20 Mayo, 2010

8:00 am clinic. It was kind of a slow day. Cone loop excision was about the most exciting thing. Two slow days in a row for the CerviCusco Clinic. You could tell that Dr. Ferris was disappointed. I sat in the grass outside of the clinic and read the book that Dr. Ferris wrote on colposcopy.

After clinic, a game of horseshoes was in order. I am terrible. Dr. Ferris and Lynn like to play at the office back home, so they schooled us all. After a couple rounds of horseshoes, we went into town. This time only five of us forced our way into a cab. I sprawled out across Bonnie, LaShon, and Lynn’s laps in the back seat. SHOPPING SPREE!!! Souvenir shopping at its finest! In Cusco back alley markets with endless supplies of alpaca and jewelry provide the perfect setting for haggling to a great deal. We knocked out most of the souvenir wish-list in a few hours, just in time to make it back to a lecture from a shaman at 5:00.

After the lecture, we all went out to a nice dinner. This was Dr. Ferris’ last night before returning to the states. Tanupa was expensive but tasty. A band dressed in Peruvian garb played a mix of native music and the Beatles along with classical music on their tiny guitars and pan flutes. Dancers in exaggerated forms of native dress twirled around the restaurant. It was a nice show for the gringos. I was content to sip my pisco sour and eat alpaca with mushrooms.

19 Mayo, 2010

Keeping my fingers crossed that giardia symptoms would resolve overnight, I promised Dr. Ferris I would be ready to hike the mountain behind the clinic at 6:00 am. From my experience, if you suspect giardia it is necessary to rule out that the patient did not consume foreign cheese, ice cream, and strong liquor drinks involving egg whites the night before. I won’t question my immune systems ability to clear whatever it was, but simple count my blessing.

At 6:00 am the sun started to make his presence known as Dr. Ferris, Bonnie, Big John, and I began our ascent. Our gluteals propelled us through the rich neighborhood of Santa Maria. The dogs were still asleep and there was no traffic on the roads. The houses were large and beautiful with gardens bursting with colors. We passed a shaman retreat at the end of the paved road just before entering the park. Trails in the park would not lead us to the top of this very tall mountain but high enough to make a good 2.5 hour hike. Some of the trails were washed out from landslides but Bonnie and I bounded up the mountain from one breath-taking flower species to the next. Dr. Ferris later admitted he didn’t think we’d keep that pace for long, but he is now convinced we were llamas in a past life.

After the hike, Bonnie and I went in search of breakfast. Fresh bread and empanadas. We got some groceries, but there was no bread. Lynn had mentioned a panaderia (bakery) near the clinic. On the way home we asked some ladies if they knew of one near by. They pointed us around the corner, and our noses lead us the rest of the way. Ham and cheese empanada for me; apple puff pastry for Bonnie. Celia at the panaderia was our new favorite neighbor. We licked out fingers and get back just in time to catch the 9:15 lecture.

The lecture ran long. Charlie’s flight was scheduled to land around 11:30. I wanted to wear the Peruvian clothes from Yanaoca. I wanted to shower. I wanted to have time to brush my hair and teeth. Most of all, I wanted to be early, so when I looked at clock that read 10:50, I literally ran out the door. I got to the airport in time to meet Charlie. I didn’t want him to be alone in an airport where he spoke very little of the language. We hopped a cab back to the clinic. Today was my day off, so we spent most of the day resting (I think I was more tired than he was from the hike that morning.) For lunch I took Charlie to the bakery we had discovered that morning. After our nap I showed him how to shop at the market here and where to exchange money.

That night we grilled out on the roof and had a big family dinner. Clinic tomorrow was 8:00 am – 2:00 pm. I went to bed early.

18 Mayo, 2010

Cold. So cold. The bus had been 2 hours late the time before, but this morning I woke up to Lynn screaming, “Buuuus is heeeeere!” ten minutes before it was supposed to arrive, approximately 3:50 am. The morning was harshly cold. The bus was wretchedly uncomfortable. We were all tired. After the longest 2.5 hour bus ride ever, we were in Yanaoca, and nothing was open. Not a soul was stirring. My stomach, on the other hand, was stirring, churning, bloated, and cramping. After sitting on the bus in the ghost town for about half an hour we were ushered out into the cold streets to a restaurant for hot chocolate, coffee, tea, and bread. The food was not particularly appealing but the clean toilet was like a long lost friend. The chamomile tea warmed me, soothed my stomach, and replaced some of the water I had just lost.

As the sun warmed the earth it was easy to understand why the Incans worshiped the sun. Within the first hour of day break, it is not uncommon for the temperate to rise 10 degrees Fahrenheit. After breakfast we walked through Yanaoca to the main square where clinic would be held. The town was celebrating their 176 anniversary and there was yet another parade. This one was big. The school marching band lead the parade. All of the school children followed with banners and flags goose stepping in unison around the square and surrounding the statue of their most famous resident. The statue was of a Peruvian revolutionary who fought against the Spanish. For his brave actions, his family was tortured and killed. Then he was drawn and quartered and his body parts were buried in various places.

I worked with Bonnie, my classmate Devin, and our translator/Harvard med student Jessie all day in another make shift clinic. At least the bed didn’t collapse like it did in Pitumarca. Fortunately, our room was attached to a bathroom where I could run for if the need suddenly come. By late morning, I had graduated to just a bad case of gas. Still painful but I was grateful for the progress.

I liked this town. The women liked to joke with us, and all of the people were happy to struggle through our language barrier just to make small talk. We played with the children in the afternoon, they liked “keep it up” and other ball games. I asked the women where I could find beautiful skirts like the ones they wore. They sent me out of the square and down the street to a hole in the wall where a man pulled bloomers, skirts, and blouses from a pile on the ground until I found the perfect ones. Every time I asked his son, who could not have been more than nine, which one he liked better. He would giggle and point. I ran back to meet the others. We were done packing and decided to go play on the playground until the bus came. Teeter toters, tall swings, and long slippery slides needed terraces to keep them from washing down the steep Andean hillside. We couldn’t resist the slide, but decided to break the entire way down to prevent us from sliding off the precipice and on to painful injury. The bus came and took us to “lunch” though it was now close to 3:00 pm. Chicken, rice, and potatoes — the usual. Peru has an absurd assortment of potatoes. They are small and flavorful. I like to think they’re better for me because they are all natural. Better doesn’t mean good for my glucose levels.

Walking to the bus after lunch, I confessed to Dr. Ferris that I had been sick all day. He wants us to be very particular about what we eat. I want to experience the culture and cuisine. “As long as your burps don’t smell like sulfur,” he replied. “Uuuhhh, why?” I asked surely looking a little shifty-eyed. “Sulfur smell is typical of giardi.” According to the CDC symptoms of giardi are diarrhea (check), gas/flatulence (check), greasy/floating stool (check), abdominal cramping (check), and upset stomach (check). Symptoms in a healthy individual tend to last 2-6 weeks and the disease is resilient, water-borne, and has a low infectious dose. As everyone on the bus would soon know, my frequent burps did indeed smell of putrid sulfur. For the rest of the day I was known as a walking stink bomb.

A few kilometers outside of Yanaoca there was a volcano. All day our nurse had been talking about the volcano and was very excited about stopping to see it on the way home. The bus rolled to a halt and we all looked around confused by the grazing livestock and pasture. Lo and behold, there in the middle of the pasture stood a cone-shaped rock about 30 feet tall with a pit in the center. Possible the world’s puniest volcano, but I found it adorable. We all climbed to the top and took turns jumping in the mouth. As we slid down the side of the volcano a woman and her son were herding their flock of sheep our way. The little boy picked up the tiniest lamb and carried it over for us to hold. Bleating and confused, we fawned over the softest fluffiness any of us have ever experienced. The bus ride home as the sun set over the glassy lakes reflecting the soaring mountains and simple villages was something I will never forget. I rode alone wishing Charlie could have been with me to see it all.

17 Mayo, 2010

Our first day in the CerviCusco Clinic. I stuck by Bonnie, the OB/GYN resident from MCG rotating at the clinic. I watched my first colposcopy and loop excision (a cowboy hat) performed by Bonnie. Dr. Ferris supervised. He wrote to book on colposcopy and travels around the world to present his research and lecture on cervical cancer. I learned how to make a wet prep and the differential diagnosis for bacterial vaginosis, Candida, and Trich. Fun times! Seriously though, I’m learning so much and will kick ass on my OB/GYN rotation.

That night I was going to stay at the clinic to cook dinner and take it easy for the 4:00 am departure to Yanaoca the nest morning. Everyone else, however, was craving pizza and the propane tank supplying the stove had run out. We jumped a combi bus into town. The driver had said yes when I asked if he was going to “plaza.” Bonnie noticed that we were not exactly headed the right direction. This combi was not going to “Plaza de Armes.” A women nursing her baby sitting next to us must have understood enough of our English to know we were lost and confused. In Spanish, she told us we would go very near Plaza de Armes. She told us when to get out of the van and told us to walk two blocks up the hill and turn left, all the meanwhile still nursing her baby on the packed public transportation.

The Plaza de Armes is beautiful at night. The fountain is lit with altering colors of lighting. The Jesuit Church and Cathedral battle for the most majestic presence on the square while the illuminated Jesus statue looks down from the mountain above. We found a delicious pizza restaurant and I ordered my first pisco sour. (Pisco sours are 3 parts pisco, a grape liquor and their national drink, 1 part lime juice, a whipped egg white, and topped with a splash of bitters. They taste like the bastard love child of margarita and pina colada.) I went in on the pizza verduras (vegetable) which had eggplant, pumpkin, and pepper. Amazing! Most people ordered ice cream for dessert but I got another pisco sour. It was getting late by the time our check finally came. We stepped out of the pizzaria and hailed a cab not wanting to risk the combi van again. There were seven of us. A difficult number to fit in one cab, but this guy had a tailgate. Big John took the front, four girls piled in the back, and I asked if I could climb in the tailgate. The cabbie replied in Spanish, “There are police here, but meet me around the corner.”

“Catch that, Cat?” I asked the other girl standing near by who understood Spanish. We both took off around the corner. The cab began to drive and the people in the car began to freak out that we were not there and had run off. They soon spotted us waiting as the cab rounded the corner. The driver jumped out and opened the tailgate for us to dive in, and home to the clinic we went.

It was late when we got home, but well worth the story. We laughed in the common room and looked through pictures until the excitement had worn off and we went to bed.

16 Mayo, 2010

Apparently the alarm clock on my iPhone doesn’t sound when it’s on airplane mode and silent. At 5:16 I woke to the clanging of breakfast preparation after a night of very light sleeping. High altitude is associated with sleep apnea and thus frequent sleep interruption.

I sprang out of bed and was dressed, caffeinated, and ready to go in ten minutes for our bus departure at 5:30. At 6:45 we received word that the bus had a flat tire and it would be another 45 minutes.

I slept for part of the three hour bus ride to make up for the light sleep the night before. When we arrived in Pitumarca the women were lined up and eager for our arrival. The mayor had arranged for a ceremonial flag raising and parade around the square. The square was becoming more and more filled with vendors setting up produce stands, clothing stands, and juice and pisco stands.

After the parade we counted off and split into groups among the doctors. I was sent to work Doctora Flores. Her English is slightly better than my Spanish. A lot was lost in translation during clinic hours, but I still learned a lot and the experience was great. Later I was able to ask Lynn about some of the things I had seen. We closed clinic at 3:15 to travel up the mountains to the Pre-Incan ruins.

The Pre-Incan ruins were along the crest of a ridge. Though one of the lower ridges, we were still about 13,000 ft plus. Some of the walls had been rebuilt in 2008 to preserve the ruins that were still stable. Devin and I tried to climb to the summit but got hindered by impassable inclines and prickly under brush. Hundreds of feet below, the natives herded their sheep and cattle. Even at 13,000 feet, the peaks soared above us. In the afternoon light it was easy to see why they call this area the Sacred Valley.

15 Mayo, 2010

They bused us out to our plane on the tarmac. I sat next to a girl who was clearly as in a daze as I was. Neither of us seemed to be sure whether the other spoke the same language and we both quickly fell asleep. We woke an hour later when the plane prepared to land in Cusco. My seat neighbor was from Toronto and traveling to Cusco to volunteer at orphanage for the summer.

In broken Spanish we negotiated prices for a bus and tried to explain the location of the clinic. I was suprised by the level of development in Cusco, but other students we perplexed by why all the buildings looked unfinished. The CerciCusco clinic, however, is nicer than any place I’ve ever lived! Hardwood and tile floors, giant windows with fantastic views, a big modern kitchen. We all found a cozy place to curl up and sleep off the jet lag/night spent in the Lima airport.

One by one we began to stir. I was running around the clinic documenting with photo when Lynn and Doc Ferris arrived. They told us how to exchange money and where the markets are located. A group of us went out to adventure and see what the market has to offer. Foreign fruits, fresh bread, exotic spices, and I’m in heaven. Peruvian wines from Ica I have discovered are not much to brag about, but there is a solid selection of Malbecs from Mendoza.

For dinner, Doc Ferris introduced us to the best chicken I’ve ever had. Free range, naturally fed, and sans steroid injections. We went to bed early to be prepared for our 5:30 departure to Pitumarca.

14 Mayo, 2010

Charlie drove me to the airport so I treated him to a romantic dining experience at the McDonald’s by Hartsfield-Jackson. The airport was bustling. Economy parking was full. The flight was over-booked, but thirty or so seats in business class had not been booked as of that morning.

With two hours to kill before my flight I convinced classmates to wander the duty free shop at our international terminal where I got kicked out of the make up department for trying too many of the samples. Perturbed by the store clerk, I vengefully sprayed myself down in Marc Jacob’s Daisy perfume and returned to the terminal.

Final boarding call and people were still running to the gate after being dropped from the flight on account of the late connector. I was prepared to hop on MARTA to meet my mom at Northside Hospital and try again tomorrow. Five minutes until departure, everyone had boarded when the desk attendant finally gets a break from ranting passengers and crashing computer systems to tell me, “There are plenty of seat available in business class.” Question 1: window seat or aisle? Window for me. I scamper through the gate to find my seat on the plane. Question 2: orange juice or champagne? Technically it was a sparkling wine from California, but I wasn’t about to argue. I initiated my phone tree by calling Charlie and Mom to let them know I was on my way to Peru.

Excellent wine selection. I started with the Sonoma Coast Pinot Noir to pair with my cream of asparagus soup, cranberry and pine nut topped salad, and seared tuna. For the main course of peppered mahi mahi, asparagus, and risotto I went with the 2004 Rioja Reserva. Bold for a rioja. I stuck with this one until dessert when I had a glass of port with my vanilla ice cream with chocolate syrup. During dinner I enjoyed Pirate Radio, which I plan to buy when I get back to the states. The movie is probably not for everyone, but it conjures up fond memories of my radio days and incorporates many anthems of my favorite era in history. Next I began to watch “It’s Complicated” but was far more entertained by the sun setting over cotton clouded Panama. I turned off the flick that was probably meant for someone else and flipped on the “Spa Selections” music. I snuggled up with my blanket and pillow and slipped into a comfy coma until the pilot instructed us to prepare for landing.

The Lima airport is pretty unremarkable, especially at midnight. The customs determine whose bag to rummage through by the press of a button. Incoming internationals press a button and a light flashes green or red “randomly.” If the light turns red, your bag gets searched. I got the green light go ahead. There are 15 of us traveling together. Four of the five Indian students got their bags searched, but no one else. Random? Someone else is going to have to figure those odds. I wasn’t that good at statistics.

Dr. Ferris directed us all through the airport and showed us where to check in and where we could wait until the TACA desk opened two hours before our flight. Starbuck, Dunkin Donuts, Papa John’s, and Dominos. What continent am I on again? We found the Cafe Aeronautico where the wait staff speak minimal English, but humor my broken Spanish.

Que tipica de cervesa tienes?

Cuzquena.

Solo? Bueno. Una Cuzquena por favor.

My first Peruvian purchase.

Now I’m sitting in Aeropuerto Internacional Jorge Chavez listening to “America the Beautiful” and “Senses Working Overtime” play over the speakers at the Starbucks across the lobby.