Dining with bigwigs and riding with chickens

10 12 2010

By Kristen Roehl

In the 5 weeks that I’ve found myself in Peru, this is only the second blog entry I’ve taken the time to write, and for that I apologize.  Who knew that working abroad would keep one so busy?  Yet, at least when I do have time to update, I have something worthwhile to say.

The past few weeks have brought experiences as far detached as sitting in a room with international health policymakers to conversing over candlelight with 14-year-old married women from a village located on the crest of the low-lying Peruvian Andes.  The former was an international taller (workshop) sponsored by Proyecto Cisne, the London School of Hygiene and Tropical Medicine, WHO, and Universidad Peruana Cayetano Heredia.  Over two days, a diverse assembly of health professionals- including the Peruvian vice-minister of health, doctors and biologists from the Cisne project, WHO experts on rapid diagnostics, project heads from other Latin American countries, and LSHTM developers of international rapid test guidelines- presented on their experiences implementing rapid tests for syphilis and HIV.  They reflected and learned from one another about implementation in both urban and rural environments of their countries, the research yet to be done, and guidelines/action items pressing upon Latin America as a whole.

Though the mere onlooker, the experience of international exchange struck me as a prime example of South-South collaboration and North-South partnership- one that (in many ways) ignored cultural differences and treated the issue at hand as one essential to all humanity.  Granted, not all global health initiatives transpire this way.  However, I found it exciting that countries like Brazil and Peru- largely paving the way for rapid test implementation- are sharing lessons and outcomes with each other in order to best adapt diagnostics to Amazon and other hard-to-reach populations.  Not to mention that countries like Argentina- which hasn’t yet begun its rapid diagnostics trials- now have the opportunity to tap into the resources that other health experts can provide.  Also, the prospect that lowly grad students like myself are able to contribute to the development of international toolkits over Skype. Not too shabby for a few days’ work.

Worlds away from that experience, however, was the experience I had over the past week.  Since my field/data collection involvement in Lima has been limited by my lackluster Spanish and the early cessation of the project, I seized the opportunity to piggyback upon another student’s project in the northern region of Peru.  She has been working for over a year as part of a Johns-Hopkins-transplanted study team at Cayetano Heredia examining Chagas disease among rural Andean villages in the department (province) of Cajamarca.  Although now living in Lima, she needed to return to one of the villages to deliver blood test results (about 20% of the samples tested positive), take follow-up EKGs, collect parasites, and conduct physical exams.  So, after a short flight, a long bus ride, and a 3-hour dirt-road taxi ride through the subsistence-farming Andes (complete with chickens), we arrived in Campo Florido.

My jobs were to a) find the patients on the list and b) take the EKGs.  Finding people turned out not to be as difficult as I imagined.  Although the village was widely sprawled across an Andean hillside, I helped to recruit a local woman who carted me from house to house talking in rapid Spanish with those we were hoping to entice to the clinic.  Her presence helped tremendously, not only were the patients more open to a gringa knocking on their doors, but they were also able to express their array of fears regarding returning to the posta de salud.  Fears ranged from taking more blood (the general belief in the village was that each person only had a limited, fixed amount of it, and the thinner or smaller the person, the less there was to spare) to letting the machine stop one’s heart to finding out results and not being able to do anything about it.  Sadly, although most fears were unfounded, the latter was not; the simple fact remains that there is no good, accessible treatment for Chagas… all one can do is be aware and monitor symptoms before the symptoms themselves are untreatable.

After a day of hiking, discussing, and mosquito-biting, we found everyone on the list except a 92-year-old woman visiting relatives in the nearest city (about an 8 hour journey via car and bus)  and commenced the EKGs.  Performing the tests elicited a range of reactions, but surprisingly, most people seemed to have fun with the whole process.  It helped that I explained everything I was about to do, one step at a time, and tried my best to chat about life in the village.  Kids and moms giggled, while grandfathers/mothers either asked questions or simply resigned and trusted.  It was, for lack of a better word… fun.

I enjoyed every minute in Cajamarca, and not just for the health experience.  The people there had a genuine, hardworking, and brutally honest quality about them that is nearly impossible to find in Lima.  Apart from the incredible scenery and cuy experience (scroll down to “as food”), engaging with the people was my favorite aspect of the trip.

Other than the punctuating events, I’ve been working away (doing and redoing my work) at the university here.  With WHO deadlines and the Christmas holidays approaching, there’s no lack of stress around the office.  There’s also no pleasing the PI, it seems… but at least we’re all in it together.  Welcome to the world of large studies and cross-cultural work experiences!  With that, signing off.  I’ll check in with pictures next time.  As they say in Lima, ¡chau y cuídate!

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