The Deep End of the Pool

It's been nearly 15 years since I've done any clinical work, so some might legitimately wonder why I've chosen to do it while on this trip. A good wondering - realistic and all that - but I've mused now and then if I still have it in me. Well, as it turns out, I do!

This week was a major medical campaign to attract rural people to get a medical check up. Because these big events are always staffed by foreign help, they have devised this order to each day:

The staff is bused up to 2 hours to arrive at the day's location by 8am. We organized the donated pharm supplies onto the biggest table and set up 12 other stations around the space - height/weight, temp, HR, Resp, BP, head, ears, eyes, mouth, neck, thorax, abd, extrem, MD for Rx plan, pharm. Two were assigned each station with a couple of floats (this week the people who spoke Spanish and Quechuan) The line had formed a few hours earlier with people walking for up to 4 hrs to get there.

Tuesday I was too exhausted to go, Wednesday we had ~150 kids and mothers. I was assigned thorax in the same small room as the abd exams. On one stretcher were often sitting 2 active chest exams - including breasts that were exposed with as much affect as taking a hand out of a glove! In addition were 2-3 babies or young kids. At the same time an equal number were milling about the reclined dental chair where the abd exams were going on. I should add that the room was about 8x12. No privacy drapes, no soundproofing, gloves used only to protect us from getting something, therefore changed only if we were trying to stop the spread of lice or pus or something obviously infected.

That was my trial by fire and by the end of it I had remembered quite a lot about chest exams - found a few chest colds and one breast dimpling, lots of lactating, a few asthma, fortunately most of the kids were healthy. Of course perhaps it was my multi doses of vit C that kept me healthy too.

The next day we left at 5:30 AM (dark and very cold) and drove 2 hours to Limatambo in the direction of the jungle where people would meet us by 8 AM for the clinic. Some patients would have walked for 4 hours to get there. (their feet are amazingly calloused and strong - I never saw socks or even closed toe shoes.) We were treated to a nice fruit breakfast and I guess some people even got eggs. Then off to prepare the clinic (read auditorium) for what turned out to be 280 patients. We worked non-stop, without pee breaks or lunch for 10 hours. There were moments when so many people had passed by that I just got blurry and had to stop my self, do a little private breathing and centering, then go back and introduce myself and make a personal connection with the next person and get back to work. That would last me about 20 patients and then I'd be in need again. I worked hard, but I still had to sit down a little more often than my younger counterparts who were whirlwinds of efficiency and curiosity.

On this particular day the station I was assigned to was "Ears" and I guess I saw close to 550 ears - deafness, impacted wax, many perforations, a few infections and many heartfelt speeches about the hazards of Q-tips and the advantages of aciete de olivio. Periodically I was able to take a moment to do some facepainted hearts. (Shades of my clown school days!) It was really funny to watch the men admire the little children running around being so happy to have a facepainted heart. At one point a man had been smiling so much at his granddaughter, that I gestured, would he like one. And indeed he did. His face broke out in a wreath of smiles and all the old men and women in the line began to laugh. Many of them wanted one too! I found myself bursting into joyful laughter in that chaos and confusion. I'm so glad I brought the paints.


One other very funny moment came when I happened to touch a woman's stomach and it began to chirp, which made me screech and jump back. It turns out that she keeps her baby chicks in her sweater right next to her stomach. Who knows why! The whole group of patients were laughing at me, which also gave me joy. It was such a long day and so laughter lightened the moments.

There is nothing like the kind of teambuilding that comes with sharing such an experience. It was a great experience - with a great group of nursing students from Minneapolis. Wonderful warm energy.

Getting to Limatambo meant driving up and up through the mudbrick communities to the top of the valley in the west and then switch backing for miles at some speed to get us down about 4000 feet. There was a startling moment at the top of the pass when the sacred glacial mountain called Salkantay was right in front of our face, but many, many miles ahead. It followed us and joined up with other glacials peaks for most of the way down the mountain. The landscape, while steep, was filled with greening produce farms. Even in winter a very productive endeavor. But still, the landscape is thick layers of dirt. I haven't yet figured out where the gigantic granite rocks came from that the early Inca used to build their fantastic walls. Will there be enough time to keep reading my guide book!! Hard to know!! Every day is SO full.

Riding home was long after dark and fortunately I had a window seat. Holding on tight through all those turns I happened to look up into the brightest starry sky I've seen since Australia, 15 years ago. Orion is down here now was lying on the horizon. I couldn't see the Southern Cross from where I was, but I could see a lot of the Milky Way. The most extraordinary moment was realizing, as we got higher, that I was looking down on stars as well as up. It was spectacular and I wished the van would stop so I could just gaze.

Friday we drove way up in the hills edging Cusco and worked in a school at the very top of a hill. It was a spectacular view across the valley to glacial mountains way in the south. Fortunately there were only 40 patients in the 2.5 hours we were there. Mostly young children and their mothers - and with the exception of some lice and a few earaches, pretty healthy.

I felt dunked back into nursing, and I rose to the occasion. I am delighted. 5 more weeks here. Next week we will be working in specialty clinics in rotation throughout the week. By the end of the week we decide which specialty we'd like to spend time in for the rest of the stay. That will be interesting. I have no idea which I'll choose. There are also medical placements in special needs clinics, but I think I would so quickly become heartbroken that I don't want to do that placement.

Spanish classes begin for me next week too. Then next weekend I am hoping to get to Lake Titicaca. I'm told it's a great trip and though the sight of the lake from the Bolivian roads is better than from Peru, the views while on the lake are spectacular.

In the meantime my housemates in the lovely place are completely turned over. The EarthMother artist with her awesome dredlocks and strong vision, the refined, but adventurous Indonesian and the fun-filled Australian have left and along with them an excitement and energy that will be hard to replicate. I will miss them and I know Ivonne and Carlos will too.