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!

 

¡Feliz Navidad!

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!

A Change of Scenery

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, Ecuador with my fellow CMMB volunteer, Amber.  We left Friday morning and after experiencing the unreliability of South American airlines, ended up staying a night in Lima.  After three months in our respective cities, Lima feels enormous and overpriced.  Our dislike for the city grew as we overpaid (by Chimbote and Trujillo standards) for dinner, drinks, water and a pack of gum.  The fact that we should have been sitting on the beach in Ecuador probably added to our bitterness.  We made it to our hostel in Montañita Saturday evening after a short bus ride from Guayaquil and a picture with Ecuadorian Santa.  Our hostel was gorgeous.  Grass huts with a swimming pool, mosquito netting, a couple spiders and cockroaches for roommates and only a few minutes walk from the ocean.  After spending three months in the Peruvian desert, I was in awe of all the green on the Ecuadorian coast.  I hadn’t realized how much my environment affected me.  Our week consisted of relaxing on the beach (even though it was cloudy), meeting some new British friends, hiking in the national park, La Machalilla, and eating a whole lot of food.  While the week went by fast and just perpetuated my desire to travel all over South America, I feel like I will be much more capable of having a positive impact in all of my worksites after a little time to myself.

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. My host family (have I mentioned how wonderful they are?) had a party for me, full of dancing, drinks, lots of food (we went on Friday to buy the two whole ducks and yet I was still shocked to see a duck head in the pot) and a great time with my Chimbotano family and friends.  One of the things I continue to struggle with down here is the fact that I simply do not have the words in Spanish to express my gratitude to my host family.  You can only say “muchisimas gracias” so many times before it starts to lose its meaning…

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’.

Mystery Meat

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.