¡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.