Dalton Scholar

Friday was my last day at the hospital in Paita.  I thought it was just going to be a regular day in the Internal Medicine clinic.  But after about an hour visiting with patients, Dr. More told me to head to the OR.  For my last day I got to scrub in on two more surgeries, and learn how to do stitches!  I assisted the surgeon throughout the surgery, and then at the end he slowly stitched the patient up and explained how to do it as he went.  He then let me practice using the forceps and needle, so that I could get the technique.  I had never used the instruments before, so I was a little shaky at first.  It was an easy process, but took a little bit to get the feel of the forceps.  Even learning something as simple as stitches was exciting, and I appreciated the surgeon taking time to teach me!!  After the two surgeries I thought we were finished, but we walked outside the OR to find a boy about eighteen years old who had been in an accident.  He had lost the tip of his left ring finger.  It was very bloody and the tip of his finger bone was exposed along with his entire nail.  After he gave the boy a local anesthetic, I helped the surgeon by cleaning the wound and putting pressure on the opening while he cut the bone down.  Once the bone and nail were even with the skin and tissue that was left on the finger, he sutured the opening closed.  The nurse and I then cleaned the boy’s finger and wrapped it in gauss.  It was a very successful day, and I learned a lot about performing and controlling my nerves in pressure situations.

Today, Dr. More and I worked our first Sunday.  It was another adventure similar to our day in Amotape.  In fact, the town we visited, called Pueblo Nuevo, is located just across the river from Amotape.  Pueblo Nuevo also lacks a health care facility, so we once again took a trip down the canyon to visit patients.  This time we went as volunteers with the Lions Club’s Compañas Médicas program.  They had turned Pueblo Nuevo’s primary school into a mini hospital for the day.  There were about five school rooms that served as clinics for different specialties, and one room acted as the pharmacy.  We were stationed in the Pediatric room with one other doctor and one nurse.  Dr. More alone saw 50 patients in about three hours.  None of the children came in with any serious problems; there was a separate emergency clinic set up for those patients, so basically Dr. More was there to prescribe medication.  The children were afflicted with diarrhea, parasites, fevers, rashes, and minor colds.  We found that many of the mothers brought two children into the clinic; one who was sick, and another who was said to be “sick” but looked seemingly healthy.  The mothers were more than likely fudging on the severity of the child’s illness to get extra antibiotics for future ailments.  We mostly went along with it, because the mothers pushed hard, and it was difficult to distinguish between who was sincere and who was exaggerating.  Dr. More didn’t refuse many, and how could we blame the mothers for trying.  If it wasn’t needed now, the children probably wouldn’t have access to medicine when they did really need it, so I guess it was justified.  After the 50 patients, Dr. More and I headed back to Paita to catch our bus home.  It was a rewarding day, and I admire Dr. More for his constant dedication to helping people.  He was the only doctor from EsSalud Hospital in Paita at the event.

The end of the week is here, and with it many Peruvians will enjoy a meal of Ceviche with their friends, coworkers, or family.  I have experienced several Ceviche meals thus far in my trip: two with Dr.More and our hospital coworkers, one with my medical student friends, and one with my host family.  I have found that the most important thing about Ceviche is that it is shared.  Whether you are celebrating the end of the work week, or the fish is fresh from the Friday market, it is delicious!!  The classic Peruvian dish is typically a plate a white fish, cooked only by the acid of the powerful lemon dressing that soaks it.  Yuca, sweet potato, and chifles (banana chips) usually accompany the fish, and it is a tasty combination!  Aside from the delicious food, I have had a full week at the hospital in Paita.  I spent most of the week with the medical students in an Internal Medicine rotation.  We would visit the hospitalized patients in the morning, and the students would practice examining and questioning the patients.  It was so exciting to see students my age already getting to do what American students will have to wait to do in medical school.  On the bus ride back from the hospital on Wednesday, I asked one of my medical student friends to explain the university system of Peru to me.  I learned that following high school, the medical bound students take a test (similar to the MCAT in idea) to gain entrance into the “medical faculty” at a particular university.  The students must study hard for this test and devote many months to learning the information that will be on it, in addition to their high school studies.  If you want to go to the public university you will probably have to enroll in a class to prepare for the test, and you will have to score very well on it.  The private universities are easier to get into, but still competitive.  Once into the university, students take courses similar to the science curriculum in the US, but they also begin rotations in the hospital from the first year.  The early introduction into the hospital setting was implemented because the students need to know what they are getting into early on, before they dedicate 3 or  4 years to medical studies and then realize they don’t like it.  Unlike the US, the students here head straight into their specific field’s studies from the beginning.  There is no concept of “liberal arts” or studying anything outside of your career path.  It still takes the students about 7 or 8 years to graduate from medical school, where they will then begin practicing or begin studying for a specialty.  I’m not sure that I would like the university system here, although it is more widely used across the world.  I would have to say that there’s a lot to gain from moving away from home, having to live with a stranger, meeting people from around the world, or playing a sport for your school.  The university students here don’t have that opportunity.  But, these differences are what I love about traveling; my mind is opened to new ideas and ways of living.

I have been in Peru for three weeks today, and the time has flown by.  I realized today that I have developed my routine for the most part, and living here has become normal.  I’ve gotten use to people always looking at me because I am the only American here, and the bustle of the streets.  People always get excited when I tell them that I am from “Los Estados Unidos”, and ask me a lot of random questions about pop culture, weather, and school.  This always reminds me how Peru is only a 5 hour flight away, and yet there is a world of difference between them.  I find it interesting that while I’m surrounded by a different culture and language, I am still very surrounded by American things.  Most of the ads here display Americans advertising products, I hear American music on the radio, and Piura has just acquired its first Starbucks.  Also, I was surprised to find in the mall food court: KFC, Pizza Hut, and Burger King.  Aside from the comparisons and contrasts, I am really enjoying the people of Peru.  No matter where I am, or who I’m talking to, people are friendly.  They are patient with my Spanish, and always interested in trying to start up a conversation.  I might be getting such a warm reception because I am a foreigner, but I’ll take what I can get because it is hard being the outsider!  I have to focus hard and listen carefully to everything that is said around me to understand what is going on.  I have gained a new respect for all of my friends at Queens who have come from a non-English speaking country to study.  I now understand their struggle, and I’m not even going to school here!!  It has been a humbling experience in many ways, and I cannot thank my Peruvian friends enough for their patience and acceptance.

Today I was at the hospital in Paita, for another morning of surgery.  But, I didn’t know that today I would be assisting!!  I changed into my scrubs like I had last time, and walked into the OR where there was a 12 year old boy laying on the table.  It was just him and I in there for a minute, and he hadn’t been sedated or anything.  I was looking at him thinking, this kid is amazingly brave to be lying there, fairly calmly, with nothing on but the surgical gown, hat, and booties.  He was connected to an IV and was laying on the table, under the lights, in this frighteningly clean room knowing he was about to be operated on.  I would have been in hysterics had it been me.  He looked at me and there I saw the terror in his eyes.  I was called out of the room and told to start washing my hands because I was going to be scrubbing in.  I was getting excited because I didn’t do this last time, and wasn’t really sure what else was going to be different.  We went through a cycle of 3 washes and then dipped our hands and arms in antiseptic before reentering the OR.  Once in the OR, I was dressed in the surgical jacket and gloves.  The boy at this point had been given the anesthetic, and we began to clean the area where we would be operating.  Once the towels were spread out we began the boy’s circumcision.  I stood directly across from the surgeon and acted as the surgeon’s third and fourth hands.  I could hardly contain myself!!  I was holding the instruments and the skin as the doctor made the cuts and incisions, and then I cut the sutures as the doctor stitched the openings.  The doctor was explaining things as he went, and directing me carefully because he knew that I was not a native speaker, but I was able to understand him well and assist in my first circumcision!  As if this wasn’t enough, following the boy’s operation I scrubbed back in for a fifty year old woman’s umbilical hernia operation.  I held up the skin with the instruments as the doctor made a four inch incision next to the woman’s belly button.  It was my job during the surgery to keep the opening retracted with the retractor in one hand and hold back different parts of tissue with instruments in my other hand as the doctor made his cuts and placed the emerging hernia back into place.  At one point, the surgeon directed me to put my finger in the opening and feel the open ring of tissue where the hernia had protruded.  It was the most amazing feeling to be so involved and hands on!!!  I still can’t believe what I did.  I then assisted the doctor in suturing a small piece of mesh looking cloth into the opening to hold the tissue in place, and then we sutured the outside skin back together.  When we stepped back and took off our gloves I was on top of the world.  I knew that I had just gotten a firsthand experience that not many people get until medical school or maybe after.  I am truly having the experience of a life time here in Peru.

Pediatric appointment with Dr. Cesar Alamo

Today I was in the Pediatric clinic in Paita working with Dr. Alamo. We saw about 20 patients, and all with different health issues to address. It was an interesting day dealing with anemia, diarrhea, constipation, hepatitis A, and many different parasites. Parasites I discovered are a major health concern for the children of Peru because the country is so dirty. If a child looses the slightest amount of weight, the parents have them in the clinic to be checked out for parasites. I am looking forward to what else I will learn this week.

Group from EsSalud of Paita in Amotape

Today was an amazing day.  Dr. More, Dr. More’s assistant, another doctor from EsSalud in Paita, and I traveled about 45 minutes down the coast of Paita to the tiny oasis of Amotape.  As the ambulance we rode in drove down the Panamerican highway, as far as I could see out either window was desert.  There was some plant life but mostly just dirt.  After about 25 minutes on the Panamerican, we took a left onto an unpaved dirt path.  I was sitting in the front in between the driver, with his Gilligan’s Island hat, and the doctor on my right.  Dr. More and his assistant were in the back, and we were bumping down the road listening to the Afro-Indian rhythms of their favorite Peruvian songs on full blast.  I am thinking that I don’t see any sign of life other than the goat herder and his goats we passed just a minute ago, and there are no road signs indicating where we are headed.  But, as we wound down the path I could see that we were approaching what looked like a canyon ahead.  As we came closer to the edge I could see down into the basin and all I saw was green, lush plant life covering the whole inside of the canyon.  It seemed as if the earth was withering away on the arid coastal plains of Peru, while the basin of this canyon looked like it had not been touched by the hot Peruvian sun.  We followed the path down into the canyon, across a bridge over a river that was surprisingly full of water.  We then drove into the center of the town where there was a small park and church, typical in most Peruvian cities.  It was a shanty town, but the colored buildings, flowers, greenery, and the tall yellow church  against the backdrop of the canyon walls made it beautiful.  We got out of the ambulance and walked into a small one room building, where we set up a makeshift clinic with two desks, two beds, and two curtains for each of the doctors.  The people, mostly elderly, were already beginning to line up outside of the clinic.  We had a list of the patients that had signed up to be seen and their charts.  So, each patient came in, would talk to one of the doctors and tell them what was ailing them.  The doctors would give them a diagnosis, a small quantity of medicine if needed, and usually an appointment to be seen in the hospital in Paita for further treatment.  Today was exactly what I wanted to experience while I was in Peru, and what I can see myself doing one day.  Dr. More and his colleague were volunteering their time to visit a small town where health care was not available, and the patients were more than grateful.  As each one said goodbye after their appointment, they would shake our hand, thank us, and smile.  I could tell this was payment enough for these selfless doctors.  Some of the patients were represented by their daughters or spouses because they couldn’t make it down the street to the clinic, and a few of the patients came in on wheelchairs made of a white plastic patio chairs and bicycle tires.  The patients were suffering from all the usual ailments of old age: osteoarthritis, cataracts, glaucoma, high blood pressure, and  high cholesterol, but they didn’t have access to a doctor to diagnose and prescribe medicine for these problems.  This is why I wasn’t surprised when patients came in saying they were 65 and looked like a 95 year old American.  Although, I couldn’t dwell on what didn’t happen earlier because this was a hopeful start to a connection between the town of Amotape and EsSalud hospital in Paita that would provide the care that is needed for the people of this town.  Our time in Amotape was closed by a wonderful lunch prepared for all of us by one of the families of the town, which we ate in their home before heading back to Paita.  Also, the neighborhood iguana came out across the path in front of the ambulance on our way out to say goodbye!!  Quite a day in Peru.

In OR for 2 umbilical hernia operations

It is Sunday in Piura, a day of rest and relaxation.  I am sitting outside on my host family’s enclosed patio.  It is a beautiful day with clear blue skies and birds chirping.  This morning I slept in, and it was wonderful! It was a nice break from the usually schedule:

5:45am wake up

6:00am breakfast with my host parents

6:20am take taxi to Dr. More’s house

6:30am take taxi to the Piura bus terminal

8:00am arrival at Hospital I Miguel Cruzado Vera- Paita

The hospital is also open on Saturday mornings, so I went in yesterday to observe Dr. More and his colleague in surgery.  I changed into my scrubs and stood right next to the surgeons as the performed two umbilical hernia operations.  The site of operation was a bit small, so I couldn’t see much detail, but the surgeons explained some of the anatomy and procedure while they were operating…it was amazing!  The anesthesiologist was very nice and showed me how to prepare the patient for the operation and how and where to inject the anesthesia.  It was a short day of work, before we headed back to Piura to enjoy the rest of our Saturday.  My host family and I ate lunch when I returned, which is the main meal of the day at about 1pm, followed by a “siesta” (nap), and usually a lighter dinner later in the evening.  At 5pm my host mother, Elena, and I met up with her friend, Violeta, and went to Saturday Mass at the local Catholic church.  It was lovely, and I could pretty much follow along, because it is very similar to Mass in the US.  We walked back from the church, across the river, to a bakery where we bought bread for the next week.  I am finding that I really enjoy being out, walking around in the evenings because it is quite lively and the weather is perfect.  After returning home Mark, Elena, and I head to the local mall which was built in December of 2011 and is the first mall in Piura.  We eat dinner and go see a movie.

Also, I forgot to mention in my previous post that on Friday I met Dr. More’s medical students.  There were seven of them at the hospital that day taking a group diagnostic exam.  It was very cool to see what they were learning, and interesting because they were 19 years old and already seeing some of the stuff that I won’t see until I’m into medical school.  They were all very nice, and laughed at me a bit because I was struggling to speak to them and answer their questions…but hopefully I will see them again next week and get to know them a bit better.

Today I was at the hospital in Paita at 8am to begin my internship.  I spent the first part of the morning in Pediatric Immunizations, where I saw many babies from 7 days old to 1 year old.  Whatstruck me as the most interesting difference between the pediatric clinic setting here in Peru compared to in the US was that at this hospital you are given the date of your appointment, but no time.  So, the mothers show up to the clinic with their babies on the day of their appointment and then take a number and wait to see the doctor.  This causes a bit of chaos as mothers crowd the doorway trying to speak with the doctor when she opens the door to call in the next patient.  This difference may be a reflection on Peru’s cultural conception of time, or lack of conception.  I think that the system may be this way because it is at the mother’s convenience when to arrive.  After a few hours I went over to the Ophthalmology clinic where it was just, if not more, chaotic.  It was very interesting though, because you see a lot of patients in a short amount of time.  It takes a different kind of character to deal with the people of this poverty level, and it is inspiring.  My host mother has been taking care of her mother, who lives in the house, for the past five years.  They have full time nurses to watch and tend to her because she cannot function.  She is staying alive by a feeding tube, and today my host father and I talked about the difficulties of the situation and the moral dilemma of taking them off support once you have already started.  Again another reflection of the culture, in that there is a sense of responsibility for your family.  They will take care of her until she dies naturally.  I am learning so much already about how to nurture.

I have made it to Piura, Peru and I am quickly immersing myself in Peruvian culture and most of all the language.  The people are amazingly friendly and I find myself speaking “Spanglish” more than anything.  I am living with a wonderful couple who have been showing me the ropes of life in Piura.  I have traveled to Europe, and this is nothing like what I’ve seen before.  It is what you would expect of a developing country as far as appearances, but the people are modern where I am.  I am enjoying spending time with my host family and discussing the interesting culture.  They are helping me settle into my internship and get up with me in the morning to eat breakfast.  The hospital is an hour bus ride from Piura, in the port city, Paita.  It is a shantytown on the water, with a small hospital.  Today was slow, as I was given a tour and met the nurses and doctors I will be working with.  I am feeling very nervous about my Spanish, but the people are helpful.  Tomorrow will be my first real day, and I will be in Immunizations.