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.

6 Blogs in One

Travel

The flights were all just fine. I am so grateful that they didn't include jet lag. (only one hour difference from home.) The most irritating part was getting from and back to the airport in Lima. The safest area for staying is about 1+ hours of harrowing travel, in taxi go-carts to get to the airport.

It turns out that by airport scale I carried a total of 56 pounds. The suitcase being most at 35. I had to check my suitcase in the end which turned out to be good because the domestic flight required a 3 oz liquid limit, not 3.4, so I got to make some last minute changes. In case you wonder, it is possible to pee with a fully loaded back pack on! Cusco was of course much easier. A small city with one really main road. I decided early on not to push myself as I would have if I was going to be here only 1 week. Instead I've moved pretty slowly, connecting to altitude and Spanish and such. I've learned that walking is easy, and which taxis are safe if I need to ride.

Food

Lots of types of potato, yucca, thick kerneled corn at every meal. Fresh food is absent. Fruits are good - the oranges are very tart, but succulent. I'm told that we should be eating 2000-2500 cal/d (mostly carbs) to keep off the chill. The woman who owns the place where I live (Ivonne) is delightful and tries her best to satisfy - tending to serve huge portions for every meal. I'm not used to this. I am thinking I'll take myself to a familiar meal once a month. Starbucks provided a familiar interlude and a sandwich I could stomach. Lots and lots of coca tea sustains me.

People

The people who run the program I am working with (Maximo Nivel) speak beautiful English and I am doing fine with that of course, but in terms of the medical side of my work here - we had a crash course in 1. anatomy in Spanish 2. Spanish terms for diagnosis 3. Quechua terms for diagnosis. I have to admit to being OVERwhelmed by that 2 hour experience. The city has been overrun with Peruvians and many foreigners this week because the biggest festival in Peru (Itzi Rayma) was this weekend. The Qechua arrived in all their finery, the women wearing numerous skirts on top of each other and having LONG braids down their backs. Men and women wear beautiful and multicolored ponchos and always a flat brimmed hat.

Crafts

I understand that there are people selling crafts every day, but this week some of the finest in Peru came to show off (and sell) their wares. I've included some photos of items that most appealed to me. I guess I'm most impressed by the weaving. When I realize the amount of time and diligence it takes to make even small items, I am amazed at the prices. A detailed woven band is about 1 sole (~.15) It would take me hours to make such a thing especially with the small gauge of the threads and a lap loom. There is some sacredness to me in the experience of devoting such time to a craft, even if the returns are low.

Events

As I mentioned before the biggest festival of the year was held yesterday. I'm told that about 1-150,000 people were here. Because I am with the medical team, we were invited to join the Red Cross to work in the triage tent during the festival. Had to be up by 7 to get to the ambulance on time. Then I got to wait for 1.5 hours for everything and everyone to be gathered together. They call this Peruvian time, but I have heard the same experience called by different names in other parts of the world!! - but never in the US.

14 of us fit ourselves into an ambulance, which was a squeeze. Off we went with sirens and horns blaring - through narrow cobblestone streets so crowded with people, cars and buses that it took us a long time to get there.

The site is an ancient Incan spiritual center with fabulous rock walls that have withstood the test of many earthquakes, but have suffered at the hands of rock thieves. The walls are extraordinary for their size and the number of sides they have. Some have as many as 12 angles. It is thought that this is the reason they have survived as walls for so long. The other extraordinary fact is that the walls are built without grout - the sides and angles fit together like hand in glove.

Back to the festival. It is a celebration of the sun, calling it to return to the sky and give warmth and light to the plants. (It is the winter solstice here!) As a point of interest the festival used to be on the solstice, but sometime after the Spanish came and brought their Saints, it was changed to a Saint's day (June 24) so that both cultures would be celebrated together. Saves time I guess. I am always grieved by the usurping of one culture by another.

But the festival itself is pure Incan and is spoken in Quechuan. The costumes are gorgeous. The music is from drums and pipes. At the beginning conch shells were used to call the group together. It's incredibly rhythmic and at times is very soulful. The historical enactment included a llama sacrifice, which yesterday's event did not include. There are hundreds of dancers parading in and then weaving themselves together in various dances. Because each group is differently dressed, the color arrangements and rearrangements were beautiful. I am sure they had some meaning that I didn't know. 

Personal
Lack of Spanish is indeed a deficit. I feel it especially with Ivonne because she so much wants to share our lives. I have decided not to pressure myself unduly. I start Spanish classes next week and will go from there. With everything I have to learn, I am overwhelmed. I just have to decide that I will do my best in the manner I am most familiar with. Usually I watch for a long time before I ask questions.

But because this is an immersion situation, I will learn. I will have to use this experience as a guide for how I will approach all the other languages I will be exposed to. Just creating that system alone is a lot of work. If I don't come out of this with a stronger brain, I am indeed on a downhill course.

Coming from 90 degrees in Boston it's hard to realize how cold it can get here in Cusco. There is no heating in any house. I am lucky to be in a house with hot water for the shower. Luckier still to have brought a warm sleeping bag to put under the blankets. I am never cold at night - it's during the day that I struggle to understand how layers work. In direct sunlight at mid-day it's hot. A cloud, especially accompanied by wind, can be suddenly freezing. I have a constant low grade chill during the days and I wrap up in a blanket until bedtime. Thank you Abby and Charlotte for your shopping advice. 

Yesterday at the festival I was one of the minor victims. I was overcome by fatigue and slept for three hours in the tent (ousted now and then by real patients). As things wound down someone took my oxygen saturation. It was 76 and should be in the 90's. I got oxygen for a few minutes, came home, crawled immediately into bed and slept for 14 hours. I am currently fighting to stay awake so that I can sleep tonight. The bed has the aspect of being the lower half of a mattress set and I wake up every morning with lots of aches and pains - makes me yearn for my puffy repose at home. Advil and time help. Fortunately I didn't suffer altitude sickness, which I have before. That was a relief.

On the personal side, I haven't regretted a moment of this trip. I'm doing just fine, though a little worried that I won't learn enough language to make any difference in the clinic. We'll see - tomorrow, if I'm feeling up to it. I am very lucky to have such a wonderful and warm hostess at my home placement. I feel entirely safe for my person, my soul and my belongings. In a day or so, I will start to plan for my side trips to Lake Titicaca and Machu Picchu. In due time!

Enough for now. Believe it or not I'm running out of words! There is no refinement to this piece. It is just what came out of my head. I hope to have the energy to put more time into the writing, for your benefit and mine.

Quick First Impressions

Taxi drivers in Lima have faster reactions than shortstops in baseball and they totally understand the angles, especially the very acute angles. It is an amazement to me that I didn't see dented cars or dead people along the road. Not one.

The mountains between Lima and Cusco are extremely dry and more rugged than any I've seen from the air in the US. The folds generally face east, but there were many coming from all directions. Roads wove in tight switchbacks in and out of every canyon, but they didn't seem to join any communities. It's a mystery!

Cusco is in a surprisingly flat-ish valley. There is room for agriculture from produce to trees - along with residential developments climbing the closely surrounding hills. The architecture, while not as ugly as Lima, is simple concrete boxes of 2-3 stories. The welcome signs at the airport feature Coco-Cola and McDonald's. I was greeted with a very pleasant cup of coca tea. I understand that I am to drink quite a lot every day in order to offset altitude sickness (It's over 12K ft here.) So far I am doing alright.

I am staying with a super delightful family. The mother is a teacher of orphans, the son is a student of business, the father a retired agricultural engineer, the grandmother a former HS teacher of Spanish, we laughed a lot and made a pact that within 6 weeks we will all be much better in the opposite language! I am going to start Spanish lessons on Tuesday at the vast expense of $60 for a week of 2 hour lessons.

I have a lovely room which I will share with another volunteer who arrives tomorrow. A little dinner and the excitement of tomorrow to look forward to in my dreams - which will be many, I think.

Full moon shining in my room. GORGEOUS

View from the window of the apt where I will be staying. A very nice place with gracious people.

The ferned fountain in my hostel patio

RIPLEY department store in Lima, I feel welcome!

DONE!!

60+ years of photos sorted, scanned, filed, notated, made into books – Done

All emails consolidated into new email file and notes sent to many folks – Done

House cleaned from top to bottom – everything touched and decisions made as to whether to have it be my special item or for the general use of the tenant (I had forgotten that having a tenant meant that I had to move out!!) – Done

All paperwork touched, sorted, filed or thrown out after decisions are made – Done

Books sorted – many sent to used book store – Done

Travel plans made, visas gotten, tickets bought, contacts list filing up, projects planned – Done

Learning to use ipad mini – difficult for a techno-klutz – Done

Lists for the tenant – Done

Clothes and books and vitamins..... chosen for packing – Done

Packing – a very difficult hurdle to overcome – kind of represented that this was not a flight of fantasy. – Done

House looks gorgeous all stripped down. Friends are being so loving and supportive. There are so many more things that could be done and won’t be. Why leave now when I’m on a roll?

I cast the runes the other day with the general question “How am I doing with my life?” The answer – Powerful forces of change are at work here. Yet what is achieved is not easily or readily shared. After all, becoming whole – the means of it – is a profound secret. Do not expect too much, or in the ordinary way, for the old way has come to an end: You simply cannot repeat the old and not suffer. Stay in the true present, the only time in which self-change can be realized.

So on with the show. I leave tomorrow.

Time is Shortening

Whoa, time is shortening. I’m feeling the pressure of tying up loose ends....

Last teaching day was stuffed animal introduction day!
Such fun. I love those kids.

1. finishing teaching – this time it’s the end (except for the teaching I’ll do on this trip) I’ve had a terrific 13 year ride which I wouldn’t trade for anything. I have loved each child and tried to make room for their uniqueness to discover itself and bloom. In Montessori-speak that’s called preparing the environment. I love teaching this way.
   
2. finishing all unfinished projects or throwing them out. I did that too. A HUGE sense of relief and bags of discards along with some really good projects – like finishing an album of iconic Ripley photos of the last 22 years. His job will be to create any hereafter!! I’ve done what I can.
3. deciding what to keep, what to leave with a tenant and what to throw out. I am completely amazed by how little I remember of what I’ve tossed – and the house still feels lived in. I hope Ripley understands what he won’t have to do down the road. I am certainly thrilled that I won’t have to deal with any of it when I get back.
4. organizing a blog and trying to understand the technology requirements I’ll have.
5. designing what to put into a 21x14x9” suitcase and a backpack. It’s cold in Peru. Mild, at first, in China. Hot in India. Hot in the day and cold at night in Botswana. Layers, a versatile sleeping bag, good shoes and some money for extra cool clothes in India.
6. staying healthy – here and there – means GOOD WATER first and foremost. And of course how many meds and supplements do I take??? All this to keep the body together – the soul will flourish on this trip, I am sure of it.
7. connecting with friends is difficult in this moment. I’m finding it hard to write about my preparations because my mind is SO FILLED UP. It’s like a logjam of thoughts, feelings, observations, wishes, concerns, hopes, practicalities.... I have truly enjoyed the family meetings to pass over whatever responsibilities I can and plan how to accomplish the rest. The small goodbye celebrations are so much more fun than the big bash would be. I don’t have the bandwidth to accommodate too excited a conversation. I really appreciate the good wishes and am very aware of the number of people who will be living vicariously through my experience. I want to do well by them. 

I am remembering several specific instances of telling people about my trip. Particularly on the airplane coming home from Nashville one woman’s reaction stands out. She may have been in her 80’s and when I told her about the trip her eyes got really big and began to glow. She was practically vibrating with excitement, even though she told me that she would never dare to do such a thing.

Older women (perhaps because they have white hair too) are hugely enthusiastic and make a great audience for my stories. It’s fun. Letting out these words is loosening up the logjam. I feel much better. Thanks for ‘listening’.

Please send me notes and comments on this blog. If you want to contact me by email – please write to anne.GrabbingTheWave@gmail.com (caps don’t matter)

Coal Energy is Fossilized Sunlight

I was listening to the radio and doing trip planning when I heard that phrase. I love it!

My current planning is about what teaching tools to take. They have to be non-verbal because language will be a problem in both directions. It would be best if they can be on my iPad, but then I have to have a printer (and it has to be a wireless printer because my mini doesn't work any other way). So many details it's overwhelming at times. Teaching in China will be the most organized and I will likely not need much supplemental material. But teaching in Peru, India, Botswana will likely be more basic. Hence my concern re: wireless printers etc.

But back to coal energy being fossilized sunlight. The reality of that use of energy is that its chemistry traps heat and we all know what that means! I wonder how I will feel and notice global warming during this trip. Certainly Beijing is known for foul air, be it from Mongolian dust storms or from trapped smog. The school where I'll be teaching has a lot of indoor activity areas - like a swimming pool and big gyms. At first I thought it was related to wealth, but now I'm thinking that more essential functions are being served. Breathing comfortably during exercise for example.

In Peru, at 12K feet for 6 weeks, my breathing will certainly be risked and not because of pollution. I'm told that people there drink coca tea - a stimulant to help with altitude sickness.  I will be drinking a lot of it as I am susceptible to altitude sickness. I will report back on that!  I expect pollution in India, but I don't think of air pollution first. I don't actually think of India as being a coal burning country.  I may be wrong about that. The city of Kathmandu, Nepal may have air pollution, because it sits in a bowl. I do remember going there once before (40 years ago!) and at the airport they had horns to scare the animals off the runways.  I could see it happening because we had to circle down in a tight circle about 4 revolutions before landing - just to descend into the bowl.

In Botswana I will be working in an orphanage near the Okavango Delta - one of the world's most impressive inland deltas.  The water comes off the mountains in the Congo and flows into the Kalihari desert - creating a huge delta. You can imagine the relief it brings to the wildlife and the people. I'm looking for ways the culture represents its impact. I may have to go to the First Ladies Detective Agency for more information!

Well this note certainly represents to randomness of my thinking as I try to grapple with all the diverse details of this trip. A beautiful phrase - coal energy is fossilized sunlight - sets me off into a wild escapade of ideas and questions! Please bear with me.  Ask questions in the comments section too! Conversation with myself is not always refreshing!

Learning – Always Learning

In an effort to familiarize myself with new technology so that I’ll some way to read books and write letters during the trip, I’ve borrowed a friend’s IPad. I have been know to be pretty outspoken about not liking tablets and smart phones – probably mostly out of fear and embarrassment of appearing stupid yet once again – just as I simultaneously realize that my personal technology (read ‘body’) is slowing down too.  I suppose that everyone of a certain age has intimations of mortality more often than they’d like.  I’m one of them. It’s an outrage to be reminded of it every time new technology comes out.  What the Hell happened to the good old days – when I was pretty sure I knew all that was necessary to know!!  Such bold confidence!  :~)

So back to the iPad.  I have decided that in order to have some stimulating reading on my trip (in case I ever need it) I should learn about how to download, or is it upload, some of the 40,000 free e-books on Project Gutenburg. Last week I started reading The Moonstone by Wilkie Collins (1868). He was a friend and writing colleague of Dickens and in this book has produced one of the best mysteries I’ve read – and I’ve read my share.  Apparently his novels were of the genre “sensation novels” which have morphed in detective and suspense fiction. He had an eye for remarkable details of life, situation and of the human heart. It took me a while to get started because of the language style, but before too long I was riveted – and gave myself the leisure this morning of finishing. It’s worth reading – and it’s free on Project Gutenberg!

Not wanting to leave this new library too soon, I found myself downloading books from the “T” list of authors. From the Roman Tacitus (500AD), to the Hindu Rabindranath Tagore (1900),  to Chinese author Qian Tao (400AD), Tennyson, Thackery, Trollpe, deToqueville and Tolstoy.....  A much wider selection than Barnes and Noble.  I could spend a whole year reading in the “T” section.

Scanning through the lesser know titles, such as A Gentleman from Mississippi,  Canadian Crusoes,  Animal Figures in the Maya Codices,  The Foundations of Geometry,  Medival Lore from Bartholemew Anglicus,  and The Life and Correspondence of Sir Isaac Brock, K.B.- Interspersed with notices of the celebrated Indian chief, Tecumseh, and comprising brief memoirs of Daniel De Lisle Brock, Esq., Lieutenant E.W. Tupper, R.N., and Colonel W. De Vic Tupper........I couldn’t help but notice the vast effort people continue to make to explain themselves to others. It made me think of the supportive family and friendship circles for each of these authors, which have disappeared over time. In the case of Chief Tecumseh, a whole culture and knowledge base has all but disappeared. But life keeps going on regardless.

Here I am documenting some observations of my own trip preparations – to what end???  To inspire you to reread the old classics, to entertain you for a few minutes, to remind you that I’m still alive and kicking, to imagine that I’m in your company and we’re having a good time together, to stimulate you to fill and then empty your own bucket list.....  I don’t know.  Perhaps I’m just talking to myself in a way I find interesting.

Whatever the cause, I hope the result is that you’ll comment now and then and we can share a mini-moment.