Week Three

Day 14: Palm Sunday.  I traveled with the nursing students and faculty to the clinic in the town of Huarocondo.  We had six examining tables, including two tables set up in tents in the back of the clinic.  This experience marked a milestone for me–a day when I started teaching paps and breast exams instead of being taught.  It was exciting to share with them what I have learned, and neat to see how much my own skills have improved from this experience.  They are a fun group and it’s nice having more people around CerviCusco.  Between all the stations, we completed about 150 exams.  Afterwards, we were told that lunch had been prepared for us.  I expected that “lunch” meant a piece of meat in a white roll, but instead we were escorted to the equivalent of the town hall.  In the center of the hall streched two long tables set with place settings and bottled water.  Women brought us each a plate of “comida tipica” (typical food), which consisted of a corn tamale, a roll, and a piece of pork.  The tamale was delicioso!  At the end of the meal, a man stood up and introduced himself as the mayor of the town.  He thanked us for our service at the clinic today and told us how much the community needs health workers to visit the town.  There are also ten communities which feed into the town and are some of the poorest communities around Cusco.  The sincerity of his plea I think touched all of us.

I road back to Cusco with Doctora Sami and Yalaida in a separate car.  On the way, we stopped at a beautiful private cemetery.  Yalaida explained to me that she had dated a man for two years who had tragically died while leading a group of tourists in kayaks down a trecherous river. It is a tradition, she told me, to visit the graves of loved ones the week of Semana Santa, or Holy Week. Outside the cemetery, some women sold flowers in tents for people to buy to place at the graves. I went with Yalaida to buy some flowers and collect water to place in a vase in the ground next to the tombstone of her loved one. There was a plaque next to the tombstone with his picture and a poem, along the lines of “weep not for me, for I am not gone, I have simply gone before you.” It was moving to stand in this beautiful cemetery with her, and to see the families seated around the grave markers of their family members, decorating them with flowers and keepsakes. When I travel abroad, it is these experiences which I feel honored to be a part of–whether it is the celebration of love and friendship, or the mourning of death come too early. It is raw, unfiltered, human experience.

Day 15: The CerviCusco crew piled into the van today for a campana to the town of Yaurisque. One of the nursing students does a quick check, and Yaurisque is not on Google Maps.  I had the opportunity to teach the nursing students on their second clinical day here, and they have improved quickly from their first patients in Huarocondo yesterday. We saw over 60 patients, and then walked a bit around the town. Tonight there is a four hour parade for Semana Santa, but I may just rest tonight. Campanas are exciting but tiring. A shower, dinner, and reading a book sound just about right.

Day 16: Today I traveled with the nursing students and Doctora Sami to a training camp for the Peruvian National Police.  It is apparently mandatory for policewomen to get an annual Pap smear, which is an interesting requirement. I think it shows that the government recognizes what a huge problem cervical cancer is in Peru, however, I’m not sure how I feel about mandatory testing for employees of the state, especially just for women. Some of these women are in their late teens (we don’t start testing in the US until age 21.) But when in Peru, do what the Peruvians do. So we set up tents at their training camp, which is a sprawling, green campus with dormitories, a chapel, and offices. The campus is surrounded by a stone wall with a huge iron rod gate letting cars in and out. We completed the exams and, after nearly an hour on the only road out, finally exited the camp. On the way back to CerviCusco, we stopped at a beautiful church which was built around 1600. Every inch of the church was filled with ornate, gold decorations and colorful, graphic murals.  We were told that the paintings on the walls were the originals, with the colors made from flowers, grasses, eggs whites, and fruit.

Day 17: Clinic Day.  The nurses and staff at CerviCusco call me Doctora Ana, and I tell them “casi, casi” (almost, almost.)  But still they insist.  It takes some getting used to.  We only saw a handful of patients today, so I helped them organize the frascos (viles) and papers from the last week’s campaigns.  It’s a logistical challenge getting the patient name and identification number on the vile, paper, and microscopic examining slide and getting everything in order.  The hundreds of exams we do each week on the campaigns is only the beginning–the sample is labeled, brought back to CerviCusco, and a woman named Erica examines the slides for pathology.  After the result is received, the woman are contacted or brought back to their home clinic to receive the result.  If they have a positive Pap test, then they are encouraged to come to CerviCusco on weeks when Dr.Ferris is here for colposcopy.  However, I can imagine that for the women in the remote regions beyond Cusco that getting to Cusco is a difficult and costly journey.  If a woman has metastasized cervical cancer and needs radiation or chemotherapy, only two cities have these technologies–Lima and Arrequipa.

Erica, the cytopathology technologist, received some training in the US in order to prepare for her current job at CerviCusco.  Also, Harvard donated a “telepathology lab,” which basically means that about once or twice a month, Erica reviews the slides with pathologists in Cambridge, Massachusetts.  It’s pretty incredible how internet technology is affecting the health care of women in and around Cusco.

Day 18: It is Holy Week here in Cusco, and stores, restaurants and banks are already shutting down for the long weekend.  CerviCusco has also shut down, but Doctora Sami accompanied myself and the nursing students to a senior citizen’s home today. The establishment (roughly translated to Brothers of Disenfranchised Elderly Persons) is mostly funded by the Catholic Church and run by monjas (nuns) who take care of the residents. Doctora Sami explained to us that the residents are mostly elderly without finances or family to care for them, or disabled persons who have no means to provide for themselves. Many of the residents were found on the street and brought to the home by police. Walking through the streets of Cusco, it seems as though Cusco could have five more of these homes–there are people (mostly women) begging on every side street. Of course, this is not so different from cities in the US.

The complex was surprisingly well-kept–it’s one of the more sturdy looking buildings I have seen in Cusco. There are gardens and a large church. We walked around and greeted the residents. Some of them were ambivalent to our presence there, but many of them seemed excited to see us, pulling our hands to their cheeks and asking us questions. Many of the residents use walkers or canes; one woman tells me she is blind, feeling my face with her hand. Some of them have a far-off gaze, as if they have seen and experienced too much to bear in their lives. We were escorted to a large room surrounded by sleeping quarters. Someone started music on a CD player, and a dance party began. About half of the women danced excitedly on the floor, the other half sat in chairs around the perimeter. We all danced with them, making a circle and dancing in turn. Afterward we distributed a snack we brought with us–juice, a frozen slushy, and of course bread.  When it was time to go several of them asked us, “when will you be back?”

Day 19: Everything has come to a standstill in Cusco on Good Friday. I will probably spend the day walking around the city. Tomorrow I leave for Machu Picchu with another OUHCOM student, Alex, who just happens to be here at the same time.  Today is a day of fasting in Cusco for those whose celebrate Holy Week (which is mostly everyone.)  Tomorrow they go to church and resume eating.  Sunday is a day of rest.  Monday the clinic work resumes.

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