Study sites and the realities of Cusco....

As my research and time here in Cusco is drawing to a close, I started reflecting on the different hospitals and health centers I've pretty much been living at for the past few weeks as well as some of the less pleasant sides of the mysterious, engaging and beautiful former Incan capital and now tourist capital of Peru - Cusco.

It's a little bit like starting out in a relationship....at first everything is so enthralling, beautiful, perfect.... then you start noticing some of the cracks in the pavement....maybe everything they do isn't so perfect? maybe there are even some things that are annoying, bothersome or just grind on your nerves...you then have to accept them for who or what they are and love them for it...or you chalk it up as an "experience" and move on to something better.....so has gone the love affair with Cusco....it continues to maintain it's allure and mystery....but the smoking has got to stop.  The air quality within the city of Cusco, like in many latin american cities, is terrible...stifling even...no emission control and the buses creaking with the weight of too many people plastered along the windows belches bellows of black smoke that plague anyone brave enough to walk along the main streets...in the historical center and the upper neighborhoods of Cusco the air is pristine and you feel like you can breathe again...but to get anywhere walking your risking some black lung ;)

Stray dogs....another compromise I've had to make with Cusco, the city has multiple packs of homeless dogs in every district...fighting, digging through trash, harboring disease....none of the poor animals are very healthy - sorry Katie :(  Nobody really seems to take any interest....some people even put out water dishes and the occasional scraps on the sidewalks for the dogs....they think of them as a cheap security system.  Again, not so much in the main tourist areas but just outside of them and all over Cusco, stray dogs rule the streets and side-walks....

My last bone to pick with Cusco is seemingly a problem everywhere but especially evident here in Cusco...the large economic gap between those who have and those who do not is especially pronounced in the largest tourist economy in Peru.....it grows the farther you step away from Cusco....
this even impacts the health professionals working in the government health centers that provide universal healthcare for the poorest of Peru's poor.....my monthly Post 9/11 GI Bill living stipend is almost as much as some of them are paid in a year.....

Which brings me to my research sites which are serving some of Peru's poorest of the poor in the mountainous Peruvian Andes...

#1 - Still in the City of Cusco - Hospital Regional Cusco - situated on the same compound as the Regional Direction for Health for all of Cusco.  The hospital was the first study site where I wanted to complete my study because of the varied patients from all over Cusco and the fact that it's one of two referral hospitals in the Region.  However, the approval process was the toughest out of all the sites and I'm still at a loss as to why....I waited for final approval for over a month and I just received it this week after finally speaking with the OB/GYN service....I'm all set to start in June.  I think the fact that they are currently going through their accreditation process probably impacted the approval process for my study...If I get to finish at this study site it will be icing on the cake....I was able to secure approval at the other Regional Hospital in Cusco which serves the poorest of the poor...the Regional Hospital serves some of the poor but most of their patients have to pay...so most of the poor go to Hospital Antonio Lorena where it's all state sponsored and nobody has to pay anything....

Regional Direction of Health - Cusco

Hospital Regional Cusco - 46 years of Health

#2 - Hospital Antonio Lorena:  The oldest Hospital in Cusco at 75 years old...and it shows.
Built in the 1930's all of the buildings are separted...the surgery suite is a separate building from OB/GYN, from Medicine, from outpatient clinics from the Emergency Department.... the plus side is that the Obstetric Center is brand new...recently completed within the last 6 months.  The building is nice but they still lack a lot of equipment...they have the basics and they do the best they can with them.  They also serve the poorest of the poor in Cusco and patients have come as far away as Madre de Dios which is a district that encompasses part of the southern jungle region of Peru...patients come from some of the farthest reaches in the Andes as well as the jungle.  Reserach at this institution is mission complete ;)

Emergency Room Enterance to Hospital Lorena

Front of Hospital Antonio Lorena - built in the 1930's

 #3 - Local Health Centers: The Region of Cusco is broken up into Cusco RED North and Cusco RED South for managing the local health centers and health posts that are out within the mountians and rural regions of Cusco.  Due to the fact that they have fewer births per month, less capacity and I have limited time on my research I decided to combine to different health centers that provide obstetric services to represent local health centers in the region of Cusco.  I selected one of the main health centers known for Obstetric Services in Cusco North - C.S. Belenpampa and one health center known for their Vertical birth procedures and obstetric services with the indigenous population in
Cusco South - C.S. Ccatcca.  I'm about 4 observations away from completing my research at the local level which has been tough because sometimes a whole week will go by with only 3 - 4 deliveries.  However, working in the health centers, especially in Ccatcca 2+ hours away from Cusco, has been the highlight of the research.  Both health centers have implimented Vertical Birth procedures as a strategy to increase the number of institutional births among the indigenous and rural population in the andes in an effort to decrease the maternal mortality rate....it has worked although in some areas unattended home births are still occuring at a higher % than institutional births and there seems to be a higher correlation to maternal morbidity and mortality in those areas....however, Cusco this year has had an extremely high number of maternal deaths....the #1 cause - Postpartum Hemorrhage. More on that later....

Centro de Salud Belenpampa - Cusco Norte - District of Santiago

Front entereance and sign for C.S. Belenpampa

Road sign for Centro de Salud Ccatcca - 2+ hour drive into the mountains South of Cusco

C.S. Ccatcca - reently re-built in 2008/2009

C.S. Ccatcca Ambulance Service

Southern Valley in the Andes home to 16 communities served by C.S. Ccatcca

More specifics on Ccatcca and some of my research experiences to follow....
so far, it's been an amazing experience...both the research, learning about Peruvian and Cusqueño culture as well as the sub-culture of Peruvian medicine, living in Peru has been incredible and...
I think I've made my peace with Cusco....still love it and I accept you for who you are Cusco.... imperfections and all....
there is no other place like it in the world.....

more to follow...

Whoop!

Día de la Madre en el Perú

Center Stage at Hospital Loren "Happy Mother's Day"

SO, Mother's Day in Peru is just about a national holiday...there were tons of fairs on Saturday night selling cakes and presents, there were Mother's Day concerts, public service anouncements on TV, there were political Happy Mother's Day from the Presidential candidates, and the hospital had a special Mother's Day celebration on their Maternity Floor. 

There were about 15 different acts of singing, dancing, shows, and an M.C. The best way I can describe it is....think of the Yale School of Medicine 2nd Year Show (for those who are familiar) or an amateur variety show but during Mother's day in the hospital for the Maternity floor patients and staff.
It was actually pretty awesome.....
followed by free food for all... consisting of roasted chicken, roasted potatoes, a little bit of red wine - just a dixie cup :) - and some cookies for dessert....

Lighting struck when a group of Obstetric Interns were short a male partner and they asked me if I wanted to dance a traditional Peruvian folkloric dance...I thought about it....hmmmmm, how many times in my life am I going to have the opportunity to dance a Peruvian dance for Mother's day in a Peruvian hospital for the Maternity ward and the hospital staff....answer: only once and probably never again...don't think lightning will strike twice....so heck yeah, I'm going to do it!

Noehlia, Benjamin & Cynthia pre-performance pic ;)

By the amount of applause and compliments we received on our dancing, costumes and overall performance, I think it's safe to say we rocked the house ;)

The traditional dance hails from Apurímac and is a very well known dance....known as, drum rollll...

La Danza Emilia


you can check out what it looks like out in the natural beauty of Peru at the YouTube link below:
http://www.youtube.com/watch?v=KGpt96lMsx0


Ours was not quite that impressive but pretty close ;)





Check out the rest of the Mother's Day performace pictures below:

All dressed up and ready to dance La Danza Emilia!!! I can almost pass for a big Peruvian...Whoop!

A duo ballad for all the Mother's of Hospital Antonio Lorena

The Bolivian Dance Troop - the guys had bells on their boots...hmmm, interesting

Me & two members the Bolivian Dance Troupe

The female clown act - they were actually pretty good and FULL of energy ;)

brand new moms and staff enjoying the days performance at the hospital.... or they're just in shock

 Next time...more info on the hospitals, local health centers and some background on the study sites...

Hope everyone wished their mom a Happy Mother's Day!!!! Maybe even do it Peruvian style with singing, dancing and some home-made food ;)

Whoop!

Life in Cusco...

 My favorite things about Cusco....it's a city full of mystery, you get a feeling of the ancient combined with spanish colonialism crashing into the 21st century in every neighborhood....it's the way all the churches are called "Templos" calling back the lives of the ancient Incas that were abolished under the weight of Spanish Imperialism and Catholicism, literally - as all the Temples were built over with Catholic Churches...the one exception being the Cusco Cathedral, the center piece of the plaza de armas.  I love how you can find the foundations of an Incan Temple within an old spanish colonial building made of adobe that is currently a "lounge-bar" in the middle of Cusco....or the enterance of a temple, the same enterances you can find in Machu Picchu, that is now the doorway to a posh hotel or restaurant.  Walking around Cusco, I wonder how much of the city planning around the Plaza de Armas is Incan vs Spanish city planning....overlooking the city is the ancient religious center of Sacsayhuaman (some people refer to it as "sexy-woman")....a reminder that Cusco was believed to be the umbilicus (aka navel or belly button) of the universe in the Andean Cosmology and view of the world...and in many ways, I think it still is....

Street in the middle of Cusco off the beaten path

Old with the new: Inca + Spanish Colonialism + 2011 = Cusco

View of Cusco from Templo San Cristobal

It's been about 10 days since I've been able to blog.... soon as I arrived in Cusco I got straight to work on finalizing the approval process for my study sites and it took almost the entire week.  I began work on my research at two locations last friday, I had to double up because of that week I lost...all together the approval process for a Regional Hospital and one Health center took a little over two weeks.  I still have not received final approval at the other government hospital that operates in the region, still waiting :(

In the meantime, I was enjoying Cusco, my neighborhood and settling into trying to become as Cusqueño as possible ;)


I LOVE my neighborhood, it's off of Calle 28 de Julio close to the Mercado de Ttio... I love it, because I can walk to a great local market with fresh Peruvian produce and buy enough fresh fruits, veggies, and cheeses for the 1 - 2 weeks for less than $5 USD.  Everymorning, I usually buy fresh bread from the bread lady (for like .30 cents) and I can buy meat from the meat vendors....although it's usually better to go in the morning and buy it fresh for the day so you can put it in your fridge...no refrigeration and all the meat is just "hanging out" on display out in the open....gotta watch those microbes....I only have so many courses of Cipro to use ;) Pictures of the market to follow soon ;)






Another perk is the Pollos a la brasa - grilled chicken - restaurant about a block away from my apartment.  It's ALWAYS filled with locals, is super reasonably priced - cheap even 4.50/soles for 1/4 chicken or 6.50 for an 1/8 of a chicken - and is probably the best Pollo a la brasa that I've had in Peru.  It's called Las Delicias, they have about three or four rotisseries where they put the whole chicken on there with their secret blend of spices and put them in a wood fired oven.  Then the cook takes a butcher's hatchet and cuts up the chicken.  You get a HUGE plate full of french fries along with the chicken and a salad of beets and cauliflower that is super delicious - I would have never guessed beets and cauliflower could be that tasty. Sorry, no pictures right now either...didn't want to look like a tourist on my first few visits by taking pictures of my own food ;) Pictures to follow soon ;)


The other perk of being in my neighborhood is that I get to live with Cusqueños, I'm far enough away from the Historical Center that there are zero tourists, all locals...but I'm close enough that in 20 - 30 min I'm in the historical center and can visit my favorite spots in Cusco.


Here are some of my favorite spots:

My favorite passageway to the historical center

Plaza de Armas - Center of Cusco at Night

Cusco Cathedral and Plaza de Armas during the day

Convent of Santo Domingo - build upon the Incan Temple of Coricancha

Front of the Templo de San Cristobal

 The Templo de San Cristobal is one of my favorite spots in all of Cusco...it's on the route to the hill top overlooking the city where there is a large Cristo (statue of Jesus Christ) overlooking the city as well as the large religious site of Sacsayhuaman.  The "Templo" or Temple is actually a church and there is a large decorated cross out front (from semana santa) and in the background you can see Incan terraces and doorways, there is even a blocked off passageway leading into the mountain...and top of that people build their homes.....it's a great metaphor of the layers that are readily found all around Cusco...just like you can trace back the history of the Grand Canyon through the exposed geological layers, the history of Cusco, the Andes, Peru and really all of the Americas can be traced in the historical layers found throughout the city....

Plaza de San Francisco - hidden away from the Plaza de Armas - the flag in the background reprsent the colors of Cusco

Plaza San Blas - my favorite neighborhood in Cusco

Templo San Blas

 The neighborhood of San Blas is my absolute favorite place in Cusco and probably all of Peru.  One of the very best restaurants in all of Peru, Pachapampa, is found in the plaza San Blas right across the street from the church.  On the steep climb up Cuesta San Blas there is "El Buen Pastor" the absolute best bakery aka "Pasteleria" in all of Cusco - they have the best Lucuma and Mango pies (mini-size), home made Peruvian Chocolates, and every other home-made Peruvian sweet you can imagine.  It's an eclectic neighborhood full of great bars, lounges, art galleries, jewelery shops and has en extra dose of that mysterious air that encompasses all of Cusco....

Archway of Santa Ana

Archway of Santa Catalina - leading to the Main Cusco Market

 Coming up...Hospital and Health Centers, as well as, everybody's favorite -
Dia de Las Madres aka Mother's Day....

Whoop!