A Busy Start

Taken by my mother literally hours before leaving

Here we are! Chris and I are a week and a half into our stay in Huancayo, Peru. You received the email directing you here because you are family, friends, those who voiced an interest, and/or those who we thought might be interested to know we are still alive every once and a while. If you didn´t already know that we are gone, I apologize that we probably didn´t get the information out as well as we should. And if you did, I apologize that this took so long. We´ve been a bit busy (and the internet cafes are a little difficult to use – including the keyboards with misplaced symbols) but I´ll get to the busy part in a moment. I´ve been writing this all intermittently over the course of several days so forgive me if it´s a little scattered and incredibly long by virtue of it being the first blog with a lot of explanation (and the fact that I waited so long) Okay, enough apologizing. Here it is.

Chris and I are taking a year off of school before completing our fourth year and moving onto the horrors of internship and residency. This is time we both need to rest and relax and hopefully get a little worldly clinical experience as well. This blog was a recommendation from a good friend who suffered through sending mass emails while in Africa and suggested this as a better alternative. If you know me at all, you'll likely be aware that I love to bake. In needing to decide upon a title for this blog, it occurred to me that we will be on the road for nearly a year and I won't be able to make any desserts! Okay, this may be a little bit stretching the truth because it's not quite a year (we've shaved off a month before and after for moving and boards exams) and I'll hopefully get to make some sort of sweet (gooey) treat while we're here. But it's close enough. So here it is - A Year Without Baking. We will do our best to update as to our whereabouts, the goings on, and any pictures we manage to upload in internet cafes the world over. Chris even made an account and may actually figure out how to post someday! But please remember this is not a one way street. We know the world doesn´t stop spinning just because we´ve left and so we truly hope that you will email or otherwise message us to keep us up-to-date on the big events in your lives (such as all the babies we know are coming soon! and a big congratulations to our friends who just got engaged – I won´t say who since I don´t want to steal their thunder). We really don´t want to miss a thing.

We are excited to be able to do this but we would be even more thrilled if you could join us. So this is an open invite to anyone who has the inclination, time, and (unfortunately) money to join us wherever we will be. We would love to see you anywhere in the world, so just let us know and we can meet you there! Here is our tentative schedule as it stands now (negotiable after December):

· Now through November 29: South America/Peru

· November 29 – December 7: Pennsylvania to visit Chris´new niece/nephew

· December – Late January: Southeast Asia (Thailand, Cambodia, Vietnam )

· February : Possibly Bangladesh to work with Chris´ OBGYN preceptor training nurse midwives (We hope)

· Early March: India (likely Calcutta to Delhi) and quick stop in Egypt

· Late March –Early April: Africa (clinical experience in Uganda or Kenya)

· Late April : Europe (France or Greece with friends or Prague)

· May: Home!!

So very briefly, the program we are working with here is in a mountain city called Huancayo. Getting here was quite a bear with 24 hours straight travel from LA (we had the pleasure of visiting my grandmother before leaving) to Panama to Lima to Huancayo but we are happy to be here now. We are at a little under 10,000 feet up in the Andes. It´s a really nice place. The mountains are beautiful. The people are all quite friendly. They are also very unused to tourists and so we get a lot of stares and people trying to practice their very limited English with us. My favorite is the quiet voice from behind saying, ¨How are choo?¨

The program here is not quite what we were expecting from the way it was advertised but after the first week or so I think we have adjusted quite well. There are three facets to the program – a government run orphanage, a government run clinic, and an after-school program for kids in the poorest part of town called the Ladrillera (the brick-making part of town) which was set up and run entirely by the people of this program. Chris and I are both involved in the Ladrillera kids´program and I am attending the clinic in the morning a few times a week. We will both probably check out the orphanage later on but when we got here there were a lot of people in all of the programs (except the clinic) and we didn´t get a whole lot of introduction so we are still kind of getting used to things.

The clinic is in a nearby town so I walk to the bus in the mornings and it is about a half an hour ride each way in little vans – camionetas. The clinic is part hospital and has a small wing for children, which is usually empty, as well as one for post-partum women, which is usually full. They also have an emergency room, which is really more of an urgent care – the Topico. There is a general clinic, which is very busy. We are usually seeing around 25-30 patients in 3-4 hours, which includes time away for anyone who comes in to the emergency room. The OBGYN clinic is next door and is run by specially trained women who are not doctors (though they all told me they were on the one day I worked with them). It is especially busy over there and I only worked there my first day. The clinic was advertised as a volunteer opportunity but it is essentially more observation, which neither Chris or I was thrilled about. So I am using it as an opportunity to improve my medical Spanish skills and a review for basic medicine as I am often finding myself thinking how differently my training would have me do something. But it is winter here so everyone is coming in with colds and the flu – everyone leaves with paracetamol and most get an antibiotic, which most of you may not I have some serious problems with. I do find it especially interesting however to see so many infants with high fevers without a definite cause but they don´t have an otoscope to look in their ears. I don´t exactly get the chance to ask a lot of questions but hopefully I´ll figure that one out in the future.

So there´s the little clinic rant but on to the more interesting stuff. At the Ladrillera, the program has built a classroom for the kids to come to after school or just in the afternoon for those who work or don´t get to go to school. We go every day for a couple hours. Twice a week we do art, twice a week we do English lessons (though we are trying to incorporate more little science lessons through the influence of some friends in the program who just left), and Fridays are for sports, though most days we finish early enough to go outside and play games or soccer. Of course, soccer is a very big deal out here and everyone plays. Though the girls do less than I would have imagined. Chris loves playing with the kids and all the kids love playing with all of us. They need a lot of energy and attention and it is wonderful being able to help out even if just a little. Today we all made paper faces in which we started with a a blank face on paper and made eyes, nose, and a mouth on separate pieces but then mixed them all up so each face would have different looking parts. They had a lot of fun with it and then we went outside and played soccer. I scored my second goal in my whole life! But I also accidentally hit a little boy with one of my shots. It happens all of the time so it wouldn't have been a big deal but it was his third time today (only first from me!) and he was not happy about it. We are very short on kids this week because next week in the Peruvian independence day and most of the kids are gone in the afternoon this week practicing various performances for the celebration.

James with Gordi and Gustavo in front of the faces we made today

We are staying at the house of the couple who runs the program with their two children. They have four bedrooms with more than nine beds for volunteers (and others stay at the woman´s parents house). When we got here, the house we are currently staying in was full. The original count for our start included six french medical students about to start their clinical years and a family including two graduate students, David and Erin, their two adorable daughters, Emma (6) and Zoe (4), and Erin´s sister Kelly (15). These two groups have since left but two veterans are still in the house with us – a young man from Belgium, James, who has been here for six months and a male Korean student, Choo, who studies in DC who has been here for two months. We have since been joined by a female german student, Ulla, in the house and their is a couple from Michigan in the other house, Walter and Ally. I´m sure this will all change with time too.

We spent much of our first week with the family of David and Erin. We spent our first weekend exploring the city and going to the big artisan market on Sunday morning, and of course watching the World Cup.  I have to say Chris and I were both sorely disappointed to have been in flight during the Spain-Germany game. We also got outside and played a soccer game with the neighbor kids at a nearby park. I have to say I did a pretty good job being goalie (David said I looked like I was doing Tae-Bo) until some of the girls started to talk to me -asking where I was from and how to say words in English. I was worried about the two little boys from the other team standing right next to the goal but they started to join in in asking me questions about English too. It was a fun weekend.

So now to the couple of points that have kept us so tired and busy over the past several days. It´s only Tuesday and our first incident was Friday early, early morning but it feels like weeks ago now. David and Erin´s family was only here for two weeks and they were set to leave last Friday. So to celebrate/say goodbye, we went out for a nice dinner in the center of town Thursday night. I got to have my first big salad here (because you can trust it is safe and clean at a big restaurant) and it was amazing. David and Chris both had chicken alla pizzarolla, which is pretty much what it sounds like – chicken used in place of dough/bread for a pizza. Chris had been sick the day before so he couldn´t finish it all but otherwise they both enjoyed it. And I loved that all of our plates had a piece of carrot cut into the shape of a blossom. I´m sure I´ll post touristy pictures of it later when I figure out how to upload pictures with these computers. So anyway, we went and had a great time. We stayed up really late to get the girls tired before their big bus ride the next day – I watched the second half of The Emperor´s New Groove in Spanish with the girls and we all played hearts. And I wish I could say that was where the night ends but David later joked that we´d complained too much that we weren´t getting enough clinical experience and Kelly was obliged to fix that for us.

It was around 3am when we were woken up Friday morning. I don´t remember if it was pounding on our door or shouting but I remember jumping out of bed and hearing, ¨Kelly´s not responding.¨ Kelly has had type I diabetes since she was three. She was staying in the room next to us and when we came in she was frothing at the mouth with he reyes rolled back in her head. Chris and I talked about it later and we don´t know how we missed it but Chris was right when he said it was our responsibility to ask better what had happened. And because we didn´t, we didn´t know that the reason her roommate had woken up and ran to get David was because he heard her seizing and that David found her with her right arm in full extension. If we had known that she´d had a seizure, we almost certainly had given her the glucagon sooner. Instead, we weren´t sure if she was hypoglycemic (very low sugar) or hyperglycemic and in DKA, or even of course if it was something else like a really bad infection. It was a frantic hell. I can remember us trying to check her insulin pump to make sure it hadn´t dislodged in her sleep. Erin, who was as white as a ghost, David, and I tried frantically to get her glucometer to work to check her sugar. I can recall that I was completely alert but certainly not completely awake, and we couldn´t get the glucometer to work. Then, we lost the automatic loading stylette for taking her blood and I had to stab that por girl´s fingers over and over again. We were yelling for an ambulance but the emergency system is terrible here and they could only get a taxi. Erin, after having to leave the room because she ready to pass out, finally got the glucometer on her pump controller to work and it was 31 (that's very very low). I´m frantically preparing the glucagon injection and panicking because I can´t get the bubble out of the needle (I think everyone was just panicked in general) and Kelly suddenly starts to come out of her post-ictal state. So we wait, just a moment, and check her sugar again. Now it´s 23 and Chris gives her the shot. And we all waited, and then she was okay. She came out of it and was cold with some sore fingers and a lot of sugar on her face where her sister had been trying to shove i tinto her mouth. We were all shaken and horrified and it was almost amusing that Kelly didn´t really seem to know what the big deal was. Go figure. Our host mother made us all tea to calm our nerves while we waited to check her sugar several times – the next reading was 102 – and we all worried and fretted over Kelly a while longer. Eventually Erin got some color back in her face too. And Kelly called her parents who are both internal medicine docs, who weren't as freaked out as we were all expecting and had to bright idea of turning off her insulin pump. Guess we were all a little to focused to think of the obvious things. Kelly´s poor roommate, Choo, was incredibly shaken up. But he was the hero that night. We were all so grateful for him waking up and I fell asleep wondering what would have happened if he hadn´t. We are all just so happy that Kelly is okay.

We were all exhausted the next day and the family still left and we hope they had a wonderful time in Macchu Picchu. I was all nerves the next day and decided to stay home to catch up on rest. On the weekend, we went to some ruins just outside of the city on Saturday where there is a temple that was built by the people here before the Inca. Outside of the temple there is a spring of water filtered through the stones of the temple above. Our host told us afterwards as we were leaving that they say that if a couple drinks the water together, they will die if they cheat on their partner. He told us he and his wife had done this and joked that he had bought life insurance immediately after. After that he brought the group of five of us to a restaurant that cooks in a traditional method called Paccha Manca in which the food is cooked in jars on hot stones underground. It was good. But almost everything I eat here is chicken (with lots of rice or potatoes), so it´s all about the same to me.

Next comes Sunday. Four of us,Chris, Walter, Ulla, and I went up to a glacier in the mountains called Huatapallana (I think that´s how it´s spelled). We had a guide but there was a Peruvian family he stayed with who went much faster than we did so we were mostly on our own. Our German roommate had only been in the country around four days and so we really short of breath. Poor thing had a very hard time but Chris was kind enough to carry her bag for her most of the way. It took hours to get there and we were all pretty exhausted (I was spent by the time we got there) but it was absolutely gorgeous. We were over 18,000 feet up. And I can finally say I´ve been present for a record for Chris since that was an all time high for him too. Damn was it hard to breath. We finally got onto the glacier and we all collapsed on the ice to cool off because despite being winter here, it was quite warm and I even had to take my jacket off. Then of course Chris and Walter had to climb higher to slide down on their butts (I´ve got good videos and pictures I´ll try to post later). It was difficult going trying not to step in crevices or anywhere that would break and let you fall into ice (my waterproof boots were quite handy - though not much in the city). And I've got a few deep cuts on my hand to show that if you fell, the ice was like razors. We filled our waterbottles with water from the glacier, which was a little iffy because people actually herd cows all the way up there (here we come Giardia) but not on top of the glacier. Chris was thrilled to drink hundreds of years old water and the rest of us were happy with cold water because we were all so exhausted.

We made our way back very slowly. Walter told Ally who was sick and couldn't come that we were like turtles. We'd move a few feet and rest. Chris was wonderful and pretended he didn't have a headache from the altitude like the rest of us (though later he showed he was hurting just as much) to try to help us all down the mountain. We finally got back to the little restaurant that is set up at the bottom and had a slight run in with the llama herding dogs. Walter and I both picked up rocks as they were running and snarling at us (something I've probably never done before) but luckily someone called them off before they got to us. Now when we got back, I needed to pee like a race horse (and I promise this has a point), and that day I had seen two of the most disgusting bathrooms I've ever encountered - one being at the restaurant. So my parents will be happy to hear I finally pulled out my Go Girl (look it up if you've never seen one - it's pretty amusing) and it worked quite well. I went back into the restaurant and collapsed on a bench. Now it was Ulla's turn and she went around the other side of the restaurant to look for somewhere else instead of the disgusting bathroom. She came back a moment later first looking slightly shaken and then bursting into tears as she told us that two of the herding dogs had bitten her and showed us the marks - one on each leg. We were appalled and we immediately set to cleaning up the wounds. The old woman who ran the place, when I asked, told me Oh yeah, that happens all the time, especially with young women and police. Chris went and got the guide who proceeded to chastise Ulla for walking around the restaurant. We carefully got Ulla to the van and she told us that other people up there had watched and done nothing. I was shocked and significantly pissed. My head was killing me but I spent most of the bus ride practicing my speech to tell off the people who just watched without helping. I mean what kind of people in any country would do that? But we got off the van early and I never got the chance to check with Ulla if they were the right people instead of the people in the other van (they were). We got home and I called our hosts who immediately came home. They took Ulla and I to the emergency room where she was told, just as we'd thought, that it would be best to go ahead and get a rabies vaccine. But she had to do it at the clinic the next day. I was in clinic (a different one) while it all happened but the long and the short of it is that they went to several clinics and none would give her the vaccine. So they had to drive back up the mountain with a government wildlife official to see the dog to make sure it was not rabbid and they will return in five and ten days. Poor Ulla is just terribly tired and shaken up by this whole thing. What an ordeal. I feel absolutely awful saying it but I had to feel to grateful that it wasn't me. I love dogs so so much and I think one more run in with a dog would have destroyed me. I'm still much more gun shy around them here now than I was before. But for the mothers, don't worry, we were already being careful.

So we are hoping very much that this is all the bad news we will have to report and that we will not be magnets for medical nightmares while we are gone. This weekend we are staying in town for a big party - even before the parties next week for Santo Domingo and Fiestas Patrias. It's going to be quite a hangover. And then maybe next weekend into the jungle. But we'll see. Otherwise, we are eating well (definitely missing vegetables), staying healthy, comfortable, and working on some fabulous farmer's tans. Sorry this one was so long. I promise they'll be shorter in the future.

Gustavo wanted a picture of us

Hoping you are all happy and healthy,
With much love,
Sara and Chris