Day 8: Clinic day. One interesting thing I noticed here–you do not need a prescription to pick up any medicine from the pharmacy. You can pick up antibiotics, blood pressure meds, and even some pretty intense seizure medications like diazepam, all without a prescription.
Day 9: Clinic day. I spoke with one of the nurses, Bianca, about health practices in Peru. She told me that sexual education is extremely rare in Peru–most of the schools and people are Catholic and are opposed to any discussion of sexual health. It is common for men of the lower class to have multiple sexual partners. Additionally, condoms are not culturally acceptable. Given all of these factors, combined with low rates of screening, it is not hard to see why cervical cancer is the number one cause of death among Peruvian women.
Day 10: Today I was supposed to go on a campana to a town called Camino Inca. I left at 2:30 in the morning with Ruthie, Bianca, and Clato, our van driver. The plan was to drive two hours to Otallaytamba, get on a train, get off the train half way to Machu Picchu, then walk two hours to the village. However, when we got to Otallaytamba I was not allowed to buy a train ticket. I didn’t understand completely what was going on, but I believe that the specific train that we needed is only for Peruvian citizens. I learned this afternoon that there are also planes which are only for Peruvian citizens. So, alas, I got back in the van and Clato drove me back to the clinic while Ruthie and Bianca continued on. I was pretty disappointed because I was all geared up to go after dragging myself out of bed in the middle of the night. I did, however, get to spend the day at the clinic with Dr.Ojeda, an ob/gyn physician who works at the clinic on certain days. Dr.Ojeda is older, wears bright make-up, and is no-nonsense. I realize I have brought with me some American expectations of medical care–namely keeping things clean and sterile and acting as educator as well as medical diagnostician. However, things in Peru are a bit different. The same examining gown is used for every patient, ready-to-use speculums are laid wherever they fall, and physicians seem to be very abrupt with diagnoses, not spending much time on explanations. I’m not saying it’s a bad system, but certainly much different from what I am used to.
Day 11: Campana to the town of Hunaoquite. We left at 6:00 this morning and drove about two hours to reach Hunaoquite. We only had one examining station, so needless to say I got a lot of experience today. As fast as I could do the exams Doctora Sami would have another patient coming in the door. I timed us, and at one point we were seeing a new patient every three minutes. We finished the exams and drove through the city center where a town meeting was taking place. There were a number of men speaking through a microphone, and the general topic was improvements to the town and forming more connections with Cusco. Probably over 200 people were gathered in the middle of the day to hear what was being said. Alongside the meeting, a few people were cooking enormous pots of an unknown food, presumably for the crowd that had gathered. We waited in the van for some papers to arrive, and in the meantime two girls from Huanoquite had a grand time peeking at me through the window, then running away laughing when I waved to them. I gave them each a Butterfinger (thank you Richard for leaving them) and I think we were friends after that.
Day 12: Campana to Chorcco. Marita, who works at CerviCusco, explained to me that Chorcco is a neighborhood within Cusco. The barrio (neighborhood) sits half way up the mountainside with a great view of the city below. This was one of the most enjoyable clinic days so far because I got to work with Wendy, a nurse at CerviCusco who loves music and dancing. She played music while we were doing the exams, everything from Alanis Morisette to Coldplay to Lorde. I think how unacceptable this would be in the States, to have Shakira in the background while a pap or breast exam is going on, but I actually think it helped put the women at ease because we were so at ease. Wendy and I realized that we are the same age, 27, and it’s interesting to think about where 27 years has brought each of us.
Eighteen nursing students from Georgia arrived today, along with three nursing faculty, so we now have a very full house here at CerviCusco.
Day 13: Today I joined the nursing program for a tour of the Sacred Valley. We visited several towns and Incan ruins which lie within the bounds of two different mountain ranges. The ruins are always at visually stunning locations, with views of snow-capped mountains and green valleys with patches of farmland. It was definitely a change putting on a tourist hat today, tomorrow it’s back to Pap smears in the pueblos.