Wrapping it all up

Hello everybody,

This may be my last post before I head back home to the family. This trip has really pushed myself in ways that I did not expect. From only speaking Spanish for 3 weeks, leaving my wife and son, traveling by bus and ¨collectivos¨ 2 hours away from Cusco, and being able to experience tons of history and culture I was only minimally aware of before I left. Its been a great trip, but I think I´m ready to come home and be with my family once again.

Last week I spent the entire time in the hospital. Each day I would rotate in different areas of the hospital: Infectious disease, GI, Cardiology, and 2 days with Tropical Medicine. I was able to return in the afternoon to go to the Emergency Department and see what rolled in the door. It was more of a learning experience than actually doing medical things for me. There are plenty of students, residents, and staff to go around that run things at the hospital. But, it was definately eye-opening to see what they have to work with. The luxuries that we just order for our patients in the States aren´t quite the same here. If someone needs a CT scan they can maybe get it in... oh 2 or 3 days once their family has the money for it. And once they do - what do we do with it. There were many patients we saw who had intracerebral hemorrhaging but no Neurosurgery here in Cusco and they didn´t have the money for a procedure anyways. The thing that struck me the most is that besides tropical medicine, most of the patients we saw here have the same diseases we see in the States - they are just further along the process. Outlook for a lot of the patients is decent - but a fair amount won´t make it much longer because of the delayed diagnosis and lack of primary care in their lives.

I did get to see how a trauma is run at Hospital Regional. It was pretty interesting. 3 men were ¨carried¨ into the ¨trauma bay¨ by a relative. They all layed on a bed while the nurses cleaned up the blood on their faces and arms. There wasn´t a doctor in there for a good 10-15 minutes. They wanted me to observe, but it was hard considering nobody was assessing the ABCs of trauma. They were rolling these guys all over the table to clean them off without proper evaluation of their C-spine! Finally some of the residents showed up, ordered some labs and x-rays and placed the patients in observation. Totally different than what we are taught! They were alive the next day when I showed up, so maybe they know something we don´t about trauma management.

This past weekend I was able to go to Machu Picchu. It was a great day - pricey - but still a must see. I left at 6AM for a 2 hour bus ride, then a 2 hour train ride, and then a 30 minute bus ride up the mountain. Once we got there we had to hike another 20 minutes to the city. It was all well worth it. We divided into 2 groups, spanish and english, and had a 2 hour tour. Our tour gide was great and gave us a lot of history and insight into the city. After the tour we were allowed to roam about the city and do whatever we wanted (to an extent). I was able to climb all over the place and get some great pictures. Finally, after exerting myself for a couple of hours in sparce oxygen, I climed one of the mountains next to the city and sat for about an hour with another couple from Atlanta and enjoyed the view - right next to the Alpacas. While we were up there the sun came out and a rainbow formed from the river in the valley up into the mountains. It was a great view!

Yesterday Haydee, my host, and I went up into the mountains (again) to see some of the ruins closer to Cusco. I was able to see some of the sacrificial temples and the Incan fortress up close. They even light them up at night for added effect. We even got some great pictures of Christo Blanco who overlooks the city, very similar to the one in Brasil. We ended the day playing volleyball, soccer, and dodgeball with her friends and their kids. They tore me apart in soccer, but I got my revenge in dodgeball. Those Peruvians don´t know how to throw a good ball overhand!

Today I tried to go back to Quiquijana and learn about the vertical birthing that they do in the country, but the road was torn to pieces about an hour outside the city. There were 11 of us packed into a sedan for 2 hours and we were stuck in a small town in the middle of nowhere. I finally made it back to Cusco - via collectivo, walking, a taxi, and a bus.

That´s all for now. It takes forever to load pictures here in Cusco so I´ll be sure to add them when I get back.