Thursday, June 16, 2011

A Farewell to Peru...

My research has finally drawn to a close....I presented my initial results to USAID and turned them in to each of the study sites....soon as I complete the final results I will email those out to the National Institute of Health for Peru (Instituto Nacional de Salud), Universidad Peruana Cayetano Heredia, USAID and the Regional Direction of Health for Cusco....still some work to do ;)

As I'm travling back to the states...I finally have the opportunity to reflect, at least a little bit, on the experiences over the last 3 months.....

I think of Cusco....what if a city could talk?  What would it say.... A city like Cusco would probably be sitting in the back of a dark smokey bar....order you a beer, a Cusqueña to be exact, and tell you to have a seat.  It would tell you about humble beginnings as just another mud hut town in a Peruvian valley....the love affair with the Incas....when Cusco was bathed in gold, silver and the vibrant colors of a growing culture....in those days, Cusco was literally the center of the universe.  Then came the Spanish adulterer.....in search of a sugar momma....who forcibly extorted the riches of the city and impovrished the culture with colonial imperialism, catholic guilt and greed....and so Cusco changed...no longer was it the center of anyone's universe or even the capital anymore...that distinction went to a new city along the coast a "city of kings" - Lima.

As Incan royalty gave way to Spanish monarchs and governors....and then finally to the new concept of "Peruvians".....Cusco saw the re-birth of a culture over the past 100 years that began with a Yalie on an adventure trip with a few friends...and so Machu Picchu, the unknown city, gave Cusco new life....

There is a mystery about Cusco...to walk it's streets is to live it's past.....to help it's people is to contribute to it's history......it's a vibrant dynamic cultural city with an energy in the air that seeps into your pores, permeates your flesh and gets into your bones. 


Cusco is nothing like Lima....Lima "The City of Kings' is a story in contradictions....sometimes enchanting and in the same minute revolting.....it's a city full of multitudes of problems worsened by a culture of beauracracy competing with genuine efforts and genuine people giving it their best.....it's the only place in the world that I know of where you can get some of the tastiest skewered beef heart (anticuchos) around and some amazing sushi all on the same block ;)

Lima is a growing uncontrolled metropolis....where the stark differences between the rich and poor are clearly and blatantly defined....but it's also a city with potential....it's also the city that reflects the future of Peru....right now, both Lima and Peru are on the edge....it's a new century, a new president, and 100 years since Machu Picchu was unveiled to the world by an unlikely Yale Scholar.....2011 was a great time to be Peru, to see Lima, and to experience Cusco, the andian culture, and it's people.....

The only thing I know for sure....is that I'll be back ;)

if you took the time to check out my blog, thanks.  I hope it gave a little bit of insight into the richness of Peru, it's culture and what an amazing cultural experience this has been.


As a final parting note, I wanted to share a few of my favorite moments in Peru....

Enjoy! Whoop!

Machu Picchu pieces from Yale on display at the Government Palace

General Elections

Mirador de los Condors

Machu Picchu with my love

Research in Ccatcca

Danza Emilia for Mother's Day

White Water Rafting the Urubamba


Exploring Cusco on a sunny afternoon - Whoop!


Sunday, June 12, 2011

Jungle Treking, Yellow River in Quellomayo & Machu Picchu

SO, as promised....a few more pics covering the Jungle Trek through the Cloud Forest and Highland Jungle on the way to Machu Picchu....BUT, before the pics...one more thing...

I LOVE going off the beaten path....on our way from Santa Maria to Santa Teresa, after our white water rafting adventure, we stopped at a place called the Yellow River...it's an amazing B&B in the middle of the cloud forest next to the Urubamba river in Quellomay...right off the Inca Trail on the way to Machu Picchu...we stopped there for lunch and had the most amazing food on the trip.....

it's run by a local Peruvian family and the husband is a British expat, so they speak english,...they also have a 3 year old daughter, Maya, who is absolutely adorable ;)  No pics though, so you'll just have to see for yourself....

Here is a link to the Yellow River - Yellow River Guesthouse & Inn, Quellomayo, Peru
here are the trip advisor reviews - complete with pics - Trip Advisor - Yellow River
Email for more information and to reserve your stay!!!
quellomayo@gmail.com

Enjoy the pics!

Whoop!

Through the Banana Trees!

Deeper into the Jungle...

Locals picking Coffee along the Inca Trail

Jungle Mud Hut

Yellow River Guesthouse...nicer than a mud hut ;)

More Yellow River...this place ROCKS!

Following the RR tracks to Aguas Calientes and Machu Picchu

The crew enjoying the view

Machu Picchu: View from the top of Huaynu Picchu - Whoop!

Speaks for itself ;)

More to follow on the Celebrations in Cusco, the end of my Research, and the long road home....

Thursday, June 9, 2011

Leftist Leaders, Machu Picchu and the last couple of weeks....

I was once again in Lima for the second round of presidential elections that will decide the fate of Peru for the next five years....to the elation of some and the chagrin of others, the darkhorse that nobody really expected to win is now the President-elect....Ollanta Humala, former Peruvian Army Captian and leftist candidate for Gana Peru, won the presidency with 52% of the vote (he needed 51% to win) over Keiko Fujimori with 48% of the vote....and the most interesting thing isn't what happened after it was announced that he won the presidency, the most interesting thing was what didn't happen...

the sky didn't fall, cities did not spontaneously combust, the markets didn't crash and Peru did not fall into the Pacific Ocean....


what did happen, is that the poorest of the poor in Peru spoke....they capitalized on the obligatory voting law enforced in Peru....although Keiko won in Lima and 8 other districts...in the poorest regions of Peru, using Cusco as an example, Ollanta carried over 75% of the vote and it was just enough to launch him into the presidency....although he is backed by Hugo Chavez and was elected on a socialist agenda he may not be all bad for Peru...he's promised to maintain the Economy while decreasing poverty and increasing Peru's middle class.....but can he deliver, and what methods will he employ?
will Peru become the next Brazil in much the same way that leftist Lulu has helped improve his country or will Peru become the next leftist dictatorship with the support of Chavez....

Peruvians, all of South America and the world will watch his first 100 days in office with interest....











Machu Picchu:
 
We're going there....up Huaynu Picchu ;)
This year is the 100th Anniversary of the "discovery" of Machu Picchu...as such, spaces on the classic inca trail, which are limited to 500 people monthly, were all booked until August.  SO, we had to settle for a different planned adventure unique for the variety of methods required to reach Machu Picchu...


We hiked the much less traveled ancient Inca Trail from Cusco to the Sacred Valley of the Urubamba river....
Followed by a 2 hour drive to a mountain top at 14,000 ft which we descended via a 5 1/2 hour mountain bike ride down to the highland jungle sitting at 4,000 feet.....

we then braved the Urubamba river's Class II & III rapids to reach the fabled Inca Trail that takes you from the jungles to the cloud forests that surround Machu Picchu....

along the trek through the jungle we crossed rickety "indiana jones" style bridges, crossed surging rivers on logs and via cable cart, braved blood sucking mosquitos, avoided dangerous jungle turkeys, and treked endlessly along jungle paths and rocky river bottoms....until finally, we reached the city etched into the Peruvian mountain-side....we still don't know it's original name so we call it what the locals call it..."old mountain" or Machu Picchu

after scaling the path up the old mountain to watch the sun part the misty mountains....we also conquered the younger sibling of Machu Picchu.....Huaynu Picchu, only allows 400 visitors per day, split into two groups of 200 at 7am and 10am...which is why you get up at 3am to hike up the mountain and be one of the first visitors to get one of the coveted stamps that will gain you entry to the path up Huaynu Picchu...and you thought waiting in line to get into a Las Vegas night club was exciting ;)

But you don't have to take my word for it....a picture speaks a thousand words...and in this case, even more than that and in multiple languages....check it out...
In the Mountains Above Cusco
My fiance and I above the Sacred Valley




Starting the ride in the clouds at 14,000ft - whoop!


Long muddy 5+hr ride complete in the town of Santa Maria

White Water rafting the Urubamba

Cable Car crossing over the roaring rapids!

Dangerous Jugle Turkeys...Watch out!

Trail washed out...make shift crossing over the river


Misty Mountains surrounding Machu Picchu 


well, having some internet issues...such is life in Peru  :(

I have a few more pics from the jungle trek and machu picchu to share....

additionally, after the Machu Picchu adventure I headed off to Las Vegas for a week to attend the National PA Conference and the Student Academy Assembly of Representatives.
I'm on the National Board of Directors for the Student Academy and they were gracious enough to pay my ticket and hotel to Vegas, so I couldn't really refust.  Took about 10 days off of my research but it was worth it.....I supported Yale's first every Medical Challenge Bowl team, worked on resolutions, attended some CME courses, and did some Salsa Dancing with PA's for Latino Health...

Check it out at the link below:


PAs in Las Vegas - ImPAct 2011

more pictures and more on Vegas on my next blog...hopefully, the internet will be more cooperative...
I've been trying to post since last night....

Headed back out to the village in the mountains one last time, trying to get some extra observations for my research ;)

Less than two weeks left in Peru and I'm going to enjoy every minute of it!

Hasta next time!

Whoop!

Saturday, May 21, 2011

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!

Sunday, May 8, 2011

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!