6th - 10th August 2011
I thought rather than a long spiel again I would use the summary style that I used for the Choquequirao summary.
There were 12 of us altogether, the volunteers from Boulder, Colorado: Val- the doctor, Julie- the nurse, Tana- the dispenser, organiser etc..and their 4 children. Joey and Cito, twins aged 15; Natalie and Kally (12 and 8 respectively I think)...lovely kids. Olivia was a volunteer who was finishing another volunteer post early due to the school holidays.....not to forget Martin, Rita, Jess and I from Living Heart. Due to the large number of people we had to hire a minivan for all the food, sleeping bags, mats, water, our stuff etc.
Our days started at between 5.30am to catch the bus at 6.30am or 4pm for 5pm for our further away community. This was a new one for the doctors. Added to this I had a half hour walk to bus.....there ain’t no moto-taxis at that time of the morning!
Day 1 – one community (held in Jose- Antonio’s house)
Day2-3 our 2nd community (supposed to be an overnight)
Day 4-5 3rd community (overnight essential here as 3 hours from the nearest town and 4 hours from our hostels)
We developed a great set up that meant a really smooth operation with all helping (even the children) when we were busy.
• Outside was myself..recording blood pressure and ages. When it was quieter I also did the weights...Cito helped me when it was really busy. All patients received a slip, with the relevant information, to take in with them. We didn’t record the BPs of the children; just their weights and heights. For fun I did a few towards the end of our first day and due to the cuff being too big it didn’t record...so I told them they must be dead! This resulted in a lot of hilarity.
It also proved to be fun trying to weigh the very young..babies and children...trying to explain to the women I needed to weigh them first then both the mother and child to allow me to subtract their weight. Holding a screaming, wriggling child took quite a few attempts before I got a weight that looked reasonable..light by our standards but not by theirs. There was a lot of laughter as I asked them to peel off some of their layers. Their traditional hats, sandals and mantas (colourful blankets) add quite a bit!
Ages were also impossible to guess. After the age of about 20-25 anything you estimated was about 10-20 years out the older they got..such is the effect of a hard life and the very strong sun here!!
Inside we had 2 tables set up for examinations:
• At one table was Val (who speaks very little Spanish), Olivia (for the English to Spanish translation) and Martin (our driver who speaks Spanish and Quechua)
• At table two we had Julie who also speaks Spanish and Rita, our nurse who speaks Spanish and Quechua.
• Jess went between them both recording all the information we need for our records and Rita to follow up. The information will also help Val and Julie to decide what meds they need more or less of next time.
• At the pharmacy table Tana, who had done quite a bit of prep beforehand with pre-printed labels, had dispensing bags, tablet cutters etc at the ready. Meds were set up in their pharmacy category, i.e. antibiotics, gastrointestinal (for the stomach) etc. Her helpers were the boys and Kally who pre-packed vitamins, painkillers, antacids etc. They also helped cut in half if a lower dose was required. As Val pointed out the kids are hardy around here so where there was no suitable liquid the kids could swallow tablets. Due to the large family sizes we used colour coding on the packets so the mother knew which drug was for which child. We also used symbols of the sun and moon for day and night, and mealtimes to ensure correct spacing of doses.
• There was a small table set up for urine testing which Joey was in charge of. (He wants to be a doctor). He got very excited on our second day when he could tell a lady she was pregnant. He seemingly got the words mixed up to everyone’s amusement.
• Natalie, Kally and any of the kids (when we were quieter and the boys weren’t needed for anything else) put tattoos on the kids, gave them pencils, lollies, toothbrushes...and at each community a selection of toys..footballs, Frisbees etc, that Tana kindly donated. They also played football with any local children that wanted to play and where there was a field.
• Day 1 and the feeling of a family setting.
o The men were really helpful to me with ensuring the elderly got faster treatment and any issues I told the team inside which person needed to push through due to very high BP or age and frailty.
o Paulo and Cristologo were great and when it was quiet I sat in the shade with the family and talked with them. They were delighted with how I had set up the printed photos of the family allowing Jose Antonio to see them while lying in his cot.
• Meeting lots of local people who were so grateful for what we could do for them. They thanked everyone after their treatment...lots of smiles and handshakes.
• Feeling like I was playing my part in helping these people as a pharmacist but also as a human being from elderly to young children...making people smile, treating them with respect, helping them relax, ensuring they understood and were comfortable with what they had been given (or not (if it was beyond the scope of our clinic) as the case may be).
• Teamwork ..it flowed beautifully with everyone helping each other as required.
• Being a pharmacist – showing patients inhaler technique, helping Tana with drug identification and a few other things, pointing out drug interactions (nicely) to Val, suggesting better ways to make up formulations for young ones, thinking on my feet (finding solutions when problems arose).....
• Improving my Spanish and even using a few Quechua words especially in the more remote communities...”samaychiy” (means to relax in Quechua ..when I was trying to get them to relax their arm to take their blood pressure...this took a few attempts I can tell you..especially with the elderly).
• What the medics have left for Rita. I had the pleasure of showing Rita how to use the BP machine (which is battery operated so we can use it anywhere as there is not electricity in every community or there may be only one plug point where there is electricity).
PROBLEMS (nothing insurmountable)...thinking on your feet really came into this section..as did peacemaker!!
• Day 2 and dismay when arrived at the second community to find no-one there....the President had forgotten the posters Rita had given him and had not told the community (only the school kids!) He wasn’t even there!! When he arrived and rounded up some patients:
o on day 1 I told him that everyone was to come early and no later than 3pm the following day. I could just see them all trickling in at 4-5pm when we really needed to get back and we all really needed to get some sleep. (We went back to our hostels that night as there was no-one after 3pm as they were all in Pisac at the market).
o I didn’t let him off the hook on day 2 either when he seemed happy we had seen about 150 people over 2 days. I told him we had seen 200 last year in one day..(too many I know but there was a point to be made)!!
• By day 2 and everyone of us with an ailment that poor Val then treated for us!!! My cough back with a vengeance and almost stopped me from being able to assist every day...I doped up and persevered!! Jess with her ongoing intestinal issues, Rita and Martin too...Val even treated the dog at Heart’s Cafe..She seemingly does some animal diagnosis and healing in Colorado for herself as she has quite a few rescue animals, and for friends too.
• Day 4, community 3 and no-one there!! All the men were in the mountains working or on the Inca trail..even though the posters were up. This was the first year for a medics clinic for this community.
o The headmaster hadn’t left the keys and the president was away....
Solution: We set up outside and conducted the clinic in the fresh air until 4pm when the cold started settling in.
We had to saw our way into a classroom after I had identified which one looked best for our clinic and overnight..that meant a lot of peeking in windows.
How to conduct a personal examination on a young woman with no private area??...
• Solution: the doctor and nurses visited her house with her!
A rather inquisitive and pushy male when the doctor and nurse wanted a private conversation with the young woman and her version of events...
• Solution: Olivia distracted him for a time and I got Martin (who had been resting in the van above the community) so we had another male!
• Tension caused by various things not running to plan and someone’s need to have order and structure caused tension on most days..in Peru to have such a strict timeframe is very difficult..if not impossible!! Peruvians don’t always understand the instructions given...they tend to answer only what you specifically ask them and no more... and are much more laid back...A phrase I use a lot is” Well it’s Peru!!” I tried to be the peacemaker to keep the doctors happy and tried to keep as much harmony in the group as possible..I wanted them to come next year!! .This proved to be particularly stressful for me over a 5 day period...as there was some problem every day and tempers took a long time to cool down!!
• Sitting talking to Paolo about her family, outside in the shade.. it felt really comfortable... I felt accepted.
• Holding one of the babies while mum was being attended to and getting them to smile.
• Rita standing at the edge of the playground of the school in community 2 and shouting down to the president.
• The president of community 2 with a very large electric loudspeaker, which took 2 men to hold, while he shouted to the community that medics were here to hold a clinic.
• Watching the volunteers kids playing with the local children... you don’t need the same language to play.
• The queues of local children waiting to be given pencils, tattoos, toothbrushes, lollies, footballs.
• Carrying all the heavy bags of drugs and our overnight stuff down to the school. When you are at 3800m this is pretty tough!!
• Our outside clinic in community 3....what a backdrop for the clinic but we had to be careful to cover up and have hats on..sunstroke is very common here.
• In community 3 a little boy who I was about to weigh, with his feet in the wrong wellingtons (the first pair I had seen in the communities). I put the initials “I” and “D” on each for isquierda and derecha...(right and left in Spanish). I then explained to his friend, who spoke Spanish, what that meant.
• Rita sawing off lock!
• Our night in the 3rd community –
o Looking at the community from the top of the adjacent mountain...feeling at peace with the world up there.
o sitting around a bonfire fuelled by sheep poo (this is what they use in the school kitchen and it doesn’t smell)
o Roasting marshmallows on sticks in front of the fire.
o Fresh trout cooked by the school cook caught by her sons for us.
o A candle lit classroom...our clinic and bedroom for that night.
o The beautiful mountains by moonlight.
o The children crowding around me wanting their photos taken repeatedly that night...and laughing at the results ...the beauty of a digital camera and the instant results.
o The 2 dead Andean geese hanging from the roof of our bedroom!
o The llamas in the early morning on the way to their grazing
o Watching the joy on the faces of the children in community 3 as they received some super warm clothing from Tana. ..especially the widowed cook who has a lot of children.
Until the next instalment my friends....Buenas Noches y Adios ...