Wednesday, December 28th

Happy 11th Birthday to my cousin Thaddeus!!!

7:30 am: Julia, Brian, and I met Katie in the square outside the house and we headed to spend our morning shadowing at the Clinic of Dr. Carbrejos. On December 19 Dr. Cabrejos taught our medicine class, discussing the difference in health and medicine. Dr. Cabrejos manages his own health clinic, which is located a couple of miles down the road from our host family’s home. His clinic cares for between seven and ten thousand patients. Mensa covers 60% of these patients and EsSalud covers the remaining 40%.

While we were waiting on Dr. Cabrejos, Katie spoke to us about Peruvian cultural norms. She noted that problems are often deflected rather than solved. Peruvians can be reluctant to spend time finding a solution for a case outside of their specialty. This stagnates society. Unfortunately, medicinal practices are not an exception to this norm. Instead, pills are relied on for problems doctors are unsure of how to solve.

The exception to this norm is Dr. Cabrejos. He is a renowned health manager in Peru. He recently won an award by the national society of Peru and by the local community of Trujillo for revamping the health system in his clinic. In Peru, the average patient comes in to see the doctor three times per month. This is not a sustainable trend. Typically, doctors only treat one issue at a time, so patients must return multiple times if they have more than one ailment. Dr. Cabrejos identified this flaw in the system and revamped the practices of his doctors. This decreased the amount of times patients are seen per month, and increased the effectiveness of visits. In the case of Dr. Cabrejos’ clinic, it reduced the average patient visit to only once per month.

At Dr. Cabrejos’ clinic, I shadowed a pediatrician, Dr. Yuri Yvan Valencia Yabar. There were some notable differences to what I have experienced in American hospitals:

Patients come into the doctor’s office rather than the doctor going into examination rooms
No gloves are used
Bed sheets are not changed in between patients
Doctor did not sanitize his hands in between patients
The most important note is that my doctor prescribed antibiotics to every single patient he saw, and in most cases, more than one

While I shadowed Dr. Yabar, he saw fourteen different patients. He allowed me to do the physical examinations on these patients. A few cases I saw were:

A baby boy with an infected anus
A seven year old girl with vaginal discharge
- I was surprised that Dr. Yabar did not examine the young girls vaginal discharge prior to prescribing her a prescription. He simply took the girl and her mother's word for it.
A teen boy with a bad rash about the size of a baseball below his belly buttion
A young girl with a bad ear infection
A young boy with an allergic reaction from medications being taken reacting negatively with the sunlight
A teen boy with hypertension in hand and arm joints
- Dr. Yabar used my joints as an example to the boy and his family of what "normal" was

12:00 pm: We headed home from the clinic to meet the rest of the group for lunch at our prospective host homes. After lunch, I took a nap and relaxed before the next activities.

3:00 pm: The group linked up and headed to see the ancient ruins of Chan-Chan.

7:00 pm: Our tour ended and we walked from downtown back to our house, a thirty-minute commute. We had churros off the street; imagine a funnel cake in cylindrical form with hot caramel in the middle. Pure deliciousness for only 1 sol. Then we opted for a nice sushi dinner since it was one of our last nights. After dinner, we got waffles for desert. Shout out to Timothy for making this your treat.

Thursday, December 29th

My last day!!!

8:30 am: The group headed to the clinic for our diabetes and men’s campaign. We were expecting it to be a slower day at the clinic with a lot of kids there to play, so our two psychologists accompanied us with lessons for the kids.

12:30 pm: I said goodbye to the clinic and we headed home for my last lunch with my host family. Lunch was a feast, and it was delicious. Mommy made fish, corn on the cob, baked corn, vinegar onions and peppers, three kinds of potatoes, and watermelon to conclude the meal. I was so full of food and of love.

2:00 pm: I laid down for a nap, and slept until 5:00 pm.

6:00 pm: Julia and I filled up on Nescafe and then hit the streets. We had mastered transportation to Huanchaco, but we had never walked downtown and back. So, off we went. I exchanged money for my upcoming travels. Julia and I enjoyed a 2-sol ice-cream cone from McDonalds, and then got another delicious churro off the street for 1 sol. I am going to miss these prices and the exchange rate.

As we were walking, we continued reflecting on the trip and talking about the future of what we would like to do to contribute our skills and abilities further to Hands on Peru.

7:45 pm: Julia and I returned home to meet Grace and our host family for dinner. Dinner was fried chicken, plantains, apple cider, and sweet bread with queso.

8:30 pm: We headed to Rosa’s parent’s house for our last medicine class. Although the class was scheduled for 8:00 pm, we were actually the first ones there since everyone else was on Peruvian time (haha). At 9:00 pm, the rest of our group and Dr. Neira joined us.

Dr. Neira is currently in his residency for physical medicine and rehabilitation. He spoke to us about the most common diseases in Peruvian children.

For the past two decades, the most common disease in children has been diarrhea. Two decades ago, Dr. Neira said this prevalence was mainly a result of a lack of nutrition. Today, Dr. Neira attributed this to a poor standard of hygiene, such as a lack of a habit to brush teeth, wash hands after using the bathroom, etc. Dr. Neira said that 75% of cases of diarrhea are due to viruses and the other 25% are due to bacteria. Only if the feces have blood or mucus are antibiotics needed. Unfortunately, mothers immediately get antibiotics at the first sight of diarrhea and the result has been the development of resistant strands of the ailment. Without antibiotics, all other cases should be gone by the 4th day. Dr. Neira told us to encourage the mothers to cook planatana (a domestic common soup) for their children when they have diarrhea.

The second disease we discussed was respiratory track infections. The three under this umbrella were pneumonia, bronchitis, and asthma. We discussed the process of identifying these sicknesses, as well as the prevalence rates. We then discussed the various tropical diseases in Peru, such as Leishmaniasis, Dengue, Tuberculosis, and Scabies.

Dr. Neira then moved into a discussion of the societal problems he sees in Peru that are contributing to a low standard of public health. He said that until there is societal progress made, all the public health efforts would be minimal in their effectiveness.

Domestic Violence: there are no laws against parental abuse to children or interpreter violence. The psychologists in our clinic speak with the men and women about domestic violence. They also hold lessons with the children about proper domestic behavior.
Child Labor: it is technically illegal; however, it prevails without law enforcement. Personally, I have seen numerous children working on the streets.
Pay Offs: many cops are paid off and crimes are permitted.

10:00 pm: After the medicine class we all spent time together as a group, and I said my goodbyes. I then headed home with the girls to pack and rest for my travels ahead.