End (?) of Trip*

Things I shall not miss:

-- drinking (potable) water out of sterile urine specimen cups

-- having a toilet that does not flush .. or is flushed with buckets of dirty

water splashed in it

-- filthy bathrooms during travel/clinic times

-- enormous amounts of dust and clay; not being able to breathe, burning

eyes, sore throat

-- altitude sickness

-- the big black spider in my room

-- not being able to brush my teeth with water from

the tap

THINGS I SHALL MISS DEARLY:

-- the Peruanos

-- "Hierba Luisa" (Herbal tea with 'powers'), Lúcuma (fruit) ice cream, chirimayo (white fruit), Aguayanta marmalade, Andean potatoes

-- the medical students (huge)

-- speaking Spanish every day

-- my doc friends

-- the waterfalls, Urubama River, mountains,

mist on the mountains

*To begin with the end in mind.."

(The Ghosts of Machu Picchu)

Day 12, Sunday, 6 June

I go to breakfast and find out our Pharmacist has been up all night vomiting (and she has

heard me coughing from next door).

I bug out of the tour (it's also been raining for a few hours). The married docs, although feeling "más o menos," decide to do the tour.

I go back to the room, open the curtains, and look out to the Andes and humble dwellings

just outside my window.

So, I spend the next few hours with chills. The solicitous waiter from breakfast insisted on helping me up back to the room bearing a tray carrying a teapot, cup, and my improvised

sandwich from the breakfast buffet. So I camp out in my room.

I simply go through the photos on my digital camera and openly smile at some. ¡Qué lindas!

I eat my sandwich and watch MONK dubbed in Spanish and keep layering up in Alpaca

blankets and the hotel-supplied terry robe (this is a Western-civilization type dig).

Reinstall myself in the hotel cafe -- drink lots of hot water with honey and wait for the bus

back to Urubamba where we'll spend the last night. I'll say goodbye to my "queridos estudiantes" and dear hotel owner who truly loves us, and we'll head to Lima for tomorrow's

flight to the U.S.

Day 11, Saturday, 4 June

O.K., so the two sick docs (married) are troopers and we leave. We being the two troopers, our pharmacist and her doc/husband, and I. Jorge has arranged our ride who, typical of the Peruano drivers we have met, is punctual ...

We are taken to the place where we will take a bus( the recent mud/landslides have taken

out large portions of the train tracks). The bus will then take us to the train bound for the town of Aguas Calientes where we shall stay the afternoon and one night.

As things seem to change here (where there is no clinic, there is suddenly a clinic; where

there wasn't a road/there is a road (or vice versa)) . Since the taxis could go only to the end of the alley, we are told that then we shall have to walk to the bus station. Today, however, we can pull right up. We're happy to be driving straight there. We board the bus. Across the aisle from me is a youngish Peruvian doctor and we chat and exchange med system info -- we then talk Machu Picchu and he laughs -- he's around 40, has lived in Peru all his life, and has never seen it. I tell him it's a cliché--

you know, the New Yorkers who've never been to the Statue of Liberty or the Empire State

Building.

He tells me a fascinating bit of info re the Incas who built it before the invention of the wheel. In order to haul the countless stones up the twisting roads, working within low oxygen levels, etc., they consumed a whole lot of coca (cocaine) leaves -- he said Machu Picchu would

never have been built without coca. Makes sense.

We arrive at the outdoor station and are called for our train. My doc friend had arranged the train from the US. Great choice. She opted for the fancier train which has a glass roof and huge windows which allow us

to see this AMAZING panorama -- Andes, waterfalls, people walking along the Inca Trail,

lush vegetation -- it is a ride in Disney World. Arrive Aguas Calientes and three of us decide to take the last bus out and last bus back to the site rather than wait till tomorrow. I have always

thought that when I got to see MP, I would want to go late so I wouldn't be amongst crowds of tourists -- also, I have always wanted to see the sun set there.

So, we scramble running frantically all around the streets of Aguas Calientes looking for a place to change and take out money for the bus and entrance tickets to the site. The bus tickets have to be purchased here in town in American dollars -- the MP tickets are only

sold in soles. ¡Qué horror!

Time is ticking away-- the last bus leaves at 3:30 -- no cash...

There is a woman with us who came to meet us since she's arranging for our guide tomorrow. She never leaves our side -- she wants us to

see MP! Finally, one of the docs comes up with a credit card that works. We're at a ATM machine. At 3:25 pm she runs away. Oh, no.

A few minutes later, however, she returns to say she has convinced the bus driver to wait for us!

We board -- we're the only ones on it -- it's 3:40 pm -- we wait. Driver's seat is empty.

I step to the door of the bus and right there, three Peruanos, one with a big sandwich he's about to consume. I ask him in Spanish if he would consider driving up now -- the ride is 25 minutes and we'll only have less than an hour and a half if we leave RIGHT NOW.

He doesn't answer, parts with his friends, slowly wraps his sandwich in a napkin, puts it in a storage box on the dash -- and we're moving!

Arrive Macchu Pichu. We pass through the ticket entrance and walk in front of the famous

luxury hotel, El Sanctuario, (on the premises and costs $1,000 American dollars a night.

Honest.

We get our passports stamped with these cute designs of MP (not a requirement -- just fun thing) and I ask the men at the counter "Si sólo tuvieran una hora y pico aquí , qué

verían hoy (if you had only a bit over an hour here, what would you see today?). One ranger tells us to go to the "Templo de las Ventanas" -- . We start out, and he sees our unsure

steps, he graciously jumps out in front of us, and says he'll lead us there. I fall behind the others; how can I not take photos? I'm surrounded 360º and from earth to sky by absolute

wonder.

We meet back up -- I see a group of students on the plateau just beneath me, stretched out on their back, forming a circle, some with outstretched arms reaching to the sky and decide to do the same from my plateau. I stretch out, put my backpack under my head and stare up and out -- mountians, trees, and a sky I feel I can touch -- feel like I'm pleasantly high and maybe floating -- filled with calm. The sky is a clear, clear, bright, blue enhanced by lacy-edged clouds forming and slowly floating.

After I don't know how long, I hear my friends calling me from another platform and walk up stone stairs to meet them. We sit on a stone ledge and watch the sun fall --- we gaze on beautiful purple/blue-backed swallows swooping and turning and diving onto a quadrangle of grass just below us -- they're going for their "swallow dinner" of insects.

Head back having made plans with one of our young recently graduated docs whom I miraculously met turning a corner as I was descending a set of steps.

Go to dinner at Lindo Indio and is it ever "lindo"! (for $10-$15 American dollars we have incredible healthy and fresh dinners -- (mine: chicken with fresh mango sauce, rice, potatoes, grilled tomatoes, string beans, white Peruvian wine, and a dessert of fresh, home-made passion-fruit ice cream).

Go to sleep around 10:30 -- awakened at 11:15 by loud phone rings -- ¡Diga! (Yes, hello)

I manage. The desk tells me I have a call. Oh, gosh -- some emergency?

No. It's the Guide Agency wanting to know if "I know the time we're leaving in the morning." So pissed off, I don't fall back to sleep -- try and try-- my really deep spasmodic

coughs keep me up until 4 or so.

Get up, shower with hot (yea) water, and pack up for guided tour.

Day 10, Friday, 3 June

My body gets me up at 6:45 a.m. since we've been leaving around 7:45 or 8 each day. Only today,

because I'm not going into the comunidades, I actually take a long, HOT shower (luxury) and don't rush nervously to gather and pack supplies and books.

I go downstairs and have some breakfast. They are leaving late (8:30 am) today for the one hour 40 minute ride into the remote village of Pampallacta (in Calca) and they delay to

take several group photos. This marks the end of our work week together, so everyone wants photos

of those who will be leaving this weekend. Nice to know we'll have a way to remember this incredible team of

So, I stroll around the grounds a little bit and now it's 11 a.m. I have checked in our really sick doc (my best friend here) after helping her upstairs and having mixed two bottles of powdered Gatorade into water for her.

She's on Cipro and a whole arsenal of necessary meds. As well, our protector and EcoHotel

owner/manager has been giving her herbal remedies "a la peruana." ¡La muy pobre! She truly is one of the "women who do too much." "Let's do some good," she says to the troops at times.

She also has an adorable sense of joy and humor.

My fingers are crossed for Machu Picchu. Can any of us still go?

I am writing this from my bed in the inn, looking up from time to time to gaze

at the Andes so close to my window that they go beyond the height and width of the window

frame --(or, is it, of course, that they are so gigantic) ... The range outside the side window is

farther off by a bit -- I can see some sky above it ... The sky here, by the way, is the bluest

blue, and clearest, crispest, purest blue that I have ever seen.

After a bit, I have soup with Doctora Kathy, la muy enferma, and leave for town with

Felipe (a worker in the estate) -- we take his Cuban-style 40 year old clunker of a VW Beetle into town to get cough drops for me, a jar of aguantamayo to bring back to the States, and two bottles of white Peruvian wine (no sulfites, just fresh, pure and lovely as my treat for tonight).

The team returns and I discover two more are down and returned early.

We have a group meeting to discuss ways to improve and what to discuss what

we have experienced this week.

Nobody has had time to prepare for our "Talent Show" (my idea at the beginning of

mission -- little did I know that we would be working hard and feeling exhausted). Someone

suggests that we can do one (corny and nerdy, of course, as I instructed), when we return to

the U.S. However, I explain that mine should be done there (my song exemplifies the symbols of the country a la americana), so ... I get up, and with my sore throat (perfect for what I am about to do) sing "Come Fly With Me, We'll Float Down to

Peru.." and do it with choreography (moves) a la Marilyn Monroe (I'm dressed in layers

of sweatshirts/jeans, etc. -- so it's pretty funny). They laugh.

A few of us have dinner and another doc starts getting sick -- the one who's to go to Machu Picchu with us tomorrow (!).

Day Nine, 2 June (Thursday) "EN LAS COMUNIDADES"

EN LAS COMUNIDADES --Outreach into the (more) Remote Villages

So off we go for a day away from the remote Urubamba district (where the Centro de Salud is located an hour or so from our EcoHotel) and up and up (to 3,800 meters/around 12,000 feet) two hours more into a remote village on slightly bumpy, hair pin roads into the beautiful stacks of the Andes -- some swirled by lovely transparent clouds and mist. Occasionally, there are layers of horizontal stairs made from stones stretching across a mountain. Stacked side by side,the stones result in horizontal stripes, all dotted by star-like bursts of Aloe plants. At the bottom of one mountain we see Incan ruins from our bus window ... then a river rushing down and a waterfall splashing over large boulders and stones ... continuing, it seems, endlessly.

We see wild boars grazing in the fields or walking along our road -- we see filthy, dust covered alpacas (strange the alpaca knitted products are so pristine), bulls, and of course, the ubiquitous colorful slings of the "Mamis" holding the children.

We have been anticipated by radio notices and cars sent out into the countryside shouting the arrival of today's arrival of the American doctors. I wonder if the announcement is also heard by some who might not like gringos ... (thank God, it doesn't happen).

We arrive. We are expecting a hut, but actually find a cozy little brand new clinic of course, without tiolets that flush or paper, but a clinic! A young, sweet, Dr. Marvin and a dentist are there. Mostly anyone we see has never seen a dentist.

We are met by two German students assigned to us by Corazones del Peru (an overseas organization with our name, but translated to Spanish, yet not associated directly with us). They help steer patients around.

We see, examine, and diagnose over 100 patients -- quite a feat since the dialogue has

to go round and round due to the three languages. Only the children speak Spanish, they

are thus given the opportunity to go beyond their home village, if they choose -- they go

to the school just minutes up the road by foot. The older generation speak only Quechua.

We see a 102 year old woman. We see very young children, some who come alone, or have

in a tow a younger sib (i.e., an eight year old who brings along a sick three year old).

We break for lunch, again provided by Jorge who transports beef milanese strips, fried cheese pieces, bread, fresh oranges, bananas de India (the tiny ones), water!, incredible

avocados and great marmalade made from Sauco (like blueberries) and Aguaymanto

(this magic fruit in sweet chunks which produces a heavy syrup when cooked). Unreal.

We decide to give everyone Albendezole even if they don't report symptoms or worms because the town is putting up a water system so the meds will get rid of them and then

they'll start drinking the potable water. Maybe we shall wipe out the parasite problem

for them!

All the children are rushing in to be seen by our eye clinic and want to be able to see

at school and read. If one of our "consultorios" is open, they all cram in at the door,

pushing to see and be seen.

The little building is a quadrangle which opens to a very, very small open air patio (patio

being a patch of dried dirt). Everyone is running between rooms, trying to get a doc's

signature, or get a Quechua translator. It's a dance set to De Falla music!

At one point, a bit desperate for help, I open the dentist's door (bilingual Quechua/

Spanish) and he breaks from his own case to help us next door. Can't imagine doing this

in the U.S. There is typically a foursome as mentioned before:patient/doc/translator/translator.

These people are dirtier and poorer than even those in Urubamba.

One of our docs is so sick now that she couldn't even come with us (while one of the young, recently graduated docs crashed yesterday but has returned to help us today.

Tonight I give into the hacking cough I've developed and which has kept me up for

nights, bloody dry nose, and burning eyes (all symptoms our patients exhibited today) and

decide not to go to the next Comunidad outreach tomorrow. I'm determined to recuperate

and not get as sick as my colleagues are. We are scheduled to go to

Pampallacta, in the District of Calca. (As I hear later, the bus ride alone was amazingly

beautiful and even more spectacular than today's!)

I try to at least take a hot shower, but after I undress and am ready for relief, my room , which has all along had intermittent hot water, has none tonight. I put on a shirt, my winter fleece jacket, and get into bed dirty, dusty, and cruddy from head to toe. My throat and

eyes burn, I'm coughing.

Got to get better -- want to go on our arranged trip to Machu Picchu day after tomorrow.

Can't read -- "ojos lagrimosos que se pican, que se rascan" -- I hear the patients' complaints as I experience the symptoms. So, I want to just see and hear the TV in my room ... hasn't worked

since I got here, so I call downstairs -- no one at from desk. One of the students gathered in

the common room picks up and it's one of my own "queridos" from last semester. His tone

is affectionate and polite, but clearly a bit amused -- that my lack of technology

(my standard line in class: "I know Spanish, not computers") extends this far. A TV?! This is pretty funny (I even think so).

He sweetly asks if I want his help -- yes, of course. He comes up, fiddles with these

crazy rabbit ears on the set which neither of us had seen in years ... milagro!

The one channel I get is great -- I dumb down and zone out -- just what I need -- it is

in Spanish -- por supuesto! -- and is about a director and his actors -- I hear all about

Gwyneth Paltrow ... then "las noticias mundiales" in Spanish and I crash ...

I drink hot water all night from the big thermos brought to each room each day.

One of the docs with stethoscope around his neck accompanied by our great

pharmacist had come earlier and left me some strong cough suppressant which (que no

se lo digas) I never did take.

I want to get better because I'm to accompany her husband and her plus one of our

Doctoras (my friend and colleague who has been a faculty facilitator for the trip) and Doctores

(her husband and Dean of Students) to Machu Picchu. I've made the hotel arrangements and am to "servir de interprete."

Day Eight, 1 June

So, we leave for our second day of the Clinic (however, the director,

Dr. Guido, doesn't want to be called "director," but rather "líder" (leader), and doesn't want us to call it "clinic," but rather "Centro de Salud," (Center of Health) because of the associated connotations ...

Begin work and see a blur of patients -- women my age (early sixties) who look eighty...weathered, wizened, exhausted -- muscle aches which they claim are their "huesos" ( bones) protesting.. no small wonder -- their daily task which is to feed the family has them laboring in the field, harvesting, carrying firewood in -- and everything is transported in the bulging, vibrantly-colored striped mantels slung on their backs.

Sweet, nice-looking woman of 39 years old, today, has never had a Pap smear. Not afraid to do it, though, she says ... just never came up ...she agrees she should have one and then we tell

her to make sure her daughter gets one when she is 18. She agrees.

Funny thing is -- they are all like this -- compliant and patient as they wait for a couple of hours to be seen. They all seem eager to have proper meds and modern medical help ... and yes, eyeglasses.

The ones who speak Quechua are clearly the poorest. They come dusty and dirty with broken shoes and ripped clothing. Yesterday, one of the doctors I was helping asked what the stripes of dark discoloration were on the young girl's chest and stomach, thinking it was a skin condition or signs of another disorder. Mamita started laughing --the "condition/disorder" is a set of deeply etched stripes of dark dirt.

"Mami Walli"

So, we're ready to leave for the day and everybody's gathering up materials and

heading out for the bus ... I happen to ask one of the Clinic staff what is beyond the dusty wall

outside the back door, and which we all passed by, as we walked to the building where

our lunch had been set up. It had the words "Mami Walli" written on it.

We're talking about two steps out the back door and another eight steps to where we ate.

Word-freak that I am, I had been curious all day as to what the Mami Walli sign, hand written, but

with happy strokes and color, meant. The fellow I ask is the generous Quechua speaker/IT fellow

who helped us yesterday and came back just to help again. He absolutely insists I hear about and

go out to see it "... pero se me pierde el autobus!," I try to leave. " No, no, profesora, tiene que verlo," he insists

and prevails.

He explains ... the Mami Walli sign on the worn, used wood wall designates "Mommy's Home",

a little compound for new mothers about to give birth and those who have given birth. It is

part of the Clini ... whoops, Centro de Salud. So, unlike the US where women go in and drop their

babies and leave the next day (in Europe they still stay in the hospital for a several days, up to

a week after childbirth). Well, the Quechuan women come, give birth and then go to these

little temporary shelters which all face each other into a common courtyard. So, to make it

comfortable and what they are accustomed to, they can elect for a shelter with gas for cooking or wood

stove (of course there is no electricity or running water in the individual huts. Pedro opens

the wooden door, the courtyard is simply dry dirt and dusty clay ...

there is a communal sink in the middle ... there is a little dusty, really dirty small child who is peering

out and comes to his "doorway" ... I peek in ... equivalent digs to what I have seen at the Reed Peoples'

huts -- manteles thrown on top of platforms of some sort to serve as a bed ... nothing more ...

The women stay for six to seven weeks if all is normal ... then they can go back

to the "comunidades" (out-lying remote villages). By that time they will have healed and

the infants are more likely to survive. As they stay here, they can socialize and help one another,

and the Centro is literally right out the door, should they need anything. I find it fascinating and

heartening.

By the way, in Quechua, women are called "Mami" or "Mamay" in direct address ... it is

said with great affection and respect ... (the first time I heard it, I was surprised on my flight

from Lima to have an older man address me this way... ) So, there is respect for motherhood, it seems.

Day Seven, 31 May, Tuesday

PRIMER IMPACTO

Wake up -- don't read my watch correctly without my glasses on and think I have ten minutes to dress, collect all my supplies, and get on bus (to say nothing of a possible shower or

breakfast) ... I panic --know I need to bring everything for the entire day (small wad of toilet paper -- very small supply in my hotel room, water, my own meds ... sunblock and hat for walks into and from town (from bus), "soles," glasses and Quechua dictionary, Spanish/English dictionary, various Applied Medical Spanish Books, note pad, pens, etc.

Bus is slow in coming, and I actually have 40 mins ... we take off and then have to

stop along the way for people from town who are partnering with us ... we arrive and are walking to Clinic -- word is out that we are here -- a few people see us dressed in scrubs and come up asking if we can help them.

Everybody from town is dressed the same -- everybody being women (few men come to the Clinic -- and then it's usually for our free prescription glasses).

Dress: even though it's 65-70 degrees F., knit leggings ( Alpaca or wool), several layers of wide skirts, layers of shirts and wool sweater and the famous bombín (Bowler hats).

Babies are carried in "manteles" slung over the mothers' backs and shoulders papoose-style.

We see lots of patients with worms -- one very old woman (who was actually 63 yrs.

old-- chronologically they all look older) says she hears worms "scream at night" in her stomach.

We see a lot who have bad vision (the climate is very dry and severe, so no small wonder)... we dispense eyedrops and give eye exams and give donated prescription glasses.

My first in-take patient is a small baby boy, nearly delirious in his mother's arms. We get him to our (really sharp-- amazing) Chilean-born pediatrician who sends him immediately to a hospital in the 'nearby' town of Cusco.

There are complaints of ringing in the ears and dizziness -- irrigations of ears reveal incredible, impacted wax and dusty debris ..

Some come with back pain from the heavy lifting and weight they carry in their manteles. They say they have pain in their "riñones" (kidneys), but I think it's the location of

the pain in their back they are describing ... they speak in terms of organs because they

butcher their own dinners ...so they know the body "parts" ...

There are several women who won't reveal to our male doctors that they are victims of

domestic violence but it's obvious ... I talk to a few privately and then to a female doctor at the Clinic who will follow up with them (there is a social agency in Cusco). The cycle is: they come with complaints of vaginal pain, STDs and UTIs caused by their husbands' wanderings --so they come,

are treated today, and then will come back with the same symptoms -- with no end in sight (the men refuse to use condoms, I'm told by the women). The women cry ...

One woman is 76 years old and has walked alone well over an hour on bumpy, dusty

roads to the Clinic -- she has to take the same route back over streets covered with stones, potholes, and the strong smell of urine. She waits for hours; I bring her water.

As a contrast, our hotel manager/owner brings us a hot lunch (little veggie "frittatas," rice, fried

yucca -- complete with real plates, water !!!, bread, and he ceremoniously serves us donning a

white toque. He's incredibly supportive of us as we are helping his people. He attends to us

as if we were family members.

Scenario for rest of afternoon: same routine -- we see patients, translate like crazy, and give out

prescriptions filled at the pharmacy we set up by our own pharmacist.

All the students get incredible hands-on practice and training. They also connect to the natives using

their Spanish skills.

One young man is seen for eye strain he says is caused by the glare of his computer (!)

screen and receives his eye drops and sees we are having enormous trouble understanding an

Andean woman speaking Quechua. He patiently stays and offers to translate as he is bilingual

(Castellano (which is Spanish)/Quechua). Turns out he works as an intern at times in this Clinic, and

is studying IT which explains the computer comment.

So, the translating goes like this: the old woman who has chest pain and eye problems speaks to him (in

Quechua). He then speaks to me and one of our students in Spanish. We then speak Spanish

back to him and he to her in Quechua. Ultimately, I speak English to the doc who tells me what

to say. I speak Spanish, explaining the doc's recommendations, to the Quechua/Castellano

translator who tells the patient in Quechua what the doc has determined. However, it bounces

around sometimes back and forth and not always in one direction of the "circle" we create.

We come back to our EcoHotel, have a meeting and dinner and I dance with Jorge (the owner)

at our dinner to the great surprise ands amusement of our team. If I hear music, I gotta dance.

As I do each night, I brush my teeth with bottled water, get into heavy sweatpants and a fleece

jacket (it's really cold) and get into bed with all these layers on. Can't take a shower ... too tired.

I pray for Marisa .. one of our patients I made a promise to ... she's separated from

her husband, came in for gyne problem and I attended her pelvic exam and she cried when we were

in private as she told me her story of her husband's abandonment of herself and her two children.

She told me of his new "woman" and child. I pray.