Tourism = soap in the bathrooms

Where is Jill? Still in Peru, if it´s even possible. I just hopped off the 3 day boat trip this morning from Iquitos, and have landed in the most boring and unexciting town of Yurimaguas. Much has happened the past 2 weeks, and I will hopefully entertain you with a few tales. As always, in flipped and reversed order. The three day boat ride was wonderful, relaxing, and just what I needed at the moment. For 3 nights and 2 days and 1 morning I swayed in a hammock, looking at the jungle scenary go by, one palm lined km at a time. It was just me and my ipod, my new best friend for a few weeks, and we relaxed to the point of exhaustion. Before that I had returned to Iquitos for 1 day from Lima after Steve left. Said goodbye to some friends, the internet guys, and their sister who sold me cookies, and the Salazars, and finally left Iquitos. Our week in Cuzco was great, if filled with a few too many travel foibles. Basically, we learned that when there is too much tourism infrastructure, we fail as travelers. And yes, I realize I´m a big fat tourist, but I prefer the term vagabond. Cuzco was lovely and cold, which was welcoming after weeks at the equator. We navigated our way through the maze of tourist infrastructure that leads one to the ever anticipated Machu Picchu over a few days (by the way, all necessary components of this maze are owned by different, usually foreign (the trains are owned by the brits!) companies who have made all schedules just conflicting enough to require you to spend extra money and make me mad), and only had to take 5 repeat bus trips up to MP and buy new return train ticket on the only available more expensive "vistadome" train (which I highly resented and was not worth the small extra charge) once. But all in all, it was humorous and well worth it, if for no other reason than to cross MP off the proverbial list. But it is the most highly touristy thing I have done in years, quite possibly ever. So, while it was beautiful and impressive, once is enough. We did a little bit of hiking and generally enjoyed the spectacular scenary (which you will not be able to enjoy because these computers are entirely too slow for me to post pictures. track me down in May). After being told that we would need at least a day or two to adjust to the altitude, we didn´t over book our week. Well, we had no ill effects at all from the altitude. I did notice that I got winded hiking considerably faster than I should have, which was likely altitude, or me being lamely out of shape. But other than that, nothing. So, if any of you are doubting a trip to MP because it´s too far off the beaten track, it´s too high, or there won´t be soap in the bathrooms, trust me, you have nothing to worry about. (You can even stay at the fancy hotel AT MP, which costs mearly $1000 a room a night.) Another note: apparently Peruanas think that the national dish of gringos everywhere is pizza. In Aquas Calientes, the town at the base of MP that exists entirely on the basis of toursim, every other store is a restuarant that hawks a pizza deal at you as you walk by. But, again, the scenary is beautiful, and the site was really quite impressive, and as humorous as all the elder hostelers were, it was a great week. Now, I have a few days to kill here in Yurimaguas and then in Tarapoto (which I apparently have to take a bus or taxi to, 3 hours away, at night because during the day the road is blocked by police or something...i will have to investigate this more) and fly to Lima (AGAIN) on sunday night and have a red eye from Lima to Buenos Aires. And then I´m sure there will be another update somewhere down the road. Much love

Babies, jungles, and the open river/road that lies ahead

An update, and answer to the question "Jill, what the hell are you doing next?" The past week has been fantastic and eye opening in several ways. I made the decision that this week, the week we are currently in, will be my last here in Iquitos for a variety of reasons. Telling this to Dr. Salazar gained me entrance into some other wards of the hospital so that I could have a more complete view of things "before I left." So, last week I spent a few days with the neonates in the neonatal ICU. This refreshed my view of medicine, doctors, and hospital workings in general, as it was nice to get out of the surgical ward and of awaiting the impending doom of the doctor. Not really. Anyway, I hung out with a very nice intern who let me do lots of stuff, and who really took charge and tried to teach me practical things, like physical examination of neonates. The babies were too cute and too small, mostly a lot of pnemonia and infection, sepsis, etc. I also had a sorta eye opening day where I watched two surgeries of two very different types: a full skin to skin cesearian section and the amputation of a diabetic elderly woman´s leg. A few weeks ago I felt like I had successfully overcome the awe struck feeling and fear of passing out in surgery. But this day, with these two surgeris, brought it back. I mean, seeing an entire human baby being pulled out of a woman´s uterus and, to be cliche, witnessing it´s first breaths, in just a matter of seconds, well, lets just say I was glad I have to wear scrub masks so that everyone else in the room doesn´t see how wide my mouth gaps open. Which is another thing, working on controlling some of those first emotions and impressions... And the amputation of the leg that for all intents and purposes had ceased to continue living as a part of this woman´s body. One minute it was attached and the next the lucky intern in front of me was holding a human leg. Again, glad the scrub mask was in place. Dr. Salazar had timed this surgery for he had a meeting to get to: it took 35 minutes. Anyway, I was forced to reflect a little bit on this dichotomous day. Today I moved onto pediatrics, which has rooms and rooms full of everything and anything. I´ve seen a little boy recovering from surgery after an alligator bite, a likely malignant tumor that has, over the course of 4 years, swelled a boy´s foot to at least 3 times it´s original size (and treatment for this only really can be found in Lima), a hermaphrodite at 3 months old (wow!), a 2 year old girl with HIV, and a baby boy that appeared to have some genetic syndrome which will likely continue to go undiagnosed. Of course there is enough skin infection, pnemonia, and TB to keep one busy for a lifetime as well. The 2 year old girl with HIV shocked me, and I was a little bit surprised at myself. Remembering back to Zambia, I had never seen a child in this state of such chronic malnutrition and illness. Of course I didn´t spend any time with actual patients in Zambia, but babies born HIV positive often don´t make it to 2 yrs anyway. This child had legs and arms literally made up of only bone and skin, a swollen tummy, and oral thrush; three months ago she weighed 10 kilos and now only 5, at 2 years old she had the appearance of maybe 6 months old. I will stop. All of that said, I really did enjoy pediatrics and neonatology, fields that I hope will continue to interest me in the future. Besides the patients, I am gaining more and more insight into what works, what doesn´t, what´s missing, etc. in this regional hospital in Iquitos. I´m seeing how utterly vital patient-physician relations are and how easy they are to dismiss. As always, I´m seeing the effects of lack of enough or misused money in "government funded" health care. While a considerably large hospital that serves as the regional center for most rural cases and the poorest Peruvians, and as many things as I have seen done here, much is lacking. You know me, I could go on forever, so we´ll move on. This weekend I went to the jungle, aka la selva. It was peaceful and relaxing, we went on walks and canoe rides, I had my own guide and met some cool travelers, went fishing (or rather I just fed the fish), read in the hammock, got a terrible sunburn (I know, we´re at the equator...blah blah blah) and too many mosquito bites, but it was all worth it. I am now finding how many mosquito bites I actually did receive, and it´s almost comical (ah...it reminds me of Zambia). Sleeping under the mosquito net gave me a strange sense of familiar comfort. My favorite part was seeing sloths high in the trees. I vaguely remembered doing a project on the sloth in like 5th grade, reporting on their laziness and 2 or 3 toes, what kind of leaves they eat and what not, so it was fun to see them and hark back to elementary school. Also saw a yellow anaconda, or part of one, while on a night canoe ride...no alligators which I was ok with. Tarantulas too, and lots and lots of birds. There was a 6 month old monkey and a young parrot as pets at the lodge, which I told my guide was really not keeping with eco tourism. The monkey tried unsuccessfully many times to nurse from me, but was adorable nonetheless. Having spent too much time with Dr. Salazar, getting away was fantastic, and necessary, as I realized while on the boat out of Iquitos, sometimes you need to just hitch a fast boat heading up the Amazon with your favorite song on replay to be reminded that life is pretty freakin awesome. And now, what´s next? Well, this is my last week in Iquitos. Next week, my very good friend Steve has decided that a week with me Peru is worth a few sleepless nights on a few planes, so we are meeting in Lima and heading down to Cuzco to snap some photos of Machu Picchu before it falls down the side of the mountain and generally have a relaxing time. Then, I will likely return to Iquitos (as I have already purchased this plane ticket) for one day to catch a river boat to one of the "nearest" major towns approximately 3 days away. From there either some buses through cocaine country and down the coast or a flight to Lima, before taking off for Buenos Aires. (An aside: a gram of cocaine here in Peru will cost you about 8 soles, or just under $3, and that´s not even as cheap as Colombia, no wonder its a lucrative trade.) If I sound vague, its because I am, I still don´t know exactly what´s going on, nor have I purchased said international flight to Buenos Aires. This week I have some decisions to make. This earlier than originally anticipated departure from Iquitos is based upon many many reasons, and I grow more sure of it each day. Estimated time of arrival in the States is early May, NY by end of May, and that´s that. My life as I know it will be over, and medical school will begin. Sorry for the long winded entry, but ya know, whatever. Much love.

photos...finally

Here are a few photos...on the way to the butterfly farm, at the butterfly farm with Jr., the monkey on my shoulder, this morning in Belen, the poorest area of Iquitos nicknamed "Venecia (ie Venice) de Peru" beacuse of the floating houses lifted up on stilts and the ´river canals´ie: when the river is high it covers the roads and streets, but the river is pretty low at the moment. We also went to the market in Belen this morning, which is huge and has anything and everything you never wanted to buy in an open air market. Watched a great surgery on Friday where a 8 cm tumor was removed from outside an man´s orbital cavity, and it had alreay eaten away his eye. It had been growing for at least 8 months or so, and he lives in the jungle, some 2 or 3 weeks away from Iquitos by regular boat. Stuff you would never see in the states, so it´s quite interesting.