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!