Gracias

On Saturday, I say good-bye to Chimbote.  I am not really sure how the end of September snuck up on me so quickly.  I find it hard to put into words exactly how I feel about my time in Peru.  What I will say is that this has been one of the best, most rewarding years of my life.  Being away from family and friends for weddings, births and family vacations was not always easy, but I think the struggles made this experience even more valuable.  I have met some of the most amazing people throughout my year.  I have been welcomed as a member of the community.  I have learned the real difference between want and need.  I have learned the value of family and creating relationships.  I have learned to just sit with someone in silence to pass the time.  I have learned that my stomach maybe is not as strong as I always thought.  I have learned how to argue in Spanish (and win!).

To the people of Chimbote, muchas gracias por todo.  No tengo las palabras para decir lo agradecida que estoy por todo lo que me han dado durante este año.  Les voy a extrañar muchisimo!  Nunca les voy a olvidar y espero que nos vemos muy pronto.

To everyone back home, thank you for your support, your prayers, your laughs, your letters and emails.  You have been just as important to me through this journey as everyone I have met in Peru.  Thank you for keeping me grounded and thank you for reminding me who I am.  This little book sums my thanks up pretty well.  I look forward to seeing you all in just a few short weeks!

(In)Dependence

Over the course of six days last week, I spent a total of 29 hours on a bus.  My host family’s grandma invited the whole family up to her pueblito for the festival of their patron saint, El Señor de los Milagros or, the Lord of miracles.  Where she lives is three hours on dirt roads from the biggest city (in which I’m sure everyone knows one another) in a tiny village called Barranco.  There are no roads, the nearest neighbor lives about a 30 minute walk away, they just got electricity within the past five years, almost everyone is family and there is no indoor plumbing.  We celebrated with the locals with mass, castillos, dancing and the vaca loca (which really is crazy).  We at five meals a day sitting in the rustic, adobe kitchen while the guinea pigs were running around, nibbling on our feet (probably because we were eating their relatives) which almost always included some sort of potato, yuca or sweet potato and pork.  While the festival was great, my favorite part of the trip was spending time with my host family and struggling to understand the grandma who talks a mile a minute.  I can’t stand the thought of having to say goodbye to them in just two short weeks.

I like to think I’m a pretty independent lady.  At least I did about a year ago.  Like a three-year-old, I was always proud when I could do things “All by self”, never needing help from anyone.  Things changed a bit when I got to Peru.  This is a culture where people rely on one another.  This is a culture where you do not even go to the grocery store by yourself.  At first, this drove me crazy.  I liked to do things on my own sometimes and I saw it as a weakness to rely on other people so frequently.  Like so, so many other things throughout this year, my opinion on independence has changed.  I now realize that this dependence on others is not a way of showing your weakness but rather, a way of showing how much you value your relationship.  When it really comes down to it, my year was all about relationships and isn’t that what life should be all about?

Congratulations to Sarah and Jeremy Orem who welcomed little Mira into the world on September 8th.  You two will be amazing parents.  I can’t wait to meet her!

August in Review

The month of August brought a welcome change of pace for my work and life down here.  The month started out with Amber and I FINALLY getting our visas.  A supposedly one month process ended five months later with our Peruvian residency cards and a nice stamp in our passports…just in time for our departure.  While in Lima, we picked up a group of physical therapy students from Regis University who spent a little over a week with us doing home visits, free clinics, learning about PT and health care in Peru and helping out with the international conference that Amber has been working her butt off on for the past ten months (you can read about it on her blog here).  I had a blast with this group.  Not only were they a ton of fun to be around for the week, but it was great to get a view of Peru from new eyes after being here for almost a year.  Things that I no longer think about were new, exciting and often challenging for them.  Perspective is a great thing and I feel that as my life has become more normal down here, I have lost some perspective and settled into the mentality that this is “just how it is”. 

Following the PT students, I had a quick couple days back in Chimbote to do some laundry and help out with a free clinic before heading back down to Lima to pick up a friend that was visiting.  We had a wonderful time camping at the base of Machu Picchu (which is just as breath-taking the second time around) before heading off for an Amazonian adventure.  We stayed at a lodge that is part of a conservation project in the Tambopata reserve.  If anyone ever goes to the Amazon, go here:  http://www.baltimoreperu.org.pe/.  We stayed with a family, had a local guide, got to meet lots of people, see wild macaws and parrots, and hitch a ride back to town on the local fruit taxi.  The jungle is unbelievable and if it were not for all the blasted mosquitos, I could have stayed there forever.  Thank you for a wonderful trip, Caitlin!  I had a blast!

Living far away from home has really helped me to realize who the important people are in my life.  A week ago, on August 25th, Fr. Phil Wallace from my parish at home passed away after a long struggle with cancer.  Fr. Phil was an amazing man who truly led by example and was a great inspiration to everyone he met.  The outpouring of love shown by everyone throughout this past week is a testament to what a great man he was.  I feel endlessly blessed to have met him.  I will be forever thankful for his presence in my life.  So please, say a prayer for Fr. Phil tonight.  For anyone interested, this is a wonderful article written on him in the Seattle Times.

Transitions

I am not the best at transitions.  My family and my college roommates can likely attest to that.  I am even worse at goodbyes.  My transition from Peruvian life to American life is looming ahead in the not so distant future and it scares the socks off of me.  So, as my support group, here are a couple things you can all do to help make my transition just a little bit easier.

1. Sit next to me.  I mean, really sit next to me.  Peruvians do not have a sense of personal space and even complete strangers will practically sit on top of you.  At first, this drove me crazy, but I have come to like it and get insulted when someone does not sit next to me.  So please, when you sit next to me, make sure we are at least shoulder to shoulder and I will likely scootch closer.
2. Greet me with a kiss on the cheek.  Not in that annoying, snobby girl way, but in that warm Peruvian way that says, “hey, I’m actually happy to see you”.  It may take me a while to break this habit, so you all may as well just give in and give me a peck back.
3. Call me names like Gringita, Flacita, Merry, and Catita.
4. Urinate in public.
5. Remind me to wear my seatbelt.  Partly because I will forget due to the lack of seatbelts in the past eleven months, but partly because the collectivo drivers always have to remind the front seat passenger to put safety first (which usually means looping the ripped seatbelt over your shoulder so as not to get a ticket).
6. Do not ask about my year unless you really want to know.  This will not be a quick answer and I will probably talk for hours.  So please, save yourself the trouble and only ask if you are truly interested.
7. Let me bask in the glory of seemingly endless toilet paper, hand soap and toilet seats.
8. Let me eat a lot of rice.  More importantly, eat a lot of rice with me.
9. Honk your horn.  All. The. Time.  Honk your horn to turn a corner.  Honk your horn when you pass someone on the street.  Honk your horn when you see someone you know.  Honk your horn when you see someone you don’t know.  Honk your horn to tell someone you want to buy a marciano or some picarones as you drive by.  If you could change your horn to sound like an ice cream truck or a clown car, sea mucho mejor.
10. Say words like “Google”, “Youtube” and “Skype” as “googly”, “youtubey” and “eskypey”.  It brings me endless joy. 
11. Have dinner with me.  Or lunch.  Then, just sit for hours, chatting about nothing in particular and with no rush to be anywhere else.

My contract with CMMB is up in a month, after which, I plan on doing some travelling around South America with a friend before heading back home for Thanksgiving.  Any suggestions of places to go/people to meet in Chile, Argentina, Paraguay or Bolivia would be much appreciated.

Te Amo Peru

Sometimes, changes happen so gradually that one hardly notices.  Sometimes, changes happen almost instantly.  Like everything else in Peru, the changes I have recently begun to notice, have happened slowly.  After practically a year down here, I have started to take notice of how different things seem now as compared to last September.  So, in order to give you a little taste of just a handful of the things that I feel have changed over the past eleven months, I made this handy-dandy little comparison table.

Last September	Now
Joked about taking showers only once or twice a week but in reality showered a good three to four times a week.	Jokes about taking a shower once or twice a week and is actually serious (lately, its been closer to once a week…).  I’d like to see you take a ice cold shower when its 50 degrees outside!
Crossed at crosswalks, waited for the streetlight to change, waited for cars to completely pass before crossing the street.	Crosses the street like a super-human!
Got nervous about knocking on doors in Cambio Puente to gather simple census data.	Does home visits and nutritional workshops without blinking an eye.
Was just that “gringa” in Cambio Puente.	Has kids yelling “Caty!!” down the streets and even had one little cutie tell his mom that “his gringita just drove by!”.
Struggled with conversations in Spanish.	Has been asked multiple times where I am from in Peru.
Sat like a deer in the headlights when my host family made jokes.	Can hold my own and make my host family proud of what they have taught me.
Fell in love with ceviche and combinado at first bite.	Knows all of the best places to eat said ceviche and combinado.
Got woken up at 4am when the roosters crowed.	Doesn’t even use earplugs and can sleep until 9am without ever hearing the roosters (on those rare days where I actually can sleep until 9am).
Could not understand anything that was said to me (in Spanish) on the telephone.	Has entire conversations with people on the phone in Spanish.  Except my host grandma, even Peruvians can’t understand her.
Was not sure how I would survive in a city that smelled of fish for a year.	What fish smell?
Walked out of the house empty-pocketed.	Always has pockets full of toilet paper and spare change, but, like every good Peruvian, never a pen when needed.
Got laughed at by my co-workers when I tried to spell Peruvian names.	No longer even have to think about how all those crazy names are spelled.
Read English words in English.	Reads English words as if they were Spanish.
Introduced myself to Peruvians with the English pronunciation of my name.	Introduce myself to English speakers with the Spanish pronunciation of my name.
Thought there were only big bananas and small bananas.	Can tell the difference between all nine different kinds of bananas.

 

If life is about progress, then I think my life in Peru throughout this year has been pretty grand.

Goooooooool!

After almost ten months in Peru, I have finally been to a local soccer game.  It was full of crazy Peruvian fans, bands, riot police, food, and a Jose Galvez (Chimbote) win.  I am pretty sure that I am the first gringa to ever been seen at a game in that stadium based on the looks from my fellow Chimbotanos.

Throughout this past week, three noteworthy events occurred here in Chimbote.  As always, the month began with getting weights and heights for all of our kids in the project in order to track their nutritional status.  This is always a big project on its own since we are a small team and have over 300 kids, but this month, we had to draw blood samples from all our kiddos as well in order to test their hemoglobin levels after three months of iron supplements.  It was a busy week.  My favorite moment happened on Thursday afternoon when I was pricking fingers and making kids cry.  I had just finished pricking the finger of one of the girls in our project and we were waiting for her results.  Back in February when we tested her hemoglobin, she was borderline.  Her mom was great about bringing her to receive her supplements every week and participated in our nutritional workshops.  When I told her mom that she had gone from being borderline anemic (according to the ministry of health standards….see this post for my rant) to being well into the normal range, her mom got tears in her eyes because she was so happy.  It is really amazing to see results like this.  We had kids who have gone from severe anemia to borderline anemia in just a matter of months.

Not only have we had some really great success with our kids and their hemoglobin levels, but the gardens that we helped our families plant are doing great.  The families who were among the first to benefit from the gardens have been able to harvest their veggies.  The gardens look beautiful and these families now have fresh veggies to eat on a regular basis.

Finally, yesterday we had a workshop with our community agents that focused on self-esteem.  Peru is a very machismo culture and you can tell that many women do not think very highly of themselves because of the culture and attitudes by which they are surrounded.  Our community agents are some of the most amazing women I have met down here.  They do really great things for their community without hope of compensation or acknowledgment.  They are smart, active, caring leaders in their community.  This is the way I see these women.  I am proud to work with them and blessed to have met them.  Because of the great things they are able to do in their community and the respect they have gained from their neighbors, I assumed they saw themselves the same way.  The workshop yesterday was really eye-opening for me.  One of the activities was to think of some of your strengths and weaknesses.  A number of the women could not think of a single strength which simply blew me away.  I could not help but wonder, “If these women have done this much without thinking they have any strengths, what could they do if they really knew how amazing they are?”.  The afternoon was spent on self-assessments and recognition.  While talking about milestones throughout their lives, many of the women talked about their involvement in the project.  This was the first time that I really realized that not only do we have the opportunity to change the lives of the children in the project, but we also have an opportunity to give something to these women that they have never had before.

This week I am thankful for skype which gives me the chance to see my goddaughter even from half a world away.  I am also thankful for my amazing parents who are celebrating their 30th wedding anniversary tomorrow.  It has been great to grow up and see them not only as my parents but as two best friends who are still very much in love.  I count myself very blessed to not only have them as parents, but to also have them as friends.  Happy Anniversary and here’s hoping for 30 more years!

Magic Baby

I have spent the past nine months being humbled.  To not feel so, would be next to impossible.  However, some things are definitely more humbling than others.  One of the strangest things is to realize that life really does go on without you.  People move, get new jobs, get married, etc.  But one of the biggest things that really makes me realize that everything continues as normal at home is the arrival of a brand new family member.  Ann Marie Chappell was born this morning to my sister and her husband.  I like to think of her as a magic baby.  When I left, my sister was not pregnant, she was just my sister.  When I come back, she will not be pregnant, but, she’ll have this new little person.  This is one of those events in life that I always thought I would be there to watch.  To watch her belly grow and then get to meet my little niece right when she was born.  Its humbling (and a little sad) to realize that things go on as normal, even when I’m half a world away.

Is it possible to miss someone you have never met?  Because I miss my goddaughter like crazy.

Lessons Learned in Huaraz

In Peru, as in other developing countries, about half of childhood deaths are caused by pneumonia, diarrheal diseases, malaria and measles.  The prevalence of malnutrition in these countries makes the children even more susceptible to these preventable diseases.  In Peru, 25% of children are classified as being chronically malnourished, in rural areas like Cambio Puente, this statistic rises to 36.1%.  Chronic malnutrition is seen in the height of children.  If not given enough protein, children do not grow.  This is why, if you look across a room full of Peruvians, the majority are almost exactly the same height.  Chile, on the other hand, has a childhood chronic malnutrition rate of only 2%.  To put this into perspective, in the United States, fewer than 1% of children have chronic malnutrition.  Chile has done a fantastic job trying to reduce the incidence of chronic malnutrition which helps protect children from other childhood diseases.  Peru is trying to do the same.  That is what this past week was all about for me.

Along with other nurses and a couple doctors from Chimbote, Nuevo Chimbote and Cambio Puente, I headed up to the city of Huaraz to participate in a training workshop.  This weeklong workshop—“Curso Clinico de Atencion Integrada a las Enfermedades Prevalentes de la Infancia con Enfoque de Derechos (AIEPI)” or “Clinical Course on the Integrated Attention of the Prevalent Childhood Diseases with a focus on Human Rights”—helped train us on how to recognize and treat the major childhood diseases seen in Peru.  Many of the nurses that attended the workshop work in clinics without a doctor, which made this training even more important.  I would say that about 90% of the material presented to me this week was brand new because most of the diseases discussed are ones that we simply do not have to worry about much in the US anymore.  New information all in Spanish made for a stressful, albeit interesting, week.  It was great to be back in a hospital setting and really interesting to see the vast differences between hospitals in the states and here in Peru.  One of the things I found most interesting in this course was the focus on basic human rights; mainly that every human (even the tiniest of us) has the right to to quality healthcare.  I love that this was so strongly emphasized as this is a culture where children often get overlooked.  There is a practice that the best food is saved for the adults, when in fact, we should be giving the most nutrient rich food to the kids that are still growing.  A couple months ago I saw a poster in Cambio Puente encouraging parents to give their child a name.  This seems so silly to those of us from the US.  My (very pregnant) sister and brother-in-law had a name picked out for their soon to be born child months ago.  It is not uncommon for children here to not have a name until they are a couple months old.  This means they do not have the equivalent of a social security number which prevents them from receiving their vaccines and eventually going to school.  This week really showed me that there is some exciting stuff going on down here that can have a huge impact.  All the people in attendance are required to hold a similar workshop for all of their co-workers as part of their evaluation.  Not only did this workshop show me the things we can do with a little bit of education, but it also opened the door for me to possibly get some more experience in a clinic in Chimbote.  If things ever slow down with the project, I have been invited over to the clinic Magdalena Nueva to work with the pediatric population.

Now, one cannot go to Huaraz without experiencing the Cordillera Blanca.  The Seattleite in me was seriously missing the mountains and a week in Huaraz was the perfect cure.  I went on a great hike with some friends, spent a couple wonderfully relaxing days in a mountain town that taught me a few, very important, lessons.

1. At altitude, I have the lung capacity of a mouse.
2. Nine months of a carbohydrate-rich Peruvian diet DOES NOT mean that you have carbo-loaded for a 18km hike.
3. While my parents taught me what to do if you encounter a bear or a mountain lion on a hike, they never told me what to do when you encounter an angry bull.  Spending 20 minutes on the side of a hill after being chased by said bull is pretty laughable once you know you will not get gored by one of his horns.
4. Two days of playing in the mountains is not nearly enough.  I cannot wait until September.
5. Peru does have good beer.  It is all in Huaraz. (It also has decent Mexican and Thai food.)

A very happy (early) Father’s day to the Grand Poobah himself, my pops, from whom I inherited my love for the mountains, beer and corny jokes.  Happy Father’s Day to Grandpa Lars, Grandpa Daly and my brother-in-law/soon to be poppa, too.  I feel pretty darn blessed to have all of you in my life.

Peruvian Dreams

When I was sixteen, I was confirmed.  My patron saint was St. Rose of Lima.  I think part of the reason I chose her was due to the fact that my family always jokes about how I was supposed to be named Rose, but when I was born my mom said I just did not look like a Rose.  I have never fully recovered.  I can give you the full sob-story later.  The main reason I chose St. Rose was her love for the poor and her humility.  Last summer, before I knew my placement for this year, my mom had a dream that I would be going to Peru.  I kind of laughed it off and thought, “Yeah, I’d be okay with that” and then moved on without giving it a second thought.  Now, I do not know if I really believe in fate or destiny, but I do know that I am (obviously) in Peru right now.  I also know that over these past eight months I have had a lot of déjà vu.  I take all these things to mean that this is exactly where I am supposed to be.  Why I am supposed to be here, is a question that may never be answered.  So on those days (which have been happening more frequently these past couple weeks) when I realize that I kill an average of eight bugs in my bedroom alone in one day and when the smell of fishmeal wafts into my bedroom from the factories, I start to wonder if it really just was coincidence that I picked St. Rose and that of all the countries in the world, my mom dreamed of Peru. 

Anyone who tells you that volunteer work is not stressful has obviously never worked in Peru.  Throughout the past couple weeks, it has not been uncommon to work five 12 hour days in a row, followed by a Saturday in order to catch up on everything that was not finished throughout the week.  I’m not complaining (ok, maybe a smidge), the project is cool and when I actually take a second while I’m walking around Cambio Puente it really hits me all the great things you can do with public health.  These realizations have not only made me thankful for this opportunity down here, but have also made me thankful that there are people who love public health as much as I love the idea of public health, because I could not do this forever.  With the start of our nutritional workshops about six weeks ago, everyone has been a little stressed out and a little more on edge.  Thankfully, we seem to have finally settled into our schedule and the end of the workshops in July no longer seems so far away.

This week was a nice work break for me.  Early Monday morning, a couple co-workers and I headed up north to Trujillo to help out with their project.  For all my complaining about having too much to do with our project, I am thankful that there are three of us to spread out the workload; the Wiñay project in Trujillo has only two and I admire their work ethic and spirit.  Its amazing how doing something we do every month (weights and heights) can be so different in another environment.  We were able to learn a lot from the Wiñay project and share some of the ideas that have been successful with our project.  On Wednesday, my fellow CMMB volunteer, Amber, came down to Chimbote with a couple of her friends who are also PTs.  We were able to do some home visits with some families in Cambio Puente as well as hold a workshop for teachers about identifying disabilities in children.  In the evening, we had a workshop for the staff at the clinic about proper body mechanics to prevent back injuries.  The whole day was a nice change of pace.

This week I am thankful for fresh bananas straight from the tree in our tree, big, sweet mangos and a host family that (vainly) keeps trying to convince me to stay for just one year longer.

 

Feliz Dia Mama!

A very Happy Mother’s Day to all the moms in my life! Especially, Grandma Daly, Grandma Marilyn, and my Peruvian mom America. An extra special ‘Happy Mother’s Day’ to the strongest, most beautiful woman I know, my mom. You are amazing!

Chancho Marino

This story really starts on Saturday, although, I did not realize it at the time.  Please don’t judge me too much for what you are about to read.  I wouldn’t say it exactly has a happy ending, but here goes….

Saturday morning, I walked into the kitchen to find a big market bag full of bloody meat.  In my house, this really is not all that uncommon; we fairly often have freshly killed chickens in our sink, just waiting to be plucked and cleaned.  This market bag was left by my host dad who has been working out on a fishing boat since February.  Every couple weeks he stops by (usually in the middle of the night) when the ship is in port, to drop off some fish and say ‘hi’ to the family.  The bag of meat in the kitchen was his gift to the family for this trip.  The meat was eventually rinsed off and put in the refrigerator.

Yesterday, I got home for lunch and saw a heaping plate of meat waiting at my place at the table.  I thought to myself, “Beef!  We haven’t had beef in a long time!” and sat down to dig in.  Before asking what it was, my host mom told me I was being served the former contents of the bloody market bag, chancho marino.  I looked at her and said, “Is it a fish?”.  She said that yes, it was fish, so I took a couple more bites.  Up until this point, I have liked everything I have been served in Peru.  This was the first dish of which I was not fond.  After seeing me struggle through a couple more bites, my host mom told me that I did not have to eat it if I did not like it, phew!

That afternoon, I went into the clinic and told my co-workers that my host family finally found something I don’t like.  I told them what it was and then innocently asked, “What is chancho marino?”  My co-worker replied that it may be better not to know.  That comment always troubles me.  After a little more nudging, she pulled some pictures up on Google and said, “Well, at least you didn’t like it!”.  The pictures she pulled up were of large marine mammals.

I went home last night for dinner and saw Johannes (the German volunteer) sitting at the table with my host sister, Milagros, eating chancho marino.  Milagros made a comment about how much Johannes liked it and I asked if he knew what it was.  The following conversations still makes me scratch my head:

Johannes: Well, it’s fish, right?

Milagros: It lives in the ocean, yes.

Cathleen: But it isn’t really fish, is it?

Milagros: Well, I guess not technically, no.  But it does live in the ocean, so kind of.

Johannes: Well then, what is it?

Cathleen: My co-worker told me it was related to sea lion, is that right, Milagros?

Milagros: Some people say it is related to dolphin.

Johannes: …………

Cathleen: So, it isn’t fish, then….

Johannes happily finished his plate of porpoise and I dug into my bowl of cereal.  Trust me, I feel terrible enough as it is about this situation, so no guilt trips please.

Elecciones

Last Sunday the primary presidential elections were held.  Out of the five leading candidates, one of the two with the highest number of votes will go on to be elected president in June.  Ollanta Humala and Keiko Fujimori were the two candidates with the highest votes.  Ollanta Humala is a leftist, former military man who is friends with Venezuela’s Hugo Chavez.  Ollanta says that he will implement a curfew in order to help cut down on violence and delinquency.  Keiko Fujimori is daughter of former president Alberto Fujimori who is currently serving multiple, concurrent prison sentences for human rights abuses and corruption.  The fear is that Keiko will pardon her father if elected president.  If you want to read a little more about Keiko, check out this article.  How did these two candidates end up on top?  Well, it is at least partially due to the bribery that is used by the candidates throughout their campaign.  In Chimbote alone, families were given pots and pans, rice cookers, bread and money for pledging their support.  Candidates have also been known to pay to have roads paved, street signs installed and other public works carried out.  One thing I can say with 100% certainty: the next couple months will be interesting.

For the past two weeks, we have been holding workshops in Cambio Puente.  For each workshop, we invited ten moms from the sector we had selected for that week.  The goal is to eventually have all the moms attend a workshop.  The focus of these workshops was nutrition, but we also included early childhood stimulation, education on safe drinking water, family planning information, anemia education and a discussion about respiratory infections and diarrhea.  It would be an understatement to say that I was overwhelmed the first week.  I was thrown into the workshop with little knowledge of what was going on and still halfway in vacation-mode.  The first workshop felt unorganized and chaotic.  This past week, however, was about a million times better.  We sat down as a team at the beginning of the week to talk about the whole plan for the workshop—something that should have been done in the beginning, but better late than never, I suppose.  I also had another nurse to work with who helped translate from ‘Cathleen Spanish’ into ‘normal Spanish’ when the moms gave me that look that said “whaaat??”.  The confidence I had lost in the first week of workshops came back as I realized that I really had not lost any of my Spanish in my two weeks of vacation and that I still do know what I am talking about when it comes to health topics.  I think we all have those moments when we doubt our skills and during that first workshop, I forgot how to cover up my own doubts. 

Along with the workshops, we also brought in an agricultural engineer to talk to our families and some of the staff of the local schools about starting their own vegetable gardens.  We are starting this project in just one sector and then hoping to spread it out through the rest of the community.  Our goal with the engineer is that he will help these families to find nutritive, inexpensive crops with a year-round harvest. 

A big thanks goes out to the Sprangers family this week.  Thank you for all the sugar cookies, pool parties, giggles and continued support throughout the years.  I feel very blessed to have you all in my life!

Pros and Cons

There are lots and lots of good things about having family come visit.  There is also one down side.  Having family visit means that eventually, they leave and you get left alone in a country that is still not quite home, no matter how hard you try.  However, the pros definitely outweigh the cons. 

Back in September, I never thought March would be here.  Before I knew it, my family’s visit was a month away and there was a point when I actually thought to myself, “but wait, I just saw them!”.  Two weeks passed much too quickly and I now find myself wondering if the next six months will go as quickly as the first six. 

One of the great things about travelling with my parents is that we stayed in hotels that had hot water, clean sheets and private bathrooms.  Long, hot showers meant I felt clean for the first time since September.  I will spare you all the details and just give you the highlights of the trip.  (If you feel like you are missing out on something, you can always shoot me an email.)  I like to think that after these past couple weeks, my parents, brother and I are now amateur archeologists.  Not only did we hit Machu Picchu, we also saw Caral, Chan Chan, Huaca de la Luna, Qorikancha and a well-hidden site in the heart of the Colca Canyon.  We started out the trip with a trip to Caral, the oldest city in the Americas.  After surviving what was the most nerve-wrecking taxi ride of my life, we got to enjoy the only partially excavated ruins that lie about three hours north of Lima.  After Lima, it was a quick trip up to Trujillo to see the ruins of Chan Chan and Huaca de la Luna in one day.  We made friends with a taxi driver who asked whether I was from Chimbote or Trujillo; one of the highlights of the trip.

From Trujillo, we headed down to Chimbote for a very short trip.  I was able to take my family out to Cambio Puente and they got to meet some of the community agents that work with us on the project.  These women are incredible.  Every single one welcomed us into their homes and were genuinely excited to meet my family.  I know how much I appreciate these women and how hard it will be for me to leave them in just a couple more months, but hearing them say the exact same thing to my family brought tears to my eyes.  It is an amazing thing to be welcomed into somebody’s home to share food, stories, laughs and broken Spanish when you know how little they have.  Peruvians give a new meaning to hospitality.

From Chimbote, we fought the altitude and headed up to Cuzco.  After trying to use, what PeruRail told us were nonexistent tickets, we spent the next couple hours trying to navigate our way through the system.  After lots of phone calls (the first time I have really been thankful for my cell phone down here) and talking to what seemed like everyone in the train station, we finally made it to Aguas Calientes and Machu Picchu.  I do not have the words to describe how beautiful Machu Picchu is, you will just have to come down and see it for yourself.  Our second day at the ruins, we were there from when the gates opened at 6am and had to be chased out by the guards at 5pm.  We got to see the fog clear over the ruins from the top of Huaynapicchu and caught a double rainbow from the Caretaker’s Hut in the afternoon.

We shipped Patrick back to the States in Cuzco and my parents and I headed down to Puno to see Lake Titicaca and the manmade islands of Los Uros.  Then it was on to Arequipa.  Arequipa is Peruvian Disney World.  Everything was clean and bright and the garbage trucks sounded like ice cream trucks.  We spent a day exploring the Santa Catalina monastery which takes up an entire city block and is a city in itself.  There are still about thirty cloistered nuns that live in the monastery, but the majority of the building is open for touring.  It is gorgeous and maze-like with hidden passages and dozens of rooms.  Arequipa is the starting point for any sort of tour or trek of the Colca Canyon.  The Colca Canyon is twice as deep as the Grand Canyon and has countless ruins inside.  We headed out to the canyon for a quick, two day tour and got to do some hiking, some more exploring of ruins and some hotspringing.  We got front row seats to see condors fly over the canyon and were stopped in the road due to a llama crossing. 

Unfortunately, Arequipa was our last stop on our quick Peruvian tour.  It was really hard to watch my parents leave, but it was a really wonderful couple weeks.  I am very blessed to have such a great family and that they had the opportunity to get a little taste of what my life is like down here. 

A couple things my family got to check off their bucket list on this trip (some of them had to be added first):

1. Having our bus stopped by the policia.
2. Having front rows seats to watch a grown man wet himself on the bus from Chimbote to Trujillo.  Gotta love Latin American transport.
3. Eating alpaca.
4. Eating guinea pig.
5. Watching the fog clear over Machu Picchu.
6. Watching sunrise over the Colca Canyon.

Thank you for a fantastic trip.  I miss you guys already!

¡Feliz Cumpleaños Mama!

A very happy birthday to my wonderful mom, Kris!

Carnaval

Things in Peru are not all work and no play.  Actually, judging by how much I love my work down here, I would say it is mostly all play. This past weekend was particularly fun.  Let me start by saying that in the month of February, Carnaval is celebrated in Peru.  This meant that the scariest sight in Chimbote was a group of kids with buckets and water balloons.  It is fairly common for people to get hit by water balloons or have buckets of water dumped on them from second floor windows by complete strangers.  Gringos make a great target.  So most of my month of February was spent peeking around street corners or high-tailing it in the other direction to avoid being hit.  Thankfully in Chimbote, only water is used.  Some cities throw paint, flour or talcum powder on innocent passersby.  The city of Cajamarca has a reputation of having one of the wildest Carnaval celebrations in all of Peru.  Friday night I went to sleep in Chimbote and woke up Saturday morning in Cajamarca.  I met up with some friends in Cajamarca and we walked to the plaza to get painted.  Innocently thinking that we would get some face painting, I was very surprised when the first handful of paint was chucked at me.  Within a matter of an hour, we were covered head to toe in paint.  Not wanting to feel left out, we bought our own bucket of paint and left our mark on everyone else (especially those who lacked any color).  The day was spent walking around the streets of Cajamarca, throwing water balloons, splattering paint on perfect strangers, banging on buckets, singing songs about Carnaval and dancing.  It took three days to get all the paint out of my hair and I am still finding spots of paint on my skin.  Not a bad way to ring in the season of Lent.

A little taste of Carnaval

Finger-Pricking Fun

Sometimes it is the tiniest successes that make everything worthwhile. Josefa and her family are one of those successes. I love handwashing, which is probably why this particular event was all the more exciting for me. Over the past couple weeks, we have been conducting home visits (among other things). Our goal is to visit all our families in Cambio Puente on a monthly basis to see how they are doing and what kind of improvements can be made to their living situations in terms of safety and sanitation. At the end of a long day, we had one more home visit before we were going to call it a day. We knocked on Josefa’s door and she opened it with a big grin on her face and welcomed us inside. We started chatting about their drinking water and told her about the SODIS system which is a method of purifying water by putting it in plastic bottles and leaving it in the sun for six to eight hours. The UV rays purify the water, making it safe to drink. (My SteriPen does the same thing, but a lot faster and was a little more costly.) She was very excited to learn about this because it means she will no longer have to use gas or wood to boil water when it could be used to cook food. Part of the home visits is evaluating the bathrooms of our families. By US standards, the term bathroom is used very loosely. Nobody in Cambio Puente has sewage pipes so most of what we saw were pit toilets and latrines. Many had no walls or doors and were little more than a hole in the ground. There were quite a few families that do not have a bathroom and just do their duty out in the open fields. Walking back to Josefa’s bathroom, we noticed her hand-made faucet that our community agents had taught their neighbors how to make. This gives the families a clean place to wash their hands with “running” water. Josefa had taken everything to heart and not only had her soap and water tap but had put a bucket on the post with all the toothbrushes, toothpaste and other toiletries. We were beside ourselves. It is such a silly little thing, but is so nice to see our families actually implementing what they have been learning.

Besides rejoicing about Josefa, I have spent the majority of my days poking kids’ fingers. Last week we started (and finished) all of our hemoglobin testing for our kids. Only about 45% of our kids are considered to have a normal hemoglobin level. There was some frustration on my part because the ranges we are using seem much lower than what should be considered normal. This gives the ministry of health the impression that anemia is not that prevalent in Peru. (On a slightly different note, the same situation can be seen with heights and weights for kids. The tables used have been shifted to the left by 0.5 or 1 standard deviation making it seem like malnourishment is no longer a problem.) Due to all of this, we have decided that even for our “normal” kids, we are going to provide prophylactic treatment. Raising their hemoglobin levels a smidge will not do them any harm and it makes us feel a lot better about using these ranges. Win-win.

A huge congratulations to Krista Horejsi and Tony Linn who are tying the knot this weekend! I wish you both the best and could not be happier for the two of you. I will be celebrating with you in spirit!

Pinworms and Giardia and H. Nana, Oh My!

The final results are in: 49% of the kids in Cambio Puente who are enrolled in our project, have some sort of parasite.  Normally, to get a good diagnosis, three…umm…samples… need to be collected.  Due to the size of the group we were testing we only had the time and resources to collect one sample from each kid.  The problem with this is that often, the parasites will not show up in the first sample or the second sample, but will stubbornly show up in the third sample.  Therefore, we can only assume that more of our kiddos actually have parasites.  This is what the breakdown looks like:

Rather than just providing treatment to the kids that we were absolutely sure had parasites, we decided to make medication available to all our kids in Cambio Puente because of the fact that we cannot be sure that the 51% that showed up negative are actually parasite free.  The tricky part is that we had two different medications we were using because unfortunately one type of medication does not cover both giardia and oxiuros (pinworms).  This is where our sectors came in handy.  Rather than just treating the whole population with one blanket medication, we looked at the parasite prevalence in each sector and treated the kids that came back with a negative diagnosis for the parasite that was the most prevalent in their area.  When it came to actual treatment, we had a complete range of reactions from the kids.  There were some that could not wait to take their medicine while others were climbing over their mom’s shoulders trying to get away from us and spraying the medicine back out as soon as it was in their mouths.

One of the (many) things I love about our project in Cambio Puente is the way it is designed.  In total, the project will be present in Cambio Puente for just a couple years.  After those years, we will leave the community to care for themselves.  In those few years, it is our goal to provide the people of Cambio Puente with the tools they will need after we are gone.  The main way we are doing this is through our community agents.  Every couple months we hold workshops that last for a day or two and talk about different health conditions in kids and what can be done about them.  My co-workers apparently think my Spanish has improved to such a level that I can now more actively participate in these workshops.  Read: lead discussions and give presentations.  There was still a little giggling at my Spanish as we worked our way through talking about infant warning signs, but at the end I think (hope?) everyone understood.  There may be one benefit to my stumbling through the language, though—there was more participation from our group of women than normal.  I think they just felt sorry for me.  Whatever the reason, I had to pat myself on the back for leading a discussion when just six months ago I could barely carry on a decent conversation about the weather.  It is an unbelievable experience to be a part of something that is much much bigger than myself and I count myself lucky and blessed every day I am down here to be a part of it.

The Wonderful World of Nursing

The last time I looked at the data, over half of our kids in Cambio Puente had parasites.  About 90% of what I know about parasites, I have learned in the past week and a half.  People look at me skeptically when I tell them that we don’t really have parasites in the US.  One of my co-workers actually laughed at me when I told her that we can drink the tap water back home.  It took some convincing for her to realize I wasn’t pulling her leg.

Parasites have taken over my life this past week.  Not in the ‘ohdearIneedabathroomNOW’ sense, but in the ‘I get to spend my days testing kids for parasites and working on treatment options’ sense.  Sounds cool, right? Right.  Starting last week, our community agents in Cambio Puente started collecting samples from all our kids.  They were nice enough to do the dirty work and we lugged those stinky coolers off to the lab for processing.  This was the first step.  The second step was left up to the nurses.  As a rule, I don’t like to sacrifice my sleep for much, but those cute kids out in Cambio Puente seem to have a way of getting me to do almost anything.  For three days this week, our team of nurses was out in Cambio Puente before 7:00 in order to get to the kids right when they woke up.  House by house, in each sector of Cambio Puente, we did the scotch tape test on the kids enrolled in our project.  If you have not heard about this test and want to know what it is, you can find a brief description here (just remember, these are intestinal parasites).  The kids were surprisingly well behaved for the uncomfortable position we were putting them in—I only had one avocado sandwich thrown at me!

Parasites are tricky little devils.  Not tricky to get.  Not tricky to identify.  Tricky to treat.  Let me rephrase, we know exactly how to treat the parasites we are dealing with, the problem comes with actually getting the medicine we require.  Anti-parasitics are cheap to buy.  Depending on your source, they cost anywhere from two to seven cents per dose.  From the standpoint of a lot of public health projects, that can really start to add up.  The hope for our project is to be able to carry out two rounds of treatment per year.  Now here’s the real problem, since parasites have been largely eradicated in the developed world, most pharmaceutical companies have little incentive to produce the medication since the majority is given out as donations.  The quantities required are not available.  This is when things get tricky; when we have to acquire said medication.  There is another tricky area—the fact that these kids will almost certainly get parasites again.  It almost feels like we’re just putting a bandaid over the problem.  However, kids who are parasite-free, even for a short amount of time, can reap great benefits.  Since parasites can consume up to 25% of what the host ingests, kids who are parasite-free have more energy, do better in school, grow like they should and are more able to fight off other diseases.  If we want our kids to remain parasite-free, however, we need to do more than just treat them twice a year.  We have to intervene at the home level.  This is why handwashing is so important!  Such a seemingly simple solution to a big problem in much of the world.

These little worms will continue to take up much of my time for the coming month and a half.  I’m looking forward to (hopefully) winning this little parasite battle.

My friend lent me the book ‘Donde No Hay Doctor’ (it comes in English, too).  For anyone interested in really rural health, it is an interesting read and a great resource to have on hand.

I think I have managed to change my settings on here as far as comments are concerned.  So for all (three) of you who have just been dying to get your comments up here and haven’t been able to, you are in luck!  Comment away!

A Very Peruvian Day

Even though most things are pretty normal after a couple months down here, there are still some occasions when it really hits me that I am living in Peru.  This past weekend was one of those.

Saturday we had a free health clinic in Cambio Puente through the Posta Santa Clara (where I spend my Thursdays and Fridays).  We loaded our team into a combi that I was sure was going to collapse with the weight of the exam table on the roof and drove the bumpy, dusty road through the rice patties.  Somehow, we made it there (and more importantly, back) safely and unloaded all our supplies.  We had two general medicine doctors, countless nurses, physical therapy, psychology, a pharmacy and dental all for free.  Typically, I do not like just giving things away, but healthcare is a little different.  One of the ways to help encourage systemic change in Peru, is to help strengthen the local economy.  Having a healthy workforce is vital.  As I have said before (and probably will say another 39823 times), healthcare in Peru is seen as a privilege and the working class simply cannot afford the care they need.  That is why I love free health clinics.  I feel that rather than encouraging dependence, it prompts people to look at their health from a preventive standpoint.   While people were waiting to be seen by the doctors, we were able to slip in some general education on parasites.  Somehow, I was talked into portraying the parasite in our skit.  The Peruvians all said it was because the parasite had the fewest lines.  I believe it was because they wanted to scare the kids and I am the tallest person on staff.  Our two doctors were able to see over 50 patients in just under four hours.  We were able to fill most prescriptions with the donations we have received over a couple months.  I was running the pharmacy and it broke my heart every time I had to tell someone that we longer had the medicine they had been prescribed.  We did not have any antiparasitics which was by far the most common prescription.  I had to remind myself that doing what little I could was better than nothing.

Sunday, I had a very Peruvian day.  My host family and I decided to go to the beach.  We originally planned on leaving at 9:00, so naturally, at 10:45 we loaded six people into a tiny Peruvian taxi.  To get to the beach, we had to drive through some sand dunes, requiring us to get out and push the taxi.  We got to the ocean and from there had to get on a boat to head to the playa.  The boat was full of about 30 Peruvians who do not know how to swim wearing life jackets that would maybe save a toddler.  After nearly capsizing twice and have the motor die numerous times, we hopped from our boat to another in the middle of the bay and puttered along the way.  At 12:30 we got to the beach safely where we set up camp for the day and watched three locals try to put up a tarp in the blowing wind for more than 30 minutes.  Needless to say, it was a very Peruvian day and I loved every second of it.

A huge thanks to everyone who has sent me packages and letters.  Not only does it ensure that my supply of Reese’s Peanut Butter Cups never runs too low, but it keeps me going on those days where home and next fall just seem way to far away.  Likewise, all the emails are appreciated more than you can know!

The Other Side of the Door

Time has really started to fly.  I feel like just last week was New Year’s.  The past couple weeks have brought some exciting occurrences and yet some more changes to life here in Chimbote.  First though, a few thoughts on health care…

I have tried really hard to paint an accurate picture of what health care looks like here in Peru.  The truth is, however, that even though I am on the inside of this system (so to speak) my view is still a little skewed.  I am very lucky to be able to afford the healthcare that I would need down here.  I also know that if something were to happen and I needed more care than can be given in Peru, I would be flown home.  That is not an option for Peruvians.  As much as I would like to believe I am living in solidarity with the people down here, this one fact makes a giant difference.  Not a day goes by that I do not realize the privileges I have been given.  I had a rather lively discussion with a co-worker a couple weeks ago.  The debate was about healthcare as a right as opposed to privilege.  I strongly believe that everyone in the world has the right to receive quality healthcare.  Whether or not they are receiving such care is a completely different matter (and one I am trying to work on).  One of the reasons I like CMMB is exactly that.  Their vision as stated on their website is: A world in which every human life is valued and quality healthcare is available to all.  I strongly believe in this and have committed myself to attempting to achieve this for as many people as possible in Peru.  However, in Chimbote, healthcare is mostly reserved for the privileged.  If you can afford the ten sole general medicine visit, you are in pretty good shape (so to speak).  Just because this is the way life is down here does not mean that it should remain so.  As one of my friends said “the secret to change is leaving apathy at the door”.  My first step is to try and do some education with the nursing staff at hospice.  By educating other healthcare workers, I can hope to achieve a much more far-reaching effect and in turn, help more patients receive the quality care they deserve.  Like everything else in Peru, poco a poco.

In the Daly household, if we see someone walking up the driveway wanting to sell us something or preach to us, we run for the nearest desk to hide under, turn off the TV and the lights and hold our breath.  I now know what the people on the other side of the door feel like.  Last week, we ventured out to Cambio Puente to gather some missing data from our population and to let people know about the free health clinic we are hosting this weekend.  In itself, this would not be all that exciting except for the fact that this was the first time I was let off on my own to gather data.  I knocked door to door and talked to people about our project and let them know about the clinic.  While a little nerve wrecking, I was pleasantly surprised to find out that I could understand everything being said to me and more importantly, that everyone else could understand me!  It took four nurses a day and a half to knock on every single door in Cambio Puente.  Afterwards, I guided my Peruvian co-workers to a ceviche stand in the middle of the market.  They were all surprised when I wanted my ceviche spicy.  As we say in our house, “Comida sin aji, no es comida (food without spice, isn’t food)”.

Last weekend, my fellow volunteer Amber and I decided to take advantage of this beautiful country we live in and explore the city of Chiclayo.  There are (supposedly) some great ruins up there (that due to time constraints we were not able to visit) and a huge market complete with a section devoted to traditional healing.  There were dozens of unidentifiable herbs, skunk pelts, amulets, voodoo dolls, dried lizards and much much more.  If I come down with some mysterious Peruvian illness, I will be heading straight for the market in Chiclayo.  We found a great little hostel in the beach town of Pimentel (after deciding not to stay at a not so great little hostel) complete with cable TV, a hot shower and toilet seat. 

A huge thanks this week goes out to my friend Kara Churchill who helped me laugh and cry my way through nursing school and continues push me to be the best nurse possible.

Congratulations to Heather and Jim Brennan on welcoming their newest addition to their family, Elliot John!

And finally, don’t forget to have a look at my pictures by following the link on the left or clicking here.

Las Fiestas

Initially, I thought that saving my blog update until after both Christmas and New Year’s was a great idea.  I now regret that decision.  So grab yourself a glass of chicha, a plate of ceviche, maybe some paneton and tuck yourself in for a long one…

Our Christmas celebration started the morning of the 24th as I innocently went downtown to buy my gift for my amigo secreto (secret Santa).  What was meant to be a simple shopping trip ended with us purchasing our Christmas turkey.  Eleven kilos, white, fluffy and squawking, my host mom decided he looked delicious.  There is a joke here that on Christmas eve day, as you are getting ready to kill your Christmas turkey, you give the poor thing a shot of pisco to help ease the pain and make it easier to wrestle with the turkey.  As the turkey drinks the pisco, so does the butcher.  This continues all day until by the end of the afternoon, the butcher and turkey are stumbling around together and the butcher will not kill his new friend.  I did not see our poor turkey drink any pisco, but he was a fighter; it took three Peruvians to hold down our soon-to-be Christmas feast.  Very appropriately, the word Peruvians use for killing a turkey is pelear or ‘to fight’.  We walked away with our turkey in a large blue plastic bag and continued on to our Christmas shopping.  Christmas Eve is called ‘La Noche Buena’ which I find charming and simple.  I was introduced to many new Christmas carols, my favorite being ‘Cholito Jesus’ in which we sing that we believe Jesus was born in Peru.  I have to say, with the parties they throw here, I can hardly blame Him.  In the same song, Joseph was brought a charango and both him and Mary drank chicha.  A version of the entire song can be found here.  I was practically bursting as I waited to wish everyone a Feliz Navidad until after mass.  Christmas here is about family.  Gifts are minimal and the focus is on spending time with loved ones over good food, drink and lots of laughter.  At about 10 minutes to midnight, the festivities really began.  Baby Jesus was removed from his box, sung to and passed from person to person to hear our wishes for the coming year.  Midnight, on the dot, he was placed in the nativity and there was an eruption of ‘Feliz Navidad!’ from the family.  There were big Christmas hugs for everyone before we sat down to eat our Christmas dinner.  The table was filled with our giant turkey, paneton (there were six panetones eaten over the course of two days), candy, bread, potatoes, champagne and hot chocolate.  By Peruvian standards, our Christmas Eve was relatively tame.  Following dinner was the gift exchange and we were all in bed by the decent hour of 4am.  It was wonderful. 

Christmas day in the Daly household is traditionally spent lounging around in pajamas, eating too much candy and playing games.  While there were no games played here in Chimbote, we did laze around in pajamas all day, ate a lot of candy and watched some Christmas movies.

Last night, we rang in 2011 in style.  If everyone celebrated New Year’s Eve like Peruvians, it would easily be my favorite holiday.  There are many different traditions down here for New Year’s.  Firstly, the color yellow is believed to bring good luck.  This means that there was yellow everywhere!  From flowers to underpants, the streets were covered in yellow things for sale.  Once armed with yellow underpants, you are at least minimally ready to welcome the new year.  With yellow balloons and garlands hanging from the ceiling, we sat down for dinner at 11:00.  At the strike of midnight, we each ate twelve grapes and made twelve wishes and then quickly ran outside.  To help receive the new year, Peruvians burn dolls (muñecas).  These dolls are made from old clothes and stuffed with hay, paper, firecrackers and all the bad from the previous year.  At the stroke of midnight, they are lit on fire in the middle of the street.  On my block alone, there were three muñecas.  Looking down the street in either direction you could see a line of flaming dolls.  Once the dolls had mostly finished burning, we grabbed our luggage and headed out the door.  Taking a trip around the block with your baggage brings you good travels for the coming year.  As we hugged and wished the neighbors ‘Feliz Año’ they asked us where we were going, to which the response was ‘Viajando! (Travelling!)’.  After our trip around the block, the neighbors were getting their party started with a visit from Woody (from Toy Story) and Jerry (as in ‘Tom and Jerry’).  The music and dancing began and a good time was had by all.  I hit the hay at the respectable hour of 5:00 after yet another great Peruvian party.

Here’s wishing my baby brother a belated Happy 21st Birthday!  Welcome to the big kids’ club.

A huge congratulations to my childhood friend Stephenie and her new husband, Jim.  While you were saying your ‘I do’s’, we were celebrating down here with you!

Wishing everyone all the best for the coming year!  Feliz Año!