Cold Spaghetti

Right after my spanish lesson this morning, I took a taxi over to Valerie’s lovely flat in Barranco. We met for a few minutes to collect our thoughts and then grabbed another taxi (after rejecting one who wanted to charge too much) out to “the southern cone” of Lima to visit Hospital Maria Auxiliadora.

Hospital Maria Auxiliadora is a large regional medical center. If you have a referral for anything remotely complicated beyond what an under-resourced community clinic can provide, you’ll come here. It is nestled between two “rougher” parts of town (pueblos jovenes) Villa del Maria Triunfo and San Juan de Miraflores.

Valerie needed to go out there to speak to a doctor about a Canadian medical team that has funding to do a double-blinded RCT on the effects of Vitamin A & E for the prevention of pre-eclampsia. She was going to meet with a head hospital OB about the study to gage their interest on behalf of the Canadian team. I went with her to check out the hospital.

As is the norm in field work, the doctor was unavailable and so Valerie joined me in my quest to “check things out.” Good thing, too — as she was more skilled than I at negotiating the long lines to ask questions. Bottom line: we found great information about a violence program for aggressors and hooked up with the hospital social worker who spends all of her time wrapped up in a program called “MAMIS,” a child and family violence treatment campaign. After feeling like stalkers for hovering around her office as she finished with a family, we finally managed to see her and talk briefly. It was a productive conversation; I’m going back in the morning to meet with her to talk more. It was a super great trip and I am very happy to have made this contact!

So tomorrow, after my morning appointment at HMA, Angela (cool doctoral student from Hopkins) is meeting me at the gates to the hospital grounds and I am joining her to Las Pampas, the barrio community most closely studied and served by PRISMA. Angela is focusing her dissertation on adolescents in this community. Added bonus: she arranged for us to meet with one of the community and PRISMA-affliated physicians before the focus group gets started. In other words, we’re gearing up for another full day!

Will loves Bob the Builder. And lucky for him, the family who lives here has a wonderful collection of Bob DVDs (from the UK, so Bob and friends all have that wonderful other-side-of-the-pond sound to their voices). We also get Bob in spanish: Bob el Constructor. Will loves it and delights in singing the theme song as we stroll down the street.

“Podemos hacerlo? Si! Podemos!”

Yesterday morning I went with a pre-arranged taxi for the 45 minute trip to San Martin de Porras, a very economically depressed community with high population concentration. (In other words, an urban “shantytown“.) Unlike other barrios which ring the outsides of Lima, San Martin de Porras has a long history and cannot claim it’s existence from the boom of desperation and poverty triggered by the double-whammy of the years of terror in the 80s and “Fuji-shock” of the early 90s that resulted in a huge internal migration to Lima during the last 20 or so years.

Met by Ruth (a public health nurse often hired by my mentor, Valerie, to conduct surveys), I was introduced to Dr. Guzman, her boss and the Director of Health for SMP, Rimac, and Los Olivos (two districts around SMP). I spent a good hour or more with Dr. Guzman — a wonderfully helpful and interesting man. We talked first about his impressions of the health of the community, his thoughts on the current challenges and limitations in both the health of the community and in his work, and spent some time going over data from the last full collection of demographic and health indicators from the communities he serves. I was surprised to learn the incredible impact of respiratory infections in this community: respiratory illness (Tuberculosis, in particular) is terribly endemic here. Of the 10 items listed as top reasons for clinic visits, 4 were related to respiratory ailments — consistent with both sexes and all age groups. With more than 19,000 people per km square (in buildings tightly packed in one to three floors), he felt that the lack of clean air, good ventilation, and many people in the same living quarters gave these districts the rich environment for the disease and kept it that way, In fact, when we discussed the future of the community, he quickly noted that the limitations and challenges were structural: namely, political and economic. This was refreshing to hear! Other interesting tidbits: rubella is currently in huge outbreak here. (In fact, my spanish tutor’s 9 month old daughter just got over a serious case.) Although a vaccine is available, there isn’t much of it here, and as a result, “sarampions” are everywhere. The graph for tracking it looked sort of like a seismograph hitting a sudden earthquake.

After my great meeting with Dr. Guzman, Ruth joined me to visit a smaller clinic a few kms away, “Clinica Salvadore” where we met the head nurse, Grimanesa. (Interesting note: Grimanesa’s brother, Pedro, was the pre-arranged taxi driver for the day and now my “go to” guy for pre-arranged rides. He was very, very nice and drove very sensibly and safely — something you don’t always get when you pick up a random taxi!) At the clinic, I also met Blanca, who provides counseling for patients. All were absolutely lovely: if I end up doing a clinic-based study based out of a smaller maternity-focused clinic, I would want to be here. I immediately felt welcome and integrated. After our tour of the facility and general questions and talk, the four of us (Grimanesa, Ruth, Pedro (the driver), and I) went out into the neighborhood to find a 9 year old boy who, several weeks before, had been diagnosed with tuberculosis. It allowed me a vantage to see the most vulnerable areas of the community (ie: those without water tap, which is only provided after a certificate of ownership can be presented for the property — in other words, these are long-term squatters who have not gathered up the resources to collect on such a needed and necessary luxury — yes, water, unpotable as is may be, is a luxury here). The mission allowed me to ask questions about the community, the building, the process of living here, the development of the region, and the challenges of serving it. The bottom line: poverty in urban Peru means illness and suffering, staff do their best to help when they can and enjoy the moments of success when they are able to provide care. In this case, there was no reunion with clinic staff and dispensing of medicine (the first line of which would have been paid by the government) — the sick child and his family could not be found.

Me, Will, and the bunny. I’m beginning to think we need our own silly animal to regularly pose with for tourist shots. Maybe we can find a stuffed wombat?

The Ovalo just beyond Parque Kennedy and the Central Park of Miraflores. We had a wonderful brunch at the cafe/restaurant across the ovalo — La Tienda Blanca (see the Swiss flag?)  

Will and Paul outside of the Central Plaza in Miraflores — the lion is a virtual geocache spot. Note that Will is holding that darn travel bunny, who is certainly getting a lot of exposure in Lima. 

Looking out towards the sea.

Paul and Will on the roof! Paul juggled a bit while Will ran around. Paul had just balanced a club on his nose (I think he’ll put that picture up on his blog) and is trying to help Will do the same.

We also found out that there is a clowning school around the corner from us. Paul is very excited about the prospect of taking juggling classes…!

I couldn’t be happier with the way things are progressing! Besides all the email contacts I’ve made and are in conversation with, set meetings and visits are falling into place. Currently on the schedule for next week:

Monday: All day in San Martin de Porras with Ruth (public health nurse)
Tuesday: 8-10 spanish class. (Paul and I are switching days so that I can spend Monday with Ruth.) 11am meeting at PRISMA with Phabi re: her drug use and sexual behavior paper; then meeting with Hilary to help with her survey questionnaire submittal
Wednesday: 8-10 spanish class. Afternoon (roughly 12-6) teen boys’ focus group in Las Pampas with Angela.
Thursday: Afternoon teen girls’ focus group in Las Pampas with Angela.
Friday: 8-10 spanish class.

Valerie and I are also going to meet with some faculty at a local University sometime during the week. And then (hopefully) on Saturday we’ll go down to Paracas!

What do we eat around here? Like in the States, mostly things made at home — we’ve only had three meals “afuera.” We eat at home for virtually every meal. The most exciting part of our daily eats is that during the week, either lunch or dinner is prepared by Josefina (with leftovers) and the quality of life that has given us is wonderful. So, we eat:

— Dishes with quinoa and fresh vegetables
— Dishes with rice and fresh vegetables
— A yellow vegetable stew whose name I can’t remember
— Sandwiches (“El Triple”: avocado, tomato, and egg is a popular and personal faves)
— Coke (we normally wouldn’t dream about having a coke, but something about being abroad; we crave a little each day.)
— Fresh fruits (current kick: pineapple)
— Cereal and oatmeal (we found my favorite quaker squares cereal and oatmeal for Will)

We wash everything in purified water. We’ll pick up iodine tomorrow to aid to the water to ensure that all the nasties are cleansed from our greens and veggies. We take procaution with peeling, washing, and prepping foods. And we are enjoying the fruit and veggie carts at street corners and amazing selection of fresh everything.