Binge Blogging

My apologies for being so bad about updating recently. Here's an update since the last time I wrote:


1. Obama ("not Osama" jajaja)

Despite being several thousand miles away, I still got to follow election night on CNN Mundo. Working in the areas of homelessness and Social Security have made me pretty cynical about the federal government, but watching Obama's acceptance speech in Chicago I couldn't help but feel at least some sense of hope, even in light of the economic crisis and all the other problems this government will inherit.

All the Peruvians I've talked to are really happy that Obama won, largely because he's not Bush and partly because they are excited to see a person of color as the President of the US (a bus driver pointed out to me that for the first time a US President looks more like him than me). Still, after singing the praises of "el moreno" there's usually some joke made about how his name is pretty close to Osama.


2. Lunahuana

My roommate Utpal and I had gotten pretty close to the doorman of our building, Don Martin, and almost every time we'd talked to him, he'd mentioned his hometown of Lunahuana where "the sun is always shining, wine flows like water, and people live practically forever". Because it was Utpal's last day here, and because we wanted to see what this "paraiso" was really like, we took a trip there with Don Martin in early November. We were accompanied by his father, who despite being 95 came down the night before to visit Don Martin in Lima on his own. As we waited for the bus, Don Martin told me that his father recently had a physical and the doctor told him he had the prostate of a 20 year old. I'm not exactly sure what that means, but maybe it has something to do with the fact that Don Martin has 9 siblings.

After a two-hour bus ride, we arrived in Lunahuana to find that Don Martin really hadn't been exagerrating much. The sun was shining as promised, and there were acres and acres of grape vinyards along the riverbanks. We also learned that several of the residents were over 100 years old. After eating breakfast with Don Martin and his father, we went to visit the town's colonial church and cemetary and Don Martin's father embarked on a two-mile walk to his house. We eventually met him there and were greeted with large bottles of sweet wine and pisco (a grape brandy that is one of Peru's most popular drinks). We sat around in a circle with Don Martin, his father, his brother, and one of his ancient neighbors and passed around the wine and pisco. The custom is to pass the bottle and a small glass, drink from the glass, shake it out over the ground (for hygiene purposes) and pass it on to the next person. Apparently another part of the custom is to do this until you have finished everything, which I learned after taking several sizable portions early on. After a while, the older folks dropped out of the circle, and then the pisco stopped burning and my Spanish started improving (or at least it seemed so) and when it came time to go we staggered off to the bus stop and slept soundly all the way to Lima.

When I saw Don Martin the next morning he started laughing and asked me if I liked the pisco, and then we started planning our next trip to Lunahuana for the grape harvest in January.



3. Huaraz

Lima hosted the APEC conference (a gathering of American and Pacific presidents) a few blocks from my apartment in mid-November and the government decided to declare a city holiday on the Thursday and Friday of the conference. My roommate Ariel I took the opportunity to travel to Huaraz, an Andean City about 8 hours from Lima. We were a bit worried when we arrived at the bus station and found that there was no power there, but we made our way by candlelight and the bus actually left on time without a problem (though we were a bit unnerved by the "customary security practice" of videotaping all the passenger's faces at the beginning of the trip).


Huaraz is easily one of the most beautiful places I've ever been (I'll post pictures as soon as Ariel's computer gets fixed). It lies at about 10,000 feet is is surrounded by snow-capped mountains and lush green hills under one of the bluest skies I've ever seen. This was a welcome change from Lima, where the cloud coverage and pollution conspire to block out the sky 90% of the time. Ariel and I spent our first day walking around the city and visiting the pre-Incan ruins of the Wari people. On day number two we got up at dawn to go on a hike at the national park. Ascending from 10,000 to 15,000 feet was seriously tiring but definitely worth it, walking in the shadow of some of the highest mountains in South America, passing through fields of grazing cows, and hiking by lakes that are so blue they don't look real (again, I'll put the pictures up as soon as I can). Day number 3 we went to a local restaurant and ate 2 classic Andean dishes: pachamanca (a mix of meats, pototoes, and spices cooked by burying the ingredients in the ground with hot coals) and cuy (guinea pig). People from the US ask me how I could eat guinea pig after owning one as a pet. For one, they taste pretty good and also, that was probably the most annoying pet I've ever had. I think the Peruvian question makes more sense: how did you have a guinea pig so long and never eat it?

On Sunday we boarded the bus and two Spanish-dubbed Sean-Claude Van Damme classics later, we were back in Lima.




4. She was just seventeen...

I've been hanging out recently with people from this Jesuit volunteer program that visits a soup kitchen in downtown Lima on Saturdays to play games with kids and make crafts. This past Saturday was their big Christmas party. There were games, a magician, and then a big presentaion of Christmas presents. Trying to keep order with 50 kids was like herding cats, but the kids had a great time and I enjoyed my first taste of Christmas in Lima.


The next day there was a big end-of-the-year party for all the volunteers, which I was invited to despite only volunteering for 2 weeks. Each volunteer group had to compete in a karaoke contest and my group thought it would be a good idea to exploit my knowledge of English by singing an English song. Despite my protests, I found myself before a group of strangers singing the Beatles' "I Saw Her Standing There". To make matters worse, the music stopped working and the lyrics came up at about half speed. It was not pretty. But overall it was a real good time, and I'll probably be joining this Jesuit group again when they start up in March.


5. Work

Things at work have been going well. My job basically involves meeting with former-patients at the office as they plan their small businesses, going out with them to buy the supplies they need, and then checking in on the businesses every few weeks to see how things are going. I really like getting to go out in the field and meet with people where they work and live, and I'm learning a lot about a lot of different kinds of businesses (including shoemaking, leather tanning, street vending, cell phone renting, and moto-taxi driving). Although a few businesses have been struggling, it seems most of them have been pretty successful. It's amazing what a few hundred dollars in starting capital can do to jump-start a business.

I've also had the opportunity in the past few weeks to participate in some really interesting public health conferences. Two weeks ago Socios hosted a World Health Organization TB training, bringing TB experts from around the world to discuss policies and treatment challenges. I got to hear some really interesting talks about the current controversies in TB treatment and see how people approached the same problems in radically different settings (from Denver to rural Tanzania). This past week Socios hosted another TB conference, but this time with the Peruvian Ministry of Health and other doctors from Latin America. It was interesting because almost all the participants were doctors or nurses working with TB patients on a daily basis, and in discussing the issues they talked about human rights and the personal impact certain policies have had on their patients. Also, they've had some really good food at the conferences, and I got a free "Stop TB" polo shirt and computer bag.

My Spanish has been improving a lot at work, but I still make mistakes from time to time. Yesterday I brought lunch-time conversation to a halt when I tried to tell a co-worker that a patient moved ("se mudo") an accidentally told her that she died ("se murio"). My follow-up of, "I think she's in a better place now," didn't help to clarify things, but we eventually straightened it out, and I don't think I'll ever make that mistake again.


So that's a not-so-brief recount of the big stuff in my past 6 weeks here. I'll try to be better about updating in the future.

Some Lighter Observations

1. Ronald McDonald gets around. I saw the fast food clown the other day giving a presentation to children on the importance of living a healthy lifestyle. Right after handing out Happy Meals to the crowd, he said,¨and remember children, we are not defined by what we eat. We´re defined by what we do.¨ In addition to this poignant insight I also learned that Ronald MacDonald only speaks Spanish and has the voice of a heavy smoker. Maybe that´s why he never talks in the US.

2. The look people often give me when I try to speak to them in Spanish is remarkably similar to the look Jeopardy contestants give when they don´t know the Daily Double question (complete with eyebrow scrunching and head shaking).

3. Saint Judas in Spanish actually refers to Saint Jude, not the disciple who betrayed Christ. In light of this new information, the massive procession in his honor last Friday seems a lot less creepy.

4. I´m not very good at soccer. I sometimes play with guys from work on Thursday afternoons and there´s a father-son duo that joins us. The son is 11 years old and schools me pretty much every time. For a while people thought I was being gracious by letting him score a few goals and steal the ball from me, but I think they´re catching on.

5. Military time can make for long afternoons. I got back from lunch the other day a little past one and to my horror realized that I had to work until 17 o´clock. I can handle an 8-5 no problem, but with this 8-17 stuff, I gotta be in bed by 23 at the latest.

6. There is a subtle but very important difference between a tomato and a Peruvian hot red pepper. Also, embarrassing stories travel around the office incredibly quickly.

7. I´m taller than most Peruvians. I discovered this when trying to sit down on a bus and discovering I am in fact capable of touching my knees to my shoulders. When I enter houses with small children, the mothers often tell their children that I must have drank a lot of milk growing up. Because I don´t know how to say ¨lactose intolerant¨ in Spanish and because I want to counteract the troubling public health message propogated by Ronald McDonald, I go along with it.

Some Observations from the Field

After two weeks of accompanying Socios health promoters in visiting patients homes ("Socios en Salud" is the Spanish equivalent of Partners in Health), I've made a few observations. The first is that if you made a topographical map of Lima by using household income instead of meters to measure altitude, that map would be almost a direct inverse of the actual topographical layout of Lima. That is to say the poorest people seem to live in the hills, and the higher up you go in the hills, the poorer people are. As it was explained to me, during Lima's population explosion in the last generation, droves of people moved from the country into the city (again, often a trip downhill from the Andes but seeking higher socio-economic ground) and began these squatter settlements or "pueblos jovenes" in the unclaimed, unaccommodating hillsides. As new families move in, they simply build higher and higher up the hills. The cruel irony of this arrangement is that the people with the best views of the grandeur of the city have the least access to its resources.


I have also been made aware of the important distinctions that define the different levels of poverty here. The health promoters I have traveled with (who often play a case management role) assess socio-economic status not primarily by asking about family income, but by noting whether the walls are made of wood or metal, whether the roof was plastic or waterproof, whether the floors are dirt or cement, whether a patient has three meals or fewer, whether there is running water or electricity, etc. These factors not only define one's level of poverty, but also one's chances of responding well to treatment, so Socios provides things like cement floors, waterproof roofs, windows, food and other resources to support the patients and their families. These modest improvements (with even the most costly intervention, the wooden housing units, costing well below $1000) can literally mean the difference between life and death for the patients and their family members. (And in seeing all this I have to remind myself that Peru is not a poor country by world standards: it's 116 out of 229 countries in GDP per capita).


I've also learned a few things about tuberculosis treatment. A central focus of Socios' work is to support patients being treated for Multiple Drug-Resistant Tuberculosis (MDR-TB). Due to the complexity and cost of treating this disease, MDR-TB used to be considered "untreatable" in resource-poor settings like the "pueblos jovenes" of Lima. It wasn't until Partners in Health started treating poor patients in Lima in the mid-90's with "first-world" success rates that the international health community started taking seriously the option of treatment. It's crazy realizing that every patient I see would have been deemed terminal just 10-15 years ago and now the vast majority are completely cured.

On a more personal note, I have also discovered that while there is no word in Spanish for "awkward," I have made sure that the experience is still alive and well in Lima. My non-use of Spanish over the past 2 years has forced me to confront a steep re-learning curve. The good news is that I have been able to pick up a lot of Spanish from the health promoters I travel with. The bad news is that the phrases I've learned from them largely consist of things like "is there blood in your flem?" and "do you have diarrhea?". So when I meet new people I usually lead with the latter in hopes that I'll immediately find something we have in common.

So in spite of a few gastro-intestinal glitches (thanks MHAPers for the Maalox) and the harsh reality of the poverty here, I have to say that Lima has been treating me well. The Socios employees are inspiring people and their impact is really tangible. I live an in apartment with 4 other volunteers and they have all been really great about helping me get acquainted to Lima and making me feel at home. I'm also slowly getting acquainted with some of the Catholic social justice communities here that I've heard so much about. One of the van drivers I met has been directly involved with the work of Gustavo Gutierrez, one of the fathers of liberation theology and the subject of my senior thesis, and he's going to get me information about when and where the groups meet for Scripture reflection and retreats. So things are in the works.

I guess I'll leave it at that for now, but I'll try to update soon. Que le vaya bien.

A Deal's a Deal

In return for Kat setting up a blog detailing her Med School experiences, I agreed to make one about my time in Peru. After resisting Facebook and MySpace for years, I've finally entered the world of internet self-presentation. I guess it's all downhill from here.

After only two days in Lima, I'm not sure what to say, except that I'm working with Partners in Health , whose mission is to bring the fruits of scientific innovation in medicine to the poorest of the poor. I also wanted to attach this poem I read recently in Pathologies of Power, a book written by Paul Farmer, one of the founders of PIH. It highlights the troubling priorities that PIH seeks to correct.

Hasta luego...

The Earth is a Satellite of the Moon
Leonel Rugama (1949-1970)

Apollo 2 cost more than Apollo I
Apollo 1 cost plenty.

Apollo 3 cost more than Apollo 2
Apollo 2 cost more than Apollo I
Apollo I cost plenty.

Apollo 4 cost more than Apollo 3
Apollo 3 cost more than Apollo 2
Apollo 2 cost more than Apollo I
Apollo I cost plenty.

Apollo 8 cost a fortune, but no one minded
because the astronauts were Protestant
they read the Bible from the moon
astounding and delighting every Christian
and on their return Pope Paul VI gave them his blessing.

Apollo 9 cost more than all these put together
including Apollo 1 which cost plenty.

The great-grandparents of the people of Acahaulinca were less hungry than the grandparents.
The great-grandparents died of hunger.
The grandparents of the people of Acahaulinca were less hungry than the parents.
The grandparents died of hunger.
The parents of the people of Acahaulinca were less hungry than the children of the people there.
The parents died of hunger.

The people of Acahaulinca are less hungry than the children of the people there.
The children of the people of Acahaulinca, because of hunger, are not born
they hunger to be born, only to die of hunger.
Blessed are the poor for they shall inherit the moon.