Friday, July 22, 2011

Living in the Third World

While living in what is sometimes called a "Third World" country (though that is now becoming a very antiquated term), I have had to readjust to many realities of daily life here. To name a few of the trickier scenarios I have had to get used to, I have learned to: take cold 2-minute showers when the electrically-run hot water gives out; sleep in long underwear, scarves, and wool socks at night to bare the 30 degree weather with the lack of a heating system; watch my step while walking through the streets to avoid running into piles of accumulated trash; wash my laundry by hand and hang-dry it on our roof; stand quietly by as a Peruvian toddler relieves herself in front of my clinic to avoid using the dirty public bathroom provided in the health center itself. And the list goes on.

One day during my rotation in pediatrics, I went with two nurses to an elementary school near the clinic to weigh and measure the students in addition to checking their vision and general hygiene. I was astounded to discover that almost 100% of the children did not have dental care and thus had horribly advanced cavities. Most of the kids did not maintain what a U.S. doctor would consider "adequate hygiene," subjecting themselves to our examinations with unwashed bodies, sunburnt faces, and uncut fingernails.What impacted me most perhaps was the mere fact that the nurses and doctors here have to go to the schools to give these kids regular checkups and integral vaccinations. Although that particular day we were not giving any injections, I have on several occasions traveled with a nurse to vaccinate young children in the communities inhabiting the hills above our clinic. What I soon learned (and what the nurse lamented openly to me as we trekked up the trash-ridden dirt paths) was that many parents wont bring their children to school the day of a vaccination, in order to avoid short-term side effects such as crying, screaming, and temporary fever. Because of these common absences, the nurse has to regularly travel from door to door, practically harrassing the families until they consent to vaccinating their children (which is often done in the middle of the dusty roads with no more than a soapy cotton ball to clean the injection site).I have talked with several nurses and doctors in my clinic, and nearly all agree that the root problem in these communities is a lack of information, education, and consistent communication about the importance of vaccines like those that fight influenza, polio, measles, mumps, and rubeola.

One slow morning in the clinic, as I was waiting in general medicine for patients to arrive, I borrowed one of the nurses medical books and began reading about main health problems in the area. Many prominent health issues in Peru, such as respiratory infections and malnutrition, are systemic, due to lack of education or extreme poverty, etc. In addition to the resistence to vaccinate described above, family planning is a huge issue that is often avoided among the more impoverished communities in the campo. The doctor explained to me that is not because of Catholic doctrine that these families end up having 8 or 9 kids they cant feed, but rather, a lack of resources and a failure to communicate information on methods of family planning. For example, most Peruvian women believe that birth control pills cause cancer. In fact, in my lesson on Family Planning during my 1-on-1 Spanish class last month, nearly all the scenarios presented in sample conversations between patients and doctors involved the patient asking the doctor for other methods of birth control, "since the pill causes cancer"; in none of these scenarios did the doctor ever correct the patient or hint that the pill is a "safe" method of contraception.
As these same systemic issues come up again and again, I got to thinking: what is the best way to communicate with the Peruvian populations? In the US we can send mail, insert informational pamphlets in the newspapers, make announcements on TV or the radio, etc. Here, where a huge percentage of the population does not have running water, electricity, or a mailbox, the most effective way to reach these communities is to go door to door, to hold charlas (or information sessions), and give demonstrations. But even this isnt easy. The doctor at my clinic explained that the only way to incentivize people to show up for the charlas or socio-dramas is to provide some sort of giveaway, which can get expensive for small clinics and health centers. Since coming here, I think I know now that I dont want to be a doctor, but that I am fascinated by the medical industry. Maybe I can pursue a degree in Public Health somewhere down the road, and help discover a better solution to reach the people of Peru.

One last thing I do want to mention is that I have been amazed and perplexed by the perception many Peruvians have of the US. One day I was talking with Jaqueli about "The Pursuit of Happiness," a movie starring Will Smith in which he loses his job and ends up living on the streets while trying to provide for his young son. Jaqueli told me how much she loved the movie and then assured me that she knew it was just made-up, a fantasy. I thought at first I had misunderstood her, so I asked for clarification. But no, my host mother explained that this situation doesnt actually happen in the US. People arent poor, everyone has a home and a job. This movie was purely fiction. Obviously this turned into a much longer conversation, in which I explained to Jaqueli that YES, this was real, that there are many people in my country without jobs or homes or family. However, I was very much taken aback that this was her perception of the US. I have run across several other Peruvian people who have held similar beliefs, some convinced that there is no crime in the US as well. Though I feel somewhat bad being the one to shatter their visions of the American Dream, Ive felt its only right to paint an accurate, unpolished picture of our country. Because being here, I have come to realize that the poverty, illiteracy, and hunger that I see every day here is also very much present in the US, though assuredly on a smaller scale. It has become so important to me to remember the difficulty and suffering that exists within the borders of our own nation, especially while we try to help others overcome similar issues in other corners of the world.

Monday, July 11, 2011

Puno and Lake Titicaca


Much unlike my usual hyper-organized self, I hopped on the bandwagon with 17 other ProWorlders to plan a last-minute trip to Puno (home of Lake Titicaca) over the weekend. Friday day we decided to go, and bought tickets to catch the 11 pm bus out that night, hurrying to our nearest La Canasta supermarkets to pick up snacks for the 7 hour ride. Luckily, I was able to sleep off and on most of the way there, so when we arrived just after 6:30 am I was ready to explore. And good thing I was, too. After dropping our bags off in the hostel and scarfing down a quick breakfast, we were off to start our tour of the Lake just an hour and a half later.

The first stop on our soon-to-be 8 hour boat tour was Los Uros: The Floating Islands. These small islands are made of a reed called totora that grows in the lake, using blocks of the roots as a base flotation for what become little villages in just several weeks of criss-crossing construction. Every week, the villagers put down a layer of totora on top of the last until 2 meters of totora, including the roots, floats on the surface of the water. And ta-dah: thus we create a floating island. While on one of the islands, we learned that the people of Los Uros not only make their homes of totora but also eat it almost constantly. I was not greatly enthusiastic about the watery, semi-sweet taste of the celery-like root, but very much enjoyed watching the islanders peel the roots like bananas every few minutes, munching away as we continued our tour. We split up into smaller groups as the islanders showed us their homes, and as we entered the hut smaller than my kitchen at home I struggled to imagine this family of 5 sleeping together in the single bed by candlelight during the cold Puñenan winters. Alicia, the mother of the house we had entered, told me that her eldest daughter had completed high school in Puno (the kids travel in totora-based boats from island to island for elementary school, but have to venture back to the mainland for further education) but that they did not have enough money to send her to University. After our small heart-to-heart, Alicia took us outside to show us her amazingly intricate weavings, literally begging us to buy something to support their family (basically 100% of these families’ income is based on tourism). I realized that us getting a sneak peak into such a different lifestyle was not possible without great hope and trust from the islanders that the many tourists marching through their homes would reciprocate with the purchase of a wall hanging, or at least a pillowcase.


After visiting a few of the floating islands, our boat made the almost 3-hour trip over to Taquile, a natural (and much bigger) island near the border with Bolivia. As we trekked 40 minutes up the mountainous island to the center plaza, our guide told us that the people of Taquile lived in an independent commune that was governed not by police but by 3 rules: don’t be lazy, don’t lie, and don’t steal. The people of Taquile are almost all trilingual in Quechua, Aymara, and Spanish, and wear traditional dress that is not only beautiful but can signify marital status from a single glance. There are no cars or other motor vehicles, and no dogs (which are regarded in the rest of Cusco as a good security system for the house). The most interesting part of the Taquile lifestyle was that the population continues to live in a highly machista, chauvinistic society. Women, who have their hair covered with long black cloth, must walk at least 3 meters behind their husbands in the streets and are never allowed to touch a man in public. If a husband and wife have a civil dispute they want brought to court, the husband goes to represent both sides of the argument- a woman is under no circumstances allowed to represent herself. Perhaps in the hopes of solving the island’s long history of incest, Peruvian ex-president Fujimori tried to build up travel to the island by establishing a hotel there, but the people rejected the idea and the project failed within less than a year of its commencement. There is, however, a market held in the plaza every few weeks that draws traders from neighboring islands to encourage some sort of local economy and to bring in outsiders to mix with the Taquileñans. We enjoyed a delicious lunch of trout (or omlette), fresh French fries, and rice before descending off the beautiful island into the lake once more as the sun set.

Sunday, July 3, 2011

Machu Picchu



Although we missed joining Jim Carrey by just a day, my 5 friends and I who adventured to Machu Picchu this weekend came back feeling we'd had an incredible experience and a lot of good stories to share. On the 3 hour train ride up, 2 friends and I sat next to a middle-aged man who seemed to have traveled to nearly every country in the world. After discussing North Korea and where we would go on a Watson Fellowship (a friend of mine is planning to apply after graduation), we all agreed that this trip would be one we'd never forget. As the train pulled into the station at Aguas Calientes, I knew that our conclusion was true- already we were surrounded by lush Peruvian jungle, the green mountains towering over us majestically among the clouds. My friends and I marveled at the beauty as we made our way to the hostel, consenting that we felt like ants walking through the expansive scenery surrounding us.

After buying our tickets to get into Machu Picchu the following day, we wandered around the tourist town where we found restaurants fighting over us for business. A woman with a menu would offer us 20 soles for a "menú" (a 3-course meal consisting of a soup or salad, an entree, and a dessert) when a woman from the restaurant next-door would return by offering us a 20 soles menú plus a free drink! The restaurants carried on like this until we became too overwhelmed and just chose one (where we enjoyed 20 soles menús with our free Pisco Sours, chips, and guacamole). Throughout the whole trip I couldnt help but feel so independent and, well, old. Here I was in a foreign country with my friends, planning a trip to one of the worlds most famous sites by ourselves; we booked our train tickets, found the hostel, budgeted meals, figured out transportation to and from train stations as well as the ruins themselves...all on our own. It was something I had seen before only in movies, this exploring the world with a handful of other college students. Never before was it something I had actually found myself doing, and being able to travel that way now was both liberating and exciting.

We woke up at 4am to walk up the mountain to Machu Picchu in the hopes that we would beat the first bus up (and save money) and make it early to climb Wayna Picchu, Machus sister peak that allows entry to no more than 400 people per day. However, our plans were doomed from the start. The first set-back was that the restaurant connected the hostel, which had offered to open early for us that morning, was not ready at 4 as we had discussed. After shoveling our Continental and American (Continental plus eggs) breakfasts down our throats, we set off on our journey a good 15 minutes later that we had planned. Walking in total darkness lit only by 2 small flashlights, we began to follow the directions we had received from a guard the day before, following the sound of the river to keep ourselves on the right track. Once we found the trail, however, our travels were not made much easier. We ended up hiking an hour and a half up 2300 feet- and I mean it when I say up. The hike was more or less like doing large lunges up endless flights of stairs that had been cut right into the side of the mountain. And after about a half hour of this, we actually lost the stairs and had to hike for a while following the looping switchbacks, jumping off the road, disheartened, when the first tourist-packed buses passed us.

As we tiredly continued to make our way up the mountain, Lena stopped and realized her backpack was open; to her dismay and ours, her jacket and the second cell phone she had bought since coming to Peru were missing. We spent about 10 minutes waiting as she re-traced our steps in search of her things, but pressed onwards when we realized they had likely fallen out at the beginning of our trek. But the excitement didnt stop there. About halfway up the mountain, my friend Gabrielle had her first real wheezing asthma attack in years. As the rest of us stood watching petrified, Natalie (a basketball player at Vassar and an asthmatic herself) expertly held Gabrielle from behind, pulled her arms back to stand her up straight, and led her through slow, deep breaths in order to calm her screaming lungs. As we forged ahead, panting and sweating in the rain, I found myself struggling to breathe through my congested nose at such high altitude, and had to stop periodically to rest so that I wouldnt faint. But when the sun slowly rose to reveal the gorgeous mountains and clouds all around us, I started to regain a bit of hope that I would make it to the top. As I struggled to carry all the layers I had worn out into the cold that morning, pressing ahead with no end in sight, I found that I had started to play the final music from the Lion King in my head (you know, the sort of rebirth theme after the storm?), motivating me to keep moving onward through the rain.

When we finally arrived at the top around 6:45 am, everyone was exhausted and absolutely delirious. To everyones surprise, Lena (who had been grumbling "I hate Machu Picchu!" the entire way up) cried instantly upon seeing the ruins from above, overcome with emotion at seeing such splendor. My friend Meredith and I were to break into fits of giggles for the next hour, unable to control ourselves and our emotions after such physical exhaustion. The ruins themselves were absolutely amazing, but really un-capturable on camera or with words. I could not believe how expansive the site was, and was astounded that it really had remained untouched by the Spanish. For those of you who dont know, Machu Picchu was undiscovered by the conquistadors, and though its presence was known by the local population, it was kept a secret from the outside world until Yale archaeologist Hiram Bingham discovered it 100 years ago. (Side note: Bingham and the "discovery" of Machu Picchu was supposedly the inspiration for my favorite adventuring anthropologist, Indiana Jones).

The "lost city of the Incas" was picture-perfect among the clouds and towering mountains of Peru, complete with llamas roaming the green terraces below. The architecture was even more impressive than other sites we had visited, as the Incas had literally built the city into the mountain, using the mountain itself as the foundations of buildings or the central altars of the temples. However, I would be lying if I portrayed the experience itself as wholly perfect. We took a 2 hour tour with a woman named Olga who refused to speak to us in Spanish (which would have been much more comprehensible than the English tour she gave) and by the end of the tour we were all wet, freezing and pretty miserable in general from the days excursions.

Under normal circumstances, we would have left the ruins to change our clothes and warm up back in Aguas Calientes before catching the train back to Cusco. But unfortunately, one of the boys in my group had bought his train tickets before coming to Peru and was not coming in until 1pm to see the ruins. Since he had no one else to go with, we had told him weeks ago that we would wait for him, and didnt realize until after finishing our tour that we had several hours to kill before his arrival. We ventured to a small restaurant nearby, recommended by Olga as somewhere the Machu Picchu workers ate (enticingly advertised as having sandwiches cheaper than the ones offered for 20 soles at the site of the ruins), and found to our delight that we were the only tourists who had discovered the damp building that day. We spent over 2 hours at the restaurant trying to warm up and dry off (to no avail), periodically taking turns to order fried egg sandwiches (served with a delicious salsa of onions and hot peppers) and loose leaf coca tea, one at a time. By the time we got back to Aguas Calientes to eat lunch and catch the train, we were all wiped out and looking forward to getting back into bed in Cusco. The weekend had been packed with fun, adventure, wonder, and lots of rain, but by the time it was over we were excited to be heading back to what we have come to know as "home."