Peru

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:  One day I was working in my room/office and I heard there were some American doctors downstairs eating lunch.  I went downstairs and introduced myself to this huge group of Americans who I soon learned were not doctors.  Instead they are missionaries from some radical sect of Christianity.  I explained to them about the clinic and they were really interested.  I chatted with the missionaries for about 30 minutes and then I said my goodbyes and excused myself.  One of the missionaries got in my face and challenged me. “Have you accepted Jesus Christ into your life as your lord and savior?”  Crap.  Are you serious?  We were doing so well and you had to open your mouth and blow it.  I tried to deflate the situation by suggesting that that was a pretty bold question to be asking someone after just having met them.  The interrogation about my faith continued and I was having trouble with my exit strategy.  Soooo I just sat there like a dumbass with an unconvincing smile on my face while this dude explains to me why it is foolish for anyone to believe in evolution.  He was standing about 2 inches from me and his passion from this one-way conversation was borderline psychotic.  The rest of the table just looked at us but I could tell they were a little embarrassed by their brother’s direct manner.  I finally cut him off in mid-preach and slapped him on the back and walked away.  I have to admit, I was a little creeped out.  I don’t really agree with missionaries spreading the word of God in 3rd world countries in general but I am still respectful to most.  Every now and again, I meet a missionary who I just want to lock in a small cell and throw away the key.

Sara Helen:

“You have to visit the tomb of Sara Helen?”
“That doesn’t sound like a very Peruvian name…who the hell is Sara Helen?”
“She is a witch who was burned at the stake in England.  They didn’t want her remains in England and they eventually ended up in Pisco.  She is now buried here.  I pray to her…as do most other people in Pisco.  We pray to her about our troubles and she is responsible for most of the evil doing in Pisco.”

I did go visit Sara Helen’s tomb and it was covered in flowers.  People were there praying to her.  Witchcraft is still fairly common in the area, many people see witch doctors, many people pray to Sara Helen.  I also heard that her ghost comes out at night and meanders through town.

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Spanish: My Spanish was quite basic upon arrival in Peru.  I certainly couldn’t carry on a conversation.  Over the past 10 weeks, I have amassed enough words in my vocabulary to have an effective conversation for hours.  This is when my Spanish is improving by leaps and bounds because I have a solid foundation of the language.  But, just when I was getting quite comfortable, I boarded a plane and flew home.

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No Entiendo!! Monster-in-Law divx We bought a ton of medical equipment in Lima that we had to transport on the bus back to Pisco with us.  I purchased three tickets for the 8:46p bus for me, Rene, and Guillermo…but when the bus showed up, the bottom luggage compartments filled up before we could put our equipment in.  So we waited for the 9:02p bus.  Rene and Guillermo were in charge of seeing that the equipment gets on the bus…and I was in charge of saving our seats (seats #1, 2, and 3).  I knew I was going to run into problems since our bus technically left and other people would have seats 1-3 on the new bus.  Eventually some people got on and they tried to kick me out.  I showed them my ticket and they quickly told me that my bus has already left.  I just looked at them blankly and held my ground.  They started yelling at me.  Some guy in the back of the bus said “El Gringo no entiende!!”  The gringo doesn’t understand!  Ha!!  I just played stupid and they thought I truly didn’t understand.  It was my finest performance.  Finally Rene and Guillermo got on and took there seats which I had still managed to save for them.  They got into a yelling match with the rightful owners of the seats but we held our ground.  The bus officials even tried to kick us out but we didn’t leave.  Eventually everyone gave up and found other seats at the back of the bus.  As the gingo, I can get away with a lot.

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Competition from Soap Operas? In Peru, the majority of the people arrive at the clinic very early in the morning.  The clinic is very busy from 8a-12n.  Very few people trickle in after 12.  I have my theories.  Keep in mind that 75% of the patients are women/mothers.  A)  Women need to get back home to prepare lunch and dinner for their families.  B)  Women do not want to miss their latin soap operas called “novelas” in the afternoon.  I am dead serious.  We are competing with friggin soap operas.  C)  They are just used to coming in the morning…always have…always will.  It doesn’t make a ton of sense to me because if they come in the morning, they will probably have to wait for a couple hours to be seen.  If they come after 12n, they can most likely walk in and be seen within 20-30 minutes.  Oh well.

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My apologies. The last time I wrote in the blog was on November 9^th. At that time, we were just about to open our temporary clinic at of the catholic parish hall. I had written my blog from my beach side hostel. It is now January 9^th…two months later. A lot has happened. I know quite a few people have been following the blog and checking it on a regular basis. If that is the case, you have probably been disappointed when the blog stopped on November 9^th right in the thick of things.

You see, processing my experience and explicating myself through my blog consumes quite a bit of mental energy.

When we opened the clinic on that Monday, November 12^th, I said goodbye to any amount of free time I did have. Every waking second, was dedicated to the operation of the clinic and my blog inevitably got pushed by the wayside. There were things I had to get done in Peru…while I was physically in Peru…and unfortunately my blog could wait until a later date…like 2 months later on January 9^th.

Now the trick is to relive my experiences from November 9^th even though soooo much has happened. Jumping ahead a bit, I am now in Los Angeles. I Tried release

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I left Peru on Dec 22 and flew to New Hampshire to spend the holidays with my family.

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We are currently operating the clinic in a permanent capacity out of one of the most beautiful houses in San Clemente. We are now seeing between 35-55 patients per day between two doctors. We have been filmed by a major Peruvian News crew and the story had been televised nationally. The clinic has been, and will continue to be, a huge success. My experience in Per uhas been the best experience of my life.

The inauguration celebration for our new clinic in San Clemente/Pisco, Peru took place on December 10th.

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Steve Henrichon & Rene Castillo did a fantastic job establishing this clinic in just two months.  We had provided medical services out of a temporary facility after the August 15 earthquake.  Now, at the permanent clinic, the number of patients per day some days already reaches 70.  Patients start lining up at 5am in the morning. San Clemente has about 25,000 inhabitants, almost all of them living in poverty, a big percentage without access to water and electricity. 

There is about 70% destruction of buildings through the earthquake. We received a grant from Merck & Co. to establish and start the clinic. We have a staff of two doctors, two nurses, and a pharmacist/lab technician as well as a nurse for the nearby school of 3,600 students, who already started workshops for the kids on hygiene, etc. UCLA/Cedars Sinai is looking into establishing a training program for residents/medical students in our projects, probably starting at our clinic in Peru.

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It is important for me to give credit where credit is do.  Even though this blog is seen through my eyes and it relates to my experience, it is important to note that this project would not be possible without Rene’s involvement.  For starters, he is fluent in Spanish and he was able to lead all of the meetings and all interactions.  That is just the tip of the iceberg, however.  Rene understands the Latin culture very well.  He commands the respect of everyone he meets whether that be doctors, lawyers, construction workers, priests, etc.  He reads into situations that I could never understand.  It would not be uncommon for Rene to bring over a 12-pack of beer for the construction workers and then actually pick up a shovel and give them a hand.  When I first told Martina about how I wanted Rene to join me in Peru, I described him as a modern-day Che Guevara…not in the crazy communist sense, but in his level of awareness, passion, and ability to follow his heart.  I am lucky, as are the people of Peru, that Rene took on this project and made it his own.  We make a great team!!

One week after our inauguration, Rene and I left for five days.  We thought it best to leave the clinic in Guillermo’s hands so he can begin making his own decisions.  It is our goal for us to be involved in the clinic as little as possible so the clinic can be as self sufficient as possible.  Anyways, we took a 12 hour bus ride to Arequipa.  Arequipa is the gateway to Colca Canyon which is the deepest canyon in the world.  After trekking, camping, mountain biking, and rafting in the canyon, we made our way back to Pisco.  Since we took the overnight bus, we arrived back at the clinic at 6:30 am.  Even 1 ½ hours before the clinic opens, there was already about thirty people waiting in line.  I couldn’t believe it.  We walked past the crowd and a child runs ups a hugs me and everyone laughs.

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In the first couple weeks, we have been seeing between 35 and 60 patients per day.  The majority of the people arrive in the morning.  Even the people who arrive at the clinic just before we open may still find themselves at the back of the line where it may take hours for them to be seen.  Everyone is patient however.  We play educational movies in the waiting room and we provide crayons and coloring paper for the children to help keep them entertained.

We have had to tweak the process a little bit which was to be expected.  To help handle the patient load, we brought on a second nurse, named Richard.  Keeping track of 60 people all trying to be seen can be a very daunting task for one nurse alone.

I believe that the people of San Clemente are proud of their clinic. It is a beautiful clinic…clean…safe…and I believe people find it a very comfortable place to go and receive their health care.

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The inauguration was on December 10th.  The work crew finished just in time and we had a crowd of people working into the night on December 9th to make sure all of the preparations were set.  We even hired an artist to paint the Real Medicine Foundation logo above the front door.  We invited many notable people from San Clemente and the event was also attended by many of the residents as well.  Both Rosy’s mother and Fio’s mother helped by preparing a few hundred hors douvres.  We had a plethora of candy to pass out to the children.  Maria’s grandmother has a bodega (wine vineyard) in Ica and she provided several bottles of sweet Peruvian wine.

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Rene and I acted as the MCs for the ceremony and we spoke in the central area downstairs with the morning sunlight filtering in.  Pocho blessed the clinic.  David, Guillermo, Martina, and Vanessa Vertiz from MSD all had a chance to speak.  I read off an impressively long list of people whom we needed to thank…anyone who helped out along the way.  It took me a long time to get through this list.  It just goes to show that certainly could not have done this alone and we wanted to reinforce that this is everyone’s clinic.

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Every building needs a “Padrino” or “Godfather” and we asked the mayor of San Clemente if he would do us the honor of serving as the godfather for the clinic.  This is an honor and he graciously accepted.  Martina served as the “Padrina” or godmother.  It is a Peru tradition to have a bottle of champagne hanging down from the doorway.  Martina and the Mayor each took hold of the hammer and together they smashed open the bottle of champagne to the applause of the many onlookers.  The last step involved everyone (about 100 people) each receiving a small cup of wine so we could cheers to the good health of the clinic.  We have done it.  Our clinic was open and people were excited.  It really was a joyous event.

Vanessa Vertiz from MSD had arranged for a popular news group from Lima to come down to cover the event.  We had eaten dinner with the team the night before at Miramar to get to know them a little better.  Fanny was excited because she recognized the interviewer from a very popular morning show.  The team filmed the inauguration and then they interviewed me, Martina, and Rene.  I hope my Spanish was good enough to make it through the editing room.  The story was to be aired all throughout Peru.  Even Jorge from Miramar was mentioning how he was seeing commercials on the major channels advertising the story of the Policlinico Peruano Americano.  We are famous!!

After the inauguration, we had a bit of an open house.  The doctors began to see patients who had lined up.  We gave tours to several interested people and we worked for 3 or 4 hours.  In the afternoon, we took the entire clinical team out to a celebratory lunch at a nice seafood restaurant in Pisco.

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Father’s Week-end video download Transporter 3 That next day, we took Martina on a tour of San Clemente and Pisco.  Fiorella let us use her car and Rene drove.  Taking a tour through San Clemente is a big eye opener for anyone.  The town is very impoverished.  The majority of the residents live in shacks erected with this special type of siding called caña (sugar cane).  Many of them don’t have water as the town is growing much faster than the infrastructure.  We drove throughout the dusty streets and we stopped at the different Olla Comunes (Communal Kitchens) to spread the word about the inauguration.  This ended up being quite an experience.  Everyone recognized me and Martina…and I mean everyone.  Apparently a lot more people watch the local talk show than I had expected.  We were a big hit.  At one of the Olla Comunes, there was a crowd of about 30 or 40 people.  I talked to them about the clinic and extended an invitation to the inauguration.  One of the girl’s requested a kiss and I gave her a peck on the cheek.  The entire group erupted in cheers!  I then went down the line a kissed all of the eager blushing ladies.  I apparently had a bit of a fan club in San Clemente.  I could get used to this.

We started on our way again.  People would see us drive by and immediately recognize us and wave or the kids would chase the car.  We passed one small olla comun and we noticed a young boy with his right eye completely clouded over.  We stopped and Martina and I went to speak to the boy’s mother so she could take him to the clinic.  Upon further inspection, the eye was not clouded over.  It was a beautiful shade of blue.  His mother had the same sky blue eye which was a stark contrast to her other dark brown eye.  I have never seen anyone with two completely different eye colors like a Siberian husky.  The little boy, who couldn’t have been more than three, was just as interested in me as I was with him.  He let me take a series of photos of him and his beautiful eyes.

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Martina graced us with her presence on the Friday before the inauguration.  Guillermo and I made the 4 hour bus ride up to Lima to receive Martina at the airport.  This trip to Lima helped me realize just how far I have come with my Spanish in just a couple months.  Guillermo and I conversed in Spanish the entire bus ride and then I took the opportunity to share a little of American culture by treating him to dinner at Tony Roma’s World Famous Ribs in Miraflores.  That evening, we also had a meeting with Jerry Galea and Jesse Clark with the UCLA Department of Infectious Diseases about a potential HIV program out of the clinic.  Jerry is actually making the trip down to San Clemente for our inauguration on Monday.

Martina was due to get in at 12midnight but here plane was delayed and she didn’t arrive until 3:30 or 4am.  It was a long night but, nonetheless we were up at 7am for a full day of meetings.  We first met with Helga from PAMS.  Helga is a specialist with the Peruvian customs and she has been working with Direct Relief International regarding medical shipments into the country.  She agreed to help facilitate a shipment from DRI for us as well.  Next we met with Vanessa Vertiz and Oscar Espinoza from MSD and updated them to our progress in San Clemente.  Vanessa will also be traveling south for our inauguration.  Lastly, we visited the 600-bed childrens hospital.  The Director, Adrian Ramirez, is actually married to a German wife and he loved speaking german with Martina.  He gave a personalized tour of the hospital and Martina talked him into coming down for the clinic’s inauguration.  I am amazed that these people are taking time out of their very busy schedules to be part of our special day.  The magnitude of the clinic is represented by people like Jerry, Vanessa, Dr Ramirez, and an entire news team making it a priority to come down to San Clemente for the inauguration.

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When we arrived in Pisco that night, we went straight to the television channel in San Clemente in hopes of getting some airtime to advertise the inauguration.  Nacho (the talk show host) was there but they we airing a previously recorded program and they instead had the studio filled with children who were preparing for tomorrow’s holiday by making signs and crafts.  Nacho decided to put us on the air anyways, so they fired up the camcorder and interrupted the program in session.  Martina, Rene, and Guillermo spoke first.  Martina introduced herself and spoke about Real Medicine.  Rene and Guillermo spoke about the clinic and mentioned the inauguration.  Then…I sat down.  I knew what was to come.  In Spanish…”Steve, have you tried any new foods since the last time you have spoken to us?”  hahahah!!!  They love speaking to me about foods so I humored them by recounting a list of foods that I new would get some chuckles…including Cau Cau which is made from cow intestines.  I then invited the entire town of San Clemente to the inauguration on Monday.  I was very tired at this point in the day and I don’t believe my Spanish made a whole lot of sense but hopefully they got the gist.

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Ever since the school campaign, we have discussed installing a school nurse at the school who would report to Guillermo.  The school has 3600 children.  They deserve to have a nurse.  In addition to filling a significant void at the school, we are reaching out to the families through their children.  It increases our clinic’s exposure.  If little Jose is ill and he needs further treatment than what the nurse is able to provide, then she refers him to the clinic.

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Last Exit buy It was Wednesday.  The Director of the school love the idea and he asked when the nurse will be starting.  Guillermo said “The nurse will start on Monday.”  Hmmmm…okay…that gives us a couple days to advertise the position, conduct a series of interviews, make a decision, purchase equipment for the nurse to use, and create and overall gameplan.  I like the way you work Guillermo!  Make yourself accountable and then do what you need to do to live up to your word…that’s the Real Medicine way.

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After interviewing a handful of nurses, Guillermo decided to hire Glenda.  To follow the philosophies of the clinic, Guillermo made it very apparent that the responsibilities of the job included prevention and education.  On the first day, Glenda, Guillermo, and I went around to several classrooms to introduce ourselves.  When we would work in, I would say “Buenos Dias Ninos!!!”  and all of the students would yell in unison “BUENOS DIAS!”  I couldn’t get enough of that.  By the second day, Glenda already had a plan to lead a series of workshops for the children on “washing your hands!”  I accompanied her on a few of the workshops for the 1st and 2nd graders.  She talked about why it is important to wash your hands and when you should wash your hands.  “Necesitan lavar las manitos!!”  We had a demonstration and then the children could come up and wash their own hands.  It was really cute.  Other workshops in the future may include “eating healthy” or “sexual education” for the older students.

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We also set Glenda up with an infirmary.  Students come in with belly aches but she also has her hands full with simple injuries from the playground.  These kids play really rough and they always seem to be throwing each other on the concrete.  One youngster came in with his head split open and she had to clean the wound and close it up.

Since we now moving into a large house, we could take the next step of expanding our services by traveling to Lima for another very lonnnnng day of purchasing medical equipment.  Guillermo and David refined a list of equipment we needed before the trip.  David stayed behind and worked at the clinic while Rene, Guillermo, and I traveled to Lima.  We had a two-page list of equipment we intended to purchase.  We gave copies of the list to several equipment vendors which line the streets on Emancipation Avenue.  This enabled us to compare quotes of individual items so we could make sure we were getting the best deals.  We bought exam tables, pediatric tables, gynecological exam table, surgery utensils, resuscitators, air splints, pinchers, pantascopes, stethoscopes, negatoscope, materials for casts…it was an extensive list.  We carried as much of with us on the bus and we shipped the rest.

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In addition to the medical equipment purchase, we expanded our medicine formulary.  We now have over 100 different medicines to offer to our patients.  Good thing we have a dedicated room for the pharmacy in the new clinic.  The room will be filled with racks which rise to the ceiling and those racks will be filled with medicine.

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