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Sunday, October 31, 2010

My Childhood Dream

When I was younger, my best friendCIMG1852 Stephenie and I would always talk about what kind of animals we wanted to keep in our backyards.  Some of them—like elephants, camels and llamas—we knew would get shot down by our parents right away.  A few, on the other hand—such as sheep and chickens—we thought we might have a shot at.  After years of waiting, at least part of my childhood dream has come true; I now have chickens on my roof.  Wednesday morning I talked with my potential host mom and Wednesday afternoon I was packing up all CIMG1851my stuff.  Apparently some things do move fast in Peru.  I now live with a wonderful family not far from my old house.  They have been great including me in everything and I can tell I will learn a lot from them.  The food is amazing and the house is always filled with laughter.  I think I’ll be just fine here.

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.

Sunday, October 24, 2010

My Love-Hate Relationship

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 taxiCIMG1758 as compared to one in the states, other than the size. Peru’s taxis are tiny. Your second option in Chimbote is a collectivo. This is a shared taxi that runs a set route. Hop in the car, wait for three other passengers and off you go. Thirdly, you have the mototaxi. Motos come in all shapes and colors. Some of them look like parade floats driving down the street with speakers blaring, flags blowing and neon lights flashing. Finally, we have the combi. Combis are old VW vans that have been modified to fit anywhere from 17 to 22 passengers. The destination of each combi can be figured out by trying to listen to what the conductor is yelling as he hangs his head out the window of the van as they speed past. I love the public transportation here because of it’s completely unexpected efficiency. I hate the public transportation here because it is built for people 5’6” under.

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.

DSC00990A big thanks goes out to those Microsofties who were brave enough to challenge Mike “Mikepedia” Daly in the Microsoft Giving Campaign 5k. Donors included were Patricia Donnellan, Long Nguyen, David Tersigni, Rodney Korn and Pradeep Narayanashetty. Pictured from left to right, Mike Daly, Long Nguyen, David Tersigni, Rodney Korn and Pradeep Narayanashetty. Congrats to Paula Mitchel for outrunning Mike! Thank you for putting your pride on the line to help support my year!

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!

Saturday, October 16, 2010

My Monthiversary

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 CIMG1824sandwiches) last weekend when some friends and I ventured up to the top of Sierra de la Paz, the small mountain overlooking Chimbote.   I was amazed by how clean and peaceful the city looked from above.  I would have loved to see Chimbote in her glory days back in the 1970s when the fishing was great and the city was young and exciting.  Walking around town, you can still see remnants of this era along the boardwalk and the Plaza de Armas.  Since I know the whole reason people read blogs is for the pictures, here’s another view from our hike looking out over the Pacific (even more photos can be found by following the link on the left).CIMG1798  Rumor has it that the Isla Blanca is white due to petrified bird poop.  I have yet to verify this fact, but have added a visit to the island onto my ‘To Do’ list for the next year. 

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!

Saturday, October 2, 2010

This is my Life

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:

aviacion

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:

lucuma

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.