Katie and Tommy

So many things have been going on lately. So much so that I can’t even believe that today marks the halfway point of my time in Trujillo. In just three short weeks, it will all be over, I will have Katie happily at my side again, and the all too familar routine of study-sleep-study-sleep will be back! Though I’m not feeling overly stressed or overworked right now, it will be wonderful to feel like I’m properly on vacation for the two weeks before I start school—no mornings that begin before 8:00, no interviews, and no writing!

On the last Saturday of June, IRO had a “campaign” day at the clinic, which meant that they made a special advertising push, announcing that Saturday would be a designated day when individuals older than 50 could come get their vision screened for free (it normally costs $4 to be seen). The “campaign” day was certainly a jackpot day for me as I got 11 interviews done in 4 hrs, nearly as many as I normally do in 3 or 4 days!

That Monday was a national holiday (the feast day of Sts. Peter & Paul) so I got to enjoy two and a half days of rest. Noon on Saturdays is a sacred hour for the residents as it marks the start of 40 hours of rest for them (if they aren’t on call, of course). Per their tradition, I joined them for the ceviche lunch they have every week. Ceviche is one of Peru’s most famous culinary exports. It is a dish served cold, consisting of “raw fish” that has been soaking in lime juice for hours, thus denaturing the proteins and effectively cooking the fish chemically (a raw egg left in vinegar will do the same). There are also lots of onions, cilantro, and spices thrown into the brine. Served with yuca, cancha, seaweed, and lima beans it is absolutely delicious.

Trujillo does not have particularly much on the touristy circuit nor does it have any lovely cafes like Buenos Aires, so my days are almost entirely spent in the clinic and my apartment in the evenings. Spending enough time in one place can really familiarize you with its peculiarities.  For example, practically every other building here looks unfinished. Steel reinforcing rods jut out of brick and walls remain unpainted. Apparently, only “finished” buildings are subject to property tax. So when the tax collector comes around, one can claim that one is still working on his home (most home are built by their owners) or one is still planning to add onto it, and therefore, skip out on the tax that year.

Many owners also keep dogs on their roofs as cheap alarm systems. They’re hardly cared for, fed only intermittently, and seem to all start barking around 2:00 AM. Other slightly richer owners (or groups of them at least) employ private security guard to patrol their street. Every few minutes the guards will toot their whistles, as if to announce their presence. And taxi drivers drive honking their horns every other block, announcing their “availability” lest anyone nearby need a ride. The inglorious symphony of noise that all of this can produce has been a bit ridiculous, so I’ve started sleeping with ear plugs.

Per HMS requirements, I followed the CDC guidelines for travel health, which included bringing malaria prophylaxis with me. But since it is winter, there aren’t any mosquitoes. With the exception of the risk of getting stomach troubles from food (which I haven’t had yet), the single biggest danger I face on a day to day basis is cars. The only stop signs I’ve seen in the entire city are in the parking lot of the (American built) mall. Right of away seems to be determined by who is driving the fastest and least likely to be unable to yield. Rather than slow down, adamant drivers may raise their hands out the window to announce, “I’m not stopping!” If I were to describe it in other terms, imagine that every driving habit that you learned in drivers ed. does not exist here, with the exception of direction of travel, but even this gets fudged from time to time. I’ve taken to sitting in the center, rear of taxis, with a knee pressed against the seats in front of me and my booksack worn in the front as an airbag. It is increasingly clearer to me why vehicular accidents are one of the leading causes of death in the third world. The only other places I remember being this crazy were Egypt and India, countries that also had really screwed up social classes.

This is one of the strange peculiarities of Peru and many other developing countries. They have one foot in the first world and another stuck in the third. I live next to a mall. It has a Radio Shack and a Starbucks. I could have used my iphone here on a local carrier.  Yet, at the same time these trivial, simple dangers exists that no one bothers to try to fix. We’re trying to solve really big problems like XDR-TB and HIV, yet intervening in the simplest ways like traffic safety would make such a difference in health and quality of life. Years ago, recognizing the money to be gained from tourism in Cuzco, the government cracked down on many of these habits. From the hills, the city gleams beautifully as all the buildings in the historic center have been well cared for. Police officers stand at important intersections, lest anyone blow through without yielding. What could possibly be so difficult about doing this here?

On Tuesday in the clinic I had a small victory. A resident told a patient and his adult daughter that the reason his vision was so poor was due to a cataract and he needed to get surgery. They said that they couldn’t pay for it and were afraid of getting it anyway, and just wanted to get glasses instead. Eyeing the stack of charts on his desk, the resident told them that glasses wouldn’t make a difference, but gave them an order to get refracted anyway. Since he technically still was a cataract patient, I invited him to participate in my interview. At home, I have a collection of important anatomical diagrams on my iphone and several times this year I have pulled it out and drawn for patients exactly what was going on inside of them. I did it again here, except this time with pen and paper of course (How outdated and 20th century, right? :-).

After the interview, we talked about cataract surgery, its complication rate, and how they could qualify to get it free. As I was bidding them farewell, I gently told him and his adult daughter that they would have to pay a lot for the glasses and wouldn’t really get much improvement from them (his cataracts were so advanced he could only see hand movements in front of his face), but I told them that I understood their concerns and didn’t want them to feel pressured. I urged them to think about what I had told them regarding the relative risks and benefit and to come back if they changed their minds or had any other questions—a few minutes later, they were knocking on the door asking when they could undergo pre-operative testing!

The rest of the week my mornings were spent with a third year Bolivian resident doing cataract screenings at distant clinics around the periphery of the city. These areas are basically slums that squatters settled years ago and within the last few years have received infrastructure, like electricity, basic health services, even a formal name. It is bitterly ironic though what names were chosen. The names of the four neighborhoods we went to this week were Happiness, Miracle, The Future, and Ocean view. The last one technically was true, but there was a wasteland of garbage miles long between the slum and the sea. My late uncle in Poland lived in the Soviet built “Sunny” neighborhood. (The joke being of course that the nearby steel factory spewed out grossly huge amounts of sky-blackening smog)

And so came Saturday and another week concluded! Ceviche at our now regular place, Mar Picante, was followed by much needed rest and relaxation! When I’m not interviewing, I really am just spending my days writing, reading past publications, and peeking at interesting retinas. I’m continuously eating delicious food, having my eyes opened to something new every day, and learning amazing things from my patients.

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