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Tuesday, February 28, 2012

Things we could appreciate a little more in the US...

Washing machines
Drying machines (even more so than washers, especially in the wet season)
Plastic baggies
Hot showers that don't electrocute you
Space heaters
(central heating and air are quite unimaginable)
Not needing to eat "scrap" pieces of meat- this includes back bones, chicken feet, neck, liver, heart, intestines, shoulder joints, hoofs, and whole heads.
Having enough pieces of silverware in the cafeteria
Dansko shoes
Thick carpeting
Dependable internet
Kleenex in doctors offices
Canned pasta sauce
Good mustard
Ethnic variety in food
Basil
Buses with a schedule and route
Cars with intact suspension systems
Drivers that use turn signals
Down comforters
Movie theaters
Store and restaurant info available online
Comfortable couches
Customer service
Availability of health care (I know we've got problems, but at least you don't have to walk hours to the nearest clinic only to have to drive hours into town, worry about whether the ER will be open or not, have to wonder if the doctors drunk or even around, or be told that life saving option is only available in one city in the whole country.)

Accha


Sunday the staff at CerviCusco did a campaign in Accha, a small village about 4 hours from Cusco. This involved getting up at 3:45 to get to the clinic by 4:15 to load the bus with all our supplies. We arrived in Accha at 8:30 and there was already a line of women waiting for pap smears. We saw 200 patients that day. Many had walked hours to come. My second patient had gotten up at 3 in the morning (earlier than me) and had walked four hours to get to Accha. I saw several patients who had some kind of tumor growing at their cervix. There were several more with very large prolapses who had no idea they needed surgery.

This is going to sound horrible- but women who have walked four hours smell really horrible. I saw more feet that clearly hadn't been washed in months that I care to think about. The city government had sent up tents in the main square for us, and do to privacy that meant no ventilation all day. I have never loved air freshener as I did that day. It made me really appreciate things like running water for regular showers, hot water, bars of soap, and sinks for washing clothes.

The most disturbing part of the day was when we were leaving. We had brought donations for the kids- pens, notebooks, crayons, coloring books, and stickers. Wendy, one of the nurses, started passing out pens and within seconds there was a swarm of people around us. Not just kids, but adults desperately trying to get their hands on a 5 cent Bic pen. Notebooks started an even bigger frenzy and we had to insist over and over that they were only for the children. At one point Wendy put her foot down and said no one was getting anything if there wasn't an orderly line. That was amazingly effective at calming the crowd.

It was a totally different experience for me. I have seen incredible poverty in India. People who live on pennies a day. I've seen Tibetan refugees who literally walked over the Himalayas with nothing but the clothes on their back. But I have never seen this type of desperation for an item that by no means is life saving. I've heard many people complain about how the campos people are lazy and greedy and just expect handouts. I know they weren't expecting these, but their intensity and cunning and getting more than one thing was startling. It was disturbing for me as well. I just hope that at least some of those supplies went to kids who really need and will enjoy them.

Friday, February 10, 2012

CerviCusco

So for the last few weeks I've been volunteering with a new organization, CerviCusco. Its a women's clinic started by some doctors in Georgia who were doing genomics research on cervical cancer. They now do thousands of papsmears every year on women in Cusco and the surrounding villages. I don't care much about genomics research, but the pap smear part is pretty impressive seeing as cervical cancer is the #1 most common cancer in Peruvian women.
When we go out to the villages we bring everything- brushes, lubricant, gloves, drapes, etc in suitcases. Sterilized speculums in canisters. Back-up plastic speculums. Folding tables for the patients to lay on (obviously no stirrups or anything). We use headlamps for lighting.
Many women come with general medical problems hoping we can help them cause there is no other doctor to talk to. Almost every woman over the age of 70 has significant osteoporosis- you can see it in their spines and shuffles. We write a lot of prescriptions for ibuprofen. For the majority of women this is the first time they have ever had a pap smear. They'll come back in two months to get their results.
Many women speak quechua and there aren't enough translators to thoroughly explain the procedure. We get by with a few essential phrases and a lot of hand gestures. At one point we needed a woman to move down the table and she just wasn't getting it. So I put my hands on my own butt and did exaggerated hip thrusts until she got the idea. She found my demonstration quite amusing. Better than being terrified by the weird gringa sticking a piece of metal into you.
In the campos and at the clinic I explain every day that cramping with your period is normal, that whitish discharge between your periods is normal, and that once you haven't had your period in over a year you are in menopause.
We had one woman who took three buses into town to be told she was going through menopause. She was afraid she had cancer because she hadn't been getting her periods. She reasoned this must because there was something (ie a tumor) blocking her period from coming out. We did an echo to confirm. She had to drink water to fill up her bladder to make the echo easier to read. She looked so uncomfortable from being bloated with water and needing to pee by the time we did the echo. She was really sad to hear she was in menopause because she really wanted to have more kids. The doctor told her to focus on grandkids instead. She was only 42.
A 19 year old girl came to us for her first pap smear. She was really nervous. She had been pregnant four months ago but had gotten into a car accident. A month later she had a miscarriage. Apparently this is a common type of story you hear to cover up an illegal abortion.
An 18 year old came to us for her first pap smear. She had been having sex with one partner, but without any type of birth control. I tried to explain to her to importance of condoms if she didn't want to get pregnant. Also that some guys might not always be so clean or faithful and therefore using a condom could also be a good idea in terms of disease prevention. She left looking totally unconvinced.
There was a woman who was referred to us from the campos because she was 38 weeks pregnant and the baby was in a transverse lie (not good). We did an echo and found that the baby had flipped and was now vertex (very good). We were able to show her the head and the profile of the face and the heart beat. We printed pictures for her to take back to her OB and to keep. We told her she was having a girl and she cried she was so happy and grateful.