Refrigerators on motocars, border crossings, and subdural hematomas...

So, the other day I saw a refrigerator and a rocking chair on the back of a motocar. They can make anything work with transport. On the subject of transport, since therea re very few cars, everyone either drives a moto (motorbike, motorcycle, motorscooter) or takes motocars (half a motorcycle witha 2 wheeled covered bench on back) the streets are a constant busy buzz. Whenever crossing the street you risk your life. And NOBODY wears a helmut. Not for the lack of them because they are in some stores. The only helmuts I have seen are worn by government officials. Coincidentally, as Dr. S is the only neurosurgeon in town, every other surgery and most head injury patients I´ve seen are the result of moto accidents. Seems like an obvious spot for an easy solution if you ask me. The other day we saw, on two different occassions, families of FIVE on a two seater moto...mom, dad, and three kids, one not more than 5 months old I would guess, hanging on for dear life...ridiculous. One news worthy case we saw last week was an emergency surgery Dr. S went in for at 12 at night...a little Colombian girl of 3 years had one leg amputated after being shot by what at first was thought to be Colombian insurgentes but was later revealed as Colombian military practicing their firing, at the Peruvian-Colombian border. She was helicoptered to Iquitos in the middle of the night. Her leg was shot and a piece of bone completely shot off, so that when she arrived, only some muscle and skin was holding her leg together. Originally, I thought that the 3 day boat journey up the river to the 3 way border of Peru, Brazil, and Colombia would be a fun journey, but now, and after talking to Dr. S and hearing about the drug trade in the Colombian border town of Leticia, I think I´ll reconsider... Over the weekend I went with my peruvian friend José to a butterfly farm and rescue center for animals...it was great, and hopefully the pictures turn out alright.... This week has been subdural hematoma week, with two surgeries and some great pictures, which I will refrain from posting here. One hematoma (patient is a sweet 79 yr old man) was caused by a falling coconut to the head, so I guess not all head injuries are from motocar accidents. In other news, I am seriously considering cutting my time abroad short, and returning in May to move to New York in time to do the summer session of public health courses for the 2 months prior to the start of medical school. I am tired of feeling illegit, of knowing nothing, of wandering. I love traveling but I´m a little bit lonely and I need something greater to be working towards. And I have just hit that point where I am not ok not knowing things, ie medicine, anymore. For the better part of 3 years I have been preparing, applying, and waiting for medical school (and I only had to apply once!). I mean, medical school itself is only 4 years. And unfortunately, not even traveling at the moment can take my mind off of that want. And one year from now, after hours upon hours in the library I will prolly look back at this and think that I was such an idiot, wasting away my last chance at international travel for quite some time. And part of me now thinks that, but I just need to feel like I´m moving towards something in my life, and right now I don´t, so by getting a few more MPH classes under my belt, I will be a little further along with that degree. Yeah, so anyway, that´s the tentative plan. As usual, the pictures are taking too long to upload and I gotta go to kick boxing with Mrs. Salazar (yeah, it´s pretty funny). I have a great picture of a monkey sitting on my shoulder...so I will try to upload them later!

perhaps a moment of clarification...

If you will allow me just a moment to clarify some previous comments, because we all know Jill can get a little excited some times and her words come out faster than intended (thanks mom). About the hospital that the evangelists built...like I think I said, it is a VERY nice thing, its beautiful and functional and new and great. And I hope it gets used appropriately, and I hope it will get used for generations. Afterall, it is worth a lot of money, and that is its intent. My problems with the establishment are a few, I will confess that not all details are known to me: I am pretty sure (info from the doc) that it was built on unpurchased state land, so they basically went behind the governments back. Likewise, they have just finished construction and only now are figuring out that there are licensure laws for physicians here, meaning that their army of American doctors who want to come work cannot come work until they figure out how to covered or licensed in Peru. To me, this would be a good detail to work out before the 5 year construction finished. Also, if there is one thing I have learned the hard way about, its development work by foreigners in places of need: coming in with fancy medical supplies, indeed building your own hospital to administer health care, can sometimes give the opinion to local citizens that their facilities are substandard, and that this is what they need becuase this is what the Americans brought. Now, dont get me wrong, the area is poor, but the medicine I have seen thus far in Iquitos (an hour away from the hospital) is not substandard medicine at all (not up to some american standards perhaps but not substandard). However, at times, these foreign built hospitals come in and they are required and necessary and serve a great purpose. But hopefully, these hospitals also provide employment for people in the area, as usually poverty is accompanied by unemployment (stop me if I´m wrong...). I hope this hospital can do the same. Also, a big fancy hospital requires expenses, and supplies and costs and continued staff and, I imagine, a sizable budget to run. I have no information on their future budget planning, so all I can say is that I hope this hospital will be sustained well into the future. Additionally, I hope they did some preliminary research into what kind of health problems they will serve...as it has been my experience previously and my observations thus far here, only guessing, that health problems arising from poverty (malnutrition, infectious disease associated with poor living conditions, cholera, teen/unwanted pregnancy, etc) are primary, and we know how to deal with those (or theorhetically so). So, I guess what I am saying is that I wish them the best of luck. Of course, I think the swimming pool is an excessive luxury and I have no stomach for evangelists who proselytize, but those are my own problems. In other news....I am having a tough time with my spanish...and while I dont have the time to vent at this moment about the difficulties in not knowing enough spanish, not knowing enough medicine, having to follow a less than kind surgeon who thinks I should know more of both (I should), I´m going to pretend at the moment that given a few more weeks, I will see improvement. Oh, one quick entertaining fact about my spanish: In Mexico, to order a Coke at a restaurant, you asked for a "Coca." Here in Peru, where the drug trade is rampant, asking for a "Coca" in a restaurant gives you wide eyes and surprised looks, because "Coca" here refers to the ever available and cheap cocaine. Whoops. Ok, now I have to go read up on hydrocephalus...my homework for tonight motivated by fear of the doc. All in all, things are still pretty good, if a bit overwhelming and frustrating. but what´s new. much love

pics

The Salazar´s cabin, a street scene in Iquitos with a handful of motocars, and two views of the Rio Amazonas, one with the floating neighborhood of Belen in the far distance, where reed houses float on the river when the water is high and are supported by beams, the poorest area of Iquitos.

stupid americans and other tales

Asi, muchas cosas. Last week was a decent start, and this week I am already feeling a bit overwhelmed. But we had a nice weekend at the river with the Salazar family, celebrating the doctor´s birthday. I am wishing my spanish was significantly better, but I got an invitation and met up with one of my taxi driver´s daughter, who is a university student needing help with English in exchange for help with my Spanish. I met up with her yesterday, and we practiced and talked in each language for an hour, and we are meeting again tomorrow, so at least I have that opportunity for practice. As for the weekend: the Salazar´s have a little rustic-ish cabin in a little town/village on the Nanay river about an hour outside of town, an hour on dirt roads though. Better than Zam dirt roads, more forgiving because the dirt is more like clay, but nonetheless a good jostle of a motocar ride. The cabin is open air, and I slept in a hammock and it was all very peaceful and nice, but they still have a pretty functional kitchen and full bathroom. The whole thing was apparently build by the doctor himself. So, there were people and festivities and 2 cakes and swimming in the river and general good times. We went to the cabin on friday to show the plastic surgeon before he left that night, and then returned again on saturday for the weekend. But just down the road from the cabin is a very long and tall and new and fancy brick wall, enclosing a compound that has just been completed. It´s a hostpial (well, one of the some 10 or 12 buildings is a hostpial) and we went and met the woman who has just headed up this project. What kind of project, you ask? Well, it is all privately funded by this woman and her husband, apparently. They are American, southern christian evangelists, and apparently god told them to move to the Peruvian Amazon, take all their retirement money and some potentially dodgy life insurance money (rumors from the locals who work there), and build a multi-million dollar hospital and school compound complete with pastor´s quarters, hotel-like accomodations for visitors and a very nice swimming pool all in god´s glory. Hmm. ok, if god said so. Here´s the thing: they have built a beautiful, expensive, complete hospital (small but beautiful) that rivals some hospitals in the states, complete with brand new x ray machines, ob-gyn rooms, surgery facilities, dental facilities, a fully stocked pharmacy and surgical supplies....and it has yet to be officially opened for work because they have no doctors, nurses, staff for the hospital. you might think that the husband or wife were a doc or a nurse, but they arn´t...they´re in business (clearly). And now they are fulfilling the wishes of evangelical rich christians who don´t do any research on such projects, the needs of their patient population or the sustainability of their actions, but think that picking up and moving to the amazon, building a beautiful medical facility to save the people while also building a huge brick wall to keep them out is the answer. They have a boat (they were going to have 2 but went over budget) like a three story steamboat, for cruzing the river up and down to save people. Stupid americans. Anyway, it´s kinda ridiculous but I hope it gets used apropriately and can be sustained for a very long time. I mean, don´t get me wrong, it´s a nice thing, to build a hospital (and swimming pool). Anyway, on saturday, we were relaxing by the river, and a kid apparently was walking toward the hospital, down the road, after just getting injured...he had a good 4-5 inch gash in the top of his head from falling somewhere. So, the doc and his son took him to the new fancy hospital, I met them there, and with the evangelist´s sutures and sterile gloves, stitched him up and bandaged a broken finger. But clearly, had the doc not been vacationing this weekend at his cabin...there would have been plenty of supplies but no one to administer them. Stupid americans...anyway, moving on. What else...oh, last week, when the subject of the surgeries was plastics, one afternoon we had a huge pig to practice taking skin grafts on. And then, that night, we ate it. Yup, even I. Gross. As for surgeries this week, yesterday I saw a VP shunt and part of a C-section...I just wish I knew more about the surgeries themselves, because between my lack of medical knowledge and my lack of spanish, I´m feeling a bit lost these days. But I will get there eventually. pictures...are taking to long to upload now, so you´ll just have to wait... thats all!

Iquitos, Peru. Holy shit!!

I´m here! And it´s hot! And I have too many things I want to say! But before I get into the details, I just have to say I´m fine, and utterly enchanted by Iquitos. Even though I´m sweating proverbial body parts off, it´s lovely, and not as hot as I actually anticipated. Ok, I´ll try to calm myself and recap some things... Yesterday was a 13 hour day of travels...3 planes, 4 airports, and new friends. I know every country has the nicest and friendliest people, more so than the last country, but I swear its truer here. I already have friends all over the country. On the first flight I talked with a Peruvian girl who was on my next flight, and we ran through the airport together on our 10 minute connection in Panama City, and then she asked if I wanted to have coffee in Lima, but I had to decline for time and connecting flights. And she talked to me in Spanish so I guess my spanish isn´t that terrible. On the second flight I made a German friend, who works in the German embassy (friends in high places no doubt) in Lima and gave me all his contact info for next time I´m in Lima...and on the flight to Iquitos I met another Peruvian friend and got contacts. And all the airport officials are so nice and complementary...they seem to get lost in my eyes (that´s a joke). Mzungu, Gringa, or just the nice eyes, I don´t know what it is, but I like it. Ok...arrived in Iquitos last night, and hopped aboard a motocar, read: three wheeled buggy contraption run by a motorcycle out front. They are everywhere. And since it was hot, the open air motocar provided decent air con. I was immediately enchanted with Iquitos, and I don´t know exactly what it was. I had this weird feeling that it was like every place I´ve ever been to yet so completely different at the same time...I know that makes no sense, just go with me here. Anyway, after becoming friends with the taxi driver, who told me whenever I need to get somewhere in town, he´s my guy, we arrived at the house, I was greeted by Dr. Salazar, and all the pleasantries of first encounters...had dinner with a whole bunch of people, the doctor, his wife, 2 sons (26 and 22, a doctor and a vet student with a masters in bio...lots of science here), one girlfriend, the docs partner, his 20 something year old wife (a 40+ year difference...) and their 3 month old baby, and a visiting plastic surgeon from Toronto who is here for the week giving talks on burn protocol and skin grafting. Oh, the family also has a 1 yr old beagle named Felipe, a yorkie, a mini schnauzer who just had puppies and there are still 3 left here at the house, a siamese cat, and 7 parakeets...yup, it´s awesome. Most of dinner and conversation was in English, so I wasn´t lost. Had a little heart to heart with Dr. Salazar on what my "training" here will entail, and then off to another restless nights sleep (hence I need a nap). Ok, now for the crazy part. Today we headed to the hospital, and after a talk on skin grafting by aforementioned Canadian doctor, Dr. Salazar, essentially owning this, the largest, hospital in Iquitos, being the only neurosurgeon in Iquitos and the cheif of surgery at this hospital and being the most senior staff (33+ yrs) at the hospital, said, hey, welcome to Iquitos, come on in to surgery. So, I was camera woman for a skin graft surgery on a little girl about 8 years old, who had already had one grafting done on both thighs and today they grafted skin onto her entire torso and part of her arm...I would guess it was about 40% of her body that was burned. And there I was, a little freaked out inside but I held it in...after all this was my first surgery where I was awake. The plastic surgeon from Canada was essentially teaching a few students and demonstrating to other docs how to do grafts of this nature, and I was taking photos for him. At first, all I could do was think about my surgery and picture myself on the table...with my incision wide open, my head draped, and a whole bunch of masked physicians surrounding me...then I eventually got over it, got over the fact that it was a little kid, and thoroughly enjoyed the experience. I was awe-struck and wide-eyed. And I´m glad that surgery was not my first choice of profession. And I´m glad this surgery today was only a skin graft and not something more bloody. But I have a feeling, I´ll see plenty here. These first two weeks I´m with Dr. Salazar in surgeries. What a way to be introduced to the whole thing, eh? Anyway, I´m exhausted and sweaty, so it´s nap time. PHEW!

Why there are so many benches in public places in Mexico, and other riddles

Yes, there appear to be an ample number of benches on which to recline in various parks and all of the zocalos (dead centers of towns, where evey day is a kind of carnival of street vendors selling foods and balloons) everywhere I´ve been so far in Mexico, and I think I figured out why. Everyone here is in love with their significant other, and people like to lounge, recline, embrace on these public benches for the world to see, which is sweet I suppose. If you´re into all that public display of affection stuff. Anyway, that´s my theory on why there are so many benches here. In other shocking news, there was snow over the long weekend in Mexico City, which, may I remind you all, is less than an hour north of Cuernavaca and is where I will hopefully be flying out from in only a few days time. In the north of Mexico, there has been snow and "frigid" cold for some time now...it´s been a very strange winter all over. Yes, its my last week in Cuernavaca, and in Mexico, as next monday I fly to Peru. I´m very excited. But first a few recaps: Last week my class, along with my very cool teacher, went to the Luchas Libres. For those of you who have seen "Nacho Libre" with Jack Black, yes, they still exist in Mexico. Luchas Libres are these theatrical fights, like WWF but much more theatrical and quite funny. Anyway, when I heard that there was one on thurday night last week, I was all over that. So a few kids from my class and our teacher went, and the first of four fights was pretty funny, but after that they got a bit repetitive. But, they wear those funny masks and do all sorts of silly things, so it was a good time. And I bought my brother a little gift (it should be, hopefully, on it´s way home). Over the weekend, I went to Tepoztlan, which is the little town I went to the first weekend with my host family, but this time I went back solo to do a little hike up to a pyramid. It was a nice hike and a beautiful, if a little hazy, view from the top. Sunday I laid low and watched part of the superbowl...Monday I went to a little silver mining town called Taxco, and did the whole gringa shopping for cheap silver jewelry for an hour or so, and just relaxed and enjoyed the town in general. It´s built into the side of a pretty decent sized hill and is very cute and quaint. Um, what else...there´s a Mexico vs US soccer game on tonight that I think I will try to catch with some folks, and probably root for Mexico (when in Rome...). Other than that, I just am trying to remember how I fit all my things in my one backpack to get myself here...this weekend I´ll have two nights in Mex City to do some stuff before heading out on monday. Thats all for now....