV ulcers where the surrounding skin is necrotic. I had my first patient who had melanoma all over his legs. I saw another woman who has an external tumor on her neck. Her quality of life would improve so much if she could afford to have it removed, but the surgery is too expensive. Besides the initial shock I felt with the patients I have seen, I have been told that nursing down here is like nursing in the US fifty years ago. That being said, I cringe when I watch their ‘sterile’ technique. There is almost no application of evidence-based practice. I am hoping that as my Spanish continues to improve, I will be able to do some education with the nurses down here so that the patients really do receive the best possible care. Even with some of their less than desirable practices, the nurses here are offering a needed service and their patients are better off in their hands than they were before. There is an admirable resourcefulness in everyone that I have worked with so far.
We went out into the farmland to see a patient earlier this week. As you start to get further and further away from the center of town, the dogs start to get meaner and more territorial. So there we were, four nurses, off to see a patient, each carrying a huge stick to fend off the rabid dogs. It was at that moment when I looked around at my co-workers and started laughing that I thought to myself, 'This is my life’.
One of my favorite parts of travelling is eating all the local food, and let me tell you, Peru has some pretty fantastic food. I have not been disappointed with anything I’ve tried so far. Avocados the size of cantaloupe, fresh coconut from the corner vendor, pulled chicken sandwiches with french fries on top from the street cart, fresh bread and of course, the Ceviche in Chimbote is said to be the best in all of Peru. Now granted, I obviously haven’t tried all the Ceviche throughout Peru, but the dish I had today was definitely worth the expensive price of 10 soles (about $3.50). Far and away, though, the best thing I have eaten is lúcuma. This, my dear friends, is a lúcuma:
A very unassuming fruit, it has a little pumpkin flavor to it and is nice and creamy, making it great for juice and desserts. With all this good food, I have to hope that my pants will still fit by the end of the year as there is no way I will be able to find pants long enough for such a gringa alta.
A big thanks this week goes out to Allen and Marcel Ballinger whose spirit and joy of life I have admired since I was lucky enough to meet them three years ago.
My Lonely Planet guidebook has one page on Chimbote. The first sentence in this short section is “Chimbote is Peru’s largest fishing port—and with fish-processing factories lining the roads in and out of Chimbote you’ll probably smell it before you see it”. This is the city I will make my home for the next year.
My house is on a dirt road, about a 15 minute walk from the center square and the ocean. The lack of hot water will make for very quick showers (if any at all) and part of our roof is unfinished so whenever it rains, it rains inside too. But, it could be worse. This is a nice house by Chimbote standards and I’m only here for a year. Plus, I don’t have termites in my headboard like one of my housemates. On the bright side, Chimbote is said to have the best Ceviche in all of Peru and I have any extra bed in my room for any visitors who don’t mind a bucket bath or a cold shower (hint hint).
I hope to start working in the next couple days, at which time, these posts will (hopefully) get much more exciting.
A big thanks this week goes out to the wonderful Brennan family as well as my dear friend Megan Hanley for saving me from a long, cold night on the floor of the Lima airport.
It is very surreal to be leaving the country knowing that I will not be back for an entire year. I don’t think I have completely wrapped my head around that fact that I will be away from family and friends for so long; maybe it is better that way.
This past week was spent in New Jersey at orientation with some of my fellow volunteers. It was really comforting to meet other volunteers who have the same fears and apprehensions as I have had. I learned a lot more about CMMB this week than I have been able to learn on my own. One of the things I really admire about the organization is that they have recognized the need for preventive care in the world and they are working on strengthening health systems throughout the world. One of the things I will be working on during my time in Peru is an example of the type of preventive care they are striving to support. There is a real emphasis on community health and education so that the people we are working with will be able to care for themselves in the future.
After some confusion, wrong addresses and phone numbers, and an impromptu stay with a friend from home, I have made it to Sister Rosaleen’s house in Lima. She is a lovely Irish woman who has been living in Peru for 31 years. I am sure she will have lots of great advice for me before I head up to Chimbote on Tuesday.
I want to send a huge thank you to everyone who has supported me so far, especially: the Sprangers’ family, John and Mona Fonseca, my Aunt Julie and Uncle Dave, the Hickey’s, Mama Chappell, Grandma and Grandpa Daly, and of course my wonderful parents. All your prayers, words of encouragement and support are very much appreciated! Thank you!
