the last month

Well... I have had quite a month. I had visitors for the last three weeks. My boyfriend came down to hike the Inca trail with me for four days... which if anyone knows me, I am not a hiker or camper. It was quite an experience. While we were hiking, I was not sure it would be worth it, but the end at Machu Picchu was fantastic. We also toured a bit more of Peru. My parents also came to visit for a week, again, I visited Cusco and Machu Picchu. I found a new appreciation for it the second time because I was not so tired. Anyways, this week, it was back to work for me. I have been too busy everyday to blog, but I finally had a minute to sit down.
On Monday I spent the day trying to organize my scattered brain after having three weeks off, but it came back to me so I pulled it together. In the afternoon, I happened to walk in on a lady who was walking around in the birth area in contractions. I asked if it was okay if I stayed to help and she said it was fine. I stayed and helped here get through the contractions and onto active labor. Once she was in active labor, it was only about 20 minutes. She had a beautiful little girl. I got to clean her up and dress her. I also helped the doctor assess her and do the APGARs as well. It was definatly another great experience to see the birth. I am thinking of midwifery as well as doing nursing... another thing to consider in the future...
Tuesday, I was able to work in the lab again. I did a few blood draws and helped test hematocrit, do urinalysis´ and look for different blood diseases in the blood under the microscope. I also worked in the topico area where I cleaned and dressed a wound of a teenage boy. For some reason, the day before, he had come in complaining of toe pain. He had quite the ingrown toenail I am told, so instead of taking one side off, they actually took the entire toenail off. I am not sure why at all and when I asked, the lady just told me it was what the nursing tech did and she thought it was what the doctor would have wanted. Very odd, because now, he is going to have to come in every couple days to get it redressed and cleaned until it heals. He is also required to keep it elevated which means he will not be able run around like a teenager for a while, and he is also more suceptible to infection because there is so much open skin. I am still confused why they did this, but I guess I will just pray I never have to get a toenail cut off here.
Yesterday, I went to the place where they cut up the animals to process again and gave vaccines in the locker rooms. I got to give about 60 vaccines which was really good. I always like to practice my vaccination technique.
Today, instead of having our usual 15 or 16 patiens, we had 23 which was quite a bit more for two of us to handle. It was quite a busy day, but it went by much faster than usual which was great. My goal for tomorrow is to have suture patients to practice my suturing before I get back to the States and cannot do it again!!

few good days more

I had quite a few nice days at work the last week. On thursday I put in my first two sutures of all time!!! It was awesome. This guy came in with a dog bite and needed a few sutures. I watched the nurses tech do the first one then she let me do the second two. There was a doctor that spoke English that explained it a bit to me before so that was good. It is wicked cool that the nurses and the nurses techs put in sutures, although if it is serious enough they are transferred to a proper hospital. In the States only the doctors put in sutures... and here I am the PCA putting in sutures. Oh well...it was a good skill to learn. After I did them, the doctor told the tech that it was my first time. She was quite surprised to learn that and stated I did very well and learned very quickly. I am hoping to do them again next week.

On friday, there was a morale boosting trip. It was put on by the psych people here, so about 40 of us piled on a bus to take a 5 hour (yes this was a DAY trip) ride to a place called Canta. It was worth the ride when we got there, but the ride was CRAZY... there a some things I miss in the States, like guard rails, speedometers, free bathrooms, bathrooms on the bus for that matter, and paved highways. When we finally got there we rode horses up the mountain and hung out by the river and waterfall. It was all quite peaceful and tranquil. Definatly a morale booster!! The ride back was equally as crazy as well. As I am riding and observing what is around me, I just think that we have it so good in the States. We complain about our crap economy when we cannot afford to buy the new shirt to add to our collection of 200 when there are people down here that have two or three to their names, and their children have to wear clothes sizes too big and sizes to small because they cannot afford to buy new clothes to fit them. Or when you look at a child and know that they are suffering from so many nutritional deficiencies that are going to cause them severe problems in later life. It is so difficult to explain the feeling of living and working in this condition. It just makes me really appreciate how good the States are to live in. I would encourage everyone to try and do something like this. Although there are definatly days where I just want to get back on a plane to the US and make some money, this experience is one that is completely life changing. There are so many things that I wish I could tell people about appreciation for what we have in the US... maybe next stop, public health care for me??....who knows

education

Although I think I realized this a very long time ago, I am just blogging about it. The answer to many issues in Peru in the health care system is education. When we go to the school it is so sad to see these children under the age of 12 with teeth rotting out. We do fluoride every once and a while, but it is a bit odd. The government pays for fluoride to be given four times a year... every three months. Unfortunatly, things at our medical center get pushed back, and everything in Peru seems to be quite slow, so they end up giving fluoride every month for four months... well in the states, we know that giving too much fluoride is actually damaging to the teeth. Education and planning ahead would make this more efficient and beneficial. It also may be more sufficient to give out toothbrushes and toothpaste as well as educate patients on how to properally brush their teeth to prevent cavities and decay. I also sat in on a patient of the dentist who came in the medical center with a very small cavity and a bit of pain in her gums. Instead of filling it (as they should have and probably would have done) she requested that the extract the entire tooth. A bit extreme for something that could have been fixed quite easily and quickly. Again, a bit of education would have been helpful for her.

Because it is a medical center, we care for all types of patients. A big portion of our patients are mothers and their children. They give birth to children there (as I have mentioned in a previous blog) as well as have their monthly checkups. What is hard for me to grasp is the fact that we have soooo many girls ranging from 15 years old to 20 years old with one or two children already. The center that I work in is paid for by the government so the care is free. I do not understand why the government would want to pay so much money for free births and care to keep populating such a poor area that is already overpopulated with mothers who have so many children they cannot feed (I have seen one mother with 7 children at the age of 45). We all know now that preaching abstinence does not work, but wouldn´t it be cheaper to provide free condoms and education instead of health care for life of a child that is not necessarily wanted or cannot be provided for? Anyways...just a few thoughts....its been interesting

another day

Haven´t blogged for a while because it has been a bit repetative at work, but had an interesting day today. I started out with a few patients and evaluated their growth and development... nothing to exciting to write about, but then I was put in charge of the vaccines, so I gave quite a bunch of them today. Of all kinds as well, IM, SC, and ID... it has been really nice to practice all of the different types of adminstration. I was bringing a chart to a different area, and one of the nurses in a different area stopped me and asked if I wanted to stay with her a bit. The area that she worked in is what they call ¨topica¨. I am not sure what it actually means, but it is like a tiny emergency room. They literally have like 8 patients a day, but it is more interesting than just the nurses station with the growth and development. This lady came in with a prescription from the doctor for a medicine for nausea. This medication comes in an ampule that has to be administered by the nurse or nurse´s tech. She let me do it, so I got to give a 3cc IM injection in the gluteal muscle of this lady, I felt bad because I used a 20G needle which is quite big, so it looked like that would have hurt quite a bit.
About 10 minutes after that, this guy with a drain coming out of a hole in his back came in to get it changed. The hole was about 1cm and the doctor explained that it was from this huge cyst that was popped three weeks ago. They put a drain in it and he gets it changed every week or so. the drain they used was just a cut up glove that was sterilized and put in his large hole up his spine. I got to clean out the wound as well as help push the drain up. When it was over, I was
dressed it and taped it up... actually with the tape I brought from home because it was stronger. Anyways, it was a pretty cool day

awesome

I had the most fantastic day today. On Wednesdays, the nurse that I work for has students with her, so usually I go somewhere else. Usually I go with the dentist to a school or something similar. Today, I went with a nutritionist that works at a center as well as a medical doctor (who is training to be a psychiatrist and speaks English really well!!!) up to a "kindergarden" a few blocks up the hill. The kindergarden is children from the age of 2 to 5 years old. It is more like a day care, but it is all government funded so parents are able to work, which I think is a great idea. Anyways, we were supposed to go on what we called a "nutrition walk" and teach the children about proper nutrition. When we got there, there was like 6 children that we played with for while. Then all of a sudden this motorcycle with like cabin in the back with three wheels pulled up and a teacher and like 8 more kids climbed out of it. It looked like a clown car, quite amusing actually. Then another one dropped off six other children and a teacher. The 20 children, the teachers, the doctor, the nutritionist and me painted small posters with fruit and chicken and fish on with lovely sayings on them. We then took a walk down the hill from the kindergarden down to the center while the children sang a cute song about healthy food. It was adorable, I had quite a good time. The kids were so proud of their song and a lot of them just wanted to be held so it was a lot of fun.
After my little nutrition parade, I was sitting and talking to my friend and I saw this lady come out of the ob/gyn room in clear active labor, I sort of just followed them into the labor room, and asked in broken Spanish if it was okay if I watched. She said it was fine. I got to watch in the room as this lady was in labor for an hour. I thought that I was not going to have enough time to see it, but all of a sudden the baby´s head popped out. With one last push, the baby was out. The whole thing was just an amazing experience. I have seen C-sections in the states, but never a natural birth. It was so beautiful, I actually had a couple tears. The baby was a boy, his APGAR score was 8 then 10 and he weighed 8.2 lbs!! So cute. They put him on the table and told me to clean him up, so I got to do that as well as dress him after. I then brought him over to his mother, who was getting sewn up after an episiotomy, definatly a bummer for her. I helped her help the baby latch on so she could breast feed him. It was really cool to be a part of the whole experience. I hope to do it again soon. Also, the doctor who spoke English with me promised me he would teach me how to do sutures!! Awesome.. will keep you all posted

a bit more work

You can always tell when a mother is very young and just had her first baby when she proceeds to try and keep breast feeding it while it urinates and poops all over her leg, the floor and chair she is sitting on, then just stands there with a horrified "deer in the headlights" look on her face. For some reason I actually saw this happen twice yesterday. Very interesting I suppose. I have to say, I have actually learned quite a bit about the growth and development of children and how to try and get them to react in the way that they are supposed to during various tasks. We had patients yesterday that were deficit in mostly language and a bit of coordination. I think that the language does not come, because the children are only strapped to their mother for so long, they do not have the chance to try and interact and learn how to speak at all, and mothers do not see the issue with that really, so that does not help. We also had quite a few giant babies, like 12.5 kg at 9 months... I am not sure how their tiny mothers cart them around all day. They are quite strong. Anyways, things are starting to get a bit better, so that is good... will keep you all posted!!

a solid few days

Well work is still going really well. I am able to have my own patients which is nice and I have been able to give more vaccines. It is starting to get a bit of the same thing every day, but that is okay, I suppose that is sort of what a job is. I am definatly learning Spanish though which makes me feel more comfortable in the medical center and in Lima in general.

I just had an amazing weekend too. We went to this place called Ica about five hours away. Its like in the middle of the desert where they have all these oasis´s with trees and water. We stayed in a hostel that was 7 dollars a night and had a bar/club, a restaurant and a really nice swimming pool. We ended up staying two nights there because it was so beautiful. We met a group of people from France who spoke English which was nice. It turns out that they live very close to us in Lima. One of the days we were there, we took these big sand buggies out into the sand dunes and the guide drove us around like mad all over the dunes... sooo crazy but so much fun, better than any rollar coaster I have ever been on! At different sand dunes, we got out of the buggy and actually sandboarded, like snowboarding only in sand, down the dunes. I only did one standing, then I layed on it instead. It was wicked fun. The next day we went the Nazca lines. The lines were really beautiful, but Nazca wasn´t that exciting. Overall it was a great weekend though. Back to work this week... I cannot believe I have been here a full month!!!