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.

Terremotos

Terremoto is the spanish word for earthquake. There's the Nazca tectonic plate that is along the coastline of Peru and it likes to move around and cause earthquakes, much the same as the North American plate does in California. Most of the biggest quakes happen closer to the coast, especially around Lima. Once in a while a doozy will hit in the mountains though. In 1984 there was a huge one that shook Cusco and the entire Sacred Valley. Buildings fell down, roads collapses, bridges crashed, and a lot of people died.

Some buildings in Cusco are constructed in a more traditional way- with adobe blocks made from dirt and dried in the sun. Others are made in a more European style with more solid concrete. In the spirit of Gandhi and Mandela and all those who have rejected that European = better; the traditional buildings actually hold up better during earthquakes. The adobe blocks have wiggle room and can absorb the shifting earthquake better. Other buildings collapse because they have no wiggle room. Obviously the poorest people get the worst of the deal because they just live in cardboard shacks which stand no chance at all.

The buildings of Hospital Lorena (multiple buildings because they couldn't build up at the time of construction 70+ years ago) are made in the newer, worse way. Therefore today we had an "earthquake drill." Everyone got called out of their work and had to stand between the buildings. They drove an ambulance up a sidewalk to use its loudspeaker system. Several people talked about the need for earthquake readiness for quite a while. There were several patients out there too- in wheelchairs and gurneys and hospital gowns.

I couldn't help but thinking as I was standing there that an earthquake drill is not inherently weird. But it would never fly in the US to call outside over half the staff away from their work. Especially in the morning when rounds are happening. Just another way different countries are different.

As we were waiting I was talking to the peds intern. He was quite surprised to learn we don't do earthquake drills regularly. We talked about where earthquakes are common in the US, and hurricanes and tornados and what drills we usually do in school. Fire drills are apparently unknown here, where at home they are the most common.

Things I've learned so far about Peru...

Peruvians put toilet paper in a trash can next to the toilet.

Neurocystersercosis (worms in the brain) is one of the most common neurologic conditions.

Cabs can hit you and not stop (actually this might not be so different from home).

Soup is regularly served with hunks of bone in it.

Stores close early for football(soccer).

Incan gods and traditions are just as important as the catholic ones. This is not seen as contradictory. There is no issue with the "thou shalt not worship false idols" or whatever that commandment said.

Just like at home, abortions happen all the time and no one talks about it.

Neighbors take down your laundry from the line for you because its getting dark and they are worried someone might steal your clothes.

Cheesefrites are way better then Cheetos or Nacho Cheese Doritos.

Peruvians are not tea connoisserus.

Peruvians did make an alcoholic hot tea drink that is actually pretty tasty. I appreciate this ingenuity.

You can find anything in Peru that you can in the United States for purchase except for Apple products.

Most of these products can be found in tiny individual stores that specialize in things such as "locks," "used electrical equipment," "anything plastic," or "anything that can be made for one sole."

Peruvians don't prescribe antibiotics for as many days as we do. This does not seem to have created any problems.

Two flowers on a woman's hat means she's single, one on the side means she's married, and one in the front means she's widowed. Apparently this makes hitting on women much easier.

Football(soccer) can actually be very riveting to watch. The fans contribute to this greatly.

Llamas are indeed as mean as everyone says they are. To be fair, this can also be very entertaining if you're not the one they are targeting (sorry Nansen).

Parts of the highway system that the Incans build are still in use today. Some of these roads are better than the "modern" roads.

Peruvians plants die under my care just as quickly as American plants.

There is something very cool about living in a city that is over 500 year old.

Arequipa la Cuidad

Today we wandered around the city of Arequipa. We went to the archeologic museum where we learned all about Juanita- a young girl the Incas sacrificed to the gods who was found 500 years later on top of a mountain frozen in ice. And remarkably well preserved. They flew her to Johns Hopkins to learn that her final cause of death had been blunt trauma to the head- done with a ceremonial stick someone lugged up a 20,000 foot mountain. They buried her body along with sacrificial artifacts at the top of the mountain. An earthquake caused her body to shift downwards about 100 meters, and that's where the researchers found her.
Her journey started months earlier, starting out from Cusco and traveling through the country summitting various peaks before the final one here in Arequipa. They did all this in leather shoes lined with wool. No cramp-ons for them. After climbing to 20,000 feet covered only in blankets, they mercifully give the children a really strong alcoholic drink (chicha) before their deaths. They covered the graves with stones, which is how researchers find them. Three other children have been found on the mountain outside Arequipa, 14 children have been found total in various mountains. The children are offered once a year to appease the gods, more frequently if there are natural disasters.
The children are raised for this honor. They live in a special house in the capital and receive only the best food and clothes. As they grow, they select the most beautiful of the children to be considered for sacrifice. They were very egalitarian about it- even royal children were enrolled.