Hasta luego

Until we meet again. The Lima 2010 Team is a great group. At our last dinner we went around the table, each saying what we loved about every member of the team. It was moving to hear positive things about others and oneself. Hearing those things also reinforces the positive behavior and builds the team. We had a fun dinner and didn't stay out too late.  Wake up was at 2:30 am.  We awake to a near miracle--rain in Lima! The van arrives, we load up and leave for the airport. Goodbye Lima, goodbye wonderful people of Pamplona Alta, San Juan Miraflores and Huycan! It was our pleasure to serve you.

Team leader

Vicky. There is no one like her, she is unique. She loves people, and loves team building. Everyone feels great around Vicky because she looks for the wonderful qualities in everyone she meets. She asks lots of questions out of genuine interest and people open up to her. She loves us all and would fight with tooth and nail like a mother bear if any of us was in danger. She knows her mind and makes decisions efficiently. But if she does not have enough data she asks for input from the team. Vicky is also a passionate photographer and we hope to see a book of her travel photos some day.

Critical care

Angela is one of our Spanish speaking medical team members. Her medical expertise combined with language ability really helps things go smoothly. For instance, the list of available pharmaceuticals in Huycan was in Spanish, so she not only translated it, she shuttled back and forth making sure we had the correct medications and dosages. The pharmacist kindly sent samples back with Angela so we could verify. She was also helpful in cabs and in town, everyone responded helpfully to her sweet inquiries. As a critical case specialist she always responds calmly and knowledgeably. She is quiet and unassuming, and she is always right there, getting the job done. We can count on her, and that is essential in teamwork.

Machu Picchu

This post comes from the top of Machu Picchu. The name means "Old Mountain." It was inhabited for around 150 years by the Incas and was abandoned before the Spanish came. It was a religious and administrative center. From the surrounding mountain peaks they could communicate with the city. Water came from a spring 749 meters up the mountain. Water flowed through a stone aqueduct and came out in 16 still-functioning water fountains. The Inca also installed drainage conduits to preserve the foundations from the heavy rains. There is an altar in the holiest area. They commonly sacrificed animals such as llamas. On very special occasions they would sacrafice virgins or children, but only from the royal family. The mummies were found in Argentina. We also see the Lock of the Sun. It is oriented so that the sun shines on one side all summer long. It is oriented to the seasons and emanates sacred power. It is forbidden to touch, but one may hold a hand over it and feel the power.

Country mouse and town mouse

Here we see Lisa playing with children who are waiting for an exam with Rebecca and Hope. Lisa is indispensible as our organizer with her comprehensive knowledge of running a health care facility. We have served three different populations in three different areas. The poorest was in the hills of Pamplona Alta. They were also the cleanest, with the most healthy teeth and least diaper rash of the populations. The city kids had more health problems including tooth decay. They all have parasites and respiratory illnesses. One theory is that the poorer populations do not have money for candies and sweets so their teeth are healthier. The hill kids have to run up & down the mountain to get anywhere. So they get lots of exercise every day. Lima lives under a perpetual haze of pollution, so city kids constantly breathe pollution. Whereas the haze lifts off the hills every day & the air is clearer for longer periods. Huycan is unique of the three in that no parents are concerned with flat feet.

The national radio star and the nun

The clinic administrators advertised today's clinic on the radio, it received lots of attention. Today is also International Osteoporosis Day. Therefore it made perfect sense for the media to interview one of our international doctors. Indeed, they wasted no time! At mid-morning the newspaper invited Dr Ricardo to speak on the radio. It was conducted by phone and recorded to be broadcasted again later. They introduced him as an osteoporosis expert, asked him, "what are the causes of osteoporosis?" and handed him the phone. Dr Ricardo ran with it and gave a very informative interview. We will all ask for his autograph when we get home. After work our hostess, Sister Rita, invited us to tour her convent. It was a short drive to a quiet neighborhood. The convent is unassuming behind white walls. Inside are flowers, banana trees, mulberry trees, some handsome chickens, arbors, and a cool placid, atmosphere. They case for children here, and it is fitting.

San Luis Maria de Montfort

Today we work in Huaycan, which is west of Lima at the edge of the foothills. There are dozens of people lined up when we arrive. We are immediately assigned rooms and start to see patients. Dr Ann Marie, Angela and Angel work together. We see fever, vomiting, ear infections, a cleft palate, diarrhea, and parasites. There are no local doctors on site until this afternoon. So when we need to know the most common parasites we ask the pharmacist. She tells us oxyieros, giardias, and salmonella. Pediatrics didnt see any tuburculosis today but we understand there is a fair amount, especially up in the hills. People go to the hospitals in Lima for treatment. The most satisfying pediatric treatment today was working with two children with asthma. Dr Ann Marie was able to provide a long term treatment plan which will permanently improve their quality of life. Many of the things we treated are not seen in the USA. This is an opportunity to expand one's medical expertise.

Pediatrics and physical therapy

Robin (pictured) has seen a fever and a sore throat. Lisa mixed his antibiotics using water which contained a drop of vanilla. The local nurses always mix it that way. Dr Ann Marie saw kids with parasites, skin issues and anemia. All the parents are concerned about flat feet in their children. We check, and fortunately most of them are ok. The children often begin to cry when they see the doctor, so Dr Ann Marie lets them listen to their own hearts with a stethoscope. They are transfixed. Rebecca saw only adults today, whereas yesterday she saw only children. One 70-year old gentleman is an avid soccer player. He is having hip problems which greatly reduce his mobility and ability to play. He has seen several doctors and physical therapists for relief. All they can prescribe is physical therapy. When he consulted with Rebecca she provided additional exercises for him. He was so happy he offered to make ceviche for all of us in his home tonight. We appreciated the invitation but were unable to accept.

Help with backs and legs

This patient, Signora Benedicta, was brought in by her daughter and granddaughter. She has hypertension and a broken back. She is in constant pain, cannot speak inteligibly, and cannot sleep, even though she has pain medication. We prescribed a stronger sleep aid. She is in a wheelchair and in a very stiff back brace that looks like a corset. Her daughter and granddaughter lovingly wheel her around and carry her from chair to bed. They are obviously experienced in her care and they are dedicated to her. The general medicine group saw a variety of ailments including unexplained pain. One gentleman complained of resparatory issues, inability to sleep, and pain in his leg. As doctor and patient got to know one another we learned that his wife died a few months ago, and then the pain and other issues started. We prescribed a little pain control, but mostly physical therapy. The key was
taking time to develop a relationship and discover the root of the problem.

Policlinica Familia Monday

Today we break into two groups at the main clinic. Dr Ricardo, Laraine and Angel go to la Familia. Drs Bob and Ann Marie with Lisa, Rebecca, Hope and Angela go to the physical therapy site across the street. We all begin seeing patients immediately. Laraine and Angel take a technical class in administering EKG tests. After each test Laraine takes the patient to see Dr Ricardo for an exam, evaluation (and prescription when necessary). Across the street the team sees patients for general medicine, pediatrics and physical therapy. The PTs use the colorful room pictured in photos of our initial clinic tour (photo of a little boy reaching for a ball). Outside the cardiology procedure room a woman receives oxygen and a doctor sutures a lacerated toe. The cardiology team sees a heart murmur patient who was diagnosed at age 10. She is monitored periodically and today Dr Ricardo lets her know
that the murmur can get worse when she gets pregnant. So, continue to keep an eye on it.

English class project

While people watching in the cathedral square we met four girls from Alfonso Ugarte School. Maria, Alessandra, Cynthia and Marcella were conducting interviews for their English language class. They asked whether we are happy, what makes us happy, and several other questions about attitudes. We replied that we are happy, that family and food make us happy, and that we are optimists. In return we interviewed them. One wants to be a doctor, another loves to dance, and one wants to be an engineer. We told them about Project CURE and said that we could work with the budding medic as the in-country doctor when we do clinics in Peru. With good will and laughter they continued on to interview other travelers. We are so glad we decided to sit in the square. We went to people-watch and we were watched instead!

Domingo en Lima

Sunday Dr Ricardo (pictured) suggested we go to Plaza de Armas. Ricardol, Laraine, Lisa and I started our day at the church of San Francisco de Assisi where I attended mass and we toured the catecombs. As we emerged we heard a joyful band playing. It was a celebration for The Virgin. Several bands and dance troupes competed for judges. The drums boomed, the trumpets blared, and the colored skirts swirled. Our hearts sang, toes tapped and hips swayed. It happens here every week; what a lovely treat for us!

Local dances

After the games came lunch and a dance competition. The four teams each danced a specific historic dance which tells a story. Two teams told a Biblical reconcilliation story, but in very different ways. Two others brought gifts of the harvest. One of the harvest stories featured the mayor who ended up getting drunk. The other harvest story included husband and wife fighting and reconciling. The funny part was when wives beat their husbands with bunches of herbs. Yes, domestic violence is no laughing matter, but the way they did it really was funny!

Fiesta de Aniversaro

Today we celebrate the 20th Anniversary of Solidaridad en Marcha. We are at one of their schools. Three teams are decked out in colors: red, green, blue, and our team color, yellow. After the speaches and prayers there is much cheering and whistling. Let the hands and dancing begin! We join in the parade with our team.

Liz's Abscess

Friday we served around 100 patients. Dr. Ann Marie, left, had an abscess case on Friday. 3-year old Liz came in complaining of cough and a sore throat. Upon examination she also had a decayed abscessed tooth. We sent to the first clinic location for a scalpel while we waited Liz's Mom went to get her other children from school. She said she would be back in 20 minutes. Of course, that meant two hours! We held out as long as possible but had to pack up. Finally she showed up just before we left. Anne Marie insisted that we wait long enough to drain the abscess after mom returned. Then Mom helped hold Liz down and Angela applied pain killer specially improvised by Dr. Bob Barelli. The procedure was sure and swift, but resulted in a host of dirty looks from the previously joyful Liz. She still has to go to the dentist for the tooth but now she is out of pain and has some time to get the tooth pulled.

Soup kitchen again

Today we work in the same location as yesterday. This photo is of staff preparing lunch, and it smells delicious! Today patients come from the villages of Emilio Ponce and Malls. First the local staff performs triage- determines their needs-then sends them to the correct doctor. Each patient receives two papers: one for diagnosis and the other for a prescription. Doctors examine patients with the help of translators. Doctors make notes, give recommendations, and write scripts when necessary. The pharmacy is a room stocked with medications which we brought or which we purchased in Lima. After the examination patients might stay and chat with friends or send their children to lunch.

The patients

Today we saw about 40-50 patients. Common ailments are upper respiratory infections and parasites. There was one possible heart condition in a baby. Everyone was gentle and friendly. I worked mostly with Ann Marie the pediatrician upstairs in the library. We shared space with Hope and Rebecca, the physical therapists. I think the patients liked physical therapy because it is so hands-on. The moms are all serious; some kids ran around and some were somber. Several moms breast fed while waiting. We were glad because it is so good for the children. Downstairs lots of kids came for lunch. Janella (Jani) from yesterday was there and she lit up when she saw me. She wanted to sing "Pato Renato" about a duck who goes "cua cua cua." Her mother, Juana, offered for us to use the toilet at her house. This was very generous as they have outhouses which are high maintenance. We are going back to the same location tomorrow and people from different villages will come. We feel helpful.

Torre de Minas

Today we work in a soup kitchen for children. It was built by volunteers and the second story is new. It contains a library and a space for a workshop. Each child pays 1 Sole (36 cents US) for a meal. This kitchen serves 100 children a day. There are 45 villages in Pamplona Alta with 15,000 children from age 4-13. There are only 140 soup kitchens. The need is much greater than the resources.

The View

Visiting homes of our new friends. Soon we start singing and I regain my sense of humor. Kids hang around and the next thing we have several songs. We work for five hours treating flu, abrasions, and infections. The families are very friendly and welcoming.

Janella

 Janella got me singing today. She and her mom sang a counting song about an elephant, a song about a duck, and a couple of others. Her mother, Juana, wrote down all of the songs for me. We had a really good time and I think Janella has adopted the team. It seems everyone here is literate, a couple of other folks wrote songs for me, and other children wanted to use my notebook to write their names, such as Kimberly, and draw pictures. They are so warm and genuine, it is a pleasure to be with them.

We begin

A dozen people have appeared, it seems to be mostly about children. Lisa and Angela spring into action. They immediatly begin triage: height, weight, complaint. Lisa´s expertise as a hospital administrator is obvious! Angela is equally efficient directing traffic, talking with the people. The patients are kind, open, and well, patient. Little children stare about wide eyed, or run around joyfully. Several times we shoo dogs out of the clinic. They, like the residents, are very curious!

They live in houses without any walls

Pueblo Joven is like the Favela of Rio de Janeiro. The title of this post is a story by Maurice Sendak.

Pamplona Alta

The team in Pamplona Alta. We are at the top of the "Publo joven" and I am not laughing now. Perhaps I will regain my sense of humor later . It is just that this is like being in a documentary.

Going to very poor area

Going to very poor area now. No posts for a bit.

El Presidente Moises

Lorenzo Aguilar Moises saw me taking a photo of his team building a house. He waved and came down to introduce himself and his mission. When our driver saw me go off he came over to make sure I was safe. All was well and we exchanged cards. Sr Moises does important work in a dangerous, gang ridden neighborhood.

Coalicion Comunitaria Drogas de Ppampas de San Juan

Across the street is a community center for the prevention of drug abuse. The President was across the street helping build a new story on a house. Their blog is Coalicionpampas.Blogspot.Com.

Incubator

Baby beds in the Infantil. To the left is an incubator with Bili lights for jaundiced babies.

Centro Matero Infantil

The team at the maternity hospital. Women receive pre natal care and deliver here. They do a lot of C-sections In order to prevent pain. There are lots of premature babies but very few are born sick. If they are sick then go by ambulance to a hospital 10 minutes away.

Physical therapy

A little boy receiving physical therapy. He reached for a ball then turned and put it away.

Pollolinico Segrada Familia

General practice family clinic. 20 Soles for service. Started 20 years ago. The most common problems are Tubuerculosis, malnutrition, skin problems from the dust and dryness, parasites and contaminated food and water. People come from an hour away by bus.

German Doig Clinic

Physical therapy clinic. 12 Peruvian soles for an hour of treatment. This clinic is for people who do not have insurance and must pay their own bills. It is run by SEM, a Catholic organisation.

Introduction

Visiting San Juan Miraflores, a poor section of Lima.

Hospital staff

This is some of the in country team. From left to right: Milagro the nurse, Dr Tovar, Jeanine the receptionist. Milagro made rabbit ears behind doctor Tovar before I took the photo. I wish I was faster!

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Planning meeting

Meeting with the in country staff. We met from 7 to 9 pm. The doctor and nurse and receptionist from Solidaridad en Marcha came to our hotel after they finished their work for the day.We figured out our schedule for the next three days. Tuesday we tour the shanty town, then we sort the medications. We will order medications a few times on the trip. Wednesday we tour another facility and start working. It is called a campaign. Our midwife is essentially promoted to doctor of gynocolgy. We leave tomorrow at 8:30 Am.

Transportation

Crazy people in a bicycle cab

Weaving

Weaving in a shop in Miraflores

So far.....so good.

The team from back left: Dr Bob Barrali (Emergency medicine), Vicky Flatt (team lead), Rebecca Askew (Physical therapist), Hope Dela Vega (Physical therpaist), Dr Ricardo Bessoudo (Cardiologist), Dr. Ann-Marie McCarthy (Pediatrician), Angela Chandracamar (Critical care/oncology), Lisa Smith (RN), Laraine Guyette (Midwife), Angel Horvath (assistant team lead).

Arrived in Peru

Arrived in Peru

Laraine Guyette

Laraine Guyette, nurse-midwife

Dr Bessoudo

Doctor Ricardo Bessudo, cardiology

All packed. Leaving tomorrow. I think I have everything.

Children's Song: Los Pollitos Dicen

I've been looking for songs to sing with the children while they wait on line. A big Thank You to Deanna Vaughn and her sister for providing the following song, and to Joe Morales for the transcription and translation.

http://www.youtube.com/watch?v=A_QrHRnGQLI&feature=PlayList&p=4D67482700A50E29&index=0&playnext=1

Los Pollitos Dicen

Los pollitos dicen pío, pío, pío
cuando tienen hambre, cuando tienen frío.
La gallina busca el maíz y el trigo
Les da la comida y les presta abrigo.
Bajo sus dos alas, acurrucaditos,
duérmen los pollitos.
hasta el otro dia
(Final time, add the following.)
Quando se levantan dicen mamacita
tengo much hambre dame lombricitas!

The little chicks say peep, peep, peep
when they are hungry, when they are too cold to sleep.
The mother hen looks for corn and wheat
she gives them food to eat.
Safe under mama's wings, huddling up,
Sleep the little chicks until the next day.
(Final time, add the following.)
When they rise again they cry Mommy
we are very hungry, give us worms!

Containers at the warehouse

Cure shipping containers being prepared for dispach around the world.

Joni Standard - Sponsor

Joni Standard is sponsoring the First Aid brochures we will distribute to the people we serve in Peru. Thank you, Joni!

Cure Kits

Received the Cure Kits today. Will take the boxes of disposable medical supplies as checked baggage. There will be a baggage charge from the airline.

Project C.U.R.E. Clinic, Lima, Peru 10/2010

Project C.U.R.E. Clinic, Lima, Peru 10/2010

Project C.U.R.E., Centennial, Colorado, USA.

2010 Peru Clinic Sponsors

Thank You!

Mel Ada, Alan Anttila and Deanna Vaughn, Bruce Benham, Ricardo Cardenas, Carol Chamberlain, Stephanie Dunn, Kristi Graning, Frank Horvath, Richard and Gayle Klose, Siuk Leong, Gail Liniger, Monica Marshall, Dave Metzger, Joni Standard, Susan Thompson, Brian Widmer, Donna Woodward, Patti Woodward, Richard and Ally Yohn.