Day one: After three flights beginning in Pittsburgh, I landed in Cusco around 8 in the morning on Monday. At about 11,000 feet high, Cusco sits nestled in a valley, surrounded by tree covered mountains that look like something from Middle Earth. Indeed, the sky seems closer here. I took a taxi to CerviCusco, and within an hour of my arrival I was staring down the barrel of a speculum, taking medical histories in Spanish. It was all pretty surreal. The clinic operates from about 8am to 2/3pm, and during that first day we saw two patients with cervical cancer. My preceptor here, Dr.Ferris, said that the rates of cervical cancer are much higher than the statistics I found, more like 30/100,000 women here have cervical cancer. I am inclined to believe him because 1.He is Dr.Ferris, an expert in the field of colposcopy and female cancer, and 2. we have seen about 2 cases of cancer a day in the clinic. The frequency that we are seeing this kind of pathology is rather shocking. Women come to the clinic from the town of Cusco, but also from the entire province of Cusco. One woman came 6 hours with her husband to get an appointment at the clinic. They told us that they didn’t have any money to pay for the exam or the tests, and Dr.Ferris tells them “Somos familia,” (we are family) and that the care here is free to those who can’t afford it. The clinic serves patients who are lawyers, business owners, venders, farmers, and everyone inbetween.
Day two: A big part of the mission of the clinic are “campanas”, or campaigns, in which we take a 14 passenger van out into the surrounding pueblos and farmlands to bring cervical cancer screening to these regions. It would be illogical to expect all of these women to make the long journey to the city to get screened, so we take the exam to them. Today myself, four PA students, and two nurses went to the town of Ccorco (2 C’s on purpose), and the drive there would rival any ride at Cedar Point. The road snakes back and forth up the mountain, and just when you think we can’t go any higher another passage appears and we continue to climb. In the distance I can see a snow covered mountain peak at about the altitude that we are driving. I have ridden up-side-down roller coasters before without problem, but this is the first time in my life that I have experienced car sickness. We arrive at the clinic, which is a nice clinic because they have examining tables for the women to lie on to get their exam. There are no exam lights, so we use headlamps that you would go camping with in order to do the Pap smears. All of the women speak Quechua, and the nurse translates my Spanish into Quechua so that I can communicate with the patient. The women out here in the campos, or countryside, wear several layers of petticoats and carry their belongings, including babies, in brightly colored blankets wrapped around their backs. Between the four of us, we collect almost 60 Pap smears that day, alternating between wielding the speculum and serving as an assistant. Everything in the town of Ccorco, including the people, seems to be covered in a layer of dust and dirt. There is trash everywhere, and dogs roam around looking for a snack. The homes are made from mud adobe bricks, with roofs of clay fired shingles or sheets of aluminum. The poverty is everywhere, but all around us are breathtaking mountains and views that I have only previously seen in National Geographic. The contrast is striking.
Day three: Clinic day.
Day four: One of the PA students, Jake, and myself, were given the honor, or perhaps the challenge, of making the journey to Antapalpa–a small town six-seven hours away from Cusco. We leave at 2am with two nurses, Wendy and another lady whose name I can’t pronounce. Before leaving the city of Cusco we are already on bumpy dirt road, lurching back and forth through the mountains. After a few hours, the van stops in front of a small landslide which covers the only road through. It is still dark, the road is mud, and the air is freezing. Jake, I realize, is far more prepared for this situation than I am. He pulls out two handheld lanterns and steps out with his waterproof boots. He carries a Swiss Army knife which comes in handy. It turns out that being a public health volunteer in Peru requires a different set of equipment.
We get out and survey the road. Wendy tells me that it is too dangerous for us to try to cross in our van, so we will wait for bigger trucks to come through and weigh down the mud. In the meantime, our van gets stuck in a muddy ditch to the side of the road. We gather rocks and put them behind the tire to create some traction, and by some miracle the van breaks free of the mud. Then we wait. I don’t see a sun rising, but slowly it becomes lighter around us and we can see misty clouds encircling the mountains. In time, several huge trucks come through. I have no idea how they managed to drive on the road we are on. But they pass over the mud and create some nice tracks for us to pass through. So on we go.
Within time the road becomes paved. It is only big enough for one car but it is a two way road, so when another car approaches one car has to go off to the side to allow the other to pass. We drive up the mountains and back down the valleys, passing towns of mud brick houses that seems to pop up out of nowhere. Jake and I wave at the people alongside the road, and they stare at us and wave back. We climb even higher, and then we are so high that there is snow filling in the grasses on the mountainside. Alpaca roam around, and look at us curiously as if to ask what we are doing there. Women’s health, alpaca, women’s health.
When we reach Antapalpa, it feels that we are truly off the grid. I doubt too many gringos (people from the US) have ventured out here. It is even the first time that CerviCusco has come out here. Women are already lined up waiting for us outside the clinic when we arrive–it took us seven hours due to the delay of the landslide. We set up shop and get to work. All of the women speak Quechua, so Jake and I read some words in Quechua that I wrote down in my notebook. I’m not sure of the correct spelling of the words, but I have the words written in my own pronunciation. “Hello” in Quechua sounds to me like “ay-ee-ahn-choo.” We also learned to say “take off your underwear,” “sit down,” “lie down” “move forward” and “goodbye.” For the most part people seem to understand us, but we do get some smiles because I’m sure our accents are horrendous. However, I think they appreciate that we are trying. The women seem extremely grateful, always thanking us. One woman hands me four pieces of fruit; another kisses our cheeks.
Six hours later, Jake and I have completed 67 Pap smears between the two of us. Wendy, the nurse, who also speaks Quechua, has done 116. The people have prepared lunch for us as a token of thanks, but we have to get on the road so we put the corn, potato, and unidentifiable piece of meat in to-go bags. Back to Cusco we go. We get back around 10pm, and prepare to be ready for the next campana at 6:30am the next morning.
Day 5: Campana to the town of Cruzpata. In the van are four students including myself, a nurse, and Doctora Sami, who is the medical director and just the nicest person. When we get to the clinic, there are no patients to be seen yet, so we first go to a laguna (lagoon) and some Incan ruins that are not far away. The ruins look like walls of stone stacked into the mountainside, overlooking a vast valley and the opposing mountain range. The Incans knew a good view when they saw one. On our drive back through Cruzpata, we pass people lining the street, dancing and playing music. Back at the clinic, there are only a few women to be seen. A few hours later, we have only seen 9 women and Doctora Sami says it’s time to go. A local clinic worker explains to us that today is the anniversary of the town, so the people we passed were the townspeople off celebrating. No one wants to come in for a pap today. Another lesson in public health.
Today was also “match day” for me, or the day I find out what residency I am going to and where I will be spending the next three years. It turned 1:00 eastern time while we were in Cruzpata, but I was able to get online when we got back. I was happy with my match, and we went to a nice restaurant tonight called Fuego, where I had the best barbecue chicken sandwich and cooked green beans of my life.
Day 6: Sabado (Saturday). We have the day off. Some of the PA students decide to take a taxi to a market outside of Cusco, but I decide to take a taxi to the city center–la Plaza de las Armas–to walk around. The afternoon turns into a perfect day. I walk around the blocks and look into little shops and markets. The plaza has flower gardens, a fountain, and two beautiful churches surrounding it. It is also tourist central. I quickly learn that I cannot sit down because immediately five people will come over to me trying to sell me food, jewelry, paintings, carved rocks, massages, and any other item. It breaks my heart because these people are so poor, but I can’t possibly please all of them. I do purchase some small things from a woman named Patricia who sells things made from alpaca in the market. I talk to her for a while and she tells me about her family. She wants to learn how to say “espera un minuto” (wait just a minute) in English. It is very humbling to be in the midst of these people who work so hard in order to receive so little.
Day 7: Domingo (Sunday). Another campaign today, but only two of the PA students were needed, so another day of rest. I am grateful because I have a lot of laundry to do (my white coat looks more brown than white) and I need to figure out where to buy a headlight. I bought one yesterday at the plaza, but when I got home it didn’t work. I will take this day to tell you about CerviCusco. It was started by Dr.Ferris during the time that he served as president of the ASCCP, the American organization that produces guidelines on cervical cancer and colposcopy, which is looking at the cervix under a microscope to identify pathology. The clinic and its outreach is funded by numerous organizations, donors, and universities, namely Georgia Regents University where Dr.Ferris is a professor. The clinic hires Doctora Sami, nurses, drivers to the campaigns, and pathologists. Just thinking about our journey to Antapalpa and the cost of a driver, gas, nurses, and clinical supplies, the clinic must require a tremendous funding base. Volunteers live on the second floor, and our space is really quite nice. We have big windows, a kitchen, stove, lots of seating, wifi that comes and goes, and several bathrooms. We have to buy purified water in big jugs because the tap water is crawling with bacteria. I have had one hot shower since I’ve been here–the rest have been ice cold and so I have mastered the art of the two minute shower. The view out my window faces other buildings that look like a Jenga game, with many buildings of different materials jutting out and running into one another. At night there are always the sounds of a dog barking, a baby crying, and the whistles of the neighborhood watchman who blow the whistles to communicate with other watchmen. The watchmen don’t particularly make us feel more safe, but if there should be a cause for alarm the electric fence surrounding the clinic and the four doors I must unlock to get to my room do the job. Everyone morning at 5am there is a rooster outside my window that begins to crow. We have taken to calling it the “throat cancer rooster” because it is the most awful sound. I told the PA students I would offer up 20 soles (The currency here) if someone would take care of that rooster. My diet here is another adjustment, I am eating the opposite of what I do in the states. I’m eating carbs, carbs, carbs, meat, and papaya. We can’t eat vegetables, salad, or fruit that doesn’t have a peel, but we can eat packaged foods, so saltine crackers and these little vanilla wafers have been my best friend. The local preferred meat is cooked guinea pig, but I haven’t ventured there yet.
My first week here has been memorable already, and I’ve met people whose faces I will remember for many years to come. I can’t post pictures from my camera, so those will have to wait, but thank you for reading. Forgive the typos and lack of accents, it’s not easy blogging from Cusco. 🙂 Hope you are all well. -Anne