Sunday 30 December 2012

Happy holidays!

The holidays here are a lot like they are at home. Lots of food, drink, and merriment. To my surprise, pavo (turkey) is as traditional here as it is in North America during the holidays. Vanessa and Carmen, two of the nurses here, prepared a turkey feast Christmas Eve for the gang. Stuffing and all, the only difference was that it was prepared with a spicy sauce made from chili peppers. And of course, Peruvian 'champagne' was served.

Vanessa and Carmen getting the turkey ready

Carmen carving the turkey

The first plate of many - at the bottom is a spicy mayo - like Quebecers, people in Peru eat mayo with everything!

After dinner it was time for the big Christmas event at the hospital. 300 children from the pueblo came up for mass, followed by special treats to be given by none other than Santa Claus himself (well, actually, it was me). Luckily it wasn't too hot that night, but that's not saying much. I was sweating bullets in that costume! I was very thankful for the cold showers when it was all over with. Handing out candy to 300 kids takes a long time!

Santa, in the flesh - what you don't see here is the large, and very hot, beard I wore for 2 hours

Christmas day was spent hanging out with the gang, cooling off from the heat with cold beer by the river. It was remarkably sunny and beautiful that day - check out the view:




Interesting medical cases this week:

This little girl was pushed from a tree onto a Chambira plant (used to make all kinds of things in this area), whose long spines pierced the skin of her back. She came in with respiratory difficulty. There was no evidence of a pneumothorax, but she had a segment of rib that moved in and out with her breath - sign of a rib fracture.

This is Karl Lewis - for 2 weeks he had been experiencing progressive swelling of his entire body. He had been admitted for almost 2 weeks a few months ago with a nephrotic syndrome (excessive loss of protein in the urine, reducing oncotic pressure in the vasculature leading to widespread edema). Unfortunately he had not come in for his follow-up appointment, and therefore did not complete his full course of oral steroid therapy. 

That's all for now. Tomorrow is New Year's Eve and I'll be cooking Italian for the group. I hope everyone is having a healthy and happy holiday season. Thanks for reading, and I'll be sure to post more updates soon!

Thursday 27 December 2012

Life in Santa Clotilde

Hi everyone. Sorry it's been a while since my last post, but iPhoto has been giving me grief and so photo uploading hasn't really been an option.

It's been just over a week here in Santa Clotilde, and I've had no trouble settling in. Let me walk you through a typical day:

- Wake up around 7:15
- Take a nice cold shower (the only kind of shower available, really)
- Have a little bread and instant coffee, then head down to meet the team for rounds at 8:00
- See some patients in clinic, finish around 2:00 or 3:00, then have lunch
- If there's a procedure or C-section to do, do it, otherwise it's siesta time!
- Dinner in 'la calle', or cook with the team
- Enjoy some Spanish TV or read
- Lights out at 11:00 (the power actually shuts off at 11:00 - good thing I brought my headlamp!)

I thought I'd use my phone as an alarm clock, but no need - the roosters roaming the grounds of the centro de salud are kind enough to make sure I wake up early.

From left to right: dentist's office, prenatal health clinic, and outpatient medical clinic
One of the offices in the outpatient clinic

Siesta time!

This little boy is climbing the tree for fruit - behind him the residence where Doctors Toni and Brian live
It rains here. A lot. At least once day, but often more like half a dozen. It's nice because it cools the air down a bit, and makes an afternoon siesta that much more pleasant. Temperatures fluctuate around 32 degrees Celsius or so, but the sun is hot and most people lay low until dusk. At night, the streets of the pueblo are busy with people riding their motorbikes, selling food, and going for walks.

Rain shots
Some interesting medical cases so far:

Burn from methyl violet, often used in dyes


Meet Carlos - suffered a head injury in the past requiring osteotomy, and now presented in status epilepticus - lumbar puncture revealed cloudy CSF, and a diagnosis of meningitis was made. He recovered remarkably with IV Ceftriaxone.

This gentleman shot himself in the hand by accident when out hunting. Dr. Julio fashioned a makeshift pin with a needle to stabilize the fractured 4th proximal phalanx, and the patient is now awaiting transfer to Iquitos for reconstruction
Hopefully iPhoto continues to behave, and I'll post some more pics and stories soon. Stay tuned for details on Christmas in Santa Clotilde and an exciting visit from a heavyset bearded fellow from up North.

Thursday 20 December 2012

The Heart of Darkness

Well, not really.

Boating deeper into the jungle up the Napo river, I couldn't help but feel like I was on my way to find Colonel Kurtz. The horror! No, the journey up to Santa Clotilde was beautiful, and I'll rewind a bit and tell you how I got here.

After arriving at the Lima airport a responsible 2 hours before my flight, I waited an extra 2 hours before I finally took off for Iquitos. A wild "motocar" ride later (kind of like a dirt bike with a cab in the back) I was at the vicariate where I was able to fit in 6 hours of sleep before my first boat ride. Before I left, I met a Quebecoise nun who was happy to speak some French for a while. She said she'd been in Peru for the past 50 years, and asked if I'd do the same. To be determined.

Motocar ride #1
The boat was packed, but I was sitting next to a very friendly 15-year old boy who had lots of questions about who I was and what Canada was like. The boat took me up the Amazon River to Mazan, where I would take another motocar to the port which services the Napo River. The road was so narrow that I almost cringed every time my driver passed someone, and he passed people a lot. I got to Mazan with time to spare before boarding the "Rapido" to Santa Clotilde, so I went for a stroll and bought some local eats: an egg sandwich, and a a rice ball stuffed with chicken wrapped in a banana leaf. Delicious.

The dock in Iquitos
Motocar ride #2: through Mazan to the Napo River

The Rapido! 

The port along the Napo River - I later found out that Peruvians eat green bananas with everything

Some friends I made in Mazan - they wouldn't tell me where they bought their popcicles
The boat ride up the Napo was beautiful. I slipped in and out of sleep as we passed endless jungle, with temperatures fluctuating with the passing of numerous downpours. You would sometimes see homes along the river with roofs made of dried leaves and children playing in the river, where we would stop and drop off a copy of what looked like the latest newspaper. And almost 5 hours after I left Mazan, and 48 hours after I left Montreal, I finally arrived in Santa Clotilde.

Docked along the Napo
That's all for now. Much and more has happened since I arrived, but technical difficulties with iPhoto have slowed me down a bit with the photo uploading. I'll post again in the next couple of days with updates on life around here and the first of many interesting medical cases!


Monday 17 December 2012

First stop, Lima

Lima. After nearly missing my connection in Miami due to a one-hour delay in Montreal (took a while to get all the ice and snow off of our plane), I've arrived in Peru. As my dear friend Erin pointed out, this is my first time south of the Equator. But I'm not stopping here. I'm going to the Amazon.

Some introductions are probably in order. A little of the who, why, and where behind this little adventure. My name is Erik, and I'm a 4th year medical student at McGill University in Montreal, QC, Canada. Outside of my budding medical career I'm also an avid outdoorsman, cyclist, hiker, skier, and epicurean (I just really like to eat). I'm applying to family medicine this year, and look forward to starting residency in July. 


So why am I going to the Amazon? I've always been interested in global health, and last January I had the good fortune of meeting Dr. Videsh Kapoor. She is a (fantastic) family physician in Vancouver, BC, and also happens to be the head of the global health program at UBC. Between patients and on generous rides home from clinic, we discussed our interests, including my desire to take my medical learning experience abroad. Having lived in Texas many years and being (adequately) proficient in Spanish, she suggested that I go to the Santa Clotilde Centro de Salud. Naturally, I said yes. 


I'm looking forward to seeing what kind of difference I can make with the medical knowledge and skills I've acquired so far. I'm also keen to learn as much as possible about how medicine is practiced in a setting where the resources aren't as abundant as say, the Montreal General Hospital. And finally, I believe that sometimes you need to throw yourself out of your routine to develop as an individual, and sometimes, if you're lucky, you learn something interesting about yourself. In other words, I'm super stoked for this trip.


A little on Santa Clotilde. Santa Clotilde is located in north-eastern Peru, on the Rio Napo. It is accessible mostly by boat, and rarely by float plane. It is north of Iquitos, the nearest major city.





Santa Clotilde is the referral center for a chain of rural health outposts linked by the Napo River.  The territory extends as far as the border with Ecuador, downriver as far as Mazan, and includes a major tributary of the Napo, the Tacsha Curaray, as far as the village of Buena Vista. Santa Clotilde serves as the primary center for supplies, patient referrals, and logistical support. 

I'll be living in Santa Clotilde for just under a month, and can't wait to get there. The plan today is fly to Iquitos, where I'll be staying the night. Then tomorrow I'll be taking a series of boats to my final destination. Today I was greeted at the airport by Father Moe and Raul, who generously took me in and made me breakfast. Can't take your malaria pills on an empty stomach!

So here's the deal: I'm not much of a writer. I plan to take as many photos as possible over the next month, and I'll use the most interesting ones to share my story with all of you. As internet access is intermittent in Santa Clotilde, I'll post updates as often as possible. Thanks for reading, and stay tuned for updates!